Key result
In the Czech Republic, biventricular cardioverter-defibrillators were implanted significantly more often than biventricular pacemakers compared to the European average (OR 1.74).
Observational (n=931)
Yes
Odds Ratio: 1.74 (95% CI 1.47–2.05)
Absolute Event Rate: 79% vs 69%
p-value: p=<0.0001
The Czech Republic demonstrates high procedural success and low complication rates for CRT implantation compared to the European average, though remote monitoring remains underutilized and indications often deviate from top-tier guidelines.
Czech CRT-D use exceeds European rates; leaves open reasons for deviation and outcome implications.
Ăvod: SrdeÄnĂ resynchronizaÄnĂ lĂŠÄba (SRL) sniĹžuje mortalitu a morbiditu u selektovanĂ˝ch pacientĹŻ s chronickĂ˝m srdeÄnĂm selhĂĄnĂm. PrvnĂ prospektivnĂ registr ukĂĄzal, Ĺže indikace SRL jsou extrapolovĂĄny i na skupiny pacientĹŻ, kterĂŠ v randomizovanĂ˝ch studiĂch nebyly dostateÄnou mÄrou zastoupeny. Byly dokumentovĂĄny takĂŠ znaÄnĂŠ rozdĂly v implantaÄnĂch technikĂĄch mezi jednotlivĂ˝mi regiony i stĂĄty. CĂlem tohoto ÄlĂĄnku je podat pĹehled o druhĂŠm mezinĂĄrodnĂm registru ESC CRT Survey II a srovnĂĄnĂ dat z tohoto registru s daty zĂskanĂ˝mi samostatnÄ za Äeskou republiku (ÄR).Metody a vĂ˝sledky: Registr vznikl jako spoleÄnĂĄ iniciativa EvropskĂŠ asociace pro srdeÄnĂ rytmus (EHRA) a Asociace pro srdeÄnĂ selhĂĄnĂ (HFA). Zahrnul celkem data od 11 088 pacientĹŻ ze 42 ÄlenskĂ˝ch zemĂ EvropskĂŠ kardiologickĂŠ spoleÄnosti (ÄZEKS). ÄR (14 participujĂcĂch center, z toho deset aktivnĂch) pĹispÄla do registru celkem 931 pacienty (prĹŻmÄrnĂ˝ vÄk 69,4 ± 9,9 roku, 23 % Ĺžen). PrĹŻmÄrnĂŠ implantaÄnĂ doby a skiaskopickĂŠ Äasy byly v ÄR vĂ˝znamnÄ kratĹĄĂ. Byly zde takĂŠ vĂ˝znamnÄ ÄastÄji implantovĂĄny biventrikulĂĄrnĂ defibrilĂĄtory ve srovnĂĄnĂ s biventrikulĂĄrnĂmi kardiostimulĂĄtory (OR 1,74, 95% CI 1,47-2,05, p < 0,0001). SRL implantuje v ÄR ÄastÄji elektrofyziolog (OR 6,18, 95% CI 4,56-8,37, p < 0,0001), pacienti majĂ na EKG mĂŠnÄ Äasto blokĂĄdu levĂŠho Tawarova ramĂŠnka (OR 0,54, 95% CI 0,47-0,62), majĂ ÄastÄji fibrilaci sĂnĂ (OR 1,32, 95% CI 1,15-1,51, p < 0,001) a mĂŠnÄ je u nich vyuĹžĂvĂĄno telemedicĂnskĂŠ sledovĂĄnĂ (OR 0,41, 95% CI 0,34-0,49, p < 0,0001).ZĂĄvÄr: DruhĂ˝ registr SRL poskytl cennĂ˝ zdroj informacĂ o souÄasnĂŠ klinickĂŠ praxi v indikaci a vĂ˝sledcĂch SRL. SrovnĂĄnĂ dat ÄR s prĹŻmÄrem ÄZEKS nĂĄs ĹadĂ mezi pĹednĂch deset zemĂ co do poÄtu vĂ˝konĹŻ, jejich ĂşspÄĹĄnosti a extrĂŠmnÄ nĂzkĂŠho poÄtu perioperaÄnĂch komplikacĂ. RozĹĄĂĹenĂ dĂĄlkovĂŠho sledovĂĄnĂ pacientĹŻ se SRL je vĹĄak u nĂĄs ve srovnĂĄnĂ s ÄZEKS stĂĄle pomÄrnÄ nĂzkĂŠ. U velkĂŠ ÄĂĄsti pacientĹŻ je stĂĄle indikovĂĄna SRL z jinĂ˝ch dĹŻvodĹŻ, neĹž odpovĂdĂĄ doporuÄenĂ s nejlepĹĄĂ evidencĂ.
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Bulava et al. (2018) conducted an observational in Chronic heart failure (n=931). Cardiac resynchronization therapy (CRT) vs. European average (ESC CRT Survey II data) was evaluated on Implantation of biventricular cardioverter-defibrillators (CRT-D) compared to biventricular pacemakers (CRT-P) (OR 1.74, 95% CI 1.47-2.05, p=<0.0001). In the Czech Republic, biventricular cardioverter-defibrillators were implanted significantly more often than biventricular pacemakers compared to the European average (OR 1.74).
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