Innovations in Arrhythmia Management: From Wearable Monitoring to Physiologic Pacing

Morning Symposium 3: Wearables and Continuous Monitoring: Impact on AF and VT Management

Moderated by Adhantoro Rahadyan, MD and Pipin Ardhianto, MD, Morning Symposium 3 highlighted the evolving role of wearable devices in rhythm monitoring. The session opened with Alice Inda Supit, MD, who presented “Wearables vs Holter: The Future of Rhythm Monitoring,” emphasizing that Holter ECG remains the gold standard for diagnosis and clinical decision-making, while wearables are valuable for screening. Agung Fabian Chandranegara, MD, in “Wearables and Continuous Monitoring: Monitoring in Bradyarrhythmia,” highlighted a hybrid workflow in which wearables provide continuous monitoring and triage, while clinical expertise remains essential. Agus Harsoyo, MD, PhD, in “Screening AF with Wearables: Benefit or Burden?”, emphasized the benefits of digital AF screening and its integration into holistic AF care to reduce adverse clinical outcomes.

Symposium 9: Managing AF in Obesity, and Comorbidities

Symposium 9 moderated by Haryadi, MD and Adhantoro Rahadyan, MD, starts with Prof. Muzakkir, MD, PhD, in “Beyond Rhythm Control: The Emerging Role of GLP-1 in AF with Multimorbidity,” highlighted the role of obesity, metabolic dysfunction, inflammation, and HFpEF in promoting AF and the potential of GLP-1 RAs to modify these underlying substrates. Rerdin Julario, MD, in “Obesity, Sleep Apnea, and AF: Does Substrate Modification Favor Rhythm Control?”, emphasized that combining substrate modification with metabolic risk-factor management may reduce AF recurrence and improve quality of life. Lastly, Faris Basalamah, MD, PhD, in “Targeting PCSK9 via RNA Silencing in AF Patients with ASCVD,” discussed intensive lipid-lowering strategies and the potential of inclisiran, a PCSK9-targeting siRNA administered twice yearly, to improve LDL-C control, treatment adherence, and clinical outcomes.

Symposium 12: The New Era of Physiologic Pacing

Symposium 12 moderated by Prof. Muzakkir, MD, PhD and Ragil Nur Rosyadi, MD, explored the evolving role of physiologic pacing and Conduction System Pacing (CSP). Dicky Armein Hanafy, MD, PhD, in “Why CSP Works: Mechanisms of Physiologic Cardiac Activation,” explained how His Bundle Pacing and Left Bundle Branch Area Pacing directly engage the His-Purkinje conduction system, preserving synchronous ventricular activation and improving cardiac efficiency, ventricular filling, and contraction, while potentially reducing heart failure progression. Irnizarifka, MD, in “Chasing Perfect Capture: Fine-Tuning CSP Post-Implant,” emphasized that achieving optimal CSP capture requires a solid understanding of cardiac anatomy, basic ECG interpretation, and EGM assessment. The session also highlighted the potential role of Bachmann’s Bundle Pacing (BBP), with Alexander Edo Tondas, MD, PhD, in “Bachmann's Bundle Pacing to Achieve Physiological Pacing - Is It Necessary?” describing Bachmann’s Bundle as the main interatrial conduction pathway. BBP may reproduce more physiological atrial activation, narrow the paced P-wave, restore a normal axis, and potentially benefit selected patients with HFpEF and AIB.