Navigating Long-Term Device Dilemmas in Cardiac Care

The symposium series held in Dian Ballroom B brought together electrophysiology experts from across the region to share practical updates, clinical experiences, and real-world strategies in long-term device management, advanced VT ablation, and Conduction System Pacing (CSP). Throughout the three sessions, speakers provided grounded, easy-to-follow insights into resolving post-implant complications, refining scar homogenization, and mastering live pacing techniques faced by cardiologists in their daily clinical practice today.

Morning Symposium 2 examined the long-term realities faced by patients living with cardiac implantable devices, exploring the dilemmas that arise well after implantation. Moderated by Muhammad Yamin, MD, PhD and Yoga Waranugraha, MD, the session brought together experts to discuss device-related complications and evolving pacing strategies. Haryadi, MD opened the session with a presentation on the hidden cost of cardiac devices, addressing infection risks and their downstream consequences for patients. Following this, Dicky Armein Hanafy, MD, PhD discussed tricuspid valve dysfunction arising from device leads, offering guidance on when intervention becomes necessary. Closing the symposium, Prof. Wei Hua, MD, PhD presented on CSP in patients with heart failure and left bundle branch block, noting that while Cardiac Resynchronization Therapy (CRT) has been shown to relieve heart failure symptoms, reduce mortality, and improve long-term clinical outcomes, CSP may serve as a valuable alternative to Biventricular Pacing (BiVP), particularly for patients with ventricular dyssynchrony when effective BiVP cannot be achieved.

In a separate session, faculty gathered to discuss contemporary approaches to VT ablation, focusing on substrate mapping, scar homogenization, and clinical outcomes. Moderated by Beny Hartono, MD and Fera Hidayati, MD, the session explored current strategies in VT ablation. Lim Tien Siang Eric, MD presented on isochronal late activation mapping in VT, tracing its journey from concept to clinical practice. Prof. Yoga Yuniadi, MD, PhD then discussed the left stellate ganglion block in VT storm, covering its indications and clinical outcomes. Rounding out the session, Tachapong Ngarmukos, MD shared insights on choosing the right strategy for VT ablation, framing the decision-making process as a battle requiring careful strategic planning.

The morning also featured a live demonstration session centered on CSP, moderated by Erika Maharani, MD and Fandi Ahmad, MD. Following the opening, Dian Andina Munawar, MD, PhD examined whether the differences between LBBAP, deep septal, and LV septal pacing truly matter in clinical practice. Prof. Dennis Lau, MD, PhD then presented on enhancing CSP efficiency through a style-driven approach, sharing techniques to improve procedural outcomes. The session concluded with a live demonstration of CSP performed by Dony Yugo Hermanto, MD, giving attendees a hands-on view of the technique in real time.

Across all three sessions, faculty members underscored the growing complexity of managing patients with long-term cardiac devices, from infection prevention and lead-related complications to refining pacing techniques for better patient outcomes. The morning's discussions reinforced the importance of continued innovation and collaboration in advancing device therapy for heart failure and arrhythmia management.