Heartpodcast.org (Physicians - Rhythm)

Episode 60 : Optimising cardiac resynchronisation therapy performance in clinical practice

Mon, 17 Nov 2008 01:00:12 +0100

Cardiac resynchronisation therapy has the potential to transform the lives of Heart Failure patients NYHA class III-IV with dyssynchrony. In this podcast, the distinguished elecrophysiologist Maurizio Gasparini MD, Head of the Electrophysiology and Electrostimulation Division at the Istituto Clinico Humanitas, Milan, uses three patient cases to illustrate how CRT performance can be optimised in individual patients. Drug regiments, device programming features and techniques such as ablation are all invaluable tools to improve patient management and increase the rates of response to therapy.

Episode 59 : Identifying the right patients for successful cardiac resyncronisation therapy

Sat, 01 Nov 2008 01:00:12 +0100

Cardiac resynchronisation therapy (CRT) is one of the fastest-growing treatments for symptomatic Heart Failure patients, with dramatic positive effects on morbidity and mortality.
However, as with all medical treatments, individual patients respond differently to the therapy.
In this podcast, the internationally renowned cardiologist Cecilia Linde MD, from the Karolinska Institute in Stockholm Sweden, discussed what patients are most likely to respond strongly to CRT and how recent clinical trials results may affect the selection of patients for this therapy.

Episode 58 : How to use monitors for primary and secondary prevention of stroke

Mon, 06 Oct 2008 01:00:12 +0200

Stroke is a devastating disease with a high morbidity and more than 20% mortality within the first year. Most strokes are ischemic and in up to a third of these the cause remains unexplained. Patients with unexplained stroke may not get the most appropriate therapy for stroke prevention. One of the big challenges is detection of paroxysmal AF, which may be asymptomatic. Prof. Lewalter will explain the possible use of implantable cardiac monitors for diagnosing previously unknown AF.

Episode 57 : Classification and epidemiology of syncope

Mon, 22 Sep 2008 01:00:12 +0200

Relaunch of a great episode how to treat Syncope more efficent.
Syncope facts: more than 500,000 new patients per year in the U.S. alone. In almost 10% of patients, syncope has a cardiac cause, in 50% it has a non cardiac cause and in 40% of patients the cause of syncope is unknown. Tilt table testing does not predict the mechanism of syncope recurrence. Syncope is often difficult to diagnose, yet the consequences can be serious.

Episode 56 : The risk of silent AF

Mon, 08 Sep 2008 01:00:12 +0200

In the field of atrial fibrillation (AF) the most important aspect is Thromboembolism. A severe thrombus formation can lead to death due to recurrent strokes. One of the questions we need to answer in order to protect our patients is if silent AF is different from symptomatic AF. An AFFIRM sub analysis showed that asymptomatic AF patients demonstrated a higher rate of stroke or transient ischemic attack compared to symptomatic AF patients. This is due to a lower rate of Oral Anticoagulation (OAC). This means we have no evidence that symptoms make a difference regarding the risk of AF but that we need to decide carefully which patients need OAC. In 15 minutes Prof. Lewalter explains how big the risk of a stroke due to AF can be.

Episode 55 : Future perspectives in the diagnosis and treatment of syncope

Mon, 28 Jul 2008 01:00:12 +0200

"In the diagnosis of syncope, Implantable Loop Recorders play an increasingly important role since the earliest introduction in 1995. Current ILRs have improved compared to this earliest generation in terms of longevity (now up to 3 years) and data transmission models. The increased longevity will allow an even higher diagnostic yield: models predict a yield of 60 and 75 % with a longevity of 3 and 4 years respectively. Despite these improvements and inclusion of the ILR in the ESC guidelines, these devices are not used as much as indicated. Reasons include uncertainty from physicians about the implantation procedure, data transmission and legal responsibility, cost-effectiveness and patient reluctance. The needs for future technology advancements include the addition of an haemodynamic sensor, wireless telemetry improvements and a GPS-type of patient locator allowing fast treatment."

Episode 54 : Organizing a syncope management unit

Thu, 24 Jul 2008 01:00:12 +0200

"Medical management of syncope (or better understood by patients : "black-out") is impossible to be dealt with by one single specialism. In practice, syncope patients are seen by the GP, cardiologists, neurologists, psychiatrists and other specialists. Therefore, the ESC 2004 guidelines advocate the development of Syncope Management Units (SMU). These can be physically present or work as a virtual department, with multidisciplinary skills and experience and must have the accessibility to a broad range of diagnostic tests. The SMU is involved if, after initial work-up, syncope remains unexplained. Early experience indicate benefits of this model in terms of efficiency gains and cost-effectiveness. Currently in the US about 14 % of hospitals have an SMU and 21 % has planned one. In Europe these numbers are probably lower. More evidence would stimulate the initiation of SMU."

Episode 53 : How to select the appropriate therapy in neurally-mediated syncope?

Mon, 21 Jul 2008 00:00:12 +0200

Episode 52 : Diagnostic tests in syncope: How usefull are they really?

Thu, 17 Jul 2008 01:00:12 +0200

"Diagnostic tests in syncope patients are performed to assess the patient's prognosis and to tailor therapy. Exclusion of a cardiac cause is important and can mostly be done with simple tests including an ECG and echocardiogram. There is no ‘golden standard test' which provides a definite diagnosis, Therefore, several tests are used in common practice. The prognostic value, in terms of sensitivity and specificity, is discussed for three diagnostic tests : electrophysiologic testing, head-up tilt test and the ATP (Adenosine Tri-Phosphate) test. All of these tests have a value in the diagnostic evaluation, with their own limitations. The ECG at the time of syncope appears the best test, although it does not always provide a definite diagnosis. The Implantable Loop Recorder (ILR) seems a promising tool in various patient subgroups."

Episode 51 : Can asymptomatic arrhythmias predict the mechanism of syncope?

Mon, 14 Jul 2008 01:00:12 +0200

"Identification of the exact mechanism of syncope is difficult due to its paroxysmal nature. Some provocative tests, including electrophysiologic and tilt testing are recommended although they have limitations concerning sensitivity and specificity. Haemodynamic and electrocardiographic recordings during syncope are the gold standard. Conventional 24-hr Holter recording has limited yield due to the low frequency of syncope, event recorders have a higher yield but have limitations in terms of patient compliance. Implantable loop recorders (ILR) could potentially play an important role. Initially, ILRs only recorded the ECG when activated by the patient in case of syncope. Current generations also can store the ECG after automatically detected arrhythmias. Data is shown which demonstrates that automatical detection of asymptomatic arrhythmias predict syncopal events to be caused by the same type of arrhythmias. In contrast, presence of normal sinus rhythm during pre-syncope or in automatically detected episodes does not exclude arrhythmias as the mechanism of syncopal events."

Episode 50 : Diagnoses of syncope and the role of the ILR

Thu, 10 Jul 2008 01:00:12 +0200

Episode 49 : Managing AF in the vicious circle of AF and HF

Mon, 07 Jul 2008 01:00:12 +0200

Episode 48 : How crypto is cryptogenis stroke

Thu, 03 Jul 2008 01:00:12 +0200

"Stroke is a devastating disease. About 20% of patients die within the first year and another 20% are bound to nursing home for the rest of their life. Stroke occurs frequently and is very costly. In the United States (US) 780,000 people experience a new or recurrent stroke each year; approximately 600,000 of these are first attacks and 180,000 are recurrent attacks. In a large percentage, the cause of stroke remains undetermined, in which case the stroke is called 'cryptogenic'. Both persistent and paroxysmal AF are potent predictors of first and recurrent stroke and can be diagnosed with continuous monitoring."

Episode 47 : Diagnosis of patients with unexplained palpitations and vague symptoms

Mon, 30 Jun 2008 01:00:12 +0200

"It is very important to realize that AF episodes may be symptomatic or asymptomatic. They may occur more often than expected. Drug therapy may be less effective resulting in residual complaints and early or late complications. An implantable AF monitor may also be used in case of unexplained symptoms. Dr Kirchhof presents patient cases where the usefulness in diagnosing unexplained symptoms with the implantable AF monitor is shown."

Episode 46 : Measuring the success of AF ablation and the clinical consequences

Thu, 26 Jun 2008 01:00:12 +0200

"Atrial Fibrillation may progress from paroxysmal to persistent to permanent. There is a 10 % recurrence of AF in the first year and these recurrences are not randomly distributed. AF doubles mortality and is difficult to treat, even with AF ablation. Symptoms are the main reason for AF patients to seek medical attention, and are often used to decide upon the success of the intervention. However the negative predictive value of symptoms over 12 months is only 30% in paroxysmal AF. Reported successful rhythm control should be read with caution unless there is extensive systematic ECG monitoring."

Episode 45 : Monitoring of AF: Symptoms, intermittent or continuous

Mon, 23 Jun 2008 01:00:12 +0200

"Continuous EGM monitoring is able to identify significantly more patients with AF episodes than routine FU based on symptomatic recurrences or standard Holter monitoring over 24 hours, 48 hours, or even 7 days. To conclude that a patient is free of atrial fibrillation based on patient-reported symptoms is often unreliable. Continuous monitoring is highly desirable for both scientific (success rates in AF interventions) and clinical issues (anticoagulation management)."

Episode 44 : Continuous remote monitoring of filling pressure

Mon, 12 May 2008 01:00:12 +0200

"High filling pressures are associated with increased mortality. Monitoring RV pressures and early alerting potentially may prevent HF related hospitalizations. The COMPASS-HF trial has shown a 21% reduction (36% in the NYHA III sub-group) in HF related event rate when patient management included RV pressure monitoring. Long term data indicate continuous RV pressure drop which may modify disease progress."

Episode 42 : Clinical indicators a guide to the management of heart faillure patients: usefulness and limitations

Mon, 28 Apr 2008 01:00:12 +0200

"HF hospitalizations are rising rapidly over time and continue to be associated with a high mortality risk. Early detection of decompensation is key in fighting this trend. History taking, ECG and physical examination are important for the first assessment of the patients congestion and perfusion status."

Episode 41 : Viewpoint: 2 - The future in heart failure management will be driven by devices

Thu, 24 Apr 2008 01:00:12 +0200

"BNP is a widely used biomarker for heart failure but is dependent on age, hemoglobin and renal function. Indexing BNP for these parameters therefore seems necessary. Specificity of BNP is not ideal as some CHF patients still have low BNP. Whether lowering BNP improves patient's outcome is still unclear. BNP levels do also not predict the effectiveness of CRT. Device diagnostics have the potential of predicting hospitalizations for heart failure and managing these patients more effectively. Combining biomarkers with device diagnostics will become important in the management of patients with heart failure."

Episode 40 : Viewpoint: 1 - The future in heart failure management will be driven by biomarkers

Mon, 21 Apr 2008 01:00:12 +0200

"Preferably biomarkers should be able to identify patients that have HF, identify his or her risk and monitor treatment effects. BNP has the ability to identify HF, serve as a prognostic marker and can be used to guide therapy. Also serial measurements of Troponin T can identify high risk patients. Novel biomarkers, such as GDF-15, are showing promising results, paving the way for multi-marker strategies."

Episode 39 : Patient case study in monitoring filling pressure

Thu, 17 Apr 2008 01:00:12 +0200

"The Chronicle RV pressure monitor produces data that correlates well with LV filling pressures, an important indicator of the patient's clinical status. Weekly uploads of the data allowed ambulatory monitoring of a group of 25 patients waiting for heart transplants. These patients were followed for an average og 9.5 months. Examples of findings in this cohort include 1) 40% of patients admitted to the hospital acute decompensation were in AF, 2) evidence of lack of medication compliance, 3) monitoring the results of medical therapy and 4) sleep apnea syndrome wasdetected in 30% of these patients."

Episode 38 : Patient case study impedance monitoring

Mon, 14 Apr 2008 01:00:12 +0200

"The number of HF patients with implanted devices steadily increases. Device diagnostic data can be used to further improve the management of HF patients and should be shared with the HF nurse practitioner of physician. Alerts should be analysed and therapy may be adjusted or patient education may be repeateda and re-evaluation after one week is performed. Remote monitoring allows for frequent trend analyses without the patient visiting the hospital."

Episode 37 : Patient case study impedance monitoring

Fri, 11 Apr 2008 01:00:12 +0200

"Monitoring congestion through impedance measurements is used in HF patients at high risk of deterioration. The algorithm that was developed is capable of detecting a drop in impedance earlier than symptoms of decompensation occurred. Audible alarms can elert the patient to contact his physician. Several ongoing studies are now testing the algorithm prospectively."

Episode 36 : ISSUE 2 / International Study on Syncope of Uncertain Etiology 2 (part 2)

Mon, 17 Mar 2008 01:00:12 +0100

"The ISSUE 2 study evaluated the effectiveness of risk stratification and diagnosis of NMS solely based on the ESC guidelines on syncope. Therapy is delayed until documentation of syncopal event by the ILR. Half of the patients had asystole at the time of syncope, indicating that pacing might be effective. Criticisms included the high number of ILRs to be implanted to diagnose one syncopal event. However, TT and ATP testing fail to predict the mechanism of spontaneous NMS, except for asystole during TT testing. Non-syncopal arrhythmic ECG findings correlate with the mechanism of spontaneous syncope."

Episode 35 : ISSUE 2 / International Study on Syncope of Uncertain Etiology 2 (part 1)

Thu, 13 Mar 2008 01:00:12 +0100

Episode 33 : Monitoring atrial fibrillation: how frequent is enough?

Thu, 06 Mar 2008 01:00:12 +0100

"Currently there is no definition of treatment success or an accepted method for follow-up of patients with AF. How long do we have to monitor to measure what endpoint? This depends on the characteristics of the patient population. Asymptomatic recurrences of AF are one of the key problems to define treatment results. After AF ablation we have observed an increase in the number of patients having only asymptomatic AF. Monitoring for AF recurrences should include asymptomatic episodes implying long term surveillance of the ECG. Guidelines underline the importance of recurrence detection for rhythm control therapies and recognize continuous ECG monitoring as the gold standard."

Episode 32 : Why and how to connect with neurologists in the challenge of therapy refractory epilepsy

Tue, 04 Mar 2008 01:00:12 +0100

"The causes of blackouts are dysfunction of the heart (syncope), of the brain (epilepsy) or of the psyche (psychogenic blackout). The majority are cardiac. In patients who are said to have epilepsy and are refractory to therapy, the diagnosis should be questioned. Diagnostics tests are generally quite unreliable, including the EEG. Investigations have shown that in approximately a quarter of patients diagnosed with epilepsy, the diagnosis was wrong and in fact had a cardiac cause for their blackout. History taking still is the cornerstone for diagnosis. Delay treatment if diagnosis is unsure."

Episode 31 : Diagnosing Atrial Fibrillation: the risk of silent atrial fibrillation

Sat, 01 Mar 2008 01:00:12 +0100

"Silent or asymptomatic AF is common and occurs in association with symptomatic AF but often alone. Survival of silent AF is the same as symptomatic AF. Since therapeutic success is often viewed on the basis of eliminating symptoms, silent AF often results in inadequate treatment. Silent AF deserves the same form of treatment as symptomatic AF, particularly in regard to anti-coagulation because silent AF is complicated by all of the adverse events associated with this arrhythmia. Quality of life scores in silent AF patients are reduced and the incidence of stroke is similar to patients with were symptomatic AF. Drug and ablation therapies often turn symptomatic AF into silent AF. Documenting AF depends on how long a patient is monitored, the ultimate device for this being an implantable device."

Episode 30 : The reasons and strategy for seeking multidisciplinary alliances in syncope evalution and management

Thu, 28 Feb 2008 01:00:12 +0100

"Why do we need a syncope unit? Standards for diagnosis and management of TLOC were derived from an evaluation of how syncope patients were managed. Less useful tests were performed frequently. The objective of a syncope unit is to create a structured care pathway and to adopt standards for diagnosis and treatment of patients with unexplained syncope. A syncope unit should be multidisciplinary since TLOC has various underlying causes. The EGSYS-2 study evaluated the effectiveness of syncope units and showed lower hospitalization, fewer tests needed for diagnosis and lower costs per diagnosis."

Episode 29 : Integrating OptiVol Fluid Status Monitoring into routine practice and case study

Thu, 21 Feb 2008 01:00:12 +0100

"Devices have become an important line of treatment in heart failure. However, the management of these patients still remains a major challenge. Along with remote monitoring technologies, information networking and a good cooperation between heart failure doctors and electrophysiologists, OptiVol and other device-based diagnostics have the potential to improve the management of patients with heart failure and to change routine practice from a reactive to a proactive approach."

Episode 28 : Clinical experience with OptiVol Fluid Status Monitoring

Mon, 18 Feb 2008 01:00:12 +0100

"The OptiVol^® alert algorithm may enhance the early detection of heart failure deterioration in ambulatory patients and may thereby facilitate the management of chronic heart failure. This podcast summarizes key clinical data using OptiVol Fluid Status Monitoring, a device-based approach to continuously monitor fluid status of patients with heart failure. Ongoing studies are testing if the use of OptiVol may reduce heart failure hospitalizations, health care utilization and mortality."

Episode 27 : The importance of fluid status monitoring in heart failure patients

Thu, 14 Feb 2008 01:00:12 +0100

"Several epidemiological and clinical trial data show that congestion is the major cause for heart failure hospitalizations and an important predictor of mortality and morbidity. Early identification of congestion is an important target in the management of patients with heart failure as early treatment will prevent hospitalizations and the progression of the disease. Traditional methods to identify congestion such as body weight measurements are limited, often delaying appropriate interventions. Improved methods to identify congestion may improve clinical management and outcomes."

Episode 26 : Consensus Conference Results; AFNET & EHRA, Jan 2007

Mon, 11 Feb 2008 01:00:12 +0100

"Endpoints of clinical trials in atrial fibrillation. Results of the joint Consensus Conference of the German Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA), January 2007."

Episode 25 : Can we predict the mechanism of syncope?

Thu, 07 Feb 2008 01:00:12 +0100

"The identification of the exact mechanism of syncope can be difficult. Tilt testing or electrophysiological study have been recommended as a diagnostic tools. However, concerns about their specificity and sensitivity, limit their diagnostic yield. The gold standard for the diagnosis of syncope is the documentation of hemodynamic and electrocardiographic behaviour during spontaneous syncopal episode. The diagnostic yield of conventional Holter recordings for recognizing the mechanism of syncope is low. External loop recorders have improved the diagnostic yield, but their results have shown to be limited. Implantable loop recorder has increased the probability of recording the ECG during a spontaneous syncopal episode."

Episode 24 : The therapeutic options and perspectives for Neurally Mediated Syncope

Thu, 31 Jan 2008 01:00:12 +0100

"The therapeutic options for treatment of patients with neurally mediated syncope are described. Among others the following options are discussed: Explanation, increased salt and fluid intake, counter pressure maneouvers, pharmacological treatment and cardiac pacing."

Episode 23 : Unexplained syncope and the role of the implantable loop recorder.

Mon, 28 Jan 2008 01:00:12 +0100

The diagnosis of syncope is often challenging. The implantable loop recorder (ILR) has given us more insight into the underlying mechanisms of syncope in a variety of patients (e.g. in structural heart disease and in bundle branch block). The ILR has also indicated the limitations of widely spread clinical tests, such as the tilt table test, in predicting the mechanism of syncope and thereby the efficacy of therapy.

Episode 22 : What are the keypoints in explaining the added value of Reveal in syncope diagnosis

Thu, 24 Jan 2008 01:00:12 +0100

"The presentation explains the indications for Reveal in the diagnosis of syncope according to the ESC guidelines of 2004. There are 3 indications to implant Reveal: a Class 1 indication if at the end of the diagnostic workup the mechanism of syncope is still unclear and a Class 2 indication early in the diagnostic workup and an other Class 2 indication in (suspected) neurally mediated syncope before embarking on cardiac pacing."

Episode 21 : Continuous atrial fibrillation monitoring: What's new?

Mon, 21 Jan 2008 01:00:12 +0100

"Several recent studies have indicated that intermittent and symptom-based monitoring of atrial fibrillation are unreliable. A new Implantable Cardiac Monitor is presented that is able to objectively document atrial fibrillation episodes and quantify AF burden."

Episode 20 : Clinical evidence and economic implications

Thu, 03 Jan 2008 01:00:12 +0100

"The existing evidence on the effect of telemonitoring on all-cause mortality together with the correlations identified in the MIDHeFT trial between changes in intrathoracic impedance and impending HF hospitalisations have justified the interest of a few Italian centers in evaluating the potential of the Medtronic CareLink^TM Network for the management of HF patients." Prof. Santini, member of the investigator group, reports the successes obtained during the pilot experience drawing interesting conclusions on ease of use of the system, as well as on efficiency in managing HF patients, through the use of specific clinical cases tracked during the evaluation period."

Episode 19 : Practicalities of implementation of remote device and disease management

Thu, 27 Dec 2007 01:00:12 +0100

"The Finnish geographical context together with the growing patient flow and ICD implant rate define the perfect environment to evaluate the Medtronic CareLink^TM Network as a remote device and disease management tool." Dr. Raatikainen describes the first European evaluation pilot led by him at the University of Oulu, giving details on the different challenges of the service set-up phase and presenting the brilliant results obtained during the 12-month experience. The use of a patient case taken from the pilot study gives, in a snapshot, the many potentials of the system with a special focus on safety and cost-effectiveness.

Episode 18 : Implantable ECG Loop Recorders in Patients with Palpitations

Thu, 20 Dec 2007 01:00:12 +0100

Diagnostic evaluation of intermittent rapid heart beating (i.e., 'palpitations') is a frequent clinical problem. Typically, after the initial clinical assessment comprising a medical history, physical examination, ECG, and if deemed appropriate an echocardiogram, the key tool for diagnosis of palpitations is ambulatory ECG monitoring (AECG). The indisputable diagnostic 'gold standard' is ECG-symptom correlation. The specific type of monitoring (i.e., Holter, wearable event recorders, implantable event recorders [ILRs]) is determined by the expected frequency of symptoms in the given individual. Recently, as the importance of ECG - symptom correlation has been increasingly accepted, the ILR has become recognized as an essential tool for establishing diagnoses efficiently and cost-effectively.

Episode 17 : Syncope clinic: Better results by an integral approach - 2

Thu, 13 Dec 2007 01:00:12 +0100

At the present time diagnosing syncope is still challenging. This is mainly due to the lack of a gold standard test useful to achieve a correct diagnosis of syncope and to the inappropriate and over-utilization in everyday practice of many clinical and instrumental tests without a methodological approach despite the development of several clinical guidelines. This leads to an expensive management of syncope associated with a poor outcome resulting in a high percentage of syncopal spells which remain unexplained at the end of a non standard diagnostic work-up (~30%).

Episode 16 : Differentiating epilepsy from syncope - 2

Thu, 06 Dec 2007 01:00:12 +0100

A misdiagnosis of epilepsy has been reported to occur in the UK in up to 30% of adults and 40% of children. Neurological sources in the USA indicate that a similar rate is prevalent there. A diagnosis of epilepsy blights life because of the impact of medication, and the impact on education, employment and childbearing. A misdiagnosis is tragic. Misdiagnoses occur partly because of confusion over terminology in patients with blackouts,(T-LOC).Often "syncope " is used when "T-LOC " is meant. "Seizure Disorder " may be used when "Epilepsy " is meant. Confusion is created, because seizures may occur in syncope.

Episode 15 : Minimizing ventricular pacing, part 2: The SAVE-PACe trial

Thu, 29 Nov 2007 01:00:12 +0100

Recent studies, such as MOST sub-study, have proven that unnecessary right ventricular apical pacing is deleterious. There are also physiologic bases showing adverse effects of RVA pacing on cardiac mechanics. Today, techniques are available to minimize undesired RVA pacing and SAVE-PACe, a prospective randomized study, tested the hypothesis that minimizing RVA pacing would have clinical benefit in Sinus Node Disease patients. The results have shown that minimizing RVA pacing led to 40 % reduction in relative risk of developing persistent AF.

Episode 14 : Minimizing ventricular pacing, part 1: Background and today's techniques

Thu, 22 Nov 2007 00:00:12 +0100

Episode 13 : Differentiating epilepsy from syncope

Thu, 15 Nov 2007 00:09:12 +0100

Episode 12 : Potential obstacles to acceptance or true barriers in remote device and disease management

Thu, 01 Nov 2007 00:00:12 +0100

Remote Patient Management technologies for implanted cardiac patients are currently available in the European market but still not widely implemented.

The benefits for patients and clinicians seem easy to show - from cost containment in managing chronic diseases to clinical benefits in accessing valuable diagnostic information more promptly. However, the healthcare systems in Europe are still facing barriers for adoption & limited availability of funds.

Given the missing proof of evidence, key questions have to be answered before the technology can be implemented consistently and Prof. Brachmann addresses the different issues in a systematic fashion, bringing in results from his experience in Coburg (DE) and sharing insights on how to make remote device and disease management accepted and adopted in the current European context.

Episode 11 : Remote device and disease management: the need for change

Mon, 22 Oct 2007 01:10:00 +0200

The phenomenon of growing implantation rates all over the world, with varying rates across Europe, is predicated and driven by the strong clinical evidence coming from studies like MADIT, COMPANION, SCD-HeFT and CARE-HF. These studies show a significant reduction in sudden cardiac death when using Implantable Cardioverter Defibrillators (ICDs) and they show the efficacy of Cardiac Resynchronization Therapy (CRT) for heart failure patients.

This creates a bigger burden when following up these patients with an increasingly complex clinical scenario and with the challenge of qualified staff constraints.

The options available to the European healthcare system suggest that only the adoption of new technologies can help respond to the current challenges, justifying "the need for change".

Episode 10 : Future perspectives on Monitoring Atrial Fibrillation

Thu, 04 Oct 2007 01:10:00 +0200

Continuous rhythm monitoring in patients with atrial fibrillation may be extremely helpful to increase safety and efficacy of rhythm control therapy and can prevent the development of tachycardiomyopathy in patients with asymptomatic AF.

Episode 9 : Diagnosis of atrial fibrillation

Sat, 22 Sep 2007 12:09:00 +0200

Diagnosis of atrial fibrillation. What do we need to know? Symptoms may be totally absent, even in recent onset AF, or really atypical like fatigue. It also has been demonstrated by transtelephonic ECG studies, that asymptomatic AF occurs far more frequently than symptomatic episodes even after drug withdrawal. Therefore, diagnosing AF is not an easy task and can be challenging at times. This podcast shines light on the evolving methods to diagnose atrial fibrillation.

Episode 8 : Cost aspects of atrial fibrillation

Fri, 07 Sep 2007 00:00:12 +0200

Cost Aspects of Atrial Fibrillation: Atrial fibrillation is an expensive disease. The management of atrial fibrillation with rate control and appropriate antithrombotic therapy is the cheapest therapeutic option. Ablation therapy is probably expensive but it has not yet been fully assessed.

Episode 7 : Monitoring of atrial fibrillation: learning points from studies

Thu, 23 Aug 2007 00:00:00 +0200

Ambulatory monitoring is routinely employed for the evaluation of atrial fibrillation recurrence following therapy. Studies have consistently demonstrated that symptoms are unreliable markers of AF recurrence and the more comprehensive the monitoring protocol
the greater the likelihood of identifying recurrent atrial fibrillation. The lessons learned from these studies should be utilized to standardize monitoring guidelines for the evaluation of new therapies of AF.

Episode 6 : Classification and epidemiology of syncope

Sat, 11 Aug 2007 00:08:00 +0200

Syncope facts: more than 500,000 new patients per year in the U.S. alone. In almost 10% of patients, syncope has a cardiac cause, in 50% it has a non cardiac cause and in 40% of patients the cause of syncope is unknown. Tilt table testing does not predict the mechanism of syncope recurrence. Syncope is often difficult to diagnose, yet the consequences can be serious.

Episode 5 : Selecting pacing candidates in neurally-mediated syncope

Sat, 21 Jul 2007 00:00:00 +0200

The efficacy of a diagnostic strategy using a Reveal to guide therapy selection was assessed in patients with suspected Neurally Mediated Syncope. For 103 patients Reveal ILR documented the first syncope recurrence.
The subset of patients who received a pacemaker, showed a 94% relative reduction in syncope burden.

Episode 4 : Diagnosis of Syncope and the role of the ILR

Tue, 03 Jul 2007 00:00:00 +0200

To compare strategies, 60 patients with unexplained syncope were randomized to undergo conventional testing (external loop recorder [ELR], tilt table test [TTT], EP study) or long-term monitoring with a Reveal. Patients who were subsequently undiagnosed were allowed to crossover.
By combining the primary strategy with crossover, the diagnostic yield is 43% with Reveal compared to 20% with conventional testing. The cost of a primary insertable cardiac monitor strategy is 26% less than that of conventional testing.

A long-term monitoring strategy with Reveal yields more diagnosis than conventional testing. Early use of Reveal reduces syncope diagnosis costs by 26%.

Episode 3 : Measuring the success of PV ablation

Fri, 15 Jun 2007 00:00:00 +0200

In patients presenting with highly symptomatic AF, asymptomatic episodes may occur and significantly increase after catheter ablation.
A symptom-based follow-up would substantially overestimate the success rate. Objective measures are needed to identify asymptomatic AF recurrences after ablation.

This podcast discusses the options of post PV ablation monitoring and the pros and cons of these options available today.

Episode 3 : Measuring the success of PV ablation

Fri, 15 Jun 2007 00:00:00 +0200

Even in patients presenting with highly symptomatic AF, asymptomatic
episodes may occur and significantly increase after catheter ablation. A symptom based
follow-up would substantially overestimate the success rate. Objective
measures are needed to identify asymptomatic AF recurrences after ablation.

Episode 2 : Atrial Fibrillation: epidemiology, morbidity and mortality

Thu, 26 Apr 2007 00:00:00 +0200

Approximately 4.5 million people in the European Union have paroxysmal or persistent atrial fibrillation. Atrial fibrillation (AF) is the most common cardiac arrhythmia with its prevalence of 0.4% to 1% in the general population.

The prevalence of AF increases markedly over the age of 60 years afflicting 3-5 % of the population aged 65 to 75 years increasing to 8% in those older than 80 years. The median age of AF patients is about 75 years and it is estimated that approximately 70% are between 65 and 85 years old. Prevalence figures for AF are probably underestimated because AF may be undiagnosed if sporadic and if not associated with significant symptoms.

Episode 2 : Atrial fibrillation: Epidemiology, morbidity and mortality

Thu, 26 Apr 2007 00:00:00 +0200

Abstract of recent completed trials on AF epidemiology, morbidity and mortality.

Episode 1 : Introduction and objectives of HeartPodCast.org

Wed, 25 Apr 2007 00:05:12 +0200

Podcasting message from the editors in chief of this podcasting site; www.heartpodcast.org, Prof. A. John Camm from London, UK and Prof. David Benditt from Minneapolis, Minnesota, USA.

Podcast is a new educational medium for physicians. We envision that this podcast will be able to provide you in an efficient and quick manner the latest developments on heart rhythm disorders their diagnoses and treatment. We anticipate that this podcast site will be useful not only for physicians but occasional to patients who are interested in determining more about their conditions.