The impact of reimbursement on the usage of pacemakers, implantable cardioverter defibrillators and radiofrequency ablation.

An international questionnaire survey was carried out in Asia Pacific, Europe, Latin America and North America to assess the impact of reimbursement on the indications, types of device prescription and waiting time for pacemakers, implantable cardioverter defibrillators (ICD) and radiofrequency ablation therapy for cardiac arrhythmias. The indications for cardiac pacing can be restricted to more symptomatic patients when funding is limited, and new therapy such as cardiac resynchronization therapy (CRT) is restricted in many regions. ICD usage may be limited to secondary prevention candidates because of reimbursement, but referral doctor's ambivalence and knowledge are also important issues independent of the types of health care system. Radiofrequency ablation is generally well accepted, but reimbursement is heterogeneous, with non-fluoroscopic mapping being reimbursed only in a limited way worldwide. Thus with the exception of a well-developed health care system, reimbursement has a major impact on the delivery of arrhythmia management devices and procedures worldwide.