Radiofrequency Ablation for Treating Cardiac Arrhythmias in Brazil: Status in the Unified Health System

Abstract Background: Cardiac arrhythmias compromise quality of life and are associated with greater morbidity and mortality. Pharmacological treatment generally has limited efficacy and often causes adverse effects. Radiofrequency ablation is effective and indicated for treating various arrhythmias; however, this therapeutic modality is not widely available in Brazil through the Unified Health System (SUS). Objective: To analyze ablation procedures in the treatment of cardiac arrhythmias performed in Brazil by the SUS in 2019, in order to identify factors that limit the availability of this treatment to patients served by the SUS. Methods: This retrospective study analyzed data from the Hospital Information System (SIH/SUS) and the National Registry of Health Facilities (CNES). The procedures were classified according to their complexity. The infrastructure of the accredited centers was assessed based on the availability of necessary equipment and trained professionals. Results: In 2019, 6,471 electrophysiology procedures were performed by the SUS in Brazil, and 82% were low or medium complexity (groups 1 to 3). The South and Southeast Regions concentrated the majority of procedures (48% and 31%, respectively). Only 53% of centers had registered all the necessary equipment. The cost of materials exceeded the amount reimbursed by the SUS by 1.5- to 4.8-fold. Conclusions: Within the SUS, there is a significant regional disparity in the availability of electrophysiology services, especially in the North and Northeast Regions. The lack of properly equipped centers and the low reimbursement of procedures are critical challenges to improving access to arrhythmia treatment in Brazil.