Bijzondere interventies aan het hart - Gezondheidsraad

esynchronisation pacemakers). Over the past 15 years, these treatments have
substantially improved the prognosis of patients. Developments in clinical electrophysiology
have been particularly important in this regard. In addition to elucidating
the mechanisms which give rise to arrhythmias, researchers in this field
have charted their various clinical forms (mapping). Catheter techniques and cardiac
imaging have also played an important part in this improvement.
At the same time, the greatly expanded range of options means that fully
integrated cardiac centres are now essential. In such institutions, heart surgeons
and cardiologists collaborate to deliver the best possible treatment to patients
with cardiac arrhythmias.
While the range of treatment options has increased, so has the incidence of
this condition. In particular, there has been a sharp increase in the number of elderly
patients with atrial fibrillation. Indeed, this condition has now become a
major pubic health problem. Fortunately, the past ten years have seen substantial
improvements in treatment results, both for patients with atrial fibrillation and
those with ventricular arrhythmias.
Another development concerns the use of ICD’s in patients with arrhythmias
who have survived an acute infarction, and who are at risk of suffering acute cardiac
arrest (sudden death). In addition to its use in preventing a return of ventricular
arrhythmias, an ICD is now also being successfully used in patients who
are at risk of ventricular fibrillation (prophylactic ICD implantation). Chronic
heart-failure patients who are at risk of sudden death from ventricular fibrillation
now have the option of resynchronisation therapy (CRT, often in combination
with an ICD).
The number of ICD and CRT treatments is expected to double during the
next few years (from 2,100 in 2005 to 4,500 in 2010). The existing 16 centres
have sufficient capacity to accommodate this growth. The anticipated growth in
the number of catheter ablations (from well over 2,500 in 2005 to 4,500 by 2010)
can initially be accommodated by the 11 existing centres that already have a permit.
Capacity can be further expanded by upgrading the permits granted to the
three existing centres that are restricted to ICD implantation.
In view of the rapid pace of development affecting the indications and techniques
for cardiac arrhythmias, it is advisable to retain the permit requirement for
treatment centres for the time being. In order to pursue a focused quality policy,
it is necessary to set requirements for those centres where cardiac arrhythmias
are treated. In addition to the presence of heart surgeons who specialise in
antiarrhythmic surgery, there are a number of other stipulations. At least four cardiologists/electrophysiologists
must be available, and the centre must conduct at
least 60 ICD/CRT implantations and 60 catheter ablations per annum.
Executive summary 37