Conference Reports in 2015

Dr Junaid A. B. Zaman (Cardiology Registrar - National Heart & Lung Institute, Imperial College London, UK / Postdoctoral Scholar- School of Medicine, Stanford University, USA)

1. American College of Cardiology, San Diego, 14-16th March.

Whilst normally not a meeting renowned for electrophysiology content, a new focus on high yield sessions and much more interactive format resulted in a very interesting and stimulating EP syllabus this year. Highlights included:

• Case based discussions with leaders in the EP field debating how to manage a case and audience voting at each stage. This was especially notable for the presence of a patient representative in the AF session, who informed a surprised audience of the Facebook group called ‘Stop Amiodarone’ and highlighted how more effort is needed in raising awareness of the latest treatments available.

• An excellent session on the current discoveries in EP that may lead to new treatments in the next few years such as a gene therapy (Dr Marco Perez, Stanford University) and biological pacemakers using tissue scaffolds (Dr Eugenio Cingolani, Cedars Sinai Medical Center).

• A ‘Controversies in Clinical Arrhythmia’ session which featured talks on risk of lead externalization, electrical remodeling after LAA ligation, outcomes using quadripolar LV leads, the silent AF burden in HOCM and the role of genetics in VT risk stratification (DISCOVERY Trial).

The next meeting will be held in Chicago next April.

2. European Cardiac Arrhythmia Society, Paris, 19-22nd April.

The 11th meeting of ECAS featured a very strong UK EP presence, with major centers in London and Eastbourne particularly providing a large proportion of research abstracts presented. Selected highlights of the 3-day program were as follows:

• Special lectures and workshops on:
o Update on catheter ablation of atrial fibrillation.
o Cardiac Resynchronization Therapy (CRT).
o CRT and Pacemaker ECG interpretation.
o Recent developments in anticoagulation for stroke prevention.

• Best Poster Prize was awarded to Dr Junaid Zaman (Imperial College London & Stanford University, USA) for his work on tissue structure function relationships in a new rat model of AF. The findings show that both direction of pacing and size of electrode used can affect the correlations between electrograms and underlying tissue structural factors such as fibrosis and connexin 43. These findings are important for study design and potentially explain the inconsistent human data correlating voltage and fibrosis detected by late gadolinium enhanced MRI. 3rd place went to another UK trainee, Dr Markus Sikkel (Imperial College London) on his description of use of the novel Rhythmia mapping system in atrial and ventricular arrhythmias.

• An excellent special lecture ‘The Story Behind the Discovery of Entrainment’, given by Dr Albert Waldo. 

The next meeting will be held in Rome next April.

3. Heart Rhythm Society Scientific Sessions, Boston, 13-16th May.

The 36th Annual Scientific Sessions gathered over 12,000 industry, healthcare and research professionals for the largest annual electrophysiology gathering globally. Specific highlights included the following:

• The AF summit started with the Founders’ Lectureship, awarded to Professor Gregory Lip (University of Birmingham, UK) who spoke on ‘Atrial Fibrillation: Stroke Risks and Decision Making’. The subsequent sessions were dominated by the recent STAR-AF II trial, published the week before HRS in the New England Journal of Medicine. The lead investigator Dr Atul Verma gave a detailed run-through of the trial results and implications. Reaction was mixed amongst the audience as the trial may not reflect the latest therapy, but the conclusion that effective wide antral ablation alone was the best evidence based ablation strategy in persistent AF is likely to impact current practice and future guidelines.

• The opening plenary by Stephen Johnson, a science author and subsequent host of a TV series in the USA, focused on innovation and how the concept of ‘eureka’ moments is often false. He also discussed the requirements for innovation to occur and especially how a critically diverse and freely exchangeable set of ideas was required for it to blossom – as was present in 18th century European coffee houses, which in his opinion was where the modern renaissance was born. He drew direct parallels with the multidisciplinary nature of EP and how millions of lives have been saved by efforts of societies’ such as HRS.

• The Basic/Translational Science Forum called ‘Emerging Science in AF’, a half-day program featuring state of the art talks on cellular EP, transcriptional and signaling pathways important for AF. It featured the Douglas Zipes lectureship presented by Professor Jose Jalife entitled ‘Mechanisms Underlying the Transition from Paroxymsal to Permanent AF’.

• A UK winner of the prestigious Highest Scoring Abstract in the Allied Professionals Category – Mr Ian Wright (Imperial College Healthcare NHS Trust) for his abstract entitled ‘Sudden Cardiac Death in Patients with a Normally Functioning ICD: a No-Win Situation?’

• A highly entertaining debate concerning the reliability of atrial fibrosis detection using imaging. After the proposer – Dr Ravi Ranjan (University of Utah) had detailed the Utah group’s research over the last decade, Professor Mark O’Neill (Kings College London), gave a well constructed and expertly delivered rebuttal over why it could neither be claimed that the techniques were reliable or accurate in detecting native fibrosis.

• A late breaking clinical trial showing botulinum toxin (Botox) prevented atrial tachyarrhythmias in 100% of a 60 patient randomized pilot study when injected into epicardial fat pads at the time of cardiac surgery after 1 year. This grabbed the attention of the chair, HRS president Dr John Day, who was featured in the media coverage of the conference commenting on the potential implications.

The next meeting will be held in San Francisco next May.

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