Merino.qxp 3/7/09 11:52 am Page 29
The Future of European Electrophysiology – How to Improve the Quality of Care in Europe
Table 1: Number of Ablation Procedures Performed per Arrhythmia Substrate from 2001 to 2005 in
Three Southern European Countries
Country Year Flutter VT AVN AVNRT ACP AT AF
Italy 2001 2,080 455 476 2,227 1,299 270 258
2002 2,194 521 504 2,362 1,497 270 1,891
2003 3,120 590 349 1,938 1,345 312 2,023
2004 3,396 675 358 2,119 1,621 340 2,868
2005 4,253 825 332 2,552 1,725 386 2,726
Spain 2001 803 298 218 1,327 1,140 137 46
2002 1,247 292 264 1,415 1,416 166 170
2003 1,035 258 243 1,377 1,149 141 151
2004 1,039 269 227 1,286 1,054 132 137
2005 1,479 389 246 1,792 1,591 189 480
Portugal 2001 144 31 0 305 276 0 14
2002 123 34 0 327 235 0 34
2003 154 40 50 273 274 15 18
2004 158 34 51 299 343 19 48
2005 210 48 40 334 382 21 69
All countries 2001 3,027 784 694 3,859 2,715 407 318
2002 3,564 847 768 4,104 3,148 436 2,095
2003 4,309 888 642 3,588 2,768 468 2,192
2004 4,593 978 636 3,704 3,018 491 3,053
2005 5,942 1,262 618 4,678 3,698 596 3,275
ACP = accessory pathway; AF = atrial fibrillation; AT = atrial tachycardia; AVN = atrioventricular node; AVNRT = atrioventricular nodal re-entrant tachycardia; VT = ventricular tachycardia.
Reprinted from Inama et al., 2009.
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Questionnaires resulting in the duplication of work and an inability to compare work
Finally, questionnaires are series of questions and other prompts for implemented in different countries due to unnecessary
the purpose of gathering objective information from respondents. methodological variations.
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In addition, the development of a
This approach has been used by the EHRA to develop the EHRA uniform and consistent set of standards is desirable to facilitate
white book, which probably provides the best available picture that qualified health services and ensure free movement across borders,
can be obtained about EP resources and personnel in the different both for professionals and for patients. These two reasons are even
countries of Europe.
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This white book was developed by a survey more relevant nowadays due to the development of European
conducted among key professionals and board members of the healthcare systems, the increasing integration of the EU and the
national societies of each European country. challenges currently arising, such as increased management
autonomy, inter-country invoicing and competition between
Establishing Pathways for Common healthcare centres.
Education – Core Curriculum
Another crucial aspect for improving quality of care in EP is For all of these reasons, the EHRA has developed a core curriculum
education. This is especially true nowadays, with the increase in for all European heart rhythm specialists that represents a
indications for and number of EP procedures depicting a scenario of harmonised and uniform way to ensure high standards of
emerging indications, an increasing number of invasive procedures excellence.
24,25
This core curriculum is a formal education plan for a
and the establishment of new practising units and professionals. training programme that establishes specific learning objectives and
These procedures require cardiologists with comprehensive requirements for trainees, trainers and training centres. It also
knowledge of heart rhythm disorders who are trained in provides a syllabus for the subspecialty, which is a listing of subject
cardiovascular catheter manipulation, heart electrical signal
recording and interpretation and device implantation and follow-up
to ensure both patient safety and quality.
It is imperative to promote and
At present, there are many excellent educational activities across
Europe, including courses and congresses organised by national
ensure sufficient and homogeneous
and European cardiology and EP scientific societies. However, most
training and qualifications in heart
of these activities are limited in time, are not comprehensive and are
mainly theoretical, with no or little training of practical skills. Thus, it
rhythm management among
appears imperative to promote and ensure sufficient and
professionals in Europe.
homogeneous training and qualifications in heart rhythm
management among these professionals in Europe.
There are training and accreditation programmes in some European matters that are covered in the training programme. Finally, the
countries,
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but co-ordination at the European level is needed document details the minimum number of procedures
because transnational co-operation is currently not well organised, recommended to be performed by the trainee during the training
EUROPEAN CARDIOLOGY 29
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