QATLANTA - Originally piloted two years ago as the Improving Continuous Cardiac Care IC³ registry, the recently rebranded PINNACLE registry is the first and only ambulatory registry for cardiovascular conditions in this country, noted William Oetgen, MD, clinical associate professor of medicine at Georgetown University, at the 59th annual American College of Cardiology (ACC) annual conference on March 16.

ATLANTA—Contrary 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 Cardiology’s (ACC) 59th annual conference. Slides»

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 we’ll have to wait for the results to know for sure.

The field of electrophysiology (EP), particularly pertaining to ablations, has been reported to be growing faster than coronary interventions, and there are no signs that it will slow down. While the volume of coronary cath procedures has remained somewhat flat over the past year, EP labs have been expanding and adding new technology. For this reason alone, it behooves attendees at ACC.10, which begins on Saturday, March 13, to take in some of the exciting EP lectures being presented at the conference.  

One of the biggest topics in EP is whether transcatheter ablation should be the first-line treatment over anti-arrhythmic drugs in patients with atrial fibrillation (AF). First results of the pilot CABANA study, being released in a late-breaking clinical trial session, could potentially indicate a new direction for this debate (see below for session details).

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The reversible anti-clotting medication ticagrelor can overcome a patient's nonresponsiveness to clopidogrel, according to results of the RESPOND trial published online March 1 in Circulation.

In many hospitals, the cath lab is the hub around which the practice of cardiology revolves. With our increasingly aging population and epidemic rise in diabetes and obesity, interventional cardiologists are performing more and more coronary interventions. To ensure efficacy and efficiency in the cath lab, physicians must focus on a broad range of areas, including devices, drugs, patient selection and protocols. All of these topics must be considered because a chain is only as strong as its weakest link.

Drug-eluting stents (DES) have proved their worth compared to bare-metal stents in terms of improved restenosis rates. Questions still exist, however, regarding stent thrombosis. In addition, newer generation DES, coupled with new drugs and drug regimens, have made significant progress in reducing adverse events during and after PCI. But cardiologists want to know which DES and which drug regimen are best for their patients? The amount of research being conducted around improving the safety and efficacy of PCI is staggering. Even more impressive, however, is the careful consideration that interventionalists give to the emerging data.

ACC.10, which kicks off Saturday in Atlanta, in conjunction with the i2 Summit, is chock full of educational sessions and late-breaking trials piloted by experts trying to determine how best to interpret the latest evidence. Attendees will no doubt hear disagreement, but they also will be treated to thoughtful analyses, robust discussions and honest deliberation. The basis of the next-generation of best practices will be defined.

The late-breaking trials alone are worth the price of admission. Most of these trials are comparative studies, pitting one therapy against another. For example, the PLATO trial compared ticagrelor with clopidogrel in patients undergoing CABG. Other trials examine various management strategies for diabetics, intense versus less intense blood pressure control and various atrial fibrillation treatment approaches.

In the past few years, there have been dramatic advances in PCI techniques, devices, and medications, with no sign that these will slow down. Guidelines published by the ACC, in conjunction with other societies, are continually being updated as new approaches supplant the old. Within the last few years, changes to guidelines include:

• Updated recommendations on using anti-clotting medications, such as clopidogrel, low molecular-weight heparin and bivalirudin, before, during and after PCI;
• A recommendation that embolic protective devices be used during PCI or peripheral arterial interventions; and
• A recommendation for early follow-up of patients who have PCI of the left main coronary artery.

Interventional cardiologists can expect to find many sessions at ACC.10 that will help them improve their daily practice. What's good for the patient is also good for the practice. With decreasing reimbursement and payment increasingly tied to performance, incorporating the latest cutting-edge research into one's practice will go a long way toward ensuring patient safety and practice efficiency.

For educational session and late-breaking trial locations as well as other details, consult the session program onsite or visit ACC10.ACC.org. To download a pdf of conference sessions, click here. Click here to download the program to a mobile device or click here from within your mobile browser to download directly. You also can download the final program to your Ebook reader here.

Cardiovascular Business News will help you navigate ACC.10. To get our daily news updates of education sessions from ACC.10 delivered to your inbox or mobile device, be sure you're signed up for Cardiovascular Business News at CardiovascularBusiness.com.

Middle age introduces itself in many ways; one is atrial fibrillation (AF). My onset of AF seems to have coincided with a mountain bike accident in the woods of North Carolina that resulted in some cracked ribs.

Use of an implantable leadless cardiac monitor in patients can better detect and monitor atrial fibrillation (AF) due to an algorithm that can detect the presence or absence of the heart arrhythmia, a study published online in the Feb. 16 issue of Circulation: Arrhythmia and Electrophysiology found.

St. Jude Medical has reported strong year-over-year and 2009 fourth quarter net income.

St. Jude Medical featured its EnSite Velocity cardiac mapping system, designed to help physicians diagnose and guide therapy to treat abnormal heart rhythms, at the Boston Atrial Fibrillation Symposium last week.