Editorial comment
Portuguese National Registry on Cardiac Electrophysiology, 2013 and 2014: An analysis
O Registo Nacional de Eletrofisiologia Cardíaca (2013/2014): uma análise
João de Sousa
Serviço de Cardiologia, Centro Hospitalar de Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
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The authors, as well as the successive governing boards of the Portuguese Association for Arrhythmology, Pacing and Electrophysiology (APAPE) and the Portuguese Institute of Cardiac Rhythm (IPRC), are to be congratulated on their perseverance and dedication in maintaining the registry continuously for 14 years. The data not only reflect the situation in Portugal in terms of the type and volume of activity and geographical distribution of electrophysiology centers, but also enable assessment of the training capability of the country, for both fellowships in cardiology and training in the subspecialty of cardiac electrophysiology. At the same time, data for Portugal from the registry can be included and compared with the figures for other countries published annually by the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC). Finally, the registry helps to predict and plan for the country's needs in the area of interventional arrhythmology, and should serve as the basis for certain organizational decisions, particularly those related to the national cardiology referral network.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Analysis of the 2014 data shows a rise in the number of electrophysiology centers to 25 (an increase of eight compared to the previous year), of which 11 were private and 14 public. A total of 2325 ablation procedures were performed, continuing the growth seen in previous years. Nevertheless, there was marked asymmetry in centers’ volume of activity, since although the mean number of ablations per center was 93, the median was 33, with only seven performing more than 100 procedures and nine performing less than 10. Ablation of atrial fibrillation (AF) accounted for a significant proportion of interventions (around 30% in 2014), although 80% of such procedures were performed in only four centers, one of which was private. Cardioverter-defibrillator implantations were performed in 30 centers in 2014, four more than in the previous year, although the new centers implanted less than 10 units each. There were a total of 1256 first implantations (of which 38.6% were cardiac resynchronization devices), an increase of 15% compared to 2013. As with AF ablations, only four centers implanted more than 100 units in 2014 and nine performed less than 10 implantations.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The considerable variation seen in the volume of procedures means that postgraduate training and specialized interventions such as catheter ablation and device implantation are available in only a quarter of cardiac electrophysiology centers in Portugal. Current regulations for cardiology fellowships in Portugal<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> recommend participation in 50 electrophysiology studies, 50 permanent pacemaker implantations and 20 cardioverter-defibrillator or resynchronization device implantations during the four-month training in electrophysiology and pacing. According to the regulations for the subspecialty of cardiac electrophysiology,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> which are outdated and in need of revision, trainees should achieve autonomy during the two-year training period by performing at least 300 diagnostic studies and 150 ablations. Thus, postgraduate training in interventional arrhythmology is limited to centers with a significant volume of activity, namely three in Lisbon (Hospital de Santa Cruz, Hospital de Santa Maria and Hospital de Santa Marta), one in Coimbra (Hospitais da Universidade, although with a limited volume of electrophysiology procedures) and one in Porto (Hospital de Gaia).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Based on figures published by the EHRA,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> developments in cardiac electrophysiology in Portugal have been very positive, approaching target rates in interventional electrophysiology and cardioverter-defibrillator implantations. However, while we are in the vanguard in terms of pacemaker implantation, we lag behind in interventional electrophysiology, including AF ablation, as well as in cardioverter-defibrillator and cardiac resynchronization therapy device implantation. Although the annual rate of first cardioverter-defibrillator implantations in Portugal in 2014 was 120 units per million population, above the European mean of 99, Portugal is in the third quartile (74-166 units per million population) among European countries, along with Spain. With regard to total ablations and AF ablations, the registry shows rates of 232 and 69 per million population, respectively, which again places Portugal in the third quartile in European terms (total ablations 179-321 per million population, and AF ablations 48-108 per million population), along with Spain and the UK. While improvement in the number of electrophysiological interventions is still desirable, rates in Portugal are in fact now similar to more developed countries.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The registry identifies the centers with the greatest volume of activity in cardiac electrophysiology and which thus form part of the national cardiology referral network<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5,6</span></a>: Hospital de Gaia, Hospitais da Universidade de Coimbra, Hospital de Santa Cruz, Hospital de Santa Maria and Hospital de Santa Marta. Public investment in cardiac electrophysiology should therefore be concentrated in these five centers so as to provide the best conditions for development and specialist training.</p><p id="par0030" class="elsevierStylePara elsevierViewall">I would like to make one last comment on the type and quality of the registry. Maintaining the registry is obviously important, but it would be extremely useful, including from a clinical standpoint, if more detailed information were included in the annual reports, particularly success rates and the incidence and type of complications associated with these interventions. This type of information, even while protecting the identity of particular centers, would be useful for both the medical and scientific community and the patients themselves.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, maintaining up-to-date and reliable registries like the National Registry on Cardiac Electrophysiology gives an overall picture of the situation in Portugal, which helps in planning an efficient treatment network and in providing a high standard of postgraduate training, with the aim of achieving excellence in patient care.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: de Sousa J. O Registo Nacional de Eletrofisiologia Cardíaca (2013/2014): uma análise. Rev Port Cardiol. 2016;35:413–414.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Registo Nacional de Eletrofisiologia Cardíaca (2013/2014)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Cavaco" 1 => "F. Morgado" 2 => "D. 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|---|---|---|---|
| 2024 November | 7 | 4 | 11 |
| 2024 October | 27 | 25 | 52 |
| 2024 September | 30 | 24 | 54 |
| 2024 August | 31 | 26 | 57 |
| 2024 July | 29 | 30 | 59 |
| 2024 June | 25 | 16 | 41 |
| 2024 May | 24 | 27 | 51 |
| 2024 April | 21 | 22 | 43 |
| 2024 March | 22 | 21 | 43 |
| 2024 February | 19 | 32 | 51 |
| 2024 January | 20 | 38 | 58 |
| 2023 December | 17 | 30 | 47 |
| 2023 November | 20 | 18 | 38 |
| 2023 October | 15 | 16 | 31 |
| 2023 September | 11 | 19 | 30 |
| 2023 August | 17 | 20 | 37 |
| 2023 July | 13 | 8 | 21 |
| 2023 June | 13 | 18 | 31 |
| 2023 May | 24 | 16 | 40 |
| 2023 April | 7 | 4 | 11 |
| 2023 March | 16 | 25 | 41 |
| 2023 February | 13 | 16 | 29 |
| 2023 January | 13 | 15 | 28 |
| 2022 December | 17 | 22 | 39 |
| 2022 November | 27 | 17 | 44 |
| 2022 October | 16 | 20 | 36 |
| 2022 September | 17 | 28 | 45 |
| 2022 August | 18 | 30 | 48 |
| 2022 July | 18 | 34 | 52 |
| 2022 June | 15 | 19 | 34 |
| 2022 May | 22 | 31 | 53 |
| 2022 April | 14 | 20 | 34 |
| 2022 March | 17 | 22 | 39 |
| 2022 February | 22 | 24 | 46 |
| 2022 January | 11 | 23 | 34 |
| 2021 December | 11 | 23 | 34 |
| 2021 November | 28 | 34 | 62 |
| 2021 October | 21 | 36 | 57 |
| 2021 September | 13 | 17 | 30 |
| 2021 August | 21 | 25 | 46 |
| 2021 July | 15 | 21 | 36 |
| 2021 June | 17 | 17 | 34 |
| 2021 May | 18 | 39 | 57 |
| 2021 April | 37 | 82 | 119 |
| 2021 March | 45 | 28 | 73 |
| 2021 February | 38 | 23 | 61 |
| 2021 January | 39 | 17 | 56 |
| 2020 December | 41 | 15 | 56 |
| 2020 November | 34 | 11 | 45 |
| 2020 October | 16 | 17 | 33 |
| 2020 September | 31 | 7 | 38 |
| 2020 August | 11 | 6 | 17 |
| 2020 July | 46 | 9 | 55 |
| 2020 June | 35 | 19 | 54 |
| 2020 May | 32 | 9 | 41 |
| 2020 April | 38 | 16 | 54 |
| 2020 March | 42 | 10 | 52 |
| 2020 February | 21 | 27 | 48 |
| 2020 January | 26 | 10 | 36 |
| 2019 December | 32 | 11 | 43 |
| 2019 November | 35 | 9 | 44 |
| 2019 October | 35 | 4 | 39 |
| 2019 September | 30 | 11 | 41 |
| 2019 August | 22 | 7 | 29 |
| 2019 July | 33 | 10 | 43 |
| 2019 June | 39 | 17 | 56 |
| 2019 May | 17 | 9 | 26 |
| 2019 April | 33 | 16 | 49 |
| 2019 March | 18 | 12 | 30 |
| 2019 February | 58 | 8 | 66 |
| 2019 January | 86 | 6 | 92 |
| 2018 December | 95 | 12 | 107 |
| 2018 November | 66 | 7 | 73 |
| 2018 October | 106 | 18 | 124 |
| 2018 September | 50 | 11 | 61 |
| 2018 August | 36 | 8 | 44 |
| 2018 July | 21 | 6 | 27 |
| 2018 June | 32 | 7 | 39 |
| 2018 May | 43 | 14 | 57 |
| 2018 April | 51 | 9 | 60 |
| 2018 March | 53 | 11 | 64 |
| 2018 February | 50 | 8 | 58 |
| 2018 January | 65 | 7 | 72 |
| 2017 December | 59 | 11 | 70 |
| 2017 November | 56 | 13 | 69 |
| 2017 October | 44 | 14 | 58 |
| 2017 September | 30 | 15 | 45 |
| 2017 August | 30 | 8 | 38 |
| 2017 July | 35 | 13 | 48 |
| 2017 June | 26 | 13 | 39 |
| 2017 May | 38 | 15 | 53 |
| 2017 April | 22 | 5 | 27 |
| 2017 March | 31 | 43 | 74 |
| 2017 February | 24 | 3 | 27 |
| 2017 January | 23 | 1 | 24 |
| 2016 December | 42 | 5 | 47 |
| 2016 November | 30 | 5 | 35 |
| 2016 October | 31 | 11 | 42 |
| 2016 September | 37 | 9 | 46 |
| 2016 August | 20 | 2 | 22 |
| 2016 July | 38 | 12 | 50 |
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