Highlight on... Lithuania 

Lithuanian working group on Cardiac Arrhythmias and Pacing

by Doctor Germanas Marinskis

About the Author

Dr Germanas Marinskis started working in clinical electrophysiology in 1986, at first in Kaunas Arrhythmia Surgery Centre, and in 1991 moved to Vilnius where together with his colleague, Dr Audrius Aidietis (present chairman of Lithuanian Working group on pacing and electrophysiology), implemented most of the methods used in arrhythmia treatment and pacing.

Dr Marinskis is now Head of Department of Cardiac Arrhythmias and Invasive Cardiology at Vilnius University hospital, and president-elect of the Lithuanian Society of Cardiology. The electrophysiology/pacing team in Vilnius consists of six doctors.

Lithuania:

Lithuania is the southernmost and biggest of three Baltic countries, and accounts for slightly more than three million inhabitants in 2011. By the end of  the 14th century, Lithuania was the largest country in Europe, and its geographical position between East and West played a major role in the past whose importance is still felt today. Depending on calculation methods and presumed borders of Europe, one of the possible geographical centres of Europe is located in Lithuania.
There are two medical schools in the country, Vilnius University and Lithuanian University of Heath Sciences in Kaunas, producing doctors who now work not only in Lithuania but across the European Union, and there are teaching programs for English-speaking students.

 A little bit of history...

The history of cardiac pacing and electrophysiology in Lithuania (until 1991 part of the Soviet Union) started in 1960 by Professor Jurgis Bredikis, who implanted the first cardiac pacemaker in the territory of former USSR. Later, in the late 70s, the developement of arrhythmology continued with arrhythmia surgery, at that time, the most innovative field of cardiac surgery. All-Union Centre for Arrhythmia Surgery and Cardiac Pacing was established and led by Professor J Bredikis and located in Lithuania.
Professor Jurgis Bredikis (left) and electronic engineer P. Kazakevicius. Their vacuum lamp external pacemaker in 1960 (right).

Enormous numbers of patients from all over the Soviet Union came for treatment to Lithuania, allowing to develop an understanding of intracardiac electrophysiology, primarily as a diagnostic step before open heart surgery, and later as a background for catheter ablation. Hundreds of surgical cryoablation procedures for Wolff–Parkinson–White (WPW) syndrome have been performed yearly. This led to the evolution of clinical cardiac electrophysiology, and the first procedures of DC-shock ablation and RF-current ablation were performed in several months after first cases had been published. This leading position in arrhythmia treatment allowed for the establishment of a teaching facility – Department of Cardiac Pacing, where hundreds of physicians from all over the Soviet Union gain their first experience in theory and practice of electrophysiology. Arrhythmia surgery and catheter ablation procedures were also performed in the  Cardiac Surgery unit of  Vilnius University hospital.

After Lithuania's restoration of independence in 1991, three centres for cardiac electrophysiology were established in Kaunas, Vilnius and Klaipeda cities. Since 2007, a fourth centre in Panevezys has started to implant pacemakers. Now, most of the modern modalities of pacing and arrhythmia treatment procedures are performed, however, some of the most sophisticated are limited in numbers because of budget restrictions.

The Lithuanian Working Group on Cardiac Arrhythmias and Pacing is a part of the Lithuanian Society of Cardiology and now includes 15 members. Plans for expanding the clinical facilities will involve new specialists and will increase the number of procedures including atrial fibrillation catheter ablation.
Lithuania has a strong tradition of meetings on cardiac pacing and electrophysiology called  "Arrhythmia-Lithuania" that started in 1992 and takes place bi-annually in turn in Kaunas, Vilnius and Klaipeda. In the beginning they were planned as dedicated meetings for electrophysiologists, although in recent years these meetings are aimed at a broader audience and range of specialties. 

The Lithuanian Society of Cardiology in brief:

Recently, the 10th Symposium Arrhythmia Lithuania 2010, highlighted 'atrial fibrillation, from basic electrophysiology to ablation and prevention'.
Future plans of  Lithuanian electrophysiologists are evolving catheter ablation of atrial fibrillation and other complex cases, expanding ICD and CRT-D implantation for primary prevention, implementation of genetic tests and much more.

Lithuanian electrophysiologists are not only colleagues. Because we are a small community, we feel like one family, sharing not only professional problems, but also leisure time. Colleagues from Klaipeda, a seaside city, organize the yearly traditional ice fishing weekend. It gives us the opportunity to know one another better personally and discuss professional problems unofficially, as if with good friends...

Talking about the future

Future plans of  Lithuanian electrophysiologists are evolving catheter ablation of atrial fibrillation and other complex cases, expanding ICD and CRT-D implantation for primary prevention, implementation of genetic tests and much more.

To increase the numbers of catheter ablation procedures for atrial fibrillation, new facilities are necessary, and insufficient funding seems to be one of mail obstacles.

To implement European guidelines, we need to communicate with patient organisations and collaborate with our colleagues and politicians and the help of EHRA in this area is invaluable.

Useful links

EHRA White Book (2008, 2009, 2010)

Lithuanian Society of Cardiology

EHRA endorsed meetings