Dr Srinivasan discusses his upcoming presentation at Heart Rhythm 2023, and what he is looking forward to at the conference, taking place May 19-21, 2023.

Transcripts:

Tell us about your upcoming presentation, entitled “How to Identify the Most Reentry-Vulnerable Zones in the Ventricular Tachycardia (VT) Substrate: My Approach.” Summarize the background and share some of the take-home messages of your work.

Neil T. Srinivasan: I am presenting at Heart Rhythm 2023 at one of the VT talks. My talk is on how to identify the most reentry-vulnerable zones in VT substrate. It is basically about the concept of functional regions within the VT circuit, which we have been investigating for several years, and about the methods that we have developed to look at these critical signals, particularly in terms of their behavior functioning. What that means is when you are looking at the heart in its resting state, the heart is not in VT—it is in a normal rhythm. That is because the tissues within the chamber have adapted to that normal state. Something often comes into the heart and disrupts that to induce VT. Functional mapping is a method to study the “something” that changes that normal substrate. If you look at device tracings in patients with VT, it is often extra beats that come in at the wrong time that then initiate VT. The mechanism by which they do that is when there are regions within the heart with slow conduction, sick tissue due to scar processes or patients that have had an infarct, and within those regions, that tissue cannot recover because of the nature of the damage that has occurred there, so it cannot recover its conduction properties quickly enough when an extra beat is thrown in. We can study that using functional mapping techniques within the heart to look at VT by putting our catheters in those regions and looking at the behavior of signals. What we typically see is delay in the electrograms, which is a marker of areas of sick and slow conduction tissue. We utilize that physiological property to try and identify areas of VT for ablation. So, I am going to be talking about the methods that we have developed called the Sense protocol, in which we apply single extra pacing within the heart and then look at the substrate during those extra beats. But we have also modified or improved the techniques slightly. We have now integrated imaging into that to smooth the procedure, make the procedural times much quicker for patients, and try to improve the outcomes by integrating the structure that you find from imaging techniques such as CT and MRI, and the functional techniques that we have developed already. Our group has 3 further abstracts at HRS regarding this, so we are also presenting some work on what we have done with integrating MRI into functional mapping as well as the large international registry that we have done with functional mapping. My fellows and I will be summarizing that work in our talks throughout the conference.

What are you looking forward to at Heart Rhythm 2023?

Neil T. Srinivasan: For me, the Heart Rhythm Society’s annual scientific sessions is the mecca of all heart rhythm meetings. I am excited to finally get a chance to come back to the States after such a long time. It has been difficult with COVID-19 and other things. We have missed the interaction of seeing world leaders in EP and getting the chance to talk to our colleagues from all over the world. It is a great opportunity to meet and talk to people. I am particularly excited about a few of the VT sessions. I have my calendar already filled up on the app. There are a lot of interesting VT sessions regarding how to predict risk in patients and how to deal with the multifaceted aspects of our patients with heart failure needs and arrhythmia needs. How do we make the procedure safe for them, but also manage their heart failure afterwards? I am also excited to see some of the talks about novel technologies, particularly with AF, pulsed field ablation, and some of the late breakers in AF. I cannot wait to learn more as well as see those sessions specializing in VT ablation. I do a whole host of other ablations, so it's important to keep up to date. Another thing is the fellows’ level of education. Although I may be a consultant electrophysiologist now, it is always important to keep in touch with that level of background education to stay refreshed. I love going to the cases and tracing meetings, which I think are so educational, and I think will benefit my practice and patients here in the UK.