My 1st Report from the 2016 Western AF Symposium
By Steve S. Ryan, PhD, March 2016
Utah! What a wonderful winter venue. The Park City Marriott was the site of the Ninth Annual Western Atrial Fibrillation Symposium held February 26-27, 2016.
After having just attended the January 2016 AF Symposium in Orlando, FL, I was surprised at how much new, relevant info was provided (sometimes by the same presenters).
There were 53 scheduled presentations of 15 minutes each. A question & answer session followed every four presentations with the previous 4 speakers and moderators talking with the audience.
In this first report, I’ve summarize 9 presentations and a Q & A session.
Ablation vs Drugs: From AFFIRM to Recent Guidelines
Dr. Eric Prystowsky discussed the now somewhat notorious AFFIRM study which many cardiologist still use to justify keeping A-Fib patients on rate control drugs (and anticoagulants) while leaving them in A-Fib.
But the AFFIRM study was only for 3-5 years. Leaving someone in A-Fib for 20-30-40 years while only trying to keep their heart from beating too fast can have disastrous long-term consequences for A-Fib patients.
Today’s guidelines recognize that it’s usually better for A-Fib patients to get back into normal sinus rhythm (NSR). But today’s antiarrhythmic drugs often don’t work. Once they fail, catheter ablation is superior. Today’s guidelines also recognize that it’s OK to do an ablation first, i.e., ablation can be a first choice. This means A-Fib patients don’t have to try and fail antiarrhythmic drugs before having an ablation.
Structural and Electrical Remodeling: From an Experimental Perspective
Hypercoagulability: a potentially dangerous condition in which blood coagulates excessively, even within the blood vessels.
Dr. Uli Schotten, gave perhaps the most innovative, breaking-new-ground presentation. He discussed how the very dangerous condition, hypercoagulability, is linked to fibrosis and A-Fib.
He discussed how NOACs (Novel Oral Anticoagulants) decrease the risk of an A-Fib stroke. In addition, they may also be a potential ‘Upstream Therapy’ to prevent the development of A-Fib by reducing hypercoagulability and the development of fibrosis.
[Think of ‘Upstream Therapy’ like living in a houseboat on a river. Anything upstream will ultimately affect you as it flows downstream. Furthermore, preventative steps ‘upstream’ can keep you from harm or improve your life ‘downstream’. See Upstream Therapy” Concept: Alternative Therapies for A-Fib?]
ASSERT Study: Are ‘Undetermined Source’ Strokes Actually from Silent A-Fib?
Dr. John P. DiMarco discussed stroke without any obvious causes (formerly called Cryptogenic, but now called “ESUS” [Embolic Stroke of Undetermined Source]). ESUS strokes accounts for 20%-30% of all strokes. He noted that, within two years of having an ESUS stroke, patients often develop A-Fib.
In addition, he discussed the ASSERT (Atrial Fibrillation Reduction Atrial Pacing Trial) study which studied 65-year-olds or older with hypertension. The study revealed that those with a pacemaker or ICD who experience a six minute or longer attack of ‘subclinical atrial fibrillation’ (asymptomatic or silent A-Fib), was at higher risk of stroke. Many ESUS strokes thought to be of “undetermined source”, may actually come from silent A-Fib.
Sleep Apnea and A-Fib
Dr. Larry Chinitz pointed out that sleep apnea, along with causing a host of other problems, expands the left atrium and causes fibrosis. CPAP (Continuous Positive Airway Pressure) breathing machines virtually eliminate sleep apnea and also reduce recurrence after an ablation.
The problem is 50% of patients don’t use theirs. These patients might be receptive to an alternative—a custom oral dental appliance that’s made by a qualified dentist in dental sleep medicine.
[These dental appliances prevent the airway from collapsing by supporting the jaw in a forward position. Caution: This may lead to misalignment of your jaw affecting your bite and causing headaches.]
In his practice, Dr. Chinitz requires that every A-Fib patient be screened for sleep apnea.
Proposed A-Fib Ablation Registry
During the question and answer session (following the above presentations), there was a lot of discussion about the proposed A-Fib ablation registry by the American College of Cardiology. The general consensus was: the ACC registry will be very burdensome and costly with 250 data points to be collected including a 20-question patient quality of life questionnaire; simpler, more focused, less burdensome registries are needed; they should be produced by electrophysiologists (EPs) instead.
You may recognize some of the speakers from my reports on the 2016 AF Symposium held in January.
How Many Times Can We Re-Do A-Fib Ablations?
Dr. Hugh Calkins stated that there is no limit to how many re-do ablation can be done. The risks for a second or third ablation compared to a first are similar. But there will be more RF scarring of the septum with each transseptal puncture. Dr. Calkins emphasized that re-do ablations should be done only after the blanking period (three months after the ablation). When re-doing an ablation, he always re-ablates (isolates) the PVs (Pulmonary Vein Openings).
Promoting AF Awareness Through The Media
Dr. John Campbell of Fox News explained how EPs should be media advocates. They should contact their local TV, radio and other media outlets and offer their services, particularly on Heart Health events or when news breaks about heart related topics.
He showed studies of how people can be greatly influenced by doctors on TV. In one study, for example, when doctors explained why to quit smoking, 1/3 of people hearing this advice did try to stop smoking. He also gave specific presentation advice and showed illustrative interview clips.
[See also my article: TV Doctors’ Talk Shows: Can You Trust Their Recommendations?]
Lesion Imaging Using MRI: Heating To Cooling
Utah is home to The CARMA Center at the U. of Utah, a leader in MRI research and A-Fib.
Dr. Eugene Kholmovski showed how the unique and perhaps most important contribution MRI may make to A-Fib is to examine and accurately determine the integrity of A-Fib lesions. He showed many imaging slides and explained how a good lesion should look, and that it works for both lesions made with RF (heating) and Cryo (freezing) energy. When checking on the integrity of lesions, he cautioned to wait at least one week after ablation. Otherwise, edema (swelling caused by ablation) may prevent the MRI from clearly examining the lesion.
Gender Influence in Patients with Arrhythmia
Dr. Nazem Akoum reported he found few differences between male and female patients with A-Fib with two major exceptions. Women have more fibrosis than men, and women with fibrosis have a much higher risk of stroke.
How Social Media are Changing Managing Patients and Physician Approach
Dr. John Mandrola (‘Dr. John M’) gave several examples of how a researcher/EP can take advantage of social media channels like blogs, Twitter and Facebook to communicate with patients.
He gave the example of a researcher who writes a scholarly article “Warfarin vs the Novel Oral Anticoagulants.” This same article can be re-written for patients with a more patient-friendly title, such as, “How to Avoid a Stroke” and removing all the difficult-to-understand medical terms, then publish it as a blog post. In addition, the researcher can create a personal tweet: “I may have saved someone from having a stroke today. He started taking (name of anticoagulant).”
This shows how the same content can be re-written to reach patients through different media channels.
[Dr Mandrola is one of the more proficient EPs I know using social media and has a huge following. At DrJohnM.org, he blogs about A-Fib, heart rhythm and general cardiac matters, and the world of cycling.]
First Report: The Wrap Up
This is just my first report. There’s more coming in the following weeks.
I was surprised at how much new, relevant info was provided since the January international AF Symposium in Orlando. Besides technical research presentations, the Western AF Symposium also included ‘softer topics’ like using with social media and working with broadcasters to communicate with patients.
Return to 2016 Western AF Symposium Reports by Steve Ryan, PhD
If you find any errors on this page, email us. Y Last updated: Thursday, April 14, 2016