Perspectives on NASPE 2003

NASPE's 24th Annual Scientific Sessions were held May 14-17, 2003, at The New Washington Convention Center in Washington, DC. In this article, we provide different perspectives from attendees about they found most interesting at the meeting. What were the controversial topics? What new products and innovations did they find interesting? What late-breaking clinical data were most useful? Included are the perspectives from physicians, RNs, MAs, techs, manufacturers, etc. 

Douglas Beinborn, MA, RN Mayo Clinic, Rochester, Minnesota NASPE is always a terrific conference to attend. Not only are you able to learn about the latest advancements in our field, but you are able to network with colleagues and gain different perspectives on varied practices. The hot topics this year seemed to be atrial fibrillation, device resynchronization therapy, long QT syndrome, and reimbursement. Pulmonary vein isolation and varied other catheter procedures for the treatment of atrial fibrillation have shown many advances. More information has been gleaned on the treatment of heart failure, and more data has been obtained on cardiac resynchronization therapy since more patients have been treated with this therapy. Advancements have been made in the field of long QT syndrome, but there continues to be debates on how to best treat different patient populations. Overall, the NASPE 2003 meeting was very educational and informative. I look forward to the 2004 meeting in San Francisco.

Jose Nazari, MD Cardiac Arrhythmia Consultants, Chicago, Illinois My focus at 2003 NASPE was on resynchronization therapy. Several good sessions included useful guidelines to the CS and coronary venous anatomy. It is apparent that those who approach CS cannulation by angiographic means find that to be the better approach. Those who approach it by electrogram/EP catheter guidance find that to be better. In short, each operator should find an approach with which he/she is comfortable, learn it well and become proficient in it. A useful tip from Dr. Byrd for surgical LV pacing was to identify the site by activation sequence mapping in sinus rhtyhm: Sites that activate latest are likely to benefit more from pacing. A similar approach can probably be carried out in the EP lab using transvenous lead placement. It is labor intensive, and only sites that can be accessed and at which the lead is stable and does not result in diaphragmatic pacing can be tested. The results of a late-breaking trial, the PainFREE Rx II, were presented on Saturday, and they were compelling. Patients who received defibrillators set for ATP for arrhythmias as fast as 250 BPM had marked decrease in the number of ICD shocks when compared to those set for shocks only. Furthermore, there was no undue increase in the incidence of VT acceleration or syncope in the ATP group compared to the shock group. When confirmed, these results may result in a significant change in our approach to arrhythmia patients treated with ICDs. There was also great interest in cryoablation as a mode of therapy for AV nodal reentry, with the release of the Freezor catheter by the FDA for this application. Finally, a booth that caught my interest was the INR home testing. This may be highly useful to many of our patients in between coumadin clinic visits. I for one will be discussing this service by Raytel with many of my patients.

Laurie Potter, RN Testamur NASPE Exam AP/EP Staff Nurse, EP Lab, St. Mary s Hospital, St. Charles, Michigan Several of the RNs from our electrophysiology lab were able to attend NASPE this year. We each had the same expectation: to learn more about our field. The difference was in our amount of time in the electrophysiology setting. NASPE did not disappoint us, offering a variety of topics to us throughout the conference. The RN relatively new to EP left the meeting excited about her new level of understanding about electrograms, and the RN with 18 months experience was challenged with some of the more complex discussions, but came away with some more pieces of the puzzle put together. The RN with several more years experience still found the new technology and frontiers presented thought provoking, and is challenged to apply these to her practice. NASPE presented a well-balanced program for all levels of allied professional practice. Atrial fibrillation ablations seem to still be the hot topic, and there are conflicting opinions on the best approach to this procedure. The ability to network and meet up with previous colleagues is always a pleasure. The exhibits and poster sessions allowed time for this activity to mingle and discuss mutual opinions and experience with a sneak peek at some future technology. I look forward to my next opportunity to attend the NASPE conference.

Larry W. Brown Territory Manager for Endocardial Solutions, Inc., Fall City, Missouri NASPE was as energizing as ever! The opportunity to greet colleagues, customers, prospects, and friends, as well as to see the dynamic processes at work in pacing and electrophysiology, is exciting. Of particular note is a technology reducing the need for fluoro as a navigational aid in some procedures. Real-time multi-plane three-dimensional visualization of up to 64 electrodes (shows any EP catheter) is now available as EnSite NavX. A healthier work environment through less radiation is a noteworthy accomplishment, and the ability to view catheters accurately in 3D is remarkable. The enabling technology of non-contact single-beat mapping (Endocardial Solutions, Inc.) offers advantages over sequential mapping and holds promise for predicting more effective device lead placement and tracking of cardiac efficiency. A new magnetic guidance and manipulation system from Stereotaxis promises improvements over the traditional in-room catheter manipulation. I have always been impressed by the synergy of the dedicated physicians, allied professionals, researchers, engineers and marketers associated with EP.

Erin Johnson St. Jude Medical Daig Division, Minnetonka, Minnesota The 2003 NASPE scientific sessions were a great success, thanks to interested customers from around the globe and numerous product releases. Once again, the topics of atrial fibrillation (AF) and heart failure (HF) dominated discussions. The result was a meeting focused on continuing evolution, both to products and to indications. Advances in electrophysiology included new catheter configurations and a wide assortment of energy sources, providing physicians with an unprecedented level of choice for catheter-based AF management. St. Jude Medical further expanded that choice with the introduction of a new diagnostic EP catheter platform Reflexion shown in bi-directional and variable radius. Now, physicians can choose between the Livewire platform s smooth, dial motion and the pendulum slide motion of Reflexion. Visitors to the booth responded well to the Reflexion platform s ergonomic design, effortless motion, and auto tip-locking technology. St. Jude Medical also expanded existing product lines. Livewire Spiral HP deflectable circumferential mapping catheters were introduced, featuring 20 bipolar-spaced electrodes to offer physicians the highest possible resolution. Also shown was the Epic+ ICD: the world s first ICD with AF Suppression technology. The AF Suppression algorithm is the first algorithm clinically proven to reduce AF burden. A new family of pacemakers was also highlighted. These new Team ADx devices are designed to work with St. Jude Medical s new FastPath programmer software. The 7th Annual Emerging Indications Symposium sponsored by St. Jude Medical shed new light on the cardiovascular consequences of sleep disordered breathing, from arrhythmias to heart failure. The OASES (Overdrive Atrial SEptum Stimulation) trial, presented at the late-breaking clinical trials session, provided further evidence that St. Jude Medical s unique AF Suppression algorithm significantly reduced atrial fibrillation (AF) in patients with a history of AF, and showed that even better results can be obtained with placement of the atrial lead in the low atrial septum. With the information, products and indications found at this year s NASPE meeting, physicians are better equipped than ever to change clinical outcomes for their patients.

Alois Langer Founder and Chief Technologist, Cardiac Telecom, Greensburg, Pennsylvania Although I have been attending NASPE Scientific Sessions on and off since its inception, this year I realized that my perspective as an exhibitor in one of the more modest booths had not changed much over the years. The concerns for the smaller exhibitors seem to center around the question how can we attract traffic into our booth and generate interest in our new innovative product or service? What phrase or graphic will catch the eye of the medical professional, our potential customer, and entice him/her into our booth? Just because a booth is small does not mean it cannot contain an important message. As an example, I think back on the first modest booth where we exhibited the first AICD shortly after the first implants occurred at Johns Hopkins. Our company name was unknown, the majority of attendees were simply unaware of what we were doing, and as of yet there was skepticism surrounding implantable defibrillators. So just how would we get some attention? Our approach was to present the product almost as a scientific exhibit. An actual defibrillator was set up in the booth connected to a power supply and a test load. Various challenging pre-recorded arrhythmias were stored in what was then an early home computer and fed to the defibrillator via an analog to digital converter. The computer also sensed the high voltage defibrillator pulse and changed the rhythm back to normal. A signal showing arrhythmia detector response and the ECG were also displayed and any of the recorded arrhythmias could be presented to the defibrillator as a test. Thus we were able to vividly demonstrate the device s functionality in a very realistic, and I believe, very successful way. Following up on this very humble beginning, I am continuously amazed at the number of sessions and papers now devoted to implantable defibrillators during the Scientific Sessions, particularly this year. Having once struggled in the environment where there were no sessions and working with Michel Mirowski to get the early papers published and presented, it seems unbelievable to see just how big it has become. So, you users of all the equipment presented at the exhibits, please look at the smaller booths carefully. You already know what the big guys do, but you never know where the next innovation may start.

Abraham Kocheril, MD Carle Heart Center, Urbana, Illinois Featured at this year s NASPE meeting is the 25th anniversary logo, including the name "Heart Rhythm Society." The migration to this new name is planned to make the society recognizable to the non-EP community. It is also not just a "North American" society. Although the leadership feels strongly about this change, 75% of the members have to approve it to make it a reality. In the Plenary Session, Dr. Albert Waldo recounted the evolution of our understanding of reentry and entrainment, in the elegant way that only he could. Improvements in technique were a common theme, especially in the areas of bi-ventricular pacing and ablation of atrial fibrillation. Basic science research and bench-to-bedside presentations continue to round out the NASPE experience. In addition, CMS has yet to render a decision on the MADIT II indication for ICD implantation. Relevant presentations included risk stratification by SAECG, mainly by QRS width. While at NASPE, FDA approval of a low-cost, minimal-feature ICD (Airbag, Biotronik) was announced. Lastly, atrial fibrillation ablation continues to evolve. Presentations on pulmonary vein isolation, surgical options, and RA linear ablation were available. An interesting twist was an abstract (Platt & Mandapati) on ablating pulmonary vein ganglia in fat pads to effect substrate modification in refractory AF patients. Our understanding continues to evolve.