The purpose of this event was to provide updated information in the field of electrophysiology including: the care and management of patients with atrial fibrillation (AF) and ventricular arrhythmias, and the emerging future of electrophysiology.  The audience consisted of cardiologists, family, and internal medicine physicians; the majority of the attendees were from the Midwest region.  Speakers came from all across the country - from UCLA Cardiac Arrhythmia Center to the Lankenau Institute for Research in Pennsylvania - even with the threat of Hurricane Irene, to participate in the symposium.

Michael Ezekowitz, MBChB, DPhil, FACC, FAHA, FRCP, Professor, currently practices at Jefferson Medical College and the Lankenau Institute for Medical Research in Pennsylvania and known for his work in Anticoagulation and cardiac arrhythmias.  Dr. Ezekowitz presented ""Emerging trends in Antiarrythmics and Anticoagulants in AF".  Currently, it is known that atrial fibrillation increases the risk of death and severe vascular events; however, the use of anti-arrhythmic drugs has shown no effect on these outcomes. Dr. Ezekowitz’s research shows that Dronedarone had some positive effects in patients with intermittent AF.  Vernakalant and Ranolazine, new antiarrhythmic agents, also show potential in being efficacious.  His research supports the safety and efficacy of Dabigatran, making it a superior anticoagulant compared to Warfarin; there was brief discussion about other new anticoagulants.

 Garrie J. Haas, MD> from the University of Ohio presented "Pressure Sensors and Leadless Technology: the Future for Monitoring Heart Failure?" He discussed the advantages of a modified patient directed left atrial pressure monitoring system, called the HeartPOD system, which powers through clothing, stores telemetry, and alerts the patient to monitor. In addition, it instructs medication and clinician contact based on left arterial pressure values and the physician's prescription. Studies showed that patient self management of heart failure was able to improve overall CHF care and significantly minimize the hospitalizations. University of Kansas Hospital is the only center in the region that offers this state-of-the-art therapy for patients with heart failure who needs tighter and closer follow up.

KCHRS Course Director,
Dr. Dhanunjaya Lakkireddy

This year, the Pioneers in Electrophysiology award was given to Warren Jackman, M.D . This is the highest honor given to an individual for their landmark contributions to the advancement of the field of electrophysiology by the University of Kansas. Dr. Jackman, a George Lynn Cross Research Professor of Medicine and Scientific Advisor at the Heart Rhythm Institute at the University of Oklahoma Health Sciences Center, is recognized for his work in the development of catheter ablation techniques for cardiac arrhythmias. A major highlight of the symposium, was listening to his keynote talk on his work in the therapeutic implications of the autonomic nervous system and atrial fibrillation. His research shows that cardiac ganglionated plexi (GP) play a very important role in the initiation and perpetuation of AF. He outlined some of their ground breaking work on RF ablation of the GP and AF outcomes. Mr. Bob Page, CEO of the University of Kansas Hospital presided over the session and gave away the award.

Dr. Warren Jackman

A talk on "The Future of Atrial Fibrillation Ablation: Is the Promise Short Lived?" was presented by Robert Schweikert, MD, FACC, FHRS who is the Director of Cardiology at the Akron General Hospital in Ohio.  The studies presented concluded that catheter ablation is a reasonably efficacious long term therapy for AF and that repeat ablation procedures for patients with recurrent atrial arrhythmia post ablation increase long-term success rate.  Paroxysmal forms of atrial fibrillation have higher percentages of long-term freedom form AF after catheter ablations compared to non-paroxysmal forms.  While AF ablation has become a popular procedure with improved outcomes, a lot needs to be done to improve this procedure further.

In his talk on “Arrhythmia Ablation – Energy Sources & Catheter Types,”   Dr. Asirvatham, who practices at the Mayo Clinic, emphasized that if a lesion is thorough, then electrical disconnection can be reasonably assured because AF recurrence is correlated to reconnection of PV. The permanency of disconnection with RFA is ~20% despite acute isolation; while a study showed that there was an 88% disconnection rate at 3 months when using a cryoballoon. Dr. Asirvatham feels that the advantages of the cryoballoon are: precision of lesion set, ease of applicability, shorter procedure time, less analgesia use and it can target difficult anatomy. A recent study showed that ablation with the cryoballoon resulted in maintenance of sinus rhythm in 74% of patients with PAF and 42% of patients with persistent AF.  He presented several pieces of information on various energy sources and catheter types. It was a great presentation with various details as it pertains to the physics of ablation energies, catheter designs and the scope of what is to come in the future.

Dr. John Fisher, a Professor of Medicine at the Albert Einstein College of Medicine talked on “Preventing and Treating Implantable Device Related Infections and Lead Failures”. Even with improvements in infection control practices regarding cardiovascular implantable electronic devices (CIED), CIED infections still continue to happen and contribute to the morbidity and mortality of these patients. Dr. Fisher reviewed the Cyanoacrylate or Dermabond debate and presented a study that found standard suturing of excisional wounds to produce a better cosmetic outcome than suturing with octyl cyanoacrylate. Dr. Fisher feels that while following guidelines, common practices such as pocket lavage that are not supported by randomized clinical trials and simple intuition also can be useful in preventing infections and lead problems.

An informative and entertaining debate between Martin Emert, MD from the University of Kansas Medical Center and Michael Gold, MD from the Medical University of South Carolina highlighted the safety and efficacy of MRI-compatible devices.  Dr. Gold took the role of the antagonist, arguing that an MRI safe device is not the best course of action for view.  Dr. Gold's main arguments were that many studies have shown that MRI imaging in the presence of cardiac devices is safe if reasonable precautions are used and current technology restricts MRI imaging of the thorax and neck region which includes the heart. He also stated that the leads for MRI safe devices do not handle well and are very expensive. He found that a majority of device patients do not even qualify for an MRI safe device or it is contraindicated.

Dr. Martin Emert

Dr. Michael Gold

Dr. Emert states that because the U.S. is increasing its MRI scan usage. For example, in 2011 about 40 million MRS scans were performed.  An MRI safe pacemaker is beneficial as it allows patients to have the option of an MRI scan if needed in the future. In addition, he has quoted a few studies that claim there are numerous risks - such as a diminished battery voltage and increased capture threshold post MRI - to undergoing an MRI scan with a standard pacemaker.

Douglas Zipes, MD, FACC, FAHA, FHRS, the Editor in Chief of Heart Rhythm and a Distinguished Professor Emeritus of Medicine, from the Krannert Institute of Cardiology at the Indiana University School of Medicine, presented on the “Collaboration of the Physician/Scientist with Industry in Advancing Patient Care – Where Should It Start & End?” Dr. Zipes emphasized that academia and industry are interconnected and require support from one another, especially in the promotion of research. 

Dr. Douglas Zipes (left) and Dr. John Fisher (right)

Dr. Zipes supports that the American College of Cardiology/American Heart Association Task Force that the Heart Rhythms Society has adequate measures already in place to prevent unnecessary influence from industry in HRS-sponsored educational programs, research, scientific documents, and policy initiatives.

Dr. Andrea Russo

"Programming ICDs to Reduce Unnecessary Shocks" was presented by Loren D. Berenbom, M.D., FACC, FHRS a Professor of Medicine at the Bloch Heart Rhythm Center of the University of Kansas Medical Center. He presented results from the SCD-HeFT study that found after 4 years of follow up of patients with ICD implants, 1/3 of the patients received an ICD shock, with half of those shocks being inappropriate. Tiered therapy, or antitachycardia pacing (ATP) was successful in 72% of patients with fast ventricular tachycardia and ATP prevented at least one shock in 85% of patients. Patients using ATP therapy had higher quality of life scores. Another tiered therapy trial, the PROVE trial, showed that 92% of VT's were terminated with ATP. He also discussed that the most common cause of patients receiving an inappropriate shock was when SVT was being treated as VT. Studies show that enabling SVT discriminators and disabling high rate time can be valuable in that they have been associated with up to a 60% reduction in inappropriate shocks.

Dr. Buddhadeb Dawn

In addition to the Pioneers in Electrophysiology Award, the Second Annual Dr. Manohar Sai Gowda Memorial Young Investigator Cardiovascular Research Award was presented at the symposium. This award has been established in appreciation of the late Dr. Gowda's contributions to cardiovascular research as both an investigator and a mentor to young investigators. Electrophysiology, Clinical CV research, and cardiovascular fellows were invited to submit their original cardiovascular research. This year, several abstracts were submitted for review from all over the world of which the top four abstracts were recognized at the symposium. 

Top Row (Left to Right): Dr. James Vacek, Dr. Loren Berenbom, Dr. Dhanunjaya Lakkireddy, Dr. Rhea Pimental, Dr. Martin Emert, Dr. Raghu Dendi, Dr. Warren Jackman Bottom Row (Left to Right): Dr.Stavros Stavrakis, Dr. Dsshraj Singh, Dr. Pasquale Santangelli

Dr. Stavros Stavrakis received the first place award for his abstract on “Inhibition of Atrial Fibrillation Inducibility by Low Level Vagus Nerve Stimulation: the Role of Nitric Oxide Signaling Pathway”.  He found that the anti-arrhythmic effects of low level vagus nerve stimulation may be mediated via the PI3K/NO signaling pathway, developing the role of neuromodulators in the pathophysiology of AF and formation of new therapeutic targets. Dr. Saurabh Malhotra, who was unable to attend the symposium received second place with his research on the “Temporal Relationship of Fragmented QRS and Microvolt T-wave Alternans with Acute Ventricular Tachyarrhythmias after Experimental Myocardial Infarction”.  His research shows that fragmented QRS occurrs early post ascute myocardial infarction and was a significant predictor of ventricular tachyarrhythmias.

Dr. Pasquale Santangelli, accepted the third place award for Dr. Luigi DiBiase on “Endo-Epicardial Homogeneization of the Scar versus Limited Endocardial Substrate Ablation for the Treatment of Electrical Storms in patients with Ischemic Cardyomiopathy”. The study concluded that ablation using endo-epicardial homogenization of the scar significantly increases freedom from ventricular arrhythmias in ischemic cardiomyopathy patients.  Dr. Dsshraj Singh received honorable mention for his abstract on “Radiofrequency Ablation in Patients with Recurrent Symptomatic Atrial Fibrillation and Gastro Esophageal Reflux Disease (GERD)/Irritable Bowel Syndrome (IBS) – The Heart to Gut Connection!” Dr. Singh found that a significant number of patients with paroxysmal AF and GERD have symptoms triggered by gastrointestinal activity, an extremely high vagal response during RFA and excellent success rates post PVAI.

Dr. Kalyanam Shivkumar, a Professor of Medicine & Radiology at UCLA Cardiac Arrhythmia Center & EP Programs, discussed therapies that may improve patient outcomes with patients experiencing ventricular tachycardia storm.  His research suggests that neuraxial modulation of higher levels of the neuraxis, thoracic spinal cord, ganglions and parasympathetic nervous system can help manage ventricular tachycardia.  He proposes that spinal cord stimulation is effective because it produces a decrease in sympathetic tone, changes in myocardial blood flow, while providing relief from pain, and an enhancement of the vagal tone. Exploring new therapies for VT and VF in the form of cervical sympathectomies attracted a lot enthusiasm from the audience. Dr. Shivkumar is an international authority on cardiac autonomics and ventricular tachycardia

Dr. Kalyanam Shivkumar

The role of genetic screening in the sudden cardiac death patient population was presented by Dr. Rhea Pimentel from the University of Kansas.  She explained that it is important for health care professionals to be updated on the role of genetic screening as inheritable monogenic arrhythmia syndromes are a major cause of unexplained sudden cardiac death in young people. Dr. Pimentel reviewed several cardiac channelopathies such as Long QT and Brugada syndrome. Genetic testing is cost effective for patients with LQT; however genetic testing identifies only 75% of mutations. She concluded that with the right patient, genetic testing can be helpful in treatment, but that we must keep in mind that a negative genetic test result does not completely rule out the diagnosis.  

Dr. Srijoy Mahaptra

The Kansas City Heart Rhythm Symposium 2011 was a successful and well attended event.  In fact, course director, Dr. Lakkireddy, said that numerous attendees expressed their enthusiasm in the impressive turnout.  With the success and positive feedback of the event, The University of Kansas Medical Center has already begun planning for the 4th annual 2012 Heart Rhythm Symposium.

Top Row (Left to Right): Dr. Steven Seals, Dr. Dak Burnett, Dr. Loren Berenbom, Dr. Warren Jackman, Dr. Robert Schweikert, Dr. Dhanunjaya Lakkireddy, Dr. Stavros Stavrakis, Joe Rogowaski, Dr. John Fisher, Dr. Martin Emert Bottom Row (Left to Right): Dr. Chandra Vasamreddy, Dr. Madhu Reddy, Dr. Jayasree Pillarisetti, Dr. Rhea Pimental, Caroline Murray