Great Debates & Updates in Electrophysiology

In this episode of The EP Edit podcast, we’re discussing the inaugural Great Debates & Updates in Electrophysiology conference, taking place online April 22-24, 2021. This will be the first EP meeting solely dedicated to a debate-style format, featuring a mix of clinical updates and lively debates on provocative scientific topics impacting the EP field. The GDU EP features over 40 expert faculty, 7.5 CME credits, and 3 months of on-demand access. We're joined by 3 of the GDU EP Course Directors — Dr. Bradley Knight, Dr. Susan Kim, and Dr. David Haines — to discuss what to expect at the upcoming meeting.

To learn more about the GDU EP meeting and to register, visit ep.greatdebatesandupdates.com.

Transcripts: Dr. Knight, what can you tell us about the GDU EP and the format of the meeting? What sets the GDU EP apart from other meetings? Dr. Knight: We’re very excited about doing this first meeting. I think that the goal here is to make the meeting a little different and representative of the readership of EP Lab Digest. So, the goal is to provide material that is educational in a diverse format with a diverse group of people. We are hoping to be able to educate the readership of EP Lab Digest, which includes nurses, device clinic nurses, EP lab nurses, EP lab technicians, fellows, faculty, physicians — the whole spectrum of people. To do that, we created a program where we are alternating between case presentations for about 5 minutes with a panel discussion, or a brief debate followed by a panel discussion. We have a great mix of faculty as well that keep that balance. We have the typical experts that present at most meetings, but then we also are having some of the nurses in device clinics present cases, and are really trying to provide some diversity in the faculty this year. What are you particularly looking forward to? Why should people attend this meeting? Dr. Knight: I think that there are many meetings that discuss heart rhythm disorders, and there are many meetings that discuss and just focus on atrial fibrillation, for example. I think the interesting part of this meeting is it’s going to be a broad spectrum of topics. We’re going to cover the usual suspects about new energy sources for catheter ablation of atrial fibrillation. We’re going to talk about same-day discharge and things like that related to atrial fibrillation. We’re also going to talk about device debates and controversies such as whether to perform EP testing in patients with Brugada syndrome, and we actually have Dr. Brugada there as one of the debaters. We’re also going to talk about some other topics that I think will appeal to the broader group, such as the role of nurse practitioners in the EP program, and how to improve start times and turnaround times in the EP lab. So I’m hoping that everybody who spends any time in the EP lab will enjoy some of the content in this program. Dr. Kim, you’ll be moderating a session on the role of the advanced practice provider in EP. What can you tell us about this session? Dr. Kim: I think it’s going to be a very interesting session on this really timely topic of advanced practice providers in the EP practice. Dr. Raul Weiss is going to present a scenario where one could envision the use of an advanced practice provider. We’ll have Dr. Weiss, one of my colleagues, Dr. Ron Passman, and some advanced practice providers as well joining us to discuss the case. How has the role of the advanced practice provider evolved in recent years? Dr. Kim: I think that as practitioners including physicians get busier and busier, and find their bandwidth either shrinking or just being filled to the gills, the availability of these highly trained, specialized professionals has been incredibly useful. So I think advanced practice providers can provide incredible service on the inpatient side and on the outpatient side. We have Jessica Charron, who is really a device superstar, who helps us with inpatient device management and frankly, training our EP fellows and the general fellows. So there is really no end to the value they can add. Dr. Haines, pulsed field ablation is a hot topic on everyone’s radar right now. What is the significance of this emerging modality, and how could it transform the field of EP? Dr. Haines: Pulsed field ablation is really exciting despite the fact that it’s been around for literally decades. In fact, the first ablation I did as a fellow was DC shock ablation, which is the same type of mechanism of tissue injury. Back then it was very uncontrolled, actually kind of scary, and we transitioned to radiofrequency which was a very controllable and effective modality. But as all of us in the field of AFib ablation are well aware, the rare but potentially life-threatening complications of collateral injury, particularly to the esophagus, has held radiofrequency ablation in check a little bit. In addition, the fact that patients can initially have a good acute response but then recover conduction, have recurrence of arrhythmia, and require redo procedures is a big limitation. Now, the promise of pulsed field is that it’s a different mode of tissue injury. It’s electrical injury to the cell membrane, to the organelles, leading to an apoptotic cell death, and the electrical field defines the perimeter of the lesion. So if you can get electricity into the tissue, you can kill off that targeted tissue. The amazing thing is, though, that these structures outside the heart seemingly are protected. Now, is this that the electricity just isn’t getting to them, that the adventitial layer of the esophagus somehow shunts electricity away from it, or is it that the esophageal muscularis is really less sensitive to injury to this approach? We don’t know those answers yet — we will know those answers. But the esophagus is protected, the phrenic nerve is protected, and arteries, veins, and pulmonary veins are protected. You don’t get pulmonary vein stenosis. It’s almost like a silver bullet. You really get right to where you want to get. The other thing that is amazing is it’s really fast. When I did my first case with my colleague, Dr. Ilana Kutinsky, she just went, “Poof, it’s gone”! One button push and the electrograms were gone, and it’s really dramatic. Now, there is a lot we don’t know about pulsed field ablation, and there is a lot we need to learn. We need to do the clinical trials, we need to optimize waveforms and dosimetry. So it’s going to be a field in evolution over the next decade, but it’s really, really promising. What can you tell us about the GDU EP session on PFA and ablation energy sources? Dr. Haines: This is going to be an exciting session because like most fields of medicine, when you don’t know all of the details, there is plenty of room for opinion and speculation. We’ve assembled a group of really smart people who know the literature and the science, but also have a creative view of the direction that the field will go. So we’re hoping to generate a really interesting discussion, maybe a little bit of debate, because there is some room for differing opinions as to how we should look at these new approaches to ablation compared to the standard techniques we’ve been doing.