HRS 2011 research highlights:A slideshow presentation
HRS 2011 Research Highlights                    The Heart Rhythm Society (HRS) 2011 Scientific Sessions took place in     ...
DISCERN-AF             Results: A small prospective cohort study has expanded on             earlier trials in finding tha...
ALTITUDE                                                              Results: An analysis from the ALTITUDE study, in whi...
PRELUDEResults: An analysis based on an Italian registry of patients with Brugada syndrome suggests that VT/VF inducibilit...
Health Policy Town Hall                                                              The Health Policy Town Hall at the HR...
HRS/EHRA Consensus Statement on Genetic Testing                                                              Summary: The ...
VT Ablation Study                    Results: Ablation of ventricular tachycardia (VT) in patients with                   ...
Poster sessions                  Over 1000 posters were presented at the HRS 2011 Scientific                  Sessions.   ...
CONFIRM          Results: The use of an investigational diagnostic mapping          system designed to locate electrical s...
Subcutaneous-lead ICD                                                                Summary: Burgeoning experience with a...
Automated external defibrillators (AED)                     Results: A bowling alley might not be a place expected to have...
Malpractice crisis                     One of the "Hyde Park" presentations at the HRS 2011                     Scientific...
RAFT       Results: Fracture rates with the Sprint Fidelis (Medtronic,       Minneapolis, MN) lead are significantly highe...
Underutilization of ICDs                      The "Hyde Park" presentation at the HRS 2011 Scientific                     ...
For more information                       HRS Scientific Sessions                       HRS 2011 coverage on theheart.org...
Credits and disclosures                      Editor:                      Shelley Wood                      Managing Edito...
More slideshows                  ACC 2011 research highlights                  AHA 2010 research highlights: A slideshow  ...
Become a member of http://www.theheart.org    Become a fan on Facebook: http://www.facebook.com/theheartorg          Follo...
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HRS 2011 research highlights: A slideshow presentation

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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.

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HRS 2011 research highlights: A slideshow presentation

  1. 1. HRS 2011 research highlights:A slideshow presentation
  2. 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. 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. 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 didnt go up with inappropriate shocks triggered by other conditions, such as sinus tachycardia or device oversensing.As the invited commenter for Powells 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 cant do inrandomized studies." In this case, he said, ALTITUDE "shows further evidence that its 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. 5. PRELUDEResults: An analysis based on an Italian registry of patients with Brugada syndrome suggests that VT/VF inducibility byprogrammed electrical stimulation (PES) is not a significant predictor of sudden death and therefore cant effectively be usedto 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 valueof a spontaneous type-1 electrocardiogram and a history of syncope" in Brugada syndrome. "But for the first time in a largeprospective cohort, we [also] show that QRS fragmentation [QRS-f] and a ventricular refractory period [VRP] < 200 ms areindependent risk indicators."See: PRELUDE: Inducibility in the EP lab a poor risk stratifier in Brugada syndrome
  6. 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, MDMR and Implantable Pacemakers, presented by Dr Brian Lewis, Food and Drug Administration; Center for Devices and RadiologicalHealth, Silver Spring, MDWhy Collect Longitudinal Data: Quality Improvement, Payment: Pay for Performance, Public Accountability, Research, presented by DrKathleen Blake, New Mexico Heart Institute, Albuquerque, NMAdvantages of Registries, presented by Dr Stephen C Hammill, Mayo Clinic, Rochester, MNDisadvantages of Registries, presented by Dr Eric N Prystowsky, The Care Group, LLC, Indianapolis, INThe Danish Pacemaker and ICD Registry, presented by Dr Jens B Johansen, Odense University Hospital, Odense, Denmark
  7. 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 tobe provided by a qualified healthcare provider."See: New recommendations for genetic testing of various channelopathies and cardiomyopathies: HRS/EHRA
  8. 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 Womens Hospital, Boston, MA). "On top of that, even if they dont come back with any recurrences, we found that their overall mortality is still very high and that theyre 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. 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. 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. 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 its as effective at stopping potentially lethal arrhythmias as a transvenous-lead ICD, but its also highlighting some limitations to balance its undeniable attributes."It wont replace transvenous systems; its an alternative for selected patients. We use it in about 10% of our implants," saidDr 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 sustainedVT—they would probably benefit from [antitachycardia pacing] and would not get the subcutaneous system. Also verydecompensated 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. 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 dont think of bowling as physically demanding, but there is some exertion. The take-home message that Im 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. 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. 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 thats 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. 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. 16. For more information HRS Scientific Sessions HRS 2011 coverage on theheart.org HRS 2011 on Medscape
  17. 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 ORiordan, theheart.org Toronto, ON Disclosure: Michael ORiordan has disclosed no relevant financial relationships. Steve Stiles, theheart.org Fremont, CA Disclosure: Steve Stiles has disclosed no relevant financial relationships.
  18. 18. More slideshows ACC 2011 research highlights AHA 2010 research highlights: A slideshow presentation TCT 2010 research highlights: A slideshow presentation
  19. 19. Become a member of http://www.theheart.org Become a fan on Facebook: http://www.facebook.com/theheartorg Follow us on Twitter: http://www.twitter.com/theheartorgtheheart.org is the leading online source of independent cardiology news.We are the top provider of news and opinions for over 100 000 physicians.

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