S. Heald

Geographic, ethnic and socioeconomic factors influencing access to implantable cardioverter defibrillators (ICDs) in New Zealand.

BACKGROUND We examined equity of access to implanted cardioverter defibrillators (ICDs) in New Zealand in 2010 by district health board (DHB), ethnicity and socioeconomic status. METHODS All new ICD recipients in 2010 were examined according to home district health board, ethnicity according to the national health database, and socioeconomic status using the NZDep index. RESULTS During 2010, 352 new ICDs were implanted nationwide, giving an overall implantation rate of 80.6/million. However, implant rates varied significantly across the 20 DHBs with the highest implant rate observed in Tairawhiti at 192.3/million, and the lowest at 22/million in the Nelson region. There was also significant variation in implant rate by ethnicity, with Maori ethnicity at an implant rate of 114/million, European patients at 83/million, Pacific Island patients at 47/million and Asian patients an implant rate of 32/million. There was no significant difference in number of implants by socioeconomic decile. CONCLUSIONS The variance in implantation rate by district health board and by ethnicity suggests that access to ICD therapy is not equitable in New Zealand. Investigation into causes of inequity of access is required.

Ventricular Pacing via the Coronary Sinus in a Patient with a Mechanical Tricuspid Valve Prosthesis

Implantation of a transvenous endocardial pacing lead in the right ventricle is contra‐indicated after mechanical tricuspid valve replacement; therefore a surgical approach to the epicardium is usually required. This case report describes ventricular pacing via a branch of the coronary sinus in a patient with mechanical mitral, aortic and tricuspid valve replacements. In conclusion, this approach is minimally invasive, provides effective ventricular stimulation with low pacing threshold and stable lead position, and is a feasible option when transvenous right ventricular pacing is not possible.