Affiliations: [a] Department of Cardiology, Heart Centre Brandenburg Bernau and Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau, Germany | [b] Heart Center Hannover, Clinic for Cardiology and Electrophysiology, Hannover, Germany | [c] Asklepios Clinic Barmbek, Hamburg, Germany | [d] Department of Cardiology, St. Marien Hospital, Hamm, Germany | [e] University Medical Center Hamburg-Eppendorf, Institute of Medical Biometry and Epidemiology, Hamburg, Germany | [f] BIOTRONIK, Berlin, Germany | [g] Department of Rhythmology and Clinical Electrophysiology, KMG Clinic, Güstrow, Germany
Correspondence:
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Corresponding author: Christian Butter, Ladeburger Straße 17, 16321 Bernau bei Berlin, Germany. E-mail: christian.butter@immanuelalbertinen.de.
Abstract: BACKGROUND: Both highly specialized heart centres and less specialized hospitals care for patients with implantable ICDs/CRT-Ds with remote monitoring. OBJECTIVE: To investigate potential differences in patient treatment according to centre’s ICD implantation volume. METHODS: Based on their 2012 ICD/CRT-D implantation volume, centres enrolled in the NORDIC ICD trial in Germany were assigned to one of three groups: high- (HV, n= 345), medium- (MV, n= 340) or low-volume (LV, n= 189). RESULTS: The HV-centres had a significant higher CRT-D proportion (41.7%; LV: 36.5%; MV: 23.2%; P𝑔𝑙𝑜𝑏𝑎𝑙< 0.001), significant shorter median procedure duration (49 min; MV: 58 min; LV: 60 min; P𝑔𝑙𝑜𝑏𝑎𝑙< 0.001) but significant longer median hospital stay (4 days; MV and LV: 3 days; P𝑔𝑙𝑜𝑏𝑎𝑙< 0.001) compared to MV- and LV-centres. The X-ray exposure was shorter in MV/HV-centres (MV: 3.4 min; HV: 3.6 min; LV: 5.5 min; P𝑔𝑙𝑜𝑏𝑎𝑙< 0.001). Only 3.5% (LV: 2.6%; HV: 3.5%; MV: 4.1%) patients received at least one delivered inappropriate shock and 2.5% (HV: 2.0%; LV: 2.6%; MV: 2.9%) patients had withheld inappropriate ICD shocks without subsequent inappropriate shock delivery within 24.5 months of median follow-up. CONCLUSION: Implantation volume-dependent differences were observed in the device selection, procedure duration and x-ray exposure duration. Remote monitoring in combination with adequate response pattern prevented imminent inappropriate shocks in all three groups.
