Atrial Fibrillation and Heart Failure 2019: many news and inputs to strategical changes

Giu 03, 2019 Cardiotool Novità Fibrillazione Atriale Commenti disabilitati su Atrial Fibrillation and Heart Failure 2019: many news and inputs to strategical changes

---

Prof Alessandro Capucci
Direttore Clinica di Cardiologia
Università Politecnica delle Marche Ancona, Italy

The 13 th Edition of the Bologna International meeting, organized by professor Alessandro Capucci had light in February 14th, 15th and collected many world experts in the Cardiological field . There were more than 350 attendants that had the chances to follow the main sessions but also to interact with the presenters during the luncheon panels sessions, posters presentations and clinical cases open discussion.
There were afforded and discussed many up to date topics.
One very burning was the role of hypocoagulation therapy in AF and HF patients and its possible expanding indications. There are data coming out ,as prof Raffaele De Caterina of Pisa university discussed, pointing out the possible role of simple and more regular atrial tachycardias that could be also related to a major stroke incidence compared to control population, the so called AHRE that usually may be recorded with an implanted device. It is therefore well possible that an atrial disease could influence the Virchow triade and favour an hypercoagulation state.Thus even simple AHRE or also more disorganized atrial fibrillation episodes could simply express that atrial disease and therefore warn a possible thromboembolic source. Two International multicentric studies( ARTESIA and NOAH AFnet) are on going on that issue.

The importance of that topic that is going to change our vision in term of affording AF therapy was also outlined by professor Stanley Nattel from Montreal that confirmed and expanded the present knowledge on the so called Atrial Cardiomyopathy recent statement. This is an evolving concept focusing on the importance of the atrial dysfunction that may precede AF or not necessarily be connected to it but conditioning the thrombi ensue and a possible consequent stroke. There is already an international consensus document pointing out the main clues to diagnose such atrial disease independently of AF presence.

Important further news were debated regarding the Heart Failure field with the issue of preventing AF episodes in the pts with an implanted pace maker through algorythms that privilege a consistent atrial stimulation (AAI) according to tha Minerva study results and the possible role of CRT ( biventricular pacing) programming in order to decrease the % of non responder to that type of therapy. Dr Mauro Biffi from Bologna University discussed that issue starting from his great experience on the field.
But since HF patients have frequent hospital admissions because of decompensation with consequent reduction of quality of life, high cost rate and also lower survival, is that possible to preview the acute HF recurrent episode and the consequent hospitalization? Many favourable data are coming in the last couple of years and the topic was discussed by several presenters.

There are to day multisense recording systems that may detect several clinical parameters on a constant way during the daily patient life at home. Those data are sent directltly to the referent centre that may interact with the patient. A recent study on people with an implanted CRT-D of the Boston Scientific Company, demonstrated that the analysis of few parameters together may lead to a final number . When that number (16) is going to be reached or overtaken there is a warning HF condition that deserve further checking of therapy compliance or even adding a new therapeutic approach. That kind of alarm may happen even 30 days before the acute HF ensue thus giving a long time to positively react in order to prevent not only hospitalization but also the acute episode per se. An international registry named Heartlogic is now on going to validate those recent very interesting data results.

Prof Maria Rosa Costanzo from Illinois gave a great lecture organized in Prof Ronald Campbell memory on the topic of “Beta blockers for patients with atrial fibrillation and HFrEF-are they truly ineffective and if so why?” She clearly evidenced limits and possible utility of those drugs considered mainstay in the HF therapeutic armamentarium but that may retain some limits according to the data derived by scientific studies according to etiology, dosages and type of beta blocker.
Cardio-oncology is a relative new field and there is a specific activity from several years in Clinica di Cardiologia of Università Politecnica delle Marche in Ancona. Dr Federico Guerra from Ancona , Prof Nicola Maurea from Naples and other relevant speakers outline how being crucial in those pts that received chemotherapy to be monitored during follow up not only for arrhythmias checking but also for contractility evaluation. There are already data suggesting that a speckle tracking echocardiographic ventricular contractile recording is more accurate than the classical ejection fraction measurement in order to detect the pts that develop a contractile precocious impairment. In that case a further chemotherapic treatment should be stopped or delayed.

The Bologna congress did also prized the best two posters presented by young new generation of cardiologists after a competition where the best 5 preselected posters were orally presented and voted by an international expert commission.

So long next February 2021!!

 

---

---

---