Christine Albert, M.D., MPH, professor, chair of the Department of Cardiology and the Lee and Harold Kapelovitz Distinguished Chair in Cardiology, and former president of the Heart Rhythm Society (HRS). She spoke at the American Heart Association (AHA) 2021 meeting on innovations in electrophysiology (EP) technologies. 

Advances she discusses include:
   • Leadless pacing and CRT systems  
   • Wearable patch heart monitors and that are largely replacing traditional Holter monitors.
   • Pulsed field ablation (also called electroporation) that may improve cardiac ablations and prevent damage to underlying tissues.
   • Cryo-ablation balloons.
   • Improved EP mapping technologies.
   • and left atrial appendage (LAA) occluders.

Find more EP lab technology news

Find More AHA 2021 Late-breaking News

Khaldoun Tarakji, M.D., MPH, associate section head, cardiac electrophysiology, Heart and Vascular Institute at Cleveland Clinic, was the lead author on a followup study to the landmark WRAP-IT trial that showed the Tyrx bioresorbable antibacterial envelope was shown it significantly lower infection risk for patients who receive cardiac implantable electronic devices (CIED) and develop hematomas.[1] 

The study results showed an 82% reduction in major infection among patients with hematoma in patients who had received the Tyrx. It is a antimicrobial envelope that is used to place implantable electrophysiology (EP) devices inside prior to closing the device pocket. While the envelope itself did not prevent hemotomas, as the rate was the same in the control group with out it, the Tyrx did lower infection rates in patients with hemotomas.

Read more in the article Tyrx Absorbable Antibacterial Envelope Effectively Reduces Infections in Cardiac Device Patients with Hematomas.

Reference:

1. Khaldoun G. Tarakji, Panagiotis Korantzopoulos, Francois Philippon, Jeff D. Lande, Swathi Seshadri, Bruce L. Wilkoff, et al. Infectious consequences of hematoma from cardiac implantable electronic device procedures and the role of the antibiotic envelope: A WRAP-IT Trial Analysis. Heart Rhythm. Punlished online July 16, 2021. DOI:https://doi.org/10.1016/j.hrthm.2021.07.011.

Samir Saba, M.D., co-director of the University of Pittsburgh Medical Center Heart and Vascular Institute, and chief, Division of Cardiology, explains the SMART MSP (Multi-Site Pacing) study. This late-breaking clinical trial was presented at the 2021 Heart Rhythm Society (HRS) meeting. It evaluated the safety and effectiveness of multi-site pacing in initial non-responders to conventional cardiac resynchronization therapy with the goal of increasing response cardiac resynchronization therapy (CRT).

CRT nonresponders make up a sizable minority of patients, about one-third. Saba said this trial, was designed to try and chip away and reduce that number. Multi-site pacing has been debated as alternative to single site pacing for several years and this trial offers additional data in support of MSP.

The trial tested the efficacy and safety of the Boston Scientific Resonate X4 CRT-D system. This device allows multi-site pacing to be turned on or off at any time by the electrophysiologist. In the study, patients who did not respond had the multi-site pacing feature turned on, which resulted in 51% of the nonresponders to respond to therapy. 

Find additional HRS 2021 late breaking trials

Find more EP device news

Find more HRS 2021 conference news

Oussama Wazni, M.D., section head, electrophysiology, Cleveland Clinic, discusses the results of the recent STOP AF First and Early AF trials. Both showed effectiveness in using early catheter ablation rather than drugs in atrial fibrillation (AF) patients. Both trials used cryo-ballon ablation, but Wazni said it is translatable to use of all cather ablation technologies.

Wazni a principal investigator for the STOP AF First trial and he shares information on the Early AF trial presented as a late-breaking study at the 2020 American Heart Association (AHA).

Related EP Ablation Technology Content:

VIDEO: Early Ablation Improved Outcomes in Atrial Fibrillation Patients —interview with Oussama Wazni, M.D.

Esophageal Cooling May Help Prevent Injury From Cardiac Ablations

VIDEO: Top New EP Technologies at Heart Rhythm Society 2020 — Interview with Andrew Krahn, M.D.

Biotronik Partners With Acutus Medical to Offer More Efficient Arrhythmia Diagnosis and Treatment

Contact Force Sensing Catheter Improved Outcomes in Persistent Atrial Fibrillation Ablation

New Technologies to Improve Atrial Fibrillation Ablation

VIDEO: Current State of Atrial Fibrillation Ablation Technologies, an interview with Hugh Calkins, M.D., at HRS 2017.

Find more EP technology news and video

Horst Sievert, M.D., is the director of the Cardiovascular Center Frankfurt, and associate professor of internal medicine-cardiology at the University of Frankfurt. He discusses left atrial appendage (LAA) device advances and new developments for more effective LAA closure to reduce the stroke risk in atrial fibrillation (AFib or AF) patients and new developments for more effective LAA closure to reduce the stroke risk in atrial fibrillation (AFib or AF) patients.

He said there are current limitations using the Boston Scientific Watchman FLX and Abbott Amplatzer Amulet devices. One of the new concepts in transcatheter LAA occlusion technology from Append Medical is a suture delivery system that eliminate permanent metal implants and mimics a surgical suture closure without the need for an open chest procedure.

Sievert has more than 30 years experience in cardiology and has been the principal investigator in a number of clinical trials and has authored more than 130 manuscripts and 500 abstracts in peer-reviewed journals and 50 books and book contributions. He is also chairman of Scientific Advisory for Append Medical, developer of a novel LAA closure device.

Read more about the Append device — First-Of-Its-Kind, No-Implant LAA Occluder Noted for Innovation at 2019 ICI Meeting
 

Find more LAA occluder technology news

Peter Weiss M.D., MSc, director of ventricular arrhythmia management and robotics, and assistant clinical professor of medicine at the Heart Institute, Banner University of Arizona Medical Center, Phoenix, explains the advantages of using robotic navigation in the electrophysiology (EP) lab. He has used Stereotaxis robots for the past decade to reduce fluoro imaging and improve ablation outcomes. Banner just opened a new robotic EP lab with a Stereotaxis Genesis system, the first to be installed in the U.S. and only the second install in the world.

Related EP Robotic Systems Content:

VIDEO: Virtual Tour of the Robotic Electrophysiology Lab at Banner Health — Interview with Peter Weiss, M.D.

Time to Take Another Look at Robotics in Electrophysiology — Article by Peter Weiss, M.D.

Stereotaxis Announces Next-generation Robotic Magnetic Navigation and Imaging Systems

Stereotaxis and Acutus Medical Announce Strategic Collaboration
 

Find more news on robotic cath lab and EP lab systems

Devi G. Nair, M.D., FHRS, director of cardiac electrophysiology, St. Bernards Heart and Vascular Center, Jonesboro, Ark., was an investigator in the PINNACLE FLX clinical trial for the Boston Scientific Watchman FLX left atrial appendage (LAA) occluder device. 

The newest iteration of the Watchman was cleared by the U.S. Food and Drug Administration (FDA) in July 2020. Read more about the Watchman FLX 

The transcatheter implant is used in close the LAA, a pouch that forms part of the left atrium. The LAA is implicated in the formation of blood clots that cause stroke in patients with atrial fibrillation (AF). The Watchman FLX is indicated to reduce the risk of stroke in patients with non-valvular AF (NVAF) who need an alternative to oral anticoagulation therapy by permanently closing off the left atrial appendage.

Nair is currently involved with another trial of the Watchman FLX, OPTION FLX trial, which is examining the use of LAA occlusion in post-ablation patients.

Nair is also chairman for the Heart Rhythm Society (HRS) member engagement sub-committee and is a board member of the Arkansas chapter of the American College of Cardiology (ACC).
 

Watch Nair in this interview — VIDEO: Impact of COVID-19 on Electrophysiology Programs

Interview with Andrew D. Krahn, M.D.,FHRS, head of the division of cardiology at St. Paul’s Hospital, and professor of medicine at the University of British Columbia, and vice president of the Heart Rhythm Society (HRS). He is an expert in long QT syndrome (LQTS) and is involved with the National Long QT Registry. He explains the issues with the drugs being used to treat coronavirus (COVID-19, SARS-CoV-2) patients and why these combined with the cardiac impact of the virus is causing prolonged ECG QT segment prolongation, leading to deadly arrhythmias. COVID-19 can cause myocarditis that causes QT prolongation and the front-line COVID drugs hydroxychloroquine and azithromycin also cause QT prolongation.

The U.S. Food and Drug Administration (FDA) issued a Drug Safety Communication April 23, 2020, reminding doctors there are serious side effects when using hydroxychloroquine and chloroquine in the off-label use to treat COVID-19 patients. This includes potentially life-threatening heart rhythm problems. The FDA said case reports from the FDA Adverse Event Reporting System database, published medical literature and the American Association of Poison Control Centers National Poison Data System are reporting serious heart-related adverse events and patient deaths. Read more about this alert.

The FDA warning confirmed fears from the American Heart Association (AHA), the American College of Cardiology (ACC) and the Heart Rhythm Society (HRS). These societies April 8 jointly published a new guidance, “Considerations for Drug Interactions on QTc in Exploratory COVID-19 (Coronavirus Disease 19) Treatment,” to detail critical cardiovascular considerations in the use of hydroxychloroquine and azithromycin for the treatment of COVID-19. The societies warned that use of  these agents in a large number of patients in combination would results in arrhythmias and deaths. Read more.

However, there are numerous advocates that argue hydroxychloroquine needs to be used in less sick patients who are not already hypoxic to treat COVID, but it is being used primarily in very sick patients where it is not effective. Advocates also argue the drug can be used to help prevent coronavirus, similar to the drug's effect in preventing malaria. In terms of drug safety, advocates argue the drug has been used in millions of patients for more than 50 years without a high risk of arrhythmias. Several trials are now underway in the United States to test its use against COVID-19, but enrollment has been hampered because of the FDA warning. There will likely be more interest in hydroxychloroquine after it was revealed May 18, 2020, that President Trump is taking the drug for prophylaxis against COVID-19.

Related Hydroxychloroquine Content:

FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine for COVID-19

WHO Database Shows Serious Health Impact of Hydroxychloroquine and Azithromycin Being Used to Treat COVID-19

VIDEO: Overview of Hydroxychloroquine and FDA Warning in its use to Treat COVID-19 — Interview with Marianne Pop, Pharm.D.

WHO Database Shows Serious Health Impact of Hydroxychloroquine and Azithromycin Being Used to Treat COVID-19

COVID-19 Hydroxychloroquine Treatment Brings Prolonged QT Arrhythmia Issues

FDA Reports of Deaths and Injuries From Use of Antimalarial hydroxychloroquine in COVID-19 Patients

VIDEO: Cardiologists Manage Trial Testing if Hydroxychloroquine Protects Clinicians From COVID-19 — Interview with William O'Neill, M.D.

First Large-scale U.S. Study on Hydroxychloroquine COVID-19 Prophylaxis Begins in Detroit

AHA, ACC, HRS Caution Use of COVID-19 Therapies Hydroxychloroquine and Azithromycin in Cardiac Patients

Andrew D. Krahn, M.D., FHRS, head of the division of cardiology at St. Paul’s Hospital, professor of medicine  at the University of British Columbia and vice president of the Heart Rhythm Society (HRS), explains how HRS organized its virtual meeting after its in-person meeting was cancelled by the COVID-19 pandemic.  

Due to the continued global escalation of the novel coronavirus (COVID-19, SARS-CoV-2), HRS has cancelled its large annual in-person electrophysiology meeting in late-March and began planning for a virtual meeting instead. HRS broke its annual meeting into three online learning sessions over the course of May June and July. The first, which included the late-breaking sessions, was held May 5-9, 2020. Others will be held June 12 and July 1.

Using its online learning platform, Heart Rhythm 365 available on the www.hrsonline.org website, HRS is offering all its sessions at no cost.

Watch another interview with Krahn in the VIDEO: Top New EP Technologies at Heart Rhythm Society 2020.
 

Find a complete list of the Heart Rhythm 2020 meeting late-breaking studies with links to articles on each.
 

An interview with Ehtisham Mahmud, M.D., FSCAI, chief, Division of Cardiovascular Medicine, executive director of medicine, Cardiovascular Institute, director of  interventional cardiology and cardiac cath lab at UC San Diego Medical Center, and president of the Society for Cardiovascular Angiography and Interventions (SCAI). He explains the how cardiology departments in the U.S. are now postponing cardiovascular procedures due to novel coronavirus (COVID-19, SARS-CoV-2) containment efforts and new guidelines from Medicare calling for delay of all elective procedures in the country. 

Mahmud explains how patients are being prioritized, with acute myocardial infarction patients or others with acute, life-threatening conditions, or at high risk for a near term hospital admission, will still receive cardiac catheterizations, cardiovascular surgery or structural heart procedures for MitraClip and transcatheter aortic replacement (TAVR) under certain circumstances. All other procedures are being postponed until further notice based in the spread and infection rates of COVID-19. He said most hospitals, including his own, are moving to telehealth visits via phone or online to continue clinic work with patients, including those with chronic conditions such as heart failure.

The Centers for Medicare and Medicaid Services (CMS) announced March 18, 2020, that all elective surgeries, and non-essential medical, surgical and dental procedures should be delayed during the coronavirus outbreak. This move is three-fold. 
   1. It is to help with containment efforts by reducing patient and family travel to hospitals, which are at the center of the COVID-19 outbreak. 
   2. Delaying procedures will help preserve and inventory of personal protective equipment (PPE), hospital beds and ventilators and other medical supplies. 
   3. With the start of social distancing and the shut down of all large gatherings, this has severely impacted blood drives and other blood donations, so the nation's blood banks have severely limited supplies.

“The reality is clear and the stakes are high — we need to preserve personal protective equipment for those on the front lines of this fight,” said CMS Administrator Seema Verma.

This will not only preserve equipment but also free up the healthcare workforce to care for the patients who are most in need. Additionally, as states and the nation as a whole work toward limiting the spread of COVID-19, healthcare providers should encourage patients to remain home, unless there is an emergency, to protect others while also limiting their exposure to the virus. 

Read Mahmud's SCAI President's letter The Evolving Pandemic of COVID-19 and Interventional Cardiology

Related Cardiology Related COVID-19 Content:

ACC COVID-19 recommendations for the cardiovascular care team

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

The Cardiac Implications of Novel Coronavirus

ESC Council on Hypertension Says ACE-I and ARBs Do Not Increase COVID-19 Mortality

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CT Provides Best Diagnosis for Novel Coronavirus (COVID-19)

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Deployment of Health IT in China’s Fight Against the COVID-19 Epidemic

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Radiologists Describe Coronavirus CT Imaging Features

Coronavirus Update from the FDA

CT Imaging of the 2019 Novel Coronavirus (2019-nCoV) Pneumonia

CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV)

Chest CT Findings of Patients Infected With Novel Coronavirus 2019-nCoV Pneumonia 

Additional COVID-19 Resources for Clinicians:

   ACC COVID-19 Hub page   

   Johns Hopkins Coronavirus Resource Center with inteavtive map of cases in U.S. and worldwide 

   World Health Organization (WHO) COVID-19 situation reports

   World Health Organization (WHO) coronavirus information page

   U.S. Food and Drug Administration (FDA) COVID-19 information page

   Centers for Disease Control (CDC) COVID-19 information page

   Centers for Medicare and Medicaid Services (CMS) frequently asked questions and answers (FAQs) for healthcare providers regarding COVID-19 related payments
 

Andrew Weintraub, M.D., FACC, associate director, of the Interventional Cardiology and Vascular Center, medical director of the Vascular and Structural Heart Center, Tufts Medical Center, discusses the use of temporary pacing in transcatheter aortic valve replacement (TAVR) patients. Implantation of TAVR valves can cause pressure from the valve against the septal wall of the heart, causing conduction delays. These delays do not necessarily mean the patient needs a permanent pacemaker.

Instead, Tufts Medical Center uses temporary pacing leads, a small catheter with two electrodes, placed in the right ventricle of the heart through a vein in the groin or neck. The lead is then connected to an external pacemaker allowing a physician to monitor and control a patient’s heart rate for up to several days.  The center uses the BioTrace Medical Tempo Lead, which incorporates a novel active fixation mechanism, bipolar electrodes and a soft tip. Stabilizers provide secure fixation and maintain stable pace capture. An elastomeric balloon may be inflated to aid passage of the lead through the venous vasculature and into the right ventricle, and  aids in wall apposition during deployment of the stabilizers. This design helps secure and stabilize the cardiac pacing lead with the goal of reducing complications and allowing patients to ambulate sooner after procedures.

Related Content:

VIDEO: Overview of the TAVR Program at Tufts Medical Center — Interview with Andrew Weintraub, M.D.

VIDEO: The Expansion of TAVR Following the FDA Clearing its Use in All Patients — Interview with Torsten Vahl, M.D.

VIDEO: Overview of the Structural Heart Program at Tufts Medical Center — Interview with Charles D. Resor, M.D.,

Find more content on Tufts Medical Center

The Consumer Electronic Show (CES) is the world's gathering place for consumer technologies, with more than 175,000 attendees and more than 4,400 exhibiting companies. New healthcare technologies are among the top trends at CES. This video offers a quick look at the trends specific to healthcare technology.

Artificial intelligence (AI) is one of the hottest technology trends across all product across the CES floor this year. There is also discussion by key note speakers that the internet-of-things (IOT) concept introduced at CES nearly a decade ago is now morphing into a new meaning for the interconnectivity-of-things. This can be seen in healthcare products shown here and across all types of consumer and business products. 

The device technology at CES include many examples of how integrated wearables can digitally enable healthcare. The future of healthcare will include system where consumers are continuously monitored with sensors, software and services that can pinpoint digital biomarkers — earlier warning signs that predict health events. This is the prediction of Leslie Saxon, M.D., executive director of the University of Southern California (USC) Center for Body Computing (CBC), is speaking as a panelist about digital health trends and challenges in the session “Proving the Impact of Transformative Technology.” 

Saxon is a board-certified cardiologist and digital health expert who understands how developing technologies can more accurately assess wellness and human performance among elite athletes, military personnel and patients. She explained this digital healthcare model of the future is a vast contrast to the current point-of-care model.

Mark Ibrahim, M.D., FACC, assistant professor of medicine and radiology, associate program director, advanced cardiac imaging fellowship, University of Utah, explains what radiologists and cardiologists need to know what is needed from CT imaging prior to ablation procedures for atrial fibrillation (AF) and ventricular fibrillation (VF). He spoke at a joint session of the Heart Rhythm Society (HRS) and the Society of Cardiovascular Computed Tomography (SCCT) at the 2019 SCCT meeting. 

Find more SCCT news and videos

Sanjaya Gupta, M.D., electrophysiologist, St. Luke's Mid America Heart Institute, and assistant professor, University of Missouri–Kansas City School of Medicine, explains how his center developed an artificial intelligence (AI) application to automatically risk stratify atrial fibrillation (AFib) patients. The Epic-based app stratifies patients into those who should be placed on anticoagulation and those who are candidates for left atrial appendage (LAA) occlusion. He spoke at the 2019 AI-Med Cardiology conference. 

His center hopes to develop similar guidelines based AI apps for other types of cardiac risk scoring. Gupta said he is looking for other centers to partner with to co-develop and test these AI apps.    

Related Cardiology AI Content:

VIDEO: Overview of Artificial Intelligence and its Use in Cardiology — Interview with Anthony Chang, M.D.

VIDEO: ACC Efforts to Advance Evidence-based Implementation of AI in Cardiovascular Care — Interview with John Rumsfeld, M.D.

VIDEO: Artificial Intelligence Applications for Cardiology — Interview with Anthony Chang, M.D.

PODCAST: Fitting Artificial Intelligence Into Cardiology — Interview with Anthony Chang, M.D.

VIDEO: How Hospitals Should Prepare for Artificial Intelligence Implementation — Interview with Paul Chang, M.D.

Technology Report: Artificial Intelligence 

Interview with Frederick Masoudi, M.D., FACC, FAHA, professor of cardiology at the University of Colorado Hospital, and a physician leader of the National Cardiovascular Data Registry (NCDR). The NCDR is the American College of Cardiology's suite of cardiovascular data registries helping hospitals and private practices measure and improve the quality of care they provide.

Additional videos and coverage of the University of Colorado Hospital

Khaldoun Tarakji, M.D., MPH, associate section head, section of electrophysiology and pacing in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute at the Cleveland Clinic. He presented the WRAP-IT late-breaking trial at the American College of Cardiology (ACC) 2019 meeting. The trial looked at the use of an antibacterial envelope for pacemakers and ICDs to reduce infection risk. 

Read the ACC.19 article Medtronic Tyrx Envelope Significantly Reduces Major Infections in Cardiac Implantable Device Patients.

Rlated EP video From ACC.19:

VIDEO: Key Trends in Electrophysiology — Apple Watch to Detect AF and the CABANA Trial — Interview with Christine Albert, M.D.

This is a virtual heart with the same electrophysiology characteristics as the real patient being developed to help optimize cardiac resynchronization therapy (CRT) lead placement. CRT currently has a 30 percent nonresponder rate, which is mainly due to the placement of leads. This model allows virtual placement of the leads In various locations to test response prior to the implantation procedure. The green dot shows the location of the virtual lead. It was unveiled at the Healthcare Information Management and Systems Society (HIMSS) 2019 annual meeting in February by Siemens. This "digital twin" technology is in development and will be able to create virtual, digital organs from a patient’s ECG, MRI scan and other clinical data. Siemens said the technology also might have applications for testing virtual ablations strategies to save procedure time when the patient is in the EP lab. 

Read more about the digital twin technology.

Look through a photo gallery of other new technologies at HIMSS19. 

Find news and videos from HIMSS 2019.

DAIC Editor Dave Fornell takes a tour of some of the most innovative new cardiovascular technologies on display on the expo floor at the American Heart Association (AHA) 2018 meeting. 

Find other new cardiovascular innovations in these videos from other conferences over the past year:

VIDEO: Editor’s Choice of the Most Innovative New Technology at TCT 2018

VIDEO: Editor’s Choice of the Most Innovative Echo Technology at ASE 2018

VIDEO: Trends and Advances in Cardiac CT Technology

VIDEO: Editor's Choice of Most Innovative New Cardiac Technology at ACC 2018

VIDEO: Editor's Choice of the Most Innovative New Imaging Technology at RSNA 2017
 

Ashish Pershad, M.D., medical director, structural heart program, Banner University Medical Heart Institute, Phoenix, explains the difference he found between the FDA cleared Watchman left atrial appendage (LAA) occluder and the Abbott Amplatzer Amulet device now in U.S. trials. He spoke on these differences at the 2018 Transcatheter Cardiovascular Therapeutics (TCT) conference. 

Watch the VIDEO: New Data on LAA Occlusion From the PREVAIL and PROTECT Trials — Interview with Vivek Reddy, M.D.

Read the article "Occluding the Left Atrial Appendage (LAA)."

#TCT2018

A new clinical trial at The Ohio State University Wexner Medical Center is examining an implanted device that uses vagus nerve stimulation to help stroke patients regain motor function. The Vivistim device is similar to a pacemaker, which uses leads to electrically stimulate the brain. 

Read the article "New Therapy Rewires the Brain to Improve Stoke Recovery."