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News from the Heart Rhythm Congress 2016

The largest heart rhythm event in the UK – the Heart Rhythm Congress – took place at the International Convention Centre in Birmingham between 9–12th October 2016. This was a unique meeting showcasing the latest developments in arrhythmia care, together with arrhythmia patient day meetings, nurse education and specialist further accreditation for cardiac physiologists. Dr Rahul Mukherjee (Clinical Research Fellow in Cardiac Electrophysiology, Guys and St Thomas’ Hospital Biomedical Research Centre) reports on some of the highlights from this meeting.

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News from the Heart Rhythm Congress 2016


Healthcare costs and innovative solutions for arrhythmia care

Healthcare costs and innovative solutions for arrhythmia care

In an increasingly difficult economic climate, it is more important than ever to develop innovative solutions to the rising cost of healthcare. Professor Richard Schilling, President Elect of the British Heart Rhythm Society (Barts Health NHS Trust, London), proposed novel solutions to the rising cost of arrhythmia care during the plenary session. He highlighted the need to simplify the patient journey by empowering paramedics to treat supraventricular tachycardias (SVTs) and reduce hospital admissions; having a national online resource for patients with intelligent information delivery.

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Improving outcomes from VT ablation

Improving outcomes from VT ablation

Some of the most innovative technologies being employed to treat patients with ventricular tachycardia (VT) were discussed during this session. Dr Charlotte Manisty (Bart’s Health NHS Trust, London) described the use of peri-procedural imaging using computed tomography (CT) and magnetic resonance imaging (MRI) to create 3D maps of scar in the heart, identify optimal ablation targets and help decide the approach to VT ablation. Some investigators are working on developing interventional cardiac MRI platforms using active and passive tracking catheters to gain real-time information and optimise VT ablation using imaging guidance.

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NOACs: translating latest clinical and cardioversion data into practice

NOACs: translating latest clinical and cardioversion data into practice

In the latest ESC 2016 guidelines for the management of patients with atrial fibrillation (AF), it is now a Class 1A recommendation to use a non-vitamin K oral anticoagulant (NOAC) in preference to warfarin where a patient would otherwise be eligible for a NOAC for non-valvular AF. Warfarin is currently still recommended in patients with moderate-to-severe mitral stenosis and mechanical heart valves.

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Young Investigator Award

Young Investigator Award

‘Lifelong endurance athletes – what is the burden of arrhythmias in this group?’ This was the question addressed by the winner of the Young Investigator Award (Clinical Science) – Dr Ahmed Merghani (St George’s Hospital, London). In an elegant study, he analysed 152 athletes >40 years age with >10 years of endurance exercise with age, sex and ethnicity matched veteran controls (<150 mins exercise/week). All participants underwent a 24hr Holter monitor, cardiac magnetic resonance imaging (MRI) scan and cardiac computed tomography (CT) scan. Interestingly, in veteran athletes, there was a higher incidence of narrow complex tachycardias, pauses >2.5s and runs of non-sustained ventricular tachycardia.

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Sponsorship statement

The writing of this report was sponsored by Daiichi-Sankyo. The company had no input into the content of the report but did examine it for ABPI compliance before publication.

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Screening for atrial fibrillation

Professor Ben Freedman (Heart Research Institute, University of Sydney, Australia) presented the latest evidence on atrial fibrillation (AF) screening.

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How to improve outcomes from ablation

Professor Mark O’Neill, Guys and St Thomas’ Hospital, London, reviewed the evidence for the use of contact force (CF) information to optimise AF ablation. To ensure adequate ablation lesion delivery, an adequate catheter-tissue contact is needed with the creation of durable, transmural scar necessary to prevent AF recurrence. The ability of ablation catheters to provide CF information in real time provides obvious benefits – better control over lesion size and reduction in ineffective radiofrequency energy delivery. Interestingly, the SMART-AF trial did not demonstrate increased clinical effectiveness with higher average CF but did suggest that if operators were able to achieve an optimal CF, then clinical outcomes were improved.

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Syncope and POTS – time for a multidisciplinary unit?

Dr Nick Gall (King’s College Hospital, London) highlighted the importance of a multidisciplinary approach in managing patients with postural orthostatic tachycardia syndrome (POTS). Patients often have multi-system involvement including: joint hypermobility, chronic fatigue syndrome and physical deconditioning, irritable bowel syndrome, autonomic neuropathy and symptoms of pre-syncope and reflex tachycardia.

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AEDs to be as common as fire extinguishers

“Our vision is to make automatic external defibrillators (AEDs) as commonplace as fire extinguishers and smoke alarms across the UK,” said Trudie Lobban, (CEO and Founder, Arrhythmia Alliance). Her comments came as the charity placed its 3,000 public access deribrillator in the UK on World Heart Re-Start The Heart Day on 18th October 2017 just after the meeting.

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Calling for access to LAAO for high-risk AF patients

There was a call at the meeting for NHS England to reconsider its ‘Commissioning through Evaluation (CtE)’ process for left atrial appendage occlusion (LAAO), the only treatment available to prevent an atrial fibrillation (AF)-related stroke in patients in whom oral anticoagulation is contraindicated.

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Diary date: HRC 2017

More on the latest developments in electrophysiology, device management, syncope and healthcare delivery will be featured at next year’s Heart Rhythm Congress, which will take place at the ICC, Birmingham, from 1st-4th October 2017.

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More real world data for OAC therapy

There are many challenges for physicians in managing patients with atrial fibrillation (AF). This has led to increasing interest in registry data giving insights into the real-world use of oral anticoagulation in non-valvular AF (NVAF). Below we highlight some of the registry data presented at this year’s congress

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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