Highlights on...Lebanon 

The Lebanese Arrhythmia and Cardiac Pacing Working Group
by Professor Charles Jazra

About the Author

Dr Charles Jazra was trained in Nancy in the mid-1970s with Dr Bernard Dodinot, one of the pioneers in pacemaker implantation.  This gave him the opportunity to witness the development of different techniques and technologies in device implantation. He came back to Lebanon in 1978 and started implanting pacemakers.  Along with device implantation, he now also provides coronary angiography and angioplasties.

Dr Dodinot and C. Jazra in Byblos when we inaugurated the first implantation center in Lebanon in 1978

He is the Head of department at Saint Joseph's Hospital, and chairman of the working group of arrhythmia and cardiac pacing in the Lebanese Society of Cardiology.  He is also a past-president of the Lebanese Society of Cardiology and was behind the organisation of the first Middle East Cardiopace event in 2003.  In his hospital there are three EPs – he works alongside Samer Nasr and Johny Abboud, both of whom also perform ablation in other hospitals.

Lebanon: 400 new medical practitioners each year

Lebanon is a country of 10,400 square kilometres with over four million inhabitants.  Located on the eastern shore of the Mediterranean Sea, Lebanon is bordered by Israel to the south and Syria to the north and east, and is historically described as the gateway to the Middle East.  The country offers a vibrant mix of cultures, with influences from both the East and West, and from all the Arab countries.

For many years, Lebanon was considered the “Hospital of the Orient” because of the quality of our medical services.  Until recently, the country had two different medical systems working in parallel and represented by two different schools of medicine: the American University of Beirut and the French Faculty of Medicine. 

Today, we have a total of seven medical schools producing around 400 new medical practitioners each year.  This is well in excess of our own needs.  Typically, our newly qualified medical students travel abroad for further training – to North America (Canada and the USA) or France and Belgium, and increasingly to Russia and parts of Eastern Europe – and it is inevitable that many of them subsequently take jobs and settle outside Lebanon.

A little bit of history...

Looking back over the past 50 years of cardiology in our country, I would like to make a special note of the great job done in the 1960s by Prof. Stephan.  He followed families in the south of Lebanon and performed Electrocardiogrammes (ECGs) on all offspring of any patient who presented an Atrioventricular (AV) block, and found that minor or major conduction diseases were present.  These findings enabled him, in collaboration with experts from Europe, to identify a gene for the disease. 

The war in 1975 prevented continuous medical education for most of the physicians who remained in Lebanon.  During wartime, it was very difficult – for example – to convince people who were living under constant bombing to manage their risk factors, especially smoking.  As for arrhythmia, wartime practices were limited to implantation of pacemakers.

Old pacemakers

When the war ended, The Lebanese Society of Cardiology (founded in 1956) made a huge effort to update our physicians by organising meetings and arranging an international congress.  These tasks were made easier by the strong communication links that existed between students in training and their qualified colleagues.  Many medical practitioners returned from abroad, and Lebanon witnessed a growth in the numbers of cardio-thoracic centres.

Nowadays, the specialised centres for electrophysiology are:

• The American University of Beirut: Maurice Khoury and Oussama Wazni (where Pacemaker implantation started)
• Saint Georges Hospital, Beirut: Salah Choueiry and Johnny Abboud
• Notre Dame de Secours Hospital, Jbeil – Byblos: Antoine Kosseifi
• Mount Lebanon Hospital: Samer Nasr
• Al Rassoul Al Aazam Hospital: Hassan Mansour (where Atrial Fibrillation ablation started a few months ago)

Arrhythmia and Cardiac Pacing Working Group

The Lebanese Society of Cardiology in short:
 

The first Middle East Cardiopace conference was organised in 2003, attended by over 300 experts from the Middle East and Arab countries.  This meeting helped increase awareness of prevention of sudden death, and of ablative therapy.  It also intensified exchanges between different countries and generated stronger interest in Cardiac Resynchronization Therapy (CRT), Implantable Cardioverter Defibrillator (ICD) and other aspects of arrhythmia prevention and management

One of the main activities of our Arrhythmia and Cardiac Pacing Working Group inside Lebanese Society of Cardiology, is to organise this meeting on a bi-annual basis. The event is now endorsed by EHRA, and is unique to the region.  Most recently it gathered not just local Lebanese physicians but also participants from Syria, Jordan, Egypt, Iraq, Kuwait, Qatar, UAE, Libya, KSA and Europe.
C. Jazra and M. khoury (left)-chairmen of Cardiopace

Attendance is on the increase; we anticipate over 500 participants at the Fourth Middle East Cardiopace in Beirut, from 9th to 12th March 2011The programme will include lectures, symposia, mini-courses, debates, workshops, luncheon panels and webcasts
Please visit www.me-cardiopace.com

Talking about the future

Currently there is no specialised centre for device implementation in Lebanon, but many hospitals implant pacemakers and ICDs and there are three centres for ablation.  Many physicians remain reluctant to send their patients to these centres.

A programme for ablation of atrial fibrillation has been set up very recently by physicians returning to Lebanon with the necessary expertise from the US and France, and we are working on a registry to collect data on device implantation.  Because of funding restrictions, these are by necessity long-term projects.

For the future, there is certainly a need for greater awareness and education in Lebanon.  We are therefore looking forward to working in close collaboration with EHRA.

Useful links

White Book 2008 and 2009
Lebanese Society of cardiology
EHRA endorsed meetings

Recent articles

- Use of national intervention coronary registry data as evaluation tools for cardiovascular prevention strategies and treatment in developing countriesG. Saade¹, A. Sarkis¹, G. Ghanem¹, J. Haddad¹, S. Dada¹, C. Abdallah¹, G. Kiwan¹, M. Tabbal¹, W. Chalak¹, F. Farhat¹, ¹Lebanese Society of Cardiology - Beirut - Lebanon

- CTU II: ACCESS presenter slides Sobhy