Ragil Nur Rosyadi Highlights Indonesia's Electrophysiology Market Potential and Calls for Enhanced International Collaboration

Electrophysiology StudyAn electrophysiology (EP) study is a cardiac diagnostic procedure that plays a critical role in the evaluation and management of arrhythmias (irregular heartbeats). It not only helps identify abnormal electrical signal pathways within the heart that cause arrhythmias, but also enables physicians to formulate more precise treatment plans—including pharmacological therapy, pacemaker implantation, or ablation procedures—through comprehensive cardiac electrophysiological assessment.

In Indonesia, the improvement of cardiovascular disease treatment is receiving further attention from the government. Surabaya, the second-largest city in Indonesia, is located in eastern Java and serves as the capital of East Java Province.

As one of Indonesia’s primary economic hubs, Surabaya boasts well-developed industrial and commercial sectors. The city’s current status and development trends will also serve as a microcosm of the future evolution of Indonesia’s healthcare system. Recently, at the Top 100 Summit held during the VBEF Future Healthcare Ecosystem Exhibition organized by VCBeat,Mr. Ragil Nur Rosyadi, a cardiologist at Dr. Ramelan Central Naval Hospital in Surabaya, shared insights on the current status of electrophysiology studies in Surabaya, Indonesia, under the theme “EP in Surabaya, Indonesia.”

Surabaya is a major seaport city in Indonesia, playing a pivotal role in the nation’s trade and economic development. As the primary city in East Java, Surabaya boasts a large population base as well as high-quality medical facilities and professional talent, giving it distinct advantages and resources in the healthcare sector.

At the conference, Dr. Ragil began by providing a detailed overview of the current status and opportunities in electrophysiology testing in Surabaya.

In the Asia-Pacific region, the electrophysiology (EP) examination market is poised for significant growth. The APAC market was valued at USD 1.252 billion in 2021 and is projected to more than triple by 2027. This presents an opportunity to optimize EP and cardiovascular services in Indonesia, with Surabaya and the eastern regions emerging as frontrunners amid intensifying competition.

Dr. Ragil provided an overview of Indonesia’s population and healthcare resources. In 2018, Indonesia had a population of approximately 265 million, around 303,000 hospitals, and roughly 223,000 physicians. Despite its large population, there is a lack of specific data on patients with sudden cardiac death, heart failure, and arterial atrial fibrillation.

In 2021, there were 65 to 67 centers nationwide in Indonesia capable of providing arrhythmia treatment. Regarding the use of medical devices, Indonesia has a low pacemaker implantation rate, with 16,000 cases recorded in 2018 and no significant change by 2021, representing a ratio of approximately 1 per 130,000 people. In terms of ICD (Implantable Cardioverter Defibrillator) application, the total number of AEDs (Automatic External Defibrillators) implanted in Indonesia amounted to only 66 units by 2023. With respect to ablation procedures, the volume in Indonesia was low, reaching merely 1,000 cases in 2021, particularly for atrial fibrillation treatment. Although ablation is one of the recommended treatments for atrial fibrillation, Indonesia’s ablation rate relative to its population is the lowest in the Asia-Pacific region.

Arrhythmia care services and resources are scarce in Indonesia. However, with socioeconomic development, the related demand is continuously rising, posing increasingly severe challenges to the healthcare system. Dr. Ragil stated that in the future, Indonesia would need to implant pacemakers in approximately 20.3 million people to raise its implementation rate to a level comparable to China’s. To increase Indonesia’s ICD implantation rate to China’s level (5.79), ICDs would need to be implanted in approximately 1.6 million people. Additionally, ablation procedures would need to be performed on approximately 28 million people to bring the ablation rate up to China’s level.

Therefore, Indonesia holds significant growth potential in electrophysiology services and cardiovascular treatment. Strengthening human resources, technology, and financial resources is essential to improve the quality and accessibility of healthcare services. Furthermore, international cooperation, particularly in knowledge sharing, technical training, and research collaboration, is crucial for enhancing Indonesia’s healthcare services.

Surabaya, Indonesia, is welcoming significant opportunities to provide ablation and pacemaker implantation services for patients; however, achieving this goal requires strengthening electrophysiology (EP) and cardiovascular services. Talent, equipment and technology, and funding will become the three core pillars promoting the treatment of cardiovascular diseases.

Currently, Indonesia faces a shortage of electrophysiologists and technical training personnel, as well as a lack of necessary medical facilities and financial resources, compounded by low reimbursement rates under public insurance. To address these challenges, Indonesia needs to collaborate with countries such as China to enhance human resources, strengthen talent development, and build technical capacity through knowledge sharing, participation in conferences, workshops, online courses, and research collaborations, thereby improving the level of cardiovascular care services.

Dr. Ragil noted that Indonesia still requires affordable, high-quality diagnostic and therapeutic tools, including electrocardiograms (ECG), Holter monitors, treadmill stress testing systems, echocardiography, 3D mapping systems, pacemakers, radiofrequency ablation devices, cryoablation devices, coronary stents, temporary pacing leads, as well as diagnostic and ablation catheters for digital subtraction angiography (DSA) and electrophysiology (EP). Public hospitals face challenges in managing consumable costs and urgently require cost-effective medical supplies to support their development.

Furthermore, adequate funding and resource sharing remain a major challenge. Indonesia needs to address this issue through private or public insurance schemes and potential partnerships with charitable organizations. By implementing these measures, Indonesia can strengthen cardiovascular services in the field of electrophysiology, thereby enhancing the overall quality and accessibility of healthcare.