Social Activism Along With Device, Drug Innovations: HRS 2017

Patrice Wendling

May 08, 2017

CHICAGO, IL — The diverse city of Chicago will play host this week to new research on subcutaneous and leadless pacing, atrial fibrillation detection in asymptomatic patients, and the possibility of converting paroxysmal supraventricular tachycardia with drug therapy at the Heart Rhythm Society (HRS) 2017 Scientific Sessions.

The international focus for the meeting is being kicked off by Australian humanitarian Hugh Evans, cofounder of the Global Poverty Project, now Global Citizen, who will speak at the Opening Plenary session the morning of May 10. Voted in 2013 by Forbes as one of the 30 under-30 most influential social entrepreneurs in the world, Evans has mobilized millions to take action to end extreme poverty, climate change, and gender inequality around the world.

Immediately following Evans at 10 am is a special session on global citizenship detailing how HRS members can work globally to achieve the society's goal of eradicating heart-rhythm disorders.

"We're taking the next step of trying to find how together across boundaries, across divisions, across different parts of the world, we can work on initiatives that will help improve cardiovascular and specifically hearth-rhythm care; " Dr Thomas Deering (Piedmont Heart Institute, Atlanta, GA), chair of the scientific sessions program committee, told heartwire from Medscape.

That may mean "getting ablations done in places where resources might be limited by training physicians, by creating staff, or by having folks go and help individuals do some of those cases," or it may be tackling anticoagulation in atrial fibrillation, which is "poorly done around the globe," he said.

Late-Breaking Clinical Trials

Three late-breaking clinical-trial (LBCT) sessions are scheduled, but the HRS is "doing things a little bit differently this year," Deering said. The first two sessions, scheduled for 8 am Thursday, May 11 and 10:30 am Friday, May 12, are dedicated to typical trials that "hopefully have an impact on how therapy can be delivered."

One of these is the phase 2 NODE-1 trial examining four doses of intranasal etripamil (Milestone Pharmaceuticals) to stop paroxysmal supraventricular tachycardia induced in the EP lab. No word on the top-line results, but the investigational small molecule is currently being tested in phase 3 trials.

There are also a number of device- and ablation-based LBCTs. Among these are:

  • Subcutaneous-ICD (S-ICD) postmarket approval study.

  • EWOLUTION: 1-year efficacy and safety of left-atrial appendage closure with the Watchman device.

  • REVEAL AF: Primary results on incidence of previously unknown/silent AF detected by the Reveal (Medtronic) implantable cardiac monitor in high-risk patients.

  • RAID: Phase 3 trial of ranolazine (Renexa, Gilead Sciences) in high-risk ICD patients.

The third group of LBCTs, to be presented at 4:30 pm Friday, "is interesting in that they aren't the huge multicenter trials, but they're more first-in-human, innovative, cutting-edge, new, and developing concepts," Deering said. Among these are:

  • Nanostim leadless pacemaker: Battery failures and worldwide chronic device retrieval.

  • First-in-human feasibility study of an implantable subcutaneous flexible-string defibrillator (ISSD, NewPace).

  • PV isolation with a multielectrode radiofrequency balloon catheter with directionally tailored energy delivery.

The Interconnected EP

The meeting is peppered with abstracts on wearable technology such as the Apple Watch heart-rate sensor and smartphone screening, but given that electrophysiologists may have bragging rights to being the most engaged community on social media, it's not surprising there's also a session dedicated to using social media—in particular, how to use it to create patient education and foster discussions about controversies and how to manage them.

In response to feedback from prior meetings, Deering said one of his main goals is to make HRS 2017 more interactive, with about a quarter of the sessions earmarked for discussion between faculty and attendees via the meeting app or an audience response system.

"It's one of the things our attendees have told us they like best," he said. "I think what you're going to see throughout the entire session is much more discussion on controversial, questionable areas."

Some of the newer sessions with this interactivity focus are the Heart Rhythm Bowl challenging younger members on unknown cardiographic tracings, a catheter ablation master class with ablation pioneer Dr Warren "Sonny" Jackman, and three featured summits.

"We've designed those summits this year to be very focused on interaction; they're case based, they're guideline driven, and they're the world experts, and there's great opportunity to interact with faculty," he said.

Clinical Documents

Finally, HRS will debut two new expert consensus statements during the meeting. The first on MRI and radiation exposure in patients with cardiac implantable electronic devices (CIEDs), is scheduled for 8 am Thursday, May 11, and will be chaired by Dr Julia Indik (University of Arizona, Tucson). The document offers recommendations on the care of adult and pediatric CIED patients referred for MRI, computed tomography, and/or radiation treatment for cancer, as well as the safety of employees with CIEDs who may come into an MRI environment.

Also at 8 am May 11 is a case-based learning session on the technical and safety aspects of CIED programming in patients who undergo MRI and/or radiation therapy.

On Friday, May 12, at 4:30 pm, Dr Hugh Calkins (Johns Hopkins Hospital, Baltimore, MD) will chair a second session on the HRS/European Heart Rhythm Association (EHRA)/European Cardiac Arrhythmia Society (ECAS)/Asia Pacific Heart Rhythm Society/Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLAECE) expert consensus statement on catheter and surgical ablation of atrial fibrillation.

Described as a complete rewrite of the 2012 HRS/EHRA/ECAS consensus statement on the subject, the document provides a state-of-the art review of the fields and makes clinical recommendations on the indications for catheter ablation in AF patients with heart failure and reduced cardiac function and to reduce stroke. It also provides guidance on designing AF clinical trials and reporting their outcomes.

Deering disclosed serving as a speaker for Boston Scientific; recently divesting an equity interest in CorMatrix and Zywie; research funding to his institution from CorMatrix, Spectranetics, Sorin Group, Boston Scientific, Medtronic, and St Jude Medical; and other compensation from Medtronic and Boston Scientific.

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