Erebouni Medical Center
Medical Journal Erebouni

Electrophysiology & Intervention Arrhythmology Department

General characteristics


Arrhythmology - one of the most complex sections of Clinical Cardiology, due to a variety of arrhythmias, the difficulty of their diagnostics and treatment, as well as the possibility of developing such severe complications as thrombosis, myocardial infarction, stroke, heart failure and others. The sudden arrhythmias often require urgent intervention to restore the normal rhythm of the heart and then maintain it. The most important factor in the effectiveness of treatment of the patients is the timely consultation, diagnostics and treatment.

 

Cardiac arrhythmias can be independent or be a complication of diseases of the cardiovascular or other organ systems. In 80% of patients with ischemic heart disease the arrhythmias of various character has been registered. Among them about 65% are life threatening. The increase of the incidence of cardiac arrhythmias with age is due to changes that occurred in the myocardium and the cardiac conduction system in the aging process. Myocytes are replaced by fibrous tissue, and so-called "sclerodegenerative" changes are occured. 

 

Arrhythmias may not appears and be clinically silent during long time and the patient may do not know about it up to the moment when it will be revealed by doctors during examination.

 

Erebouni Medical Center: Cardiology & Cardiac Surgery Clinic: Electrophysiology & Intervention Arrhythmology Department

The most common symptoms of arrhythmia are following:

 

  • Feeling disruptions in the rhythm of the heart, or vice-versa - tachycardia, or "fluttering" of the heart,
  • Extremely fast or slow heartbeat,
  • Dizziness,
  • Shortness of breath,
  • Pain in the chest that has pressing character,
  • A sense of "failure" of the earth under the feet,
  • Nausea and / or vomiting (especially during the transition to the normal rhythm of the arrhythmia, and vice versa),
  • Loss of consciousness.

 

These various manifestations of arrhythmia not always testify the complexity of the arrhythmias. People with minor arrhythmias may lose consciousness, and those patients who have life-threatening arrhythmias - do not have any complaints. Everything can be very individual! However, it is very dangerous to treat arrhythmias oneself! Arrhythmia should be treated by the doctor, after a special examination and determination of the type of arrhythmia, taking into account its location and genesis.


In the department of electrophysiology and interventional arrhythmology noninvasive and invasive electrophysiological studies of the cardiovascular system, advice on arrhythmology and pacing are used, as well as to medical and interventional, endovascular (angioplasty of the coronary arteries, radiofrequency ablation of arrhythmogenic zones, various methods of pacing, resynchronization therapy) and surgical correction of heart rhythm in accordance with international standards and recommendations are carried out.

 

The Department is equipped with the most modern equipment including patient's monitoring systems, defibrillators, electrocardiographs, and also with wide array of medical equipment for the invasive electrophysiological diagnostics and interventional treatment of arrhythmias.

 

Electrophysiology & Intervention Arrhythmology Department         Electrophysiology & Intervention Arrhythmology Department

 

The main activities of the department are the treatment of complex cardiac arrhythmias, as well as combined heart disease - coronary heart disease, congenital and acquired (valvular) heart disease, complicated by the development of cardiac arrhythmias.


The department employs 4 doctors arrhythmologists, including two certified invasive electrophysiologists, who provide the whole spectrum of arrhythmology procedures. Every year in the Department get treatment around 2000 patients, 1400 of which are out-patients.

 
Specialists of the Department actively cooperate with leading clinics in Europe, Russia and USA, particularly with Providence Sacred Heart Medical Center and Children's Hospital and Institute of Cardiology of Debrecen (Hungary), periodically conduct scientific seminars, consultations and jointly intervention procedures.

 

The Center provides urgent and planned in-patient diagnostics and treatment at the following diseases:


  • Various Arrhythmias,
  • Cardiomyopathy,
  • Syncope,
  • Heart failure,
  • Ischemic heart disease,
  • Hypertension,
  • Valvular and congenital heart diseases
 
Equipping

Erebouni Medical Center: Cardiology & Cardiac Surgery Clinic: Electrophysiology & Intervention Arrhythmology Department

  • Biplan angiograph Arlis (Siemens), equipped also for electrophysiological studies and performance of such intervention procedure as implantation of the pacemaker and cardioverter – defibrillator. Has also all facilities for  resynchronizing therapy and ablation performance,
  • Echocardiograph (Philips),
  • Electrocardiograph (Shiller),
  • Treadmill (Shiller) (GE),
  • Holter monitoring System (Shiller),
  • Defibrillator (Medtronic 20e),
  • Multifunctional monitors,
  • intensive care unit with a central oxygen supply and with individual monitoring system
 
Main activities

 

Study and procedures performed on an outpatient base


   

Multichannel electrocardiography (ECG),

   

Echocardiography (EchoCG),

   

Holter monitoring,

   

Event monitoring,

   

Study, diagnostics and programming of the stimulator, CVD and devices, synchronizing the work of the heart,

   

Excercise test (Treadmill test),

   

Monitoring of blood pressure,

   

Out-patient and out-going arrhythmology consultations.

 

Procedures, implementing  at the in-patient conditions


   

Mapping,

   

Electrical cardioversion

   

Pharmacological cardioversion

   

Some types of electrophysiological studies

   

Transesophageal echocardiography

    Implantation of temporary transcutaneous pacemaker.

 

Interventional procedures, conducted at the Department of electrophysiology and interventional arrhythmology


 

   

Inplantation of cardiostimulators, cardioverters – defibrillators (CVD), stimulators and cardioverters – defibrillators with heart work synchronization, and diagnostic mini-systems (Implantable Loop Recorder):

     
  • Cardiac Stimulators (Pacemaker) which are the small electronic devices that implanted in case of atrioventricular blockades and at slow heart rate, for maintenance of normal heart rate.
  • Cardioverter – defibrillator are implanted into the human’s body for the treatment of life- threatening arrhythmias,
  • Stimulators and CVD with synchronization of ventricles contraction function that are auxiliary medical devices, which are implanted for the treatment of heart failure and arrhythmias.

   

Electrophysiological studies

 

   

Radiofrequency ablation of ventricular and supraventricular arrhythmias. Ablation - is the destruction of arrhythmogenic foci. In our center performed all types of ablations. In particular:

     
  • in case of  supraventricular tachycardia::
      AV reentri,
      AV nodal reentri
  • In case of ventricular tachycardia:
      right ventricular
      left ventricular
  • Ablation of main bundle of His,
  • Ablation in case of atrial tachycardia,
      right atrial,
      left atrial,
  • Ablation in case of atrial fibrillation,
  • Atrial flutter ablation.

   

Selective angiography of the heart (coronarography) angioplasty and stenting

    Angiography of great and periferic vessels of upper and lower extremities.

 

Staff
Mihran Martirosyan,  MD, PhD Mihran Martirosyan, MD, PhD Write a letter Head of Electrophysiology & Intervention Arrhythmology Department arrhythmologist - electrophysiologist
Ofelia Ghukasyan Ofelia Ghukasyan Write a letter cardiologist
Evgine Mkhitaryan Evgine Mkhitaryan Write a letter cardiologist
Hasmik Hovhannisyan Hasmik Hovhannisyan Write a letter cardiologist
Education

 

Education material for specialists

 

Education material for Patients

 

  Catheter ablation in arrhythmia
Publications
Price list

 

15.07.2020 թ.

 

Medical care and Service

Price (AMD)

 

Primary consultation with doctor

10,000

 

Repeated consultation with doctor

5,000

 

Echocardiography

12,000

 

Transesophageal echocardiography (TEE) (outpatient)

20,000

 

ECG

1,600

 

Testing of Pacemaker

6,000

 

Holter monitor test

15,000

 

Treadmill test / (consultation is included)

15,000

 

Wound management

6,000

 

Online consultation (based on data provided by a relative of the patient)

20,000

 

On-site consultation (to other clinic)

15,000

 

 

 

Arrhythmology Inpatient Services

Implantations- bradyarrhythmias treatment

 

Pacemaker implantation/reimplantation

Price (AMD)

 

Pacemaker implantation/reimplantation, single-chamber EFFECTA SR, Biotronik

1,350,000

 

Pacemaker implantation/reimplantation single-chamber VITATRON SR, Medtronic

1,450,000

 

Pacemaker implantation/reimplantation single-chamber   SENSIA SR, Medtronic

1,650,000

 

Pacemaker implantation/reimplantation single-chamber   ADAPTA SR, Medtronic

1,750,000

 

Pacemaker implantation/reimplantation, dual-chamber EFFECTA DR, Biotronik

1,600,000

 

Pacemaker implantation/reimplantation, dual-chamber VITATRON DR, Medtronic

1,750,000

 

Pacemaker implantation/reimplantation dual-chamber SENSIA DR, Medtronic

1,850,000

 

Pacemaker implantation/reimplantation, dual-chamber ADAPTA DR, Medtronic

2,150,000

 

 

 

Implantations-Tachyarrhythmias treatment

 

Implantable cardioverter-defibrillator (ICD) implantations /reimplantations

Price (AMD)

 

ICD implantation/ reimplantation PROTECTA DR, Medtronic

5,300,000

 

ICD implantation/ reimplantation IFORIA 3 DR-T, Biotronic

3,900,000

 

ICD implantation/ reimplantation PROTECTA VR, Medtronic

4,950,000

 

ICD implantation/ reimplantation IFORIA 3 VR-T, Biotronic

3,800,000

The price of implantation of all other models not listed in the table is determined by a separate agreement

 

 

 

Implantations-Tachyarrhythmias treatment

 

Resynchronization of ventricular contraction ICD implantation

Price (AMD)

 

Resynchronization of ventricular contraction,device implantation/ reimplantation Consulta CRT-P, Medtronic

4,150,000

 

Resynchronization of ventricular contraction ICD implantation /reimplantation, Maximo II CRT-D, Medtronic

5,450,000

 

Resynchronization of ventricular contraction ICD implantation /reimplantation Maximo II CRT-D, Biotronik

5,000,000

 

Resynchronization of ventricular contraction ICD implantation /reimplantation, Consulta CRT-D, Medtronic

6,150,000

The price of implantation of all other models not listed in the table is determined by a separate agreement

 

 

 

Bradyarrhythmias treatment, others

 

Pacemaker implantations,others

Price {AMD)

 

Temporary epicardial pacing implantation

135,000

 

Pacemaker lead repositioning, UNCLASSIFIED

1,300,000

 

ICD Electrode repositioning

1,400,000

 

Left ventricular electrode repositioning

1,250,000

 

Atrial electrode repositioning

1,250,000

 

Right ventricular electrode repositioning

1,250,000

 

Wound revision

1,250,000

 

Subcutaneous pocket preparation

1,250,000

 

Pacemaker explantations /extractions

Price (AMD)

 

Pacemaker explantation

895,000

 

Cardioverter-Defibrillator Explantation

895,000

 

Resynchronization devices explantation for ventricular contraction

895,000

 

Resynchronization ICD devices explantation for ventricular contraction

895,000

 

Complete electrode extraction

1,000,000

 

Incomplete electrode extraction

1,000,000

 

 

Pacemaker electrode implantation

Price (AMD)

 

Epicardial electrode pacemaker implantation (on-site)

380,000

 

Right ventricular electrode lead implantation

1,150,000

 

 

Left ventricular electrode lead implantation

1,650,000

 

Atrial Electrode Implantation

1,150,000

 

Pacemaker/ICD electrode implantation UNCLASSIFIED       

1,000,000

 

 

 

Ablations

 

Paroxysmal ventricular tachycardia ablation

1,700,000

 

Paroxysmal supraventricular tachycardia ablation

1,300,000

 

His bundle ablation

1,300,000

 

Ablation for Atrial Tachycardia

1,300,000

 

Atrial fibrillation ablation

1,300,000

 

Reablation

850,000

 

Ablation failure

370,000

 

 

 

Diagnostic Interventions

 

Electrophysiology studies test (EPS) – Diagnostic

Price (AMD)

 

Electrophysiology studies test – transesophageal

175,000

 

Electrophysiology studies test – Intracardiac

370,000

 

EPS – epicardial (on-site)

400,000

 

Diagnostic (other)

 

 

Phlebography

75,000

 

Diagnostic mini system implantation Reveal DX

1,500,000

 

 

 

Inpatient treatment

 

Inpatient procedures

Price (AMD)/ (cost of bed and per day is not included

 

Cardioversion

55,000

 

Medication exam

35,000

 

Device-mediated EPS

65,000

 

Inpatient procedures Other

30,000

 

Transesophageal echocardiography (TEE)

45,000

 

Transcutaneous pacemaker implantation (temporal)

95,000

 

General anesthesia during procedure

125,000

 

Transesophageal echocardiography (TEE) with Cardioversion

80,000

 

Inpatient treatment/hospitalization

Price (AMD)/ (cost of bed and per day is not included

 

Cost for 1-Day treatment (medication and examinations are not included)

20,000

 

Cost for 2-Day treatment (medication and examinations are not included)

40,000

 

 Cost for 3-Day treatment (medication and examinations are not included)

60,000

 

Cost for 4-Day treatment (medication and examinations are not included)

80,000

 

Cost for 5-Day treatment (medication and examinations are not included)

100,000

 

Cost for 1-Day treatment (including medication, without examinations

30,000

 

Cost for 2-Day treatment (including medication, without examinations

60,000

 

Cost for 3-Day treatment (including medication, without examinations

90,000

 

Cost for 4-Day treatment (including medication, without examinations

120,000

 

Cost for 5-Day treatment (including medication, without examinations

150,000

 

Day-time inpatient treatment (medication and examinations are not included)

115,000

 

Inpatient treatment of the patient

175,000

 

Inpatient treatment with concomitant disease

215,000

 

Inpatient treatment with concomitant disease and/or complications   

265,000

 

Inpatient treatment complicated, with impairment of the function of the vital organs 

315,000

 

Treatments for severe somatic symptom disorder including non-profile examinations

515,000

 

Reimbursement of additional medicine, based on the actual costs incurred

1,000

 

Reimbursement of additional medicine, based on the actual costs incurred 1

5,000

 

Reimbursement of additional medicine, based on the actual costs incurred 2

10,000

 

Other inpatient service

Price (AMD)

 

Pacemaker implantation FAILED                                   

500,000

 

Left ventricular electrode implantation FAILED               

375,000

 

Diagnostic procedure FAILED                    

375,000

 

 

 

 

Cost of paid hospital rooms

Price (AMD)

 

Individual hospital-room

10,000

 

 

 

Bardyarrythmias treatment (other)

 

Pacemaker implantation other

Price (AMD)

 

Pacemaker repositioning UNCLASSIFIED, simple cases

1,150,000

 

ICD electrode repositioning, simple cases

1,250,000

 

Left ventricular electrode repositioning, simple cases

1,100,000

 

Atrial electrode repositioning, simple cases

1,100,000

 

Right ventricular electrode repositioning, simple cases

1,100,000

 

Wound revision, simple cases

1,100,000

 

Subcutaneous pocket preparation, simple cases

1,100,000

 

Pacemaker explantations /extractions

Price (AMD)

 

Pacemaker explantation, simple cases

745,000

 

Cardioverter-Defibrillator Explantation , simple cases

745,000

 

Resynchronization devices explantation for ventricular contraction, simple cases

745,000

 

Resynchronization ICD devices explantation for ventricular contraction, simple cases

745,000

 

Complete electrode extraction, simple cases

850,000

 

Incomplete electrode extraction, simple cases

850,000

 

Pacemaker electrode implantations 

Price (AMD)

 

 

Right ventricular electrode lead implantation, simple cases

1,000,000

 

 

Left ventricular electrode lead implantation, simple cases

1,500,000

 

Atrial Electrode Implantation, simple cases

1,000,000

 

Pacemaker/ICD electrode implantation UNCLASSIFIED, simple cases

850,000

 

 

 

Ablations

 

Paroxysmal ventricular tachycardia ablation, simple cases

1,550,000

 

Paroxysmal supraventricular tachycardia ablation, simple cases

1,150,000

 

His bundle ablation, simple cases

1,150,000

 

Ablation for Atrial Tachycardia, simple cases

1,150,000

 

Atrial fibrillation ablation, simple cases

1,150,000

 

Atrial fibrillation ablation (Pulmonary vein isolation), simple cases

2,250,000

 

Ablation, simple cases

1,100,000

 

Reablation, simple cases

700,000

 

Diagnostic mini system implantation Reveal DX, simple cases

1,350,000

 

 

 

 

 

 

 

 

 

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