SAN FRANCISCO, CA — The Denver Rockies hosted the San Francisco Giants at Coors Field as the Heart Rhythm Society (HRS) 2007 Scientific Sessions were running full steam. Nine years later, the Giants will be returning the gesture at AT&T Park only a mile from the Moscone Center and trying not to unduly distract attendees of HRS 2016.

Planners for this year's meeting did their part to draw crowds, inviting Salman Khan, founder of the Khan Academy, to speak at the Opening Plenary session the morning of May 4. Khan, the celebrated pioneer of a movement that is turning the conventional didactic model on its head, launched the academy 8 years ago to make free educational programs available to anyone with an internet connection.

Education is a principal mission of the HRS, and patient education is "our most important education challenge," program chair Dr George F Van Hare (Washington University, St Louis, MO) told heartwire from Medscape. "The normal patient-physician encounter isn't really optimized for teaching patients what they need to know about their medical condition. We're hoping that having Sal Khan speak will sort of invigorate our society to start thinking about innovative ways of educating our patients, so that they can become better partners in their own care."

Of course, there are also the traditional sessions aimed at other groups to which the HRS caters in promoting education: the students, residents, and fellows who came to this city for a deep dive into the field of cardiovascular electrophysiology (EP), along with more experienced physicians and allied health professionals here to "get up-to-date in their field in three and a half days," according to Van Hare.

Hot off the Press

Then there are the oral and poster sessions based on abstracts starting the evening of May 4, and a full dozen late-breaking clinical trials (LBCTs) evenly spread across May 5 and May 6. Many of the scheduled LBCTs focus on catheter and surgical ablation strategies for atrial and ventricular arrhythmias. As titled by the HRS, they include but aren't limited to:

  • Ablation or antiarrhythmic drugs for ventricular tachycardia: the VANISH Trial.

  • Randomized trial comparing pulmonary-vein isolation using the SmartTouch catheter with or without real-time contact-force data.

  • Effect of left atrial appendage excision on procedure outcome in patients with persistent atrial fibrillation undergoing surgical ablation.

  • Results of the pulmonary vein reisolation as a routine strategy: A success-rate evaluation (PRESSURE) randomized controlled trial.

Cardiac rhythm devices are featured in most of the rest, including several the field hopes will improve on the hardware component of pacing and implantable cardioverter defibrillator (ICD) systems most likely to cause trouble.

Today's pulse generators are, "for the most part, very reliable, with very rare exceptions. The Achilles' heel of cardiac implantable devices has always been the leads," Van Hare observed. Among this year's LBCTs is a mid-term look at the subcutaneous-lead ICD (S-ICD, Boston Scientific).

There is a lot less clinical experience with another potentially game-changing technology aimed at eliminating leads altogether for some patients. There are several so-called leadless pacemakers in development or approved for use, and the LBCTs feature a comparison of one vs conventional pacing systems with transvenous leads.

Among the cardiac-rhythm-device LBCTs:

  • A comparative study of acute and mid-term complications of leadless vs transvenous pacemakers.

  • Performance and outcomes in patients with the subcutaneous implantable defibrillator through mid-term follow-up: the EFFORTLESS study.

  • Clinical response to cardiac resynchronization therapy with the SonR hemodynamic sensor: the RESPOND-CRT randomized trial.

  • A prospective multicenter randomized controlled trial of early discharge compared with hospitalization after elective implantable cardioverter-defibrillator procedures: first results of the Same-Day Discharge for Implantable Cardioverter Defibrillator trial.

Clinics for Clinicians

Another focus of this year's sessions: "one of our strengths," the multidisciplinary nature of the cardiac EP field, said Van Hare. "We wanted to hold a number of multidisciplinary sessions that highlight how the different members of the team work together." They emphasize "how we can learn from each other, how we can teach each other."

The HRS community includes specialists in device implantation, lead extraction, AF or VT ablation, heart failure, and many other areas, Van Hare noted, but he "encourages people, when they go to meetings like this, to get out of their comfort zone. If you're somebody who ablates VT, don't just go to sessions on ablating VT. Maybe go and learn about something that's not completely in your area of expertise, because you might actually learn something that you can bring back to your main functions."

As a pediatrician, he said it's been a natural part of his professional development. "I was trained with adult electrophysiologists. I would say they continue to teach me, and I teach them a few things from time to time."

He pointed to key opportunities for specialists to mix it up with each other, including three multidisciplinary clinics. One, called Patient-Centered AF Care, brings together physicians, nurses, social workers, and other professionals to highlight "how you take care of the entire patient with atrial fibrillation."

Another, entitled The Inherited-Arrhythmia Clinic: Family-Centered Diagnosis and Management, is based on some programs emerging at a number of US centers, Van Hare said. "Children all have parents, and many adults have children, and for an inherited condition it doesn't make sense to be splitting them up between the pediatric world and the adult world. We should actually take care of families together."

And Integrating Pediatric and Adult Congenital EP Care Through Transitions addresses "a rapidly growing population that is becoming increasingly important in the adult cardiology world. For the first time we actually have a board examination for caring for adults with congenital heart disease [ACHD]," he said.

Other sessions on the topic, reflecting a budding field with unknowns ahead, include the juxtaposed ACHD Electrophysiology Care in the Adult Hospital: Why Does It Work? and Care of the ACHD Patient in the Children's Hospital: Why Does It Work?

Reaching the Summit

In recent years, Van Hare observed, the HRS sessions have added a third "summit," daylong three-part immersions that make attendees "feel like they've become completely up-to-date in an important area of electrophysiology," to its popular AF Summit and VTVF Summit. In 2016, the Left Atrial Appendage Summit will focus on the various devices and procedures available and in development for excluding or eliminating the common source of emboli in AF.

The session will highlight the Watchman (Boston Scientific) and other "endocardial plugs" and surgical and percutaneous epicardial techniques, along with pathophysiologic insights into left atrial appendage thrombogenesis, and pharmacologic and imaging issues. Also on the agenda: a take on regulatory concerns from Dr Andrew Farb (Center for Devices and Radiological Health, US Food and Drug Administration).

Van Hare disclosed fellowship support from Medtronic and serving as an officer, trustee, director, committee chair, or other fiduciary role for the International Board of Heart Rhythm Examiners.

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