The European cardiac resynchronization therapy survey: patient selection and implantation practice vary according to centre volume

AIMS: The European cardiac resynchronization therapy (CRT) survey is a joint initiative taken by the Heart Failure Association and the European Heart Rhythm Association of the European Society of Cardiology with the primary objective of describing current European practice associated with CRT implantations. The results demonstrated that a substantial number of implantations took place in patients without conventional guideline indications. We investigated whether the volume of implants per centre was a determinant of the propensity to use devices for 'off-label' indications.

METHODS AND RESULTS: One hundred and forty-one centres from 13 European countries contributed data from consecutive patients successfully implanted with a CRT-P or CRT-D device between November 2008 and June 2009. Centres were categorized into low volume (LVol; ≤ 120 implantations/year) and high volume (HVol; >120 implantations/year) based on median implantable cardioverter-defibrilator implantation the previous year. No differences were noted with regard to sex, age, or peri-procedural and device-related complications. High-volume centres implanted CRT devices in significantly more patients with mild symptoms and a narrow QRS width. The procedure and fluoroscopy times were substantially longer at LVol centres and devices were more frequently implanted by surgeons and interventional cardiologists. Patients stayed longer in hospital in LVol centres with a median of 4 (2-9) vs. 2 (2-6) days.

CONCLUSIONS: High-volume centres explore newer indications in their CRT practice and implant devices more frequently in patients with mild symptoms and narrow QRS durations. Electrophysiologists dominate implantation practice at HVol centres and duration of hospitalization is substantially shorter at these centres.