Electronic Gadgetry in Clinical Practice April 26, 2011
Posted by John D. Day, MD, FHRS in Scientific Sessions.Tags: Blackberry, Droid, iPhone, smart phone, Special Session, Technology
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We just cannot live without our electronic gadgets. It seems that smart phones, iPads, and other gadgets have now become a part of our lives. So, which gadget is best for an EP in practice? That is the question my colleagues and I hope to answer in the Special Session, “The iPad, the iPhone, and DROID Debate: Which is Best for an EP?” taking place in two weeks at Heart Rhythm Society’s 32nd Annual Scientific Sessions. (more…)
Great News for AF Patients and Healthcare Providers in the U.S. September 27, 2010
Posted by John D. Day, MD, FHRS in Atrial Fibrillation (AF), Science & Research.Tags: Atrial fibrillation, dabigatran, U.S. Food and Drug Administration, Warfarin
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On September 20, 2010, the U.S. Food and Drug Administration (FDA) Cardiovascular and Renal Drugs Advisory Committee recommended unanimously that dabigatran be approved for stroke prevention in atrial fibrillation patients. (more…)
Atrial Fibrillation Management at HR 2010 June 23, 2010
Posted by John D. Day, MD, FHRS in Atrial Fibrillation (AF).Tags: Ablation, Quality & outcomes, Scientific Sessions
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I had an absolutely amazing experience at the Heart Rhythm Society’s 31st Annual Scientific Sessions last month in Denver, Colorado. It seems that this meeting just continues to get better each year. This time, there were many new and provocative studies presented on atrial fibrillation (AF) management. Over the next few posts, I would like to share some of the studies that I think are most impactful. (more…)
New Study Questions Efficacy of Dronedarone April 7, 2010
Posted by John D. Day, MD, FHRS in Atrial Fibrillation (AF).Tags: Amiodarone, Atrial fibrillation, Dronedarone
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Dronedarone once held the promise of potentially becoming the Holy Grail of atrial fibrillation management…a drug as effective as amiodarone but without all of the toxicities of amiodarone. Unfortunately, as this drug was quickly integrated into clinical practice in the United States in 2009, it became readily apparent that its effectiveness at maintaining sinus rhythm was limited.
Despite its limited clinical efficacy, we continued to prescribe this medication in atrial fibrillation patients without heart failure with the thought that while it may be a weak antiarrhythmic, at least it was “safe.” We took heart in the fact that in the ATHENA Trial, this medication did not increase mortality (it was even shown to decrease the combined end-point of mortality and cardiovascular hospitalizations) and that a post-hoc evaluation even showed that it reduced strokes in atrial fibrillation patients.
However, an upcoming study by researchers at the Cedars-Sinai Heart Institute that will be published in the Journal of the American College of Cardiology questions the notion that this is a “safer” drug. In this study, the authors found no clear safety benefits of dronedarone. (more…)
The Stop-AF Trial: Another Step in Catheter Ablation March 31, 2010
Posted by John D. Day, MD, FHRS in Atrial Fibrillation (AF).Tags: Atrial fibrillation, Catheter ablation, Stop-AF Trial
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During a late-breaking clinical trials session on March 15 at the American College of Cardiology Annual Scientific Sessions in Atlanta, Georgia the results of the STOP-AF Trial were presented. In this study, the new pulmonary vein cryoballoon (The Arctic Front ® Cardiac CryoAblation Catheter System, Medtronic) was successful in eliminating atrial fibrillation in 70 percent of patients with paroxysmal atrial fibrillation at one year versus only 7 percent of the patients who were free from atrial fibrillation on medical therapy.
This study, along with a number of other studies, clearly documents the superiority of catheter ablation over medical therapy in the maintenance of sinus rhythm. It also represents a shift in the paradigm of catheter ablation in that it is a balloon designed to electrically isolate the entire pulmonary vein in a single application with a potentially safer cold energy source rather than a point by point ablation strategy using radiofrequency or heat energy. (more…)
Totally Wired: How You Can Improve Your Practice with Technology March 23, 2010
Posted by John D. Day, MD, FHRS in Scientific Sessions.Tags: Electronic medical records
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A national survey of 2,758 physicians published in the July 2008 issue of the New England Journal of Medicine found that only 4 percent of physicians reported having an extensive, fully functional electronic medical records system. Moreover, a mere 13 percent of physician respondents reported having even a basic electronic medical record system.
Clearly, as the rest of the professional world is moving forward quickly with the adoption of new technologies, most physicians are still struggling to adopt a basic electronic medical record system. In addition, as Facebook, Twitter, and other new social mediums are rapidly transforming U.S. culture, many physicians are still trying to figure out how to send text messages.
As heart rhythm specialists, we work within a medical specialty dominated by technology and are very in tune with new technologies. However, even though we are at the forefront of technology in medicine, there is still much we can learn to improve our efficacy at providing care.
To meet this need, the Heart Rhythm Society has organized a special technology session, Totally Wired: How You Can Improve Your Practice with Technology, at the upcoming 31st Annual Scientific Sessions in Denver. We have invited David Lee Scher, MD, FHRS, Director of Cardiac Electrophysiology at the Pinnacle Health System, to share how a totally wired EP practice can improve patient care and maximize efficiencies. Following Dr. Scher, Ben Wilkoff, founder of Learning is Change, will show how EPs can utilize the new social networking tools such as Facebook, Twitter, and others to reach out to patients, referring physicians and colleagues and build communities in ways previously unimagined. (more…)
Watching for the Watchman February 19, 2010
Posted by John D. Day, MD, FHRS in Atrial Fibrillation (AF).Tags: AF, Atrial fibrillation, Blood thinners, Coumadin, Warfarin, Watchman
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In my last post, I discussed possible new blood thinner medications to prevent strokes from atrial fibrillation. However, what are the options for patients with atrial fibrillation who cannot take any blood thinners?
Unfortunately, atrial fibrillation increases the risk of stroke by about fivefold. Most strokes from atrial fibrillation occur from blood clots which develop in a pouch-like structure of the upper left chamber of the heart (left atrial appendage). A new device, the Watchman, can be placed without surgery (inserted through a vein in the leg) in the left atrial appendage to seal this pouch off so that blood clots do not have a place to form. We observe patients overnight following the procedure and they are discharged home the next day (no stitches with this procedure). Patients with the Watchman device do not have to take Coumadin (warfarin) long-term. (more…)
The Old and the New: Warfarin and Dabigatran February 4, 2010
Posted by John D. Day, MD, FHRS in Atrial Fibrillation (AF).Tags: AF, Atrial fibrillation, Blood thinners, Coumadin, dabigatran, Warfarin
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Is there anything better than Coumadin (warfarin) to prevent the atrial fibrillation strokes?
I cannot think of a medicine that is more detested by patients, nurses, and physicians than Coumadin (warfarin). I wish I had a dollar for every time a patient tells me “I don’t want to take ‘rat poison’.”
Yes, this medication has been used in rat poison. The rats are given a massive dose of the drug which causes internal bleeding. However, in humans if the medicine is properly monitored and dosed it can be life-saving by preventing most of the strokes caused by atrial fibrillation.
For the last 50 years we have not had any better oral blood thinners than Coumadin (warfarin). Fortunately, this will hopefully change in 2010!
This year we expect FDA approval of a new blood thinner, dabigatran, for atrial fibrillation. Dabigatran is one of several new blood thinners that we hope will soon be approved.
In a large clinical trial, dabigatran was shown to be as good at preventing strokes as Coumadin (warfarin). The clear advantage of dabigatran is that it does not require frequent monitoring and there are not all of the food interactions, so patients can again eat their “green leafy vegetables.” The only downside I can see at this point is that it will definitely cost much more than Coumadin (warfarin).