Arrhythmia care in ESC member countries: the 2025 ESC-EHRA atlas on heart rhythm disorders
Michal M Farkowski, Daniel Scherr, Giuseppe Boriani, Denis Kazakiewicz, Moti Haim, Radu Huculeci, Katarzyna Malaczynska-Rajpold, Steffen E Petersen, Adam Timmis, Vassil Traykov, Panos E Vardas, Helmut Pürerfellner, José L Merino, , Mohamed Seddik Ait Messaoudene, Wafa Boudjelida, Arman B Danoyan, Christoph Schukro, Georgios Kollias, Aytan Hajili, Yasmin Rustamova, Michael Wolf, Caroline Lepièce, Johan Vijgen, Boris Goronja, Krasimir Dzhinsov, Tchavdar Shalganov, Krasimir Karamitev, Šime Manola, Ivan Zeljković, Ivica Benko, Panayiotis Avraamides, Petr Peichl, Dan Wichterle, Jacob Moesgaard Larsen, Rene Husted Worck, Jens Brock Johansen, Haitham Badran, Priit Kampus, Mart Elmet, Aapo Lauri Aleksi Aro, Jarkko Karvonen, Pascal Defaye, Frédéric Sacher, Estelle Gandjbakhch, Khatuna Jalabadze, Giorgi Mepharidze, Christian Veltmann, Andreas Rillig, George Andrikopoulos, Konstantinos P Letsas, Ioannis Doundoulakis, Mate Vamos, Peter Kupo, Csaba Laszlo Földesi, David O Arnar, Sigfus Gizurarson, Kristjan Gudmundsson, David Keane, Ibrahim Marai, Moshe Katz, Arie Lorin Schwartz, Antonio D’Onofrio, Sakis Themistoclakis, Martina Nesti, Ayan Abdrakhmanov, Omirbek Nuralinov, Zhanasyl Suleymen, Edmond Haliti, Arber Osa, Arlind Ferati, Erkin Mirrakhimov, Saamay S Abilova, Kurban Kalysov, Oskars Kalejs, Kristine Jubele, Kaspars Kupics, Bernard Harbieh, Bernard Abi-Saleh, Gediminas Rackauskas, Tautvydas Rugelis, Jonas Jarasunas, Carlo Dimmer, Mark Anthony Sammut, Melanie Zammit Burg, John Bonello, Mikhail Popovici, Mihail Rizov, Radu Darciuc, Mihailo Vukmirović, Blagoje Babić, Sing-Chien Yap, Vincent Van Dijk, Lidija Poposka, Jane Taleski, Brage Høyem Amundsen, Adam Sokal, Diogo Cavaco, Francisco Moscoso Costa, Sergia Rocha, Stefan Bogdan, Cristian Statescu, Marco Zavatta, Roberto Bini, Gianfranco Bernardini, Srdjan Raspopović, Bratislav Kircanski, Dejan Kojic, Lubos Urban, Silvia Misikova, Gabriela Kaliska, Andrej Pernat, Rafael Skale, Tomas Datino, David Calvo Cuervo, Concepción Alonso, Anneli Svensson, Anna Björkenheim, Michael Ringborn, Tobias Reichlin, Valon Spahiu, Emna Allouche, Sofien Kamoun, Aymen El Hraiech, Taylan Akgun, Olena Marchenko, Oleg Sychov, Serhiy Lyzohub, Eleri Gregory, Anish N Bhuva, Zakirov Nodir Uzuevich, Bakhtiyor Djumaevich Amirkulov, Khurshid Gayratovich FozilovAbstract
The ESC-EHRA Atlas on Heart Rhythm Disorders was developed to comprehensively map arrhythmia care across the European Society of Cardiology (ESC) member countries. A survey of National Cardiac Societies, Working Groups, and other EHRA partners in ESC member countries was conducted to gather data from 2023 or the most recently available year on arrhythmia care organization and delivery. In total, 51 ESC member countries actively participated in the study, with a survey completeness rate of 91%. The median number of hospitals performing EP or CIED procedures was 3.3 per million people. The annual median numbers of ablation procedures for heart rhythm disorders, atrial fibrillation, and supraventricular tachycardia per million people were 432, 151, and 136, respectively. The annual median numbers of pacemakers, implantable cardioverter-defibrillators (ICD), and cardiac resynchronization therapy cardioverter-defibrillator (CRT-D) implantations per million people were 739, 195, and 54, respectively. The median number of hospitals performing remote monitoring of CIEDs per million people was 0.5, though this service was unavailable in 15 countries. Two main universal issues emerged among the obstacles to guideline implementation: a lack of heart rhythm allied professionals and general dissatisfaction with the country’s reimbursement system. The first edition of the ESC-EHRA Atlas presents up-to-date information on arrhythmia care organization and delivery among ESC member countries and highlights significant discrepancies in patients’ access to ESC-guideline-recommended therapies.