Cardiovascular Business - January/February 2009 - (Page 9)

people would expect, in the range of 20 percent or less. Even with drugs as the first-line therapy, the success rate of controlling A-fib is much lower than what people think. Drugs are the answer for some patients, but might not be the preferred choice for others, especially young people who are active. Ablation, if properly done, is certainly the best long-term solution. There are studies looking at ablation as a first-line therapy, but it will take another three or four years to have the results. : Where do you see the specialty of electrophysiology in five to 10 years? n Wilkoff: I see EP being part of the main economic engine of the cardiovascular department or division. It’s going to be a larger part of what’s going on and it’s going to focus on two major areas: devices and ablation. You should expect to see important trial results in that timeframe including the MADIT-CRT trial, which is looking at people with less severe heart failure symptoms (NYHA FC I and II), but wide QRS for cardiac resynchronization therapy, and the DETERMINE Trial, which will help us determine whether an ICD can help prevent sudden cardiac death in people with mildly impaired ejection fractions and coronary disease when MRI determines that there is significant left ventricular scar. s Morin: I agree with a lot what Dr. Wilkoff said. I am particularly interested in identifying patients who don’t presently meet guidelines for implantation of ICDs, patients with preserved ejection fractions who may be at risk for sudden cardiac death. The DETERMINE Trial, as mentioned, is going to be very interesting, using MRI to look at the scar burden of patients with preserved ejection fractions who have had an MI. This has the potential to identify an enormous number of patients who might meet future criteria for ICD implantation. Also, as we advance the safety and efficacy of atrial fibrillation ablation, we may reach a point—perhaps in 10 years— where ablation becomes the primary therapy, particularly for those patients with paroxysmal AF. Finally, as we train more electrophysiologists and they go into underserved areas, we will have enough trained doctors so that general cardiologists “Electrophysiology has the potential to grow with advances in implantable devices and ablative therapies,” says Bruce L. Wilkoff, MD, director of cardiac pacing and tachyarrhythmia devices, Cleveland Clinic. Illustration of an implantable cardioverter defibrillator (ICD) in the body. Source: Medtronic won’t have to provide these therapies, thereby reducing the complication rate. n Natale: I agree with what has been said so far. The only addition that I can make is there would be probably an increased attention to ventricular tachycardia and ablative therapies, especially in the presence of structural heart disease, and perhaps studies showing that earlier intervention is something that we should consider. l Steinberg: I see us making headway in refining AF ablation techniques, making them more efficient, perhaps more successful, and probably safer. We also may see an era of remote magnetic navigation, where catheters are manipulated by a magnetic field. This also may improve safety and efficacy measures because the catheters are extremely soft, thereby causing less perforation; the catheters can be manipulated into difficult-to-reach areas; lesions that are more connected and contiguous can be ablated; and there’s better contact with tissue, making the lesions more durable and deeper. cardiovascularbusiness.com cardiovascular business 9 http://www.CardiovascularBusiness.com

Table of Contents Feed for the Digital Edition of Cardiovascular Business - January/February 2009

Cardiovascular Business - January/February 2009 Contents First Word Electrophysiology Roundtable Forum: A Candid Conversation about Profits, Procedures and Patients Heart Failure Care Gets Boost from Technology Emerging Technologies in Peripheral Vascular Interventions Stent vs. Graft: Choosing the Best Path for the Diabetic Patient with Multivessel Disease Cardiology Groups and Hospitals Strive to ‘Connect’ Seamlessly CT Beyond 64 Slices Clinical Study Digest: Kidney Disease & PCI; Women and Valve Disease Compact Echo Systems Come Up Big in Cardiac Care News & Views Reader Resources The ACC Corner

Cardiovascular Business - January/February 2009

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