AHA 2024 Conference Summary Featuring John L. Sapp MD FRCPC FHRS FCHRS — Professor of Medicine, Dalhousie University and Dr. Amit Khera is the Chair of the American Heart Association (AHA) Scientific Sessions Planning Committee

Dr. Amit Khera, UT Southwestern Medical Center, AHA Scientific Sessions Program Committee

I am Dr. Amit Khera. I'm director of Preventive Cardiology and professor of medicine at UT Southwestern Medical Center and I'm chair of the AHA Committee on Scientific Session Programing.

This is the 100th anniversary of the AHA. So, our challenge was to really honor this history of cardiovascular medicine of the 100 years and really get people excited at this pivotal moment for the future. What really started the meeting was our history and the finale is about the future and what to expect and what’s to come. We really wanted to leave people inspired and I think we're doing that.

You know, I'd be remiss if I don't talk about our late breakers, because those always get the most attention in that first day. We had some really fantastic ones.

We had a study in 12,000 patients with diabetes looking at more stringent blood pressure numbers under 130 over 80. And it did, in fact, show that that was better with fewer side effects. So, it concurred with our guidelines. And yes, we got to be pretty aggressive.

But the study that's going to get a lot of attention is the Summit trial involving patients with obesity and heart failure with preserved ejection fraction -- so very common shortness of breath related to obesity and giving towards appetite.

GLP-1 Receptor Agonist type medicine achieved marked reduction of weight as they always do, but also a significant reduction in hospitalization for heart failure and cardiovascular death.  So that's a big deal and a marked improvement in quality of life. So really an expansion of the potential use of these medicines in a group that doesn't have them.

And I think another one that'll get a lot of discussion because it’s really tantalizing but unsettled, is about atrial fibrillation. Boy, you know, almost 30 million Americans have it. Many people go for these ablation procedures to treat atrial fibrillation.

And in that, the question is when you're done, do you stay on blood thinners or do we add this occlusion device to reduce the risk of recurrent strokes.

It turns out the occlusion device, when you're off the blood thinners, you have a lot less bleeding. But it was non-inferior, meaning not worse than using blood thinners. There's a lot of nuances to every trial and there were some complications to the procedure itself. So, I think this would be one that is not settled at the end of a meeting, but has a lot of ongoing discussion, a lot of food for thought, which is exactly what you hope.

I think that the one thing for me as I leave this meeting today is I think the future is bright. You know, we're really at a pivotal point. I know we always say those things, but it was so tangible for me here to see that, particularly with the advent of AI, the globalization of of cardiovascular health and a focus on prevention, it really is a pivotal moment. I think you're going to see so much related to prevention and cardio metabolic health coming forward. And I think we're going to see how we harness A.I., the good, the bad and the ugly as one of the talks wise. And there's so much opportunity. We should all be really excited about the future.

The VANISH2 Trial Catheter Ablation or Antiarrhythmic Drug Therapy for  Ventricular Tachycardia in Ischemic Cardiomyopathy

 John L. Sapp MD, FRCPC, FHRS, FCHRS, Dalhousie University, and QEII Health Sciences Centre

My name is John Sapp. I'm a clinical cardiac electrophysiologist in Halifax, in Canada, Dalhousie University, and I do research in ventricular tachycardia and sudden cardiac death. We've just reported the Vanish 2 trial today at the American Heart Association scientific sessions.

When a person has a heart attack, it leaves a scar in the heart. And that scar can lead to short circuits that cause very dangerous heart rhythms called ventricular tachycardia or VTI, which is the most common cause of sudden cardiac death. We implant a defibrillator when we know that somebody is at high risk for for VAT. And one of the highest risks for VT is if you've already got VT. So a defibrillator can protect a person from dying suddenly by shocking the heart back. Or sometimes it can piece the heart back into a normal rhythm.

But we know that once a person starts getting shocks from their defibrillator, not only is it really an adverse effect on quality of life, it can be a very negative experience. But also the risk of death starts to go up. 

So, we often have to suppress the main options we have for suppressing it are either antiarrhythmic drugs. And the mean to being so low or any odorant or a procedure called a catheter ablation in which we thread wires up through the blood vessels into the heart and then we can move the wires around inside the heart, find the areas in the sky that have short circuits and try to cauterize them or get rid of them.

We reported the Vanish trial, the original Vanish trial in 2016. And in that study, we showed that if antiarrhythmic drugs aren't working in this population, it's better to go on to an ablation instead of going to a much more aggressive, higher dose or stronger antiarrhythmic drugs.

Vanish 2  trial was intended to answer the question of what should be our first- line-treatment for VTE.

So, in this study we enrolled 416 patients at 22 centers, mostly in Canada, but also U.S. and France. And the patients were randomly assigned to either treatment with antiarrhythmic drugs or catheter ablation.

The results are that we saw with catheter ablation a 25% reduction in the composite outcome of death, appropriate shocks from defibrillators, VTE storm that's a clustering event or a sustained slow beat that wasn't treated by the defibrillator and the patient had to go to the emergency room and get treated. Each of those components of that primary outcome was either literal or a lot lower in the ablation group.

Safety outcomes were fairly balanced between the two groups. Obviously, there are procedural risks from what I describe, going up in the heart with an ablation catheter. And similarly, the drugs, the drugs also carry some risk. 

I think this means that we don't have to wait for drugs to fail before intervening with an ablation procedure. Now, that decision is always going to be an individualized choice. But what we now see is that the effectiveness of catheter ablation is at least as good as the drugs, if not better, And the safety profile is is comparable. So, I think that gives really meaningful data that, you know, physicians can bring to their patients when they're trying to make a decision about what to do next after VTE has started coming back.

Next steps in research, I think we need to we need to figure out when we should be applying this therapy, whether it's drug or ablation procedures. How much VTE should someone have before we start to think about doing more than just having a defibrillator? So that's a really important study that we're trying to get underway.

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