Traductor

23 June 2013

Resynchronising Europe: reducing inequality for arrhythmia patients



Angelo AuricchioProfessor Angelo Auricchio, the President of the European Heart Rhythm Association (EHRA), should feel justly proud of the way he has steered our association from strength to strength. Under his leadership EHRA has grown into an organisation that has over 1600 members and is not afraid to lobby for minimum electrophysiology (EP) standards. “My key objective has been to provide more uniform access to the best therapy for arrhythmic disorders across Europe. It’s really great that more and more people in the field now appreciate the importance of having a strong scientific association that advocates for better management of patients,” said Professor Auricchio, who is director of the clinical electrophysiology (EP) unit at the Fondazione Cardiocentro Ticino, in Lugano, Switzerland.
Over the course of his career Auricchio has specialised in transcatheter ablation of different cardiac arrhythmias, implantation of cardioverter defibrillators, pacemakers and cardiac resynchronisation devices, in addition to coordinating major international trials and designing innovative new pacing wires.

This last achievement stems from his undoubted talent for engineering. At school, Auricchio, who hails from the town of Terzigno at the foot of Mount Vesuvius in Southern Italy, was primarily interested in mechanics and electricity. But his first career choice of biomedical engineering led him to study both medicine and engineering at University. “I discovered I really liked interacting with patients and by the end of my first year dropped engineering because I wanted to focus on the clinical side,” he said.

Auricchio’s time at the University of Naples was heavily influenced by Pasquale Vitale, who fired his imagination about the possibilities of EP and in 1985 (the year of his graduation) took him to a medical conference in Bari. It was here he had a chance meeting with Helmut Klein, who was treating ventricular tachycardias and Wolff Parkinson White (WPW) syndrome with surgery and implantable defibrillators. “I was completely fascinated by the thought that instead of using medications it might be possible to cure arrhythmias,” he said.

By sheer force of personality Auricchio persuaded Klein to take him on as a trainee in clinical EP and invasive cardiology at Hannover Medical School. The venture was made possible by a three year educational grant from the Italian government.
 
Auricchio at the 2012 Summit
Highlights of this time include an article he wrote showing that syncope was a relatively common clinical finding for patients with WPW syndrome and that its occurrence did not identify patients with a risk for sudden death;  cardiomechanic studies exploring whether it was possible to discriminate stable from unstable arrhythmias; and a cardiac fulguration project using high energy shock waves in cardiac ablation.

A point he stresses to young fellows attending EHRA EUROPACE 2013, is that so many of his own career-defining opportunities arose out of the contacts he made attending international meetings. At a conference, this time in the US, Auricchio met Morton Mower, from The Johns Hopkins University School of Medicine, who introduced him to the concept of treating left ventricular heart failure with pacing. In addition to having leads to the right atrium and ventricle, Mower was placing a third lead on the left free wall of the heart with the objective of improving mechanical coordination. Auricchio became an instant convert.

Between 1991 and 1994 Auricchio studied for his PhD at the University of Rome, where he researched interactions between EP and cardiac mechanics. It was during this period he also carried out innovative work in the design of novel leads for pacing the left ventricle. Borrowing the ‘over the wire’ concept from invasive cardiology Auricchio recognised the importance of generating a venous road map by balloon angiography to allow precise evaluation of coronary vein anatomy. He used guide wires to reach specific targets within the coronary veins, and developed novel pacing leads (with hollow centres) that could be pushed over the guide wires.

In 1994 Auricchio was appointed director of the Cardiac Catheterisation laboratory at the newly established University hospital of Magdeburg, Germany. Much of his time here was spent helping to establishing resynchronisation therapy as a standard of care for heart failure patients. The landmark Pacing for Congestive Heart Failure Study (PATH-CHF), of which he was the principle investigator, established that pacing in patients with advanced heart failure improved both their functional class and quality of life. The study showed for the first time that patients with different QRS durations could have different outcomes.

In 2006 Auricchio moved to his current post in Lugano, where he was attracted both by the geographical location close to Italy and the informatics strengths of the university. “This has allowed us to develop computer modelling for patients with heart failure and atrial fibrillation,” he said. “Our ultimate goal is to develop specific therapies for specific patients, with the idea that we could feed the different statistics for individual patients into the computer to determine the most appropriate therapy and optimum positions for lead placement,” he said.

Other recent endeavours have included the PERMIT CARE registry, presented at the ESC Congress 2011 in Paris, showing that in patients with severe heart failure and mitral regurgitation who were not responding to cardiac resynchronisation therapy significant improvements could be obtained with percutaneously inserted mitral valve clips. Auricchio is now involved in the Reshape trial, randomising heart failure patients with significant mitral regurgitation to receive the mitral valve clip.

On the day we spoke Auricchio had published online in EP Europace the WISE CRT study with the first experience of a wireless approach to pacing in three patients. “The concept of no physical connection between the source and generator is likely to be a real game changer because it overcomes the multiple problems of leads,” he said.

For the last two years EHRA has taken up vast tracks of time. “I really appreciate the support of the hospital management at Lugano who had the foresight to see the importance of leading an international society,” he said. He is also grateful, he added, for the forbearance of his wife and three children aged 15, 12 and 6 years.

Data from the EHRA White Book, established in 2008 to understand what was being done in the electrical treatment of arrhythmias in Europe, revealed shocking discrepancies in the availability and use of interventional therapies for cardiac arrhythmias.  As President,  Auricchio was responsible for introducing the new approach of looking at each of the procedures in turn and comparing how frequently they were performed in each country. This revealed large treatment gradients from East to West, with Eastern European countries undertaking significantly less procedures. Discrepancies, they found, not only depended on budgets but also on the infrastructures that countries have in place.

An EHRA ICD for Life Summit, held in Belgrade, Serbia, last October, discussed challenges and unmet needs in Central and Eastern European countries. The Summit, targeted at politicians, health insurance companies, arrhythmologists and electrophysiologists, has resulted in an initiative where targeted countries will identify their own obstacles to treating patients, with EHRA helping suggest solutions.

One of these solutions has been EHRA enabling the education of doctors, with the development of the fellowship programme allowing young EP clinicians (particularly those from Eastern Europe) to train in different locations. Auricchio‘s own experience in Germany awakened him to the vital importance of such opportunities.

Much of the funding for the scholarships, which are highly competitive (EHRA is only able to support around one quarter of applicants), has come from industry. “Many people still look on this kind of relationship with suspicion but they have to realise that in the current financial climate it’s the only way,” he said.

Education remains a key activity for EHRA with world class courses (both for trainees and established clinicians) now held in wide ranging geographical locations, as well as the certification exams. With the knowledge that many applicants face language barriers, EHRA is now introducing the exams in different languages on tablet computers. “In addition to going green this allows us to translate questions into European languages and has the facility to display ECG traces,” he said. Online EP learning is now available through the ESC e-Learning Platform (ESCeL), allowing both knowledge and skills assessment.

AFibmatter.orgAccreditation of EP labs is also in the cards. “This should give patients reassurance that they’re getting high quality state of the art treatment, and allow health professionals to know they’re being trained in a high quality centre,” he said.

A key initiative for 2013, which will be launched at EHRA EUROPACE 2013, is the development of a website specifically for AF patients, AFibMatters.org, to provide a reliable source of unbiased information.”Once patients are onside we can really raise the awareness of arrhythmias to governments,” said Auricchio.

No comments:

Post a Comment

CONTACTO · Aviso Legal · Política de Privacidad · Política de Cookies

Copyright © Noticia de Salud