Dr John M

cardiac electrophysiologist, cyclist, learner

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Day 2 ESC — AF ablation and more bike commuting

September 2, 2013 By Dr John

IMG_3298Okay, I’m getting the hang of this. The Monday morning and evening commute in Amsterdam is something special. You talk about focus. It requires laser-like focus. You’ve got bikes, narrow lanes, buses, trams, pedestrians and tourists. Still though, traveling 6k by bike took 15 minutes; a cab from the convention center, more than 30. I was coasting and still passing standing cars.

I wasn’t the only cardiologist who had figured out the transportation.

You don't see this at US meetings

You don’t see this at US meetings

And the Dutch people look perfect. Do they even eat? Tall, Nordic-like, pleasant appearing, unflappable, all these come to mind when you ride here. I think the Dutch people may be prettier than Californians.

Here’s a short video from yesterday. You can see what I speak of.

The temperature too. Now I understand what the young people meant about being able to ride in dress clothes. You can. I did. Actually, with wool pants, a button dollar collar shirt and dress shoes, I was under-dressed compared to some.

One more thing about Amsterdam. It’s really dangerous to text and walk. I almost meandering into the way of this thundering herd. The Sporza-sounding voices alerted me seconds before a collision.

IMG_3303

Now to the work.

Cardiology/Electrophysiology

Yes, this is serious work. It says on the top of the blog that I am a learner. I spent most of yesterday leaning about AF ablation. My take of the aptly named DECAAF trial is now posted on theHeart.org page. I sense a change coming in the way we think about AF ablation. Not this week or next, but soon.

Another controversial trial released yesterday looked at preventative coronary stenting. And no, that’s not a typo. The PRAMI trial, covered nicely by Michael O’Riordan from theHeart.org, showed that stenting open non-culprit blockages at the time of a heart attack improved outcomes. This goes against current thinking, which held that it was best to open only the blocked vessel causing the heart attack, and then get out. This study has faced a lot of criticism, mainly because it goes against everything we know about vulnerable plaques and atherosclerosis. Plus, the 64% reduction in outcomes seems very high. Stay tuned on this one.

Today, I spent the morning at multiple sessions. One was on the role of high-intensity training as an exercise prescription. Yeah, that will work in Kentucky. The second touched on molecular biology’s role in atrial fibrillation. Award-winning, Italian-turned-British, woman scientist, Barbara Casadei Unknownsummarized her work with reactive oxygen species, NO, inflammation, and statins. I like molecular biology but this one was over my head a bit. I voice-memo-ed it for possible use later.

Then I went to a session on screening athletes for sudden death. I was supposed to see a friend from Leipzig speak about ECHO screening, but they changed the line-up posted in the book, and I ended up hearing a spirited debate on ECG screening. I’ve heard this story before.

Finally, I went to the poster sessions and got a blog topic for the day.

It has to do with the management of this: (Image taken with permission from the Life In the Fast Lane ER blog.)

Tachy-brady syndrome

Tachy-brady syndrome

The reflex therapy treatment for this was a pacemaker and rhythm drugs. There is a better way to manage it in 2013. My post on the matter, including a neatly done study will come up soon atTheHeart.org.

I’m going to give you a closing tip: Cyclists, triathletes and endurance athlete will want to pay attention to tomorrow’s ESC coverage.

JMM

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Related posts:

  1. Day 1 ESC — Cardiac Pacing, MRIs and RV lead position
  2. Made it to Amsterdam for ESC 2013
  3. New Trials and Fibrillations post up: Thoughts on left atrial appendage occlusion to prevent stroke in AF
  4. CW: A bike-racing heart doctor’s top-12 ‘likes’ about cycling

Filed Under: AF ablation, Atrial fibrillation, Cycling Stuff, Doctoring, Exercise, Healthy Living, inflammation Tagged With: ESC 2013

John Mandrola, MD

Welcome, Enjoy, Interact. john-mandrola I am a cardiac electrophysiologist practicing in Louisville KY. I am also a husband to a palliative care doctor, a father, a bike racer, and a regular columnist at theHeart.org | Medscape

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Find me on theheart.org | Medscape Cardiology

  • Electrophysiology commentary on Medscape/Cardiology

Mandrola on Medscape

  • My Medscape column on general medical matters

For patients...Educational posts

  • 13 things to know about Atrial Fibrillation — 2014
  • A new cure of AF
  • Adding a new verb to doctoring: To deprescribe is to do a lot
  • AF ablation — 2015 A Cautionary Note
  • AF Ablation in 2012–An easier journey?
  • Atrial Flutter — 15 facts you may want to know.
  • Benign PVCs: A heart rhythm doctor’s approach.
  • Caution with early Cardioversion
  • Decisions of 2 low-risk cases of PAF
  • Defining success in AF ablation in 2014
  • Four commonly asked questions on AF ablation
  • Inflammation and AF — Get off the gas
  • Ten things to expect after AF ablation
  • The medical decsion as a gamble
  • The most important verb in our health crisis
  • Wellness Requires Ownership

 

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