ATLANTAContrary to current guidelines, taking a lenient approach to controlling heart rate in patients with atrial fibrillation appears to be just as good as taking a strict approach and poses no greater risk of death or other serious complications, according to the RACE II trial presented today during the late breaking clinical trials session at the American College of Cardiologys (ACC) 59th annual conference. Slides

ATLANTAIn high-risk patients with atrial fibrillation who cant tolerate standard blood thinners, such as warfarin, a combination treatment of aspirin and the more expensive clopidogrel (Plavix, Bristol-Myers Squibb/Sanofi-Aventis) is clinically effective for preventing stroke as well as being cost-effective, according to an ACTIVE-A economic substudy presented Sunday at the American College of Cardiologys (ACC) 59th annual scientific session.  Slides

Monday, March 15, 8:00 AM to 9:30 AM   Who doesnt love the pearls and pitfalls sessions? These are one of the best ways to get to the heart of a topic.   It was just a few years ago that papers were appearing describing the successful ablation of idiopathic outflow tract ventricular tachycardia from the distal great cardiac vein rather than the aortic cusp. While this might give EPs another option for treatment protocol, its still important to understand the challenges associated with the aortic valve cusp approach. That is just one of the topics that will be discussed in this session.

Monday, March 15, 8:00 AM - 9:30 AM   In an address to the media, ACC.10 program chairs highlighted some of these late-breaking clinical trials as potential game-changers. In particular, the RACE II trial, depending on the results, could inform how to best control the blood pressure of patients with atrial fibrillation (AF).   Over the last few years, there have been scattered studies evaluating the impact of remote monitoring of patients with implantable devices. This session will contribute to the growing evidence. The study looked that automatic clinical notification via remote monitoring. If past studies are any indication, we can assume that the remote monitoring made for more efficient patient care and better use of physician time. But well have to wait for the results to know for sure.

March 14, Sunday 4:30 PM to 6:00 PM   An ATHENA trial showed that after a 30-month follow up of more than 4,000 atrial fibrillation (AF) and atrial flutter patients, cardiovascular hospitalizations and death occurred 24 percent less in patients administered dronedarone than in those administered a placebo. A post-hoc analysis of the ATHENA trial also showed that those on the drug had a reduction in stroke.While amiodarone has been on the U.S. market since the mid-1980s, dronedarone is a new-comer. How do physicians gauge the difference between drugs that have been around for decades with newer-generation therapies? In this session. Dr. Peter Smith from Marshfield, Wis., will present anti-arrhythmic case presentations and a panel of distinguished physicians in the EP field will discuss the ramifications.

March 14, Sunday 4:30 PM to 6:00 PM   At ACC.09, the controversies in implantable cardioverter defibrillator (ICD) therapy included: Misuse of SCD-HeFT dataProphylactic ICDs in the elderly and patients with comorbidities, and ICD therapy in the era of genetic testing  At ACC.10, the controversial topics in ICD therapy include: Update in risk stratification for sudden cardiac deathAppropriate patient selection for cardiac resynchronization therapyManagement of patients with frequent appropriate and inappropriate ICD shocksUpdate in lead extraction: indications, techniques and management

March 14, Sunday 2:30 PM to 3:30 PM   Ventricular tachycardia that lasts at least 30 seconds is termed sustained VT. It generally requires termination by anti-arrhythmia drugs, anti-tachycardia pacing techniques or electrical cardioversion. The most commonly used drugs are amiodarone, lidocaine and procainamide.   Sustained VT can occur in conjunction with some other cardiac dysfunction such as ischemic MI and the patient can be hemodynamically stable or unstable. How do EPs determine the best course of treatment?

Sunday, March 14, 9:30 AM -12:30 PM   Lead management and placement has taken center stage in the last few years. In fact, the INCREMENTAL trial found that echo-targeted placement of leads for ischemic cardiomyopathy patients receiving a cardiac resynchronization therapy (CRT) device improved cardiac function and survival.   A study by Patterson et al found that the use of rotational angiography to construct a 3D model of the patients heart facilitated lead placement in a similar patient population receiving a CRT device (J Invasive Cardiol 2010;22:E27E29).