The bi-annual international Workshop took place October 2-5 and open-heart.net was there. Read the short report and see the pictures from a meeting worthwhile to attend. Antonio Raviele, president and initiator of the workshop has assembled again an outstanding faculty and provided an excellent program with the most actual developments in electrophysiology.

The ninth edition of the bi-annual international workshop on cardiac arrhythmias workshop “Venice Arrhythmias 2005” took place in Venice, Italy from October 2-5.  Antonio Raviele, chief of cardiology in the nearby clinical centre Umberto 1. in Mestre, is the initiator of this event with a faculty of many of the world’s best electrophysiologists.
The aim of this international meeting is to provide the exchange of state-of-the-art information on the management of patients with cardiac arrhythmias, and to present and discuss most recent advances in the field of basic and clinical cardiac electrophysiology.

The first edition of this Workshop was held in 1989. Since then, the Workshop has increased in fame and popularity over the years. The last edition, held this year, brought about 2.000 delegates together on the San Giorgio island a one stop boat-trip away from San Marco’ Square right in front of the spectacular and picturesque view on the Doges Palace and skyline of central Venice.
While this year, clouds and the rain were taking away a bit of the charm and seduction for tourism of the Venetian attractions, the sessions were particularly crowded over the four days of the meeting, from October 2 to 5, 2005. Closely surveyed by electronic check-in and out of each session the delegates had to find their ways through the labyrinth of the Giorgio Cini foundation – an inspiring historic congress venue created by Count Vittorio Cini in memory of his son. (http://www.cini.it/english/foundation/01.history/history.htm )

The meeting has been an update on all the aspects of cardiac arrhythmias, presented and discussed simultaneously in the 96 sessions, 5 mini courses, 33 structured symposia, 2 symposia jointly organized with scientific societies, poster sessions and many more.
Subjects varied from epidemiology to physiopathology, electrogenetic mechanisms, diagnosis, prognosis, treatment, psychological implications, quality of life, and economic issues.

Particular highlights were:
Sessions on the postoperative Atrial Fibrillation a very common complication associated with cardiac surgery for coronary bypass (post CABG in 5-40 % of patients in the first postoperative week). Even less invasive procedures as percutaneous coronary interventions the incidence of post-PCI atrial fibrillation have reported to be in between 1,5 - 4.3 %.
The subject seems to get increasing attention of both cardiologists and cardiac surgeons aiming at the research of predicting factors and new technologies to provide means for early treatment and prevention of postoperative atrial fibrillation. Whether an ablation procedure, very successful in non-postop A-Fib or an epicardial surgical application shall be effective and safe performed as routine procedure seems to be unclear. New methodologies to prevent the initiation of AF believed to be caused by the parasympathetic nervous system are currently under investigation. The vagal system with its post ganglionic neurons located in “well-defined anatomic fat-pads” situated in two posterior epicardial regions around the heart. Transvenous radiofrequency ablation of such fatpads has shown vagal denervation to result in improved outcomes in patient with non postop-atrial fibrillation. Animal studies using new technology of cellular therapy in order to denervate these fatpads are underway and seem to have encouraging results.

In an almost unnoticed introductory meeting around the workshop, a group of cardiologists associated with the Cleveland Clinic already have presented preliminary data from a first human trial for treatment of post-op A-Fib in Germany. The initial observations and results are encouraging and underline the viability of such a new therapy.
The open-heart.net will focus on the subject of postop-op atrial fibrillation within the next weeks.

As 4,7 Million people are affected by Arrhythmias in Europe with almost 900.000 new cases reported each year over 60 % of these patients need therapy as the 60 % of these patients are either recurrent or symptomatic.
Antonio Raviele pointed out the ablation therapy to be the fist choice today with most recent methods reported in several studies being at 80 % success rate. He stated in an interview that in 65 % of cases success to be complete, (without the needs for anti-arrhythmic medication) while in the remaining 15% success may be only partial with a need for anti-arrhythmic agents to avoid recurrence. Patients, previously refractory to these drugs, will after ablation have a chance that anti-arrhythmic medication becomes effective again. 

Impact of Imaging and mapping
In several sessions mapping-, imaging- and diagnostic techniques have been discussed and compared. New 3 D technologies propel the progress and expand the diagnostic possibilities of the electrophysiologists. Clinical electrophysiology benefits from the latest developments in echocardiography. Intracardiac transducers are now available, and this allows better intracardiac structure identification. Significant advances in microprocessor technology, allowed to develop three-dimensional (3D) echocardiography to a practical imaging modality which provides imaging of cardiac structure in realistic forms, helping to understand complex pathology and to reduce interpretation variability.
The technology serves for two approaches in 3D echocardiography:
3D reconstruction which uses a sequence of appropriately timed two-dimensional images and real-time volumetric imaging. Currently, automated contour analysis allows to measure and monitor global ventricular as well as regional function. The clinical application of these devices is subject of ongoing studies. With very promising results and further improvement in imaging the electrophysiology procedures will require significantly less fluoroscopy time with increased accuracy, efficacy and safety.

One of the most significant innovation of this year in mapping was presented at the conference by the organizers from Mestre, who introduced a video projection about the “CARTOMERGE” system which allows the acquisition of data from Computertomography or Magnetic or magnetic resonance Imaging. The integration of 3D images with electroanatomical mapping does not only look rather sensational but provides excellent guidance for ablation procedures. Merging the CT/MRI image with the CARTO™ XP System 3-D map gives electrophysiologists a very precise view of the heart, allowing them to better navigate catheters to targeted points within the heart. This newly available technology and its precision will help to deal with the highly variable anatomy of the pulmonary veins and may increase effectiveness and reduce the time of the ablation procedure.


Several papers have been presented on the particularities of cardiac anatomy, its variations and risks for failure. Y. Ho from Imperial college London reported about:
Cardiac anatomy "know it before ablating"
She gave a very detailed presentation about the enormous variations and risks for failure for the interventional electrophysiologists.

Dr. Josef Kautzner from Prague, Czech Republic summarised the experience within his talk on Anatomy of Left pulmonary veins – what have we learned in recent years?  He suggests that due to the complex and variable anatomy of pulmonary veins pre-procedural 3 D imaging (and image integration) or intra-procedural imaging ICE, Intracardiac echocardiography is essential for successful ablation procedures. He believes the latter to become the universal tool for guidance for catheter positioning, monitoring of energy delivery, and/or reduction of complications of this very complex procedure.

The Venice Arrhythmia Meeting 2005 has been again offering a wide spectrum of subjects, presented by a fantastic faculty from all over the globe, reflecting the actual status of advanced electrophysiological science and clinical therapies. The organizers merit recognition for the impeccable organisation. The missing sunshine may have had a positive effect on the attendance – as sessions were particularly crowded this year!