Late Summer Update
Here is a digest of my recent work
Before writing a word more, I want to express my thanks for your support. Thank you all x 1000.
I recently attended the European Society of Cardiology congress in Amsterdam. I went mostly as a physician journalist/editorial writer.
In addition to my duties as a full-time electrophysiologist, I host a weekly podcast called This Week in Cardiology and write regular columns for the online healthcare-news site TheHeart.org | Medscape Cardiology.
My hobby used to be bike racing. Now it’s communicating medical evidence.
(The content I link to below is intended for an audience of healthcare professionals.)
The first thing to say about the ESC meeting is that I love Amsterdam. It’s a unique city in that bikes are the main way of getting around. Not carbon-fiber racing machines, but upright sturdy Dutch bikes.
The first thing I did after checking in at the hotel was rent a bike for the five days. I took it everywhere—to the congress, to dinner, to the grocery. I even rode that bike with my suit on. That is the custom in the Netherlands.
As a bike commuter here in Louisville, I am often scolded for not wearing a helmet. In Amsterdam, almost no one wears helmets. Locals tell me that they grow up on bikes; it’s like walking. And if I tried to tell you about infrastructure, I’d fail, because it’s beyond your imagination.
The second thing to say about ESC is its attendance was strong. While American medical meetings seem to be on the decline, ESC looks to be growing.
Content:
ESC Preview Column: I did pretty well and picking some of the important studies.
NOAH AFNET 6 Trial: The NOAH trial addresses one of the biggest topics in cardiology today: should we prescribe oral anticoagulation for patients who have short-duration atrial fibrillation? It’s a huge topic because in the old days, you had to have AF long enough to get to a doctor for a standard ECG, but now, many devices allow detection of much shorter duration AF. My column is titled How Much AF Warrants Anticoagulation? NOAH-AFNET 6 Provides Clues
STEP-HFpEF Trial: The GLP-1 agonists stand to become one of the blockbuster drugs of this decade. First shown effective in patients with diabetes. Then proven to induce weight loss in patients with obesity. At ESC, heart failure doctors tested semaglutide in patients with heart failure. My column is titled The GLP-1 Agonist Semaglutide in HFpEF Cleared a Low Bar
BUDAPEST CRT Trial: If a patient has a left bundle branch block and heart failure that is bad enough to be eligible for an internal defibrillator, a biventricular device is superior to a standard ICD. (Biventricular pacing is now called CRT or cardiac resynchronization therapy.) But we did not have data for similar patients who have a device already. So called “upgrades” to CRT are more complicated than new implants. My column is titled Supporting Evidence for a Common Practice: BUDAPEST CRT
ADVENT Trial: When we ablate atrial myocardium to eliminate AF, we use thermal energy—either heat (radiofrequency) or cold (cryoballoon). Pulsed field ablation is a new energy source. It delivers electrical current that kills heart cells by poking holes in cell membranes. PFA promises greater safety because it only affects heart cells—not esophagus and nerves. Europeans have embraced PFA. FDA will consider approval. My column is titled Pulsed Field Ablation Noninferior but Underwhelming in ADVENT
CASTLE-HTx Trial: I like to say that most patients with AF should be treated with mega-doses of education and reassurance. Slow treatment is best in most. But. There is a small segment of patients who have heart failure and AF that require aggressive treatment. Investigators from one major heart transplant referral center in Germany decided to study AF ablation vs medical therapy in patients referred for consideration of transplant. My column is titled: AF Ablation in End-Stage HF: Is CASTLE-HTx Too Good to Be True?
FRAIL AF Trial: Simply stated, FRAIL AF is the most important trial from the ESC meeting. I write that not only because it informed a simple question surrounding oral anticoagulation in older patients who had frailty, but because the main lesson of this trial speaks to how doctors use evidence from trials to treat individual patients. We call this evidence translation, and it’s one of the most critical jobs of a modern clinician. The title of my column is The Most Important Study From ESC: FRAIL-AF
Podcast
The This Week in Cardiology podcast comes out every Friday afternoon. I think it does OK because after 679 ratings, it holds to a 4.9 ranking. Thanks for your support.
The links to the first ESC recap podcast are here:
Medscape (which includes partial transcript)
Apple Podcasts
Spotify
Interviews
I did a number of video interviews with trial authors and experts while at ESC. Stay tuned for those.
yikes, DrM,don't look down...🇳🇱 bikes in ' picturesque grachten of old Amsterdam' youtube.com/watch?v=SSEahShEZz0
Boat crane fishes bicycle wrecks from Amsterdam canals
Rumble Viral
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www.theguardian.com/lifeandstyle/2022/jul/28/bicycle-graveyards-why-do-so-many-bikes-end-up-underwater
Every year, thousands of bikes are tossed into rivers, ponds, lakes and canals.
What’s behind this mass drowning?...In Amsterdam, drowned bikes were at one time heaped so high in the city’s 165 canals that they scraped the underside of flat-bottomed barges.
The solution was fietsen vissen, “bicycle fishing”.
In the old days, this task was accomplished by freelance scavengers who plied the canals in rowboats, using hooked poles to extract bikes, which were sold for scrap.
In the 1960s, Amsterdam’s water agency assumed responsibility for bicycle fishing.
These days, a corps of municipal workers trawl for drowned bikes on boats equipped with cranes attached to hydraulic claw grapples.
The problem is not as severe as it once was, but fishers still pull 15,000 bicycles from the canals each year.
It is a unique Amsterdam spectacle that never fails to draw a crowd of onlookers: the big metal claw rising out of the water with a dripping haul of wheels and frames and handlebar baskets.The bikes are dropped into garbage barges and transported to scrapyards for recycling.
It is said that many of the recycled bikes are turned into beer cans.
...Alcohol surely plays a role, and there could well be a kind of ecosystem at work: a bicycle is pulled from the canal and recycled into a beer can, whose contents are guzzled by an Amsterdammer, who, weaving home at the end of a dissipated night, spots a bicycle and is seized by an impulse to hurl the thing into a canal.
The writer Pete Jordan, in his charming book about Amsterdam and cycling, In the City of Bikes,
[ www.amazon.com/City-Bikes-Story-Amsterdam-Cyclist/dp/0061995207 ]
devotes several pages to bicycle drowning, linking it, in part, to the city’s tumultuous political history. In the 1930s, communists pranked fascists by tossing their bicycles into the Prinsengracht,
the “Prince’s Canal”; during the German occupation in the second world war, resistance leaders called on Amsterdammers to dump their bicycles into canals to keep them from falling into the hands of the Nazis, who were confiscating bikes....
The situation in Amsterdam is perhaps best explained by simple maths.
There are an estimated 2m bicycles in the city and 30 miles of canals,
and logic dictates that there will be some spillover of one into the other.
When an Amsterdammer needs to get rid of an old bicycle,
a waterway will often provide the most convenient dumpster.
The Dutch newspaper Trouw
once characterised Amsterdam’s canals
as “those traditional garbage cans where we take our visitors on boat trips”.
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www.theguardian.com/cities/gallery/2018/may/01/unexpected-beauty-china-bicycle-graveyards-share-bikes-in-pictures
Good stuff!