The Sixteenth Annual “Arrhythmia Diagnosis and Management Conference”

For 2008, the focus was on “Late-Breaking Clinical Trials.” The sponsor of this meeting was the Al-Sabah Arrhythmia Institute of St. Luke’s and Roosevelt Hospitals and Columbia University College of Physicians and Surgeons. The Co-Chairmen of the meeting were Dr. Jonathan Steinberg, the Endowed Director of the Al-Sabah Arrhythmia Institute, and Dr. Suneet Mittal, the Director of the Electrophysiology Laboratory of the Al-Sabah Arrhythmia Institute. Dr. Steinberg is a Professor of Medicine at Columbia University and Dr. Mittal is an Associate Professor of Medicine at Columbia University. Among the prominent features of this meeting are the presentations provided by guest faculty who are invited from around the world. This year, one of the meeting highlights was a lecture given by Dr. Paul Dorian, Director of Cardiology at St. Michael’s Hospital in Toronto, Canada and a Professor of Medicine at the University of Toronto. Dr. Dorian was one of the prominent leaders of a recently presented trial, the Atrial Fibrillation Congestive Heart Failure Trial, soon to be published in the New England Journal of Medicine. Dr. Dorian provided an excellent review of the challenges faced when treating patients with atrial fibrillation in the setting of congestive heart failure, and the absence of data documenting benefits when using anti-arrhythmic drugs. In summary, this large multicenter and well-designed clinical trial ultimately concluded that there was no advantage to the use of anti-arrhythmic drugs for these patients and the endpoint of total mortality was equivalent when using anti-arrhythmic drug treatment or a rate control strategy. Dr. Blair Grubb, Professor of Medicine at the University of Toledo in Ohio, was another invited guest lecturer. He is a renowned expert in the treatment of autonomic dysfunction and syncope. His talk was a thorough and comprehensive review of the many manifestations of autonomic dysfunction, in particular how to work through the clinical presentation related to autonomic syncope. He further described the appropriate diagnostic workup and gave guidelines on appropriate therapeutic interventions. The Al-Sabah Arrhythmia Institute is the largest arrhythmia program in the New York community. There are more than 20 members of the institute staff, including six experienced electrophysiologists. These attendings were among the presenters at this meeting and the two panel discussions. Drs. Tina Sichrovsky and Aysha Arshad updated the audience on “The Controversial Value of T-wave Alternans Testing” to screen for the risk of sudden cardiac death and the need for an implantable cardioverter defibrillator. They concluded that the findings were ambiguous at the present time, especially based on the most recent clinical trial results, and that this test should only be used as adjunctive evidence in determining the need for ICDs in high-risk populations and should not be used in patients who have no significant or severe structural heart disease. Dr. Mark Preminger, Director of Implantable Arrhythmia Devices in the Al-Sabah Arrhythmia Institute, presented an important and timely topic, “The Arrhythmic Manifestations of Sleep Apnea Syndrome.” Describing the bradyarrhythmias and tachyarrhythmias that plague many patients with sleep apnea, Dr. Preminger outlined the appropriate work-up and treatment for these difficult to manage patients. Dr. Steinberg provided an up-to-date analysis of “The Non-traditional Treatments” that can be used to prevent stroke in patients with atrial fibrillation. Reviewing data on anti-thrombotic and anti-platelet therapies, transcutaneous devices for prevention of atrial appendage embolic events, surgical amputation of the left atrial appendage, as well as catheter and surgical ablation of atrial fibrillation, the audience was able to appreciate the diverse approaches that are being studied to prevent stroke in patients who are unable to use warfarin therapy. Finally, Dr. Mittal provided another late-breaking result, “The Value of Cardiac Resynchronization Therapy in Patients with a Narrow QRS” in the setting of advanced heart failure. Unfortunately, very recent clinical trial results do not support CRT therapy in this population as of yet. The major challenge relates to the inability of echocardiographic factors to correctly identify a sub-population likely to benefit. The medical community in New York looks forward to next year’s meeting and another update in arrhythmia diagnosis and management. For more information, please visit: www.chpnet.org/cme