Publish in this journal
Journal Information
Vol. 68. Issue 11.
Pages 996-1007 (November 2015)
Share
Share
Download PDF
More article options
Visits
Not available
Vol. 68. Issue 11.
Pages 996-1007 (November 2015)
Special article
Full text access
Spanish Implantable Cardioverter-defibrillator Registry. Eleventh Official Report of the Spanish Society of Cardiology Electrophysiology and Arrhythmias Section (2014)
Registro Español de Desfibrilador Automático Implantable. XI Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2014)
Visits
...
Javier Alzueta
Corresponding author
jalzueta@telefonica.net

Corresponding author: Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario Virgen de la Victoria, Campus de Teatinos s/n, 29010 Málaga, Spain.
, Antonio Asso, Aurelio Quesada
Sección de Electrofisiología y Arritmias, Sociedad Española de Cardiología, Madrid, Spain
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (8)
Show moreShow less
Tables (5)
Table 1. Implantations by Autonomous Community, Province, and Hospital
Table 2. Implantations by Autonomous Community and Province
Table 3. Number of First Implantations According to the Type of Heart Disease, Type of Clinical Arrhythmia, and Form of Presentation From 2009 to 2014
Table 4. Changes in the Main Indications for Implantable Cardioverter-defibrillators (First Implantations, 2003-2014)
Table 5. Distribution (%) of the Types of Devices Implanted
Show moreShow less
Abstract
Introduction and objectives

We present the results of the Spanish Implantable Cardioverter-defibrillator Registry for 2014, as compiled by the Electrophysiology and Arrhythmia Section of the Spanish Society of Cardiology.

Methods

Data collection sheets were voluntarily completed by each implantation team and prospectively sent to the Spanish Society of Cardiology.

Results

The number of reported implantations was 4911 (82% of the estimated total number of implantations). The implantation rate was 106 per million population while the estimated rate was 128. First implantations comprised 72.2%. Data were obtained from 162 hospitals (8 more than in 2013). Most implantations (82%) were performed in men. The mean patient age was 61.8±13.7 years. Most patients showed severe or moderate-to-severe ventricular dysfunction and were in New York Heart Association functional class II. The most frequent cardiac condition was ischemic heart disease, followed by dilated cardiomyopathy. Implantations for primary prevention indications comprised 58.5%. Electrophysiologists performed 85.6% of the implantations.

Conclusions

The 2014 Spanish Implantable Cardioverter-defibrillator Registry received information on 82% of the implantations performed in Spain. The number of implantations has increased from previous years and the percentage of implantations for primary prevention indications has increased from the previous year.

Keywords:
Arrhythmias
Registry
Defibrillator
Abbreviations:
CRT
EUCOMED
ICD
SEC
Resumen
Introducción y objetivos

Se presentan los resultados del Registro Español de Desfibrilador Automático Implantable de 2014, elaborado por la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología.

Métodos

Se envió de forma prospectiva a la Sociedad Española de Cardiología la hoja de recogida de datos cumplimentada voluntariamente por cada equipo implantador.

Resultados

El número de implantes comunicados fue 4.911 (el 82% del total de implantes estimado). La tasa de implantes fue 106 por millón de habitantes y la estimada, 128. Los primoimplantes fueron el 72,2%. Se obtuvieron datos de 162 hospitales (8 más que en 2013). La mayoría de los implantes (82%) se realizaron en varones. La media de edad fue 61,8±13,7 años. La mayoría de los pacientes presentaban una disfunción ventricular grave o grave-moderada y clase funcional II de la New York Heart Association. La cardiopatía más frecuente fue la isquémica, seguida de la dilatada. Las indicaciones por prevención primaria han sido el 58,5%. Los implantes realizados por electrofisiólogos fueron el 85,6%.

Conclusiones

El Registro Español de Desfibrilador Automático Implantable de 2014 recoge información del 82% de los implantes realizados en España. El número de implantes ha crecido respecto a los datos de los últimos años. El porcentaje de indicación por prevención primaria ha aumentado con respecto al registro anterior.

Palabras clave:
Arritmias
Registro
Desfibrilador
Full Text
INTRODUCTION

Implantable cardioverter-defibrillators (ICD) are useful for the primary and secondary prevention of sudden cardiac death. The main indications for ICD implantation have been derived from numerous studies and have been included in the successive clinical management guidelines of patients with ventricular arrhythmia or at risk of sudden cardiac death.1–3 However, the increased use of ICD has raised questions about their effectiveness outside the setting of clinical trials, about the real-world selection of patients for implantation, and about the availability, safety, and cost-effectiveness of this therapy.4 Thus, considering the little information in the medical literature on these aspects and the application of the clinical guidelines to unselected patient populations, health care registries could be extremely useful.

The current study presents the data on ICD implantation reported to the Spanish Implantable Cardioverter-defibrillator Registry in 2014. Most Spanish centers implanting ICD have contributed to the registry. As in the previous official reports on this activity in Spain,5–13 this report has been prepared by the members of the Electrophysiology and Arrhythmia Section of the Spanish Society of Cardiology (SEC, Sociedad Española de Cardiología).

The main aim of the registry is to determine the current implantation situation in Spain, with special emphasis on indications, patients’ clinical characteristics, implantation data, types of devices, programming, and procedural complications.

METHODS

The registry data were obtained using a data collection form, available at the SEC website.14 Each implantation team directly and voluntarily completed this form during or after the procedure with the help of the technical staff of the ICD manufacturer.

A specially appointed technician introduced the information into the database of the Spanish Implantable Cardioverter-defibrillator Registry, with the help of a computer technician of the SEC and a member of the Electrophysiology and Arrhythmia Section. The computer technician and section member also performed data cleaning. The authors of this article analyzed the data and are responsible for this publication.

The census data for the distinct calculations of rates per million population, both national and by autonomous community and province, were obtained from the estimations of the Spanish National Institute of Statistics as of 1 January, 2014.15

To estimate the representativeness of the registry, the proportion of implantations and replacements recorded in the registry was calculated with respect to the total number of implantations and replacements performed in Spain in 2014. This number was based on the data for 2014 reported to the European Medical Technology Industry Association (EUCOMED) by the suppliers of ICD in Spain.16

If the data collection sheet recorded various clinical presentations or arrhythmias in the same patient, only the most serious condition was included in the analysis.

The percentages of each of the variables analyzed were calculated by taking into account the total number of implantations including information on the analysis variable.

Statistical Analysis

Numerical results are expressed as mean±standard deviation or median [interquartile range], according to the distribution of the variable. Continuous quantitative variables were compared using analysis of variance or the Kruskal-Wallis test. Qualitative variables were compared using the chi-square test. The relationships between the number of implantations and the devices implanted per million population and the total number of implantations and the number of implantations for primary prevention in each center were studied using linear regression models.

RESULTS

The response rates to the distinct fields of the data collection sheet ranged from 99.6% for the name of the implanting hospital to 12.6% for QRS width.

Implanting Centers

In total, 162 hospitals performing ICD implantations reported their data to the registry (154 in 2013). The data from 152 hospitals are shown in Table 1; 10 centers were excluded due to errors in the data collection sheet. As in the previous year, 90 were public centers. The total number of implanting centers, rate per million population, and total number by autonomous community according to the data sent to the registry are shown in Figure 1. During 2014, only 13 centers implanted more than 100 devices; 79, fewer than 10; and 32, only 1.

Table 1.

Implantations by Autonomous Community, Province, and Hospital

Andalusia
Almería  Hospital Torrecárdenas  15 
Cádiz  Hospital de Jerez  20 
  Hospital Universitario de Puerto Real  12 
  Hospital Universitario Puerta del Mar  44 
Córdoba  Hospital de la Cruz Roja de Córdoba 
  Hospital Reina Sofía de Córdoba  54 
Granada  Hospital Clínico Universitario San Cecilio 
  Hospital Clínico de Granada 
  Hospital Universitario Virgen de las Nieves  96 
Huelva  Hospital General Juan Ramón Jiménez  50 
Jaén  Complejo Hospitalario de Jaén  34 
Málaga  Clínica El Ángel 
  Clínica Parque San Antonio  11 
  Hospital Internacional Xanit  13 
  Clínica Quirón de Málaga 
  Clínica Quirón de Marbella 
  Hospital Virgen de la Victoria  212 
  Hospiten Estepona 
Seville  Clínica Sagrado Corazón, S.A. 
  Clínica San Juan de Dios 
  Hospital Infanta Luisa (Clínica Esperanza de Triana) 
  Hospital Nisa Aljarafe 
  Hospital Viamed Santa Ángela de la Cruz 
  Clínica Santa Isabel 
  Hospital Nuestra Señora de Valme  60 
  Hospital Virgen Macarena  75 
  Hospital Virgen del Rocío  84 
Aragon
Zaragoza  Hospital Quirón Zaragoza 
  Hospital Clínico Universitario Lozano Blesa  34 
  Hospital Miguel Servet  94 
Principality of Asturias  Hospital Central de Asturias  150 
Balearic Islands  Clínica Juaneda 
  Clínica Quirón Palmaplanas 
  Hospital Son Llàtzer  23 
  Hospital Universitari Son Espases  61 
  Clínica Rotger Sanitaria Balear, S.A. 
  Policlínica Miramar (AMEBA S.A.) 
Canary Islands
Las Palmas  Hospital Dr. Negrín  26 
  Hospital Insular de Gran Canaria  36 
Sta. Cruz de Tenerife  Clínica Santa Cruz 
  Hospital Nuestra Señora de la Candelaria  40 
  Hospital Universitario de Canarias  68 
  Hospiten Ramblas 
  USP Hospital La Colina 
Cantabria  Hospital Universitario Marqués de Valdecilla  75 
  Igualatorio de Cantabria 
Castile and León
Ávila  Hospital Nuestra Señora de Sonsoles  12 
Burgos  Hospital Universitario de Burgos, S.A. (HUBU)  68 
Leon  Hospital de León  57 
Salamanca  Complejo Hospitalario de Salamanca  76 
Valladolid  Hospital Campo Grande 
  Hospital Río Hortega  28 
  Hospital Sagrado Corazón de Jesús 
  Hospital Clínico Universitario de Valladolid  82 
Castile-La-Mancha
Albacete  Clínica Recoletas de Albacete 
  Hospital General de Albacete  35 
  Sanatorio Sta. Cristina 
Ciudad Real  Hospital General de Ciudad Real  39 
Cuenca  Hospital Virgen de la Luz 
Guadalajara  Hospital General y Universitario de Guadalajara  31 
Toledo  Hospital Nuestra Señora del Prado  14 
  Hospital Virgen de la Salud  117 
Catalonia
Barcelona  Centre Cardiovascular Sant Jordi, S.A. 
  Centro Médico Teknon 
  Clínica Delfos 
  Clínica Pilar Sant Jordi 
  Clínica Quirón 
  Clínica Sagrada Familia 
  Hospital Clínic de Barcelona  199 
  Hospital de Bellvitge  104 
  Fundació de G.S. de l’Hospital de la Santa Creu i Sant Pau  130 
  Hospital del Mar  20 
  Capio Hospital General de Catalunya  13 
  Hospital Germans Trias i Pujol  51 
  Hospital Sant Joan de Déu 
  Hospital Vall d’Hebron  76 
Lleida  Hospital Universitario Arnau de Vilanova  18 
Tarragona  Hospital Universitario de Tarragona Joan XXIII  17 
  Hospital de Sant Pau i Santa Tecla 
Valencian Community
Alicante  Clínica Benidorm 
  Hospital General Universitari d’Alacant  152 
  Hospital IMED de Levante 
  Hospital Universitari Sant Joan d’Alacant  31 
  Sanatorio del Perpetuo Socorro 
Castellón  Hospital General de Castelló  26 
  Hospital Rey Don Jaime 
Valencia  Grupo Hospitalario Quirón, S.A. 
  Hospital Arnau de Vilanova 
  Hospital Clínico Universitario  71 
  Hospital de Manises 
  Hospital General Universitario  52 
  Hospital Universitari de la Ribera  32 
  Hospital Universitario Dr. Peset  40 
  Hospital Universitario La Fe  121 
Extremadura
Badajoz  Clideba. IDC SALUD 
  Hospital Infanta Cristina de Badajoz  124 
Cáceres  Clínica Quirúrgica Cacereña 
  Clínica San Francisco 
  Complejo Hospitalario de Cáceres  32 
  Hospital San Pedro de Alcántara 
Galicia
A Coruña  Complejo Hospitalario Universitario de Santiago  91 
  Complejo Hospitalario Universitario A Coruña  127 
  Hospital USP Santa Teresa 
  Hospital HM Modelo 
Pontevedra  Complejo Hospitalario Universitario de Vigo (CHUVI)  104 
  Hospital Miguel Domínguez 
  Hospital Povisa 
  Hospital Provincial de Pontevedra 
La Rioja  Hospital San Pedro  32 
Community of Madrid  Clínica La Luz 
  Clínica Moncloa ASIS 
  Clínica Ruber 
  Clínica Sanitas La Moraleja 
  Fundación Hospital Alcorcón  13 
  Fundación Jiménez Díaz. Clínica Nuestra Señora de la Concepción  42 
  Grupo Hospital de Madrid (H. Norte y H. Montepríncipe)  11 
  Hospital 12 de Octubre  70 
  Hospital Central de la Defensa  17 
  Hospital Clínico San Carlos  113 
  Hospital de Fuenlabrada 
  Hospital de Torrejón  16 
  Hospital General Universitario Gregorio Marañón  86 
  Hospital Infanta Cristina de Parla 
  Hospital Infanta Elena de Valdemoro 
  Hospital Infanta Leonor de Madrid 
  Hospital Quirón de Madrid 
  Hospital Ramón y Cajal  86 
  Hospital Rey Juan Carlos  13 
  Hospital Ruber Internacional 
  Hospital San Rafael 
  Hospital Sanitas La Moraleja 
  Hospital Severo Ochoa  13 
  Hospital Sur de Alcorcón 
  Hospital Universitario de Getafe  14 
  Hospital Universitario La Paz  86 
  Hospital Universitario Puerta de Hierro de Majadahonda  129 
  Hospital Virgen de la Paloma 
  Hospital Virgen del Mar 
  Hospital Vithas Nuestra Señora de América 
  Sanatorio San Francisco de Asís 
Region of Murcia
  Hospital General Universitario Morales Meseguer 
  Hospital General Universitario Reina Sofía  11 
  Hospital General Universitario Santa Lucía 
  Hospital Rafael Méndez  15 
  Hospital Universitario Virgen de la Arrixaca  92 
Chartered Community of Navarre  Hospital de Navarra  41 
  Clínica Universitaria de Navarra  42 
Basque Country
Álava  Hospital Universitario de Araba  43 
Guipúzcoa  Hospital Universitario Donostia 
Vizcaya  Hospital de Basurto  32 
  Hospital de Cruces  42 
  Hospital de Galdakao-Usansolo  23 
No data    23 
Figure 1.

Distribution of activity by autonomous community in 2014: number of implanting centers/rate per million population/total number of implantations.

(0.31MB).
Total Number of Implantations

The total number of implantations (first implantations and replacements) in 2014 was 4899, more than in 2013 (total number, 4722). Because the EUCOMED data16 showed a total number of devices of 5980, this figure represents 82% of the total. The total number of implantations reported to the registry and those estimated by the EUCOMED in the last 12 years are shown in Figure 2.

Figure 2.

Total number of implantations recorded and those estimated by the European Medical Technology Industry Association from 2003 to 2014.

(0.2MB).

The overall rate of recorded implantations was 106 per million population; according to the EUCOMED data, the rate was 128 per million population. The change in the implantation rate per million population during the last 12 years according to the registry and EUCOMED data is shown in Figure 3. Implantations reported per implanting center are shown in Table 1; the number of implantations performed in each province and the corresponding rate per million population by autonomous community are shown in Table 2.

Figure 3.

Total number of implantations recorded per million population and those estimated by the European Medical Technology Industry Association from 2003 to 2014.

(0.18MB).
Table 2.

Implantations by Autonomous Community and Province

Autonomous community  Rate per 106 inhabitants  Province  Implantations, no. 
Andalusia  98.9  Almería  15 
    Cádiz  76 
    Córdoba  57 
    Granada  107 
    Huelva  50 
    Jaén  34 
    Málaga  253 
    Seville  238 
Aragon  98.4  Zaragoza  131 
Principality of Asturias  138.8  Asturias  150 
Balearic Islands  83.3  Balearics  93 
Canary Islands  82.3  Las Palmas  62 
    Sta. Cruz de Tenerife  112 
Cantabria  124.2  Cantabria  75 
Castile and León  132.2  Ávila  12 
    Burgos  68 
    Leon  57 
    Salamanca  76 
    Valladolid  117 
Castile-La-Mancha  119.9  Albacete  37 
    Ciudad Real  39 
    Cuenca 
    Guadalajara  31 
    Toledo  131 
Catalonia  87.9  Barcelona  609 
    Lleida  18 
    Tarragona  25 
Valencian Community  109.2  Alicante  186 
    Castellón  27 
    Valencia  327 
Extremadura  153.2  Badajoz  128 
    Cáceres  40 
Galicia  121.2  A Coruña  225 
    Pontevedra  109 
La Rioja  101.5  La Rioja  32 
Community of Madrid  120.1  Madrid  766 
Region of Murcia  48.1  Murcia  123 
Chartered Community of Navarre  130.4  Navarra  83 
Basque Country  70.6  Álava  53 
    Guipúzcoa 
    Vizcaya  97 
No data      23 

The implanting hospital was recorded in 99% of cases. Most implantations, 4506 (92.4%) were performed in public health care centers.

First Implantations vs Replacements

This information was available in 4741 forms sent to the SEC (96.8%). There were 3446 first implantations, representing 72.6% of the total (68.8% in 2013; 69.4% in 2012; 70.2% in 2011; and 73.8% in 2010). The rate of first implantations per million population was 79.0 in 2014 (63.8 in 2013; and 64 in 2012).

Age and Sex

The mean age±standard deviation [interval] of patients receiving an ICD implantation or replacement was 61.8±13.7 [7-94] years. In first implantation patients, the age was 60.9±13.4 years. Most patients were men, who represented 82.00% of all patients and 81.57% of first implantation patients.

Underlying Heart Disease, Left Ventricular Ejection Fraction, Functional Class, and Baseline Rhythm

The most frequent underlying cardiac condition in first implantation patients was ischemic heart disease (53.6%), followed by dilated cardiomyopathy (27.3%), hypertrophic (7.1%), the group of primary conduction abnormalities (Brugada syndrome, idiopathic ventricular fibrillation, and long QT syndrome) (2.6%), and, at lower percentages, valve diseases and arrhythmogenic dysplasias (Figure 4).

Figure 4.

Type of heart disease prompting implantation (first implantations). Sole diagnosis.

(0.14MB).

Left ventricular fraction was < 30% in 53.8% of first implantation patients, 30% to 40% in 24.6%, 41% to 50% in 6.6%, and > 50% in 15%. Patients who underwent ICD replacement showed a similar distribution (Figure 5). These data were recorded in 80.7% of the data collection sheets of the registry.

Figure 5.

Left ventricular ejection fraction of the registry patients (total and first implantations). LVEF, left ventricular ejection fraction.

(0.06MB).

With respect to the New York Heart Association (NYHA) functional class, most patients were in NYHA II (48.7%), followed by NYHA III (32.6%), NYHA I (16.7%), and NYHA IV (2.1%). For this parameter, the distribution was also similar between total implantations and first implantations (Figure 6), and these data were reported in 58.6% of the data collection sheets.

Figure 6.

New York Heart Association functional class of the total and first implantation patients in the registry. NYHA, New York Heart Association.

(0.06MB).

The baseline rhythm, reported in 85.3% of the patients, was largely sinusal (79.3%), followed by atrial fibrillation (16.5%) and pacemaker rhythm (3.9%); the remaining patients had other rhythms (atrial flutter and other arrhythmias).

Clinical Arrhythmia Prompting Device Implantation, Its Form of Presentation, and the Arrhythmia Induced in the Electrophysiological Study

These data were contained in 80.7% of the registry forms. For first implantations, most patients had no documented clinical arrhythmias (54.7%), followed by those with sustained monomorphic ventricular tachycardia, nonsustained ventricular tachycardia, and ventricular fibrillation (18.7%, 13.8%, and 11.2%, respectively). In total, patients with no documented clinical arrhythmia comprised 54.7% (Figure 7). The differences in the type of arrhythmia between the first implantation group and the total were significant for patients with polymorphic ventricular tachycardia (P<.001). There were no significant differences in the other categories. The most frequent clinical presentation in both the total implantation group and the first implantation patients (62.2% and 68.9% of completed responses) was asymptomatic, followed by syncope, cardiac arrest, and “other symptoms” (Figure 8).

Figure 7.

Distribution of arrhythmias prompting implantation (first implantations and total). NSVT, nonsustained ventricular tachycardia; PVT, polymorphic ventricular tachycardia; SMVT, sustained monomorphic ventricular tachycardia; VF, ventricular fibrillation. *P<.001.

(0.07MB).
Figure 8.

Clinical presentation of the arrhythmia in the registry patients (first implantations and total). SCD, sudden cardiac death.

(0.06MB).

Data on electrophysiological studies were available for 1525 first implantation patients (44.3%). Such studies were performed in only 244 patients (13.8%). Sustained monomorphic ventricular tachycardia was the most common induced arrhythmia (43.0%), followed by ventricular fibrillation (17.6%) and, to a lesser extent, nonsustained ventricular tachycardia (11.5%) and others (3.3%). No arrhythmia was induced in 24.5% of the electrophysiological studies. Most of these studies were performed in patients with ischemic heart disease or dilated cardiomyopathy.

Clinical History

Data on the clinical history of patients have only been available since 2011 because such data were not previously recorded.

Responses to questions on clinical history were obtained for between 66.8% and 82.1% of first implantation patients, with the following findings: hypertension, 58.8%; hypercholesterolemia, 51.2%; smoking, 36.9%; diabetes mellitus, 31.8%; history of atrial fibrillation, 25.0%; kidney failure, 13.6%; history of sudden cardiac death, 7.3%; and stroke, 5.0%.

The QRS width was recorded in 37.1% of the forms (mean, 122.6ms±37ms). In 33.4% of the patients, the recorded width was > 140ms. Of these patients, 83.3% of the first implantation patients and 83.7% of the total had a defibrillator-resynchronization device (ICD-CRT [cardiac resynchronization therapy]) device.

Indications

The changes in the type of heart disease and presentation in first implantation patients from 2010 to 2014 are shown in Table 3. Data on this parameter were recorded in 85% of the registry collection sheets. For ischemic heart disease, the most frequent indication was prophylactic prevention (45.5%), representing a slight decrease from the previous year (48.8%). For dilated cardiomyopathy, the main indication was also prophylactic (47% vs 52.1% in 2013 and 62.3% in 2012). For less common heart diseases, the most frequent indication was primary prevention of hypertrophic cardiomyopathy, valve diseases, congenital diseases, and Brugada syndrome. For long QT syndrome, secondary prevention was the most common indication.

Table 3.

Number of First Implantations According to the Type of Heart Disease, Type of Clinical Arrhythmia, and Form of Presentation From 2009 to 2014

  2010  2011  2012  2013  2014 
Ischemic heart disease
Aborted SCD  154 (10.0)  150 (10.8)  134 (9.9)  135 (10.5)  141 (6.7) 
SMVT with syncope  132 (8.6)  199 (14.4)  110 (8.1)  160 (11.9)  173 (10.6) 
SMVT without syncope  317 (20.7)  197 (14.2)  148 (10.9)  179 (13.3)  108 (6.6) 
Syncope without arrhythmia  68 (4.4)  95 (6.8)  77 (5.7)  43 (3.2)  70 (4.3) 
Prophylactic indication  642 (42.0)  623 (45.0)  682 (50.5)  657 (48.8)  740 (45.5) 
Missing/unclassifiable  212 (13.9)  120 (8.7)  200 (14.8)  169 (12.6)  393 (24.8) 
Subtotal  1525  1384  1351  1343  1625 
Dilated cardiomyopathy
Aborted SCD  49 (6.0)  47 (5.9)  50 (6.6)  46 (6.0)  25 (6.8) 
SMVT with syncope  58 (7.1)  57 (7.1)  44 (5.8)  79 (10.4)  72 (8.5) 
SMVT without syncope  136 (16.8)  157 (19.6)  46 (6.0)  81 (10.7)  111 (13.4) 
Syncope without arrhythmia  34 (4.2)  37 (4.6)  38 (5.0)  49 (6.5)  37 (4.3) 
Prophylactic indication  393 (48.7)  427 (53.4)  473 (62.3)  395 (52.1)  400 (47.0) 
Missing/unclassifiable  136 (16.8)  74 (9.3)  108 (14.2)  108 (14.2)  173 (20.3) 
Subtotal  806  799  759  758  851 
Valvular heart disease
Aborted SCD  9 (8.3)  16 (10.8)  15 (13.4)  11 (10.2)  11 (9.0) 
SMVT  29 (26.8)  47 (31.8)  24 (21.6)  41 (37.9)  38 (31.5) 
Syncope without arrhythmias  4 (3.7)  5 (3.4)  12 (10.8)  4 (3.7)  7 (5.7) 
Prophylactic indication  50 (46.2)  66 (44.6)  48 (43.2)  38 (35.2)  46 (37.7) 
Missing/unclassifiable  16 (14.8)  14 (9.6)  12 (10.8)  14 (12.9)  20 (16.4) 
Subtotal  108  148  111  108  126 
Hypertrophic cardiomyopathy
Secondary prevention  90 (54.5)  52 (27.9)  53 (26)  58 (29.9)  62 (25.8) 
Prophylactic indication  53 (32.1)  127 (68.8)  140 (68.6)  131 (67.5)  166 (69.2) 
Missing/unclassifiable  22 (13.2)  7 (3.8)  11 (5.3)  5 (2.8)  12 (5.0) 
Subtotal  165  186  204  194  240 
Brugada syndrome
Aborted SCD  17 (24.6)  7 (13.5)  11 (14.1)  9 (13.6)  8 (13.7) 
Prophylactic implantation in syncope  18 (26.6)  25 (40.8)  22 (28.2)  28 (42.4)  17 (29.3) 
Prophylactic implantation without syncope  23 (33.3)  15 (28.8)  42 (53.8)  18 (27.2)  22 (37.9) 
Missing/unclassifiable  11 (15.9)  5 (9.6)  3 (3.8)  11 (16.7)  11 (18.9) 
Subtotal  69  52  78  66  60 
ARVC
Aborted SCD  4 (15.9)  2 (4.6)  1 (3.3)  5 (12.2)  6 (13.3) 
SMVT  23 (71.8)  21 (48.8)  11 (33.3)  14 (34.5)  16 (35.5) 
Prophylactic implantation  4 (12.5)  17 (39.5)  13 (39.4)  14 (34.5)  16 (35.5) 
Missing/unclassifiable  1 (3.1)  3 (6.9)  8 (24.4)  8 (19.5)  7 (15.5) 
Subtotal  32  43  33  41  45 
Congenital heart disease
Aborted SCD  3 (8.1)  4 (12.5)  6 (20.0)  4 (17.4)  5 (13.9) 
SMVT  15 (40.5)  8 (25.0)  7 (23.3)  6 (26.1)  7 (19.4) 
Prophylactic implantation  16 (43.2)  15 (46.8)  12 (40.0)  10 (43.5)  15 (41.7) 
Missing/unclassifiable  3 (8.1)  5 (15.4)  5 (16.6)  3 (13.4)  9 (25.0) 
Subtotal  37  32  30  23  36 
Long QT syndrome
Aborted SCD  18 (60.0)  11 (50.0)  10 (41.6)  19 (48.7)  19 (70.4) 
Prophylactic implantation  6 (20.0)  9 (40.9)  10 (41.6)  18 (46.1)  5 (18.5) 
Missing/unclassifiable  6 (20.0)  2 (9.1)  4 (16.6)  2 (5.3)  3 (11.1) 
Subtotal  30  22  24  39  26 

ARVC, arrhythmogenic right ventricular cardiomyopathy; SCD, sudden cardiac death; SMVT, sustained monomorphic ventricular tachycardia.

Data are expressed as No. (%).

The implantation indication was reported in 65% of the records. Most first implantations were indicated for primary prevention (58.5%), reversing the decreasing trend of the previous 2 years. This variability has been growing, and was statistically significant until 2008, in 2009 and 2010, and in 2013 and 2014 (P<.02) (Table 4).

Table 4.

Changes in the Main Indications for Implantable Cardioverter-defibrillators (First Implantations, 2003-2014)

Year  SCD  SMVT  Syncope  Primary prevention 
2003  13.7  42.8  14.0  29.0 
2004  14.8  37.0  16.0  32.2* 
2005  11.1  34.8  14.6  39.5* 
2006  9.5  27.0  13.2  50.3* 
2007  9.9  25.0  14.1  50.7* 
2008  9.3  21.4  12.3  57.0* 
2009  9.4  20.8  13.9  55.9 
2010  10.9  20.6  11.1  57.1* 
2011  10.7  15.1  14.6  59.4 
2012  12.5  10.2  19.1  58.1 
2013  13.5  11.1  22.4  53.0* 
2014  13.2  17.9  10.2  58.5* 

SCD, sudden cardiac death; SMVT, sustained monomorphic ventricular tachycardia.

*

Significant difference compared with the previous year (P < .02). the previous year.

Implantation Setting and Attending Specialist

There was an 87.4% response rate to these questions. In 83.4%, the main implantation location was the electrophysiology laboratory (79.8% in 2013, 81.4% in 2012, and 76.4% in 2011), followed by the operating room (15.0%). Electrophysiologists performed 81.7% of implantations (80.7% in 2013; 81.0% in 2012; and 78.4% in 2011); surgeons, 11.0% (13.8% in 2013; 14.0% in 2012; and 15.5% in 2011); both specialist types, 4.6%; and other specialists and intensivists, 1.4% and 1.3%, respectively.

Generator Placement Site

Information on the placement of first implantations was provided in 2906 forms (87.8%). Placement was subcutaneous in 95.2% of patients and subpectoral in the remaining 4.8%. The figures were also 95.2% and 4.8% for all devices implanted, respectively.

Device Type

This information was available in 94.9% of the records and is summarized in Table 5. Single-chamber devices comprised 48.8% of implanted ICD (48.2% in 2013 and 49.4% in 2012), dual-chamber devices comprised 17.4% (18.9% in 2013 and 18.0% in 2012), and ICD-CRT devices comprised 33.7% (32.9% in 2013 and 32.5% in 2012).

Table 5.

Distribution (%) of the Types of Devices Implanted

  2010, total  2011, total  2012, total  2013, total  2013, first implantations  2014, total  2014, first implantations 
Single-chamber  50.3  46.7  49.4  48.2  50.9  48.8  53.4 
Dual-chamber  20.2  18.4  18.0  18.9  19.5  17.4  16.3 
Resynchronization device  28.2  34.9  32.5  32.9  29.5  33.7  30.3 

In patients with ischemic heart disease, 76.8% of implants (74.8% in 2013 and 72.3% in 2012) were single- or double-chamber devices and 23.1% (25.5% in 2013 and 27.7% in 2012) were ICD-CRT devices. In patients with dilated cardiomyopathy, ICD-CRT devices comprised 53.7% (51.7% in 2013 and 56.5% in 2012).

Reasons for Device Replacement, Need for Lead Replacement, and Use of Additional Leads

Of the 1282 replacements, information was available on 976 (76.1%). The most frequent reason for replacement was battery depletion (83.5%); complications motivated 7.9% (same as in 2013) and a change of indication prompted 8.6%. Of the latter, 84 replacements or 9.62% (11.6% in 2013) were required before 6 months.

Information was available on the status of the leads in 70.8% of the replacements; 9.3% were malfunctioning (85 records) and they were extracted in 46% of the patients reporting this problem.

Device Programming

Information on this parameter was provided in 73.5% of records. The most widely used programming was VVI (54.1%), followed by DDD (31.6%), VVIR (6.4%), DDDR (5.1%), and other modes, largely algorithms to prevent ventricular pacing (2.3%).

Induction of ventricular fibrillation was tested in 128 patients, 2.9% (5.1% in 2013 and 6.7% in 2012) of the 4385 records providing this information. The mean threshold was 19.7±6.8 (20.4±6.5 in 2013 and 20.5±7.1 in 2012) and the mean number of shocks was 1.3.

Complications

With a response rate of 83.6%, 27 complications were reported: 6 coronary sinus dissections, 5 pneumothoraces, 3 tamponades, 2 deaths, and 11 unspecified complications. The mortality rate was 0.05%, the same as in the previous year (0.05%).

DISCUSSION

The 2014 data of the Spanish Implantable Cardioverter-defibrillator Registry continue to adequately reflect the implantation situation in Spain. The registry information is pertinent, particularly the number of implants, type of implant, indications, and patients’ clinical characteristics.

Comparison With Registries of Previous Years

The Spanish Implantable Cardioverter-defibrillator Registry was first published in 2005 with the results of 2002 to 2004.4 The number of implanted ICD increased each year until 2010,5–10 with 2011 and 2012 then showing a decreased total number of implantations, in both the registry11,12 and EUCOMED data. In 2013, the number of implantations rose again, exceeding the figures of the 2010 registry, and the number of implanted devices has increased further in 2014. A continual increase was also seen in Europe, in both the number of ICD and the number of ICD-CRTs.16

In contrast to 2013,13 when a decrease was seen in the percentage of implantations for primary indications, the current registry found an increase (58.3% vs 53.0%), with the percentage now exceeding that of 2012 (58.1%).12

There was a slight increment in the percentage of ICD-CRT implantations (33.7% vs 32.9% in 2013 and 32.5% in 2012). The percentage of single-chamber ICD stabilized (48.8% vs 48.2% in 2013 and 49.4% in 2012). There were practically no variations in the use of dual-chamber ICD (17.4% vs 18.9% in 2013 and 18.0% in 2012). The resynchronization rate has slightly increased in recent years, and no major changes are expected, unless the resynchronization indications are updated.

The most frequent indication in 2014 continued to be ischemic heart disease (53.6%), followed by dilated cardiomyopathy (27.3%). As in previous years,13 more than half of the implantations in patients with dilated cardiomyopathy were of ICD-CRT devices (53.7%). The incidence was lower in patients with ischemic heart disease (23.1%).

The progressive increase in the number of ICD implantations stopped in 2011 and 2012. The 2013 results showed somewhat of a recovery with the total number of implantations slightly surpassing the rate per million population of 2010 (102 vs 100).13 This increase was confirmed by the data for 2014, with an implantation rate of 106 in our registry.

No recent studies have modified the ICD implantation indications. In 2002, the Multicenter Automatic Defibrillator Implantation Trial II17 study was published, followed by the Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure18 in 2005 and the Sudden Cardiac Death in Heart Failure Trial trial19 in 2006, which established the current indications in primary prevention and cardiac resynchronization and triggered a progressive increase in the number of implantations during that decade. The indications for ICD and CRT implantation are well supported in clinical practice guidelines.20–25 However, the implantation rate per million population does not correspond with that expected from the clinical evidence, both in Spain and in other European countries,26 a tendency that has become consolidated with time in these countries.

As in previous registries, the 2014 registry represents 82% of the implantations reported to the EUCOMED (85% in 2013). Most of the hospitals implanting ICD provided the registry with data but 100% participation of the implanting centers remains to be reached. In addition, some data are lost while being sent and processed. All of these factors can explain the differences from the EUCOMED data.

The number of implanting centers slightly increased from 2013. One hospital reported more than 200 implantations; 11 hospitals (14 in 2013 and 8 in 2011) reported more than 100 implantations, and 68 centers, mainly private, reported less than 10 implantations. Some studies have shown an inverse relationship between the implantation volume and the number of complications.27

There were no changes from previous registries in the epidemiological characteristics of the patients. Patients with severe ventricular dysfunction and in NYHA II and III continue to predominate. The growing tendency for implantations to be performed in the electrophysiology laboratory continues (83.4% vs 79.8% in 2013 and 81.4% in 2012), as well as those performed by electrophysiologists (81.7% vs 80.7% in 2013 and 81% in 2012).

Differences Among Autonomous Communities

Differences among autonomous communities continue to be evident. The implantation rate was 106 per million population and 128 according to the EUCOMED data; both databases showed an increase from 2012 (102 and 120). Several autonomous communities showed higher rates than the average: Extremadura (153 implantations per million), Principality of Asturias (138), Castile and León (132), the Chartered Community of Navarre (130), Galicia (121), Cantabria (124), Community of Madrid (120), Castile-La-Mancha (119), and the Valencian Community (109). The following were below the average: Andalusia (99), Aragon (98), Catalonia (88), the Region of Murcia (84), the Balearic Islands (83), the Canary Islands (82), and the Basque Country (71). Although the difference between communities with the highest and lowest rates of implantations is currently more than double (153 vs 71), it is lower than in the previous registry (186 vs 71). The number of implantations markedly increased in the Community of Madrid and in Castile-La-Mancha and Castile and León. There was a decrease in the Principality of Asturias and slight decreases in Extremadura, the Chartered Community of Navarre, the Basque Country, and the Valencian Community.

The 2014 data confirm the general increase in Spanish implantation activity seen in the previous registry, which was more acute in the communities with rates below the average. There was no association between the gross domestic product of the community and the number of implantations. Curiously, most high-income communities incomes were below the mean. The communities above the mean are the least populated, except for the Community of Madrid and the Valencian Community. There was also no relationship between the incidence of ischemic heart disease and heart failure in the various communities. There are other possible explanations for these differences, such as the health care organization of each community, the number of arrhythmia units, and the distribution of the referral hospitals.

Comparison With Other Countries

Including ICD and ICD-CRT, the implantation rate in the countries participating in the EUCOMED was 302 per million population (289 in 2013). Germany, with 555 devices per million population, is still the country with the highest number of implantations. Spain (126 implantations per million) was the country with the lowest number of implantations. Above the average are the Netherlands (377 implantations per million), Italy (394), Denmark (313), and the Czech Republic (358). Below the average are Poland (296), Austria (278), Ireland (242), Belgium (235), Sweden (226), Norway (221), France (208), Switzerland (226), Finland (215), the United Kingdom (195), Portugal (148), Greece (144), and Spain (126). The difference in the implantation rate in Spain from the European mean continues to grow (126 vs 302 in 2014 and 120 vs 289 in 2013). The difference between Spain and the second-last country persists (126 vs 144).

The ICD implantation rate was 183 per million population in 2013 (176 in 2013). Germany (340 implantations per million population) had the highest number of implantations, whereas Spain (84) had the lowest.

The ICD-CRT implantation rate was 119 per million population (113 in 2013). Germany (215 implantations per million population) continued to be first, whereas Spain (44) had the lowest implantation rate.

The proportion of ICD-CRT with respect to the total varies from 29% in Ireland and Poland to 45% in the Czech Republic and United Kingdom. The European average is 39%. Above the average are Austria, France, Switzerland, the United Kingdom, Italy, and the Czech Republic, whereas Ireland and Poland are below 30%. Spain has a proportion of 35%.

These countries had the same regional differences28,29 seen in the Spanish registry, for unknown reasons. One possible explanation is the number of available arrhythmia units, but that does not explain the relationship, at least in Spain, because communities with the highest number of available units had lower implantation rates. Other explanations, such as per capita income, also fail to show a correlation, with countries such as Ireland, the Czech Republic, and Poland showing much greater implantation rates than Spain. The prevalence of cardiovascular diseases, access to the health care system and its organization, and the degree of acceptance of and adherence to the clinical practice guidelines could be related to the rate and variability of implantations in Spain.

Limitations

The registry included 82% of implantations performed in Spain according to the EUCOMED data. This figure is lower than that of the previous year (85.6%) but higher than that of 2012 (80.8%). The percentage has decreased from 2007, when the representativeness was 90%. Nonetheless, the number of registered implantations continues to accurately reflect the situation in Spain and the number of participating centers has remained practically unchanged in the last 2 years.

The true number of implantations in some hospitals differs from that reported to the registry, given that the registry only includes the data collection sheets received. Because data can now be sent in various ways, some sheets were not received or correctly registered. Indeed, 2015 will be a year of transition as the registry data will be collected in 2 ways, on paper and via the Internet. From 2016, all data will be collected via the website, which should improve the results and minimize the differences between the data obtained and those provided by the EUCOMED.

There is excessive variability in the percentage of responses to the various questions in the ICD registry sheet, ranging from 99.6% for the implanting hospital to 37.1% for QRS width. Finally, the percentage of complications reported to the registry fails to reflect reality because these data are provided during or immediately after the implantation, meaning that most subacute complications are not recorded.

Future Prospects of the Spanish Implantable Cardioverter-defibrillator Registry

This registry is the XI official report. The durability of this registry is a credit to all of the participating members of the Section of Electrophysiology and Arrhythmias of the SEC. The continued modernization of the registry will allow more and better information to be obtained with less effort on the part of the staff involved in its maintenance. The quality of the information will improve with further computerization of the registry, and the completion of certain fields will be obligatory. In the future, it may permit more ambitious clinical objectives and include parameters such as death, shocks, and complications that provide relevant clinical information.

CONCLUSIONS

The 2014 Spanish Implantable Cardioverter-defibrillator Registry collected information on 82% of all implantations performed in Spain and continues to be representative of the activity and current indications of this therapy in Spain. After 2 years of decreases in the number of implantations, a recovery was seen in 2013, which was confirmed this year with a figure of 106 per million population. As in previous years, the total number of implantations in Spain continues to be much lower than the average for the European Union, with the difference continuing to grow, and the autonomous communities continue to show considerable variability.

CONFLICTS OF INTERESTS

J. Alzueta has participated in research projects with St. Jude Medical, Medtronic, Boston Scientific, Biotronik, and the Sorin Group. A. Aso has participated in research projects sponsored by Medtronic, St. Jude Medical, and Boston Scientific. A. Quesada has participated in talks and round tables sponsored by Medtronic and the Sorin Group.

Acknowledgments

We would like to thank all of the health care professionals involved in ICD implantation in Spain who have voluntarily and selflessly contributed to the ultimate success of the registry. We also thank José María Fernández, an SEC fellow who maintains the database of the Spanish Implantable Cardioverter-defibrillator Registry, for his enthusiastic work in maintaining the database and his participation in its development. Our thanks also go to the personnel at the ICD manufacturers (Medtronic, Boston Scientific, St. Jude Medical, Biotronik, and the Sorin Group) for their help in collecting and sending datasheets to the SEC for most of the implantations. Finally, we thank the SEC for its work in receiving the information, particularly Gonzalo Justes and José María Naranjo.

References
[1]
D.P. Zipes, A.J. Camm, M. Borggrefe, A.E. Buxton, B. Chaitman, M. Fromer, European Heart Rhythm Association; Heart Rhythm Society. American College of Cardiology; American Heart Association Task Force; European Society of Cardiology Committee for Practice Guidelines, et al.
ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death).
J Am Coll Cardiol., 48 (2006), pp. e247-e346
[2]
A.E. Epstein, J.P. Dimarco, K.A. Ellenbogen, N.A. Estes 3rd, R.A. Freedman, L.S. Gettes, et al.
American College of Cardiology/American Heart Association Task Force on Practice; American Association for Thoracic Surgery; Society of Thoracic Surgeons. ACC/AHA/HRS 2008 guidelines for device-based theraphy of cardiac rhythm abnormalities.
Heart Rhythm., 5 (2008), pp. 934-955
[3]
R. Tung, P. Zimeetbaum, M.E. Josephson.
A critical appraisal of implantable cardioverter-defibrillator theraphy for the prevention of sudden cardiac death.
J Am Coll Cardiol., 52 (2008), pp. 11111-11121
[4]
R. Peinado, A. Arenal, F. Arribas, E. Torrecilla, M. Álvarez, J.M. Ormaetxe, et al.
Registro Español de Desfibrilador Automático Implantable. Primer Informe Oficial del Grupo de Trabajo de Desfibrilador Implantable de la Sociedad Española de Cardiología (años 2002-2004).
Rev Esp Cardiol., 58 (2005), pp. 1435-1449
[5]
R. Peinado, E.G. Torrecilla, J. Ormaetxe, M. Álvarez.
Registro Español de Desfibrilador Automático Implantable. II Informe Oficial del Grupo de Trabajo de Desfibrilador Implantable de la Sociedad Española de Cardiológica (año 2005).
Rev Esp Cardiol., 59 (2006), pp. 1292-1302
[6]
R. Peinado, E.G. Torrecilla, J. Ormaetxe, M. Álvarez.
Registro Español de Desfibrilador Automático Implantable III Informe Oficial del Grupo de Trabajo de Desfibrilador Implantable de la Sociedad Española de Cardiología (2006).
Rev Esp Cardiol., 60 (2007), pp. 1290-1301
[7]
R. Peinado Peinado, E.G. Torrecilla, J. Ormaetxe, M. Álvarez.
Registro Español de Desfibrilador Automático Implantable IV Informe Oficial del Grupo de Trabajo de Desfibrilador Implantable de la Sociedad Española de Cardiología (2007).
Rev Esp Cardiol., 61 (2008), pp. 1191-1203
[8]
R. Peinado, E.G. Torrecilla, J. Ormaetxe, M. Álvarez, R. Cozar, J. Alzueta.
Registro Español de Desfibrilador Automático Implantable. V Informe Oficial del Grupo de Trabajo de Desfibrilador Implantable de la Sociedad Española de Cardiología (2008).
Rev Esp Cardiol., 62 (2009), pp. 1435-1449
[9]
J. Alzueta, A. Linde, A. Barrera, J. Peña, R. Peinado.
Registro Español de Desfibrilador Automático Implantable. VI Informe Oficial del Grupo de Trabajo de Desfibrilador Implantable de la Sociedad Española de Cardiología (2009).
Rev Esp Cardiol., 63 (2010), pp. 1468-1481
[10]
J. Alzueta, J.M. Fernández.
Registro Español de Desfibrilador Automático Implantable. VII Informe Oficial del Grupo de Trabajo de Desfibrilador Automático Implantable de la Sociedad Española de Cardiología (2010).
Rev Esp Cardiol., 64 (2011), pp. 1023-1034
[11]
J. Alzueta, J.M. Fernández.
Registro Español de Desfibrilador Automático Implantable. VIII Informe Oficial del Grupo de Trabajo de Desfibrilador Automático Implantable de la Sociedad Española de Cardiología (2011).
Rev Esp Cardiol., 65 (2012), pp. 1019-1029
[12]
J. Alzueta, J.M. Fernández.
Registro Español de Desfibrilador Automático Implantable. IX Informe Oficial del Grupo de Trabajo de Desfibrilador Automático Implantable de la Sociedad Española de Cardiología (2012).
Rev Esp Cardiol., 66 (2013), pp. 881-893
[13]
J. Alzueta, A. Pedrote, I.F. Lozano.
Registro de Desfibrilador Automático Implantable. X Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiologia (2014).
Rev Esp Cardiol., 67 (2014), pp. 936-947
[14]
Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología. Hoja de recogida de datos [accessed 2014 Jul 9]. Available at: http://www.secardiologia.es/images/stories/file/arritmias/registros-arritmias-hoja-datos-dai.pdf
[15]
Instituto Nacional de Estadística. Datos poblacionales [accessed 2014 Jun 25]. Available at: http://www.ine.es/jaxi/tabla.do?path=/t20/p321/serie/2001/l0/&file=02001.px&type=pcaxis&L=0
[16]
EUCOMED. Datos de implantes de 2014 [accessed 2015 Jun 20]. Available at: http://www.eucomed.org/uploads/_medical_technology/facts_figures/CRM__Graphs_2015.pdf
[17]
A.J. Moss, W. Zareba, W.J. Hall, H. Klein, D.J. Wilber, D.S. Cannom, Multicenter Automatic Defibrillator Implantation Trial II Investigators, et al.
Prophilactic implantation of a defibrillator in patients with a myocardial infarction and reduced ejection fraction.
N Engl J Med., 346 (2002), pp. 877-883
[18]
M.R. Bristow, L.A. Saxon, J. Boehmer, S. Krueger, D.A. Kass, T. De Marcto, et al.
Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure (COMPANION).
N Engl J Med., 350 (2004), pp. 2140-2150
[19]
G.H. Bardy, K.L. Lee, D.B. Mardk, J.E. Poole, D.L. Packer, R. Boineau, Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators, et al.
Amiodarone or an implantable cardioverter-defibrillator for congestive Heart failure.
N Engl J Med., 352 (2005), pp. 225-237
[20]
D.P. Zipes, A.J. Camm, M. Borggrefe, A. Buxton, B. Chairman, M. Fromer, American College of Cardiology/American Heart Association Task Force; European Society of Cardiology Committee for Practice Guidelines; European Heart Rhythm Association and the Heart Rhythm Society, et al.
ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death—executive summary. A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.
Eur Heart J., 27 (2006), pp. 2099-2140
[21]
A.E. Epstein, J.P. DiMarco, K.A. Ellenbogen, N.A. Estes 3rd, R.A. Freedman, L.S. Gettes, American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices); American Association for Thoracic Surgery; Society of Thoracic Surgeons, et al.
ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons.
Circulation., 117 (2008), pp. e350-e408
[22]
P. Vardas, A. Auricchio, J.J. Blanc, J.C. Daubert, H. Drexler, H. Ector, European Society of Cardiology; European Heart Rhythm Association. Guidelines for cardiac pacing and cardiac resynchronization therapy, et al.
The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in collaboration with the European Heart Rhythm Association.
Europace., 9 (2007), pp. 959-998
[23]
K. Dickstein, A. Cohen-Solal, G. Filippatos, J.J. McMurray, P. Ponikowski, P.A. Poole-Wilson, ESC Committee for Practice Guidelines (CPG). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology, et al.
Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM).
Eur Heart J., 29 (2008), pp. 2388-2442
[24]
A.E. Epstein, J.P. DiMarco, K.A. Ellenbogen, N.A. Estes 3rd, R.A. Freedman, L.S. Gettes, et al.
American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; Heart Rhythm Society. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.
J Am Coll Cardiol., 61 (2013), pp. e6-e75
[25]
A.M. Russo, R.F. Stainback, S.R. Bailey, A.E. Epstein, P.A. Heidenreich, M. Jessup, et al.
ACCF/HRS/ASE/HFSA/SCAI/SCTT/SCRM 2013 appropriate use criteria for implantable cardioverter defibrillator and cardiac resynchonization theprapy: a report of the American College Cardiology Foundation Appropiate Use Criteria Task Force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography an Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance.
Heart Rhythm., 10 (2013), pp. e11-e58
[26]
J. Camm, S. Nissam.
European utilization of the implantable defibrillator: has 10 years changed the ‘enigma’?.
Europace., 12 (2010), pp. 1063-1069
[27]
J. Freeman, Y. Wang, J. Curtis, P. Heindenreich, M. Hlatky.
Physician procedure volume and complications of cardioverter-defibrillator implantation.
Circulation., 125 (2012), pp. 57-64
[28]
A. Lazarus, N. Biondi, J. Thébaut, I. Durand-Zalenski, M. Chauvin.
Implantable cardioverter-defibrillators in France. Practices and regional variability.
Europace., 13 (2011), pp. 1568-1573
[29]
F. Madeira, M. Oliveira, M. Ventura, J. Primo, D. Bonhorst, C. Morais.
[National Registry on Cardiac Electrophysiology (2010 and 2011)].
Rev Port Cardiol., 32 (2013), pp. 95-100
Copyright © 2015. Sociedad Española de Cardiología
Idiomas
Revista Española de Cardiología (English Edition)

Subscribe to our newsletter

View newsletter history
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?