Great Debates & Updates in Electrophysiology: Highlights and What to Expect at Upcoming Sessions

Jessica Charron: Hi, my name is Jessica Charron, and I’m an inpatient electrophysiology (EP) nurse practitioner at Northwestern Medicine.

Susan Kim: My name is Susan Kim. I’m an associate professor of medicine at Northwestern, in cardiac EP.

JC: We wanted to talk about EP Lab Digest’s GDUEP conference and tell people about it so they can join us for the next session if they missed our March 24 session or the inaugural conference in 2021. Let’s start by describing the debate format of the meeting and why we like it. Susan, what do you think about the setup of this meeting and why do you think it is a good approach to talking about all things EP?

SK: I think with the pandemic, and even prepandemic, there was a focus on didactics and presenting useful information and updates on clinical trials and best practices. One issue that has emerged is that sometimes that can be less engaging, so I think this debate format allows for real-life debate. It’s not black and white or always clear what to do in clinical situations, so I personally have found it incredibly engaging—dare I say, entertaining at times—to see people debate about approaches to things such as how to treat patients with persistent atrial fibrillation (AF) and what the best approach is to keeping patients in sinus rhythm. What about you?

JC: I agree. I think we have all been to plenty of conferences where we feel we’re mostly being lectured at with data. The GDUEP format allows us to take one topic and have speakers debate different perspectives, so we can hear the data on all sides. We get to hear how everybody else is approaching this complex EP management, because there is more than one way to do things—sometimes it’s science, and sometimes it’s a combination of science and style. It’s nice to hear what everyone else is doing across the country and across the world.

SK: Absolutely. Our upcoming session is going to be an excellent focus on those gray areas. Before we get to that, though, could you tell us about the debate session on March 24th, including your presentation?

JC: The March 24th session went great! We divided the session into 2 portions, but the whole session had an AF theme. The first section was dedicated to repeat AF ablation when the pulmonary veins (PVs) are still isolated, and all of us in the field know that this is a challenge and that there is no one right way to do things. So we had a lot of different discussions on when to isolate the posterior wall, create linear lines, or perform left atrial appendage (LAA) isolation. We even discussed convergent ablation. I thought there was a lively debate on each of those approaches. We then talked about what everybody was doing at their institution. Next, we did an update on AF and talked about pulsed field ablation as well as ways to improve signal quality in the lab. After that, I did a talk on intravenous (IV) sotalol, which has been an emerging practice in the last year. At Northwestern, we started doing IV sotalol infusions in August of last year. The session was an introduction to the drug for those who might not be familiar with it. I tried to provide a quick, boots-on-the-ground version of how to use it, what clinicians need to know about it, and how to implement it into practice. We went over both the positive aspects of rolling out sotalol and the things we could have done a little better. Hopefully, people came away with more knowledge on the protocol, saving them a few of the hiccups along the way when they roll it out into their own hospitals.

SK: I thought that was a great session. I feel like you were able to share some of your growing pains to save others some time when setting up their own program. I also want to add that I think we had a nice mix of professionals who joined us last time. Can you comment on how this conference is useful for both allied health professionals and physicians?

JC: I think a lot of times when we go to conferences, a lot of it is definitely pointed at the physician audience, but there is a lot for us to gain from an allied health professional standpoint. There is constant change in the field of EP that is going to impact our practice, even though we are not the ones who, for example, are performing ablations or implanting devices. We need to be knowledgeable about the evidence behind our recommendations and knowledgeable about all of this new cutting-edge technology that is going to be available to our patients so that we can deliver the best care. So coming into these conferences, you get these bursts of micro learning that you’re able to apply right away to your practice, from not just the physician standpoint, but from anybody in the allied health community.

SK: I couldn’t agree more. I think our responsibilities are very much in line with each other, and Jess, you know that we rely on you 100% to take care of our patients! So let’s look ahead to June 9th.

JC: I’m excited. You’re presenting, right?

SK: Yes, I will be moderating with Dr Albert Lin and we will be exploring some ripe areas for debate, including difficult decision-making in various situations. The first session will be focused on LAA closure using the Watchman (Boston Scientific), Amulet (Abbott), or AtriClip (AtriCure, Inc), with a good panel discussion. I think now that the devices are US Food & Drug Administration approved for percutaneous closure, there are questions about which one to choose and when. In our next session, there will be updates on the related issue of stroke prevention in AF and a discussion on how best to manage patients with bleeding issues, including patients with a gastrointestinal (GI) bleed. We’ll have a GI specialist as well as a neurologist helping us go through those issues step-by-step. Then, a bonus session at the end will look at the question of apixaban vs rivaroxaban. Oftentimes, we think of those as being fairly interchangeable, but there are nuanced differences to consider.

JC: I think that is going to be so helpful to have that multidisciplinary approach, because we see this all the time in patients who have a high CHADS₂ score who need anticoagulation and they’re in with a bleed. Having neurology and gastroenterology weigh in at the same time, and all in one format, not just reading each other’s notes in the charts but having a discussion about each of our goals, is going to be great.

SK: Absolutely. And of course, as usual, there will be full opportunity for audience participation. We love getting questions relevant to the issues we’ll be discussing.

JC: This has been great! I hope that everybody heard a little about our program and we’ve sparked your interest to join us in June as well as for all of our quarterly sessions. Just in case you missed our March session, everything is available on-demand on ep.greatdebatesandupdates.com through 2022. So if you want to catch those sessions about repeat AF ablation when the PVs are isolated as well as the updates in AF, you can find them there as well as all of our upcoming sessions.

SK: Great, thanks Jess!

JC: Thanks Susan!