© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.
COMMENTARY ON SYMPOSIUM
The 7th international Dead Sea symposium on cardiac arrhythmias and device therapy
Division of Cardiology, University Hospital Magdeburg Leipzigerstrasse 44, D-39120 Magdeburg, Germany; Universität Magdeburg, Department of Internal Medicine Leipzigerstrasse 44, D-39120 Magdeburg, Germany
Manuscript submitted 14 March 2005. *Corresponding author. Tel.: +49 391 6713203; fax: +49 391 6713202. E-mail address: helmut.klein{at}medizin.uni-magdeburg.de
Key Words: electrophysiology, pacing
The 7th international Dead Sea symposium (IDSS) on cardiac arrhythmias and device therapy was held in Tel Aviv from October 17–20th 2004. Those who have attended some of the earlier IDSS conferences already knew that this meeting is worth while and colleagues who participated for the first time will confirm that the 7th IDSS was a very successful congress, despite being in Tel Aviv rather than the marvellous landscape surrounding the Dead Sea.
There were more than 400 attendees from 21 countries, experts in electrophysiology and physicians in training enjoyed lectures given by faculties from 12 different countries. The IDSS congress offered new science, reviews of current knowledge in the field of pacing and implantable cardioverter defibrillator (ICD) therapy, excellent training courses, "how to" workshops on physiological pacing, management of difficult ICD implantations, and a live demonstration of echocardiographic assessment of haemodynamic improvement after cardiac resynchronization with biventricular pacing (given by M.V. Pitzalis and M. Feinberg).
Of note was the idea to arrange a session for physicians in internal medicine to raise issues with specialists in electrophysiology and for the latter to discuss the relevant cardiology. This included dyslipidemia, diabetes mellitus, hypertension, renal failure and syncope in the elderly – all in the context of arrhythmias. Similarly attractive was an all day special satellite symposium on cardiac arrhythmias in primary care, on congestive heart failure and coronary artery disease for family physicians.
Learning from case presentations could not be better demonstrated than during a session where clinical cases were presented and then discussed by an outstanding faculty from the USA and Israel including M. Scheinman, A. Kadish, B. Strasberg and E. Konen.
Nowadays, clinical electrophysiology and device therapy cannot be effectively performed without electrophysiology nurses and laboratory technicians. Therefore high quality meetings, such as IDSS, have to offer a full programme for the allied professions. Teaching sessions and courses were held on catheter ablation, pacemaker malfunction, patient monitoring, tilt table testing and psychological disorders in ICD patients.
The highlights of the symposium were the three keynote lectures. D. Zipes revealed the spectrum of sudden arrhythmic death with new insights into the cellular and molecular background of congenital and acquired electrical disorders, also stressing the role of the failing autonomic nervous system. Research on sudden death has reached a new dimension although still in its initial phase of applicable knowledge.
A. Moss in his keynote lecture presented new data on substudies of the MADIT II trial. Analyzing the outcome of patients after their first ICD intervention demonstrates that ICD shocks for rapid ventricular tachycardia or ventricular fibrillation have a significantly poorer outcome than patients with ICD therapy for slower ventricular tachycardia (VT), thus indicating that rapid VT or ventricular fibrillation (VF) may be a harbinger of pump failure death. These data are in accordance with the recently published results of the DINAMIT trial.
The expanding use of ICD therapy to protect patients from sudden death, particularly in the setting of congestive failure was discussed in the light of the new trial results from COMPANION, DEFINITE and SCD-HEFT (A. Kadish, D. Zipes, H. Klein, M. Glikson). It was interesting to learn that even in the USA only 66% of patients in whom ICD implantation is indicated receive one (D. Zipes). Z. Rotstein meticulously outlined the complex problem of cost-effectiveness of guideline-oriented ICD therapy. Despite the high initial costs ICD therapy remains well in the range of a society accepted cost-effectiveness ratio, with drug treatment of hypertension, haemodialysis or heart transplant being significantly higher.
Debating syndromes of autonomic failure J. Goldberger discussed the still unsolved problem of the most reliable non-invasive risk stratification technique. He stressed the importance of heart rate recovery after exercise testing. In patients with low left ventricular ejection fraction (LV-EF) a technique that gives a high negative predictive accuracy is as important as an approach that yields a high positive predictive value in patients with a better or normal LV-EF. Future investigation should be directed to exercise related markers of autonomic failure.
Congenital arrhythmia syndromes, their cellular changes, molecular disturbance as well as their electrocardiographical and clinical picture were subjects of highly interesting lectures (C. Antzelevitch, M. Eldar, M. Scheinman).
However, we still do not know how to identify the carrier of highest risk, and if the ICD is the only available treatment for the Brugada syndrome (B. Belhassen). Future research will focus on genomics and proteinomics (B. Avitall), and it may be that gene or cell therapy will play a role in the treatment of cardiac arrhythmias (L. Gepstein).
Although biventricular pacing reduces the clinical symptoms of heart failure, a deeper insight into the remodelling process of gap junctions in heart failure and the difference of action potential duration between endocardium and epicardium was clearly elaborated by D. Rosenbaum. He emphasized the importance of the repolarization alternans as an electrical and not a mechanical marker of heart failure.
One session during IDSS was fully dedicated to the new concept of heart failure treatment by cardiac contractility modulation using non-excitatory signals (G. Hindricks, M. Woltz, Y. Mika). Further results from larger trials will be necessary to consider an alternative approach to cardiac resynchronization.
Thirty-four guided posters, selected from submitted abstracts from 21 countries, were presented and discussed during IDSS. Main topics dealt with pacemaker function, non-invasive risk stratification, nerve sprouting in sudden death, experience with loop recording systems, antiarrhythmic drug action and ion channel function, ablation of atrial fibrillation and cardiac resynchronization therapy. A. Kutarski and colleagues from Lublin, Poland received the Mirowski-Mower investigator award for the most interesting presentation on the haemodynamic effect of cardiac resynchronization with left to right ventricle pacing delay.
A very successful symposium was closed with an impressive lecture by M. Mower on the history of ICD development.
IDSS was held under the auspices of the Israel Heart Society, Heart Rhythm Society and the European Heart Rhythm Association (EHRA) of the European Society of Cardiology. The president of IDSS, Eli Ovsyshcher and his colleagues Michael Eldar and Michael Glikson chairing the scientific and organizing committees deserve congratulation and thanks for having arranged such an outstanding arrhythmia conference. We all are looking forward to coming back to Israel to enjoy IDSS in 2006.
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