HRS Announces Worldwide Coalition to Improve CIED Follow-up at Heart Rhythm 2023 in New Orleans

NEW ORLEANS – The Latin American Heart Rhythm Society (LAHRS), together with Heart Rhythm Society (HRS), the European Heart Rhythm Association (EHRA), and the Asian-Pacific Heart Rhythm Society (APHRS) is proud to announce the Second World Forum on Cardiac Implantable Electronic Devices (CIED) Follow-up, at its Heart Rhythm 2023 in New Orleans, Louisiana on Thursday, May 18, 2023.

The number of patients with CIEDs, ranging from implantable loop recorders to pacemakers and defibrillators, is continuously growing. Data from these devices are interrogated at in-office visits and remotely. However, physicians are challenged by limited integration of the different interrogation data (i.e. limited inter-operability), not only between CIED vendors, but also between type of interrogation and type of device. This unnecessarily increases workload and hampers patient care.

The World Forum on CIED is an initiative of the four major EP societies to bring together all stakeholders in the field (physicians, CIED vendors, middleware companies, standardization agencies, EMD companies…) to create a collaborative spirit to find solutions for better inter-operability within the framework of existing data formats and exchange standards. The Forum is chaired by Prof. Hein Heidbuchel, former EHRA President, and Prof. David Slotwiner, Former Chair of the HRS Interoperability Committee. The inaugural event took place in Barcelona on August 22, 2022.

“We are excited to host the second World Forum on CIED Follow-up at our Heart Rhythm 2023in New Orleans,” said Andrew Krahn, MD, FHRS Heart Rhythm Society President. “This forum provides a unique opportunity for clinicians, researchers, and industry leaders to come together and advance the field of device interoperability.”

The forum will feature practical demos on the current state of the art of data export and integration from the different vendors, a keynote lecture on evolving standards, and most importantly a small celebration to sign a Statement of Common Goals that the stakeholders developed after the first Forum and that expresses their collaborative spirit.

“Electrophysiologists worldwide share the same desire to better streamline data flows during the follow-up of CIED patients, and I am extremely happy that our call for a creative forum was enthusiastically met by all stakeholders” said Hein Heidbuchel. David Slotwiner added that “The forum provides a platform for discussion between expert users and all industry involved on how to best implement existing standards, and develop newer ones, to improve patient care.”

The HRS annual meeting is the premier event for heart rhythm professionals, featuring cutting-edge science, education, and networking opportunities. The meeting attracts more than 7,000 attendees from around the world, including physicians, allied health professionals, researchers, and industry leaders. Registration for the HRS Annual Meeting. For more information, visit the HRS website at www.HRSonline.org.

LAHRS Webinar Cycle

The Latin American Heart Rhythm Society cordially invites you to its 3rd webinar 2023 entitled “STRATEGIES IN VENTRICULAR TACHYCARDIA ABLATION”

We will have the participation of great experts in the field:

  • Dr. Mauricio Abello (Argentina)
  • Dr. Luis Carlos Saenz (Colombia)
  • Dr. Mauricio Scanavacca (Brazil)
  • Dr. Andreu Porta (Spain)
  • Dr. Fermín García (United States)

It will take place on June 7 at 8:00 p.m. Argentina – Brazil and 5:00 p.m. Mexico, 6:00 p.m. Colombia, and 1:00 a.m. España (+1 day)

Access is free to the public

Link to register for the event

We´ll be waiting for you

How to use digital devices to detect and manage arrhythmias: a practical guide from EHRA

The evolution of technology has allowed heart rate monitoring devices to become smaller and smaller, putting them within the reach of each individual whether through a cell phone, small dedicated devices or even watches that allow continuous monitoring of the rhythm and performing an electrocardiogram.

There are two main forms of monitoring, one of which is based on plethysmography, either by light and cell phone cameras, sensors attached to fingertips, or on watches. This plethysmography technique allows even non-purpose cell phones to obtain a reasonably accurate heart rate reading, allowing heart rate counting and identification of rhythm irregularities that may be associated with atrial fibrillation. However, it is important to note that whenever an arrhythmia is detected in plethysmography-based devices, it must be confirmed by electrocardiogram.

The second way, more precise, but requiring adapted or dedicated devices, consists of reading the electrocardiogram itself. The devices contain electrodes that allow the capture of electrical signals from the heart, being able to record two leads when there are only two electrodes, but being able to record up to six leads in devices with more than two electrodes. This technology associated with artificial intelligence systems allows, in addition to recording the ECG, its interpretation, being able to alert the patient of the appearance of atrial fibrillation, high or low heartbeats.

Recently, the European Heart Rhythm Association (EHRA) prepared, with the contribution of LAHRS, a document entitled “How to use digital devices to detect and manage arrhythmias: a practical guide for EHRA” (1) where the characteristics and applications of these devices are described, discussed in a very interesting and in-depth way, including recommendations based on expert consensus are presented in this document.

Regarding the monitoring of Atrial Fibrillation (Figure 1), the intermittent use of these devices is indicated and is beneficial in people over 75 years of age, and they can also be used in people over 65 years of age with comorbidities that increase the risk of stroke. In younger or lower-risk individuals, sporadic screening can be performed, but in these cases, due to the very low incidence of AF, they have low detection rates. An important point regarding the detection of AF is that, when it was identified and evaluated in relation to the use of anticoagulants and risk factor management, there was evidence of benefits in the prevention of embolic events. (2)

Figure 1 – Electrocardiogram demonstrating atrial fibrillation detected on a watch with electrocardiogram recording

In patients with a previous diagnosis of AF, these devices also play an interesting role in patient management. The use of these devices can contribute to improving commitment and adherence to the ABC (3) strategy for the management of AF. Another very interesting use of these devices is after the AF ablation procedure, with the aim of detecting cases of recurrence during follow-up, which allows for better drug adjustment.

Another population where devices can help conventional treatment are patients with ventricular arrhythmias and syncope (Figure 2). However, one of the limitations of these devices is that they do not promote continuous electrocardiographic monitoring, and must be activated or inserted by the patient. In such cases, self-adhesive patch-based devices with continuous monitoring may be beneficial. Patients with paroxysmal palpitations lasting a few minutes, generally when they go to the emergency room to record the arrhythmia, they revert before arriving and, as the episodes are sporadic, often cannot be recorded on Holter or symptomatic event monitor. Currently, with the use of detection devices, it is easy to record the arrhythmia tracing, often identifying supraventricular tachycardias that are susceptible to ablation and complete control of the arrhythmia.

Figure 2 – Documented ventricular tachycardia in a patient with ischemic cardiomyopathy, inferior scarring, and episodes of short-duration rhythmic tachycardia palpitations. The recorded episode was hemodynamically well tolerated and lasted approximately 5 minutes with spontaneous reversal. The patient underwent ventricular tachycardia ablation in evolution, with no recurrence after ablation

Currently, more and more patients will carry these devices, bringing benefits in the diagnosis and treatment of cardiac arrhythmias, so it is extremely important that the doctors involved know the characteristics, advantages and disadvantages of each device, as well as its use in the different cardiac arrhythmias, being this publication of great relevance for the doctors of our society.

 



Dr. Cristiano Pisani


Assistant Physician of the Arrhythmia Unit of the Heart Institute – HC/FMUSP

1. Svennberg E, Tjong F, Goette A, Akoum N, Di Biase L, Bordachar P, et al. How to use digital devices to detect and manage arrhythmias: an EHRA practical guide. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2022.

2. Svennberg E, Friberg L, Frykman V, Al-Khalili F, Engdahl J, Rosenqvist M. Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP): a multicentre, parallel group, unmasked, randomised controlled trial. Lancet. 2021;398(10310):1498-506.

3. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. European heart journal. 2021;42(5):373-498.

20th Anniversary of the European Heart Rhythm Association

As we celebrate the 20th anniversary of the European Heart Rhythm Association, it is an honor to recognize the collaboration with the Latin American Heart Rhythm Society, our “younger” sister society. Together, we have accomplished much in the field of cardiac arrhythmias and electrophysiology.


Through joint scientific meetings, educational initiatives, and the sharing of expertise, we have strengthened the field and improved patient outcomes. Our shared commitment to advancing the diagnosis and treatment of heart rhythm disorders has brought us closer as societies, and we are proud of the progress we have made together.

As we look towards the future, we are excited to continue this collaboration and expand our efforts to reach even more patients in need. We are grateful for the contributions of all members of the European Heart Rhythm Association and the Latin American Heart Rhythm Society, and we look forward to many more years of partnership and progress.

LAHRS executive board

LAHRS Webinar Cycle

The Latin American Heart Rhythm Society cordially invites you to its 2nd webinar 2023 entitled “STRATEGIES TO INTERPRET AN ELECTROCARDIOGRAM”

We will have the participation of great experts in the field of electrocardiography:
• Dr. Ana Claudia Venancio (Brazil)
• Dr. Luis Aguinaga (Argentina)
• Dr. Adrian Baranchuk (Canada)
• Dr. Carlos Morillo (Canada)

It will take place on April 5 at 8:00 p.m. Argentina – Brazil and 5:00 p.m. Mexico, 4:00 p.m. Alberta, Canada, and 6:00 p.m. Kingston, Canada

Access is free to the public

Link to register for the event

We´ll be waiting for you

Download pdf

LAHRS Celebrates 5 Years

El 20 de Mayo de 2017, se llevó a cabo en la sede de la Sociedad Uruguaya de Cardiología la ASAMBLEA CONSTITUTIVA de la Sociedad Latinoamericana del Ritmo Cardíaco/ Latin American Heart Rhythm Society (LAHRS).
En dicho acto, se realizó la inscripción jurídica de la sociedad, hasta entonces llamada SOLAECE, renombrada como LAHRS, considerando este nombre más apropiado para la inserción en el marco de Sociedades Científicas referentes a nivel mundial tales como HRS, EHRA y APHRS (Asia-Pacific Heart Rhythm Society).

Desde entonces, LAHRS se encuentra en pleno crecimiento, institucional, societario y científico.

Mensaje del Dr. Marcio Figueiredo, presidente LAHRS

Compartimos con todos ustedes un breve video que resume los logros y principales actividades de nuestra sociedad.

A message on or use of messages

When we read the research carried out by Guerra et al. (1) Regarding the use of electronic means in medical practice, we were curious to know what the situation was in Latin America. We intuitively knew that technological advances and, mainly, the need to work remotely due to the pandemic catalyzed their use, but we did not quantify them. We also made it important that the LAHRS become institutionally involved in the matter (2).

A large majority of those interviewed send (89%) and receive (98%) clinical data from patients through two instant message applications. That allows us to affirm that it is an integral part of medical practice. The instruments that we use are the ones that are more widespread in the region and the data obtained is more of an assessment of the situation of the digital market. The type of information shared is expected according to the specialties of the two doctors surveyed. At the top of the list are the different recording modalities of cardiac electrical activity. A majority of two electrophysiologists (71%) stated that they send the information without using the patient’s affiliation data, but 51% stated that they receive clinical information with data that would allow their identification. In that difference we see an important aspect to be reflected. In addition, it is believed that the legal regulations relating to the exchange of sensitive information are not known and, therefore, it is possible that they are not a cause for concern.

The work does not inquire about the use of new technologies that are used between patients and their doctors. This aspect is also an important issue. The heterogeneity in use is probably even greater and may be the cause of inequity in care. They also generate situations of potential risk for patients and doctors. To the former, in their quality of assistance and to the latter in the legal medical field. Another actor involved is the assistance institutions. During the pandemic they were forced to look for alternatives to face-to-face care and this has introduced instruments that will probably last after the emergency. Here are added labor relationship issues with health personnel, which often have not been formally resolved.

It is undeniable that the new information and communication technologies are here to stay. Medical deontology and ethics are also evolving, but not at the same speed. In many respects today they are being challenged. The legislation on the subject in each country can vary and in many it is non-existent. We insist that the survey carried out shows the lack of knowledge we have about this aspect.

In all countries there are codes of medical ethics that we cannot ignore. We also have the code of medical ethics of the World Medical Association (3). There it is established that we have the obligation to “respect the patient’s right to confidentiality. It is ethical to disclose confidential information when the patient gives consent…”. It also says that the physician must “when medically necessary, communicate with colleagues caring for the same patient” and “This communication must respect the patient’s confidentiality and be limited to necessary information”.

These precepts are prior to the existence of new technologies. The question is when and how much should we update them.


Dr. Alejandro N. Cuesta Holgado PhD FESC
Cardiologist – Pediatric Cardiologist – Electrophysiologist
Prof. Adj. University Cardiovascular Center, Clinic Hospital, UdelaR
Head of the Arrhythmia Service, Institute of Integral Cardiology, MUCAM, Montevideo
Pro-Treasurer LAHRS

References:

  1. Guerra, F., Linz, D., Garcia, R., Kommata, V., Kosiuk, J., Chun, J., Boveda, S., Duncker D. Use and misuse of instant messaging in clinical data sharing: the EHRA-SMS survey. Europace. 2021 Aug 6;23(8):1326-1330. doi: 10.1093/europace/euab063

  2. de Oliveira Figueiredo, M. J., Cuesta, A., Duncker, D., Boveda, S., Guerra, F., Márquez, M. F. Use of instant messaging in electrophysiological clinical practice in Latin America: a LAHRS survey. Europace. 2022 Jun 21:euac080. doi: 10.1093/europace/euac080
  3. https://www.wma.net/es/policies-post/codigo-internacional-de-etica-medica/

New perspectives in Cardiogenetics

xpert Consensus Statement EHRA/HRS/APHRS/LAHRS on the State of Genetic Testing for Cardiac Diseases

Knowledge about the genetic basis of cardiovascular diseases has made significant progress in recent decades, with the incorporation of new technologies in molecular diagnosis, functional characterization efforts, artificial intelligence, and strengthening of the genotype-phenotype association. The reduced cost of genetic sequencing allowed for widespread access to testing, making it an important part of clinical practice in cardiology. Eleven years after the first document published by Ackerman et al, (1) concepts and recommendations were updated, with multicontinental participation, including the Latin American Heart Rhythm Society (LAHRS). (2)

The basic principle for the use of clinical genetic tests is the understanding that the genes evaluated must have strong scientific evidence of association with the disease (for classification, see https://clinicalgenome.org/). In 2015, the American College of Medical Genetics and Genomics (3) provided a standard criteria-based approach to interpreting genetic variants in clinical trials. The sum of the tests leads to a classification of the variant in a probabilistic range of categories: pathogenic (pathogenic, P), probably pathogenic (probably pathogenic, LP), variant of uncertain significance (VUS), probably benign (probably benign, LB) and benign (benign, B). The VUS classification represents the challenge of current clinical practice when the experience of specialized and multidisciplinary centers is even more necessary.

Family counseling plays a fundamental role in providing guidance on the clinical impact of genetic tests for the testers and their relatives, being recommended before and after molecular diagnosis, in centers of experience in cardiovascular genetics. The clinically actionable outcome (presence of LP/P variants) can provide diagnostic, prognostic, and therapeutic information for the tester, depending on the disease investigated (Table 1). The main benefit of genetic testing is family cascade screening, i.e. accurately identifying family members who are carriers of LP/P variants, who benefit from specialized medical care, and non-carrier family members who are unlikely to develop the disease. Progress in genetic testing in inherited cardiovascular diseases has also increased understanding of oligogenic and polygenic diseases through the development of polygenic scores.

Table 1. Impact of genetic test for the tester

Illness

Diagnosis

Prognosis

Therapeutic

Arrhythmic syndromes

SQTL

+++

+++

+++

TVPC

+++

+

+

SBr

+

+

+

DPSC

+

+

+

SQTC

+

+

+

DNS

+

FA

+

Rep precoce

Cardiomyopathies

CMH

+++

++

++

CMD

++

+++

++

CMA

+++

++

++

MNC

+

+

CMR

+

+

+

Congenital cardiopathies

Syndromic

+++

++

Non syndromic

+

Familiar

++

SQTL: long QT syndrome, TVPC: catecholaminergic polymorphic ventricular tachycardia, Br: Brugada syndrome, DPSC: progressive wasting system disease, SQTC: congenital short QT syndrome, DNS: sinus node disease, AF: atrial fibrillation, Early Rep: early repolarization, CMH: hypertrophic cardiomyopathy, CMD: dilated cardiomyopathy, CMA: arrhythmogenic cardiomyopathy, MNC: non-compaction myocardium, CMR: restrictive cardiomyopathy.

The consensus provides disease-specific information organized into a disease summary, genes with strong and moderate association with phenotype (suggestion of which panel to order), as well as therapeutic and prognostic implications of genetic testing for the tester and their relatives. In family counseling, the recommended age to perform the genetic test is also specific to the diagnosis and age of clinical presentation in the family. In general, in channelopathies such as long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and Brugada syndrome, genetic testing is indicated from birth, since there are strategies for the prevention and treatment of life-threatening arrhythmias. In cardiomyopathies, on the other hand, the suggested age for genetic screening is between 10-12 years, due to age-dependent penetrance, unless there is a family history of a phenotype developed in childhood.

Long QT syndrome represents the disease with the highest performance and usefulness of genetic tests, when the pre-test clinical probability is high (Schwartz score 3.5), helping in the classification of subtypes 1 to 3, in the identification of syndromic forms. (Jervel Langue-Nilsen, Andersen Tawil, Thimoty and Triadin knockout) and calmodulinopathies (CALM1, CALM2 and CALM3). In hypertrophic cardiomyopathy, the distinction between sarcomeric disease and phenocopies such as Danon, Fabry, amyloidosis, and PRKAG2 syndrome can also guide specific medical follow-up and influence treatment.

Unlike the 2011 consensus, (1) atrial fibrillation (AF), progressive conduction system disease, and sinus node disease appear to be more based on a context of monogenetic inheritance or associated with other channelopathies/cardiomyopathies (overt or No). Another significant change in the current consensus was the weight of the genetic test in arrhythmogenic and dilated cardiomyopathies, since molecular diagnosis allows a more precise clinical stratification, with the development of new risk calculators, contributing to therapeutic decisions such as the indication of an implantable cardioverter-defibrillator (ICD).

The current consensus also provides recommendations for genetic testing in congenital heart disease. When congenital heart disease is diagnosed by fetal ultrasound (CHD), genetic testing of fetal tissue (chromosomal microarray or CNV sequencing) should be offered for pregnancy monitoring and genetic counseling.

It is easy to understand, therefore, that “genetic cardiology” is a new field of medicine, with specialists involved in the translation of genetic findings, reflecting on better clinical care. New gaps are emerging, and old challenges remain, including the accurate classification and interpretation of variants. The prospect is the development of gene therapy together with the precise identification of the disease-causing substrate, allowing not only genotype-guided therapies, but also gene-specific therapies, including variant-specific therapies.

Link: https://lahrs.org/guias/test-genetico-en-cardiopatias/

Dra. Luciana Sacilotto
MD, PhD, arrhythmologist focused on inherited Cardiac disease at University of Sao Paulo

Biobliography

1. Ackerman MJ, Priori SG, Willems S, Berul C, Brugada R, Calkins H, et al. HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies: this document was developed as a partnership between the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA). Europace. 2011 Aug;13(8):1077-109. PubMed PMID: 21810866. eng.

2. Wilde AAM, Semsarian C, Márquez MF, Sepehri Shamloo A, Ackerman MJ, et al. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) Expert Consensus Statement on the State of Genetic Testing for Cardiac Diseases. Heart Rhythm. 2022 Apr 4:S1547-5271(22)01697-6. doi: 10.1016/j.hrthm.2022.03.1225.

3. Sue R, Nazneen A, Sherri B, David B, Soma Das et al. Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Genet Med. 2015 May;17(5):405-24. doi: 10.1038/gim.2015.30. Epub 2015 Mar 5.

The revival of verapamil in atrial fibrillation

Summary of the study:

Koldenkof et al published in Europace the work entitled “Rate control differs in the prevention of progression in atrial fibrillation” 1. It is a sub-analysis of the RACE 4 study. Only patients without using antiarrhythmics were included. Investigators included 666 patients over 18 years of age with a diagnosis of paroxysmal atrial fibrillation (AF) of recent diagnosis. They classified subjects into three groups, those who used heart rate (HR) control with verapamil, those who used beta-blockers (BB) and one group who did not use any drug for rate modulation. It is important to note that those patients who presented symptoms of heart failure decompensation and patients with acute coronary syndrome within 3 months prior to screening were excluded. Of 666 study participants, 47 (7%) used verapamil, 383 (57.5%) used BB, and 236 (35.4%) received no treatment for HR control. The primary endpoint was a combined of need for first electrical cardioversion, pharmacological cardioversion and pulmonary vein isolation due to AF, while the secondary points included major cardiovascular events such as decompensated heart failure, acute coronary syndrome, hospitalization for arrhythmias, major bleeding, thrombotic events embolic or adverse effects of the drugs administered. After a 37-month follow-up, the analysis showed that the primary composite endpoint occurred in 17% of the subjects in the group that used verapamil compared to 33% in the groups that used BB or those that did not use HR control, with a statistically significant P value of 0.038. Authors concluded that the use of verapamil, a non-dihydropyridine calcium antagonist, was associated with a lower probability of progression of AF, in patients recently diagnosed with this condition1.

Editorial comment:

The published results of this substudy are really interesting. They show the advantages of the initial use of calcium antagonists not only as a HR control strategy but also as a preventive therapy to avoid progression of the disease in patients with newly diagnosed AF compared to other pharmacological drugs such as the most commonly used BB. From a pathophysiological point of view, this benefit is easily understandable since it is well known that the release of significant amounts of calcium from the sarcoplasmic reticulum is fundamental for the perpetuation and, therefore, the progression of the substrate responsible for the onset of atrial fibrillation2,3,4. It is known that calcium overload participates in signaling silencing and the progression of more calcium leak during diastole causing afterdepolarizations and therefore, helping to the development of an electrical substrate that perpetuates atrial fibrillation5, 6.If we take into consideration electrophysiological factors such as heterogeneous refractory periods favor the start of fibrillatory conduction waves and abnormal electrical activity that leads to the progression of atrial fibrillation because the calcium reduces the atrial refractory periods5.Therefore, the early implementation of a non-dihydropyridine calcium antagonist therapy, such as verapamil, would be justified, as it not only is associated with a lower need for pharmacological or electrical cardioversion, but it also reduces the need for invasive procedures such as pulmonary veins isolation7. On the other hand, it would be interesting to define the exact role of the autonomic nervous system and what is its participation in the pathophysiology of this condition, especially the role of the adrenergic pathways in the perpetuation and sustaining of AF8. BB therapy may be limited in many patients because it is associated with lower HR in those with concomitant sinus node disease.

What are the limitations of this publication?

We must keep in mind that these benefits are the result of an early diagnosis and a timely establishment treatment. Once AF has progressed to its persistent or permanent presentations, maybe it would not be possible to obtain these advantages. On the other hand, we must highlight that the number of patients who were in the verapamil group (n=47, only 17% of the study sample) was much lower compared to the other groups (i.e., BB were used in 383 patients [57.5%])1.Therefore, a prospective and controlled study is needed to confirm these results. Such study could provide with a more balanced groups, with the same clinical and demographic characteristics, including the HATCH score that was lower in the verapamil group than in the beta-blocker group9.In such prospective study, emphasis in contraindications for the use of verapamil should be taken into account as it may result in a lower number of candidates for such therapy. Adverse events must be clear registered. A sufficient sample size should be calculated to detect significant differences in mortality. Another consideration to be made is that other non-dihydropyridine calcium antagonists should probably also be studied, like diltiazem10.

Final remarks:

Verapamil has been studied in Ibero-America since many years ago11-14. With this new information presented by Koldenhof et al, the early use of non-dihydropyridine calcium antagonists such as verapamil, in patients with newly diagnosed atrial fibrillation, can be beneficial in those who do not have contraindications. Its use could be associated with less progression of this condition. We must keep in mind that these benefits may be restricted by the exclusion criteria mentioned above, so the selection of patients according to their comorbidities is of vital importance prior to the initiation of this pharmacological agent. The study of Koldenhof et al could represent the “revival” of an old drug, verapamil, in AF.

Autores:

Dr. Manlio F. Márquez Murillo

Médico Adscrito al Servicio de Electrocardiología del Instituto Nacional de Cardiología Ignacio Chávez.

Académico Titular de la Academia Nacional de Medicina de México.

Vocal del Comité de Investigación del Instituto Nacional de Cardiología Ignacio Chávez

Secretario del Consejo Mexicano de Cardiología

Coordinador de la Alianza contra la Muerte Súbita, una Iniciativa de la Sociedad Interamericana de Cardiología

Sistema Nacional de Investigadores SNI II

Dr. Manlio F. Márquez Murillo
Médico Adscrito al Servicio de Electrocardiología del Instituto Nacional de Cardiología Ignacio Chávez.
Académico Titular de la Academia Nacional de Medicina de México.
Vocal del Comité de Investigación del Instituto Nacional de Cardiología Ignacio Chávez
Secretario del Consejo Mexicano de Cardiología
Coordinador de la Alianza contra la Muerte Súbita, una Iniciativa de la Sociedad Interamericana de Cardiología
Sistema Nacional de Investigadores  SNI  II

Dr. Angelo Columna Capellán
Dr. Angelo Columna Capellán
Médico Residente de Electrofisiología del Instituto Nacional de Cardiología Ignacio Chávez

References

  1. Koldenhof T, Wijtvliet PEPJ, Pluymaekers NAHA, Rienstra M, Folkeringa RJ, Bronzwaer P, Elvan A, Elders J, Tukkie R, Luermans JGLM, van Kuijk SMJ, Tijssen JGP, van Gelder IC, Crijns HJGM, Tieleman RG. Rate control drugs differ in the prevention of progression of atrial fibrillation. Europace. 2022 Mar 2;24(3):384-389.

  2. Márquez MF, Gómez-Flores J, Aranda-Faustro A, Cazares-Campos I, Cárdenas M. Avances recientes en la fisiopatología de la fibrilación auricular [Recent advances in the pathophysiology of atrial fibrillation]. Arch Cardiol Mex. 2009 Dec;79 Suppl 2:18-25. Spanish.

  3. Jost N, Kohajda Z, Kristof A, Husti Z, Juhasz V, Kiss L et al. Atrial Remodeling and Novel Pharmacological Strategies for Antiarrhythmic Therapy in Atrial Fibrillation. Current Medicinal Chemistry. 2011;18(24):3675-3694.

  4. Dagres N, et al. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: what is the best practice?. Europace 2018;20(9):1399-1421.

  5. Márquez MF (Ed.) “Fibrilación Auricular”. 2nd Ed. Sociedad Mexicana de Cardiología, PyDESA Editorial, Mexico City, 2018.

  6. Rodríguez-Diez G, Márquez MF, Iturralde-Torres P, Molina-Fernández de L LG, Pozas-Garza G, Cordero-Cabra A, Rojel-Martínez U. Joint Mexican position document on the treatment of atrial fibrillation. Arch Cardiol Mex. 2020;90(1):69-76.

  7. Márquez MF, González Hermosillo JA, Cárdenas M. Guía para el diagnóstico y tratamiento de la fibrilación auricular [Guidelines for the diagnosis and treatment of atrial fibrillation]. Arch Cardiol Mex. 2006 Apr-Jun;76(2):231-6. Spanish.

  8. de Vos C, Pisters R, Nieuwlaat R, et al. Progression From Paroxysmal to Persistent Atrial Fibrillation. J Am Coll Cardiol. 2010 Feb, 55 (8) 725–731.

  9. https://doi.org/10.1016/j.jacc.2009.11.040Hu WS, Lin CL. Comparisons of HATCH, HAVOC and CHA2DS2-VASc scores for all-cause mortality prediction in atrial fibrillation: a real-world evidence study. Postgrad Med J. 2022 Jan 24:postgradmedj-2021-141147. doi: 10.1136/postgradmedj-2021-141147. Epub ahead of print. PMID: 35074802.

  10. Luciardi H, Berman S, Santana M, Monteros L. Diltiazem por vía intravenosa en la conversión a ritmo sinusal de taquiarritmias supraventriculares [Intravenous diltiazem in the reversion to sinus rhythm in supraventricular tachyarrhythmias]. Arch Inst Cardiol Mex. 1996 Nov-Dec;66(6):505-9. Spanish.

  11. De Soldati L, Stritzler G, Balassanian S, Fuksman A, Mario Krasnov C, Rosental R, Chutlian A, Fabregas R. Ensayos de desfibrilación auricular con la asociación quinidina-verapamil por vía oral [Trials of auricular defibrillation with the quinidine-verapamil combination by oral route]. Prensa Med Argent. 1972 May 26;59(17):665-70. Spanish. PMID: 5048460.

  12. Shapiro M, Malo R, Férez S, Martínez-Ríos MA, Salazar E. Effectos antiarrítmicos del verapamil [Antiarrhythmic effects of verapamil]. Arch Inst Cardiol Mex. 1976 May-Jun;46(3):305-16. Spanish. PMID: 1088854.

  13. Ronderos R, Escudero EM. Efectos del verapamilo en la fibrilación auricular [Effects of verapamil in atrial fibrillation]. Medicina (B Aires). 1985;45(3):247-51. Spanish. PMID: 3841935.

  14. Sobrino JA, et al. Combinación de quinidina y verapamil en la fibrilación auricular. Rev Esp Cardiol 1989;42(4):262-266.

EP Fellowship Program

The Latin American Heart Rhythm Society (LAHRS) announces the Registration to the Fourth Edition (2023-2024) of its Cardiac Electrophysiology Training Program at McGill University (Montreal, Canada)

Director: Dr. Vidal Essebag – Head of Electrophysiology – McGill University

Vacancies: one (1)

Duration: two (2) years

Start: July 1, 2023

LAHRS SCHOLARSHIP: Includes salary of $60,000 CAD per year, and tuition fees to McGill University. Does not include costs of transportation (air) and accommodation.

Registration closes: September 1, 2022

Those interested must meet the following 2 application requirements:

1) SEND MOTIVATION LETTER and CURRICULUM VITTAE BY EMAIL to info@lahrs.org and vidal.essebag@mcgill.ca(before August 15, 2022)

2) COMPLETE THE McGill ONLINE APPLICATION by accessing the following webpages for detailed instructions (deadline for COMPLETE application by September 1, 2022). The registration fee will be discounted by LAHRS in future activities (will be informed shortly).

  1. For information pertaining to the Fellowships admission requirements:

http://www.mcgill.ca/pgme/admissions/prospective-fellows

  1. A step-by-step guide to help candidates successfully navigate through the admissions process can be found under the Menu: Application Process that includes an Applicant Guide

  1. Candidates will have to choose the following for your program selection:

a. Faculty/School: Postgraduate Medicine

b. Program: Post Residency Fellowship

c. Major or subject: Residency Program (Cardiology)

d. Concentration or area of ​​specialization: Fellowship Program: (Cardiac Electrophysiology Fellowship – 2 years)

  1. A description of the EP fellowship can be found at: https://www.mcgill.ca/pgme/fellowships/fellowship-programs/internal-medicine-cardiology by accessing the link for Cardiac Electrophysiology Fellowship (2 year program)

Contact Information:

a. Dolly Rabbath 1-514-398-8264, email: pgfellows.med@mcgill.ca

Admissions Manager, Postgraduate Medical Education, Faculty of Medicine

and Health Sciences

b. Ms. Mathushni Suntaram: pgcoordinator.med@mcgill.ca

c. Ms. Lisa Campbell: fellowshipspg.fmhs@mcgill.ca

Important: in the “proof of funding” field write LAHRS-McGill Scholarship Award

Selection Procedure: The candidate will be selected by a committee of members from LAHRS and McGill University, who will evaluate the technical and academic excellence of the candidate, and their career goals, through the curriculum vitae. Cardiology degree is a prerequisite and additional training in electrophysiology is desirable. The acceptance of admission to the program by the candidate implies the commitment to develop their subsequent professional activity within the Latin American territory for a minimum period of 2 years.