Atlas of invasive treatment for cardiac arrhythmias in Ukraine in 2018

Abstract

The aim of the analysis was to provide comprehensive data on invasive therapies of cardiac arrhythmias in Ukraine in 2018. Association of Arrhythmologists of Ukraine has been collecting data on invasive cardiac arrhythmia therapies since 2010. In 2019, data for the survey were provided by 39 centers from all regions of Ukraine, with the exception of the temporarily occupied territory of the Autonomous Republic of Crimea, as well as a part of armed conflict zone in the east of Ukraine. In this analysis, we present updated data based on demographics and population statistics. In 2018 a total of 9597 procedures were performed, which is 824 (9.4 %) more compared to 2017, and has been the largest number since 2010. In total, 6265 pacemakers were implanted, which is 472 (8.1 %) more than in 2017. 54.8 % of them were dual chamber devices. The number of replacements for pacemakers decreased to 782, which is 143 (15.5 %) fewer than in 2017. In 2018, 98 CPT devices were implanted, which was 20 (24 %) more compared to 2017. Simultaneously, the number of CPT-D implantations grew by 24 (92.3 %) and equaled to 50. The number of defibrillator cardioverter implants increased to 166, which is 95 (133.8 %) more than in 2017. In 2018 a total of 2914 radiofrequency ablations were performed, which is 190 (7.0 %) more than in 2017. A total of 861 ablations of atrial fibrillation were performed, which is 127 (17.3 %) more compared with 2017. At the same time, the number of ablations in ventricular tachycardia with complex substrate decreased by 1 (2.7 %), totaling 36 procedures. A total of 96 extractions of electrodes were performed, which is 20 (26.3 %) more than in 2017. In addition, in 2018, 5 ECG recorders were implanted and 3 left atrial appendage closures were performed. Despite the positive dynamics, in the total number of procedures, primarily due to artificial rhythm drivers, there remains a significant heterogeneity in the availability of invasive methods of treatment across different regions of Ukraine. For example, ablation is only available in 7 regions, and atrial fibrillation ablations are performed only in 4 regions of the country. More than 10 defibrillator cardioverters have been implanted in only five centers in four regions of Ukraine. Despite the steady positive dynamics in Ukraine, the number of procedures performed is much lower than in other countries, members of ESC (European Society of Cardiology).
Conclusions. There has been a significant increase in the number of invasive interventions for cardiac arrhythmias in Ukraine. In 2018, their number was the highest since 2010. At the same time, heterogeneity in access to them continues to exist across different regions of Ukraine, so further efforts are needed to improve the situation.