It’s been a few days since I returned home from Spain. The jet leg has resolved and normal sleep patterns have returned. I’ve had time to review the entire ESC program book. What follows is a review of my work and some notes on the past week in Barcelona.
The first thing to say about the European Society of Cardiology sessions is its massiveness. The convention site is huge; it’s streaming with people and technology. The press room stretched for more than a hundred meters while more than 500 journalists from all over the world jostled for desk space and power outlets, which led to signs like this:
Another thing to say about ESC is that Europeans seem OK with industry influence. The industry exposition area, which is shrinking at US meetings, seems more magnificent every year at ESC. The word largesse comes to mind. Outside the expo, posters get displayed on high-definition monitors; conference rooms have the latest AV equipment and lunch sessions overflow with free food.
The press gets a free lunch (grin), but I often went exploring outside at lunchtime. Interestingly, the speakers at said “sponsored” sessions were often prominent clinical researchers and first authors of major papers. I’m no cynic but it gets you thinking. (Especially since dubious procedures, such as renal denervation and left atrial occlusion, are being performed routinely in Europe.)
My thoughts on industry influence were influenced by my experience in Mexico. There, I was taught, if industry doesn’t support mass medical education, it doesn’t happen. I wonder whether this may also apply to Europe. A number of European doctors I spoke with don’t come to ESC unless they are sponsored.
Sorry, that was a lot on industry.
Let’s move to the medical stories. TheHeart.org | Medscape Cardiology offers me leeway on topics to cover. The meeting spans five days and I try to get one post done each day–which seems hard, except, my journalism colleagues at THO finish 2-3 posts each day. It’s amazing to watch. “Hey Mike, “is that your second story today,” I might ask. “Ah…no, it’s my third.”
Heart failure therapeutics:
This was a big year for ESC. The PARADIGM-HF trial, released on day 1 of ESC, represents the first positive news in heart failure therapy in decades. Novartis came up with a combination drug, still awkwardly named LCZ696, and tested it in a multinational blinded clinical trial against an established winner, the ACE-inhibitor, enalapril. Even though this wasn’t an electrophysiology story, it was the story of the meeting. Here is my take: 10 Reasons to Like PARADIGM-HF and Four That Warrant Pause.
Atrial Fibrillation therapy:
It turns out that Europe, too, has a problem with atrial fibrillation. One center in Maastricht Netherlands has a remarkable way to approach the disease. This group of clinicians and scientists have been both smart and courageous enough to harness the power of nurses. I know that sounds foreign for an American physician to say, but this group not only began a nurse-led AF clinic, but they have actually published data showing that patients randomized to nurse-led care did better than those in traditional doctor-led care. Here is my post on this remarkable work: Dedicated Atrial-Fibrillation Clinics: There Is No ‘I’ in TEAM.
One of the coolest aspects of cardiology is our tools. I sometimes stare at the block of computers in my EP lab. It’s a stunning display of biomedical engineering, as are the capabilities of pacemakers and defibrillators. Still, though, with implantable devices, an Achilles heel is the battery. This is why I got interested when one of the featured abstracts at ESC introduced the concept of a batteryless pacemaker, which, of course, came from Switzerland. It was a delight to sit down with Adrian Zurbuchen, a mountain-biking PhD student from Bern whose thesis is the self-winding pacemaker. Here is my report: The Self-Winding Pacemaker That Could . . . Seeing the Future of Batteryless Cardiac Devices
AF ablation: Less-is-more wins again.
The inherent problem with ablating AF is a knowledge deficit. We simply don’t know (exactly) where to ablate. The STAR AF 2 study, released at ESC, doesn’t give us these answers, but it does, once again, confirm that less-is-more. STAR AF 2 was a multinational study of how best to ablate persistent AF. We’ve known for some time that PVI (pulmonary vein isolation) alone is the best practice for ablation in paroxysmal AF. What was so remarkable about STAR AF 2 was that PVI-alone also looked best for persistent AF, too. Remarkable because 2/3 of “experts” believed more ablation was necessary in persistent-AF–often a more advanced atrial disease. Here is my coverage: STAR AF 2: Finding the Optimal Approach to Ablation of Persistent AF.
Beta-blockers are drugs, too:
On clinic days, I sometimes keep a running tally of how many drugs I prescribe and how many I stop. It’s usually more than five to one—in favor of stopping. When I do prescribe medication, it is often beta-blockers. If a doctor could have a favorite class of drugs, mine would be beta-blockers. But two abstracts at ESC show us that even beta-blockers are susceptible to “just-because” reasoning. Here is my recap: The ‘Just-Because’ Use of Beta-blockers Comes Into Question at ESC 2014.
My colleagues at theHeart.org, including fellow blogger/columnist, Dr. Melissa Walton-Shirley, did an amazing job covering this massive meeting. If you want a comprehensive summary, this page and link has it all.
Now it’s off to the trails. Kentucky is not Switzerland, but it feels good to be back on the bike again.