Practice Update: Cardiology

AMERICAN COLLEGE OF CARDIOLOGY SCIENTIFIC SESSIONS 6

Dr Doug Zipes discusses ROC-ALPS, FIRE AND ICE and INOVATE-HF trials

Douglas P Zipes MD is Editor-in-Chief of PracticeUpdate Cardiology. Here are his top abstracts, and their take-home message, from ACC 2016.

0.001 for noninferiority). Researchers did not find a difference in safety between the groups. • Results showed that cryoballoon ablation was noninferior to radiofrequency ablation for the treatment of drug-refractory paroxysmal AF. A randomised trial of rate control versus rhythm control for atrial fibrillation after cardiac surgery. AM Gillinov, E Bagiella, A Moskowitz, et al • In order to compare the efficacy of rate and rhythm control for postoperative atrial fibrillation, researchers randomised 523 patients to receive rate control or rhythm control treatment. The majority of patients had undergone either coronary artery bypass surgery or isolated valve surgery. Researchers did not find a difference in the total number of hospital days, rates of death, or serious adverse events. At 60 days, significantly more patients in the rhythm- control group had a stable heart rhythm without AF in the previous 30 days than patients in the rate-control group (97.9% vs 93.8%; P = 0.02), but there was no significant difference in the rate of patients free from AF from discharge to 60 days. • Researchers concluded that rate and rhythm control for postoperative AF are associated with similar treatment outcomes. Session 412: Late-breaking clinical trials The effect of vagal nerve stimulation in heart failure: primary results of the INcrease Of VAgal TonE in chronic Heart Failure (INOVATE- HF) Trial. MR Gold, BJ Berman, M Borggrefe, et al • In order to evaluate the safety and efficacy of vagal stimulation, researchers of the INOVATE-HF trial randomised more than 700 patients with heart failure to undergo implantation of a vagal stimulation device or to continue medical management. Researchers did not find a difference in the rates of hospitalisation for heart failure or death between the groups. There were no major safety concerns. • The trial was ended early for clinical futility, and researchers concluded that vagal stimulation in patients with heart failure did not offer additional benefits compared with medical management.

Session 410 : Joint American College of Cardiology/ New England Journal of Medicine late-breaking clinical trials Antiarrhythmic drugs for shock-refractory out- of-hospital cardiac arrest: the Resuscitation Outcomes Consortium Amiodarone, Lidocaine or Placebo Study. PJ Kudenchuk • In patients with out-of-hospital cardiac arrest (OHCA), antiarrhythmic drugs are often used for shock-refractory ventricular fibrillation or pulseless ventricular tachycardia, even though there is no proven survival benefit. Researchers randomised 3027 patients with shock-refractory ventricular fibrillation or pulseless ventricular tachycardia OHCA to receive standard care along with amiodarone, lidocaine, or placebo. They did not find differences in survival or neurologic outcome between the groups.

• Researchers concluded that survival and neurologic outcomes were not improved with amiodarone or lidocaine when compared with placebo for OHCA due to initial shock-refractory ventricular fibrillation or pulseless ventricular tachycardia. Largest randomised trial demonstrates an effective ablation of atrial fibrillation: the FIRE AND ICE Trial (NCT01490814). K Heinz Kuck • In order to compare the efficacy of the two most common methods for ablation, the researchers of the FIRE AND ICE trial randomised 762 patients with drug- refractory paroxysmal atrial fibrillation (AF) to undergo cryoballoon ablation or radiofrequency ablation. After 90 days, 138 patients in the cryoballoon group and 143 patients in the radiofrequency group experienced clinical failure (HR 0.96; P <

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