P1872Canadian electrophysiology labs registry report update 2011–2018

Background

Interventional cardiac electrophysiology (EP) is rapidly evolving; a nationwide registry was established and re-administered since 2011 to conduct a periodic review of resource allocation across Canada.

Methods

The registry collects annual data on EP lab infrastructure, imaging, tools, human resources, procedural volumes, and wait times. Leading physicians from each EP lab were contacted electronically.

Results

All Canadian EP centres were identified (n=30); 50% and 45% of active centres participated in the last 2 instalments of the registry. Since 2011, data has been consistently obtained from 11 university-affiliated centres. Table 1 reports trends in procedural volumes and operators. Figure 1 depicts the ablations done per operator. The mean wait time to see an electrophysiologist for an initial non-urgent consult is 23 weeks. The wait time between an EP consult and ablation date is 17.8 weeks for simple ablation, 15.9 weeks for VT ablation, and 30.1 weeks for AF ablation. On average centres have 2 (range: 1–4) rooms equipped for ablations; each centre uses the EP lab an average of 7 shifts per week. While diagnostic studies and radiofrequency ablations are performed in all centres, point-by-point cryoablation is available in 85% and cryoballoon in 77% of the centres; 38% of the respondents use circular ablation techniques.

Trends in procedural volumes + operators 2015–2016 2013–2014 2011–2012 Procedures per operator 117±70 120±68 113±42 Procedures per centre 498±299 477±245 446±237 Ratio of staff to trainees 2.0:1 1.6:1 1.5:1 Full time physicians per centre 4.1 (0–7) 4.1 (1–7) 3.5 (0–7) Nurses trained specifically for EP 4.6 (0–10) 4.4 (0–10) n/a Ablation procedures volume:   AV Reciprocal Tachycardia 12% 10% 11%   AV Nodal Re-entry Tachycardia 18% 19% 23%   Atrial Fibrillation/Atypical Flutter 33% 35% 30%   Typical Flutter 20% 14% 19%   Ventricular Tachycardia 8% 8% 10%   Total annual ablations in all respondent centres 5478 5243 4908 Mean ± standard deviation. Staff (full-time + part-time prorated to 0.5).

Annual ablation volumes per operator

Conclusion

This initiative provides contemporary data on invasive EP practices. The results show feasibility in data collection which will serve as a reference for decisions regarding resource planning.

Are there increased periprocedural complications with the MRI-conditional Medtronic Revo SureScan Pacing System? : A meta-analysis

BACKGROUND

The use of magnetic resonance imaging (MRI)-conditional permanent pacemakers has increased significantly. In this meta-analysis, we examine the safety of MRI-conditional pacing systems in comparison with conventional systems.

METHODS

An electronic search was performed using major databases, including studies that compared the outcomes of interest between patients receiving MRI-conditional pacemakers (MRI group) versus conventional pacemakers (control group).

RESULTS

Six studies (5 retrospective and 1 prospective non-randomised) involving 2,118 adult patients were identified. The MRI-conditional pacemakers, deployed in 969 patients, were all from a single manufacturer (Medtronic Pacing System with 5086 leads). The rate of pacemaker lead dislodgement (atrial and ventricular) was significantly higher in the MRI group (3% vs. 1%, OR 2.47 (95% CI 1.26; 4.83), p = 0.008). The MRI group had a significantly higher rate of pericardial complications (2% vs. 1%, OR 4.23 (95% CI 1.18; 15.10), p = 0.03) and a numerically higher overall complication rate in comparison with the conventional group (6% vs. 3%, OR 2.02 (95% CI 0.88; 4.66), p = 0.10) but this was not statistically significant.

CONCLUSIONS

In this meta-analysis, the rates of pacemaker lead dislodgement and pericardial complications were significantly higher with the Medtronic MRI-conditional pacing system.