Clinical implementation of cardiac resynchronization therapy-regional disparities across selected ESC member countries.

BACKGROUND: The present analysis aimed to estimate the penetration of cardiac resynchronization therapy (CRT) on the basis of the prevalence and incidence of eligible patients in selected European countries and in Israel. METHODS AND RESULTS: The following countries were considered: Italy, Slovakia, Greece, Israel, Slovenia, Serbia, the Czech Republic, Poland, Romania, Hungary, Ukraine, and the Russian Federation. CRT penetration was defined as the number of patients treated with CRT (CRT patients) divided by the prevalence of patients eligible for CRT. The number of CRT patients was estimated as the sum of CRT implantations in the last 5 years, the European Heart Rhythm Association (EHRA) White Book being used as the source. The prevalence of CRT indications was derived from the literature by applying three epidemiologic models, a synthesis of which indicates that 10% of heart failure (HF) patients are candidates for CRT. HF prevalence was considered to range from 1% to 2% of the general population, resulting in an estimated range of prevalence of CRT indication between 1000 and 2000 patients per million inhabitants. Similarly, the annual incidence of CRT indication, representing the potential target population once CRT has fully penetrated, was estimated as between 100 and 200 individuals per million. The results showed the best CRT penetration in Italy (47-93%), while in some countries it was less than 5% (Romania, Russian Federation, and Ukraine). CONCLUSION: CRT penetration differs markedly among the countries analyzed. The main barriers are the lack of reimbursement for the procedure and insufficient awareness of guidelines by the referring physicians.

Surgical treatment of supraventricular tachycardia: experience with 61 patients.

Sixty-one patients underwent operation for supraventricular tachycardia: 52 had tachycardia associated with the atrioventricular accessory pathways; 9 patients had other forms of tachycardia. Accessory pathways were successfully divided in 92.3% of the patients. Classic endocardial approach was used in 30 patients; closed heart ablation of the accessory pathways was performed in 22 patients. There were two reoperations for return of conduction through the accessory pathways. Six patients underwent cryoablation of the His bundle through the right atrial approach. Four patients underwent attempts at curative operations for atrioventricular node reentry tachycardia, atrial flutter, and atrial ectopic tachycardia. Concomitant cardiac surgical procedures were performed in 14 patients. Operative mortality was 1.6%. A satisfactory result, without tachycardia and without medication, was achieved in 93.4% of all patients.