From info at hf-symposium.org Mon May 1 08:09:47 2006 From: info at hf-symposium.org (HF Symposium) Date: Mon, 1 May 2006 08:09:47 -0300 Subject: [HF-FORUM] Until the next activity. Dr. Perez Riera In-Reply-To: Message-ID: Dear colleagues of the Forum of the ISHNE Heart Failure World-Wide Internet Symposium, These 30 days went by so fast. It feels as if it only started yesterday. This type of event brings people together, besides providing information both of quality and updated. I would like to thank this unique opportunity offered to be able to actively participate. First, to the "sacred monster of world cardiology," the generous Professor Arthur Moss, and the first- quality star of his team, Prof. Dr. Zareba, who believed in our potential and made this event possible with our participation. I would like to thank too, my long-time friends Dr. Edgardo Schapachnik and Dr. Sergio Dubner, with whom I had the joy to share our common enthusiasm in the organization of this event. I have to say something special about my dear "sister," Dr. Li Zhang, a colleague with rare human and intellectual qualities, who propitiated our contact with the faraway and fantastic Chinese world, which we admire so much for its great vital energy and desire of improvement. Anyway, I am grateful with all my heart to all the colleagues from around the world who participated in one way or another in this magnificent event. I am happy due to the feeling of having fulfilled my duty, and with a great will to continue with future events. Now another dream has become real for me, and let us remember that: "A man doesn't die when he ceases to exist. But he ceases to exist when his dreams die". Best for all and until the next event!! Andr?s Ricardo P?rez Riera, MD Chief of the Sector of Electro-Vectocardiography of the Discipline of Cardiology, School of Medicine, ABC Foundation Santo Andr? - S?o Paulo - Brazil. -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee From info at hf-symposium.org Mon May 1 08:32:11 2006 From: info at hf-symposium.org (HF Symposium) Date: Mon, 1 May 2006 08:32:11 -0300 Subject: [HF-FORUM] Congratulation. Dr. Makarov Message-ID: Dear Drs. Arhthur Moss, Sergio Dubner, Edgardo Schapachnik, Wojciech Zareba, Andrei Vorotniak and all team of the HF Symposium. Thank you very match for it biggest international event. It was really big new experience for all of us. Especially thank you very match for active involving of russians and all russian language doctros in HF- Symposium. I am sure that all materials of the HF Symposium will be very actually for our clinical and scientific practise very lonf time. Sincerely yours Dr. Leonid Makarov, Moscow, Russia -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee From info at hf-symposium.org Mon May 1 08:41:49 2006 From: info at hf-symposium.org (HF Symposium) Date: Mon, 1 May 2006 08:41:49 -0300 Subject: [HF-FORUM] Congratulation. Dr. Locati Message-ID: Congratulation with your extraordinary achivements. Many thanks for your endeavor Best regards, Dr.ssa Emanuela Locati Via Vittoria Colonna 40 20149 Milano Tel/Fax +39-02-48021954 GSM +39-335-6189402 e-mail: emlocati at fastwebnet.it ----- Edgardo Schapachnik Director General y Cient?fico Grupo AKROS edgardoschapachnik at mac.com -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee From info at hf-symposium.org Mon May 1 14:47:35 2006 From: info at hf-symposium.org (HF Symposium) Date: Mon, 1 May 2006 14:47:35 -0300 Subject: [HF-FORUM] 174E RE: NS-VT and S-VT. Dr. Levine Message-ID: Dear Dr. Almeida The patient whom you describe is younf (50 years old) and has a symptomatic cardiomyothay. He has already had spontaneous episodes of VT from which he required resuscitation, While Amiodarone will reduce the number of VT episodes, it will not absolutely prevent all episodes. Unfortunately, EP studies in patients with a cardiomyopathy is neither sensitive nor specific for who will or will not respond to amiodarone or who might need an ICD. The criteria for a prophylactic (primary prevention) of sudden death is an EF < 35%, (SCD-HeFT and DEFINIT studies), the "requirement" of a low EF is not applicable for patients who have had spontaneous episodes and required resuscitation. I would recommend implantation of an ICD. Given the high risk of systemic side effects from Amiodarone particularly in a young patient looking towards many years of survival, I would also discontinue Amiodarone. With respect to the ICD, I would also enable two-zone therapy with a VT zone first treated with ATP therapy. Many of the VT episodes may respond very nicely to ATP which will minimize current drain from the ICD but more importantly, will be painless for the patient. If he has recurrent and frequent shocks, I would then resume Amiodarone or some other antiaarhythmic in an effort to reduce the number of shocks making this more comfortable for the patient. As to carvedilol and ACE inhibitors, I would use these in maximum tolerated doses. It will be essential to control his even mild Hypertension to reduce the afterload on his weaked LV. It would be premature to recommend CRT for this patient based on an EF of 42% and his apparent good response to pharamcologic therapy. Thus, if he doesn't require pacing for standard reasons, I would select a single chamber ICD programmed to a low base rate to minimize unneccesary ventricular pacing. If, however, with the Amiodarone slows his sinus rate (based on your recent experience with this drug in this patient), I would choose a DDD-ICD programming an appropriate base rate to provide atrial pacing support with either a long AV Delay or even program pacing to the AAI mode. ADDITIONAL COMMENT I am responding from my Blackberry and missed the comment about "aortic disease". If there is a valve abormality and his CHF is believed to be caused by this, this should be repaired. If this is believed to be incidental to a primary cardiomyopathy, then it might be prudent to follow the patient for his aortic valve disease. Paul A. Levine, MD, FHRS, FACC ----- Edgardo Schapachnik Director General y Cient?fico Grupo AKROS edgardoschapachnik at mac.com -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee From info at hf-symposium.org Mon May 1 19:12:51 2006 From: info at hf-symposium.org (HF Symposium) Date: Mon, 1 May 2006 19:12:51 -0300 Subject: [HF-FORUM] 171S RE: Heart failure + renal failure. Dr. Pereira Message-ID: <206D996F-BE1B-455E-8FAB-8597C0537295@hf-symposium.org> Dr. Bartolomeo, The response varies according to the degree of renal failure presented by the patient. With a creatinine below 3 mg/dl it is possible, under a strict monitoring, to use most of the usual medications. The combination of digitalis, spironolactone and ACEI regarding potassium is what we should be most careful about. On the other hand, renal failure patients with CHF respond bad to loop diuretics and thiazide agents. With creatinine above 3 mg/dl there will be an important limitation in the response to drugs and an increase of toxic effects. From 5 mg/dl onward, the possibilities are hemofiltration and dialysis. Ref.: ACC/AHA Practice Guidelines 2005 Kind regards, Dr. Luciano Pereira -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee From info at hf-symposium.org Mon May 1 21:27:20 2006 From: info at hf-symposium.org (HF Symposium) Date: Mon, 1 May 2006 21:27:20 -0300 Subject: [HF-FORUM] 172S RE: Chagasic cardiomyopathy. Dr. Pellizon In-Reply-To: <398BE6BE-DCF3-40FB-BCB0-D3FA32574944@grupoakros.com.ar> Message-ID: Dear Edgardo, I totally agree with your concepts. Over these days, the National Conference of Cardiology is being held in Rosario, by the Argentine Federation of Cardiology, and I had to speak about the role of ICD and antiarrhythmic drugs in SCD by chronic chagasic cardiomyopathy. Interestingly, there are important findings about basic and immunological research concerning this disease. But clinicians still have little information; therefore evidence-based cardiology for chronic chagasic cardiomyopathy does not exist, so the question is: where do we look for this evidence? And I can just find it in common sense, and this leads us to individualize patients with the greatest risk of SCD, which is closely related to the degree of severity of the ventricular arrhythmia. Gathering Argentineans is not difficult; the difficult part is joining them with a common purpose? May scientific societies would get together to solve this problem? This is a gratifying symposium. Warm regards, Dr. Pellizz?n -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee From info at hf-symposium.org Mon May 1 23:28:52 2006 From: info at hf-symposium.org (HF Symposium) Date: Mon, 1 May 2006 23:28:52 -0300 Subject: [HF-FORUM] 173S Role of hemodynamic monitoring. Dr. Bonzon In-Reply-To: Message-ID: Dear Dr. Oswaldo Gutierrez (Costa Rica), In reply to your question: "What is the current role of invasive hemodynamic monitoring with catheter in pulmonary artery and wedge pressure measurement? What do you think of this?" I will modestly dare to answer the following: Currently there is a discussion about whether hemodynamic monitoring improves survival or not in patients with Heart Failure (HF), BUT among so many authors, NO ONE defined if it is a "terminal" HF (I think your question is about this subset of patients), and if it is "resilient" (there is evident or concealed intercurrence) or really "refractory." We cannot even think of using it with each HF etiology. The worst is that from all the authors, none is thinking of the physicians that should manage this type of patients; consequently, I will try to answer from this approach, in an attempt to mix practical and theoretical aspects. Assuming we are talking about patients with HF (not discriminating etiologies, which is a subject long enough to write several books) and ejection fraction of 30%, I tell you my honest opinion about your question: Today in real life, EVERYTHING DEPENDS on who you are with and the means you have (Human and Technological Resources). 1- If you are in an environment where you don't have trained staff, the best you can do is using the clinical symptoms of the patient as guide. The physical test (edema, other congestion signs, peripheral hypoperfusion, etc.), the stethoscope (third noise, pulmonary rales, etc), front chest roentgenogram and a balance (to accurately measure hydric balance) are your best allies, just as simple lab tests. If you also have a chance to perform a reliable echocardiogram, you have high chances of having the necessary judgment elements to make the therapeutic decisions that would enable compensating, stabilizing and getting your patient out of a bad setting. 2- If you are in an environment where you do have trained staff, be careful. You have to clearly supervise the measurements and check that the flow leads of the Swan-Ganz catheter are not used to administer other fluids that are not necessary to maintain permeability. 3- If you are in an environment with staff and technological resources that would allow you to be confident, trust them but supervise everything. The technician insufflating the balloon to measure the wedge may exceed the volume to be injected and produce buffered wedge readings, which would give you the impression that the patient lacks volume. Result: a beautiful acute pulmonary edema by the decision made from a mistaken measurement reading. The control of the position of the end of the balloon is essential, as well as stability, which largely depends on the pathway used. There's no need to say that Swan-Ganz catheters have a reliable half life of approximately 72 hours, a period through which plasmatic lipoproteins are fixed in the latex balloon, alter their distensibility and predispose ruptures. As a reflection about this first and scan part of my answer (we could write for days about this topic), I could summarize: It all depends on who's using it, who you are using it with, and where do you use it. Being somehow extreme in our comparisons, hemodynamic monitoring catheters are like a gun in the hands of an alleged pacifist. If we assume that the prevalence rate of HF is about 1.5 to 1.8% of the general population, and that the possibility of a new case per year is about 1.5 per thousand, out of which only 10% or less will come to the office with HF and ejection fraction equal or lower than 30%, you have more chances to be robbed or murdered than of having to use a Swan-Ganz catheter. At least it is so in my country. For this reason, have the hemodynamic monitoring set always ready to use and learn how to manage it well; but use it only if necessary. If, on the other hand, you work in a center with a high rate of referred patients with HF, do the same thing police elite corps do: use it when strictly necessary and no more. That is to say, I think that hemodynamic monitoring is a weapon you will have to use a few times in daily life (not being in referral center), but when such moment comes, you better know how to use it well. If you read this far, you may have noticed that I haven't mentioned hemodynamic monitoring of direct blood pressure, which is a different topic, and too extensive to be treated in a message. Frequently we wonder: if we use a Swan-Ganz catheter, why not supplement it with direct blood pressure? A good question, don't you think? And the answers will be the same as the abovementioned. Colleague: if we are in a world where papers on HF are "raining" on us and NO ONE finally agrees on how to define the patients at a greater risk, where clinical, echocardiographic and arrhythmic criteria are used in a strange mixture of definitions about HF: "decompensate," "refractory," "resilient," "terminal," etc., to concur in a mess of definitions, including NYHA functional classes, CCS's, etc., with different and changing transthoracic echocardiogram criteria?What do we have left? OUR OWN CRITERION. Now, in what do we base our criterion? In what functional class and defined by whom? In what physical findings and defined by whom? In what radiological findings and defined by whom? In what lab findings and defined by whom? In what echocardiographic parameters and defined by whom? Even worse: when we say that the patient is treated in an optimal way, what do we mean? What "optimal treatment" and defined by whom? What drugs and defined by whom? What doses of such drugs and defined by whom? Good. And now, how do we define who "responds" or "does not respond" to this mess of keys and instruction? Your question, as you will see, implies more interrogations than accurate answers. It is very easy to base on the Task Force classification for the AHA/ACC guidelines and define a patient as in a D State ("structurally advanced heart disease with marked symptoms in rest, in spite of maximal medical therapy. It requires specialized interventions, including hospital care or transplantation.") WHAT A DEFINITION!!! Do you understand it well? I don't. I could go on analyzing subsequent results and analyses, for instance, from well-known studies, such as the CONSENSUS, FIRST, SOLVD, and others, as well as sensitivity and specificity criteria for each isolated particular clinical sign. The problem with these and other "canned" studies is that they do not reveal which are the really defining clinical signs to make decisions to treat each individual patient. We will see what the ESCAPE trial states, analyzed from the future, trying to compare the hemodynamic monitoring with clinical variables. Once the moment comes, we will have to ask what clinical variables were used, which were not, and why. Those that were valuable for them, may not be so for us. And we may also ask why the PROMISE, SOLVD, VHEFT, PRAISE, and other studies use inclusion and exclusion variants different from guidelines, don't you think? And, what do we do with the patients who undergo (or not) hemodynamic monitoring and have important ventricular arrhythmias? What do we do with those that have ventricular tachycardia, extreme bradycardia or electromechanic dissociation? Do we implant ICDs on all of them? Well, if we assume that we will only see 1 such patient each 0.015 million inhabitants, why not "spending," if from these patients, 1 each 1,500 will be in our care, a 10% of this 0.015 per million? To end this message, boring for most: Have you seen how "figures" play against us or for us according to the analysis? Well: this is so for the Industry and for the Health Care Systems. They want to confuse us with figures. We should not let them. Warm regards from Argentina. Dr. Gustavo R. Bonz?n Resistencia, Chaco Argentina -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee From info at hf-symposium.org Tue May 2 16:12:54 2006 From: info at hf-symposium.org (HF Symposium) Date: Tue, 2 May 2006 16:12:54 -0300 Subject: [HF-FORUM] Congratulations. Dr. Pereira In-Reply-To: Message-ID: <4E56A163-3E6A-49BF-85BF-3A54163DCC3E@hf-symposium.org> 10 CME credits available for Virtual Heart Failure Symposium ? take advantage now! Go to HF-Symposium homepage, click on CREDITS and follow the instructions or go directly to http://www.hf-symposium.org/credits.php ------------------------------------------------------------------------ --------------------------------------------------------- Congratulations to all the organizers for the excellent work made. Gathering colleagues from 107 countries is just admirable. I feel satisfied for having been a protagonist in this symposium, with this nice -and apparent- contradiction of legitimate pride and true modesty. Thanks to all of you, Dr. Luciano Pereira Paraguay -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee From info at hf-symposium.org Tue May 2 16:13:41 2006 From: info at hf-symposium.org (HF Symposium) Date: Tue, 2 May 2006 16:13:41 -0300 Subject: [HF-FORUM] Congratulations. Dr Yabluchansky In-Reply-To: <9EAD3F8A-7F2A-4416-9A9D-7EB43861FE33@grupoakros.com.ar> Message-ID: 10 CME credits available for Virtual Heart Failure Symposium ? take advantage now! Go to HF-Symposium homepage, click on CREDITS and follow the instructions or go directly to http://www.hf-symposium.org/credits.php ------------------------------------------------------------------------ --------------------------------------------------------- I would like to join the thank-you messages! And besides, I would like to acknowledge the titanic work by the organizers, who made it possible to carry out this great party in the world of Heart Failure. I wish you success in your work and personal life. I hope this event will become a tradition. Once again, thank you! Myckola ( Nikolay) Iabluchansky Ukrayne -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee From info at hf-symposium.org Tue May 2 16:54:10 2006 From: info at hf-symposium.org (HF Symposium) Date: Tue, 2 May 2006 16:54:10 -0300 Subject: [HF-FORUM] CME Credits Message-ID: <03E2FF47-5B73-4C4B-ACC4-9D39A9CD57AD@hf-symposium.org> 10 CME credits available for Virtual Heart Failure Symposium ? take advantage now! Go to HF-Symposium homepage, click on CREDITS and follow the instructions or go directly to http://www.hf-symposium.org/credits.php -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee From info at hf-symposium.org Tue May 2 19:29:18 2006 From: info at hf-symposium.org (HF Symposium) Date: Tue, 2 May 2006 19:29:18 -0300 Subject: [HF-FORUM] 175E Nonresponders prediction of CRT: what's the next step?. Dr. Steinberg Message-ID: 10 CME credits are available for the Virtual Heart Failure Symposium ? seize this opportunity now! Go to the HF-Symposium homepage, click on CREDITS and follow the instructions or go directly to: http://www.hf-symposium.org/credits.php Dear Dr. Xia, Your question is an excellent one. Ideally, complete and consistent restoration of sinus rhythm should be highly advantageous. The problem arises in the means to acheive sinus rhythm. Clearly antiarrhythmic drugs are inconsistently effective and as we have published with the AFFIRM data, may increase the risk of noncardiovascular death by 50%. On the other hand, a retrospective statistical analysis of AFFIRM suggested that the achievement of sinus rhythm during follow-up was associated with a better outcome. In an observational study, ablation in heart failure patients was also associated with an improved outcome. Bottom line is that at present, care must be individualized and there is no clearcut consensus about the proper management strategy in heart failure patients with AF. Restoration of sinus rhythm (including by catheter ablation) is likely to be favorable and should be sought if feasible and better than alternative approaches. A randomized clinical trial would greatly help clarify the best treatment. Jonathan S. Steinberg, M.D. Chief, Division of Cardiology Director, Arrhythmia Service St. Luke's-Roosevelt Hospital Center Professor of Medicine Columbia University College of Physicians & Surgeons Phone: 212-523-4007 Fax: 212-523-3915 -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee From info at hf-symposium.org Tue May 2 23:28:39 2006 From: info at hf-symposium.org (HF Symposium) Date: Tue, 2 May 2006 23:28:39 -0300 Subject: [HF-FORUM] 176E RE: Role of hemodynamic monitoring. Dr. De Souza Message-ID: Dear Dr. Oswaldo Gutierrez and Dr. Gustavo R. Bonz?n, according to ESCAPE study including patients with left ventricular ejection fraction less than 30% and advanced heart failure, addition of the invasive hemodynamic monitoring (with catheter in pulmonary artery and wedge pressure measurement) to careful clinical assessment increased anticipated adverse events, but did not affect overall mortality and hospitalization (JAMA. 2005;294:1625-1633). But I agree with Dr. Bonz?n that some situations should be analysed. In my experience, I believe some patients could benefit, for example patients with left and right ventricular dysfunction. It is possible to find very high pressures on right side (central venous pressure) and low pulmonary wedge pressure because of right ventricular failure and some degree of pulmonary hypertension. In this situation of systemic congestion, increasing diuresis worses low output state. Unfortunately, it is very difficult to prove my belief. Thank you, Marcos Roberto de Sousa - Brazil -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee From info at hf-symposium.org Wed May 3 07:47:24 2006 From: info at hf-symposium.org (HF Symposium) Date: Wed, 3 May 2006 07:47:24 -0300 Subject: [HF-FORUM] 177E Nonresponders prediction of CRT: what's the next step?. Dr. Oto Message-ID: <267EC9B8-B58E-4FF4-B4AD-0B9F58D3F754@hf-symposium.org> Dear Dr Xia, Thank you for the very important questions Indeed the prediction of response to CRT or the selection of appropriate patients is still the major caviate in CRT . Now we have realized that this issue is not an easy task . Although ECG is helpful , it seems inadequate as the patients with narrow QRS have also been shown to have benefit. Spescific answers to the questions: 1. At the present time I would not go for CRT if the patient is likely to be a non-responder. 2. Echocardiographic guidance during implantation would be a good help. Besides a general recommendation could be pacing from the site and observing the QRS width . If one can not find an optimal lead position despite all efforts , a hybrid approach with the epicardial implantation would be appropriate. 3. Alternative sites pacing should be considered in whom pacing is indicated . There is no robust evidence suggesting use of alternative sites pacing as a therapeutic modlity in patients with refractory heart failure without conventional indication for pacing . Sincerely, Ali Oto, MD, FESC, FACC > Nonresponders to CRT treatment is a major problem in device > management of HF patients. In several lectures of this forum, the > methods for prediction of nonresponders of CRT treatment have been > recommended, such as noncontact mapping, MRI, echocardiography etc. > In Dr Ali Oto's lecture, he listed Algorisms to predict responders to > CRT by Tissue Synchronization Imaging (TSI), which are helpful even > in HF patients with narrow QRS. Those with the most severe delay not > at lateral ventricular wall are likely to be non-responders. Then > several questions raised here: > > 1. When you find the patients are LIKELY to be nonresponders, > will you go on CRT treatment under present situation? > 2. Echocardiography can help us avoiding 'site of delay - site > of pacing' mismatch, and optimizing the lead positioning. In some > cases, however, the LV lead can hardly be located wherever you want > with adequate sensing and capture threshold. Could you please give us > some technique recommendations for lead positioning? > 3. Could we try to use some other alternative pacing sites, > such as RVOT pacing, when we find the possible nonresponders? > > Best regards > > Yunlong Xia > > Department of Cardiology > The First Affiliated Hospital of Dalian Medical University -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee From info at hf-symposium.org Wed May 3 16:30:57 2006 From: info at hf-symposium.org (HF Symposium) Date: Wed, 3 May 2006 16:30:57 -0300 Subject: [HF-FORUM] 178E RE: Role of hemodynamic monitoring. Dr. Madias Message-ID: I am enjoying the hf-forum immensely!!! Congratulations to all organizers and participants. In reference to employing pulmonary catheters for monitoring patients with decompensated CHF, an alternative can be diuresis with monitoring of weights, BUN, creatinine, blood pressure, heart rate, frequent lung auscultation, careful I/O, consideration of insensible fluid losses, particularly in intubated patients, and occasional "fluid challenges" of small volumes at a time. These, and a central venous catheter for monitoring, may go a long way, refgardless of pathology involving the left ventricle and/or the right ventricle. The above require that a knowledgeable physician is available and does and reviews all the above, instead of delegating care to other less astute clinicians. Warmest Regards to all our colleagues Sincerely, John E. Madias, MD, FACC, FAHA, Professor of Medicine (Cardiology) Mount Sinai School of Medicine of the New York University, Cardiology Division, Elmhurst Hospital Center Tel: (718) 334-5005 FAX: (718) 334-5990 email:madias at nychhc.org -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee From info at hf-symposium.org Wed May 3 18:20:36 2006 From: info at hf-symposium.org (HF Symposium) Date: Wed, 3 May 2006 18:20:36 -0300 Subject: [HF-FORUM] End of message exchange In-Reply-To: <966F5D35-BF63-4101-AE86-7E8878100AD5@mac.com> Message-ID: <1391D136-59F3-49F1-BE55-9AC6F3CDEFCD@hf-symposium.org> Dear colleagues and friends, We inform you that as of next May 5th, the activities of opinion exchanging of the different forums that were enabled during the Worldwide Symposium on Heart Failure, will end. ISHNE may possibly use the channel to send interesting information and/or new bibliographical updates. Let us remind you that until October 1st, the questionnaire to obtain CME credits will be available at: http://www.hf-symposium.org/credits.php As it has occurred previously, the participants of the symposium are especially invited and will be registered into the next Symposium on SUDDEN CARDIAC DEATH, which will be held since October 1st, 2006, and that will be chaired by Prof. Dr. Douglas Zipes, unless you request the contrary. We hope to meet with you again. Kind regards, Edgardo and Sergio -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee From info at hf-symposium.org Wed May 3 19:28:36 2006 From: info at hf-symposium.org (HF Symposium) Date: Wed, 3 May 2006 19:28:36 -0300 Subject: [HF-FORUM] End of message exchange. Dr. Mabadeje Message-ID: <02D2988A-F7C9-4349-96B4-C6F696E72949@hf-symposium.org> Dear Dr. Sergio Dubner President of Scientific Committee & Dr. Edgardo Schapachnik President of Steering Committee Thank you for the state of the art knowledge imparted during the Worldwide Symposium on Heart Failure. I shall look forward to the October 1st Symposium on Sudden Cardiac Death. Dr. A. F. B. Mabadeje Box 191, University of Lagos Akoka Lagos, Nigeria -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee From info at hf-symposium.org Thu May 4 14:43:58 2006 From: info at hf-symposium.org (HF Symposium) Date: Thu, 4 May 2006 14:43:58 -0300 Subject: [HF-FORUM] Congratulations. Dr. Xia Message-ID: Dear Drs. Arthur Moss, Sergio Dubner, Edgardo Schapachnik, Li Zhang and all teams and colleagues of the HF Symposium. Here I would like to express my most sincere congratulations to the success of this excellent international symposium. I really appreciate your hard work for this free internet forum without any limit of time and space. In special, I appreciate many Chinese experts and colleagues who have actively involved in this event, which make more than 1,200 registered Chinese colleagues benefit from it. From LQT syndrome, ARVD, AF to HF symposium, this pioneer program is growing up rapidly, and its increasing impact could be seen. I am sure it will play more and more important role in the cardiac world. Good luck to the future of this program. Thanks again, and looking forward to meeting you again in Sudden Cardiac Death symposium in October, 2006. Best regards Yunlong Xia The First Affiliated Hospital of Dalian Medical University , China Yunlong.xia at gmail.com -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee From info at hf-symposium.org Thu May 4 14:50:34 2006 From: info at hf-symposium.org (HF Symposium) Date: Thu, 4 May 2006 14:50:34 -0300 Subject: [HF-FORUM] 180E RE: Chagasic cardiomyopathy. Dr. Sternick Message-ID: To support the comments of Dr Edgardo, that ICD might be indicated in chagasic patients with "better hearts", we have recently published in the Journal of Cardiovascular Electrophysiology (Vol 17, pp 113-116, january 2006) our findings in 5 patients with Chagas Heart Disease who suffered sudden cardiac death while having their underlying rhythm recorded. All 5 patients had preserved left ventricular function. It is a cenario known as unexpected sudden death, and the only clinical variable predictive of the arrhythmic event was the occurrence of syncope or near syncope in all. The number of syncopal episodes and their timing was quite variable, but usually less than 30 days. Eduardo Sternick Minas Gerais, Brazil -- Dr. Sergio Dubner President of Scientific Committee Dr. Edgardo Schapachnik President of Steering Committee