TY - JOUR
T1 - Factors determining the choice between subcutaneous or transvenous implantable cardioverter-defibrillators in Poland in comparison with other European countries: A sub-study of the European Heart Rhythm Association prospective survey
AU - Jędrzejczyk-Patej, Ewa
AU - Boveda, Serge
AU - Kalarus, Zbigniew
AU - Mazurek, Michał
AU - Gościńska-Bis, Kinga
AU - Kiliszek, Marek
AU - Przybylski, Andrzej
AU - Potpara, Tatjana S.
AU - Tilz, Roland
AU - Fumagalli, Stefano
AU - Dagres, Nikolaos
AU - Lenarczyk, Radosław
N1 - Funding Information:
Finally, the distribution of device types was different in Poland as compared to other European countries. The number of S-ICD implantations was lower, whereas the number of CRT-D devices was higher (reaching over 40% of all ICDs). In other European countries the proportions of ICD-VRs and S-ICDs were comparable. However, in Poland the number of implanted S-ICDs was significantly lower than the number of ICD-VRs, making up only one-sixth of all ICDs. Previously published data show that S-ICD technology penetrates clinical practice in Poland [20–22], but our analysis suggests that this process is slow; similar unfavourable trends were previously observed with the spreading adoption of conventional ICDs [23]. Looking at published data on feasibility and safety, as well as system performance and inappropriate shock rates, which were comparable with those reported for conventional ICDs, it seems justified to suppose that, in the absence of the need for pacing or CRT, S-ICD could gradually replace a considerable percentage of single-and dual-chamber TV-ICDs. This suggestion is supported by the European Society of Cardiology guidelines for the management of patients with ventricular arrhythmias and the prevention of SCD. These recommendations treat S-ICD as an alternative to TV-ICD in patients with an indication for ICD, when pacing therapy for bradycardia support, CRT, or ATP is not needed, and in young patients with a long-term need for ICD therapy. When looking at our data on the reasons for choosing TV-ICD instead of S-ICD, the need for pacing or CRT was comparable in Poland and other European countries, whereas the potential need for ATP was even more common in other European countries. Thus, the percentage of patients in whom S-ICD was not an option was probably comparable in Poland and other European countries. Lastly, CRT-Ds were implanted in a higher percentage of Polish patients when compared to other European countries. This might be the effect of different baseline characteristics of Polish ICD recipients, who had more advanced HF and, probably, greater prevalence of wide QRS complex and left bundle branch block.
Funding Information:
Conflict of interest: Ewa Jędrzejczyk-Patej — consultant fees from Biotronik, Medtronic, St. Jude Medical, and Boston Scientific; Serge Boveda — consultant for Medtronic, Boston Scientific, and Livanova; Zbigniew Kalarus — company sponsored speaker’s bureau from Pfizer, Eli Lilly, Boehringer Ingelheim, Abbott, Bayer, travel expenses to cardiology congresses from. St. Jude Medical and Adamed, advisory committee: Boehringer Ingelheim, Amgen, AstraZeneca; Michał Mazurek and Radosław Lenarczyk — consultant fees from Biotronik, Medtronic, Abbott, and Boston Scientific; Andrzej Przybylski — lecturer fees from Abbott and Medtronic, proctor to Medtronic, Principal Investigator in the study funded by Zoll; Nikolaos Dagres — research grant from Abbott, Biotronic, Boston Scientific, Medtronic to the institution outside of the submitted work. Other authors declare no conflict of interest.
Publisher Copyright:
© Kardiologia Polska Polish Cardiac Society 2018
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2018/11/16
Y1 - 2018/11/16
N2 - Background: Subcutaneous implantable cardioverter-defibrillator (S-ICD) may be an alternative to transvenous ICD (TV-ICD). Aim: We sought to evaluate factors determining the choice of S-ICD vs. TV-ICD in Polish patients in comparison to other European countries. Methods: All consecutive patients who underwent TV-ICD or S-ICD implantation in centres participating in the European Heart Rhythm Association prospective snapshot survey were included. Results: During an eight-week study period, 429 patients were recruited, including 136 (31.7%) ICD patients from Poland (eight with S-ICD). In comparison to other European centres, the proportion of S-ICD implantations in Poland was lower (7% vs. 26%, p < 0.001), whereas the ratio of cardiac resynchronisation therapy defibrillator implantations was higher (43% vs. 26%; p < 0.001). Subjects receiving S-ICD in Poland were more often over 75 years old (25% vs. 0%, p < 0.001), in New York Heart Association class II (87.5% vs. 29.4%, p = 0.001), with chronic kidney disease (37.5% vs. 5.9%, p = 0.003), and with lower left ventricular ejection fraction (32% [14%–50%] vs. 50% [25%–60%], p = 0.04), compared to other European countries. Additionally, in comparison to subjects from other European centres, Polish patients were significantly more often implanted with S-ICD due to prior infection (37.5% vs. 1.5%, p < 0.001) and a lack of venous access (25% vs. 0%, p < 0.001), whereas the largest subset of patients in other European countries were implanted with S-ICD because of young age (50% vs. 25%, p = NS). Conclusions: The main reasons leading to S-ICD implantations in Polish patients differ from the indications adopted in other European countries. In Poland, patients referred for TV-ICD or S-ICD implantation had more advanced heart failure and more comorbidities in comparison to subjects from other European countries. S-ICD is still underused in Polish patients.
AB - Background: Subcutaneous implantable cardioverter-defibrillator (S-ICD) may be an alternative to transvenous ICD (TV-ICD). Aim: We sought to evaluate factors determining the choice of S-ICD vs. TV-ICD in Polish patients in comparison to other European countries. Methods: All consecutive patients who underwent TV-ICD or S-ICD implantation in centres participating in the European Heart Rhythm Association prospective snapshot survey were included. Results: During an eight-week study period, 429 patients were recruited, including 136 (31.7%) ICD patients from Poland (eight with S-ICD). In comparison to other European centres, the proportion of S-ICD implantations in Poland was lower (7% vs. 26%, p < 0.001), whereas the ratio of cardiac resynchronisation therapy defibrillator implantations was higher (43% vs. 26%; p < 0.001). Subjects receiving S-ICD in Poland were more often over 75 years old (25% vs. 0%, p < 0.001), in New York Heart Association class II (87.5% vs. 29.4%, p = 0.001), with chronic kidney disease (37.5% vs. 5.9%, p = 0.003), and with lower left ventricular ejection fraction (32% [14%–50%] vs. 50% [25%–60%], p = 0.04), compared to other European countries. Additionally, in comparison to subjects from other European centres, Polish patients were significantly more often implanted with S-ICD due to prior infection (37.5% vs. 1.5%, p < 0.001) and a lack of venous access (25% vs. 0%, p < 0.001), whereas the largest subset of patients in other European countries were implanted with S-ICD because of young age (50% vs. 25%, p = NS). Conclusions: The main reasons leading to S-ICD implantations in Polish patients differ from the indications adopted in other European countries. In Poland, patients referred for TV-ICD or S-ICD implantation had more advanced heart failure and more comorbidities in comparison to subjects from other European countries. S-ICD is still underused in Polish patients.
UR - http://www.scopus.com/inward/record.url?scp=85056803237&partnerID=8YFLogxK
U2 - 10.5603/KP.a2018.0155
DO - 10.5603/KP.a2018.0155
M3 - Journal articles
C2 - 30091137
AN - SCOPUS:85056803237
SN - 0022-9032
VL - 76
SP - 1507
EP - 1515
JO - Kardiologia Polska
JF - Kardiologia Polska
IS - 11
ER -
