The International Society for Holter and Noninvasive Electrocardiology


Interview by Jodie Elrod

In this article, we speak with Dr. Sergio Dubner, President of the International Society for Holter and Noninvasive Electrocardiology (ISHNE).

Tell us about the ISHNE. When was it formed, and why?

The International Society for Holter and Noninvasive Electrocardiology was created to promote and advance the science of noninvasive electrocardiology in all of its phases and to encourage the continuing education of physicians, scientists, and the general public in the science of Holter and Noninvasive Electrocardiology.

The ISHNE, which was formed in 1984, provides a specialized focus on noninvasive electrocardiology. Our particular emphasis is on new developments in 12-lead ECG, exercise ECG, Holter monitoring, signal averaging, dispersion of repolarization, T-wave alternans, heart rate turbulence, external defibrillation, as well as advances in the diagnosis and treatment of arrhythmia and ischemia. Most of those who developed these methods as well as the main investigators in recent noninvasive trials are members of our Society.

The Society is active in more than 100 countries and is committed to advancing the science of cardiology through its educational programs, mainly Web based, fellowships, and scientific awards. We offer memberships to physicians and scientists involved in clinical and research aspects of noninvasive electrocardiology. The Society’s official journal is the Annals of Noninvasive Electrocardiology (ANE), the Editor-in-Chief of which is Arthur Moss, MD; ANE is indexed in the Index Medicus with an important impact factor.

Who can join the ISHNE? Approximately, how many members are there currently?

Any cardiologist or medical professional, as well as allied professionals, may become members of the Society. Registration is free of charge, according to our philosophy, and there are more than 17,000 members worldwide.

What are some of the benefits of ISHNE membership?

Benefits of membership include being part of a growing society where all the members have the chance to participate in the development, sharing a place to discuss the topic of arrhythmias, and having access free of charge to all the activities.

What are some of the activities or meetings that the ISHNE has participated in this year?

ISHNE had both live and Web-based educational activities. During most of the major congresses related to arrhythmias, the Society had joint activities:

• At the World Congress of Cardiology in Buenos Aires in May 2008, a joint HRS-ISHNE meeting was conducted within the framework of the World Congress, with quite a good audience.

• We participated in the 2nd International Workshop in Noninvasive Electrocardiology in Timisoara, Romania, in June 2008. Victor Moga served as Chair.

• At the Cardiostim meeting in June 2008, a three-day symposium was held, with roundtable talks and the presentations of oral brief communications and posters. The symposium was chaired by Drs. Zareba, Dubner, Moss, and Hombach. Sessions included: Update on Inherited Arrhythmia Disorders, Inherited Arrhythmia Syndromes, Resynchronization Therapy, Atrial Fibrillation, Syncope, Autonomic Control and its Monitoring, and Timing of Noninvasive Testing.

• Also this year was the 19th Great Wall International Congress of Cardiology (GW-ICC) in Beijing, in October 2008. Chair was Dayi Hu (joint session).

• The Educational Symposium on Noninvasive Electrocardiology took place in Belgrade, Serbia, on November 1st. Chair was Branislav Milovanovic.

• The International Forum of Arrhythmias – 4th Congress on Update in Cardiology and Cardiac Surgery was just recently held in Anatolia, Turkey, from Nov. 28th to Dec. 2nd. Chair was Ali Oto (joint session).

• Finally, the 13th International Symposium on Progress in Clinical Pacing, which took place in December 2008 and was chaired by Dr. Santini. Three roundtables related to arrhythmias in sports were presented.

Other upcoming events include ACC.09 in Orlando, Florida, where a joint ACC.09/ISHNE session will be performed. However, our most important activity will be the Biannual Congress of ISHNE, which will take place in Yokohama, Japan, on June 2nd-4th, 2009.

Another important activity of the Society is our Web-based program. This year we presented the World Congress on Myocardial Ischemia and the 2nd Worldwide Internet Symposium on Heart Failure, both via the Internet, in English with simultaneous translations into Chinese, Russian, Spanish, and Portuguese. Each offered CME credits and an important interaction between faculties and registrants. There were 16,000 registrants at each one and a large number of visits per day.

Tell us about the upcoming 13th Biannual Congress of the ISHNE. What are some of the topics that will be covered at this meeting?

Every two years the Society organizes a congress, the most important educational activity of the Society. Next year’s congress will be held in Yokohama, Japan, and Teruhisa Tanabe, president of the Biannual Congress, is doing an outstanding job preparing for its success. Some of the topics that will be covered are the following:

• SCD: Epidemiology, Mechanism, and Underlying Disease
• Practice Guidelines for Prevention of Sudden Cardiac Death
• Update on Risk Stratification Methods
• Clinical Issues in MI, DCM, HCM, and Inherited Disorders
• Noninvasive Early Detection of CV Risk
• Resynchronization Therapy
• High-risk Identification for ICD Implantation.

The next biannual congresses after this will be held in Moscow, Russia (in the year 2011), and Sao Paulo, Brazil, in 2013.

What are some of the ways in which Holter monitoring and noninvasive EP practices might differ around the world? What are some of the ways in which clinical guidelines for monitoring and electrocardiology might also differ?

Noninvasive studies are similar all over the world; the only problem is that they are not always available for all professionals, or are available in different conditions. For instance, numerous studies have been conducted on TWA and HRT that show the significance of these two methods to identify patients at risk of sudden cardiac death; however, these techniques are not available in most of the countries other than the USA or in European countries. For this reason, the Society will conduct a joint ACC.09/ISHNE session in March 2009 to address such an important topic.

What do you consider the most promising technological or research developments in electrophysiology? What advancements would you like to see made?

Currently, a reduced left ventricular ejection fraction of 35% or less is the main indicator to identify high-risk patients. Although it is considered an excellent marker of total cardiac mortality, it is not specific for sudden cardiac death. Therefore, noninvasive risk stratifiers should be the most promising technological developments in the evaluation of cardiac arrhythmias and high-risk identification. Several advancements have been made in this arena; ISHNE recently published a consensus statement about one of these techniques in the October 2008 issue of JACC.

Why is it important for electrophysiology professionals to get involved with the ISHNE?

It is important because of the scientific level of its members and the chance of a direct interaction with all of them. We are a society that has grown tremendously over the last few years, but on the other hand, we still maintain the relationships proper of a small society, thus enabling a direct relationship without protocols.

What are the ISHNE's goals for the future?

Future goals include providing education through our upcoming Biannual Congress in Japan, participating in the most important international congresses such as the ACC, continuing our activities through the Internet, including the CRT 2009 symposium, chaired by Drs. Auricchio and Steinberg, a course on electrocardiography chaired by Dr. Bayés de Luna, and the Symposium on Atrial Fibrillation chaired by Dr. John Camm. Besides these activities, the Society is encouraging the preparation of guidelines and consensus about noninvasive electrocardiography that will be published in ANE and other renowned journals.

Is there anything else you'd like to add?

According to the philosophy of the Society, all of the activities are free of charge, and I invite all colleagues who are interested in noninvasive electrocardiography to join us in this very promising project.

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