Do we need more or better electrophysiology centres?

This editorial refers to ‘A survey of German centres performing invasive electrophysiology: structure, procedures, and training positions’ by H.-R. Neuberger et al ., on page 1741. Invasive electrophysiology (EP) and device implantation have markedly increased in complexity and in numbers. The possibility to ablate almost all arrhythmias and in particular atrial fibrillation (AF) has been accompanied by a growing number of EP centres, who have started to tackle all complex atrial or ventricular arrhythmias.In this issue of the Journal , Neuberger et al .1 make an interesting survey of the actual situation in Germany. Their conclusions are the following: first, the results indicate an increasing super-specialization of arrhythmology when, in the authors' opinion the link with or the dependence on general or interventional cardiology can be questioned. Secondly, AF has become the first indication for arrhythmia ablation with a continuous increase in number and a growing demand for the procedure, which has also been recently observed in other surveys.2 Another question arises regarding the adequacy of the training potential of the present structures as well as their ability to comply with the proposed criteria for training centres.3For us, it is surprising to observe, how the situation in our country is similar to observations in this survey, suggesting it is a reflection of the general situation in Europe. Looking at the spontaneous expansion of EP activity, the discussion has to be oriented towards complying with the obvious clinical need, and the necessity for a better regulated competency recognition and rational distribution of accredited high level and high-volume centres. On the other hand, excessive control by regulatory bodies may limit access of patients to state-of-the-art therapy. We would like to share our thoughts on this topic, working in a country with a well-organized insurance system.4Taking into …