California Heart Rhythm Symposium September 9-10, 2016 Westin St. - - PDF document
Department of Medicine, Division of Cardiology University of California, San Francisco School of Medicine presents 7 th Annual California Heart Rhythm Symposium September 9-10, 2016 Westin St. Francis Hotel San Francisco, California Course
University of California, San Francisco School of Medicine
This CME activity was supported in part by educational grants from the following:
University of California, San Francisco School of Medicine Presents
Educational Objectives Upon completion of this activity participants will be better able to:
fibrillation;
Accreditation The University of California, San Francisco School of Medicine (UCSF) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. UCSF designates this live activity for a maximum of 13.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This CME activity meets the requirements under California Assembly Bill 1195, Continuing Education and Cultural and Linguistic Competency. NURSES: For the purpose of recertification, the American Nurses Credentialing Center accepts AMA PRA Category 1 Credit™ issued by organizations accredited by the ACCME. PHYSICIAN ASSISTANTS: AAPA accepts category 1 credit from AOACCME, Prescribed credit from AAFP, and AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. PHARMACY: The California Board of Pharmacy accepts as continuing professional education those courses that meet the standard of relevance to pharmacy practice and have been approved for AMA PRA Category 1 Credit™.
Attendance Verification/ Sign-In Sheet
Please remember to sign-in on the sign-in sheet when you check in at the UCSF Registration Desk on your first day. You only need to sign-in once for the course, when you first check in. Evaluation / CME Certificates After the meeting, please visit this website http://www.ucsfcme.com/evaluation to complete the online Course Evaluation / Electronic CME Certificate Claiming Upon completing the Course Evaluation/ CME Certificate, your CME certificate will be automatically generated to print and/or email yourself a copy. For smartphone users, you may want to take a photo of your certificate as some settings prevent you from emailing the certificate. We request you complete this evaluation within 30 days of the conference in order to receive your CME certificate through this format. Otherwise you will need to certify your hours with the registration office at registration@ocme.ucsf.edu Speaker Survey Your opinion is important to us – we do listen! The speaker survey is the bright yellow hand-out you received when you checked in. Please complete this during the meeting and turn it in to the registration staff at the end of the course.
Security
We urge caution with regard to your personal belongings and syllabus books. We are unable to replace these in the event of loss. Please do not leave any personal belongings unattended in the meeting room during lunch or breaks or overnight. Exhibits Industry exhibits will be available outside the ballroom during breakfasts and breaks, and lunches. Final Presentations A link to PDF versions of the final presentations will be sent via e-mail approximately 3 – 4 weeks post course. Only presentations that have been authorized for inclusion by the presenter will be included.
Federal and State Law
Regarding Linguistic Access and Services for Limited English Proficient Persons I. Purpose. This document is intended to satisfy the requirements set forth in California Business and Professions code 2190.1. California law requires physicians to obtain training in cultural and linguistic competency as part of their continuing medical education programs. This document and the attachments are intended to provide physicians with an overview of federal and state laws regarding linguistic access and services for limited English proficient (“LEP”) persons. Other federal and state laws not reviewed below also may govern the manner in which physicians and healthcare providers render services for disabled, hearing impaired or other protected categories II. Federal Law – Federal Civil Rights Act of 1964, Executive Order 13166, August 11, 2000, and Department of Health and Human Services (“HHS”) Regulations and LEP Guidance. The Federal Civil Rights Act of 1964, as amended, and HHS regulations require recipients of federal financial assistance (“Recipients”) to take reasonable steps to ensure that LEP persons have meaningful access to federally funded programs and services. Failure to provide LEP individuals with access to federally funded programs and services may constitute national origin discrimination, which may be remedied by federal agency enforcement action. Recipients may include physicians, hospitals, universities and academic medical centers who receive grants, training, equipment, surplus property and other assistance from the federal government. HHS recently issued revised guidance documents for Recipients to ensure that they understand their obligations to provide language assistance services to LEP persons. A copy of HHS’s summary document entitled “Guidance for Federal Financial Assistance Recipients Regarding Title VI and the Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons – Summary” is available at HHS’s website at: http://www.hhs.gov/ocr/lep/ . As noted above, Recipients generally must provide meaningful access to their programs and services for LEP persons. The rule, however, is a flexible one and HHS recognizes that “reasonable steps” may differ depending on the Recipient’s size and scope of services. HHS advised that Recipients, in designing an LEP program, should conduct an individualized assessment balancing four factors, including: (i) the number or proportion of LEP persons eligible to be served or likely to be encountered by the Recipient; (ii) the frequency with which LEP individuals come into contact with the Recipient’s program; (iii) the nature and importance
resources available to the Recipient and the costs of interpreting and translation services. Based on the Recipient’s analysis, the Recipient should then design an LEP plan based on five recommended steps, including: (i) identifying LEP individuals who may need assistance; (ii) identifying language assistance measures; (iii) training staff; (iv) providing notice to LEP persons; and (v) monitoring and updating the LEP plan. A Recipient’s LEP plan likely will include translating vital documents and providing either on-site interpreters or telephone interpreter services, or using shared interpreting services with other
emergent needs of the LEP individual, such as hiring bilingual staff who are competent in the skills required for medical translation, hiring staff interpreters, or contracting with outside public
examples of the mix of services that a Recipient should consider and implement. HHS’s guidance also establishes a “safe harbor” that Recipients may elect to follow when determining whether vital documents must be translated into other languages. Compliance with the safe harbor will be strong evidence that the Recipient has satisfied its written translation obligations.
In addition to reviewing HHS guidance documents, Recipients may contact HHS’s Office for Civil Rights for technical assistance in establishing a reasonable LEP plan. III. California Law – Dymally-Alatorre Bilingual Services Act. The California legislature enacted the California’s Dymally-Alatorre Bilingual Services Act (Govt. Code 7290 et seq.) in order to ensure that California residents would appropriately receive services from public agencies regardless of the person’s English language skills. California Government Code section 7291 recites this legislative intent as follows: “The Legislature hereby finds and declares that the effective maintenance and development of a free and democratic society depends
with their government and the right and ability of the government to communicate with them. The Legislature further finds and declares that substantial numbers of persons who live, work and pay taxes in this state are unable, either because they do not speak or write English at all, or because their primary language is other than English, effectively to communicate with their government. The Legislature further finds and declares that state and local agency employees frequently are unable to communicate with persons requiring their services because of this language barrier. As a consequence, substantial numbers of persons presently are being denied rights and benefits to which they would
It is the intention of the Legislature in enacting this chapter to provide for effective communication between all levels of government in this state and the people of this state who are precluded from utilizing public services because of language barriers.” The Act generally requires state and local public agencies to provide interpreter and written document translation services in a manner that will ensure that LEP individuals have access to important government services. Agencies may employ bilingual staff, and translate documents into additional languages representing the clientele served by the agency. Public agencies also must conduct a needs assessment survey every two years documenting the items listed in Government Code section 7299.4, and develop an implementation plan every year that documents compliance with the Act. You may access a copy of this law at the following url: http://www.spb.ca.gov/bilingual/dymallyact.htm
COURSE DIRECTORS Edward P. Gerstenfeld, MS, MD Melvin Scheinman Endowed Professor of Medicine Chief of Cardiac Electrophysiology UCSF School of Medicine Gregory M. Marcus, MD, MAS, FACC, FAHA, FHRS Director of Clinical Research Division of Cardiology Endowed Professor of Atrial Fibrillation Research UCSF School of Medicine GUEST FACULTY Gust Bardy, MD Clinical Cardiac Electrophysiologist University of Washington Medical Center Seattle, WA, USA Andre D’Avila MD, PhD Director - Cardiac Arrhythmia Service Hospital Sos Cardio Itacorubi, Florianópolis - SC, Brazil Timm-Michael L. Dickfeld, MD, PhD Associate Professor, Director of Electrophysiology Research University of Maryland College Park, MD, USA Srinivas Dukkipati, MD Assistant Professor of Medicine Director, Electrophysiology Laboratory, Co-Director of Cardiac Arrhythmia Service Mount Sinai Hospital New York, NY, USA Peter Guerra, MD Chief of Cardiology Montreal Heart Institute Montreal, Quebec, Canada
GUEST FACULTY - continued Dennis Lau, MBBS, PhD Senior Lecturer Attending Electrophysiologist University of Adelaide and the Royal Adelaide Hospital Adelaide, Australia Sanjiv Narayan, MD, PhD Professor of Medicine Stanford University Stanford, CA, USA Babak Nazer, MD Assistant Professor of Medicine Oregon Health & Science University Portland, OR, USA Eric Prystowsky, MD Director, Clinical Electrophysiology Laboratory at St. Vincent Hospital Indianapolis, Indiana Consulting Professor of Medicine Duke University Medical Center William Sauer, MD Associate Professor, Medicine-Cardiology University of Colorado Hospital Denver, CO, USA Ulrich Schotten, MD, PhD Chair in Cardiac Electrophysiology Assistant Professor of Physiology
University of Maastricht Maastricht, The Netherlands Jagmeet (Jag) P. Singh, MD, PhD Associate Chief, Cardiology Division Professor of Medicine at Harvard Medical School Boston, MA, USA Atul Verma, MD Director of Heart Rhythm Program at Southlake Regional Health Center Ontario, Canada Associate Professor of Medicine at the University of Toronto Toronto, ON, Canada
UNIVERSITY OF CALIFORNIA FACULTY Noel Boyle, MD Professor of Clinical Medicine Director, Cardiac Electrophysiology Program UCLA School of Medicine Jason Bradfield, MD Assistant Professor of Medicine UCLA School of Medicine Susan Eisenberg, MD Cardiac Electrophysiologist John Muir Medical Center Gregory K. Feld, MD Professor of Medicine Director, Cardiac Electrophysiology Program UCSD Health System Kurt Hoffmayer, MD, PharmD
UCSD Health System Henry Hsia, MD Professor of Medicine University of California, San Francisco Jonathan Hsu, MD, MAS
UCSD Health System Byron K. Lee, MD Professor of Medicine Director of the Electrophysiology Laboratories and Clinics UCSF School of Medicine Randall Lee, MD, PhD Professor of Clinical Medicine UCSF School of Medicine Joshua David Moss, MD Associate Professor of Medicine UCSF School of Medicine Jeffrey Olgin, MD Professor of Medicine Chief of Cardiology; Co-Director, UCSF Heart and Vascular Center UCSF School of Medicine
UNIVERSITY OF CALIFORNIA FACULTY - continued Mohammad Shenasa, MD Cardiologist UCSF School of Medicine Melvin Scheinman, MD Professor, Emeritus UCSF School of Medicine Zian H. Tseng, MD, MAS Associate Professor of Medicine in Residence Murray Davis Endowed Professor UCSF School of Medicine Marmar Vaseghi, MD Assistant Professor of Medicine Director of Clinical and Translational Research UCLA School of Medicine Vasanth Vedantham, MD, PhD Assistant Professor of Medicine UCSF School of Medicine
The following faculty speakers, moderators, and planning committee members have disclosed they have no financial interest/arrangement or affiliation with any commercial companies who have provided products or services relating to their presentation(s) or commercial support for this continuing medical education activity: Noel G. Boyle, MD PhD Jason Bradfield, MD Andre d'Avila, MD PhD Srinivas R Dukkipati, MD Gregory Kent Feld, MD Kurt S Hoffmayer, MD Dennis Lau, MBBS, PhD Mohammad Shenasa, MD, PhD Zian H Tseng, M.D., M.A.S. Marmar Vaseghi, MD PhD Vasanth Vedantham, MD PhD The following faculty speakers have disclosed a financial interest/arrangement or affiliation with a commercial company who has provided products or services relating to their presentation(s) or commercial support for this continuing medical education activity. All conflicts of interest have been resolved in accordance with the ACCME Standards for Commercial Support:
Timm Dickfeld, MD PhD Biosense Webster GE Siemens Grant/Research Support Consultant Grant/Research Support Consultant Edward Paul Gerstenfeld, MS MD Boston Scientific Biosense-Webster St Jude Medical Biosense-Webster St Jude MEdical Rhythm Diagnostic Systems Boehringer Ingelheim Honorarium Recipient Honorarium Recipient Honorarium Recipient Grant/Research Support Grant/Research Support Board Member Consultant Peter G Guerra, MD, CM, FRCP(C) Medtronic St Jude Medical Grant/Research Support Grant/Research Support Henry H Hsia, MD Biosense-Webster Medtronic VytonUS Honorarium Recipient Advisor or Reviewer Consultant Consultant
Jonathan C. Hsu, MD, MAS Medtronic
Biotronik Bristol-Myers Squibb Janssen Pharmaceuticals Honorarium Recipient Honorarium Recipient Honorarium Recipient Advisor or Reviewer Advisor or Reviewer Byron Lee, MD Medtronic, Zoll Biotronik, CardioNet Biotronik, Boston Scientific Research Funding Consultant Honorarium Randall J Lee, MD, PhD SentreHeart LoneStar Heart Consultant Stock Shareholder (excluding mutual funds) Consultant Stock Shareholder (excluding mutual funds) Gregory Marcus, MD, MAS Medtronic Cardiogram Rhythm Diagnostic Systems InCarda Grant/Research Support Grant/Research Support Grant/Research Support Consultant Stock Shareholder (excluding mutual funds) Joshua D Moss, MD Biotronik Honorarium Recipient Sanjiv Narayan, MD, PhD Topera Medtronic St Jude Stock Shareholder (excluding mutual funds) Honorarium Recipient Honorarium Recipient Babak Nazer, MD Biosense-Webster Grant/Research Support Jeffrey Olgin, MD ZOLL Grant/Research Support Eric N Prystowsky, MD Abbott EP Stereotaxis Medtronic CardioNet (BioTelemtry) Consultant Board Member Consultant Stock Shareholder (excluding mutual funds) Consultant Consultant William H Sauer, MD Boston Scientific Biosense Webster Grant/Research Support Consultant Grant/Research Support Consultant
The following individuals will present on or moderate topics for which they have unique expertise and relationships with commercial interests. These individuals have a conflict that was not or could not be resolved. Therefore, CME credit cannot be claimed for attendance at sessions where these individuals teach, present, or moderate:
This UCSF CME educational activity was planned and developed to: uphold academic standards to ensure balance, independence, objectivity, and scientific rigor; adhere to requirements to protect health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA); and, include a mechanism to inform learners when unapproved or unlabeled uses of therapeutic products or agents are discussed or referenced. This activity has been reviewed and approved by members of the UCSF CME Governing Board in accordance with UCSF CME accreditation policies. Office of CME staff, planners, reviewers, and all
melvin M scheinman, MD
Biotronik Medtronik Boston Scientific Bio-Sense gilead Honorarium Recipient Honorarium Recipient Honorarium Recipient Honorarium Recipient Honorarium Recipient Grant/Research Support Ulrich Schotten, MD, PhD Roche Bayer Consultant Honorarium Recipient Jagmeet Singh, MD DPhil ScM Medtronic
Liva Nova Boston Scientific Biotronik Impulse dynamics Consultant Grant/Research Support Consultant Honorarium Recipient Consultant Grant/Research Support Consultant Consultant Consultant Atul Verma, MD Biosense Webster Medtronic Bayer St Jude Medical Grant/Research Support Advisor or Reviewer Grant/Research Support Advisor or Reviewer Honorarium Recipient Grant/Research Support Honorarium Recipient Grant/Research Support Gust H Bardy, MD Cameron Health Bardy Diagnostics Stock Shareholder (excluding mutual funds) Holder of Intellectual Property Rights Stock Shareholder (excluding mutual funds) Holder of Intellectual Property Rights
FRIDAY, SEPTEMBER 9, 2016 7:30 am Registration and Continental Breakfast ATRIAL FIBRILLATION • Moderators: Jonathan Hsu, MD, MAS and Byron Lee, MD 8:00 Is There Endo-epicardial Dissociation During AF? Uli Schotten, MD, PhD 8:20 When to Consider Antiarrhythmic Drugs vs. Catheter Ablation Eric Prystowski, MD 8:40 Risk Factor Modification in AF Patients – Is it Really Necessary and Achievable? Dennis Lau, MBBS, PhD 9:00 Anticoagulation Pre/Post AF Ablation – Is Uninterrupted Anticoagulation Therapy Now Standard? Atul Verma, MD 9:20 The Vicious Cycle of Hypercoaguability and AF Uli Schotten, MD, PhD 9:40 Panel Discussion – Anticoagulation and AF Prystowski, Lau, Schotten, Verma 10:00 Coffee Break ATRIAL FIBRILLATION • Moderators: Gregory Feld, MD 10:15 Novel Predictors of Atrial Fibrillation Gregory Marcus, MD, MAS 10:45 Long Term Outcome after AF Ablation Dennis Lau, MBBS, PhD 11:15 Managing Complications During and After AF Ablation – What to Watch For Andre D’Avila, MD, PhD 11:40 Panel Discussion – When to Ablate? First Line Therapy? Long-term Follow-up D’Avila, Marcus, Lau 12:00 pm Lunch (provided) PERSISTENT AF – WHAT TO DO BEYOND PVI • Moderators: Jeffrey Olgin, MD and Gregory Marcus, MD, MAS 1:00 Rotors Sanjiv Narayan, MD, PhD 1:20 PERSISTENT AF – WHAT TO DO BEYOND PVI: AF Electrogram Dennis Lau, MBBS, PhD 1:40 PVI is Enough Atul Verma, MD
2:00 What to Do When All PVs Are Isolated? Edward Gerstenfeld, MS, MD 2:20 Role of Surgical MAZE/Hybrid Approaches Randall Lee, MD 2:40 Panel Discussion Narayan, Lau, Verma, Gerstenfeld 3:00 Coffee Break LAA LIGATION 3:15 Watchman Srinivas Dukkipatti, MD 3:40 Lariat Randall Lee, MD, PhD 4:00 Panel Discussion: When to Consider LAA Isolation? Dukkipatti, R. Lee, Verma 4:15 Is Cryoballoon the Preferred Approach to Ablation of Paroxysmal AF? Peter Guerra, MD 4:45 – 5:30 Posters with Wine and Cheese Reception SATURDAY, SEPTEMBER 10, 2016 7:30 am Registration and Continental Breakfast VENTRICULAR TACHYCARDIA • Moderators: Noel Boyle, MD and Edward Gerstenfeld, MS, MD 8:00 Evaluation and Management of Patients with Suspected Cardiac Sarcoidosis Vasanth Vedantham, MD, PhD 8:30 Role of Pre-procedure Imaging Before VT Ablation – Just Pretty Pictures or Critical Information to Guide Ablation? Timm-Michael Dickfeld, MD, PhD 9:00 VT Ablation 2016: Indications and Expected Outcomes Henry Hsia, MD 9:30 Management of ARVC 2016 – Exercise Restrictions, AAD, Role of Ablation Andre D’Avila, MD, PhD 10:00 Panel Discussion: Should Ablation Be First Line Therapy for VT? Vedentham, Dickfeld, Hsia, D’Avila 10:15 Coffee Break
NOVEL THERAPIES • Moderators: Jason Bradfield, MD and Joshua Moss, MD 10:30 Autonomic Modulation for Refractory Ventricular Arrhythmias Marmar Vaseghi, MD 10:50 “Facilitated” Ablation of Arrhythmias – How to Optimize Energy Delivery for Difficult Arrhythmia Substrates William Sauer, MD 11:10 High-intensity Ultrasound and Linear RF Ablation Babak Nazer, MD 11:30 Management of Ventricular Arrhythmias in Patients with Ventricular Assist Devices Joshua Moss, MD 11:50 Panel Discussion: What Improvements are Needed for VT Ablation Dickfeld, Sauer, Vaseghi, Moss 12:10 pm Lunch (provided) SCD/DEVICE • Moderators: Kurt Hoffmeyer, MD, PharmD and Mohammad Shenasa, MD 12:50 Redefining “Sudden Cardiac Death” – Insights from the San Francisco POstmortem Systematic InvesTigation of Sudden Cardiac Death Study Zian Tseng, MD, MAS 1:10 Newer Understanding of Pathogeneses and Therapy of Genetic Arrhythmia Syndromes Melvin Scheinman, MD 1:30 Can We Reduce Sudden Death in the Immediate Post-MI Period? Byron Lee, MD 1:50 When to Consider LV Lead Placement in Non-LBBB IVCD? Jagmeet Singh, MD, PhD 2:10 Subcutaneous ICD - History and Evolution ** Gust Bardy, MD 2:30 Leadless Pacemakers – A New Paradigm? Srinivas Dukkipatti, MD 2:50 Panel Discussion: Role of ICDs in Sudden Death Prevention – When to Consider Subcutaneous ICD** Singh, Bardy, B. Lee, Scheinman, Dukkipatti 3:00 pm Adjourn ** - Not for CME credit