Leading experts from international agencies, NGOs, the food industry and academia will meet at McGill University, in Montreal, Oct. 57 to discuss the increasing challenges relating to food security in the world. The 2nd McGill Conference on Global Food Security will focus on the effects of the global economic crisis on food supply and production.

In the past year, approximately 100 million people have been added to the ranks of the roughly 1 billion people worldwide considered to be undernourished, according to a recent report by the United Nations Food and Agricultural Organization.

The discussions at the McGill conference will address topics such as food security in a challenging economic environment, the effects of markets and trade, climate change and the production of biofuels, access to farm credit, the investments needed for agricultural development as well as the response of international agencies to challenges of food security.

Representatives of developing and emerging economy countries will speak on their countrys experiences. Joining them will be leading academics and officials from a wide range of international agencies, such as the World Bank, the United Nations World Food Program, the United Nations Food and Agricultural Organization, the Organization for Economic Cooperation and Development, and the Canadian International Development Agency, among others. Several of these experts will gather for a public panel discussion, on Oct. 5 at 5 pm, on “The effects of the global recession and future prospects”.

WHAT McGill Conference on Global Food Security

WHEN October 5, 6 and 7, 2009

WHERE New Residence Hall, McGill University 3625 avenue du Parc, Montreal

Public Lecture (October 5, 5 p.m.) Salon MontRoyal, Centre MontRoyal 2200 Mansfield St., Montreal

For more information on the program, please visit mcgill.ca/globalfoodsecurity/program/

For more information on the speakers, please visit mcgill.ca/globalfoodsecurity/speakers/

Source
Doug Sweet

Threehundred cancer vaccine researchers and immunologists from academia and industry will meet for three days in New York City to discuss the different ways cancer exploits the human bodys selfprotective mechanisms of immune regulation to avoid elimination by the immune system, a problem which researchers in the field have identified as one of the key challenges to therapeutic cancer vaccination. The conference, titled “Control of Cancer Immunosuppression The Challenge for Cancer Vaccine Development,” will take place September 30 to October 2, 2009, at the Millennium Conference Center in the heart of Manhattan.

The Cancer Research Institute (CRI), a U.S.based nonprofit organization dedicated to the development of immunebased approaches to cancer treatment, control, diagnosis, and prevention, is sponsoring the event. It is the seventeenth in the CRI Annual International Cancer Immunotherapy Symposia Series.

Twentyfive plenary lectures and a poster session will address topics including cellular and molecular mediators of cancer immunosuppression, targets for immunotherapy of cancer, and strategies to overcome cancer immunosuppression during cancer treatment.

Presentation highlights include

Regulatory T cells and their suppression program, by Dr. Alexander Rudensky, HHMI and Immunology Program, Memorial SloanKettering Cancer Center, New York, NY

Antigen immunoselection as an escape mechanism during cancer immunoediting, by Dr. Robert D. Schreiber, Washington University School of Medicine, St. Louis, MO

Modulating innate and adaptive immunity through the manipulation of dendritic cells, by Dr. Nina Bhardwaj, New York University Langone Medical Center and NYU Cancer Institute, New York, NY

Regulation of tumorassociated inflammation by epithelial cell cytokines, by Giorgio Trinchieri, National Cancer Institute, Frederick, MD

Checkpoint blockade in tumor immunotherapy, by Dr. James P. Allison, Ludwig Center for Cancer Immunotherapy, HHMI, and Memorial SloanKettering Cancer Center, New York, NY

From immunosuppression to immune recognition Antigenspecific cancer immunotherapy, by Dr. Vincent G. Brichard, GlaxoSmithKline Biologicals, Rixensart, Belgium

Prioritization of cancer antigens and immunotherapeutic agents for vaccine trials, by Dr. Martin A. Cheever, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA

Recombinant viral vectors as a platform for cancer vaccines, by Dr. Kunle Odunsi, Roswell Park Cancer Institute, Buffalo, NY

Objective clinical responses by therapeutic vaccination with synthetic long peptides, by Dr. Cornelis J.M. Melief, Leiden University Medical Center, Leiden, The Netherlands

Correlative immunological results of compassionateuse trial of Ipilimumab, by Dr. Jedd D. Wolchok, Memorial SloanKettering Cancer Center, New York, NY

About the Cancer Research Institute

The Cancer Research Institute (CRI) is the worlds only nonprofit organization dedicated exclusively to the support and coordination of scientific and clinical efforts that will lead to the immunological treatment, control, and prevention of cancer.

Guided by a worldrenowned Scientific Advisory Council that includes four Nobel Prize winners and twentynine members of the National Academy of Sciences, CRI supports leadingedge cancer research at top medical centers and universities throughout the world. CRI is an initiator and steward of global collaborative research efforts aimed at accelerating the translation of basic discovery into effective cancer vaccines and other immunebased therapies to provide new hope to cancer patients.

The Cancer Research Institute has one of the lowest overhead expense ratios among nonprofit organizations, with more than 85 percent of its resources going directly to the support of its science, medical, and research programs. CRI meets or exceeds all 20 standards of the Better Business Bureau Wise Giving Alliance, the most comprehensive U.S. charity evaluation service, and according to Charity Navigator exceeds or meets industry standards and performs as well as or better than most cancer charities. CRI has also received an A grade for fiscal disclosure and efficiency from the American Institute of Philanthropy as well as top accolades from other charity watchdog organizations.

This conference and networking event will present a fresh and original perspective on communicating the value and costeffectiveness of highvalue oncology drugs with payers, HTA assessors and other key stakeholders.

Unlike other general pricing & reimbursement meetings which broadly discuss many therapeutic areas, this event will be focused specifically on the oncology marketplace. This conference will look at the latest innovative market access techniques such as valuebased pricing schemes, risk sharing, as well as satisfying HTA requirements to build the right dossier.

Why attend?Benchmark, network and cooperate with pharma & nonpharma decision makers.Get up to date on innovative reimbursement schemes and their implementation.Learn what data makes the difference for HTA agencies and payers and how to present it.Understand the best ways to communicate value and achieve maximum patient and market access.Hear multistakeholder perspectives from pharmaceutical industry, academia, public insurers, HTA, policy makers, patient groups.Discover how payers are viewing risksharing and valuebased pricing agreements and what their initiatives in the field are.Understand what patients want and what they view as quality treatment.Who will benefit?

Pharmaceutical companies
VicePresidents, Directors, Managers involved in oncology Pricing & Reimbursement, Health Economics & Outcomes, Government & Stakeholder Relations, Regulatory Affairs, Medical Affairs, Marketing, Therapy Area Heads, Market Access, Country Managers

Solution providers & consultants
CEOs, Business Development, Senior Consultants, Regional Heads

Independent Academics, Health Economists, Senior Doctors, & Patient Representatives.

Date and Location

The conference will be held on the 14th and 15th December 2009 in Prague, Czech Republic.

Agenda request

To request the full agenda please follow this link.

For Booking Information contact

Erika Vavrovicova
Tel +421 232 660 382
Fax +421 232 660 397
erika@nextlevelpharma.com
nextlevelpharma.com

Elite cardiovascular surgeons from around the world will travel to suburban Atlanta this week for the twoday Ross Summit to review and discuss current peerreviewed data relating to the survival advantage of the Ross Procedure and to practice the technical nuances required to perform this heart surgery successfully.

The Ross Procedure is a type of specialized aortic valve surgery in which the patients diseased aortic valve is replaced with his or her own pulmonary valve. The pulmonary valve can then be replaced with a cryopreserved human pulmonary valve.

Nine peerreviewed articles regarding the Ross Procedure representing individual series from eight different countries, comprising a total of 2,234 patients have appeared in major medical journals over the past four years and report that The Ross Procedure is associated with excellent longterm survival;

Late survival with the Ross Procedure is comparable to that of the agematched general population; and

There is an excellent propensityadjusted survival with the Ross Procedure in a pediatric patient population study compared to the excess mortality demonstrated with using a mechanical valve (as reported by one of the nine reports). Led by Professor Sir Magdi Yacoub, FRS, FRCS, of Imperial Colleges Heart Science Center in London in tandem with William F. Northrup III, MD, vice president of physician relations and education at CryoLife, the Ross Summit will have a faculty of more than 30 worldrenowned cardiovascular surgeons and cardiologists, who will present clinical data on heart reconstruction surgery at their respective clinics. The summit includes two sessions of handson instruction in the various techniques of cardiac reconstruction.

The Ross Procedure is performed on up to 1,500 individuals globally each year a number that is expected to increase as survival data become more widely known.

“In children, young adults and in active older adults, the Ross Procedure offers several advantages over other traditional aortic valve replacement options,” said Dr. Northrup. “The most important advantage is growing evidence of improved longterm survival over other valve replacement options. The procedure is also attractive because patients do not have to take longterm, bloodthinning medications after surgery as they would with mechanical valves. This is particularly appealing to women of childbearing age, athletes and active adults.”

These clear advantages along with the growing catalog of survivability data spotlighted at the summit are bringing new attention to the procedure from surgeons and potential patients.

“The Ross Procedure requires very specific surgical expertise to achieve predictable, longlasting results, and The Ross Summit was created to foster data exchange to provide a wellrounded point of view in addition to offering critical procedural training,” noted Steven G. Anderson, chairman, president and CEO of CryoLife.

A full faculty list and summit agenda can be found at TheRossSummit.org. A live webcast of the Ross Summit can be viewed at TheRossCommunity.org.

A decellularized human pulmonary heart valve, CryoValve(R) SG, processed using CryoLifes SynerGraft(R) technology, was cleared by the FDA in February 2008 for use in cardiac reconstruction procedures, which includes the Ross Procedure.

Source
Dana Hartline

Research to be presented at the Annual Meeting of the Society for the Study of Ingestive Behavior (SSIB), July 28 August 1, 2009, the foremost society for research into all aspects of eating and drinking behavior, finds that women who possess genetic modifications associated with low activity of the reward neurotransmitter dopamine in the brain when they imagine eating appetizing foods are more prone to weight gain. Functional Magnetic Resonance Imaging (fMRI) scans of brain activity revealed that women who had lower activity in food reward regions of the brain and who had genetic modifications associated with lower dopamine activity showed the greatest weight gain after one year. Eric Stice from the Oregon Research Institute says, “These findings provide some of the first prospective evidence that people who experience blunted reward from food may compensate by overeating, increasing risk for unhealthy weight gain.” Overconsumption of appetizing foods may occur in an attempt to increase brain reward in less responsive systems. The results of this study highlight the need for further research into the role that neural reward systems play in the development of obesity. “It may be useful for individuals who show low foodrelated reward to increase their physical activity, which not only promotes activity the same reward circuitry but also reduces unhealthy weight gain from overeating” says Stice.

Lead author Eric Stice, Oregon Research Institute, Eugene, OR, USA

Coauthors S. Spoor and C. Bohon, Oregon Research Institute and University of Oregon, C.N. Marti, University of Texas at Austin, USA.

Source
Jamie Price

This week, more than 3,000 leading scientists convened to report and discuss the latest advances in research on treatments, risk factors, diagnosis and causes for the health epidemic of the 21st century Alzheimers disease at the Alzheimers Association 2009 International Conference on Alzheimers Disease (ICAD 2009) in Vienna, Austria.

“The cost of caring for people who have Alzheimers, and those who will get it, will bankrupt the healthcare system and devastate Medicare and Medicaid,” said William Thies, PhD, Chief Medical and Scientific Officer at the Alzheimers Association. “Fortunately, the field is progressing and we may soon see changes in the landscape of Alzheimers diagnosis, care, treatment, and prevention. How fast we get there depends completely on investment in research. We must capitalize on the advances made in the last decade.”

Highlights from ICAD 2009 include

DHA Drug Trials

Results from two large studies using DHA, an omega 3 fatty acid, were reported at ICAD 2009. DHA (docosahexaenoic acid) is the most abundant omega 3 fatty acid in the brain. An 18month study in people with mild to moderate Alzheimers by the Alzheimers Disease Cooperative Study (ADCS) supported by the U.S. National Institute on Aging (NIA) showed no evidence for benefit in the studied population. The results do not support the routine use of DHA for people with Alzheimers.

A six month study was conducted by Martek Biosciences Corporation in healthy older people to see DHAs effect on “age related cognitive decline.” This trial showed a positive result on one test of memory and learning. The results need confirmation. Both studies used Marteks algal DHA.

These two studies and other recent Alzheimers therapy trials raise the possibility that treatments must be given early in Alzheimers process for them to be truly effective. For that to happen, we need to get much better at early detection and diagnosis of Alzheimers.

Phase III Alzheimers Drug Raises Level of a Toxic Protein

Recent evidence suggests that the drug Dimebon may improve cognitive function in people with mild to moderate Alzheimers, but how the drug produces these benefits remains unclear. In a surprising result from ICAD 2009, researchers found that treatment with Dimebon caused an increase in a brain protein, known as beta amyloid, in animal models of Alzheimers. Beta amyloid is a protein that is the main constituent of plaques found in the brains of people with Alzheimers. It is thought to be a key player in the development and progression of Alzheimers. This result is highly unexpected as most Alzheimers drugs are tested for how much they can lower beta amyloid levels.

News Cases of Alzheimers and Dementia Continue to Rise, Even Past Age 90

The number of people with Alzheimers and dementia both new cases and total numbers with the disease continues to rise among the very oldest segments of the population, according to research reported at the Alzheimers Association International Conference. This age group is the fastest growing segment of the population in western countries. This is different from past research results. Previous studies have suggested that the number of people with Alzheimers and dementia begins to level off and perhaps even go down a bit in people age 90 and above.

Post Traumatic Stress Disorder May Raise Alzheimers Risk; Moderate Alcohol May Lower It

Two studies from ICAD 2009 looked at how post traumatic stress disorder (PTSD) and alcohol consumption may affect risk levels.

A study of more than 181,000 veterans aged 55 and older without dementia showed that there may be nearly two times higher Alzheimers risk in veterans with posttraumatic stress disorder (PTSD) than those without it. Further research is needed to fully understand what links these two important disorders. With that knowledge we may be able to find ways to reduce the increased risk of dementia associated with PTSD.

A second study suggests lower Alzheimers risk among adults who consume moderate amounts of alcohol (1 or 2 drinks per day), versus those who do not drink or who are heavy drinkers. However, this does not appear to be true for those who already have mild cognitive impairment.

The good news is that we now know theres a lot you can do to help keep your brain healthier as you age. These steps might also reduce your risk of developing Alzheimers disease or another dementia.

Heart Healthy Diet and Ongoing Moderate Exercise May Reduce Risk of Cognitive Decline

Scientists at ICAD 2009 reported that following the Dietary Approaches to Stop Hypertension diet or DASH diet was associated with higher scores for cognitive functioning. The researchers found that four food categories from the diet plan whole grains, vegetables, lowfat dairy foods, and nuts and beans may offer benefits for cognition in late life. We need more research before we can confidently say how much of these foods to include in your diet to experience some benefit.

Two studies from ICAD 2009 looked at physical activity and mental performance as we age.

One study found that maintaining or increasing physical activity throughout life may slow cognitive decline as we age. Older adults who were sedentary throughout the study had the lowest levels of cognitive function at the beginning and had the fastest rate of decline.

A second study in postmenopausal women found that moderate longterm physical activity may improve late life cognition; while longterm strenuous activity may actually increase risk of cognitive impairment.

Neurologists Surveyed on Diagnosing and Treating Mild Cognitive Impairment (MCI)

Scientists at ICAD 2009 reported on how clinicians view and treat mild cognitive impairment (MCI), a research category used to define the state between normal aging and Alzheimers, that is now being used widely in clinical practice. Millions of people can be classified as having MCI, and these numbers are expected to rise in coming years. Researchers found that neurologists regularly see and treat people with MCI, despite the fact that the medications they are prescribing are not FDAapproved for MCI. They also found that clinicians vary greatly in the education and support they provide or recommend for people with MCI, suggesting that there is a need for practice guidelines.

There are now more than 26 million people living with dementia around the world. The cost of caring for these people, and those who will get it in the next few years, have potential to bankrupt the worlds healthcare systems. But, as these studies and many hundreds more reported at ICAD 2009 show, there is hope.

Successful Recruiting Strategies for Alzheimers Clinical Trials

Several studies at ICAD 2009 investigated the most effective method of recruiting people for Alzheimers clinical studies. Researchers in one study found that successful Alzheimers trials promote volunteerism and study participation by conducting community educational events, and actively partnering with local physicians. Surprisingly, in this study, patient registries and Internet recruiting were found to be much less successful recruitment strategies.

In a study looking specifically at recruiting African Americans for Alzheimers genetics studies, researchers found that having a relative with the disease, use of minority study personnel, and monetary compensation were the most powerful incentives for participation in research. The researchers found that large percentages of African Americans are willing participants for Alzheimers genetic studies, if culturally sensitive techniques are used to recruit them.

Recruiting participants for clinical studies is the second greatest barrier to developing better treatments for Alzheimers disease, behind inadequate funding. The Alzheimers Association has initiated a Clinical Studies Initiative to begin to address this problem.

About ICAD 2009

The 2009 Alzheimers Association International Conference on Alzheimers Disease (ICAD 2009) brings together more than 3,000 researchers from 70 countries to share groundbreaking research and information on the cause, diagnosis, treatment and prevention of Alzheimers disease and related disorders. As a part of the Associations research program, ICAD 2009 serves as a catalyst for generating new knowledge about dementia and fostering a vital, collegial research community. ICAD 2009 will be held in Vienna, Austria at Messe Wien Exhibition and Congress Center from July 1116.

The Alzheimers Association is the leading voluntary health organization in Alzheimer care, support and research. Our mission is to eliminate Alzheimers disease through the advancement of research, to provide and enhance care and support for all affected, and to reduce the risk of dementia through the promotion of brain health.

The worldwide economic downturn has exacerbated a global food crisis that started in 2007, leading to a significant increase in the number of people who are malnourished. The Institute of Medicine will convene top experts at a threeday workshop to explore the implications of the food crisis on nutrition and health. Participants will discuss the effects of the economic crisis and escalating food prices on nutrition, country and global responses, U.S. policies, and actions to mitigate food crises now and in the future. Speakers include representatives from the World Bank, World Food Program, UN Task Force on Global Food Security Crisis, academic health centers, and organizations from Bangladesh, China, Ethiopia, Kenya, Mexico, and other countries.

DETAILS

The workshop will run from 9 a.m. to 530 p.m. on July 14 and 15 and from 9 a.m. to 1215 p.m. on July 16 at the Barbara Jordan Conference Center of the Kaiser Family Foundation, 1330 G St., N.W., Washington, D.C. An agenda and registration are available at iom.edu/CMS/3783/62976/65148.aspx. Due to space limitations, advance registration is required.

Source
Christine Stencel

Dey, L.P., a subsidiary of Mylan Inc. (NYSE MYL), has announced that data from two presentations highlighting the use of Perforomist® (formoterol fumarate) Inhalation Solution will be featured in poster format at the International Conference of the American Thoracic Society on May 19, 2009 in San Diego.

In one analysis, use of Perforomist Inhalation Solution, when added to maintenance tiotropium, resulted in improved pulmonary function, dyspnea (shortness of breath) and rescue medication use versus treatment with tiotropium alone. In a second study, patient satisfaction increased in those treated with Perforomist Inhalation Solution twice daily compared with ipratropium/albuterol metereddose inhaler (MDI) four times daily.

Presentation Details

In COPD, Adding Nebulized Formoterol to Tiotropium Treatment Provides Added Benefits in Pulmonary Function, Dyspnea, and Rescue Medication Use A Pooled Analysis; poster board # J51

Date Tuesday, May 19, 2009
Poster viewing 1030 a.m. to 1245 p.m. PT
Location Area J (Sails Pavilion, Upper Level), San Diego Convention Center

Nebulized Formoterol Improved Efficacy and Increased Patient Satisfaction Compared with Ipratropium/Albuterol MDI; poster board # J50

Date Tuesday, May 19, 2009
Poster viewing 1030 a.m. to 1245 p.m. PT
Location Area J (Sails Pavilion, Upper Level), San Diego Convention Center

About COPD

COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.

COPD is the fourth leading cause of death in America, behind heart disease, cancer and stroke. 12 million Americans have been diagnosed with COPD, and at least another 12 million have symptoms but have not been diagnosed. COPD is not well understood or recognized most Americans have not heard of it, not even those who may be living with the condition. The most common cause of COPD is cigarette smoking, which is responsible for an estimated 80 to 90 percent of COPD cases. For patients who smoke, quitting smoking is the single most important step a patient can take to treat or slow down COPD. Estimates of the total incidence of COPD in America range from 24 to 30 million.

About Nebulization

Of the three types of devices used to deliver bronchodilators nebulizers, metereddose inhalers, and dry powder inhalers nebulizers convert medication into a fine liquid mist that the patient inhales through a mouthpiece or facemask. The patient breathes naturally, inhaling the medicine until the complete dosage has been delivered. Nebulization is a very gentle, but also very thorough, method of delivering medicine directly into the lungs.

With Perforomist Inhalation Solution, nebulization may become a more widely used treatment option for many COPD patients at earlier treatment stages who could benefit from twicedaily maintenance dosing of a nebulized longacting beta2adrenergic agonists (LABAs) such as Perforomist Inhalation Solution. For example, this COPD treatment may be a valuable clinical option for many patients whose symptoms are not adequately controlled with their current therapy. COPD patients should consider asking their doctor whether nebulized treatment may be right for them.

About Perforomist® Inhalation Solution

Perforomist Inhalation Solution is indicated for the longterm, twicedaily (morning and evening) administration in the maintenance treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema.

Important Safety Information

Perforomist® (formoterol fumarate) Inhalation Solution belongs to a class of medications known as longacting beta2adrenergic agonists (LABAs). LABAs may increase the risk of asthmarelated death. Data from a large placebocontrolled US study comparing the safety of another LABA (salmeterol) or placebo added to usual asthma therapy showed an increase in asthmarelated deaths in patients receiving salmeterol. This finding with salmeterol may apply to formoterol (a LABA), the active ingredient in Perforomist Inhalation Solution.

Perforomist Inhalation Solution should not be initiated in patients with acutely deteriorating COPD, which may be a life threatening condition, or to treat acute symptoms. Acute symptoms should be treated with fastacting rescue inhalers. Perforomist Inhalation Solution is not indicated to treat asthma. The safety and efficacy of Perforomist Inhalation Solution in asthma has not been established. Perforomist Inhalation Solution should not be used with other medications containing LABAs. Do not use more than one nebule twice daily. Perforomist Inhalation Solution should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias and hypertension.

In COPD clinical trials, the most common adverse events reported with Perforomist Inhalation Solution (>2% and more common than placebo) were diarrhea, nausea, nasopharyngitis, dry mouth, vomiting, dizziness, and insomnia.

Please see full Prescribing Information, including Boxed Warning, at perforomist.com.

Source
Julie Piszczor

A call to action for more research to be undertaken into catheter ablation in the field of ventricular arrhythmia (VA) has been issued in a joint consensus document from the European Heart Rhythm Association (EHRA) a registered branch of the European Society of Cardiology (ESC) and the US Heart Rhythm Society (HRS). The consensus document launched at Heart Rhythm 2009, the Heart Rhythm Societys 30th Annual Scientific Sessions, being held 13 to 16 May in Boston provides an up to date review of indications, techniques and outcomes of catheter ablation for treatment of ventricular arrhythmias, a technique now being offered to increasing numbers of patients.

“In the last few years there has been a substantial evolution of techniques for catheter ablation in VA. We hope this document will help identify the areas in catheter ablation that require further research, and encourage clinicians to embark on more clinical and registry studies,” says Etienne Aliot, the European cochair from Nancy, France. “It is only by conducting more clinical trials and registries that we can begin to get an idea of exactly how catheter ablation fits into the whole VA treatment paradigm including Implantable Cardio Defibrillators (ICDs) and antiarrhythmic drugs.”

The document authored by 20 leading European and US electrophysiologists recognises there is still “very limited” data establishing the long term impact of catheter ablation on morbidity and mortality.

Unanswered questions highlighted by the joint document include the long term efficacy of catheter ablation

the comparative success rates of drug and ablative therapies

can ablation slow the progression of ventricular remodelling in structural heart disease?

definition of patients with different underlying cardiac and non cardiac diseases. “Over the past decade there has been great progress with important advances in methods for mapping and ablating ventricular arrhythmias, but there are also many gaps in our knowledge where more work is needed. EHRA and HRS recognized that a document summarizing where we are now, where there is agreement and where we need to go would be timely and important,” says William Stevenson, the US cochair from Brigham and Womens Hospital, Boston, MA USA.

The document is the third joint consensus document to be issued by EHRA and HRS at the Heart Rhythm meeting, with EHRA taking the lead this year.

“Having one document between Europe and the US is vitally important since it gives both clinicians and patients the confidence that they are doing the right thing. Having different documents on both sides of the Atlantic is a recipe for confusion,” says Professor Aliot.

In an area with few clinical trials, but many single centre reports, the consensus document summarised the opinion of task force members based on their own experience of treating patients, in addition to a review of the literature. For each topic, two members of the task force drafted a discussion document that was then considered and edited by all members of the team.

The document examines indications, outcomes, and contraindications of catheter ablation, which are important concerns for physicians and their patients with ventricular arrhythmias that require treatment. In addition, specific technical aspects of ablation procedures important for electrophysiologists are discussed including methods for mapping to identify ablation targets, roles for newer technologies, the use of anticoagulation, analgesia and anesthesia, and antiarrythmic drug management. The knowledge base that physicians need, and the support staff and equipment required, are also considered.

There are two major types of ventricular arrhythmias. Those associated with heart disease are often due to abnormal electrical circuits originating from diseased areas of scar in the ventricular myocardium. A prior heart attack is a common cause. The second type concerns those where there is no structural disease, known as idiopathic ventricular arrhythmias.

Ventricular arrhythmias may cause symptoms such as syncope and palpitations, and in the most severe cases, cause cardiac arrest and sudden death. Many patients with ventricular arrhythmias and structural heart disease have implantable defibrillators that terminate VA when they occur, but these episodes may still cause symptoms and in some cases require painful shocks for termination. Catheter ablation has an important role in preventing or reducing recurrent attacks of symptomatic VA in these situations and can be lifesaving for patients with incessant arrhythmias.

Most idiopathic VA are benign, but careful evaluation is required to distinguish idiopathic from potentially dangerous VA. Ablation is an important alternative to antiarrhythmic drug therapy in many patients with idiopathic VA.

Catheter ablation, the procedure used to selectively eliminate the cells responsible for the arrhythmia, involves inserting catheters (thin flexible wires) into blood vessels, usually in the groin, and threading them through the blood vessels into the heart ventricle under Xray guidance.

The next step is for the electrophysiologist to use the catheter to identify the source of the abnormal electrical activity in a procedure known as mapping. Mapping may involve triggering VA, or identifying abnormal areas that contain the substrate for VA based on findings during sinus rhythm. Radiofrequency energy is then applied through the catheter to destroy the abnormal area. Finally, testing is performed to determine if ablation has been sufficient to prevent the VA. The process of “mapping and ablation” continues until the electrical disturbance can no longer be triggered by catheters or no further substrate can be identified.

Recent innovations in catheter ablation include 3D mapping systems that superimpose electrical maps of the heart on 3D images of the heart from echocardiography, which gives recordings in relation to anatomic locations in the heart and facilitate identification of the arrhythmia substrate during stable sinus rhythm.

Percutaneous epicardial mapping and ablation of ventricular tachycardias that originate from the epicardial surface of the heart.

The delineation of the relation between cardiac anatomy and focal ventricular tachycardia origins in the right and left ventricular outflow tracts and papillary muscles. Source
ESC Press Office

A Queens University research team has blown open the myth that massage after exercise improves circulation to the muscle and assists in the removal of lactic acid and other waste products.

“This dispels a common belief in the general public about the way in which massage is beneficial,” says Kinesiology and Health Studies professor Michael Tschakovsky. “It also dispels that belief among people in the physical therapy profession. All the physical therapy professionals that I have talked to, when asked what massage does, answer that it improves muscle blood flow and helps get rid of lactic acid. Ours is the first study to challenge this and rigorously test its validity.”

The belief that massage aids in the removal of lactic acid from muscle tissue is so pervasive it is even listed on the Canadian Sports Massage Therapists website as one of the benefits of massage, despite there being absolutely no scientific research to back this up.

Kinesiology MSc candidate Vicky Wiltshire and Dr. Tschakovsky set out to discover if this untested hypothesis was true, and their results show that massage actually impairs blood flow to the muscle after exercise, and that it therefore also impairs the removal of lactic acid from muscle after exercise.

This study will be presented at the annual American College of Sports Medicine conference in Seattle, Washington May 2730, 2009

Source
Stephanie Earp
Queens University