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Atrial Fibrillation JUNE 2014, ISSUE IX

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TRENDING NEWS IN HEART & VASCULAR DISEASE AND SERVICES

Exciting option for cardiac arrest patients: subcutaneous implantable-cardioverter defibrillator Each year, more than half a million individuals in the United States experience a cardiac arrest, which is often fatal. Implantable cardioverterdefibrillator systems are a wellestablished treatment with a high number of successful conversions for patients with heart rhythm disorders that place them at risk for life-threatening arrhythmia. Traditionally these systems have transvenous leads that are placed through the bloodstream into the heart chambers. Beaumont’s Heart Rhythm Center is offering an exciting new option for patients at risk for sudden cardiac arrest. S-ICD, a totally subcutaneous implantable defibrillator system, has leads that are tunneled under the skin without entering the blood stream or touching the heart. The recent “Effortless Study” showed a high number of successful conversions of ventricular tachycardia (VT) and ventricular fibrillation (VF) (98.5 percent acute termination of induced VT or VF; 100 percent conversion of spontaneous VT/VF events) with a low complication rate of 7 percent at one year. Eligible patients have an indication for an implantable defibrillator, but do not require transvenous pacing for bradycardia or pace-termination of VT.

Update on novel oral anticoagulants for atrial fibrillation The introduction of novel oral anticoagulants (direct thrombin and factor X(a) inhibitors), has ushered an effective and more convenient options for stroke prevention when compared to the vitamin K antagonist, warfarin. However, these agents have also resulted in new challenges. Now, more than ever, it is critical to individualize such treatments, weighing the risk of bleeding against the risk of stroke, and carefully looking for potential drug interactions, especially with the concomitant usage of potent antiplatelet agents in cardiac patients. This requires a collaborative effort between cardiologists, primary care providers and pharmacists. It also requires prescribing physicians to have a clear understanding of the pharmacology of these agents. It is anticipated that with proper usage, increasing numbers of vulnerable patients with atrial fibrillation will be protected from embolic strokes, and the devastating morbidity and mortality associated with such strokes.

RESEARCH Beaumont’s Heart and Vascular Research department is one of the largest in the country with many ongoing leading edge clinical research trials.

Selected Current Trials

Victory-AF trial Persistent atrial fibrillation (AF) is an arrhythmia that can cause significant symptoms in patients and is associated with an increased risk of stroke. Catheter ablation of persistent AF has had moderate success, but has been limited by the lack of specialized ablation catheters designed specifically for this purpose. The Victory-AF trial is testing ablation of persistent AF with phased radiofrequency (RF) ablation, which is a new, promising mode of ablation energy that is delivered via a trio of unique catheter designs. Beaumont anticipates that the investigational ablation system will be effective, efficient and safe. Principal Investigator: DAVID HAINES, M.D. Coordinator: SCOTT ELDREDGE, RN, 248-898-6602 or scott.eldredge@beaumont.edu

Transcatheter aortic valve replacement (TAVR): Is my patient eligible? Currently, transcatheter aortic valve replacement (TAVR) is approved and commercially available for inoperable and high-risk patients with severe symptomatic aortic stenosis. Beaumont uses the Edwards Sapien balloon expandable transcatheter heart valve utilizing the transfemoral, transaortic and transapical approaches, depending on patient anatomy. Additionally, Beaumont is participating in two TAVR trials. The first is utilizing the Sapien 3 device to treat intermediate risk patients (STS score of 4 to 8 percent). All patients deemed eligible are treated with the Sapien 3 valve and are not randomized to surgery. The Sapien 3 device is inserted through a 14 F expandable sheath and has a fabric cuff to reduce the risk of paravalvular aortic regurgitation. The second TAVR trial is enrolling extremely high risk patients (estimated surgical morbidity and mortality of greater than 50 percent) with degenerated bioprosthetic valves (stenosis or regurgitation). To refer a patient, call Beaumont’s Heart Valve Clinic at 248-898-0230.

Visit: heart.beaumont.edu for other Beaumont Health System heart and vascular information.


$50 lung cancer screening available at Beaumont More people die of lung cancer each year in the United States than any other type of cancer, yet when it’s caught early, there are more treatment options and much higher survival rates. To promote early detection and save lives, Beaumont now offers a $50 Lung Cancer Screening that uses low-dose CT imaging for earlier diagnosis of lung cancers. Lung cancer death rates in CT screened patients fell by 20 percent and overall survival improved. Patients should be from 55 to 80 years of age, have a smoking history of one pack a day for 30 years, and have smoked within the last 20 years. They should also have an anticipated survival of greater than five years from co-morbid conditions. Beaumont also has the Lung Nodule Clinic for patients with positive scans. Patients require an order in EPIC or a prescription ordering “Lung Cancer Screening CT.” Your patients can schedule an appointment by calling 800-328-8542.

Medicare expands coverage to include cardiac rehabilitation for CHF Medicare has recently expanded its coverage of Phase II exercise-based cardiac rehabilitation services to include selected patients with chronic congestive heart failure (CHF). Structured exercise coupled with appropriate cardioprotective medications, aggressive risk factor modification and ongoing medical surveillance has been shown to significantly improve prognosis in this escalating patient population (JAMA 2009; 301:1439). Your CHF patients may qualify for Medicare coverage of Phase II cardiac rehabilitation if they meet the following criteria:

BEAUMONT HEART & VASCULAR UPDATE FOR PHYSICIANS

3601 West | RoyalDISEASE Oak, MI TRENDING NEWS13 IN Mile HEARTRd. & VASCULAR AND48073-6769 SERVICES heart.beaumont.edu

M A R K YO U R CA LE N DA R UPCOMING CONFERENCES/EVENTS

Advances in Cardiovascular Imaging and Interventions Oct. 9 - 11, 2014 TROY MARRIOTT, TROY, MI

Practical Update in Cardiology, 2014 DETAILS PENDING

24th Annual Cardiovascular Conference Feb. 22 – 25, 2015 PARK HYATT BEAVER CREEK, BEAVER CREEK, CO

• left ventricular ejection fraction less than or equal to 35 percent • New York Heart Association class II to IV symptoms despite “optimal heart failure therapy for at least six weeks” (e.g., ACE/ARBs, beta blockers, digoxin, statins, at dosages deemed appropriate by contemporary guidelines) • no major cardiovascular procedures or hospitalizations within the previous six weeks from referral date • no planned major cardiovascular procedures or hospitalizations over the next six months from referral date

For more information or to register for any of the above conferences, visit: http://meded.beaumont.edu/cardiology-conferences For more information about Heart and Vascular Continuing Medical Education, contact Shannon Herrington, CMP, Heart and Vascular Education at 800-732-6368 or email heartandvascularconferences@beaumont.edu.

Beaumont offers three cardiac rehabilitation locations that you can call for additional information: Beaumont, Grosse Pointe: 586-443-2960, Beaumont, Royal Oak: 248-655-5750 or Beaumont, Troy: 248-964-8520.

For more information visit: heart.beaumont.edu or to talk to a Beaumont heart and vascular specialist, call 888-877-8766. D I D YO U K N OW ?

Beaumont’s Hyperbaric Medicine Center is one of the largest programs in the country. Hyperbaric oxygen therapy is used to treat diabetic foot wounds, chest wound secondary to radiation therapy as well as radiation cystitis, osteoradionecrosis and chronic refractory osteomyelitis. For more information, call Beaumont’s Hyperbaric Medicine Center at 248-655-3147.

To receive the Beaumont Heart & Vascular Update for Physicians e-newsletter, opt-in at heart.beaumont.edu.

EDITORS:

Steven Almany, M.D. & Simon Dixon, MBChB, FACC

Visit: heart.beaumont.edu for other Beaumont Health System heart and vascular information.


For Physicians - Beaumont Heart & Vascular Update