Background information
Today in Europe it is estimated that around 290,000 pacemakers of various types are implanted each year, with 50% of these being implanted to treat disturbances of sinus node function and the remainder because of various degrees of impairment of the atrioventricular conduction.
For more than twenty years, a central European registry has been maintained for the recording of details concerning implanted pacemakers, indications for pacing, and the types of pacing leads used (1,2). Even though this initiative has contributed significantly to our knowledge of conditions in many European countries, it is a long way from being accurate, since the recording system differs from country to country, the information entered on the existing Eurocard regarding pacing indications is often incomplete, while data are frequently not submitted on a regular year by year basis, or worse, may not be supplied at all (3)
In spite of these reliability problems, the information stored in the Registry has made us well aware that within our continent there are extremely large differences from country to country in the number of implantations per capita and in the pacing modes chosen for permanent pacing.
Objectives of the project
- To investigate the diagnostic algorithm that is followed in different hospitals in Europe. This will include an assessment of the use of Implantable Loop Recorders (ILR) (4) for the determination of the cause of syncopal or presyncopal episodes.
- To examine the applicability and the nature of the guidelines employed and the rationale behind the decision whether or not to implant a pacing system according to the kind of bradyarrhythmia. The rationale behind the choice of pacing lead will also be evaluated.
- To examine the reasoning behind the choice of pacing mode. At the same time it will be determined whether the results of large clinical studies are taken into account.
- To record the mode of the implanted pacing systems .
- To determine the duration of patients’ hospitalisation (admission, investigation time, device implantation, discharge).
- To note the rate of early infections related with the implantation procedure and to assess the usage of preventive antibiotics.
- To study the policy observed in Europe for pacemaker replacement.
- Ultimately, to study the cost of the investigation and treatment of bradyarrhythmic patients in different hospitals and different European countries.