Physician Update: AHA Special Edition
Read more articles from our most relevant research presented at the 2021 AHA Scientific Sessions.
Clinical Heart and Vascular Center
Professor of Internal Medicine
Director of Cardiology,
Parkland Health & Hospital System
It was my pleasure to moderate a #AHA21 session titled “Advances in EP: Leaks, Pacing, and Persistence.” The speakers were renowned scientists from the EP community across the world and discussed the latest science in electrophysiology.
Dr. Vivek Reddy, from the Mount Sinai Health System, reported that patients with incomplete left atrial appendage occlusion after receiving the Watchman device were at higher risk for ischemic stroke after one year. His data emphasize the importance of ensuring total occlusion of the left atrial appendage at the time of Watchman implantation. Fortunately, most strokes were not disabling, and the device remained beneficial in preventing stroke in the entire cohort.
The second presenter, the University of Amsterdam’s Dr. Reinoud Knops, reported a secondary analysis of the PRAETORIAN trial, demonstrating that transvenous and subcutaneous ICDs have comparable efficacy in terminating life-threatening arrhythmias. Yet, his analysis raised the possibility that anti-tachycardia pacing, a method to terminate some arrhythmias without painful shock, although generally effective, in some cases could accelerate arrhythmias and cause an “arrhythmic storm.”
“The speakers were renowned scientists from the EP community across the world and discussed the latest science in electrophysiology.”
Dr. Weijian Huang, of the Wenzhou Medical University in China, studied patients with atrial fibrillation with rapid ventricular response, in the setting of heart failure with reduced ejection fraction, who underwent ablation of the AV node followed by implantation of a pacemaker system. His group sought to determine the optimal pacing approach in this setting. He demonstrated that His bundle pacing, a novel method to pace the heart in a more physiologic manner, was possibly superior in improving cardiac function as compared to cardiac resynchronization therapy.
The last discussant was Dr. Andreas Goette from Germany’s St. Vincenz Hospital Paderborn and University Hospital Magdeburg, primary investigator of the EAST-AFNET 4 trial, an important study showing that early rhythm control improved clinical outcomes compared to usual care in patients with atrial fibrillation. He presented a secondary analysis of that trial demonstrating the importance of ruling out concomitant cardiac conditions in patients who present with atrial fibrillation for the first time.
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