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Comparison of current German and European practice in cardiac resynchronization therapy: lessons from the ESC/EHRA/HFA CRT Survey II

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Abstract

Introduction

The European CRT Survey II was introduced to offer insights into CRT implantation practice in Europe. We compared the national data from the participating German centres with that of the other European countries with regard to differences in patient selection, implant results, and initial properties.

Methods and results

11,088 patients were enrolled in 288 centres from 42 countries between 2015 and 2017. Of these, 675 (6.1%) were included in 17 centres in Germany. Patients from Germany were older, had more comorbidities and more symptoms of heart failure (HF) than patients from other European countries. There were no differences with regard to HF aetiology and guideline-directed medical treatment was overall well implemented. There was a high use of CRT in patients with atrial fibrillation, even higher in German patients. CRT was most often applied due to HF with wide QRS complex (class I recommendation) but with relatively higher frequency in Germany due to HF with primary indication for an implantable cardioverter-defibrillator (class IIb) or a pacemaker with expected pacing dependency (class I). The overall implant success rate was high with some differences in the implant procedure. The use of remote monitoring was lower in Germany.

Conclusion

This analysis from the European CRT Survey II overall shows good guideline adherence, high implantation success and a low rate of complications in daily practice. There are some regional differences in baseline characteristics, CRT indication, and procedural aspects. The use of remote monitoring in Germany lags behind other European countries.

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Acknowledgements

A special thanks to the other members and initiators of the European CRT Survey II, the European Society of Cardiology, the Heart Failure Association and the European Heart Rhythm Association. Thanks to our sponsors Medtronic (Minneapolis, MN, USA), Boston Scientific (Marlborough, MA, USA), St. Jude (Saint Paul, MN, USA), Biotronik (Berlin, GER), Sorin Group (Milano, Italy), Abbott (Abbott Park, North Chicago, IL, USA), Bayer AG (Leverkusen, GER), Bristol-Myers Squibb (New York City, NY, USA) and Servier (Neuilly-sur-Seine, FRA).

Funding

This survey was sponsored by Medtronic (Minneapolis, MN, USA), Boston Scientific (Marlborough, MA, USA), St. Jude (Saint Paul, MN, USA), Biotronik (Berlin, GER), Microport (Shanghai, China, formerly SORIN, Milano, Italy), Abbott (Abbott Park, North Chicago, IL, USA), Bayer AG (Leverkusen, GER), Bristol-Myers Squibb (New York City, NY, USA) and Servier (Neuilly-sur-Seine, FRA) and also supported by the European Society of Cardiology, the Heart Failure Association and the European Heart Rhythm Association.

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Correspondence to Christoph Stellbrink.

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Conflicts of interest

Dennis Lawin received financial support for attending symposia from Novartis, Basel, CH. Christoph Stellbrink received research support and speaker fees from Medtronic (Minneapolis, MN, USA), Biotronik (Berlin, GER), Sorin Group (Milano, Italy), Abbott (Abbott Park, North Chicago, IL, USA). No potential conflict of interest was reported by the authors.

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Research was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Lawin, D., Israel, C.W., Linde, C. et al. Comparison of current German and European practice in cardiac resynchronization therapy: lessons from the ESC/EHRA/HFA CRT Survey II. Clin Res Cardiol 109, 832–844 (2020). https://doi.org/10.1007/s00392-019-01574-z

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