Please introduce yourself and your focus of work. 

I'm Emily Murtagh, an electrophysiology (EP) technologist at St Paul's Hospital in Vancouver, Canada. I'm also an EP instructor at the British Columbia Institute of Technology and I'm vice chair of the HRS Core Concepts in EP Committee. 

What are some of the key challenges in the diagnosis, management, and treatment of PVCs? What can you tell us about the presentations being featured during the session you will be chairing?

We may see multiple PVC morphologies. Here we need to correlate symptoms and ambulatory Holter strips to which morphology is causing the predominant burden and LV dysfunction. It's likely that if we get rid of that dominant one, that the others are a more acceptable burden.

It's also important to figure out if the trigger is ischemic or not. So, we may need to do a treadmill test. A high PVC burden could be the consequence of an unwell heart, a diseased myocardium where the cardiomyopathy is driving the PVCs, or, is it that the heart is healthy and the PVCs are actually driving the cardiomyopathy.

We might see a high PVC burden, but then be unable to induce any in the lab, so this we see quite often. [The patient] may have a daily variability of their burden, so if we did a Holter every day at different times, we might see the patient's burden fluctuate. Then for the procedure, we need at least one PVC to map the morphology to and do some pace mapping. We can get reasonable outcomes with that, but it's not as accurate in certain regions of the heart, such as the cusps, because when we pace, we would capture myocardium below the cusp itself and then we would get a wider area to target for ablation. So, activation mapping of frequent PVCs is preferable, because the mapping catheter has better resolution than pace mapping. With not having many PVCs at the beginning of the case, the endpoint is poor, whereas, if we have incessant PVCs that go away with ablation, we're much more confident in our success.

So, we have presentations on this. My session is on Sunday, May 19^th, called “The ABCs of PVCs for the Allied Health Professional.” We have 4 really interesting presentations: “PVCs: The Benign and the Not So Benign,” “Localizing PVCs on the ECG,” “Treatment of PVCs: Medication vs Ablation,” and “Tools for Mapping PVC in the Lab” with case study examples. So, I think these offer a great opportunity of PVCs, which is good if you're here to learn more or preparing for the IBHRE exam. I recommend you come join us for an interesting and interactive session. 

What are you looking forward to at Heart Rhythm 2024?

First, I want to plug my other session. I have a moderated poster session, which is “The A to Z’s of EP: Managing From Clinic to the EP Lab.” Seeing some of these titles is so humbling. It seems like you are always making progress in EP, and then you learn some more and it humbles you yet again. So, some of these topics include sympathetic denervation, para-hisian VT, workflows looking at using APs as a first assist in AF ablation, pediatric Brugada, AI-guided electrogram tracking in persistent AF ablation, and Julie Shea of HRS TV fame has a poster case series on “AV mirroring in silicone pacing leads with tribological wear”. So, it's just a fantastic showcase of the work allieds have been up to, what they've been researching and have to offer in the field so I'm really excited to learn more about these topics. Outside of that, I just love HRS and cannot wait to connect with old friends and colleagues from around the world. I also look forward to seeing more about pulsed field ablation. We started using PFA in British Columbia with a few companies in studies. I've not seen it used commercially yet and the manufacturers are all different, but the technology will change the scope of our work, so I'm really excited to see the advances in that. So, cannot wait to see everybody at HRS 2024. Thank you and have a great time!

The transcripts have been edited for clarity and length.