title: Implantation of subcutaneous implantable cardioverter defibrillators in Europe: results of the European Heart Rhythm Association survey.
abstract: OBJECTIVE
  The purpose of this European Heart Rhythm Association (EHRA) survey is to provide an overview of the current use of subcutaneous cardioverter defibrillators (S-ICDs) across a broad range of European centres.
  
  
  RESULTS
  A questionnaire was sent via the internet to centres participating in the EHRA electrophysiology research network. Questions included standards of care and policies used for patient management, indications, and techniques of implantation of the S-ICDs. In total, 52 centres replied to the questionnaire. More than one-fourth of the responding centres does not implant the S-ICD (n = 14, 27%). The majority reported to have implanted <10 (50%) or 10-29 (23%) S-ICDs during the last 12 months. Lack of reimbursement (25%), non-availability (19%), and cost of the device (25%) seem to limit the use of the S-ICD. The most commonly reported indications for S-ICD implantation are a difficult vascular access (82%), a history of previous complicated transvenous ICD (8O%), young age (69%), or an anticipated higher risk of infection (63%). Inappropriate therapies were the most frequently reported major problems (38%), but the majority of respondents (51%) never encountered any issue after an S-ICD implantation. Most of the respondents (83%) anticipate significant increase of S-ICD use within the next 2 years.
  
  
  CONCLUSIONS
  This survey provides a contemporary insight into S-ICD implantation and management in the European electrophysiology centres, showing different approaches, depending on local policies. Cost issues or lack of reimbursement strongly influence the dissemination of the device. However, most respondents retain that S-ICD use will significantly increase in a very short time.
authors: Department of Cardiology, Cardiac Arrhythmias Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France sboveda@clinique-pasteur.com.
authors: Serge
authors: S
authors: Boveda
authors: Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors: Radoslaw
authors: R
authors: Lenarczyk
authors: Department of Cardiology and Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway University of Oslo, Oslo, Norway.
authors: Kristina
authors: K
authors: Haugaa
authors: Intensive Care Unit, Geriatric Cardiology and Medicine Division, Experimental and Clinical Medicine Department, University of Florence and AOU Careggi, Florence, Italy.
authors: Stefano
authors: S
authors: Fumagalli
authors: Cardiology Department, Ramón y Cajal Hospital, Alcala University, 28034 Madrid, Spain.
authors: Antonio Hernandez
authors: AH
authors: Madrid
authors: Arrhythmia Department, University Hospital Grenoble-Alps, 38043 Grenoble, France.
authors: Pascal
authors: P
authors: Defaye
authors: Consultant Cardiologist, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK.
authors: Paul
authors: P
authors: Broadhurst
authors: Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors: Nikolaos
authors: N
authors: Dagres
mesh_terms: D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000191:economics / Q000639:trends*; D004554:Electric Countershock / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000639:trends*; D005060:Europe; D017048:Health Care Costs / Q000639:trends; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000639:trends; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000639:trends*
keywords: EHRA; European survey; S-ICD implantation; S-ICD indications; Standards of care; Subcutaneous ICD