Dave Fornell, Editor DAIC
There were several technology takeaway messages for the future of electrophysiology (EP) at the Heart Rhythm Society (HRS) 2015 meeting in Boston.
One of the takeaways was an official recommendation from HRS to remotely monitor patients with implantable EP devices. HRS said this will improve patient care and efficiency, and reduce the number of required in-office visits.
There has been a lot of discussion at HRS in recent years about new EP electromapping systems that promise to improve outcomes of catheter ablations. The latest system discussed this year with first-in-human data is a dipole density mapping system that uses an intra-cardiac ultrasound transducer-studded basket catheter. The Acutus Medical AcQMap is a high resolution imaging and mapping system that generates a complete heart chamber electrical map with a four-fold improvement in resolution compared to the standard voltage-based mapping used in patients with atrial flutter.
Implantable device therapy continues a march toward leadless and miniaturized transcatheter delivered technology. Highlighted this year was Medtronic’s Micra catheter-delivered, leadless pacemaker, which just gained European market approval.
Magnetic resonance imaging (MRI) has not been an option for patients with implantable EP devices up until recently. Today, there are now MRI-compatible pacemakers on the market, and the next innovation will be MRI-compatible implantable cardioverter defibrillators (ICD). The latest clinical data was presented as a late-breaking trial for Biotronik‘s Iforia ProMRI ICD, which is pending final FDA review.
An interesting late-breaking study was presented on the use of botulinum toxin (Botox) injections in the epicardial fat pads for prevention of atrial fibrillation (AF) after cardiac surgery. Data show the injection not only reduces the incidence of post-operative AF, but also provides substantial AF suppression after one year.
There was a lot of new AF data presented at HRS 2015. A couple of interesting studies included significant differences between men and women with AF and the safety of intense physical activity and how women who experience menopause at a younger age are at a decreased risk of AF. Another large-scale study has found use of a smartphone ECG device and app accurately detects AF and significantly increases patient awareness of heart rate and behavior, which may shed light on how these devices will be used for greater patient engagement in the coming years.
Cryo-ablation for AF has been a big topic in the past couple years at HRS, and Medtronic just gained FDA clearance for its latest version of its cryo-ablation system, the Arctic Front Advance.
A new device technology to treat heart failure was presented as a late-breaker. Carotid baroreflex activation therapy (BAT), using electrical pulses from an implanted pacemaker type device, was shown to improve symptoms, exercise capacity and quality of life in patients. Half of the patients in the study saw reductions in symptoms from one class to a less severe class of heart failure.