Arrhythmia
Care In India - Poised For The Big Leap
Yash
Lokhandwala, MD, DM.
Address for correspondence: Dr.Yash Lokhandwala, MD, DM, Associate
Professor of Cardiology, KEM Hospital, Parel, Mumbai, India.
Email: yashlokhandwala@hotmail.com
Till the late 1980s, there
was precious little one could do to permanently cure arrhythmias.
Cardiac surgery did not live up to its promise for ventricular
tachycardia. For WPW syndrome, surgery was too invasive a procedure,
with a significant chance of major complications. Electrophysiologists
spent hours trying to unravel tachycardia mechanisms, and were often
referred to as "electrophilosophers". Since the advent of RF ablation,
this scenario underwent a sea change. Suddenly one was able to get rid
of many arrhythmias with a much less invasive procedure.
Electrophysiology centers mushroomed and got upgraded in the developed
world.
In
India, there were only a couple of centers which had tried intracardiac
DC shock ablation, with varying results. In 1995, RF ablation was being
performed in a handful of centers, notably AIIMS, Delhi and KEM
Hospital,
Mumbai. Within the next year a few more centers such as Medicity,
Hyderabad,
GB Pant Hospital, Delhi and Escorts Institute, Delhi also started RF
ablation
programmes. Today there are over 20 hospitals in various parts of the
country
with well-established RF ablation programmes. It is estimated that over
15,000 RF ablation procedures have been performed so far in India. This
is against a backdrop of around 2 million patients with curable
tachycardias
in our country. Thus, there is a need for around 100 active EP centers
spread
all over the country. It is expected that this growth will occur over
the
next decade. Thus we are now past the "critical mass" and are well
poised
for the big leap forward.
Viewed in the context of the developing world, this is a satisfying
progress.
In South Asia we are today among the best equipped to offer
comprehensive
arrhythmia care services. This includes RF ablation, all modalities of
pacing therapy, AICD implantation and also atrial fibrillation surgery.
There are over 30 well-trained electrophysiologists in India and the
number
is steadily growing. There have been many notable academic
contributions
too, both in the form of original articles as well as paper
presentations
at peer-reviewed international fora.
Yet
some deficiencies need to be looked into. The EP services are focussed
in Delhi, Western Maharashtra, Hyderabad, Bangalore, Chennai, Cochin,
Trivandrum and Ahmedabad. Several parts of the country, notable the
East, North-East, M.P., Rajasthan, U.P. and Orissa urgently need at
least a few advance centers for arrhythmia care. It is often very
difficult for patients from these regions to travel and stay in far-off
cities for treatment. Post-pacemaker and especially AICD follow-up and
programming can be a nightmare in these settings. Hopefully this
disparity will get ironed out in the coming years.
