ORIGINAL ARTICLE
Heart, Lung and Circulation (2015) 24, 291–297 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2014.09.017
The Australian and New Zealand Cardiac Pacemaker and Implantable Cardioverter-Defibrillator Survey: Calendar Year 2013 Harry G. Mond, OAM, MD, PhD, FRACP, FCSANZ a*, Ian Crozier, MD, FRACP, FCSANZ b a Adjunct Associate Professor, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia b Christchurch Hospital, Christchurch, New Zealand
Received 26 August 2014; accepted 22 September 2014; online published-ahead-of-print 5 October 2014
Background
A pacemaker (PM) and implantable cardioverter-defibrillator (ICD) survey was undertaken in Australia and New Zealand for calendar year 2013.
Results and Conclusions
For 2013, PMs sold as new implants in Australia was 15,203 (12,523 in 2009) and implanted in New Zealand were 1,641 (1,277 in 2009). The number of new PM implants per million population 652 for Australia (565 were in 2009) and 367 for New Zealand (299 in 2009). Although PM replacements rose in New Zealand, there was a fall in Australia as a result of improved power source service life. Pulse generator types sold in Australia were predominantly dual chamber 74% (71% in 2009) and implanted in New Zealand 59% (54% in 2009). There were 661 biventricular PMs implanted in Australia (446 in 2009) and 83 in New Zealand (45 in 2009). Transvenous pacing leads were overwhelmingly bipolar with preferences for active fixation leads, although, since 2009, there has been a minor resurgence in Australia of passive fixation lead usage in the atrium from 20 to 24%. There was also a marked increase in the ICD implants with 3904 new implants in Australia (3555 in 2009) and 423 in New Zealand (329 in 2009). The new ICD implants per million population were 167 for Australia (160 in 2009) and 95 for New Zealand (77 in 2009). Biventricular ICD implants increased significantly in both Australia (2211) and New Zealand (118).
Keywords
ANZ Survey Cardiac pacemakers Cardioverter-Defibrillators Pacemaker leads Bipolar Lead fixation
Introduction Cardiac pacemakers (PM) have been implanted in Australia and New Zealand since 1961. Implantable cardioverterdefibrillators (ICD) were first used in Australia in 1984 and in New Zealand in 1988 with more recently, biventricular models for cardiac resynchronisation therapy (CRT) being introduced. Each four years, since 1972, an Australian and New Zealand PM and ICD survey has been undertaken
and to coordinate with previous surveys, the calendar year 2013 was selected as the survey period.
Methods Survey Questionnaire Previous comprehensive PM surveys have been conducted in Australia for calendar years 1972 [1,2], 1975 [3,4], 1978 [5],
*Corresponding author at: Cato Cardiology, Suite 3, 888 Toorak Rd Camberwell, Victoria, 3123, Australia. Tel.: +03 9805 4305; fax: +03 9527 9262, Email: [email protected] Published by Elsevier Inc on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
292
H.G. Mond, I. Crozier
1989, 1993 [6], 1997 [7], 2001 [8], 2005 [9] and 2009 [10]. New Zealand conducted surveys in 1972 [1,2], 1978 [5], 1981, 1993 [6], 1997 [7], 2001 [8], 2005 [9] and 2009 [10]. ICDs were included in the survey for the first time in 1993 [6]. With significant increases in the number of Australia implanting centres over the last 20 years, it became obvious that the collection of separate data from each implanting institution had become impossible. Consequently, it was decided that for the surveys after 1993, all implanted Australian PM and ICD hardware information would be obtained through pacing companies. The companies were sent a questionnaire on pulse generators, leads and ICDs sold and registered in Australian states during calendar year 2009. No attempt was made to determine individual hospital implant numbers. The individual company data were received in plain, sealed envelopes, transcribed to a working sheet and individual forms destroyed after the data were collated and transferred to a separate sheet without individual pacing company figures. All pacing companies cooperated with the survey and are listed in the acknowledgements. The data collection and analysis was performed without influence from any of the companies involved and all companies provided information asked
in the survey form, although there were situations to be discussed in the results, where data could not be accurately distributed in the way the survey was designed. For the smaller New Zealand survey, the more traditional individual hospital approach was undertaken together with assistance from pacing companies when necessary. For each survey, an accurate number of implants, or at least PMs and ICDs sold, were obligatory. This needed to be divided into new implants, replacements and types. Information on PM lead types was also obtained. As well as this, the number of implanting institutions in each country was required. No attempt was made to obtain clinical and demographic information.
Results During 2013, there were 128 Australia and 10 New Zealand centres implanting PMs. The breakdown of pacing details in each Australian State and Northern Territory and the corresponding 2009 results for both Australia and New Zealand are listed in Table 1. All Australian Capital Territory
Table 1 Pacemaker Sales Australia and Implants New Zealand, 2013 {2009}. Total Sales
New
Replacement
4475
1346
Popn
NIMP
Centres
AUSTRALIA New South Wales#
5821
7.47
Victoria Queensland
5548
4574
3715
{3906} 3094
974
1786
1462
621
790
41
4.69
{710} 660
20
{601} 324
1.68
1704
1339
365
2.55
Northern Territory*
240 53
214 {202} 45
9
525
11
{462}
{1049} Tasmania*
870 {706}
{1152} Western Australia
42
5.79
{2686} South Australia
599 {538}
{4054}
26 16
0.51
470
4
0.24
{396} 187
1
{122}
{28} Total 2013
18867
15203
3664 (19%)
23.32
652
128
{Total 2009
16265
12523
3742 (23%)
22.16
565
111}
Total 2013
2135
1641
494 (23%)
4.47
367
10
{Total 2009
1695
1277
418 (25%)
4.27
299
10}
NEW ZEALAND
()
=%
{}
= 2009 survey
Popn = Estimated population in millions, December 31st 2013 NIMP = New Implants per million population # *
New South Wales figures include Australian Capital Territory. Figures may be low because one company included Tasmanian implants in Victoria and Northern Territory figures in South Australia.
293
2013 Australian and New Zealand Pacing and ICD Survey
implantation data were included with New South Wales. The Tasmanian figures are low and the Victorian figures are slightly higher because one company included Tasmanian sales in their Victorian sales. Previous surveys suggested that sales data did not always accurately reflect new and replacements numbers, although this has now become much more accurate with registrations [9,10]. In comparison with the 2009 survey, there was a marked rise in the total PM sales in Australia (14%) or actual implants in New Zealand (21%). For Australia, unlike the comparison with the 2009 survey [10], the PM sales increase was predominantly in new implants (15,203) with a fall in replacements (3664) from 23% to 19% of all sales, reflecting the longer service life of pulse generators. For New Zealand, there was a rise in both new PM implants (1641) and replacements (494), although like Australia, the percentage of replacements to new implants fell from 25% to 23%. The number of new implants per million population in 2013 was markedly increased for both Australia (652) and New Zealand (367). The changes in the Australia and New Zealand markets since the first PM survey in 1972 are tabulated in Figure 1. Surveys were not conducted in Australia for 1981 and 1985 and in New Zealand for 1985 and 1989. For the 2013 survey, the individual states of Australia were separately analysed and reported, but the numbers for New Zealand were too small to allow this. All Australian states had an increase in new PM implant numbers with New South Wales having the largest number, closely followed by Victoria. New implants per million population increased for all
Figure 1 Number of new PM implants per million population from all the Australian and New Zealand surveys since 1972.
Australian states and with 870 new implants per million population, South Australia had the highest implant rate followed by Victoria with 790. Table 2 details the type of pulse generators sold in Australia and implanted in New Zealand in 2013. Because of difficulties obtaining accurate figures, there was no attempt to classify pulse generator types into new implants or replacements. All pulse generators sold in Australia and New Zealand are programmable and rate adaptive (R). Single chamber models designated SSI(R) are implanted almost
Table 2 Pulse Generator Type (New and Replacement), 2013. SSI (R)
DDD(R)
VDD
BiVP
AUSTRALIA New South Wales
1294 (22%)
4362 (75%)
1
164
Victoria
1145 (21%)
4110 (74%)
2
291
Queensland
811 (24%)
2809 (76%)
12
83
South Australia Western Australia
415 (23%) 399 (23%)
1261 (71%) 1229 (72%)
62 2
48 74
Tasmania
51 (21%)
188 (78%)
0
1
Northern Territory
16 (30%)
37 (70%)
0
4131 (22%)
13995 (74%)
Total 2013 {Total 2009
26%
71%
0
79 (
Heart, Lung and Circulation (2015) 24, 291–297 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2014.09.017
The Australian and New Zealand Cardiac Pacemaker and Implantable Cardioverter-Defibrillator Survey: Calendar Year 2013 Harry G. Mond, OAM, MD, PhD, FRACP, FCSANZ a*, Ian Crozier, MD, FRACP, FCSANZ b a Adjunct Associate Professor, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia b Christchurch Hospital, Christchurch, New Zealand
Received 26 August 2014; accepted 22 September 2014; online published-ahead-of-print 5 October 2014
Background
A pacemaker (PM) and implantable cardioverter-defibrillator (ICD) survey was undertaken in Australia and New Zealand for calendar year 2013.
Results and Conclusions
For 2013, PMs sold as new implants in Australia was 15,203 (12,523 in 2009) and implanted in New Zealand were 1,641 (1,277 in 2009). The number of new PM implants per million population 652 for Australia (565 were in 2009) and 367 for New Zealand (299 in 2009). Although PM replacements rose in New Zealand, there was a fall in Australia as a result of improved power source service life. Pulse generator types sold in Australia were predominantly dual chamber 74% (71% in 2009) and implanted in New Zealand 59% (54% in 2009). There were 661 biventricular PMs implanted in Australia (446 in 2009) and 83 in New Zealand (45 in 2009). Transvenous pacing leads were overwhelmingly bipolar with preferences for active fixation leads, although, since 2009, there has been a minor resurgence in Australia of passive fixation lead usage in the atrium from 20 to 24%. There was also a marked increase in the ICD implants with 3904 new implants in Australia (3555 in 2009) and 423 in New Zealand (329 in 2009). The new ICD implants per million population were 167 for Australia (160 in 2009) and 95 for New Zealand (77 in 2009). Biventricular ICD implants increased significantly in both Australia (2211) and New Zealand (118).
Keywords
ANZ Survey Cardiac pacemakers Cardioverter-Defibrillators Pacemaker leads Bipolar Lead fixation
Introduction Cardiac pacemakers (PM) have been implanted in Australia and New Zealand since 1961. Implantable cardioverterdefibrillators (ICD) were first used in Australia in 1984 and in New Zealand in 1988 with more recently, biventricular models for cardiac resynchronisation therapy (CRT) being introduced. Each four years, since 1972, an Australian and New Zealand PM and ICD survey has been undertaken
and to coordinate with previous surveys, the calendar year 2013 was selected as the survey period.
Methods Survey Questionnaire Previous comprehensive PM surveys have been conducted in Australia for calendar years 1972 [1,2], 1975 [3,4], 1978 [5],
*Corresponding author at: Cato Cardiology, Suite 3, 888 Toorak Rd Camberwell, Victoria, 3123, Australia. Tel.: +03 9805 4305; fax: +03 9527 9262, Email: [email protected] Published by Elsevier Inc on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
292
H.G. Mond, I. Crozier
1989, 1993 [6], 1997 [7], 2001 [8], 2005 [9] and 2009 [10]. New Zealand conducted surveys in 1972 [1,2], 1978 [5], 1981, 1993 [6], 1997 [7], 2001 [8], 2005 [9] and 2009 [10]. ICDs were included in the survey for the first time in 1993 [6]. With significant increases in the number of Australia implanting centres over the last 20 years, it became obvious that the collection of separate data from each implanting institution had become impossible. Consequently, it was decided that for the surveys after 1993, all implanted Australian PM and ICD hardware information would be obtained through pacing companies. The companies were sent a questionnaire on pulse generators, leads and ICDs sold and registered in Australian states during calendar year 2009. No attempt was made to determine individual hospital implant numbers. The individual company data were received in plain, sealed envelopes, transcribed to a working sheet and individual forms destroyed after the data were collated and transferred to a separate sheet without individual pacing company figures. All pacing companies cooperated with the survey and are listed in the acknowledgements. The data collection and analysis was performed without influence from any of the companies involved and all companies provided information asked
in the survey form, although there were situations to be discussed in the results, where data could not be accurately distributed in the way the survey was designed. For the smaller New Zealand survey, the more traditional individual hospital approach was undertaken together with assistance from pacing companies when necessary. For each survey, an accurate number of implants, or at least PMs and ICDs sold, were obligatory. This needed to be divided into new implants, replacements and types. Information on PM lead types was also obtained. As well as this, the number of implanting institutions in each country was required. No attempt was made to obtain clinical and demographic information.
Results During 2013, there were 128 Australia and 10 New Zealand centres implanting PMs. The breakdown of pacing details in each Australian State and Northern Territory and the corresponding 2009 results for both Australia and New Zealand are listed in Table 1. All Australian Capital Territory
Table 1 Pacemaker Sales Australia and Implants New Zealand, 2013 {2009}. Total Sales
New
Replacement
4475
1346
Popn
NIMP
Centres
AUSTRALIA New South Wales#
5821
7.47
Victoria Queensland
5548
4574
3715
{3906} 3094
974
1786
1462
621
790
41
4.69
{710} 660
20
{601} 324
1.68
1704
1339
365
2.55
Northern Territory*
240 53
214 {202} 45
9
525
11
{462}
{1049} Tasmania*
870 {706}
{1152} Western Australia
42
5.79
{2686} South Australia
599 {538}
{4054}
26 16
0.51
470
4
0.24
{396} 187
1
{122}
{28} Total 2013
18867
15203
3664 (19%)
23.32
652
128
{Total 2009
16265
12523
3742 (23%)
22.16
565
111}
Total 2013
2135
1641
494 (23%)
4.47
367
10
{Total 2009
1695
1277
418 (25%)
4.27
299
10}
NEW ZEALAND
()
=%
{}
= 2009 survey
Popn = Estimated population in millions, December 31st 2013 NIMP = New Implants per million population # *
New South Wales figures include Australian Capital Territory. Figures may be low because one company included Tasmanian implants in Victoria and Northern Territory figures in South Australia.
293
2013 Australian and New Zealand Pacing and ICD Survey
implantation data were included with New South Wales. The Tasmanian figures are low and the Victorian figures are slightly higher because one company included Tasmanian sales in their Victorian sales. Previous surveys suggested that sales data did not always accurately reflect new and replacements numbers, although this has now become much more accurate with registrations [9,10]. In comparison with the 2009 survey, there was a marked rise in the total PM sales in Australia (14%) or actual implants in New Zealand (21%). For Australia, unlike the comparison with the 2009 survey [10], the PM sales increase was predominantly in new implants (15,203) with a fall in replacements (3664) from 23% to 19% of all sales, reflecting the longer service life of pulse generators. For New Zealand, there was a rise in both new PM implants (1641) and replacements (494), although like Australia, the percentage of replacements to new implants fell from 25% to 23%. The number of new implants per million population in 2013 was markedly increased for both Australia (652) and New Zealand (367). The changes in the Australia and New Zealand markets since the first PM survey in 1972 are tabulated in Figure 1. Surveys were not conducted in Australia for 1981 and 1985 and in New Zealand for 1985 and 1989. For the 2013 survey, the individual states of Australia were separately analysed and reported, but the numbers for New Zealand were too small to allow this. All Australian states had an increase in new PM implant numbers with New South Wales having the largest number, closely followed by Victoria. New implants per million population increased for all
Figure 1 Number of new PM implants per million population from all the Australian and New Zealand surveys since 1972.
Australian states and with 870 new implants per million population, South Australia had the highest implant rate followed by Victoria with 790. Table 2 details the type of pulse generators sold in Australia and implanted in New Zealand in 2013. Because of difficulties obtaining accurate figures, there was no attempt to classify pulse generator types into new implants or replacements. All pulse generators sold in Australia and New Zealand are programmable and rate adaptive (R). Single chamber models designated SSI(R) are implanted almost
Table 2 Pulse Generator Type (New and Replacement), 2013. SSI (R)
DDD(R)
VDD
BiVP
AUSTRALIA New South Wales
1294 (22%)
4362 (75%)
1
164
Victoria
1145 (21%)
4110 (74%)
2
291
Queensland
811 (24%)
2809 (76%)
12
83
South Australia Western Australia
415 (23%) 399 (23%)
1261 (71%) 1229 (72%)
62 2
48 74
Tasmania
51 (21%)
188 (78%)
0
1
Northern Territory
16 (30%)
37 (70%)
0
4131 (22%)
13995 (74%)
Total 2013 {Total 2009
26%
71%
0
79 (
