Aranda Juan M, Girod Miguel, Ochoa Fernando, Abreu Miguel, Rivera José J, Sotomonte Juan C, Rodríguez Angel, Arzola Daniel, Fiménez Raúl, Aranda Juan M
Cardiovascular Center of Puerto Rico.
Bol Asoc Med P R. 2008 Jan-Mar;100(1):39-49.
Surveys of cardiac pacing and implantable cardiovertor defibrillators (ICD) have been reported since 1969 and 1993 respectively. Increasing costs of medical technology, budget constraints and emergent new clinical indications prompted our committee to conduct the first survey of cardiac rhythm management and device implant patterns in Puerto Rico.
Clinical and demographic data were obtained for all cardiac devices sold and implanted from 2000 to 2006, through a joint agreement with official representatives of the 2 largest manufacturers and distributors of cardiac pacemakers and ICD in Puerto Rico.
13,854 cardiac devices were implanted from 2000 to 2006. The number of permanent pacemakers (PP) implanted per million population has varied from 430 in the year 2000 to 482 in the year 2006. A significant greater number of males received PP than females (P < .05). Yearly increases in implant rates for cardiac resynchronization therapy (CRT) and ICD were observed, mainly due to new emergent clinical indications, appropriate insurance coverage and availability of implanting electrophysiologists.
Sales figures from PP and ICD manufacturers are a reliable system to calculate and analyze changes in cardiac device implant patterns. The rate of 482 PP per million population positions Puerto Rico as the third largest implant market in North and South America. This finding should be useful to insurance health providers since 76% of the implants are performed in patients over 65 years old. In the year 2006, Puerto Rico was the 10th largest implant market in the world with 67 CRT implanted per million population. A significant greater number of CRT and ICD were implanted in males than females. This gender difference has increased in spite of strict requirements to include more females in clinical trials and intensive, educational and awareness efforts conducted among physicians and patients. A summary of the current guidelines and clinical indications is provided to assist the physician in the selection of patients referred for cardiac rhythm management and implant procedures.
自1969年和1993年以来，分别有关于心脏起搏和植入式心脏复律除颤器（ICD）的调查报道。医疗技术成本的不断增加、预算限制以及新出现的临床适应症促使我们的委员会对波多黎各的心律管理和设备植入模式进行首次调查。
通过与波多黎各最大的两家心脏起搏器和ICD制造商及经销商的官方代表达成的联合协议，获取了2000年至2006年期间所有售出和植入的心脏设备的临床和人口统计学数据。
2000年至2006年期间共植入了13,854台心脏设备。每百万人口中植入的永久性起搏器（PP）数量从2000年的430台变化到2006年的482台。接受PP植入的男性数量显著多于女性（P <.05）。观察到心脏再同步治疗（CRT）和ICD的植入率逐年增加，主要是由于新出现的临床适应症、适当的保险覆盖以及植入电生理学家的可获得性。
PP和ICD制造商的销售数据是计算和分析心脏设备植入模式变化的可靠系统。每百万人口482台PP的植入率使波多黎各成为北美和南美第三大植入市场。这一发现对健康保险提供者应该是有用的，因为76%的植入手术是在65岁以上的患者中进行的。2006年，波多黎各是世界第十大植入市场，每百万人口植入67台CRT。植入CRT和ICD的男性数量显著多于女性。尽管有严格要求在临床试验中纳入更多女性，并且在医生和患者中进行了密集的教育和宣传努力，但这种性别差异仍在增加。提供了当前指南和临床适应症的总结，以协助医生选择转诊进行心律管理和植入手术的患者。
