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HRS Roundtable: Managing Risk of Premature and Rapid Battery Depletion

A discussion on the details of the safety alert and implications for patients on premature battery depletion in a subset of St. Jude Medical ICD and CRT-D devices.

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Cryptogenic Stroke: Diagnostics and Tools to Determine Root Cause

Now Available — Diagnosis of Cryptogenic Stroke Case Study

This complimentary activity is jointly provided by the Heart Rhythm Society and National Stroke Association. The program will educate healthcare professionals on the connection between cryptogenic stroke and atrial fibrillation and identify cardiac monitoring as an effective tool in determining root cause.  

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New Learning Pathway

Ventricular Tachycardia Mapping and Ablation in Structural Heart Disease

The ablation strategy for Ventricular Tachycardia (VT) varies greatly depending on the etiology of the VT.  This learning pathway begins with the common idiopathic and scar related VTs for routine ablation, highlighting critical basic concepts and techniques.   Next up, high level tips for the complex and rare  arrhythmias that many electrophysiologists will have minimal exposure to in daily practice.  Completing the entire learning pathway will provide users with a broad base of experience and perspective to assist in providing quality care to VT patients.

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HRS Roundtable: Managing Risk of Premature and Rapid Battery Depletion

  • Description
  • Learning Objectives
  • Faculty

On October 11, 2016, the U.S. Food and Drug Administration issued a safety communication alerting health care providers and patients about premature battery depletion in a subset of St. Jude Medical ICD and CRT-D devices.

During this 70 min on-demand webinar, Dr. Gold, Dr. Van Hare, Dr. Slotwiner from the HRS, Dr. Carlson from St Jude Medical, Dr. Selzman and Ms. Paulsen from the U.S. Food and Drug Administration answer the questions submitted during a HRS-hosted Twitter Chat held on October 24, 2016. Among the questions addressed are:

  • Are issues related to lithium clusters unique to the St Jude Medical ICDs and CRT- D manufactured between January 2010 and May 2015? Are you aware of other device models or manufacturers that are affected?
  • How frequently we should interrogate the patients that have existing device?
  • Should all affected patients be on remote monitoring?
  • Were measures taken after May 2015 to mitigate the problem of premature battery depletion?

For more information about this safety alert, please visit the Society’s Safety Alert Resource Center.

  • Explain the details of the safety alert.
  • Understand the implications for patients. 
  • Discuss and answer the questions that were submitted during the twitter chat. 

Michael R. Gold, MD, PhD, FHRS
President
Heart Rhythm Society

George F. Van Hare, MD, FHRS
President-Elect
Heart Rhythm Society

David J. Slotwiner, MD, FHRS
Chair, Health Policy Committee
Heart Rhythm Society

Mark D. Carlson, MD, MA
Chief Medical Officer and Vice President Global Clinical Affairs
St Jude Medical

Jessica Paulsen
Branch Chief
Implantable Electrophysiology Devices Branch
Division of Cardiovascular Devices
Office of Device Evaluation
Center for Devices and Radiological Health
U.S. Food and Drug Administration

Kimberly Selzman, MD, FHRS
Medical officer
Implantable Electrophysiology Devices Branch
Division of Cardiovascular Devices
Office of Device Evaluation
Center for Devices and Radiological Health
U.S. Food and Drug Administration

Cryptogenic Stroke: Diagnostics and Tools to Determine Root Cause

  • Desription
  • Learning Objectives
  • Faculty

Cryptogenic Stroke: Diagnostics and Tools to Determine Root Cause
Program Date: Oct. 26, 2016
Time: 1 p.m. EDT

Register for the Live Webinar 

This complimentary activity is jointly provided by the Heart Rhythm Society and National Stroke Association.

The program will educate healthcare professionals through a multi-platform case study based CME initiative, which will highlight the connection between cryptogenic stroke and atrial fibrillation, and identify cardiac monitoring as an effective tool in determining root cause.

The Heart Rhythm Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Heart Rhythm Society designates this live activity for a maximum of 1 AMA PRA Category 1 CreditTMPhysicians should claim only the credit commensurate with the extent of their participation in the activity

Learning Objectives

Through participation in this activity, learners should be able to:

  • Explain the relationship between cryptogenic stroke and atrial fibrillation
  • Discuss different types of cardiac monitoring and define which patients might benefit
  • Identify points at which cardiac monitoring is appropriate during the course of treatment
  • Report greater confidence in recommending diagnostic tests to monitor and test for atrial fibrillation

Faculty

Gorelick picture

Philip B. Gorelick, MD, MPH, FACP
Professor, Translational Science & Molecular Medicine
Michigan State University College of Human Medicine
Medical Director, Mercy Health Hauenstein Neurosciences

Richards Picture

Mark Richards, MD, PhD, FACC, FHRS
Director, Arrhythmia Services Northwest Ohio Cardiology Consultants

Ventricular Tachycardia Mapping and Ablation in Structural Heart Disease

  • Description
  • Presentations
  • Faculty

The ablation strategy for Ventricular Tachycardia (VT) varies greatly depending on the etiology of the VT.  This learning pathway begins with the common idiopathic and scar related VTs for routine ablation, highlighting critical basic concepts and techniques.   Next up, high level tips for the complex and rare  arrhythmias that many electrophysiologists will have minimal exposure in daily practice.  Completing the entire learning pathway will provide users with a broad base of experience and perspective to assist in providing quality care to VT patients

Learning Pathway presentations include:
•Anatomy of Substrate for VT in Structural Heart Disease – duration <16 minutes
•Entrainment Mapping for Scar-Related Ventricular Tachycardias – duration <26 minutes
•Epicardial Substrate Ablation of Ventricular Tachycardia in Late Myocarditis: Techniques & Outcomes – duration <20 minutes
•Anterior, Posterior Puncture And Needle-in-Needle Technique – duration <20 minutes
•Important Anatomical Landmarks of Epicardial Access – duration <20 minutes
•Curing the Brugada Syndrome with Epicardial Ablation: When and How – duration <15 minutes
•Conduction System Re-entry VT – duration <15 minutes
•VT Ablation in Patients with Cardiac Sarcoidosis – duration <15 minutes
•Sympathectomy to treat LQTS and CPVT – duration <15 minutes

*Paticipation only / continuing education credits/points NOT available for this activity

Samuel J. Asirvatham, MD, FHRS
Mayo Clinic
Rochester, MN

William G. Stevenson, MD
Brigham and Women's Hospital
Boston, MA

Takumi Yamada, MD, PhD
University of Alabama at Birmingham
Birmingham, AL

Paolo Della Bella, MD
Ospedale San Raffaele
Milano, Italy

Saurabh Kumar, BSc(Med), MBBS
Brigham and Women's Hospital
Melbourne, MA

Koonlawee Nademanee, MD, FHRS, CCDS
Pacific Rim Electrophysiology Research Institute Center
Los Angeles, CA

J. David Burkhardt, MD, FHRS
Texas Cardiac Arrhythmia Institute
Austin, TX

Kyoko Soejima, MD
Kyorin University Hospital
Mitaka-City, Japan

Christopher Moir, MD
Mayo Clinic
Rochester, MN

 

Journal CME/HeartRhythm Journal: December 2016 Vol. 13, Issue 12: Entrainment of Ventricular Tachycardia: Is the Pacing Site In or Out?

  • Description
  • Faculty
  • CME Information

A 77-year-old man with history of ischemic cardiomyopathy with an ejection fraction of 35% was referred for ablation of recurrent VT.  Electroanatomic mapping of the epicardium revealed apical scar during RV pacing, with focal activation during VT, originating from the apex. Endocardial mapping confirmed the extensive dense scar extending from the base toward the apex along the anteroseptal wall.  Within the more apical portion of the scar, there was a localized region with late potentials and split electrograms.

The clinical VT was induced by endocardial pacing within the anteroseptal scar and was hemodynamically tolerated.  Overdrive pacing was performed to assess the response to entrainment with a multielectrode catheter that recorded local diastolic activity.  Is the pacing site in or out of the reentrant circuit?

Andrew Beaser, MD
Kelvin Chua, MD
Gaurav Upadhyay, MD
Roderick Tung, MD, FHRS

The Heart Rhythm Society designates this journal-based CME activity for a maximum of AMA PRA Category 1 Credit™

S-ICD Device Therapy: Management and Patient Selection

  • Description
  • Presentations
  • Faculty

S-ICD Device Therapy:  Management and Patient Selection

This learning pathway will help with decision of choosing the right ICD for a patient - SICD or transvenous ICD.   

Participants will understand the benefits and limitations of S-ICDs. They will also learn practical tips and tricks for the management and troubleshooting of these devices.

HRS Members - Complimentary (after log in)

Non-Members - $29 USD

Learning Pathway presentations include:

  • What is the Optimal Single Chamber ICD System: Transvenous or Subcutaneous? – duration <45 minutes
  • S-ICD Versus a Transvenous ICD: Screening and Selection of Patients – duration <20 minutes
  • S-ICD versus Transvenous ICD: What You Need to Look for During Device Follow-up – duration <20 minutes
  • Single Chamber ICD Lead Fracture: New Transvenous Lead or New Subcutaneous ICD – duration <25 minutes
  • Impact of BMI on Safety and Efficacy of the Subcutaneous ICD – duration <15 minutes

Ronald D. Berger, MD, PhD, FHRS
Johns Hopkins University
Baltimore, MD

Reinoud E. Knops, MD, CCDS
Academic Medical Center
Amsterdam, Netherlands

Bradley P. Knight, MD, FHRS
Cooley Professor of Medicine
Director of Cardiac Electrophysiology Northwestern University

Carrie Brown, APN
Heart Rhythm Center
University of Chicago Medicine

Melanie Maytin, MD, FHRS
Brigham and Women's Hospital
Boston, MA

David S. Frankel, MD, FHRS
Hospital of the University of Pennsylvania
Philadelphia, PA

Journal CME/HeartRhythm Journal: November 2016 Vol. 13, Issue 11: What is the Mechanism of Second Tachycardia?

  • Description
  • Faculty
  • CME Information

A 26-year-old female patient underwent an electrophysiology study for symptoms of recurrent palpitations and documented supraventricular tachycardia (SVT) on Holter monitoring. The electrophysiology study was performed with quadripolar catheters placed at the high right atrium, the right ventricle, and the His region and an octapolar catheter placed in the coronary sinus.

Dinesh Sharma, MD
Shigeki Kusa, MD
Srinivas Dukkipati, MD, FHRS
Vivek Y. Reddy, MD

The Heart Rhythm Society designates this journal-based CME activity for a maximum of AMA PRA Category 1 Credit™.

CRT for Atypical Populations

  • Description
  • Presentations
  • Faculty

CRT for Atypical Populations

As the tools to provide successful left ventricular lead placement have expanded, the appropriate patient population to benefit from cardiac resynchronization therapy is still unclear.  Is there a role for CRT in the patient with a non-left bundle branch block pattern, or for a narrow QRS? 

What are future advances?  Once a CRT device is implanted, this pathway will provide insights on how to avoid non-responders.  

HRS Members - Complimentary (after log in)

Non-Members - $29 USD

Learning Pathway presentations include:

CRT in Octogenerians <20 minutes
CRT in Patients with Renal Dysfunction <20 minutes
CRT in Patients with RBBB <20 minutes
CRT Gender and Race Considerations <20 minutes

Debate - Is AV Node Ablation Necessary to Achieve Cardiac Resynchronization in AF Patients? <45 minutes

Cardiac resynchronization therapy in the elderly with or without an implantable defibrillator <20 minutes

Multiple comorbidities and response to CRT-D: Results from the MADIT-CRT long-term follow-up study <20 minutes

CRT for the Patient with a Narrow QRS <20 minutes

Challenges CRT Cases - My Patient has Pacing Induced CM. Should I Implant a CRT-D or CRT-P? <15 minutes
Challenges CRT Cases - My Patient With a PPM Needs an Upgrade to a BiV ICD Cap or Extract? <15 minutes

Sana M. Al-Khatib, MD, MHS, FHRS, CCDS
Duke University Medical Center
Durham, NC

Theofanie Mela, MD
Massachusetts General Hospital
Boston, MA

Maurizio Gasparini, MD
Humanitas Research Hospital
Rozzano-Milano, Italy

Uma N. Srivatsa, MD, FHRS
University of California - Davis Medical Center
Sacramento, CA

Michele Brignole, MD
Ospedali del Tigullio
Lavagna, Italy

Derek V. Exner, MD, MPH, FHRS
Libin Cardiovascular Institute of Alberta
Calgary, AB, Canada

Michael Doering, MD
University Leipzig, Heart Centre
Leipzig, Germany

Emily P. Zeitler, MD
Duke University Hospital
Durham, NC

Rupa Bala, MD
University of Pennsylvania
Philadelphia, PA

Sherry Saxonhouse, MD
Sanger Heart and Vascular Institute
Charlotte, NC

Charles A. Henrikson, MD, FHRS
Oregon Health and Science University, Knight Cardiovascular Institute
Portland, OR

Journal CME/HeartRhythm Journal: October 2016 Vol. 13, Issue 10: 'Wide-narrow-wide' QRS complex tachycardia. What is the mechanism?

  • Description
  • Faculty
  • CME Information

The tracing of Figure 1 (leads II, III, and V1 taken simultaneously) has been recorded from a 58-year-old man during the recovery phase of exercise stress testing. At tachycardia onset,the R-R interval is relatively long but shortens over the course of the first few beats.Surprisingly, the event begins with wide QRS complexes, but suddenly beats 8–14 become relatively narrow and quite variable in duration and morphology.

Vincenzo Carbone, MD
Alessio Poggi, MD 
Vincenzo Marafioti, MD
Giuseppe Oreto, MD

The Heart Rhythm Society designates this journal-based CME activity for a maximum of AMA PRA Category 1 Credit™

Implantation Procedure for a Subcutaneous Implantable Cardiac Defibrillator (S-ICD)

  • Description
  • Faculty
  • CME Information

Description

This learning pathway discusses the pre-, intra-, and post- procedure care for the implantation of a subcutaneous implantable defibrillator (S-ICD).   This activity is complimentary.

The presentations are:

  • Pre-Procedure S-ICD Assessment – duration <6 minutes
  • S-ICD Implantation Techniques – duration <10 minutes
  • Live Case - Implantation of a S-ICD – duration <25 minutes
  • Successful Implantation of CIED Devices –
    - Ensuring an Adequate Defibrillation Threshold Following a Subcutaneous ICD Implant - duration <20 minutes 
    - CIED Implantation in a Patient on Anticoagulation - duration <20 minutes
  • Post-Procedure S-ICD Assessment – duration <5 minutes
  • Improving Efficacy - 
    -Impact of BMI on Safety and Efficacy of the Subcutaneous ICD - duration <20 minutes
    -Evaluation of a High Pass Filter Designed to Reduce Over-sensing in the S-ICD – duration <20 minutes
    -First Report On Communicating Leadless Anti-Tachycardia Pacemaker and Subcutaneous Implantable Defibrillator – duration <20 minutes
  • Novel Extravascular Defibrillation Configuration with a Coil in the Substernal Space - duration <20 minutes
  • Current Status of the S-ICD and Its Use in Pediatric Patients – duration 25 minutes

 

Raul Weiss, MD, FHRS, CCDS
Ohio State University Medical Center
Division of Cardiovascular Medicine

Emile Dauod, MD, FHRS
Professor of Internal Medicine
Ohio State University Medical Center
Division of Cardiovascular Medicine

Dan L. Musat, MD
Valley Health System
Ridgewood, NJ

David S. Frankel, MD, FHRS
Hospital of the University of Pennsylvania
Philadelphia, PA,

Dominic A. Theuns, PhD
Erasmus Medical Center
Rotterdam, Netherlands

Fleur V.y. Tjong, MD
Academic Medical Center
Amsterdam, Netherlands

Janice Till, MD
Royal Brompton Hospital
United Kingdom

Joseph YS Chan, MD
Prince of Wales Hospital
Hong Kong

No CME is available for this complimentary activity.

Optimal ICD Programming and Testing: Strategies and Highlights from the International Consensus Document

  • Description
  • Faculty
  • CME Information

The HRS/EHRA/APHRS/SOLAECE Expert Consensus Statement on Optimal Implantable Cardioverter-Defibrillator Programming and Testing contains 32 consensus recommendations developed by a writing group of international experts. Learn how to implement these recommendations in your clinical practice by viewing this activity, presented by the document Chairs.

Laurent Fauchier, MD, PhD

Carlos Morillo, MD, FRCPC, FHRS

David Slotwiner, MD, FHRS

Martin Stiles, MBCHB, PhD

Bruce Wilkoff, MD, FHRS, CCDS

No CME credit is attached to this activity.

Mapping and Ablation of Atrial Tachycardias and Atypical Flutters

  • Description
  • Faculty
  • CME Information

This learning pathway discusses the clinically relevant day-to-day challenges in mapping and ablation of atrial tachycardias and atypical flutters. Choose from multiple presentations that each focus on a different aspect and/or audience level of the topic via the HRS Learning Center.

Jonathan M. Kalman, MBBS, PhD, FHRS 
Royal Melbourne Hospital, Melbourne, Australia

Peter M. Kistler, MBBS, PhD
Alfred Hospital and Baker Heart and Diabetes Institute, Melbourne, Australia

Samuel J. Asirvatham, MD, FHRS
Mayo Clinic, Rochester, MN

Natasja De Groot, MD, PhD 
Erasmus Medical Center, Rotterdam, Netherlands

Edward P. Gerstenfeld, MD, FHRS
Cardiac Electrophysiology 
Univeristy of California, San Francisco

Fermin C.Garcia, MD
Hospital of the University of Pennsylvannie, Philadelphia, PA

Pierre Jais, MD 
Hôpital Haut-Lévêque, Bordeaux, France

Mark McGuire, MBBS, PhD 
Royal Prince Alfred Hospital, Sydney, Australia

CME/CE is NOT available for this activity

Preparing for the New MACRA, Medicare MIPS & APM Payment Updates

  • Description
  • Faculty
  • CME Information

In April 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that will dramatically change the face of the United States’ health care environment. The new law repeals the sustainable growth rate (SGR) methodology for determining updates to the Medicare physician fee schedule and establishes:

- The annual positive or flat fee updates for 10 years and institutes a two-track fee update beginning in 2019.
- The Merit-based Incentive Payment System (MIPS) that consolidates existing Medicare quality programs.
- A pathway for physicians to participate in an Alternative Payment Model (APM).

This 30 min complimentary on-demand webinar, presented by David Slotwiner, MD, FHRS and Robert Jasak, JD, provide an overview of the program as it is detailed in the law. (Note: The Centers for Medicare and Medicaid Services will release the proposed regulations establishing the program in spring 2016 and the final regulations in Fall 2016.)

David J. Slotwiner, MD, FHRS
Chair, Health Policy Committee

Robert Jasak, JD
Vice-President
Coverage and Payment Policy
Hart Health Strategies, Inc.

This activity does not provide CME credits.

Barriers in Anticoagulation

  • Description
  • Faculty
  • CME Information

This learning pathway discusses the clinically relevant day-to-day challenges in anticoagulation management that may not be addressed in the guidelines, but are common in clinical practice.  Choose from six presentations available within this pathway via the HRS Learning Center.

Ralph Verdino, MD
Director, Cardiology Electrophysiology Fellowship Program
Associate Professor of Medicine at the Hospital of the University of Pennsylvania and 
the Presbyterian Medical Center of Philadelphia and the Veteran's Administration Medical Center

Cynthia Tracy, MD
Associate Director, Division of Cardiology
George Washington University Medical Center

Stuart J. Connolly, MD, FRCPC
Director, Division of Cardiology 
McMaster University 
Population Health Research Institute
Hamilton Health Sciences

David A. Vorchheimer, MD, FACP, FACC
Cardiologist
Montefiore Hospital

Charles Pollack, MA, MD, FACEP, FAAEM, FESC, FAHA
Professor of Emergency Medicine and Associate Provost
Thomas Jefferson University
Philadelphia, PA

No CME is available for this activity. Participation credit only.

Imaging Technologies Applied to the EP Lab

  • Description
  • Faculty
  • CME Information
This learning pathway focuses on the utility of imaging technologies applied to the EP lab. Presentations provide useful tips for the use of intracardiac echography (ICE) to guide catheter ablation procedures (from basics of ICE imaging to more advanced tips on the use of ICE to guide complex ablation procedures). The utility of pre-procedural MRI to predict success of AF ablation as well as to guide AF ablation strategies is also discussed. This activity is complimentary.

The presentations are:

  • Utility of Pre-Procedural MRI Prior to Initial and Repeat AF Ablations (<22 minutes)
  • An overview of the role of MRI in assessing pre-ablation fibrosis and post-ablation atrial scar
  • Atrial MRI: The Impact on Techniques and Clinical Outcomes (<23 minutes)
  • A focus on the technical issues in obtaining a good artial MRI and the steps involved in processing atrial MRIs and the signal to noise ratio for pre- and post-ablations MRIs.
  • MRI Imaging of Scar: Is There Clinical Value? (<15 minutes)
  • (as presented at the 2015 AF Summit)
  • Debate Session :Protagonist and Antagonist (<38 minutes) 
  • This House Believes That Current Imaging Technologies Can Reliably Detect Artial Fibrosis
  • (as presented at HR2015)

Mark D. O'Neill, MB, BCh, BAO, DPhil, FHRS 
St. Thomas' Hospital & King's College London 
London, United Kingdom

Ravi Ranjan, MD, PhD, FHRS 
University of Utah
Salt Lake City, UT

Nassir F. Marrouche, MD, FHRS 
University of Utah 
Salt Lake City, UT

No CME credit is available for this complimentary activity.

2015 Consensus Statement:Remote Interrogation & Monitoring of Cardiovascular Implantable Electronic Devices

  • Description
  • Faculty
  • CME Information

In 2015, the Heart Rhythm Society released the Expert Consensus Statement on Remote Interrogation and Monitoring for Cardiovascular Electronic Implantable Devices. In this 60 minute webinar, the document Chair, Dr. David J. Slotwiner, and Co-Chair, Dr. Niraj Varma, in collaboration with writing group member Dr. Renato Pietro Ricci present highlights from the expert consensus statement. They are joined by Dr. Bruce Wilkoff, Chair of the 2015 Expert Consensus Statement For Optimal ICD Programming and Testing.

Dr. David J. Slotwiner, Chair, 2015 Consensus Statement:Remote Interrogation & Monitoring of Cardiovascular Implantable Electronic Devices

Dr. Niraj Varma, Co-Chair, 2015 Consensus Statement:Remote Interrogation & Monitoring of Cardiovascular Implantable Electronic Devices

Dr. Renato Pietro Ricci, writing group member, 2015 Consensus Statement:Remote Interrogation & Monitoring of Cardiovascular Implantable Electronic Devices

Dr. Bruce Wilkoff, Chair, Chair of the 2015 Expert Consensus Statement For Optimal ICD Programming and Testing

No CME credit is awarded for this acitivity.

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