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 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 President, Nucleus of European Society of Cardiac Pacing 1989 Prof. Goran Milasinovic
National Pacemaker Registry 2009 Population in million 7,498,001 Number of implanting centers 16 Total PM implants 3207 Total ICD implants 405 New PM implants 2802 New PM implants in male 1782 New PM implants in female 1020
Pacing mode Serbia 2008-2009 2009 2008 % 60 51.51 50.68 40 20 0 24.63 17.93 9.84 9.85 7.05 3.59 2.96 0.37 2.43 4.55 4.26 2.8 0.3 1.96 AAI-R VVI-R VDD-R DDD DDDR CRT CRT+ICD ICD
Implantation number 2000-2009 6 centers 16 centers
WE Czech Greece Poland Slovenia Slovakia Israel Lithuania Croatia Serbia Latvia Hungary CEEGI Belarus Montenegro Russia Bosnia Macedonia Ukraine Albania Kosovo Implant Rates: Low Power Source: Implant Rates per Million CY07; EUCOMED, Industry Estimate - 100 200 300 400 500 600 700 800 900 1.000 IPG CRT-P
LP Implant Rates: Growth CY07 vs 06 70% 60% 50% 40% 30% 20% 10% 0% -10% Russia Serbia Croatia Hungary Israel Slovakia Slovenia Poland Greece Czechia -20% -30% -40%
Implant Rates: High Power WE Israel Czech Republic Greece Slovakia Hungary Poland Slovenia Serbia CEEGI Croatia Lithuania Montenegro Latvia Russia Belarus Bosnia Macedonia Ukraine Albania Kosovo - 20 40 60 80 100 120 140 160 180 200 ICD CRT-D
HP Implant Rates: Growth CY07 vs 06 120% 100% 80% 60% 40% 20% 0% Russia Serbia Croatia Hungary Israel Slovakia Slovenia Poland Greece Czechia
Implant Rates: CRT Israel WE Czech Republic Hungary Greece Serbia Latvia Slovakia Slovenia Poland Lithuania CEEGI Montenegro Croatia Belarus Russia Macedonia Ukraine Bosnia Albania Kosovo - 10 20 30 40 50 60 70 80 90 100 CRT-P CRT-D
CRT Implant Rates: Growth CY07 vs 06 200% 150% 100% 50% 0% Russia Serbia Croatia Hungary Israel Slovakia Slovenia Poland Greece Czechia -50%
RF ablation 2009 Population in million 7,498,001 Number of centers 3 Total number ~ 750 AF ablation ~ 50
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 highvolume 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? Prof. Goran Milasinovic
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