Highlights from Heart Rhythm 2016
Journal of Innovations in Cardiac Rhythm Management
2016 Innovations in Cardiac Rhythm Management Heart Rhythm 2016 in San Francisco, CA was an incredible success by all measures. As other big cardiology meetings are decreasing, Heart Rhythm remains as strong as ever with more than 12,000 in attendance this year. In this article, I share my five biggest takeaways from Heart Rhythm 2016. The subcutaneous ICD works Since the subcutaneous implantable cardioverter-defibrillator (S-ICD) was FDA approved in 2012, how has it fared in the real world?
... tunately, we now have the data from the Effortless Trial. 1 In this late breaking clinical trial, 985 patients from 45 European centers were studied. And the data look impressive. In fact, with an average follow up of 3.1 years, only 12% of patients suffered an inappropriate shock and only 2% of the S-ICD devices were extracted. These numbers compare very favorably to the traditional ICD. Of the extracted devices, the primary reason was a need for pacing or shocks that failed to terminate ventricular arrhythmias. With regards to efficacy, the S-ICD performed every bit as well as the traditional ICD. Fully 89% of clinical ventricular tachycardia (VT)/ventricular fibrillation (VF) episodes were terminated with the first shock. Allowing for multiple shocks, 97% of VT/VF episodes were stopped. The S-ICD is definitely here to stay. Fortunately, generator size and battery longevity have improved since the initial release. For patients who don't require pacing, and want to avoid potential lead complications, the S-ICD is an excellent option. Leadless pacemakers are the future Patients and doctors want a leadless pacemaker. While this technology is still in its infancy, it won't be long until the leadless systems can do everything the traditional pacemaker can do. Having just seen a patient with severe tricuspid regurgitation one year after pacemaker implantation, the sooner we can get this technology the better. In another late breaking clinical trial, Dr. Vivek Reddy presented a study 2 comparing acute and mid-term complications of leadless versus traditional pacemakers. In this study of 718 leadless VVI pacemakers (Nanostim, St. Jude Medical, St. Paul, MN) and 10,521 traditional pacemakers, the leadless system had far fewer complications. Despite the high risk of device dislodgement (1%) and tamponade (1.5%), the leadless pacemaker had fewer complications both at the time of implantation and through the follow-up period. I should point out that this study included new implanters. I'm confident that with operator experience and better technology, these complications will only go down over time. Fortunately, the Medtronic version of the VVI wireless pacemaker is now FDA approved. Hopefully, it won't be long until we have dual chamber or left ventricular options also available with these wireless pacemakers. Evolving role of VT ablation It seems as if every year at Heart Rhythm there is another big study comparing ablation to drugs for VT. This year was no exception. The late-breaking clinical trial, the VANISH Study, 3 was a 22-center trial involving 259 patients. The entry criteria were similar to the kind of patients you may see while on call at your hospital. All patients had an ICD and all were on an antiarrhythmic. Despite an ICD and drug, these patients presented with ongoing VT. With this trial they were then randomized to VT ablation or two antiarrhythmics.