Cardiac resynchronization therapy: do patient selection and implant practice vary depending on the volume a center handles?

Abstract

Background: The annual volume of implants may condition and determine many aspects of cardiac resynchronization therapy (CRT).

Methods: After the Spanish centers performing CRT were identified, data were recorded voluntarily by each implantation team from September 2010 to September 2011.

Result: A total of 88 implanter centers were identified, and of these 85 (96.5%) answered the questionnaire. In total, 2,147 device implantations were reported, comprising 85% of the Eucomed's overall estimate for the same period, which was 2,518 implantations. Centers handling a higher volume of implants have a higher percentage of patients referred from other centers and more indications in patients over 80 years of age, with atrial fibrillation (AF), right bundle branch block, and unspecific disorders of intraventricular conduction. These high-volume centers stimulate more frequently in patients with very wide QRS > 200 ms. Lower-volume centers select more classic patients for resynchronization, whereas higher-volume centers increase the rate of patients with AF and prior cardiac stimulation (upgrade). Implant duration is shorter for higher-volume centers, which also perform implants in patients with congenital heart disease. By contrast, there are no significant differences in terms of heart disease, device type (pacemaker or defibrillator), implant techniques, achieved optimal site location, or complications.

Conclusions: High-volume centers perform CRT more frequently in elderly patients, mostly with AF and other alternative implants. No significant differences were found between the complications reported by high-volume centers and those reported by low-volume centers.

Keywords: CRT; congestive heart failure.