Timm Dickfeld recently spoke with Dr. Magdi Saba, Consultant Cardiac Electrophysiologist, Senior Lecturer at St. George's Hospital and University of London, and organizer and Chair of the 1st London Ventricular Tachyarrhythmia Symposium, which took place on September 26, 2011 at the Royal Society of Medicine, London. Professor John Camm Co-Chaired the meeting. The inaugural meeting included a wide range of speakers from England, France, Italy and the US, and was heavily attended by electrophysiolgists and cardiologists from all over Great Britain.

Dr. Dickfeld: Dr. Saba, congratulations on organizing this wonderful and well-attended inaugural meeting. It is great to see how interest in VT ablations is growing on both sides of the Atlantic. London is the perfect location for such a meeting. What made you organize this important meeting?
Dr. Saba:Timm, I first want to thank you for accepting the invitation to participate in this meeting, and for your stimulating and thoughtful lecture on multimodality cardiac imaging to improve VT ablation outcomes. It is the excellent quality of the lectures that makes a meeting successful. When we first started thinking about what is missing in the field of EP in the UK, it was easy to see the gap. There are several meetings addressing atrial fibrillation around the world, but very few meetings specifically dedicated to ventricular tachyarrhythmias. While AF is more common, VT is more complex. As an electrophysiologist interested in this field, I wanted to raise awareness of VT as an ablatable condition. The more interest and research effort dedicated toward VT, the better we will become at controlling this frequently life-threatening arrhythmia. All this, and we have not scratched the surface of VF.

Dr. Dickfeld: The feedback from the attendees was unanimously very positive. Do you think that there will be future meetings like this, and what would be your goal for these?
Dr. Saba: We had over 180 registrants, 40% of whom were from outside London, from all over the UK. I was very pleased to see the positive response from the audience, which was equally split between consultants and trainees. We have had a nice response from the attendees and faculty alike, with particular reference to the longer lectures and the ample discussion and Q/A time allowed for between sessions, which gave the audience a good opportunity to interact directly with the faculty and express their views. I certainly hope that we can make this meeting a regular event in the future, with the goals being maintaining a high level of knowledge in this field and as a catalyst for new directions in research. Hyde Park is just around the corner.

Dr. Dickfeld: Do you feel that VT ablations in 2011 have reached a tipping point similar to where atrial fibrillation ablations were ten years ago?
Dr. Saba: I think that there is a growing interest in VT ablation worldwide, and the number of procedures performed is on the rise. This has to be matched by more funding for research to make the procedures faster and easier and with fewer complications. There is no risk in making the procedure faster and safer, of making it more accessible, as this can only help patients. The risk is in perpetuating the status quo, thus making the control of this group of arrhythmias only available to a lucky minority of the patients who could potentially benefit.

Dr. Dickfeld: What do you feel is mostly missing to make VT ablations more mainstream and bring this procedure to the majority of clinical electrophysiologists in Great Britain?
Dr. Saba: Training. One does what one is trained to do. We all know that one can go through an EP fellowship and only get minimal exposure to VT ablation procedures. In programs where there is no emphasis or limited expertise in this field — still a majority of EP training programs — fellows will not get the requisite training. With symposia like this, we hope to change that and get more people interested. EP fellows will become excited and will seek out the knowledge and the training they need.

Dr. Dickfeld: Having worked extensively in both the US and now the English health care system, you are one of the few people that can speak knowledgeably about both. What do you think are some interesting differences in the practice of clinical electrophysiology between the US and the UK?
Dr. Saba: Interesting point, Timm. The US and the UK have very different health care delivery structures. To the American reader, the NHS in the UK covers the whole population, and so people feel they have a safety net. They understand there are certain limitations, such as the notorious waiting list, but they do not necessarily bemoan them. However, if something is urgent, it will get done. There is a fair amount of autonomy in this regard. Keeping the waiting times as short as possible is a main goal of the NHS management, but the system is overloaded. Although, as in the US, it is good for a particular hospital to have more procedures done, we generally do not have to compete for patients as vigorously. Cardiac electrophysiologists are referred an enriched population, usually after their GP has already tried first-line therapies, with more patients requiring intervention. Another important difference is the lower utilization of ICD therapy in the UK in the setting of primary prevention of SCD, particularly for those with NICM.

Dr. Dickfeld: Dr. Saba, thank you very much for this interview. We are looking forward to many more of these exciting and innovative meetings!

Timm Dickfeld, MD, PhD is the Chief of Electrophysiology at the VA Baltimore, Associate Professor of Medicine at the University of Maryland, and Founder of the Maryland Arrhythmia and Cardiology Imaging Group (MACIG).