Gulf Implantable Cardioverter-defibrillator Registry Reflects Advanced Cardiac Care in the Arab Gulf.

Forty-one years ago (1974) while I was a medical resident in Portland, Oregon at the University of Oregon Health Sciences Center, as it was called then (Oregon Health Sciences University now), I had a very nice and intelligent patient with recurrent ventricular tachycardia. He was an editor in the Oregonian daily newspaper. With all the sophisticated workup and antiarrhythmic therapy for that era, we could not help him much. I arranged with him to call me when he felt the tachycardia, and then I would meet him in the emergency room (ER) to cardiovert him under sedation with the electric defibrillator without admission to the hospital. He used to come to the ER for cardioversion every few months.

The above story of the newspaper editor reflects our handicap status in treating life-threatening arrhythmia in a well-known medical center, in a country that was and still is technically and scientifically the most advanced in the world – the USA. At that time, 41 years ago, cardiac care at home in our region – the Arab Gulf – was not developed yet. Properly trained cardiologists were rare in the region. Cardiopulmonary resuscitation was not even performed in most hospitals due to lack of knowledge and experience. There were Intensive Care Units in some hospitals but no coronary care units anywhere in the Gulf. Most of the Gulf patients who needed advanced medical care were sent abroad for treatment.

After completion of my training in the USA, I returned to establish a cardiology service in Qatar in August 1978. Within 3 months of my arrival, I had to insert the first permanent pacemaker in Qatar. I do not know if anyone inserted a permanent pace-maker in the Gulf before that date, but the press in the Gulf handled it as a miracle. Newspaper reporters came to see my patient with the pacemaker – Abdulla. His story was published locally and taken up by the Arabian Gulf and Egyptian newspapers. It was something new for laymen in the region. Abdulla's picture appeared in newspapers and magazines. He became an instant celebrity. The newly established Cardiology Division, including myself, shared in his glory. Through him, our cardiology section became known in the area. Patients came to us for treatment from the other Gulf States. I published that interesting story in Heart Views.[1]

In contrast to the above cardiac care status in the Gulf four decades ago, I could say with pride as a professional and an educated witness, that the cardiac care practiced in the Arab Gulf now is advanced, modern and up to the standards of this era. A good proof and testimony of this advancement is the enclosed paper in this issue of Heat Views (p.): The Gulf Implantable Cardioverter-Defibrillator Registry (Gulf ICD): Rationale, methodology, and implementation. For me, it is thrilling to witness the progress from the rarity of the permanent pacemaker to a registry targeting 1500 patients with ICD's in our region.

The above paper was submitted by my colleagues in the Gulf Heart Association (GHA). I, with other pioneer cardiologists from the Arab Gulf countries known as the Gulf Cooperation Council (GCC) states, created GHA in 2002 as a private, nonprofit, and nongovernment organization. GHA succeeded in establishing several multicenter cardiovascular registries in the Gulf, such as acute coronary syndrome (ACS), atrial fibrillations, and heart failure. The findings in these registries was published in leading international cardiology journals.[23456789] For us – the cardiologists in the Gulf – these registries helped disseminate correct information, exposing our strengths and weaknesses which was essential to improve the cardiac care of our patients. I admit that in our hospital in Doha, we worked hard to shorten our door to needle time for primary percutaneous coronary intervention after the result from the GHA Acute Coronary Syndrome registry showed us that we were not the best as we thought in that regard.

This (Gulf ICD) registry is also multicenter (15 centers in 6 of the GCC states: Saudi Arabia, United Arab Emirates, Kuwait, Oman, Bahrain, and Qatar). It is the first prospective, multinational, and systematic study of the characteristics and outcomes of patients receiving ICDs in the Gulf region. The paper stated that two-thirds of the centers have dedicated electrophysiology laboratories and the remaining centers implant ICDs in nondedicated cardiac catheterization laboratories or operating rooms. In 14 of the 15 centers ICDs are implanted exclusively by electrophysiologists. Since this paper is only concerned with the methodology, it is premature to discuss the outcomes related to ICD therapy and the medical achievement of treating life-threatening arrhythmia in the Gulf yet. We will have to wait for the data from the registry to tell us. I am sure several papers will be published in the future from this registry.

After I wrote the above I saw in my email an article dated 17 September, 2015 from the NEJM with the title of Percutaneous Implantation of an Entirely Intracardiac Leadless Pacemaker [Figure 1] in over 500 patients.[10]

Figure 1

Leadless pacemaker

I look forward to the future when GHA will publish a registry named: Gulf Leadless Cardioverter-Defibrillator Registry