Current state of arrhythmia care in Latin America: A statement from the Latin American Heart Rhythm Society

Abstract

Background

On May 18, 2023, the Latin American Heart Rhythm Society and the Heart Rhythm Society convened a meeting of leaders committed to arrhythmia care in Latin America to discuss clinical and health care policy issues and the barriers to delivering world-class standards in electrophysiology (EP) services, discuss potential future solutions, and share experiences and best practices.

Methods

A questionnaire on clinical arrhythmia problems, access to EP procedures, annual numbers of arrhythmia and device implantation procedures, and the largest medical issues that face each country was sent to 15 Latin American Heart Rhythm Society representatives from 15 different countries of the 20 that make up Latin America and was completed by all of them before the meeting. The event was organized as a series of individual reports, provided by the representatives as well as 11 regional leaders, followed by open discussion among the chair and meeting participants.

Results

Atrial fibrillation is the major clinical arrythmia–related problem throughout the region, followed by Chagas disease in some countries. There is significant variability in access to advanced arrhythmia care (ranging from 5 ablation procedures and 16 device implantation procedures per million inhabitants [PMIs] in Venezuela to 189 ablation procedures and 617 device implantation procedures PMIs in Uruguay) due to differences in workforce availability (ranging from 0.36 electrophysiologists PMIs in Cuba to 13.03 electrophysiologists PMIs in Argentina), resources (ranging from 0.74 EP centers PMIs in Brazil to 4.68 EP centers PMIs in Uruguay), technology (ranging from 0 operational and new generation 3D mapping systems PMIs in Cuba, Bolivia, and El Salvador to 1.98 operational and new generation 3D mapping systems PMIs in Argentina), drug availability, and national health policies. Collaboration in the area already occurs on an individual country basis, but no systematic regional efforts for working together is present.

Conclusion

Although atrial fibrillation is the most common arrhythmia problem, Chagas disease is highly prevalent in several countries of Latin America. Although there are significant variations concerning the practice of EP (including differences in policies and access to technology, drugs, and devices), overall there is limited access to implantable cardiac defibrillators, complex ablation procedures, resources (including 3-dimensional mapping systems, intracardiac echocardiography, and remote monitoring), trained physicians, and centers of excellence; thus, access to adequate health care is limited.