First Word: A-Fib, ICDs and the Internet
Reverberations still are being felt from the enormous amount of scientific and educational material presented and discussed at ACC.10 in Atlanta in March. And this month, we’re readying for two more meetings: the Society of Cardiovascular Angiography and Interventions (SCAI) and the Heart Rhythm Society (HRS).

Many topics covered at ACC.10 overlap with those that will be presented at SCAI and HRS, and in this issue, we tackle three such subjects.

The cover story, beginning on page 4, explores the latest therapeutic choices electrophysiologists have to treat atrial fibrillation: RF ablation versus drugs, rate control versus sinus rhythm control, as well as various ways to reduce the risk of stroke. One thing that electrophysiologists seem to agree on is that having many choices for treatment better serves their patients. The challenge is sifting through the data to make the right choice, which is where we can help you.

Patients with atrial fibrillation also are benefitting from the specialty’s better understanding of when and in whom to implant devices—and by whom they should be implanted. The field is expanding so quickly that outcomes data are still being studied. But we’ve got the scoop (see page 20).

With SCAI’s conference looming, we explore where the field of interventional cardiology is in terms of revascularizing chronic total occlusions (CTOs). It turns out that guidewire and catheter technology is highly advanced, as are newer techniques such as the retrograde approach. While observational evidence is pointing toward better success rates, PCI CTO utilization remains low. What is missing are experienced practitioners who can successfully open up the most complex CTOs (see page 16). Another missing piece to the puzzle is adequate reimbursement.

In a sign of the times, patients increasingly want access to their healthcare providers via the internet. Practices expend enormous resources implementing patient portals, sometimes with staff support, sometimes not. One question that seems to arise: How should practices measure success, particularly since many will see a drop in office visits, while not necessarily getting reimbursed for online or phone “consults” (see page 14). The new ACC president, Dr. Ralph Brindis, says in his column (see page 13): “Our greatest value is that direct relationship with our patients.” He might be onto something.

As usual, look to our web site for conference coverage, as well as our twice-weekly e-newsletter that contains all the relevant clinical, economic and practice management information you need. We also regulary feature timely web exclusive stories that you won’t want to miss.

And as always, I welcome your comments.