How to Perform Cardioneuroablation

In this latest video from Arrhythmia Academy’s Journal Club, moderator Prof Dhiraj Gupta meets with Dr Tolga Aksu (Istanbul, TR) and Prof Josef Kautzner (Prague, CZ) to discuss the latest issues and evidence base surrounding the novel cardioneuroablation (CNA) technique.

Dr Aksu presents evidence of success through real-life case examples of CNA and Prof Kautzner discusses the experiences from his heart centre in Prague. Together they discuss the importance of this novel methodology for both EPs and patients and discuss issues around indications and patient selection. They consider if the time has come for cardioneuroablation to be part of formal EP training programmes or whether should it remain limited to a few operators until RCTs can provide further evidence of data.

Twitter for Electrophysiologists

Dr David Duncker and Dominik Linz join Prof Dhiraj Gupta in the latest journal club episode to discuss their new paper, recently published in Europace, on the use of Twitter in electrophysiology #EPeeps.

In this short video discussion, they highlight key do’s and don’ts, along with practical advice, for using Twitter professionally and present their thoughts on the advantages and disadvantages of using social media to promote research, education and networking as they consider the changing dynamic in this field.

Watch the video above and read their article here to learn more.

The Treatment of VT Storm

VT electrical storm is a life-threatening event and an acute clinical emergency.

This edition of Arrhythmia Academy’s Journal Club, moderated by Prof Dhiraj Gupta, features an interesting panel discussion with the lead authors of two recently published papers on the topic.

Prof Della Bella provides us with an overview of treatment options for VT storm using a multi-disciplinary approach.

Dr Simone Savastano presents a ‘how to’ presentation that showcases the procedural steps needed for the promising new technique: percutaneous left stellate ganglion blockade (PLSGB).

The video concludes with a panel discussion.

The WRAP-IT Study: An Educational Interview

Did you know that mortality is x3 times more likely once a cardiac infection takes hold? Therefore preventative solutions are vital.

In our latest Journal Club video, editorial board member, Dr Anil Saxena meets with the lead author of the WRAP-IT study, Dr Suneet Mittal.

Hear them discuss the outcomes of the randomised WRAP-IT global study which aimed to assess if the incremental use of an antibacterial envelope could help drive zero infections.

They discuss the results, insights into what role the envelope plays in the prevention of device-related infections, considerations around cost-effectiveness and which patient populations might benefit from the antibacterial envelope in light of the results.

Catheter Ablation for AF: RCT Review

In this latest ‘Journal Club’ video episode, Prof Dhiraj Gupta (Liverpool, UK) meets withs Dr Jason Andrade (Vancouver, CA) to discuss the latest findings from his EARLY-AF trial that he recently presented at AHA2020.

Together, they consider the differences between EARLY AF and other recent RCTs that have looked at cryoballoon PVI as a first-line therapy option for patients with paroxysmal AF including, STOP-AF, MANTRA-PAF and CAPTAF to assess if it’s time to offer catheter ablation as a first-line therapy option for AF patients.

Questions:

1. What were the headline results of the recent EARLY AF and STOP AF trials?

2. Why are EARLY AF and STOP AF results so different from previous studies looking at ablation as first-line therapy?

3. Absence of Crossover in EARLY AF is truly unique: how did you prevent this?

4. Can these study results be extrapolated to radiofrequency (RF) PVI?

5. Did you specify a minimum operator experience level before enrolment in trial?

6. How readily can the EARLY AF outcomes be applied to the real world? Should we be concerned that a number of small-volume centres and operators may start taking up Cryo PVI now?

7. Can the results be extrapolated to offer catheter ablation as first-line treatment for persistent AF too?

8. With the decrease in Healthcare utilization shown in the ablation arms in both studies, would universal healthcare systems start covering ablation as the first-line treatment? What are the barriers and challenges?

The CIRCA-DOSE Trial


The pivotal CIRCA-DOSE study was a randomized study that examined the AF burden in detail and changed how we conceptualise study endpoints when it published in Circulation back in 2019. Dr Dhiraj Gupta (Liverpool, UK) meets with the principal investigator of the study, Dr Jason Andrade (Vancouver, CA), who presents the data behind the original CIRCA-DOSE study and discusses the results from the recent secondary analysis examining the clinical definition of AF, which has recently been published in JAMA Open. They close by discussing how this research might influence clinical practice going forwards.

Prognosis of iLBBB

In this video presentation and discussion, Prof Dhiraj Gupta (Liverpool Heart and Chest Hospital) meets with senior author, Prof Francisco Leyva (Queen Elizabeth Hospital, UK) to review the results of his retrospective, real-world study that aims to answer the common and clinically important question surrounding how to treat patients with an incidental LBBB (iLBBB), and how imaging can be used to support detection. The results showed that patients with iLBBB should be assessed using cardiac MRI as a tool.

References:
1. Zegard A, Okafor O, Bono J, et al. Prognosis of incidental left branch block. Europace 2020;22:956-963.