Arrhythmia care in ESC member countries: the 2025 ESC-EHRA atlas on heart rhythm disorders

The ESC-EHRA Atlas on Heart Rhythm Disorders was developed to comprehensively map arrhythmia care across the European Society of Cardiology (ESC) member countries. A survey of National Cardiac Societies, Working Groups, and other EHRA partners in ESC member countries was conducted to gather data from 2023 or the most recently available year on arrhythmia care organization and delivery. In total, 51 ESC member countries actively participated in the study, with a survey completeness rate of 91%. The median number of hospitals performing EP or CIED procedures was 3.3 per million people. The annual median numbers of ablation procedures for heart rhythm disorders, atrial fibrillation, and supraventricular tachycardia per million people were 432, 151, and 136, respectively. The annual median numbers of pacemakers, implantable cardioverter-defibrillators (ICD), and cardiac resynchronization therapy cardioverter-defibrillator (CRT-D) implantations per million people were 739, 195, and 54, respectively. The median number of hospitals performing remote monitoring of CIEDs per million people was 0.5, though this service was unavailable in 15 countries. Two main universal issues emerged among the obstacles to guideline implementation: a lack of heart rhythm allied professionals and general dissatisfaction with the country's reimbursement system. The first edition of the ESC-EHRA Atlas presents up-to-date information on arrhythmia care organization and delivery among ESC member countries and highlights significant discrepancies in patients' access to ESC-guideline-recommended therapies.