obstacles in arrhythmia treatment in serbia...aai-r vvi-r vdd-r ddd dddr crt crt+icd icd % 2009 2008...
TRANSCRIPT
Prof. Goran Milasinovic
Obstacles in Arrhythmia
treatment in Serbia
“ a capite ad calcem”
Prof. Goran Milasinovic
Referral Pacemaker center
in Clinical center of Serbia
Referral center
established 1967
President, Nucleus of European
Society of Cardiac Pacing 1989
• Separate clinic, 12 beds, 10
physicians
• 1300 IPG, 150 ICD, 180 CRTp/D
• National registry
• Official National training center
• Official international “Hands-on”
training center
• International Research center
National Pacemaker Registry 2009
Number of implanting centers 16
Total PM implants 3207
New PM implants 2802
New PM implants in male 1782
New PM implants in female 1020
Population in million 7,498,001
Total ICD implants 405
Pacing mode – Serbia 2008-2009
0.37
51.51
3.59 2.43
24.63
4.55 2.8
9.85
0.3
50.68
2.96
9.84
17.93
4.261.96
7.05
0
20
40
60
AAI-R VVI-R VDD-R DDD DDDR CRT CRT+ICD ICD
%
2009 2008
Implantation number 2000-2009
6 centers 16 centers
Implant Rates: Low PowerSource: Implant Rates per Million CY07; EUCOMED,
Industry Estimate
- 100 200 300 400 500 600 700 800 900 1.000
KosovoAlbania
UkraineMacedonia
Bosnia
Russia Montenegro
BelarusCEEGI
Hungary LatviaSerbia
CroatiaLithuania
Israel Slovakia
SloveniaPoland
Greece
CzechWE
IPG CRT-P
LP Implant Rates: Growth CY07 vs 06
-40%
-30%
-20%
-10%
0%
10%
20%
30%
40%
50%
60%
70%
Russia Serbia Croatia Hungary Israel Slovakia Slovenia Poland Greece Czechia
Implant Rates: High Power
- 20 40 60 80 100 120 140 160 180 200
Kosovo
AlbaniaUkraine
Macedonia
BosniaBelarusRussia
LatviaMontenegro
Lithuania
CroatiaCEEGISerbia
SloveniaPoland
Hungary
Slovakia Greece
Czech Republic
Israel WE
ICD CRT-D
HP Implant Rates: Growth CY07 vs 06
0%
20%
40%
60%
80%
100%
120%
Russia Serbia Croatia Hungary Israel Slovakia Slovenia Poland Greece Czechia
Implant Rates: CRT
- 10 20 30 40 50 60 70 80 90 100
KosovoAlbania
BosniaUkraine
Macedonia
Russia BelarusCroatia
Montenegro
CEEGILithuania
Poland
SloveniaSlovakia
LatviaSerbia
Greece Hungary
Czech Republic
WEIsrael
CRT-P CRT-D
CRT Implant Rates: Growth CY07 vs 06
-50%
0%
50%
100%
150%
200%
Russia Serbia Croatia Hungary Israel Slovakia Slovenia Poland Greece Czechia
RF ablation 2009
Number of centers 3
Total number ~ 750
AF ablation
Population in million 7,498,001
~ 50
Prof. Goran Milasinovic
Current status
• Awareness: moderate
• Referrals: moderate
• Number of implanters: satisfied
• Number of implanting centers: satisfied
• National Pacing society activity: satisfied
• English speaking cardiology community:
satisfied
Prof. Goran Milasinovic
Current status
• Single chamber vs. Dual chamber: 50%
• Primary prevention vs. Secondary: 50%
• CRTp vs. CRTd: 60-70% - unsatisfied
• RF ablation: unsatisfied
Prof. Goran Milasinovic
Obstacles in Arrhythmia
treatment in Serbia
• Current economical situation
• Centralized tender: price as main issue
• Reduced budget: no space for last technology
• State investment vascular cardiology vs. electrophysiology:
unsatisfied
• Lack of trained EPs for RF ablation: (8 EPs for
RF ablation vs. 53 pacing implanters
Prof. Goran Milasinovic
Advantages
• High volume Referral center with good potential for Research and “Hands-on” trainings
Prof. Goran Milasinovic
Potential Solutions for Serbia:
TEI
• Trainings for EPs for RF ablation in European high-
volume centers
• New Equipment for RF ablation: (currently only one
el.mapping system in country)
• “Quick-shot”-Investment in Primary prevention ICD
supply for next 2-3 years (around 400 devices per year): industry or EHRA/ ESC action?
Eastern Initiative
EHRA Summit 2010
with the Participation of Central-Eastern European Countries
“ICD* for Life Initiative - Fighting against Sudden Cardiac Death
in Emerging Economies”
(*Implantable Cardioverter Defibrillator)
26th November 2010 Friday
13:00 Opening Ceremony, Venue TBA
Chairmen: P. Vardas, A.Auricchio C. Wolpert, G. Milasinovic, B.
Merkely, R Hatala, Hungarian Minister of National Resources