title: Access to and clinical use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology Countries: 2016 Report from the European Heart Rhythm Association.
abstract: OBJECTIVE
  The aim of this analysis was to provide comprehensive information on the access to and use of cardiac implantable electronic device (CIED) and catheter ablation therapy in the European Society of Cardiology (ESC) area.
  
  
  RESULTS
  The European Heart Rhythm Association (EHRA) has been collecting descriptive and quantitative data on invasive arrhythmia therapies since 2008. This year 50 of the 56 ESC member countries provided data for the EHRA White Book. Up-to-date information on procedure rates for the last 5 years together with information on demographics, economy, vital statistics, local healthcare systems, and training activities is presented for each country and the 5 geographical ESC regions. Our analysis indicated that considerable heterogeneity in the access to arrhythmia therapies still exists across the ESC area. In 2015, the CIED implantation rates per million population were highest in the Western followed by the Southern and Northern European countries. The catheter ablation activity was largest in the Western followed by the Northern and Southern areas. Overall, the procedure rates were 3-10 times higher in the European than in the non-European ESC countries. Economic resources were not the only driver for utilization of arrhythmia therapies as in some Eastern European countries with relative low gross domestic product the procedure rates exceeded the average values.
  
  
  CONCLUSIONS
  These data will help the healthcare professionals and stakeholders to identify and to understand in more depth the trends, disparities, and gaps in cardiac arrhythmia care and thereby promote harmonization of cardiac arrhythmias therapies in the ESC area.
authors: Department of Cardiology, Heart and Lung Center Helsinki University Central Hospital, Helsinki and University of Eastern Finland, Meilahti Tower Hospital, PO Box 340, FI-00029 HUS, Kuopio, Finland pekka.raatikainen@uta.fi.
authors: M J Pekka
authors: MJ
authors: Raatikainen
authors: Division of Cardiology, Department of Medicine, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
authors: David O
authors: DO
authors: Arnar
authors: Semmelweis University of Budapest, Heart and Vascular Center, Budapest, Hungary.
authors: Bela
authors: B
authors: Merkely
authors: Division of Cardiovascular Sciences, St George's University of London, London, UK ICMS, Imperial College, London, UK.
authors: A John
authors: AJ
authors: Camm
authors: Department of Electrophysiology, Heart Centre, University of Leipzig, Leipzig, Germany.
authors: Gerhardt
authors: G
authors: Hindricks
mesh_terms: D000352:Africa, Northern; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000639:trends; D058406:Cardiac Resynchronization Therapy / Q000639:trends; D058409:Cardiac Resynchronization Therapy Devices / Q000639:trends; D002309:Cardiology / Q000639:trends*; D017115:Catheter Ablation / Q000639:trends; D017147:Defibrillators, Implantable / Q000639:trends; D004554:Electric Countershock / Q000295:instrumentation / Q000639:trends; D022062:Electrophysiologic Techniques, Cardiac / Q000639:trends*; D005060:Europe; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000639:trends*; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D010138:Pacemaker, Artificial / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011237:Predictive Value of Tests; D000071836:Professional Practice Gaps / Q000639:trends; D012955:Societies, Medical; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation ablation; Cardiac resynchronization defibrillator (CRT-D); Cardiac resynchronization pacemaker (CRT-P); Catheter ablation; Implantable cardioverter-defibrillator (ICD); Pacemaker