2016 AF Symposium Overview
Mechanisms and New Directions in Therapy, January 14-16, 2016, Orlando, FL
by Steve S. Ryan, PhD, February 9, 2016
The annual AF Symposium is an intensive and highly focused three-day scientific forum which brings together the world’s leading medical scientists, researchers and cardiologists/electrophysiologists to share the most recent advances in the treatment of atrial fibrillation.
Why I Attend
Each year I attend the AF Symposium to learn and ‘absorb’ the presentations and research findings. Attending the sessions gives me a thorough and practical view of the current state of the art in the field of A-Fib. I then sort through this newly acquired knowledge and understanding for what’s relevant to patients and their families. Over the next months, I will try to post 20–35 reports on my website, A-Fib.com.
The Venue: Hyatt Regency Orlando
The 2016 AF Symposium was held at the 4-star Hyatt Regency Orlando hotel in Orlando, Florida.
The scientific session presentations were held in the huge Windermere Ballroom equipped with five floor-to-ceiling display screens with additional floor monitors and perfect audio from any seat. the ballroom’s temperature was comfortable (and not too cold/hot like last year.)
An improvement from last year was the separate Exhibition area just down the hall. (Last year the sound from the exhibit area intruded into and disrupted the scientific sessions’ presentations.) Everything ran smoothly (except the initial audio of the first live case presentation.) and included satisfying lunches and break refreshments.
With the room rates starting at $129/night and parking at $18.00/day, I stayed at the Motel 6 nearby ($30.00 per night with an AARP card discount) and happily was able to park nearby for free.
News & Views from the 2016 AF Symposium
Each day started at 7:00 AM and finished around 6 PM (Saturday adjourned mid-afternoon to enable catching evening flights home.)
There were 55 different short presentations (10 or 15 minutes) by 56 A-Fib experts and researchers from around the world. Each talk was usually followed by a Q&A with audience members.
Every seat was equipped with an interactive audience response device so each attendee could enter their answer to any multiple choice question posed by presenters. The results were then flashed up on the screen for further discussion.
Some sessions were followed by “Lightning Rounds” on a particular problem or question. Panelists and the audience could answer the question or share how their facility handles that particular problem. For example, “Which patients should have their Left Atrial Appendage closed off?” or “How do you protect the esophagus during an ablation?”
Live Ablation Cases via Streaming Video: Worth the Price of Admission
There were six live video presentations (via internet streaming video) of ablations from centers around the world:
• Seoul, S. Korea
• Munich, Germany
• Bordeaux, France
• Austin, Texas
• Philadelphia, Pennsylvania
• Boston, Massachusetts
As usual, these live case presentations were worth the price of admission.
The presentation of the live case from Korea had to be postponed for a while until they could work out a technical problem with the audio. (Having worked in broadcast television for 16 years, I know you can have a perfect test run but have something go wrong during the live event.)
To give you a sense of the scope of subjects covered at this AF Symposium, each of the following eleven session topics had 6-9 different talks relating to that subject:
• New Insights into the Pathophysiology, Genetics and Epidemiology of AF— The Science and Mechanisms of A-Fib
• Frontiers in Atrial Fibrillation—Management of A-Fib Patients
• Challenging Cases in AF Management: Anticoagulant Drugs, Anticoagulation, and Clinical Decision Making
• Clinical Trials and Regulatory Issues in AF Ablation—Featuring Presentations by the FDA
• Left Atrial Appendage Closure: Devices, Techniques and Clinical Outcomes—Probably the Second Most Important Topic of this AF Symposium
• Case Presentations: Catheter Ablation for Atrial Fibrillation—Six Live Cases
• Optimizing the Safety and Effectiveness of Pulmonary Vein Isolation Part I and Part II
• Anticoagulation Part I and II: A New Era in Pharmacological Stroke Prevention in Atrial Fibrillation
• Advances in Catheter Ablation for Persistent AF: Mechanisms, New Tools and Outcomes
• Rotors and Other Mechanisms in Persistent AF: Concepts and Controversies—The Most Hotly Discussed Topic in this AF Symposium
• Challenging Cases in Catheter Ablation and LAA Closure for AF
The Most Discussed
The most discussed and argued about topic was non-PV triggers/drivers/rotors.
The most important and historically significant statement made at this AF Symposium was by Dr. Vivek Reddy of Mount Sinai Hospital in New York City:
“The mapping and ablation of Non-PV Triggers is the next step in the evolution of catheter ablation of atrial fibrillation.”
The Most Controversial
The most important and controversial session was Saturday morning’s “Rotors and Other Mechanisms in Persistent AF: Concepts and Controversies.”
It was somewhat disconcerting to hear some cardiologists argue that rotors don’t exist. Dr. Waldo: “I don’t find any rotors.” Dr. Allessie: “If you see rotors, they are wrong.”
Yet during the three days of the Symposium, rotors were the subject of many presentations. The new mapping systems like FIRM and ECGI/ECVUE map, identify and ablate rotors. I kept asking myself how can they say that rotors don’t exist?
The panel discussions about rotors became very heated. A possible reconciliation occurred when Dr. Allessie stated that rotors and breakthroughs can coexist. One drives the other.
Dr. Karl-Heinz Kuck added to the confusion and controversy when he showed a different but similar type of ECGI vest that he uses to map rotors. He doesn’t get the same results as the Bordeaux group and Dr. Haissaguerre.1
As Dr. Jose Jalife summed up:
“For the first time in 20 years, we are talking about mechanisms rather than being ‘anatomicalists’.”
Dynamic, Incremental, Focused Change
Though this is a very subjective non-scientific view, to me the dominant mood or feeling of this year’s AF Symposium was a sense of or awareness of ‘dynamic, incremental, focused change’ coupled with heated controversy over rotors.
The Next AF Symposium: The 2017 AF Symposium will also be at the Hyatt Regency Orlando, January 12-14, 2017.
My Summary Reports
Look for my first summary reports starting later this week.
If you find any errors on this page, email us. Y Last updated: Saturday, May 21, 2016
- I couldn’t tell if Dr. Kuck was speaking tongue-in-cheek or was really serious when he added: “I burn and nothing happens. I don’t understand how to ablate.” Then he said he was stopping ablations until he knew how. (No one in the room knew if he was kidding or not.)↵