Dr. HK Chopra
I think it is very important, a time has come without intervention no emergency can be rendered whether it is a STEMI or it is an acute pulmonary syndrome or it is a stroke or a peripheral vascular disease or an aortic disease or a renal disease, everywhere the catheter has to go in. I attended just few days ago a meeting in Delhi. Everything in the electrophysiology is catheter-operated, whether it is atrial fibrillation or VT or VF and every possible treatment they go by catheter. I think a time has come, the importance of international cardiology in the electrophysiology has been known to each and everyone. There is an enormous contribution of international cardiology in reduction of morbidity and mortality in reference to cardiology with added comorbidity. I think it is something very heroic and something very panacea in the years to come. (01:00) I have with me Dr. Shiv Kumar. Dr. Shiv Kumar I just would like to ask you a very simple question I find a little change this time and I find every time the NIC is improving day by day. What are your impressions about the NIC and what would you think is a future vision of NIC in the US to come?
Dr. Shiv Kumar : Thank you very much sir for your kind words. Dr. Chopra almost is like my mentor and I am really privileged and honored to get this opportunity to come to this NIC 2016 at Hyderabad. Yes, I totally agree, it is unique in its own way. This is the first the time, we almost made it possible a paperless conference. Everything is tech-based. It is all available on your mobile devices. It is available on web. The biggest thing (02:00) which happened in this conference is we had almost like a 2500 delegates who are attending. They are not only registered, they all came in here, we just had conference which is for the first time which is a biggest conference in Southeast Asia in terms of individual cardiology numbers. The second good which was made possible this time was that all the meetings all the competitive sections which are going on like the CD presentations where we are having a competition, in all these every delegate has the right to vote and depending on the voting we are selecting the best case, so there is an involvement of each and every delegate of this 2500 which is all time high for this conference. In the ability of progressing, I feel that in future the more the cooperation, the technology and the industry, I am sure we will reach much more biggest heights 03:00.
So I think it is very nice I think Shiv what we learnt from you that there is a definitely a new advance in the NIC 2016 in Hyderabad, everything IT related. Yes, everything is in the mobile phone and everything is happening in accordance with the new technology what we call as digital technology. The phone NIC has become digital now. Digital way is the only way whether we impart education or impart training or impart any competitive program or impart any operation and I saw so many live shows yesterday I really enjoyed for whatever time we attended the hall yesterday and the best thing which I liked yesterday for the first time we do something known as mann ki baat or dil ki baat and I was really happy that a very senior member of our CSI, who is past surgeon of CSI Dr. Mehta was interviewed, I was there, (04:00) Dr. Amal Banerjee was there and Dr. Brian Pinto was there, that was really very nice. I just want to ask you one thing more what is a contribution of international faculty here. Do you think the faculty has more, less and the live workshop done was the contribution of the international faculty different from the last year or how many books have you published.
So, I think it has been extremely fruitful contribution from the foreign delegates. We have the biggest number of attendants by the foreign delegates, almost 200 people from different parts of the world they have come and they are performing the live cases right now, places and this time we are coming up with three books releases. In another hours time all the three books will be released in the main (05:00) hall and at this time the interventional cardiology book which is a handbook for all the students and all the students it will be a very useful work which has been contributed by more than 30 authors who are the best of best in the world in their own fields.
Thank you very much Shiv I think that is a very nice message. Whatever you do in life there is a no life without complication. The message should be very clear whether it is an ACC or AHA or EAC you can publish or perish. Publication is the only way I just heard four days ago, in an interview in the ACC and the interview was very clear. Education with we used. If we publish the data either in the form of a book or a booklet or a white paper or any document that document is ready because the document is available in text as well as in the electronic media from digital media and can go all over the world (06:00).
I think it is very nice and I am very happy that this whole conference is being web casted all over the world so there are lot of achievements and I really need to complement you and congratulate you for a brilliant achievement and I am sure in the future the thing will improve further that is what I presume.
Thank you sir. On the left side of me is Dr. Viveka Kumar who is the director of international cardiology and the electrophysiology of the Max Heart Institute in Delhi and a very tough academician, looks very simple, but very complicated man so far as profession is concerned. He deals with all the complexity in a very simple manner and a very divine person.
Welcome to the studio here at the rightdoctors.com. I would like to ask you there is a lot of data coming up in the ECC and there is a huge word about atrial fibrillation this time. I saw two important sessions on atrial fibrillation and they say that the cryoablation is superior as compared to radiofrequency ablation one data and second one is also coming. (07:00) there is a little integrity or suggestion about the radiofrequency ablation also with the new addition of technology. There is some modification in the radiofrequency ablation. I would like to ask you is, in the appendage closure, the first data published from Manipal in India, what is your views about the radiofrequency ablation as to how superior and how practical it will be in India because LA appendage closure is a very-very important entity and 3D echo or echo is also a very-very important mode of operating on these patients. What are you views on this?
Yeah, first of all I would like to thank Dr. Chopra for giving me this opportunity and I would say that you know he has been like a friend and supporting all these years and this topic of atrial fibrillation is the most pertinent topic apart from the acute myocardial infarction. As for the Indian (08:00) patient data is concerned, as you would know that atrial fibrillation is the disease we talk of nonvalvular atrial fibrillation that is a disease of elderly population as our country’s life expectancy is increasing, so there is going to be more and more AF burden and we are one of the few centers in the country who has been doing AF ablation on the regular basis. So, I would say that first of all AF ablation is a very good tool for paroxysmal atrial fibrillation or focal source of atrial fibrillation and the cryoablation has come up in a big way; in fact one of my first few projects in UK when I went to St. George’s Hospital in London was the LA appendage that is called you know LA trial where the LA appendage was being done; I was part of that and then the AF ablation thing and cryoablation we have used it for last 10 to 12 years, but problem (09:00) is that it is based on a balloon technology where you can just isolate the pulmonary veins and we know that there are lot of other places where we need to do ablation like you know roof CFAE ablation and then we have to give the isthmus line and all. These things are not possible with the cryoablation, but as Dr. Chopra has rightly said that cryoablation would definitely decrease the procedure time because you can go, inflate the cryo balloon in the ostium of all the four pulmonary veins and in one go that can be isolated quickly and then you can ablate the other places with the conventional technique or you can do with the catheter also, though the cost is a major hindrance in India. There is no company which has come directly for cryoablation, but definitely the future use for cryoablation and the data clearly suggest that complication rates of cryoblation is far far lower than the conventional ablation even if we compare the data with the cooled tip catheter ablation that is lower and then coming (10:00) to the LA appendage closer that is a huge advantage in people who already have you know cerebrovascular accident and they are at a risk of CVA. They cannot tolerate the oral anticoagulants even the newer anticoagulants if they cannot tolerate or those who cannot afford NOACs with cumulative course cost of NOACs for one year would be equal to putting them on LA appendage closure device and one of the data which has been published from Manipal but I think still the cost is slightly on the higher side, but I think yes the time has come where the LA appendage closure device would be very handy especially in elderly people where we need to keep the pill burden lower and the complications related to the pills should also come down. So I think this is in short what we can say about the new epidemic in aging population of India where the atrial fibrillation and acute coronary syndrome is going to be big epidemic burden.
I think in the aging population, especially after It is so contradictory that Diabetes, hypertension, obesity, atrial fibrillation is going to touch the sky, very very common, at least as echocardiologist, we know how many large LA we see, how many LA appendage we see and how much low flow state in LA we see. I would just like to ask you if the data which you told me is the success of Watchman device which you do for LA appendage closure or there is some other technology, one. Two, radiofrequency ablation are there any advance in the technology or it is the same procedure.
No, there is a huge advancement. I can remember when I did first AF ablation it took six hours you know going from spot to spot, mapping and then ablating. Now, with the 3D technology where you do a NavX mapping of the left atrial or you can do a CARTO mapping and then on the 3D mapping the (12:00) Fluoro time has come down and the procedure time has come down. Now, we perform atrial fibrillation ablation in less than one hour time. The second as you rightly said that you know the comorbidities is high so we need to focus more on the appendage closure and to decrease the pill burden, so I think the newer advancement should be inculcated in our practice, be it appendage closure, be it 3D mapping and AF ablation so that this disease burden can be contained if this is not being controlled by the pharmacotherapy.
So ladies and gentleman, the message is very clear, whenever something new comes, there is initially a reaction, then a time comes there is an adjustment and then a time comes there is a liking. In other words, this is a simple way of explaining, we collect the data by the time. We have more the data, more we are convinced, more the evidence, more we are convinced. Let us give a big hand to both the people especially Dr. Shiv Kumar for beautifully organizing this meeting, the NIC 2016. I am sure in the years to come NIC will be lifted very high under the leadership of (13:00) none other than Dr. Shiv Kumar. We have with us Dr. Viveka Kumar. I think he gave a very beautiful explanation about the newer advances in atrial fibrillation in the years to come and I am sure he is working very actively with the data of new book which is coming up atrial fibrillation update which is a book for the first time which will go from India to the world. We are teaching the whole world now that is my perception that the whole education publication should be done here, why we should follow the western world all the time, we should generate our own data, we should generate our own publications and that is how we will go in the world. Lets give a big hand to both the speakers and I feel really honored to be here in the platform of therightdoctors.com.