Atrial fibrillation Cycling Stuff Doctoring ICD/Pacemaker

Day 4 ESC 2013 — Female gender and AF, patient selection for CRT and a Dutch cycling adventure

On the last day of ESC2013 I attended a press conference entitled Update in Rhythmology. The purpose was to highlight four rhythm-related studies released at ESC2103.

The most noteworthy of the four abstracts involved gender-related issues in atrial fibrillation therapy.

French researchers used a 1.6 million patient database (including 1200 French GPs) to come up with about 15,000 atrial fibrillation patients. They then compared the rates of anticoagulation in men and women. There were significant differences–a gender gap if you will. The research team used the words, French women with AF undertreated. I wondered, is it really fair to say undertreat? I posted my take over at

Other topics covered in the press conference included reports on:

Pacemakers and prognosis. The bottom line from Dutch investigators: Having a pacemaker did not affect mortality. Outcomes turned solely on accompanying factors, like age, previous heart attacks, diabetes etc. That’s reassuring because a lot of patients worry that having a pacemaker means death is near. That’s not the case.

Sudden Cardiac Death awareness — French researchers reported on their work to enhance the treatment of out of hospital cardiac arrest. They emphasized the need for education–of the community and caregivers. Two important areas of emphasis were early CPR and defibrillation in the community, and increased use of cooling therapy in the hospital.

Lead extraction. Italian researchers spearheaded a European registry to study the new and growing field of lead extraction. Taking leads out of the body is very serious. The risks are significant. Lead extraction is a procedure that should be done only when necessary, and only by well-trained experienced operators. The phrase, “just because we can, does not mean we should,” fits lead extraction very well. The main finding of the report was a bit troubling: Increasingly, in Europe, more extractions are being done for non-infection reasons.

I also spent a good part of the morning working on a post for what I feel is the most impactful study released at ESC2013.

Cardiac Resynchronization Therapy:

The EchoCRT trial looked at CRT therapy (bi-ventricular pacing) in heart failure patients without significant conduction delay. The findings of this trial will change practice in the treatment of congestive heart failure, a disease that affects millions of patients worldwide. Although CRT can be strikingly good for some patients with heart failure, EchoCRT teaches us that we must be careful in selecting patients.

Click here for my take over at Trials and Fibrillations on

My colleague and friend, Dr. Jay Schloss (@EJSMD) posted his take of EchoCRT on his brand new medical blog, Left to My Own Devices. Congrats Jay. Welcome to the blogosphere.

Oh, and one more thing…

I had a momentous day on the bike in Holland. So good, in fact, I wrote an entire ride report. The generosity of others to a stranger features prominently in the experience. How could you have such a life experience and not write it down? Life is short; you want to remember these sorts of things, right?

Here is a link to my cycling adventure in Holland.