http://www.theheart.org/editorial-program/1225027.do The Heart Rhythm Society (HRS) 2011 Scientific Sessions took place in San Francisco and key trials presented at the sessions include: DISCERN-AF, ALTITUDE, PRELUDE, HRS/EHRA Consensus Statement, Working with industry, VT Ablation Study, EFs CONFIRM, Subcutaneous-lead ICD, AEDs and RAFT.

1. HRS 2011 research highlights:
A slideshow presentation

2. HRS 2011 Research Highlights
The Heart Rhythm Society (HRS) 2011 Scientific Sessions took place in
San Francisco, CA, from May 4 through May 7, 2011.
Key trials presented at the sessions include:
DISCERN-AF: Asymptomatic atrial-fib recurrence clouds perception of
ablation success
ALTITUDE: "Inappropriate" ICD shocks off the hook for mortality increase
PRELUDE: Inducibility in the EP lab a poor risk stratifier in Brugada
syndrome
HRS/EHRA Consensus Statement: New recommendations for genetic
testing of various channelopathies and cardiomyopathies
Working with industry: ProPublica investigates industry dollars at
medical meetings and new HRS task force stresses transparent
collaboration
VT Ablation Study: High VT recurrence, mortality, and heart
transplantation in VT ablation patients with very low EFs
CONFIRM: Ablating electrical "rotors" plus pulmonary vein isolation gets
results in persistent AF
Subcutaneous-lead ICD: Experience gained; niches, limitations found
AEDs: Lives saved in "nontraditional" exercise facilities, including bowling
alleys and dance halls
RAFT: Fidelis lead fracture rates higher in CRT-ICD devices
View our complete HRS coverage here here.

3. DISCERN-AF
Results: A small prospective cohort study has expanded on
earlier trials in finding that while catheter ablation does sharply
reduce the prevalence of atrial fibrillation (AF) for many
patients, there may be a disparity between what patients feel is
an AF recurrence and what the heart is actually doing.
"More than half of the symptoms recorded by the patients had
no associated arrhythmia episode, indicating that not only were
patients overrecording, but that their recording was not entirely
reflective of arrhythmia recurrence," noted Dr Atul Verma
(Southlake Regional Health Centre, Newmarket, ON), a co-
primary investigator of the study.
See: DISCERN-AF: Asymptomatic atrial-fib recurrence clouds
perception of ablation success

4. ALTITUDE
Results: An analysis from the ALTITUDE study, in which
patients with primary-prevention implantable cardioverter-
defibrillators (ICDs), with or without biventricular pacing, were
followed with remote monitoring for up to five years, confirms
and expands on earlier studies suggesting that inappropriate
ICD shocks increase mortality. The elevated risk of death from
such shocks was in patients with atrial fibrillation (AF) or atrial
flutter; mortality didn't go up with inappropriate shocks triggered
by other conditions, such as sinus tachycardia or device
oversensing.
As the invited commenter for Powell's presentation, Dr Michael R Gold (Medical University of South Carolina, Charleston)
said the analysis "shows the power of these very large databases to be able to point out to us things we can't do in
randomized studies." In this case, he said, ALTITUDE "shows further evidence that it's likely the substrate or arrhythmias,
and not the shocks themselves, that are killing people."
See: ALTITUDE: "Inappropriate" ICD shocks off the hook for mortality increase

5. PRELUDE
Results: An analysis based on an Italian registry of patients with Brugada syndrome suggests that VT/VF inducibility by
programmed electrical stimulation (PES) is not a significant predictor of sudden death and therefore can't effectively be used
to risk-stratify such patients for treatment with an implantable cardioverter-defibrillator (ICD).
"As expected", said Dr Carlo Napolitano (Fondazione Salvatore Maugeri, Pavia, Italy), "we confirmed the prognostic value
of a spontaneous 'type-1' electrocardiogram and a history of syncope" in Brugada syndrome. "But for the first time in a large
prospective cohort, we [also] show that QRS fragmentation [QRS-f] and a ventricular refractory period [VRP] < 200 ms are
independent risk indicators."
See: PRELUDE: Inducibility in the EP lab a poor risk stratifier in Brugada syndrome

6. Health Policy Town Hall
The Health Policy Town Hall at the HRS 2011 Scientific Sessions took
place on Wednesday, May 4, 2011.
The session focused on regulatory issues and health policy and included
the following presentations:
Regulation of Devices throughout the Total Product Life Cycle: FDA
Update 2011, presented by Mitchell J Shein, Food and Drug
Administration, Silver Spring, MD
EMC Issues including Radio Frequency Identification, presented by Dr
Soma S Kalb, Food and Drug Administration, Silver Spring, MD
Expanding and Limiting Indications for CRT, presented by Dr Kimberly A
Selzman, Food and Drug Administration, Silver Spring, MD
MR and Implantable Pacemakers, presented by Dr Brian Lewis, Food and Drug Administration; Center for Devices and Radiological
Health, Silver Spring, MD
Why Collect Longitudinal Data: Quality Improvement, Payment: Pay for Performance, Public Accountability, Research, presented by Dr
Kathleen Blake, New Mexico Heart Institute, Albuquerque, NM
Advantages of Registries, presented by Dr Stephen C Hammill, Mayo Clinic, Rochester, MN
Disadvantages of Registries, presented by Dr Eric N Prystowsky, The Care Group, LLC, Indianapolis, IN
The Danish Pacemaker and ICD Registry, presented by Dr Jens B Johansen, Odense University Hospital, Odense, Denmark

7. HRS/EHRA Consensus Statement on Genetic Testing
Summary: The Heart Rhythm Society (HRS) and European
Heart Rhythm Association (EHRA) have released a joint
statement on the current state of testing for various genes that
cause channelopathies and cardiomyopathies, stating that while
genetic testing is recommended for some disorders and is
considered useful in others, it is just one piece of information
used to diagnose patients and should not be used to circumvent
the clinical decision-making process.
"We have to communicate to the cardiology community and to users of these tests that these are not simple blood tests,"
said lead coauthor Dr Michael Ackerman (Mayo Clinic, Rochester, MN). "Before any test is ordered for genetic testing,
there has to be genetic counseling provided and administered to the patient and their families. Genetic counseling needs to
be provided by a qualified healthcare provider."
See: New recommendations for genetic testing of various channelopathies and cardiomyopathies: HRS/EHRA

8. VT Ablation Study
Results: Ablation of ventricular tachycardia (VT) in patients with
very low ejection fractions (EFs) results in high rates of early
recurrence compared with individuals with low EFs. Even
successful ablation does not reduce short-term mortality or
reduce the need for heart transplantation in this very low EF
population, according to the results of a new study.
"The patients with very low ejection fractions who come into the
clinic with ventricular tachycardia, and we ablate them, they still
have very high rates of recurrences," said Dr Stanley Tung
(Brigham and Women's Hospital, Boston, MA). "On top of that,
even if they don't come back with any recurrences, we found
that their overall mortality is still very high and that they're likely
to die from other problems. It suggests this is a very sick
population, and while we can maybe modify the substrate, the
mortality rates are high."
See: High VT recurrence, mortality, and heart transplantation in
VT ablation patients with very low EFs

9. Poster sessions
Over 1000 posters were presented at the HRS 2011 Scientific
Sessions.
Moderated poster sessions included the following:
Lessons Learned from CRT Trials
Chair: Dr Angel R Leon, Emory University, Atlanta, GA
Novel Mapping Strategies and Ablation Techniques in SVT,
Chair: Dr Amin Al-Ahmad, Stanford University Medical Center,
Stanford, CA
Risks and Predictors of ICD Shocks
Chair: Dr Claudio D Schuger, Henry Ford Hospital, Detroit, MI
Advances in EP Technology
Chair: Dr Glenn I Fishman, New York University, New York, NY
Atrial Fibrillation and Thromboembolism
Chair: Dr Eric M Grubman, Cardiology Associates of New
Haven, New Haven, CT

10. CONFIRM
Results: The use of an investigational diagnostic mapping
system designed to locate electrical sources not traditionally
ablated during conventional atrial-fibrillation (AF) ablation
procedures identified localized electrical rotors, or focal drivers,
of AF in nearly all patients. Furthermore, ablation of these focal
electrical sources, in addition to conventional wide-area
circumferential ablation (WACA) of the pulmonary veins,
resulted in significantly better outcomes than pulmonary vein
isolation alone.
"The results from the study show that with a single procedure
we can improve the success rate over conventional ablation,
and we should really evaluate the way we think about atrial
fibrillation," said lead investigator Dr Sanjiv Narayan (University
of California, San Diego).
See: Ablating electrical "rotors" plus pulmonary vein isolation
gets results in persistent AF

11. Subcutaneous-lead ICD
Summary: Burgeoning experience with an implantable
cardioverter-defibrillator (ICD) that has an entirely
subcutaneous lead system (S-ICD, Cameron Health, San
Clemente, CA) continues to suggest that it's as effective at
stopping potentially lethal arrhythmias as a transvenous-lead
ICD, but it's also highlighting some limitations to balance its
undeniable attributes.
"It won't replace transvenous systems; it's an alternative for selected patients. We use it in about 10% of our implants," said
Dr Lara Dabiri Abkenari (Erasmus Medical Center, Rotterdam, the Netherlands). "We exclude patients who have higher-
degree [atrioventricular] AV block or any kind of symptomatic bradycardia. And patients with nonsustained or sustained
VT—they would probably benefit from [antitachycardia pacing] and would not get the subcutaneous system. Also very
decompensated patients or those with a potential for resynchronization therapy in the future would not get it, either."
See: Experience gained with subcutaneous-lead ICD; niches, limitations found

12. Automated external defibrillators (AED)
Results: A bowling alley might not be a place expected to have
an automated external defibrillator (AED), but a new study
suggests that such facilities should have the devices on hand.
In fact, the placement of AEDs at nontraditional exercise
facilities improves survival rates after sudden cardiac arrest, say
experts.
"The thing that is interesting is what these people were doing
when the events happened," Dr Richard Page (University of
Wisconsin, Madison) told heartwire. "They were playing
basketball, dancing, and bowling. One in 25 deaths occurred at
the bowling alley. You don't think of bowling as physically
demanding, but there is some exertion. The take-home
message that I'm hoping to get out there is that survival is
actually pretty good if sudden cardiac arrest occurs in an
exercise facility. We could probably make it better by having
AEDs not just at fitness clubs but also at other less traditional
exercise facilities, like a dance studio or a bowling alley."
See: Bowling alleys and dance halls: AEDs save lives in
"nontraditional" exercise facilities

13. Malpractice crisis
One of the "Hyde Park" presentations at the HRS 2011
Scientific Sessions on Friday, May 6, 2011 focused on the
"Malpractice Crisis."
The session was presented by Dr Peter R Kowey, Mainline
Heart Center, Wynnewood, PA

14. RAFT
Results: Fracture rates with the Sprint Fidelis (Medtronic,
Minneapolis, MN) lead are significantly higher among patients
who received an implantable cardioverter defibrillator with
cardiac resynchronization therapy (ICD-CRT) than those who
received an ICD alone, a new study shows.
"There is a lot of work being done on identifying the risk factors
that might help us predict lead fracture, something that's very
important," lead investigator Dr Ratika Parkash (Queen
Elizabeth II Health Sciences Center, Halifax, NS) told
heartwire. "This is one of the findings, and what we found was
that patients with a CRT have nearly three times the risk of
fracture than patients with a standard ICD. The fact that it was
so dramatic is actually quite surprising."
See: Fidelis lead fracture rates higher in CRT-ICD devices

15. Underutilization of ICDs
The "Hyde Park" presentation at the HRS 2011 Scientific
Sessions on Thursday, May 5, 2011 focused on the
underutilization of ICDs.
The session was presented by Eric N Prystowsky MD of The
Care Group, LLC, Indianapolis, IN.

16. For more information
HRS Scientific Sessions
HRS 2011 coverage on theheart.org
HRS 2011 on Medscape

17. Credits and disclosures
Editor:
Shelley Wood
Managing Editor, heartwire
Kelowna, BC
Disclosure: Shelley Wood has disclosed no relevant financial relationships.
Contributor:
Steven Rourke
Manager, Editorial Programming
theheart.org
Montreal, QC
Disclosure: Steven Rourke has disclosed no relevant financial relationships.
Journalists:
Michael O'Riordan, theheart.org
Toronto, ON
Disclosure: Michael O'Riordan has disclosed no relevant financial
relationships.
Steve Stiles, theheart.org
Fremont, CA
Disclosure: Steve Stiles has disclosed no relevant financial relationships.

18. More slideshows
ACC 2011 research highlights
AHA 2010 research highlights: A slideshow
presentation
TCT 2010 research highlights: A slideshow
presentation

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