HRC attracts record numbers of delegates

Academic sessions ranged from advanced elcctrophysiology featuring new technologies for atrial fibrillation (AF) ablation, developments in community defibrillation, and arrhythmia surgery, to sessions with pre-recorded cases (eg vein based ablation for paroxysmal AF) NHS improvement, channelopathies, , cardiac genetics, and ‘Arrhythmic collapse in the child and teenager’.

The clinical sessions organized with the Primary Care Cardiovascular Society (PCCS) were particularly good ‘crowd pullers’. As well as ‘Syncope blackouts and the irregular pulse’, topics such as, ‘Atrial fibrillation and its management in primary care’ were particularly relevant for the implementation of Chapter 8 of the National Service Framework, and the Quality Outcomes Framework.

AF patient numbers are increasing dramatically as the population ages. Apparently it is widely under-diagnosed and under-treated. Professor David Fitzmaurice (Birmingham) gave a candid overview of ‘anticoagulation issues’. He considers AF to be “a marker of coronary heart disease unless proved otherwise”. It increases stroke rate five-fold and very few patients have contraindications to warfarin, in his view. It reduces stroke risk by over 60%. Aspirin has very little role in treatment and there is rarely justification to use combined aspirin and warfarin. High risk patients can be identified using the CHADS2 score, which a recent survey suggests only about half of UK cardiologists have ever heard of!

General practitioners, in particular, are frequently reluctant to initiate warfarin treatment (confirmed from work presented by Dr Kathryn Griffith a York GP with Special interest in Cardiology) especially in older patients at risk of falls and for fear of ‘doing harm’ eg intracranial bleeds.  Warfarin is however, “probably a wonder drug” which may even have antimetastatic effects, said Newcastle, Consultant Cardiologist,  Dr Steve Murray, who reviewed classic trials of rate versus rhythm control and also considered the diminishing role of DC cardioversion for AF.

Professor Fitzmaurice, described some of the new anticoagulants such as rivoroxaban and dabigatran, which may be potential warfarin replacements.  We are witnessing a “huge change in the landscape of anticoagulant treatment” and he predicts that we will be unlikely to be prescribing warfarin for new AF patients within the next 2-3 years. Interesting times indeed!

A more detailed report from HRC 2009 will be published on Arrhythmia Watch in the near future.