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Guest Blogger – New AF Guidelines: What’s the Buzz About? December 23, 2010

Posted by Heart Rhythm Society in Atrial Fibrillation (AF), Society News.
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At long last, the ACCF/AHA/HRS 2011 Focused Update on Management of Patients with Atrial Fibrillation (AF) is available. In addition to this new guidance, I recommend that everyone review the 2006 Guidelines for the Management of Patients with AF and the  European Society of Cardiology’s Guidelines for the management of atrial fibrillation, as well.  (more…)

Updated AF Pocket Guide March 26, 2010

Posted by Heart Rhythm Society in Atrial Fibrillation (AF).
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Don’t miss the updated Practical Rate and Rhythm Management of Atrial Fibrillation Pocket Guide, adapted from the ACC/AHA/ESC 2006 Guidelines (825 KB PDF) as part of the Heart Rhythm Society’s AF 360° disease state initiative.

The guide includes information on:

  • General Approaches to the Patient with AF
  • Stroke Prevention in Patients with AF
  • Ventricular Rate Control
  • Restoration of Sinus Rhythm
  • Maintenance of Sinus Rhythm
  • Catheter Ablation
  • Dosing Guidelines for Drugs Commonly Used to Treat AF

Download and print a copy of the guide for free (1.15 MB PDF) or order (60 KB PDF) brochure-quality copies suitable for distribution among staff.

Live AF Ablation Case on the Today Show: Education or Spectacle? March 25, 2010

Posted by Leonard Ganz, MD, FHRS in Education.
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In early February 2010, a live AF ablation case aired on the Today Show. To be correct, I should say that a live case was the central element in a brief segment on AF on the Today Show. Even at scientific meetings, the concept of live case presentations is controversial. There are patient confidentiality issues, and the ever present “what if there’s a complication?” concern. In a CME setting, presenters must be extremely careful to present a balanced view and not show bias towards one particular technology or piece of equipment. When these issues are carefully considered, many will concede that the educational value of a live case presentation outweighs all of these caveats. (more…)

Contemporary ICD Therapy Discussions at Heart Rhythm 2010 February 25, 2010

Posted by Andrea M. Russo, MD, FACC, FHRS in Scientific Sessions.
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The Heart Rhythm Society’s 2010 Scientific Sessions will present exciting discussions on state-of-the-art arrhythmia management and device therapy, including highlights on controversial topics with emphasis on quality-related issues.

Featured topics include:
- Programming Devices to Optimize Patient Outcomes
- Minimizing and Managing Device Complications
- Risk Stratification for ICD Implantation and Non-Conventional Indications
- Lead extraction in 2010
- Implantable Device Therapy for Atrial Fibrillation
- Pacing Lead Positioning and Simplifying Implantable Lead Systems (more…)

Watching for the Watchman February 19, 2010

Posted by John D. Day, MD, FHRS in Atrial Fibrillation (AF).
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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…)

Repeat Paroxysmal AF Patients…what does this mean for AF in 2010? February 17, 2010

Posted by David Wiggins, RN, BS BME, CEPS in Allied Health Professionals.
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 As I begin this year assisting with repeat ablations on atrial fibrillation (AF) patients who had AF procedures in 2009 and 2008 (and 2007…), I find myself wondering what will be ‘new’ in AF ablation this year.  Paroxysmal AF patients – the ones I typically see once and never again – are becoming fewer and fewer.  Much like the well of coronary patients who dried up a couple of years ago, post-DES, the number of AF patients that can actually be treated ablatively seems, in my very narrow world view, to be dwindling.

 I spend a lot of my working hours wishing that AF (and for that matter, VT) ablation had the cure rate that AVNRT and the other “solved” arrhythmias have.  Independent of the widely-variable published success rates for AF, the AF patients are the ones I see over and over again for procedures, often with the same results.  And I know this observation is not limited simply to where I work.

 So then, what will it be for AF in 2010? Will CFAE sites be shown to be the “answer” for AF? What about AF “nests?” Will it be a new ablation technology, such as the laser balloon? Will it be the surgeons assisting us in the relatively new “hybrid” procedures in the OR that allow us to treat this arrhythmia in a more permanent fashion? Or will we ever have a long-term solution for persistent and permanent AF other than AV node ablation? (more…)

HRS Health Policy and Healthcare Reform February 10, 2010

Posted by Michael Giudici, MD, FACC, FACP, FHRS in Health Policy.
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As a bit of background, I have practiced electrophysiology in my hometown of Davenport, Iowa, for 20 years and I serve on the Heart Rhythm Society’s Health Policy Committee. I’m not a political person by nature and hadn’t really given much thought to health policy until the last few years. I’m in a large cardiology group and am shielded from the day-to-day challenges with payers. 

There are two areas that I’d like to bring up to get the discussion going, as I’m sure most of you understand much more about these subjects than I do.

First, to assist the Heart Rhythm Society’s Health Policy staff in advocating on our behalf in the changing health care environment, it would be helpful to hear from you about your experiences working with private health insurance companies and your Medicare regional carriers. For example, what are their coverage polices for atrial fibrillation?  (more…)

The Old and the New: Warfarin and Dabigatran February 4, 2010

Posted by John D. Day, MD, FHRS in Atrial Fibrillation (AF).
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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).

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