The Five Most Important EP Publications in 2015

Identification of the top five publications from the Cardiac Electrophysiology literature from last year is challenging. Most of the metrics that are used to define notable scientific papers, such as the number of citations, require time to generate, and the oft-quoted impact factor is a metric used to rank journals rather than individual studies. Some journals, such as the Journal of the American College of Cardiology (JACC), will publish a list of studies that the editors deem the most important from the previous year¹, but these are limited to those published in a single journal. 

The list below of the top five publications from last year in our field is subjective, but is intended to highlight five trials that have already, or will likely, have a large impact on clinical cardiac electrophysiology, and that cover a broad range of topics.

1. STAR AF 2 Trial². This landmark study showed no benefit in patients with persistent atrial fibrillation (AF) to additional ablation beyond pulmonary vein antral isolation (PVAI) — when that involves linear left atrial ablation or targeting of complex fractionated electrograms. This study has helped answer a specific question, reminded us how poor the results of ablation for persistent AF are in general, and has rejuvenated efforts to develop better ablation and non-ablative strategies for persistent AF.
2. LAALA-AF Registry³. In contrast to the ablation strategies used in the STAR AF 2 trial to supplement PVAI, left atrial appendage (LAA) ligation using the LARIAT® procedure improved rhythm control in patients undergoing catheter ablation for persistent AF. The results from this non-randomized study suggest an important role of the LAA in persistent AF, and have prompted initiation of the randomized, multicenter aMAZE trial to further study this approach.
3. Safety and Efficacy of the S-ICD: 2-Year Results From a Pooled Analysis of the IDE Study and EFFORTLESS Registry⁴. The pooled data from the U.S. IDE study and the mostly European EFFORTLESS registry represent the largest experience with the subcutaneous implantable defibrillator. The continued safety and efficacy of the device have solidified the global role of the S-ICD in the prevention of sudden death.
4. LEADLESS Pacing Study⁵. This landmark paper demonstrated a relatively low 8% risk of acute complications associated with implantation of a leadless pacemaker, and will likely be referenced for years to come as leadless pacing disrupts the field of cardiac pacing — a field that seemed so permanent.
5. SCAI/ACC/HRS Institutional and Operator Requirements for LAAO and CMS NCD for LAAC⁶. One year after FDA approval of the WATCHMAN™ Left Atrial Appendage Closure Device, Medicare (CMS) finally released a National Coverage Determination (NCD) related to the technology. One of the criteria in the NCD addresses operator experience. Fortunately, CMS had this important paper from our professional societies to work with when it came up with its own criteria, which expect that the proceduralist has previously performed at least 25 transseptal punctures and continues to perform at least 12 LAA closure procedures over the next two years. (Although this document was published in print in 2016, it was first available online in 2015.)

References

1. Fuster, V. Editor-in-Chief’s Top Picks From 2015: Part Two. J Am Coll Cardiol. 2016;67(7):817-842. doi: 10.1016/j.jacc.2015.12.003.
2. Verma A, Jiang CY, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med. 2015;372(19):1812-1822. doi: 10.1056/NEJMoa1408288.
3. Lakkireddy DJ, et al. Left Atrial Appendage Ligation and Ablation for Persistent Atrial Fibrillation: The LAALA-AF Registry. JACCCEP. 2015;1(3):153-160. doi: 10.1016/j.jacep.2015.04.006.
4. Burke MC, Gold MR, Knight BP, et al. Safety and Efficacy of the Totally Subcutaneous Implantable Defibrillator: 2-Year Results From a Pooled Analysis of the IDE Study and EFFORTLESS Registry. J Am Coll Cardiol. 2015;65(16):1605-1615. doi: 10.1016/j.jacc.2015.02.047.
5. Knops RE, Tjong FVY, Neuzil P, et al. Chronic performance of a leadless cardiac pacemaker: 1-year follow-up of the LEADLESS trial. J Am Coll Cardiol. 2015;65(15):1497-1504. doi: 10.1016/j.jacc.2015.02.022.
6. Kavinsky CJ, Kusumoto FM, Bavry AA, et al. SCAI/ACC/HRS Institutional and Operator Requirements for Left Atrial Appendage Occlusion. J Am Coll Cardiol. 2015 Dec 8. [Epub ahead of print] doi: 10.1016/j.jacc.2015.12.001.