The year 2005 in electrocardiology will be remembered as the year of the Gdansk congress! The Joint Congress of the International Society for Holter and Noninvasive Electrocardiology (ISHNE) and the International Society of Electrocardiology (ISE), that took place on June 2–4, 2005 in Gdansk, Poland, featured 87 scientific sessions attended by 1700 registered participants representing over 40 countries. The high level of the scientific program of the congress, with excellent contributions by international faculty presenting state‐of‐the‐art lectures, and with interesting contributions of participants in the form of over 300 presented abstracts (details can be found at http://www.ishne.org) elevated electrocardiology to a new level of science and appreciation in 2005.
ELECTROCARDIOLOGY IN 2005 AND BEYOND
What are the main directions of electrocardiology research and clinical activity in 2005? Noninvasive electrocardiology in 2005 offers a wide spectrum of novel approaches, methodologies, and solutions bringing theory to bedside with vast benefits to physicians and patients. Major directions of research in electrocardiology in 2005 and beyond are listed below with full realization that this list is not exhaustive and could be subjective.
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New developments in molecular biology and pathophysiology of ion channel function and structural proteins in myocardium will remain a major focus of electrocardiology research. Identification of ECG abnormalities in LQTS, Brugada syndrome, hypertrophic cardiomyopathy, catecholamine polymorphic ventricular tachycardia led to breakthroughs in understanding the genetics and mechanisms of inherited arrhythmia disorders with clear impact on clinical practice related to these disorders as well as on research investigating more common arrhythmia and myocardial disorders. This translational research from bedside to gene and back to bedside will bring more breakthroughs in arrhythmology.
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Improvement in risk stratification for cardiac arrhythmias and sudden death is essential to broadly implement primary prevention of sudden death with implantable cardioverter‐defibrillators. Currently, there is no single method that could work universally. Over the years, we have learned that combinations of clinical and ECG factors are essential to identify high‐risk individuals. Especially since invasive electrophysiology methods fail to serve as universal risk stratifiers, there is more room for noninvasive electrocardiology methods. Further work is needed to develop comprehensive algorithms for evaluating the risk of patients with a variety of common and also infrequent cardiac conditions.
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There is more and more emphasis on the dynamic features of ECG phenomena taking opportunity of long‐term recordings. Heart rate turbulence and nonlinear heart rate dynamics emerge as important and clinically applicable risk stratifiers reflecting the behavior of heart rate in response to a disease process. Repolarization dynamics with T‐wave alternans, QT variability, and the QT–RR relationship remains the focus of research aiming to identify novel algorithms indicating increased risk of arrhythmic events in the course of a disease process or due to proarrhythmic effects of cardiac and noncardiac drugs. It is expected that this area of noninvasive electrocardiology will be further enriched during the coming few years.
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Atrial fibrillation is the arrhythmia causing the highest number of hospitalizations among all cardiovascular disorders and the magnitude of the problem is growing with the aging populations. Active research is being pursued regarding the mechanisms of atrial fibrillation initiation, perpetuation, and termination. This research will lead to a better understanding of the underlying mechanisms, but more importantly it will lead to the development of more effective therapies (beyond ablation) for patients with atrial fibrillation.
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Implantable devices (pacemakers, ICDs, resynchronization devices) have increasing storage capabilities opening further possibilities for capitalizing on long‐term EGM monitoring as well as monitoring of several physiologic parameters (like impedance). The interrogation of devices and noninvasive acquisition of ECG/EGM data will lead to research toward new developments for biological monitoring and ultimately better patient diagnosis and care.
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Following the above, telemedicine utilizing a myriad of novel methods of communication will enhance the practice of medicine. Access to medical records and ECGs through wireless communication will speed up the response in acute conditions and will improve the reaction time in chronic disease (e.g., home monitoring of heart failure patients). This is definitely an underinvested and underinvestigated area of electrocardiology, which will strive in the future.
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Worth emphasizing is the active research toward novel ECG signal processing methods taking advantage of more and more computerized systems. The development of methods for noninvasive electrocardiographic imaging and mapping of ischemic and arrhythmic zones are just examples of new directions of electrocardiology going beyond standard ECG or Holter monitoring. One hundred years after the development of ECG concepts and 50 years after widespread implementation of electrocardiography in clinical practice, there is room for innovation going beyond just 12‐lead ECG as we know it today.
ISHNE IN 2005 AND BEYOND
Over the last 20 years, ISHNE has developed from a small society to the current powerful organization promoting science and education of noninvasive electrocardiology. The leadership and legacy of past presidents of ISHNE: Drs. Shlomo Stern, Harold Kennedy, Arthur Moss, Branco Mautner, Vinzenz Hombach, Prakash Deedwania, and Ali Oto will be continued and enriched to elevate the society to even higher levels of accomplishments.
The ISHNE Congress is a featured educational and scientific activity of ISHNE, and the Gdansk congress demonstrated and confirmed that the interest in electrocardiology and cardiology of arrhythmias is growing rapidly and requires further educational activities promoting updates of information disseminated in a quick manner.
During the last few years, ISHNE implemented the concept of virtual symposia and our President Elect, Dr. Sergio Dubner from Buenos Aires, Argentina, is the mastermind behind it. Past virtual symposia focusing on the Brugada syndrome, the long QT syndrome, and recently on arrhythmogenic right ventricular dysplasia were extremely popular. It is enough to say that during the last virtual symposium on ARVD, the lecture by Dr. Frank Marcus was downloaded over 6000 times proving that virtual symposia successfully complement traditional congresses which we value so much not only for their scientific content but also for personal interactions. In October 2005, the society will feature another (even bigger than previous) virtual symposium focused on atrial fibrillation under the leadership of Dr. John Camm together with Dr. Sergio Dubner and Dr. Paul Levine.
Our journal, the Annals of Noninvasive Electrocardiology, led by Drs. Arthur J. Moss and Shlomo Stern, is becoming the journal elected by authors to present their noninvasive electrocardiology work. We are very pleased with the increasing number and increasing quality of manuscript submitted to the Annals and we are glad that our impact factor, which is currently close to 1.0 is on the rise. We can contribute further to the success of the journal by publishing in the Annals the papers that are likely to be quoted as well as by quoting interesting papers already published in the Annals. We encourage our colleagues and members of ISHNE to support our journal in both ways by submitting papers and quoting papers published in the Annals. It is important to realize that all participants of the Gdansk congress have free on‐line access to the Annals until the end of 2005.
The ISHNE educational activity will also continue in the form of educational sessions during congresses and meetings around the world. Over the past 10 years the society has organized over 125 educational sessions worldwide and we are planning to continue spreading up‐to‐date information about new and exciting concepts in electrocardiology to medical communities in several countries. Just during the past 3 months after Gdansk congress, ISHNE educational sessions were organized in Katowice (Poland), in Malaga (Spain), and in Venice (Italy). A number of sessions are planned for 2006 with our traditional 3‐day ISHNE symposium on Advances in Noninvasive Electrocardiology during Cardiostim 2006 in Nice, France.
The newsletter “Scientific ISHNE News” together with the automatic reference library system on selected topics will continue bringing our members with up‐to‐date developments in the areas of interest. We recently launched the “ISHNE Technology Update” newsletter, allowing our members and guests to learn about novel developments in the rapidly evolving technology of noninvasive electrocardiology. Our web‐based educational activity at the site: http://www.ishne.org will grow, serving as a common platform for learning, educating, exchanging ideas, and enjoying noninvasive electrocardiology, which has become such an integral part of clinical practice in cardiology and medicine in general.
There is growing interest in novel applications of noninvasive electrocardiology; simultaneously some existing methods require standardization. Therefore ISHNE aims to develop a series of consensus documents and guidelines papers aiming to systematize and standardize both methodological as well as clinical approaches using those methods. The first such document will be focused on heart rate turbulence, a very promising risk stratifier of growing interest.
We are planning to further increase our international activity focusing on education and science. We want to encourage many colleagues worldwide, such as you, to join us in attending our educational activities, but more importantly, join us by actively contributing and submitting scientific papers to the Annals, submitting interesting case reports for the ISHNE website, sharing with us comments on the web, organizing locally educational sessions under auspices of the ISHNE; all of it in the name of advancing the knowledge and science of noninvasive electrocardiology. Please feel free to contact me (wojciech_zareba@urmc.rochester.edu) with new concepts and ideas regarding the above and other new directions of ISHNE activity.
Wojciech Zareba, M.D., Ph.D. President of ISHNE