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Welcome to the European Society of Cardiology. Our mission: to reduce the burden of cardiovascular disease in Europe
 

Device implantation rate still increasing 

ESC Congress News 2013 - Amsterdam

Topics: Arrhythmias
Date: 04 Sep 2013
ONLY 6.8% OF PATIENTS suffering sudden cardiac arrest in the Greater Paris area leave hospital alive, according to the Sudden Death Expertise Centre (SDEC) registry, featured in an ESC press conference on rhythmology. Other notable presentations included first reports from the EHRA lead extraction registry and a study showing that survival of pacemaker recipients without concomitant CVD at implantation was comparable to that of age and sex matched controls.

Maria Grazia Bongiorni, co-chair of the EHRA’s ELECTRa registry, said systems with more than a single lead were most represented.

Since May 2011 the Paris SDEC registry, based at the European Georges Pompidou Hospital, has continuously recorded all cases of sudden death and initiated a standardised follow-up of patients admitted to their intensive care unit.
 
Results showed that over the first year 1903 cases of sudden cardiac arrest occurred, with 72% taking place at home, 81% with bystanders present, and CPR being performed in 42% of cases. Altogether 635 (33%) of patients were admitted to hospital alive, but only 129 (6.8%) were discharged alive.

Although therapeutic hypothermia and early coronary angiograms were both significantly associated with survival, less than two-thirds of hospitalised patients received coronary angiograms.
 
‘Our study provides a unique opportunity to catch the real picture of sudden death, whereas most cardiologists see only the survivors,’ said speaker Xavier Jouven. Such descriptions, he added, will help to identify high risk patients and improve education of the general public. ‘There’s also a need to focus on improving hospital care by making therapeutic hypothermia and coronary angiograms more widely available.’
 
Last year the European Lead Extraction ConTRolled (ELECTRa) registry was set up by the European Heart Rhythm Association (EHRA) of the ESC to provide ‘real world’ information on lead extraction across Europe.
 
Results show that implantation of cardiovascular implantable electronic devices (CIED) continues to rise, with the number of leads per patient also increasing because of the higher proportion of dual versus single chamber devices. Despite developments in technology and improvements in reliability, leads remain a weak point and may fail and require extraction.
 
Between November 2012 and January 2014 the aim of the ELECTRa registry, which is managed by the ESC EURObservational Research Programme (EORP), is to sign up at least 3500 consecutive patients from 110 European centres. ‘This study will allow us to have a more accurate knowledge of outcomes in real world clinical practice and improve the quality of the procedural diagnostic process,’ explained Maria Grazia Bongiorni, co-chair of the registry.
 
It is hoped, she added, that the information can be used to inform future guidelines and educational activities, and reduce the lead extraction inequalities that exist in Europe both within and between countries.
 
The press briefing was told that by the end of July 1200 patients had been enrolled in the registry, and that infections accounted for 52% of extractions. The finding is notably lower than the recent EHRA survey (of 164 centres across 30 countries), which found infections accounting for 70% of lead extractions. Results showed dual chamber pacemakers accounted for 41.02% of the devices, CRT defibrillators for 16.36%, and dual chamber defibrillators for 15.91%. ‘CIED systems with more than a single lead are the most represented in the registry. Such information is in line with the worldwide trend where more complex devices correlate with more complications,’ said Bongiorni.
 
Finally, in the Dutch FollowPace study Erik Udo and colleagues from the University Medical Center Utrecht explored the determinants of survival in a large contemporary cohort of bradycardia pacemaker recipients. While previous studies have explored survival in pacemaker patients, such information was collected over 20 years ago. ‘The profile of both patients and pacemaker technology has changed considerably, necessitating an update,’ said Udo.
 
In the study 1517 patients receiving a first bradycardia pacemaker between 2003 and 2007 at 23 Dutch hospitals were followed for a mean of 5.8 years. Results showed that by the end of follow-up 512 (33%) had died, mostly of non-cardiac causes (67%). Actuarial survival rates were 93%, 81%, 69%, and 61% after 1, 3, 5, and 7 years, respectively.
 
Pacemaker recipients without concomitant cardiovascular disease at implantation showed survival comparable to age- and sex-matched controls of the general Dutch population.
 
Independent predictors of cardiac mortality measured at pacemaker implantation included age at time of implantation, a history of CAD, valve disease, congestive heart failure, and diabetes. ‘The particular strength of the study is its detailed documentation of current standard pacemaker care in a large representative sample of western pacemaker clinics. It offers a new reference point of survival in modern day pacing,’ said Udo.


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Authors: Janet Fricker, ESC Congress News

Notes to editor

About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 80,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.

About ESC Congress 2013
The ESC Congress is currently the world’s premier conference on the science, management and prevention of cardiovascular disease.  The spotlight of this year's event is “The Heart Interacting with Systemic Organs”.  ESC Congress 2013 takes place from 31 August to 4 September at the RAI centre in Amsterdam, Netherlands. More information on the scientific programme.

References

Refers to sessions presented at press conference:  What's new in rhythmology 2013?