Resynchronization therapy: implications for pacemaker implantation in Europe.

Abstract

Cardiac resynchronization has proved a valuable adjunctive therapy in heart failure patients with ventricular conduction disturbances. It improves the patient's clinical status and quality of life, increases functional capacity and causes left ventricular reverse remodeling. The application of this new therapeutic method is expected to affect the pacemaker implantation rate, although the exact degree cannot yet be calculated. One of the main determining factors is the number of patients who are candidates for resynchronization therapy. Although this cannot be estimated precisely, it seems that it does not exceed 10-14% of heart failure patients. Additional factors that will influence the implantation rate, at least during the next few years, are the familiarization of cardiologists with the new implantation technique and follow-up, the availability of cardiac laboratory time and the cost of this new therapy. Although the latter seems high, the financial burden will be minimal when it is taken into consideration that it will lead to a decrease in the number of hospital admissions and a significant reduction in the number of hospitalization days, the greatest determining factors in the current high management cost of heart failure patients. Further to the above, taking the differences between the implantation rates of conventional pacing systems into account in different European countries, the same could be expected of biventricular systems. Thus, although the incidence of heart failure is constantly increasing and conduction disturbances are frequent in such patients, we believe that the implantation rate of biventricular systems in Europe will not exceed an average of 10 per million population, fluctuating according to the country. In conclusion, resynchronization therapy has been established in special subsets of heart failure patients. Due to the epidemiological characteristics of heart failure, the implantation rate is expected to rise. Possible education and/or training issues that appear will be addressed respectively, enabling all suitable patients to enjoy the benefits this new therapeutic technique ensures.