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.............................................................. developed has been published.839 To date, a suite of quality indicators for an initial tranche of cardiovascular conditions has been produced.839,840 To facilitate quality improvement initiatives, the diseasespecific ESC quality indicators are included in corresponding ESC Clinical Practice Guidelines.296,841 This is further enhanced by way of their integration in the ESC registries, such as the EurObservational Research Programme (EORP) and the European Unified Registries On Heart Care Evaluation and Randomized Trials (EuroHeart) project.842

A number of registries exist for patients undergoing CIED implantation,843 providing ‘real-world’ data about the quality and outcomes of CIED care.702 However, there is a lack of a widely agreed set of quality indicators that encompasses the multifaceted nature of CIED care, and that serves as a bridge between clinical registries and guideline recommendations. Thus, and in parallel with the writing of these guidelines, a suite of quality indicators for patients undergoing CIED implantation was developed. The full list of these quality indicators, as well as their specifications and development methodology, has been published elsewhere,844 with a selection presented in Table 15. 14 Key messages

• In the evaluation of candidates for permanent pacemaker implantation, a thorough and detailed pre-operative evaluation is recommended. This should always include careful history taking and physical examination, laboratory testing, documentation of the type of bradyarrhythmia requiring treatment, and cardiac imaging. In selected cases, additional tests, EPS, and/or genetic testing are indicated. • Ambulatory ECG monitoring is useful in the evaluation of patients with suspected bradycardia or cardiac conduction disorder, to correlate rhythm disturbances with symptoms. Choice of type of monitoring should be based on frequency and nature of symptoms and patient preferences. • In patients with SND including those with bradycardiatachycardia type of SND, when symptoms can clearly be attributed to bradyarrhythmia, cardiac pacing is indicated. • In patients with SR and permanent or paroxysmal third- or second-degree type 2 or high-degree AVB, cardiac pacing is indicated irrespective of symptoms.

Table 15 A selection of the developed quality indicators for patients undergoing cardiovascular implantable electronic device implantation Quality indicator Domain Centres providing CIED services should participate in at least one CIED registry Structural quality indicatora Numerator: Number of centres participating in at least one registry for CIED Centres providing CIED services should monitor and report the volume of procedures performed by individual operators on an annual basis Structural quality indicator Numerator: Number of centres monitoring and reporting the volume of procedures performed by individual operators Centres providing CIED services should have available resources (ambulatory ECG monitoring, echocardiogram) to stratify patients according to their risk for ventricular arrhythmias Structural quality indicator Numerator: Number of centres with an available ambulatory ECG and echocardiogram service Centres providing CIED services should have a preprocedural checklist to ensure discussion with the patient regarding risks, benefits, and alternative treatment options Structural quality indicator Numerator: Number of centres that have a checklist to ensure discussion with patient regarding risks, benefits, and alternative treatment options before CIED implantation Centres providing CIED services should have established protocols to follow-up patients within 2 - 12 weeks following implantation Structural quality indicator Numerator: Number of centres that have an established protocol to follow up patients within 2 - 12 weeks following CIED implantation Proportion of patients considered for CIED implantation who receive prophylactic antibiotics 1 h before their procedure Patient assessment Numerator: Number of patients who receive antibiotics 1 h before their CIED implantation procedure Denominator: Number of patients undergoing CIED implantation procedure Annual rate of procedural complicationsb 30 days following CIED implantation Outcomes Numerator: Number of patients who develop one or more procedural complicationsb within 30 days of CIED implantation Denominator: Number of patients undergoing CIED implantation procedure CIED = cardiovascular implantable electronic device; ECG = electrocardiogram. aStructural quality indicators are binary measurements (yes/no), and thus only the numerator is defined. bCIED-related bleeding, pneumothorax, cardiac perforation, tamponade, pocket haematoma, lead displacement (all requiring intervention), or infection. ESC 2021 Downloaded from academic.oup.com/eurheartj/article/42/35/3427/6358547 by guest on 07 October 2026