Do cardiologists follow the European guidelines for cardiac pacing and resynchronization therapy? Results of the European Heart Rhythm Association survey

The purpose of this European Heart Rhythm Association (EHRA) EP wire survey was to evaluate the implementation of the current guidelines for cardiac pacing and cardiac resynchronization therapy (CRT) in Europe. A total of 48 centres replied to the survey, 34 of them (71%) were university hospitals. All responding centres implement CRT in patients with classical indications, i.e. sinus rhythm, New York Heart Association (NYHA) functional class II, III, or ambulatory IV, left ventricular ejection fraction (LVEF) 35%, and left bundle-branch block (LBBB) with QRS duration. >150 ms, while 31 centres (67%) would implant a CRT device in patients with the same characteristics but with a non-LBBB pattern. Forty-one centres (89%) would also implant CRT in patients with sinus rhythm, NYHA Class II, III, or ambulatory IV, LVEF <35%, and LBBB with QRS duration between 120 and 150 ms, while only eight centres (17%) would implant the device in patients with the same characteristics but with a non-LBBB pattern. In patients with LVEF <35% and QRS duration below 120 ms, the majority of the centres (80%) would implant a single-or dual-chamber implantable cardioverter-defibrillator, but in nine cases (20%) no device was considered to be indicated. The results of this survey showed a good adherence to some of the current recommendations. Still some reluctance exists when offering the device therapy to patients with QRS duration in the lower range.