Replacement of implantable cardioverter defibrillators and cardiac resynchronization therapy devices: results of the European Heart Rhythm Association survey.
The aim of this EP Wire was to assess the management, indications, and techniques for implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) device replacement in Europe. A total of 24 centres in 14 European countries completed the questionnaire. All centres were members of the European Heart Rhythm Association Electrophysiology Research Network. Replacement procedures were performed by electrophysiologists in 52% of the centres, by cardiologists in 33%, and both in the remaining centres. In the majority of centres, the procedures were performed during a short hospitalization (<2 days; 61.2%), or on an outpatient basis (28%). The overwhelming majority of centres reported that they replaced ICDs at the end of battery life. Only in a small subset (<10%) of patients with ICD for primary prevention and without ventricular tachycardia (VT) since implantation, ICD was not replaced. In inherited primary arrhythmia syndromes, 80% of the centres always replaced the ICD at the end of battery life. After VT ablation, only few centres (9%) explanted or downgraded the device that was previously implanted for secondary prevention, but only in those patients without new VT episodes. Patient's life expectancy <1 year was the most commonly reported reason (61%) to downgrade from a CRT-D to a CRT-P device. While warfarin therapy was continued in 47% of the centres, non-vitamin K oral anticoagulants were discontinued without bridging 24 h prior to replacement procedures in 60%. Finally, in 65% of the centres, VT induction and shock testing during ICD and CRT-D replacement were performed only in the case of leads with a warning or with borderline measurements. This survey provides a snapshot of the perioperative management, indications, and techniques of ICD and CRT device replacement in Europe. It demonstrates some variations between participating centres, probably related to local policies and to the heterogeneity of the ICD population.
University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lubeck, Germany tilz6@hotmail.com.
Roland
R
Tilz
Service de Cardiologie, Cardiologie Interventionnelle, Clinique Pasteur, Toulouse, France.
Serge
S
Boveda
Service de Cardiologie, Hopital Timone Adultes, Marseille, France.
Jean-Claude
JC
Deharo
Cardiology Clinic, Emergency Institute for Cardiovascular Diseases and Transplant, University of Medicine and Pharmacy, Tirgu Mures, Romania Emergency Institute for Cardiovascular Diseases and Transplantation, Tirgu Mures, Romania.
Dan
D
Dobreanu
Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway University of Oslo, Oslo, Norway.
Kristina H
KH
Haugaa
Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany.
Nikolaos
N
Dagres
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000706:statistics & numerical data*; D005060:Europe; D006760:Hospitalization; D006801:Humans; D059035:Perioperative Period; D010818:Practice Patterns, Physicians'; D012955:Societies, Medical; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents; D000925:Anticoagulants
Cardiac implantable electronic device; Cardiac resynchronization therapy; EHRA survey; EP Wire; Implantable cardioverter defibrillator; Pacemaker; Replacement