Quality criteria proposed by the BWGCPE

• Proportion high curative (CH-p): proportion of procedures performed with a curative goal and excellent rhythmologic prognose (Atrial flutter type 1 - Atrial tachycardia - AV node reentrant - Accessory pathways - Idiopathic VT).

• Succes high curative (CH-s): proportion of success considering procedures done with a high curative goal (see above).

• Proportion « low » curative (CL-p): proportion of procedures performed with a curative goal and low rhythmologic prognose (atrial fibrillation, ventricular tachycardia, intramyocardial, etc). Il faut absolument préciser les arythmies à partager entre CH et CL. DONE

• Succes « low » curative (CL-p): : proportion of success considering procedures done with a « low » curative goal (see above).

• Proportion His (His): proportion of procedures performed with a palliative goal without cure of the arrhythmia (His bundle ablation).

• Complication rate (Co): proportion of major complications.

Method

• The data are taken from the Rfdatabase program delivered to all the interventional rythmology centers in Belgium since 1996.

• 4355 RF procedures were volontarily recorded between february 1996 and march 2004.

• Number of participating centers : 24

• Number of non participating centers : 13

Principles of quality evaluation of ablation practice in Belgium

• The purpose of quality evaluation is to reveal aberrant practices in terms of :

– Indications (to promote curative procedures)

– Succes (to promote permanent cure)

– Complications

• It would offer each center a comparison between the indications and performance of their own practice and that of the national practice.

• This may guide each center to «  auto-correction » of sub-optimal practices.

Submitted cases to database between 7/2/1996 and 29/3/2004

125

267

111

404

184

24 4017 24

9169

293

113

638

6138

125 106

24

280

92139

990

100

0

200

400

600

800

1000

1200

3 9 11 16 19 26 28 33 34 39 41 43 47 49 52 56 64 75 78 81 82 84 89 99

Centers

Pro

ced

ure

s

0

50

100

150

200

250

300

350

400

1996 1997 1998 1999 2000 2001 2002 2003 2004

Years

Pro

ced

ure

s

3

9

11

16

19

26

28

33

34

39

41

43

47

49

52

56

64

75

78

81

82

84

89

99

Centers

Annual Cases submitted (all centers)

Annual Cases submitted Center x

245

235

245

265

220

225

230

235

240

245

250

255

260

265

270

1996 1997 1998 1999 2000 2001 2002 2003 2004

Years

Pro

ced

ure

s

Annual Evolution Ablation Indications (all centers)

0

50

100

150

200

250

300

350

400

1996 1997 1998 1999 2000 2001 2002 2003 2004

Years

Pro

cedu

res

none (eg:asymptomatic WPW)

type I atrial flutter

atypical atrial flutter

paroxysmal atrial fibrillation

chronic atrial fibrillation

atrial tachycardia, right side

atrial tachycardia, left side

orthodromic tachycardia

antidromic tachycardia

unknown

antidromic Mahaim

OT, decremental ABT (Coumel)

AV node reentrant, slow-fast

AV nodal reentrant, atypical

Ventricular tachycardia, intramyocardial

Ventricular tachycardia, bundle branch reentry

Ventricular tachycardia, idiopathic right

ventricular tachycardia, idiopathic left

Innapropriate sinus tachycardia

Else/free text

cf tableau précédent mais en %

Annual Evolution Ablation Indications (Center x)

0

10

20

30

40

50

60

70

80

90

1996 1997 1998 1999 2000 2001 2002 2003 2004

Years

Pro

ced

ure

s

none (eg:asymptomatic WPW)

type I atrial flutter

atypical atrial flutter

paroxysmal atrial fibrillation

chronic atrial fibrillation

atrial tachycardia, right side

atrial tachycardia, left side

orthodromic tachycardia

antidromic tachycardia

unknown

antidromic Mahaim

OT, decremental ABT (Coumel)

AV node reentrant, slow-fast

AV nodal reentrant, atypical

Ventricular tachycardia, intramyocardial

Ventricular tachycardia, bundle branch reentry

Ventricular tachycardia, idiopathic right

ventricular tachycardia, idiopathic left

Innapropriate sinus tachycardia

Else/free text

cf tableau précédent mais en %

92.494.7

19.0

86.2

22.6

77.7

89.4

10.5

53.9

11.7

1.8

63.1

84.1

2.0

21.6

0.8

76.9

92.5

22.4

86.9

0.6 1.1

3.3

0.4

-10.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

110.0

CH-p CH-s CL-p CL-s His Co

SD+

Mean

SD-

Center

96.7100.0

30.0

100.0

41.1

5.0

35.2

75.0

0.0 0.0 0.5 0.0

76.9

92.5

22.4

86.9

0.6 1.1

-10.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

110.0

CH-p CH-s CL-p CL-s His Co

Max

Min

Center

Global all criteria : center x compared with all centers statistics

73

80

82

85

95

79

93

35

67

91

88

73

81

69

85

63

84

60

50

86

97

81

77

9191

94

8890

9395

92

83

75

89

93

84

89 89

83

96

90

86

100

92

8990

93

82

10

18

3

7

4 43

24

0

5

911

6

30

7

11 10

16

29

10

0

12

22

3

46

67

0

68

63

100

0

50

0

40

50

32

14

78

100

50

75

82

100

57

0

69

87

67

17

2

15

8

1

17

5

41

33

3 3

16

12

0

8

26

6

24

21

4 3

8

1

6

1

3 3 21

0 0 0

4

10 0

3 3 3 3 2 20

21

5

13

-10

0

10

20

30

40

50

60

70

80

90

100

110

3 9 11 16 19 26 28 33 34 39 41 43 47 49 52 56 64 75 78 81 82 84 89 99

CH-p

CH-s

CL-p

CL-s

His

Co

92.4

94.7

19.0

86.2

22.6

3.3

77.7

89.4

10.5

53.9

11.7

1.8

63.1

84.1

2.0

21.6

0.8 0.4

-10.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

110.0

CH-p CH-s CL-p CL-s His Co

Global all criteria : all centers compared with all centers statistics

87.6

110.7

85.5

94.597.5 99.5 99.1

94.5

78.7

70.5

81.1

72.675.9 75.3

79.181.9

69.8

30.2

76.6

50.754.3

51.2

59.1

69.466.1 68.5

82.8

89

92.9

92.6

92.2

-20.0

-10.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

110.0

120.0

1996 1997 1998 1999 2000 2001 2002 2003 2004

SD+

Mean

SD-

Center

CH-p over the years : center x compared with all centers statistics

99.0

117.7

101.5

114.2

107.7 107.5

98.7 97.5

68.5

75.2

96.1

83.186.8 85.4

92.8 91.7

38.0

32.7

90.6

52.1

65.963.2

86.9 86.090.7 90

92.695.3

84.9

84.0

83.0

-20.0

-10.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

110.0

120.0

1996 1997 1998 1999 2000 2001 2002 2003 2004

SD+

Mean

SD-

Center

CH-s over the years : center x compared with all centers statistics

17.7

8.4

17.5

26.021.6 19.7 20.6 21.2

9.2

2.6

9.113.4

9.4 9.2 10.5 12.0

0.8-3.2

0.6 0.8-2.8 -1.3 0.3 2.7

33.830.2

16.310.5 4.6

1.9

-0.8

-20.0

-10.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

110.0

120.0

1996 1997 1998 1999 2000 2001 2002 2003 2004

SD+

Mean

SD-

Center

CL-p over the years : center x compared with all centers statistics

60.7

32.4

97.2102.7

72.0

80.9 79.3

91.5

22.2

10.0

46.750.0

34.739.6 40.8

52.9

-16.3-12.4

-3.9 -2.7 -2.6 -1.72.2

14.4

91.588.7

80 78.5

120.7

50.0

-20.7-20.0

-10.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

110.0

120.0

1996 1997 1998 1999 2000 2001 2002 2003 2004

SD+

Mean

SD-

Center

CL-s over the years : center x compared with all centers statistics

24.6

68.2

20.5

29.7

36.041.3

24.4

11.812.0

26.9

9.813.9 14.7 15.4

10.36.0

-0.5

-14.4

-0.9 -1.9-6.6

-10.5

-3.70.30 1.27 0.81 0.37

7.85.53.2

-20.0

-10.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

110.0

120.0

1996 1997 1998 1999 2000 2001 2002 2003 2004

SD+

Mean

SD-

Center

His over the years : center x compared with all centers statistics

10.15.6

3.1 3.4

3.7 2.3 1.9 1.7 1.5

10.1

-2.7

-17.1

2.04 1.27 0.4 0.75

17.1

1.44.9 3.6

37.4

7.1

0.4 1.3-2.9

-0.5 -1.2 -0.5 -0.2 -0.4-1.0

-20.0

-10.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

110.0

120.0

1996 1997 1998 1999 2000 2001 2002 2003 2004

SD+

Mean

SD-

Center

Co over the years : center x compared with all centers statistics

Details Center x

Arrhythmias target Total Succes %Succesnone (eg:asymptomatic WPW) Accessory pathway posteroseptal 13 13 100.0none (eg:asymptomatic WPW) Accessory pathway left free wall 6 6 100.0type I atrial flutter Accessory pathway posteroseptal 1 1 100.0type I atrial flutter Slow AV nodal pathway 1 1 100.0type I atrial flutter AV node or His 2 2 100.0type I atrial flutter atrial focus or reentry circuit 147 145 98.6atypical atrial flutter Slow AV nodal pathway 1 0 0.0atypical atrial flutter atrial focus or reentry circuit 126 120 95.2atypical atrial flutter AV node or His 2 2 100.0paroxysmal atrial fibrillation Accessory pathway left free wall 4 4 100.0paroxysmal atrial fibrillation Accessory pathway midseptal 1 0 0.0paroxysmal atrial fibrillation Accessory pathway posteroseptal 4 4 100.0paroxysmal atrial fibrillation VP deconnexion 28 24 85.7paroxysmal atrial fibrillation atrial focus or reentry circuit 25 20 80.0chronic atrial fibrillation atrial focus or reentry circuit 2 0 0.0chronic atrial fibrillation VP deconnexion 2 1 50.0atrial tachycardia, right side AV node or His 1 1 100.0atrial tachycardia, right side atrial focus or reentry circuit 66 57 86.4atrial tachycardia, left side AV node or His 1 1 100.0atrial tachycardia, left side atrial focus or reentry circuit 25 15 60.0orthodromic tachycardia Accessory pathway anteroseptal 10 10 100.0orthodromic tachycardia Accessory pathway posteroseptal 46 43 93.5orthodromic tachycardia Accessory pathway midseptal 2 2 100.0orthodromic tachycardia Accessory pathway right free wall 13 12 92.3orthodromic tachycardia Accessory pathway left free wall 122 122 100.0antidromic tachycardia Accessory pathway anteroseptal 2 2 100.0antidromic tachycardia Accessory pathway left free wall 6 6 100.0antidromic tachycardia Accessory pathway midseptal 1 1 100.0antidromic tachycardia Accessory pathway posteroseptal 2 2 100.0antidromic tachycardia Accessory pathway right free wall 3 3 100.0unknown Accessory pathway left free wall 1 1 100.0unknown Slow AV nodal pathway 2 0 0.0antidromic Mahaim Accessory pathway right free wall 5 4 80.0OT, decremental ABT (Coumel) Slow AV nodal pathway 1 0 0.0OT, decremental ABT (Coumel) Accessory pathway posteroseptal 4 4 100.0OT, decremental ABT (Coumel) Accessory pathway left free wall 1 1 100.0AV node reentrant, slow-fast Slow AV nodal pathway 196 188 95.9AV nodal reentrant, atypical Slow AV nodal pathway 60 50 83.3Ventricular tachycardia, intramyocardial Ventricular focus or reentry circuit 12 9 75.0Ventricular tachycardia, bundle branch reentry VP deconnexion 1 1 100.0Ventricular tachycardia, bundle branch reentry Right bundle branch 1 1 100.0Ventricular tachycardia, idiopathic right Ventricular focus or reentry circuit 13 9 69.2Ventricular tachycardia, idiopathic left Ventricular focus or reentry circuit 13 5 38.5

Arrhythmias target Total Succes %Succesnone (eg:asymptomatic WPW) Accessory pathway anteroseptal 2 2 100.0none (eg:asymptomatic WPW) Accessory pathway left free wall 14 13 92.9none (eg:asymptomatic WPW) Accessory pathway midseptal 6 2 33.3none (eg:asymptomatic WPW) Accessory pathway posteroseptal 29 26 89.7none (eg:asymptomatic WPW) atrial focus or reentry circuit 1 0 0.0none (eg:asymptomatic WPW) sinus node 1 1 100.0none (eg:asymptomatic WPW) Slow AV nodal pathway 1 0 0.0none (eg:asymptomatic WPW) Ventricular focus or reentry circuit 1 0 0.0type I atrial flutter Accessory pathway posteroseptal 2 1 50.0type I atrial flutter atrial focus or reentry circuit 1257 1161 92.4type I atrial flutter AV node or His 8 8 100.0type I atrial flutter sinus node 1 0 0.0type I atrial flutter Slow AV nodal pathway 1 1 100.0type I atrial flutter VP deconnexion 1 1 100.0atypical atrial flutter atrial focus or reentry circuit 339 242 71.4atypical atrial flutter AV node or His 8 8 100.0atypical atrial flutter Slow AV nodal pathway 1 0 0.0paroxysmal atrial fibrillation Accessory pathway anteroseptal 2 1 50.0paroxysmal atrial fibrillation Accessory pathway left free wall 14 14 100.0paroxysmal atrial fibrillation Accessory pathway midseptal 3 2 66.7paroxysmal atrial fibrillation Accessory pathway posteroseptal 11 9 81.8paroxysmal atrial fibrillation Accessory pathway right free wall 1 1 100.0paroxysmal atrial fibrillation atrial focus or reentry circuit 80 64 80.0paroxysmal atrial fibrillation AV node or His 48 47 97.9paroxysmal atrial fibrillation Right bundle branch 1 1 100.0paroxysmal atrial fibrillation VP deconnexion 71 57 80.3chronic atrial fibrillation atrial focus or reentry circuit 20 12 60.0chronic atrial fibrillation AV node or His 176 170 96.6chronic atrial fibrillation sinus node 1 1 100.0chronic atrial fibrillation VP deconnexion 11 7 63.6atrial tachycardia, right side Accessory pathway right free wall 1 1 100.0atrial tachycardia, right side atrial focus or reentry circuit 163 119 73.0atrial tachycardia, right side AV node or His 4 3 75.0atrial tachycardia, right side sinus node 4 3 75.0atrial tachycardia, right side Slow AV nodal pathway 1 1 100.0atrial tachycardia, left side Accessory pathway posteroseptal 1 1 100.0atrial tachycardia, left side atrial focus or reentry circuit 52 26 50.0atrial tachycardia, left side AV node or His 5 5 100.0atrial tachycardia, left side Slow AV nodal pathway 1 0 0.0orthodromic tachycardia Accessory pathway anteroseptal 24 20 83.3orthodromic tachycardia Accessory pathway left free wall 329 317 96.4orthodromic tachycardia Accessory pathway midseptal 12 8 66.7orthodromic tachycardia Accessory pathway posteroseptal 147 124 84.4

DetailsAll Centers (1)

antidromic tachycardia Accessory pathway left free wall 9 8 88.9antidromic tachycardia Accessory pathway midseptal 2 2 100.0antidromic tachycardia Accessory pathway posteroseptal 10 7 70.0antidromic tachycardia Accessory pathway right free wall 3 3 100.0unknown Accessory pathway anteroseptal 1 1 100.0unknown Accessory pathway left free wall 6 6 100.0unknown Accessory pathway midseptal 1 1 100.0unknown Accessory pathway posteroseptal 3 3 100.0unknown atrial focus or reentry circuit 3 2 66.7unknown Slow AV nodal pathway 3 1 33.3antidromic Mahaim Accessory pathway left free wall 1 0 0.0antidromic Mahaim Accessory pathway right free wall 6 5 83.3OT, decremental ABT (Coumel) Accessory pathway left free wall 1 1 100.0OT, decremental ABT (Coumel) Accessory pathway posteroseptal 9 6 66.7OT, decremental ABT (Coumel) Slow AV nodal pathway 1 0 0.0AV node reentrant, slow-fast atrial focus or reentry circuit 8 8 100.0AV node reentrant, slow-fast AV node or His 2 2 100.0AV node reentrant, slow-fast Slow AV nodal pathway 1022 991 97.0AV nodal reentrant, atypical AV node or His 1 1 100.0AV nodal reentrant, atypical Slow AV nodal pathway 137 123 89.8Ventricular tachycardia, intramyocardial Accessory pathway posteroseptal 1 1 100.0Ventricular tachycardia, intramyocardial Left bundle branch 1 1 100.0Ventricular tachycardia, intramyocardial Slow AV nodal pathway 3 3 100.0Ventricular tachycardia, intramyocardial Ventricular focus or reentry circuit 39 29 74.4Ventricular tachycardia, bundle branch reentry atrial focus or reentry circuit 1 1 100.0Ventricular tachycardia, bundle branch reentry Right bundle branch 6 6 100.0Ventricular tachycardia, bundle branch reentry Ventricular focus or reentry circuit 3 1 33.3Ventricular tachycardia, bundle branch reentry VP deconnexion 1 1 100.0Ventricular tachycardia, idiopathic right Ventricular focus or reentry circuit 72 41 56.9Ventricular tachycardia, idiopathic left Ventricular focus or reentry circuit 33 18 54.5Innapropriate sinus tachycardia atrial focus or reentry circuit 2 2 100.0Innapropriate sinus tachycardia sinus node 2 2 100.0

DetailsAll Centers (2)

Aberrant activity : % centers with quality criteria > (Mean + SD)

Year Nb centers % 1 < MET % 1_s < MET % fa < MET % fa_s < MET % 2 > MET % 3 > MET

1996 3 0.00 33.33 0.00 0.00 33.33 33.33

1997 5 20.00 20.00 0.00 0.00 20.00 20.00

1998 5 20.00 20.00 0.00 0.00 20.00 20.00

1999 10 20.00 10.00 0.00 0.00 20.00 20.00

2000 22 13.64 13.64 0.00 0.00 4.55 18.18

2001 19 10.53 10.53 0.00 0.00 10.53 26.32

2002 15 6.67 6.67 0.00 0.00 20.00 20.00

2003 13 23.08 23.08 0.00 0.00 23.08 7.69

2004 2 50.00 0.00 0.00 0.00 0.00 0.00

En chantier : MAJ avec nouveaux critères et présentation + lisible