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Erebouni MC / Էրեբունի ԲԿ

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.

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.

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

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 Write a letter Head of Electrophysiology & Intervention Arrhythmology Department Specialty:arrhythmologist - electrophysiologist
Ofelia Ghukasyan Write a letter Specialty:cardiologist	Evgine Mkhitaryan Write a letter Specialty:cardiologist
Hasmik Hovhannisyan Write a letter Specialty:cardiologist

Partners and sponsors

Education

Education material for specialists

Education material for Patients

Catheter ablation in arrhythmia

Publications

, Adamyan K.G., Tumasyan L.R., Chilingaryan A.L. - Comparative assessment of long term outcome of acute myocardial infarction with/without ST-segment elevation , Eur J Echocardiography Abstracts Supplement (2012) 13 (S1), i123
, S.Jamalyan, Z.Kartoyan, K.Petrosyan, L.Hayrapetyan - Development of Cardiac Electrophysiology in Armenia , Second International Medical Congress of Armenia, Yerevan, Armenia. 2007
, Smbat Jamalyan, MD, FESC - Emerging risk stratification in Syncope , The European Journal of cardiovascular medicine. Vol. I, issue II, summer 2010, p 38-48.
, Adamyan K.G., Tumasyan L.R., Chilingaryan A.L. - GRACE risk score as a predictor of short- and long-term events after acute myocardial infarction , IX Congress of Armenian Cardiologists Association / May, 2013
, S.V.Jamalyan - I control my heart failure or How can we live with heart failure “(patient guide in Russian)
, Alexandra Kiss, Edina Nagy-Baló, Gábor Sándorfi, Orsolya Hajas, Diana Tint, István Édes, Zoltán Csanádi - Learning curve in circular multipolar phased radiofrequency ablation of atrial fibrillation , Cardiology Journal (ahead of print). DOI: 10.5603/CJ.a2014.0085
, - Long-term outcome of patients presenting with acute myocardial infarction , VIII Congress of Armenian Cardiologists Association / May, 2011 / (1st Prize at the Young Scientists’ Competition)
, Adamyan K.G., Chilingaryan A.L. - Prognostic value of GRACE risk score as a predictor of short- and long-term events in patients with acute coronary syndrome. Review. Medical Science of Armenia , National Academy of the Republic of Armenia;N1-2014;3-11
, Adamyan K.G., Vardanyan S.I., Astvacatryan T.R., Mkhitaryan V.K. - Prognostic value of markers of endothelial dysfunction in patients with acute coronary syndrome , VIII Congress of Armenian Cardiologists Association / May, 2011
, Smbat Jamalyan, MD, FESC, Jan A. Staessen, MD, PhD, FAHA, FESC - Right Ventricular Outflow Tract Arrhythmias from single ectopic beats to arrhythmogenic right ventricular cardiomyopathy. , Healthcare bulletin. European cardiovascular disease. Clinical insights and practice. Spring edition 2009; page 12.
, Aharonyan A., Manukyan V., Hovaguimian H.S. - Surgical treatment of dysrythmias in rheumatic mitral disorders: early postoperative and long-term results , Panarmenian international surgical congress journal 2003.
, - Translation into Russian ESC pocket guideline: “Angina”and ESC pocket guideline: “Acute heart failure”
, - Translations into Russian ACC and ESC Guidelines:“Management of patient with Atrial Fibrillation” and “Hypertrophic cardiomyopathy”
, S.V. Jamalyan - When you receive anticoagulation therapy” (patient guide in Russian and Armenian

Special events and achievements

09.12.2016 - MC Erebouni and MC Erasmus (Holland): New prospects for cooperation in arrhythmology
02.05.2015 -
03.11.2014 - First conference of Armenian Heart Rhythm Association
31.10.2014 -
30.10.2014 -
09.06.2014 -

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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