12th Annual International Symposium on Ventricular Arrhythmias: Pathophysiology and Therapy

In this feature interview, we learn more about the upcoming 12th Annual International Symposium on Ventricular Arrhythmias by speaking with course co-director Francis Marchlinski, MD from the University of Pennsylvania Health System in Philadelphia. The symposium will take place October 13-14th, 2017, in Philadelphia, Pennsylvania. 

When and why was this symposium created? How did it come about?

About 12 years ago, the course codirectors decided there was a real need for this type of scientific and educational event. There had been symposia dedicated to the topic of atrial fibrillation, but the topic of ventricular fibrillation (VF) and tachycardia (VT) was, to some extent, not being completely addressed. We knew of a sizable number of people who we referred to as the “VT club” with a real interest in ventricular arrhythmias, and that there would be enthusiasm and a potential for considerable growth over time if we started this type of symposium. We wanted to create an event that allowed everyone to get up to date on state-of-the-art information related to ventricular arrhythmias. With this effort, we hoped to move the field forward by gathering together thought leaders and researchers with an interest in VT and VF in one venue to talk about new topics  that they were investigating and those that were of major clinical concern. We could then come up with ideas through discussion with the audience and with each other to help move VT and VF treatment forward. I think we’ve been very successful at doing that. The symposium has certainly grown in terms of attendance and number of faculty that are participating, and the field has mushroomed in terms of the scientific interest and achievements. 

Tell us about the extensive faculty presenting at this year’s meeting.

This year, we’re going to have 63 faculty from 10 countries. It’s quite the “who’s who” in electrophysiology, all with recognized expertise related to ventricular arrhythmia research. This includes those who are doing cutting-edge basic laboratory investigation, as well as those involved with directly advancing the clinical care and treatment of VT and VF patients. 

This year is the 12th annual conference. What changes have you seen in the field over the years? 

I think the main thing that has changed is the rapid growth in the number of patients undergoing ablative therapies for ventricular arrhythmias, driven by the advance in science and technology. For example, in the last 12 years, there has been more than a doubling in the number of VT/VF procedures that we’ve been doing at our institution. We started 20 years ago doing only 50 per year, and now we do over 450 VT ablation procedures every year. There has been rapid growth in the number of VT ablation procedures thoughout the globe. The new techniques and technologies that are being applied to ventricular arrhythmia management are fantastic, and have allowed us to improved outcomes and safety. We’re also training a large number of the next generation of electrophysiologists; the symposium provides very specific training courses for fellows, so they get state-of-the-art management experience and knowledge from our symposium faculty. It’s a great opportunity for training and education.   

Tell us about some of the key highlights to be included at this year’s symposium. 

We plan to cover a broad range of topics. To some extent, the focus of the event is on physiology and VT and VF catheter ablation. For example, we feature a session on basic EP principles and physiology related to ventricular arrhythmias. However, we also cover mapping and sophisticated ablation techniques for idiopathic ventricular arrhythmias, VT with structural heart disease, and how to ablate recurrent VT or VF in the setting of Brugada syndrome and other idiopathic VF symptoms. We also plan to discuss topics such as ablation endpoints and bail out procedures that provide unique ways of treating patients with more difficult problems that we encounter. We have a session on clinical ablation trial updates and another on the role of imaging. To make sure the focus of the symposia is balanced, we also have special sessions on optimizing device as well as drug therapy for ventricular arrhythmias. It’s very comprehensive in terms of the number of topics that are covered. 

There are two main highlights of this symposium, which is co-hosted by the University of Pennsylvania Health System in Philadelphia and The Mount Sinai Hospital in New York. The first highlight is the live case presentations. Every year, live cases addressing complex ventricular arrhythmias are performed; these help teach the audience about how to approach different complex arrhythmias using catheter ablation, and how to recognize and overcome the frequent challenges encountered.

The other highlight of this year’s event is brand new — we’re introducing the First Annual Mark Josephson Abstract Competition. We’ve sent out invitations to all program directors to have their fellows send in research submissions. We’ll pick the three best research presentations to showcase during lunchtime on the second day, and then provide an award for the best presentation. The award competition is meant to highlight the “best of the best” in the next wave of clinicians and scientists with an interest in  VT and VF investigation. We’re currently in the process of collating these research submissions and reviewing them. We are very excited about the enthusiasm and interest this special event has created. Dr. Josephson would have been happy with the effort being made to continue to push this field forward and the interest shown by young EP talent.

What CME opportunities are available at this meeting?

This event is designated for a maximum of 18.25 AMA PRA Category 1 Credits™. Associate professionals and physician assistants can also receive additional crediting. 

How many attendees are expected to attend this year’s conference? 

We have a wonderful and historic venue at the Hyatt at the Bellevue on Broad Street, located in the heart of downtown Philadelphia. It holds a maximum capacity of 450 people with a second-tier level of seating. I hope to see the place packed, and I think we’ll get close to that!  

Why should people attend this meeting? 

I think anyone with an interest in knowing what is state of the art related to the science and clinical management of ventricular arrhythmias will be happy with the information that is provided. I don’t think there is another educational opportunity like this. The symposium is cosponsored by the Heart Rhythm Society, and is incredibly intellectually rigorous as well as contemporary. Attendees will leave feeling very satisfied with the new information provided. 

What are some of the most exciting advances today in the treatment of ventricular arrhythmias, such as novel ablation approaches for VT or clinical research?

I think we are currently moving towards integrating imaging with some of the mapping and ablation tools that we have, so we can better define the ventricular arrhythmia substrate, and better target and eliminate these arrhythmias. These efforts have moved the field along considerably. The use of cardiac MR and CT imaging and intracardiac echo, coupled with image integration with our cardiac mapping system data, has allowed us to dramatically improve outcomes. We’ve also worked on better defined techniques and endpoints to improve our ability to achieve long-term success. We now work collaboratively across a number of major institutions  to show the efficacy of ablative therapy in a variety of situations — in patients with structural heart disease or different disease settings such as nonischemic cardiomyopathy or sarcoidosis. This year, we have a special session dedicated to arrhythmogenic right ventricular cardiomyopathy, to highlight that we’ve moved beyond only taking care of patients with coronary artery disease and ventricular arrhythmias. Advances in the field to improve outcomes in the setting of ventricular fibrillation, particularly as it relates to idiopathic VF or Brugada syndrome, will also be highlighted. The progress has been very exciting, and I think this symposium has served as an important catalyst. 

Is there anything else you’d like to add?

I want to credit the course codirectors. We all work as a team, and there is an incredible amount of effort and planning involved. David Callans, MD, who has been so instrumental in the overall program development and in helping establish the First Annual Mark Josephson Abstract Competition, deserves a special tip of the hat. 

It has also been incredible to have the enthusiasm and support from industry. It’s a collaborative effort — having new technology, techniques, and advances that help our patients is very exciting. Creating this important forum for pushing the field forward has been very rewarding, and we are grateful for the opportunity. This is really a “must attend” EP event for anyone with an interest in VT and VF, and I am really looking forward to it.