SHA24/082001

History of EPS in Egypt Dr Mervat Aboulmaaty Professor of Cardiology Ain Shams University 2013

Prof. Sherif El Tobgy President of EgSC

Prof. Wagdy Galal President of ECRA

Mohamed Sobhy

Adel El Eitrby

Ali Ramzy

First international meeting in cardiac electrophysiology ) Jan. 1999)

ď‚— Egypt has NEVER been far beyond the

tremendous progress in cardiac electrophysiology since Benjamin Scherlag in 1968, and Antony Damato in 1970 had succeeded in recording His Bundle Electrograms.

ď‚— That was the time for shifting from simple

ECG recording to Static and then to Dynamic His Bundle recording when Hein J. Wellens in 1971 introduced the technique of Programmed Electric Stimulation.

 We were NOT far behind this amazing technical

progress in both fields of pacing & cardiac electrophysiology.  The progress in Egyptian Electrophysiology in the fields of:  Pacing  Diagnostic Electrophysiology  Interventional Electrophysiology

 MD Thesis of Dr Mamdouh Elashry 1973  His bundle recording in Pts with AMI compared to Normal Egyptians  MD Thesis of Dr Wagdy Galal 1977  Prognostic implication of HV interval in Patients with LBBB. Provocation with Ajmaline  First extrastimulation technique in Egypt  France

Prof. Sherif Mokhtar

Prof. Of Cardiology, CC unit Cairo University

History of Interventional EPS DC Ablation Surgical ablation RF Ablation 1989

DC shock Ablation of the AVN and His Bundle

1990

Surgical resection of accessory pathways

1994

RF Ablation for AVNRT, AP, Atrial Tachycardia, AT Flutter, Idiopathic VT

DC shock fulgration of the His bundle

Dr. Breithert, President of The European Society for pacing & electorphysiology during his last visit to the center “Jan 2003� to participate in the 3rd international meeting for cardiac pacing & electrophysiology.

History of Interventional EPS : RF Ablation in Egypt 1994

No of EP labs and EP specialists in Egypt Cardiac Center

Number of RP labs / EP doctors

Cairo University

3 labs

15

EP Doctors

Ain Shams University

2 Labs

17

EP Doctors

Alexandria University

2 labs

5

EP Doctors

El-Azhar University

2 Labs

5

EP Doctors

Mansoura University

1 Lab

5

EP Doctors

Banha University

1 Lab

4

EP Doctors

Assuit University

1 lab

3

EP Doctors

Elmenya University

1 Lab

1

EP Doctor

Suez Canal University

1 Lab

3 EP Doctors

National Heart Institute

1 Lab

6

Naser Institute

1 Lab

5 EP Doctors

Military Hospitals

4 Labs

3 EP Doctors

Private Hospitals

4 Labs

Total NO

24 Labs

EP Doctors

72 EP Doctors

History of Interventional EPS RF Ablation 1994

RF Ablation for AVNRT, AP, Atrial Tachycardia, AT Flutter, Idiopathic VT

 No of EPS/ RF ablation `836 EP/RF ablations per year  210 Ain Shams  160 Cairo university  100 Alexandria University  1 20 NHI  150 Military hospitals  60 private hospitals  12 Mansoura children hospital  12 Banha University  12 Elazhar University

3D Electroanatomical Mapping 2004 2005

2010

Pulmonary Vein Isolation for AF Lasso CARTO xp 2 Cairo/ 2 Ain Shams 2008 Ischemic VT Ablation CARTO 3 Ain Shams /Alexandria/Cairo universities/ NHI Insite 3 D mapping system Air Force Military Hospital

PV isolation both conventional and Carto cases 2005 - 2012  Convent.,Carto XP then Carto 3

 150 cases Cairo University  100 cases  100

NHI

Ain Shams

CARTO 3 has been launched in 2010

Progress of Pacing in Egypt 1981 1983 1986 1988 1989 1993

Simple VVI Pacing Epicardial then Endocardial Multi-programmable PM Dual Chamber PM Rate Responsive PM Antitachycardia Pacing for SVT Single Lead VDD

1994

ICD Implantation

Progress of Pacing in Egypt 2000 2001 2001

Single lead DDD AT pacemaker for AF prevention Multisite PM Implantation- CRT-p

2005

Multisite ICD Implantation-CRT-D

Surgeons implanting Epicardial PMs  Surgeons Implanting epicardial VVI/DDD PM at OR  4 at Ain shams university  3 at Cairo university  1 at NHI  1 at Mansoura university

Cardiologists not EPS implanting Endocardial PMs  60 Cardiologists Implant VVI/DDD PM at Cath Lab  8 at Ain shams university  6 at Cairo university  24 at NHI  4 at Alx university  3 at Military Hospitals  4 at Mansoura university  3 at Assuit university  2 at Zagzig university  2 at Banisuiv university  2 at Banha university  2 at Tanta university

No of Devices implanted in Egypt (82 million population) in 2010  VVI/R  DDD/R

1200 PM 350 PM

19/million population compared to 14/million in 1998  CRT-P  ICD single& dual  CRT-D

120 PM 40 ICD 20 Device

2/million population compared to 0.5/million in 1998

No of PM/ICDs/million implanted in Egypt in 2010 compared to Europe and USA Country

Egypt

Germany France

CRT-P

150

1,100

CRT-D

30

8,500

Population/ million

82

82

Italy

UK

Belarus

Poland

Austria

2,100

1,000

2,000

25

520

270

3,500

8,500

3,000

25

820

600

58

61

10

40

64

8,2

EPS Course 2003-2010

EPS Online

www.epsegypt.com

Cardiac EP in EGYPT Past, Present and Future ď‚— There might have been some difficulties, obstacles

and financial constraints but perseverance will overcome all problems and Whenever There is a Will There is a way.

Cardiac EP in EGYPT Past, Present and Future ď‚— We are finally facing the need for: ď‚— Recruiting new teams of young

electrophysiologists, enhancing their interest in electrophysiology with the most difficult task of keeping them away from being persuaded by the irresistible fees of interventional coronary angiography.

We are all ONE family