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AF Symposium & other medical conferences articles

2018 AF Symposium: The Innovative iCLAS Cyro Catheter

My first report from the 2018 International AF Symposium is about an innovative, ultra-low temperature Cryo catheter, the iCLAS catheter from Adagio Medical.

Various positions possible with the iCLAS catheter from Adagio Medical

I knew it was something special by the incredibly high-powered, renowned presenters: two of the most important people in the treatment of Atrial Fibrillation―Dr. James Cox of the original Cox Maze operation and Prof. Michel Haissaguerre of the original PVI catheter ablation.

One Catheter. Unlimited Shapes.

The iCLAS catheter is a Cryo catheter that uses ultra-low temperatures and is and unlike anything currently on the market. The catheter can be manipulated into many different configurations depending on the lesions which need to be made.

When I visited the Adagio booth, it was fascinating to see how easily the catheter could be designed into unlimited profiles.

Using its full length, the catheter can produce ultra low temperatures along its whole span (110mm). It has 20 electrodes which can also produce cryo-mapping of the atria.

For Flutter Ablations in the Caviotricuspid Isthmus in the right atrium, a shorter catheter is used … continue reading my report–>.

2018 AF Symposium: Innovative iCLAS Cyro Catheter by Adagio Medical

by Steve S. Ryan, PhD.

I knew it was something special by the incredibly high-powered, renowned presenters: two of the most important people in the treatment of Atrial Fibrillation―Dr. James Cox of the original Cox Maze operation and Prof. Michel Haissaguerre of the original PVI catheter ablation.

iCLAS Cryo ablation catheter hand graphic at A-Fib.com

iCLAS catheter (Continuous Lesion Ablation System) by Adagio Medical

One of the most fascinating presentations at the Product Theatre on Friday, January 12, was about the innovative, ultra-low temperature iCLAS catheter. Dr. Hugh Calkins of Johns Hopkins was the session moderator. The panel of presenters were:

James Cox of NW Feinberg Sch. of Medicine in Chicago, IL
Professor Michel Haissaguerre of the Bordeaux LIRYC group
Tom de Potter of the Cardiovascular Center in Aalst, Belgium
Lucas Boersma of AMC/U. of Amsterdam, The Netherlands
Alex Babkin, Chief Technical Officer of Adagio Medical

One Catheter. Unlimited Shapes.

Examples of the many different configurations of the iCLAS

The iCLAS catheter is a Cryo catheter that uses ultra-low temperatures and is unlike anything currently on the market. The catheter can be manipulated into many different configurations depending on the lesions which need to be made.

When I visited the Adagio booth, it was fascinating to see how easily the catheter could be designed into unlimited profiles.

Using its full length, the catheter can produce ultra low temperatures along its whole span (110mm). It has 20 electrodes which can also produce cryo-mapping of the atria.

For Flutter Ablations in the Caviotricuspid Isthmus in the right atrium, a shorter catheter is used with a continuous length of 54mm. It can also do Focal Tip Ablations. (The temperatures are so cold they use a heating balloon in the esophagus to prevent any damage.)

About Adagio Medical, Inc.: It’s a privately held medical device company founded in 2011 by Dr. James Cox and Mr. Olav Bergheim. It uses liquid nitrogen to produce ultra-low temperature lesions and developed Near Critical Nitrogen (NCN) technology which permits liquid nitrogen to be used in catheters inside the heart.

VIDEO Animation: iCLAS Catheter by Adagio Medical

Check out the excellent animation of the ultra-low temperature iCLAS catheter. With titles and music, illustrates examples of the creation of long and continuous lesions with full transmurality via endocardial approach with small size catheters (≤9Fr). (1:45) Produced by Adagio Medical, Inc.

YouTube video playback controls: When watching this video, you have several playback options. Settings (speed/quality) are located in the lower right portion of the frame, along with the option to enlarge video to full frame. 

Editor’s Comments:
Why is the iCLAS Cryo catheter special and innovative? The iCLAS catheter produces ablation lesions like current CryoBalloon catheters but at lower temperatures (colder). One would expect that such ultra-low Cryo lesions would be deeper, more transmural, and more lasting. In addition, the ability to produce unlimited shapes gives the iCLAS catheter a unique ability to position Cryo lesions in a variety of locations in the heart. It will make ablations much simpler and easier for EPs.
Historical! Attendees at this AF Symposium presentation were amazed and astounded by the possibilities of the iCLAS system. Endorsed by Dr. James Cox and Prof. Michel Haissaguerre, it was a historical breakthrough moment that few present will ever forget.
Next Great Breakthrough in Treating A-Fib! The iCLAS ultra-low temperature catheter with its unique ability to configure in unlimited shapes is the next great breakthrough in treating A-Fib! Barring any unforeseen problems with approval by the FDA, it will become the treatment of choice for ablating A-Fib/Flutter. (You heard it here first, folks!)

2018 International AF Symposium: My First Report

Held Jan. 11-13, 2018 in Orlando, FL, the annual International AF Symposium is an intensive and highly focused three-day scientific forum which brings together the world’s leading medical scientists, researchers, cardiologists and electrophysiologists to share the most recent advances in the treatment of atrial fibrillation.

The 45 distinguished faculty were leaders in the Atrial Fibrillation field from around the world (the U.S., England, Canada, France, Italy, Germany, Switzerland, Ireland, The Netherlands, Russia, Taiwan, South Korea, the Czech Republic, and two members of the U.S. FDA [Food and Drug Administration].

I made it to every presentation despite being sick with some kind of a virus I caught on the plane to Orlando. I was running on fumes.

Hot Topics

KISS OF DEATH FOR FIRM?

In a late-breaking presentation, the interim results of REAFFIRM trial were presented by Dr. John Hummel from the Ohio State University Wexner Medical Center. The success rate for PVI plus FIRM was not significantly different (78%) for patients receiving only a standard PVI (70%).

Barring further research, this may mean the end of the FIRM system as an effective player in A-Fib ablation. See my upcoming report for more.

FOCUS ON LEFT ATRIAL APPENDAGE

Like last year, there was great interest in and examination of the importance of the Left Atrial Appendage (LAA). Four of the six live case presentations dealt with the LAA. Ten of the more than 62 presentations focused on the LAA.

…To continue reading… Go to My Overview of the 2018 International AF Symposium->

Jeremy Ruskin, MD, Mass. General Hospital and AF Symposium

Dr. Ruskin

“Steve Ryan’s summaries of the A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation.” — Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

2018 AF Symposium: Reports for Patients by Steve S. Ryan, PhD

AF Symposium 2018

My Summary Reports Written for A-Fib Patients

Orlando, FL, Jan 11-13, 2018

by Steve S. Ryan, PhD

The annual AF Symposium is one of the most important scientific conferences on A-Fib in the world. I attend to learn about advances in research and treatments directly from the most eminent scientists and doctors. 

My goal is to offer A-Fib.com readers the most up-to-date research and developments that may impact their treatment choices.

REPORT TITLE PRESENTER (S) DATE POSTED
2. Innovative iCLAS Cyro Catheter by Adagio Medical Hugh Calkins, MD moderator; Panelists: Drs. James Cox, Michel Haissaguerre, Tom de Potter, Lucas Boersm and Alex Babkin Feb. 7, 2018
1. 2018 AF Symposium Overview by Steve S. Ryan, PhD – – – Feb. 4, 2018
Archive: Link to my 2017 AF Symposium reports of all Atrial Fibrillation-related medical conferences

J. Ruskin

“Steve Ryan’s summaries of the A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation.” — Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

Return to AF Symposiums Summaries By Year

 If you find any errors on this page, email us. Y Last updated: Wednesday, February 7, 2018

2018 International AF Symposium: My Overview

By Steve S. Ryan, PhD

I made it to every presentation despite being sick with some kind of a virus I caught on the plane to Orlando. I was running on fumes.

The annual International AF Symposium is an intensive and highly focused three-day scientific forum which brings together the world’s leading medical scientists, researchers, cardiologists and electrophysiologists to share the most recent advances in the treatment of atrial fibrillation.

Long, Full Days: Held Jan. 11-13, 2018 in Orlando, the AF Symposium days started early each day at 7:00 am and were tightly scheduled with presentations which usually lasted till 5:30 or 6:00 pm (except for a shorter last day so attendees could catch a flight home).

Live Streaming Video: There were six live procedures presented via internet streaming video. This year they were scheduled throughout the days depending on what topic they related to. (Previously all the live cases were scheduled back-to-back in one morning.)

Networking: The generous breaks and lunches allowed attendees to interact with and visit the manufacturer’s exhibits to learn what’s new from the many vendors. I made a point of visiting each vendor.

AF Symposium 5-floor-to-ceiling video monitors at the Hyatt Regency Orlando

AF Symposium 5-floor-to-ceiling video monitors

Faculty and Feedback

The 45 distinguished faculty were leaders in the A-Fib field from around the world (the U.S., England, Canada, France, Italy, Germany, Switzerland, Ireland, The Netherlands, Russia, Taiwan, South Korea, the Czech Republic, and two members of the U.S. FDA [Food and Drug Administration].)

Interactive Feedback: Audience feedback was done this year through the Cloud. Presenters would pose multiple choice questions and invite each attendee to cast a vote. The vote tally would be flashed on the screen within seconds for further discussion.

The Venue: The Hyatt Regency in Orlando

Hyatt Regency Orlando, Fl

The Hyatt Regency is a magnificent, vast venue. One does a lot of walking to get back and forth from the presentations to the exhibit/lunch area. (For those concerned, bathrooms are scarce and not well situated.)

HOT TOPICS

Kiss of Death for FIRM?

In a late-breaking presentation, the interim results of REAFFIRM were presented by Dr. John Hummel from the Ohio State University Wexner Medical Center. The success rate for PVI plus FIRM was not significantly different (78%) for patients receiving only a standard PVI (70%).

Barring further research, this may mean the end of the FIRM system as an effective player in A-Fib ablation. See my upcoming report for more.

Focus on Left Atrial Appendage

Like last year, there was great interest in and examination of the importance of the Left Atrial Appendage (LAA). Four of the six live case presentations dealt with the LAA. Ten of the more than 62 presentations focused on the LAA.

Live Cases via Streaming Video

Live Streaming Video from AF Symposium at A-Fib.comThere were six live video presentations (via internet streaming video) of procedures from centers around the world. The live cases came from these centers:

Prague, The Czech Republic: Na Homolce Hospital
Milan, Italy: University of Milan Centro Cardiologica Monzino
Boston, Massachusetts: Massachusetts General Hospital
Aalst, Belgium: Cardiovascular Center Aalst. OLV Hospital
Austin, TX: Texas Cardiac Arrhythmia Institute
Chicago, IL: Northwestern Memorial Hospital

The sheer technical complexity of producing these live video events is staggering. (As someone who worked in broadcast TV at NBC for many years, I was in awe at how well they pulled off these technological feats.) Each live case came off without a hitch and was integrated seamlessly into the topics and other presentations.

Topics and Agenda

The following general topics included several 15 minute presentations on each topic, followed by time for audience questions and discussions. 

The first presentations dealt with the “basic science” of A-Fib. Often this session provides new insights, advanced research and breakthrough findings.

Day 1, Thursday January 11

• Pathophysioloogy, Risk Factors and Genetics 
• Stroke Prevention in and Screening for Atrial Fibrillation
• Left Atrial Appendage Closure & Case Transmissions
• If I Had Permanent AF and Previous Intracranial Hemorrhage, I Would Choose? (Endocardial LAA Closure, Epicardial LAA Closure, or Apixaban (Eliquis) 5mg B.I.D.)
• Challenging Cases in AF Management I: Antiarrhythmic Drugs, Anticoagulation, and Clinical Decision Making

Day 2, Friday January 12

•  Physiology and Experimental Insights: Implications for AF Ablation
• Mechanism-Guided Ablation of Atrial Fibrillation and Case Transmissions
•  New Technologies, Late Breaking Trials, First Report Investigations in AF Ablation and Case Transmissions
•  New Technologies for AF Ablation (Continued)

Day 3, Saturday January 13

•  Clinical Trials, Guidelines and Regulatory Issues in AF Management
•  Evolving Strategies to Improve the Success and Safety of AF Ablation
• Challenging Cases in AF Management II: Catheter Ablation and Left Atrial Appendage Closure

Steve with Dr. Michele Haisaguerre, The French Bordeaux Group

Excellent Presentations But Attendance Discouraging

The presentations were excellent, as usual, and well coordinated by topics. Attendance this year was down (about 700 attendees vs. 1,000+). I heard that this was due to new financial regulations in Europe which prevented many from attending. The low attendance was surprising and, discouraging. Can the wonderful AF Symposium continue with such a reduced attendance?

As someone who has been attending the AF Symposium for 15 years, it’s unique and invaluable. It provides info and discussions on A-Fib unlike any other conferences. Each day one comes away with incredible insights into A-Fib.

Each day one comes away with incredible insights into A-Fib.

Why I Attend: Expect My Reports

It’s a privilege to be able to attend presentations by the best clinicians and researchers working in A-Fib today. I learn more in three days than in a year of reading the various A-Fib research reports.

I’m especially blessed by being able to ask questions of the presenters and dialogue with them.

I will share the current state of the art in A-Fib research and treatments. Look for my reports on what’s relevant to patients and their families. (I already have 8 reports to share.)

Orlando, FL Here I Come—2018 International AF Symposium

When this gets posted, I’ll be on an 8 am flight from Los Angeles to Orlando. Upon arrival, I hope to pick up my 2018 AF Symposium registration badge and other materials before heading to my hotel for a good night’s sleep (the conference day starts at 7 am and continues into the early evening).

Three Intense Days to Come

The next 3 days will be intense and highly focused. More than 50 of the world’s leading medical scientists and cardiologists will make over 65 presentations, and participate in live procedures via video, and panel discussions. I listen intensively, take loads of notes, make audio recordings (with permission), renew friendships and make new contacts among the over 1,000 international attendees.

After the conference (often on my way home Saturday night), I select the presentations on topics of interest to readers of A-Fib.com.

Index to All the Atrial Fibrillation-Related Medical Conferences

Index to reports

In the meantime, you may want to browse my Index to all the Atrial Fibrillation-related medical conferences and symposiums I’ve reported on. You may find a topic of interest. (Or just type your topic into the ‘Search’ box in the upper right corner of every web page and you’ll get a list of results.) For now, go to Index: Steve’s Reports of Atrial Fibrillation Medical Conferences.

Look for my first, overview report soon after the conference.

Coming in January: The International AF Symposium 2018

To stay current about advances in the treatment of Atrial Fibrillation, each year I attend the annual International AF Symposium. This intensive, highly focused three-day symposium brings together more than 50 of the world’s leading medical scientists and cardiologists for a thorough and practical course on the current state of the art in the field of atrial fibrillation.

From January 11-13, 2018, I’ll be traveling to Orlando, FL, to attend and report on presentations at the 23rd Annual International AF Symposium at the Hyatt Regency.

I select the topics of most importance from a patient’s point of view and write summaries for my readers on A-Fib.com.

This meeting has become a major scientific forum for health care professionals to learn about advances in research and therapeutics directly from many of the most eminent researchers, scientists and investigators in the field.

As in years past, I usually attend most of the over 65 presentations, live procedures via video, and panel discussions.

Then I select the topics of most importance from a patient’s point of view and write summaries for my readers on A-Fib.com. Look for reports in the months following the symposium.

In the meantime, you may want to review my reports from the 2017 AF Symposium.

AF Symposium 2018 at A-Fib.com

AF Symposium 2018, Orlando, FL

My Summary Reports: California Heart Rhythm Symposium 2017

Held at the UCLA Luskin Conference Center in Los Angeles from November 17-18, the California Heart Rhythm Symposium is a regional symposium focused on the latest advances in the field of cardiac arrhythmias (Atrial Fibrillation and Ventricular Arrhythmias).

The one and one-half day Symposium was well attended and featured presentations by recognized leaders in the field. (I only attended the sessions on A-Fib.)  I attended as a journalist representing A-Fib.com.

The following are 15 brief descriptions of the presentations that made the most impression on me.

Recurrence Rates Have Improved

Dr. Greg Michaud from Vanderbilt described how recurrence rates have improved with the use of newer treatments such as contact force sensing catheters and CryoBalloon ablation (and the new Laser balloon). The focus now is where else to ablate besides the Pulmonary Veins (PVs). In his ablations Dr. Michaud tends to ablate or fill in the posterior wall with ablation burns.

“The focus now is where else to ablate besides the Pulmonary Veins (PVs).” Dr. Greg Michaud

A-Fib and Dementia

Dr. Jared Bunch of the Intermountain Heart Institute in Utah shocked the attendees with the statements: one in three of us will develop A-Fib in our lifetime; A-Fib doubles the risk of developing dementia; and Dementia has become the third leading cause of death in the U.S.

He also pointed out that being on warfarin causes microbleeds in the brain which increase dementia. The younger you are when you develop A-Fib, the more likely you are to develop dementia. (See my article A-Fib Doubles Risk of Dementia.) But a catheter ablation reduces the risk of developing dementia to that of a normal person.

“…when he went into A-Fib, he lost the ability to speak because he was in dementia. Dr. Jared Bunch”

Dr. Bunch gave the striking example of a patient who would speak normally when in sinus rhythm. But when he went into A-Fib, he lost the ability to speak because he was in dementia.

Ablating LAA Increases Ablation Success Rate

Dr. Andrea Natale of the Texas Cardiac Arrhythmia Institute in Austin, TX, described his current ablation strategy. Of special note, he showed how ablating the Left Atrial Appendage (LAA) increases ablation success rates. During an ablation, he also concentrates on the posterior wall between the PVs. He also pointed out there is currently no standard, agreed-upon protocol for mapping and ablating non-PV triggers.

Contact Force Sensing Catheters & CryoBalloon Ablation

“Contact force sensing catheters have lower recurrence levels.” Dr. Jocob Koruth

Dr. Jocob Koruth of Mount Sinai Medical Center in New York described how contact force sensing catheters have lower recurrence levels. But CryoBalloon ablations seem more durable. He mentioned that the FIRM and CardioInsight ECGI vest systems have not been proven.

Editor’s Comments: The FIRM system has received a good deal of negative press and research papers. See Firm Mapping System  and FIRM Research.  But the CardioInsight ECGI vest system, though very new, seems to have great potential.

Flutter As Risky as A-Fib

Dr. Kim Rajappan from Oxford University in Oxford, UK discussed A-Fib and A-Flutter. Both carry the same risks for patients. Rate control is harder for Flutter. Most EPs would do a Flutter ablation even if the patient were not in A-Fib at the same time.

Editor’s Comments: Flutter can be considered as a milder or more organized form of A-Fib. It may feel slightly better than A-Fib and be better tolerated. But it’s still as dangerous as A-Fib.

Importance of Isolating the LAA

“… the importance of measuring flow velocity out of the LAA after isolating it.” Dr. Luigi Di Biase

Dr. Luigi Di Biase of the Albert Einstein College of Medicine in New York echoed Dr. Natale in stressing the importance of the LAA (Left Atrial Appendage) in A-Fib. But he also pointed out the importance of measuring flow velocity out of the LAA after isolating it. If LAA flow velocity is low, it’s necessary to keep a patient on anticoagulants for life or remove the LAA such as by using the lariat device. … Continue reading this report…->

Increasing Your Quality of Life: Catheter Ablation versus A-Fib Drugs

When seeking your Atrial Fibrillation cure, you’re often faced with the choices of catheter ablation versus antiarrhythmic drugs therapy.

We know from previous research studies that it’s safer to have an ablation versus living a life on antiarrhythmic drug therapy (AAD). (See Ablation Safer Than Life on Antiarrhythmic Drugs.)

But how do the two treatments compare when it comes to improvement in general health and ‘quality of life’?

Measuring ‘Quality of Life’

To determine success after treatment, researchers traditionally measure if A-Fib recurs using periodic ECGs. But this is “hardly a measure of successful treatment”, says Dr. Carina Blomstrom-Lundqvist, principal CAPTAF investigator from Uppsala University in Sweden.

CAPTAF stands for ‘Catheter Ablation compared with Pharmacological Therapy for Atrial Fibrillation‘.

The CAPTAF clinical trial is one of the first studies in which improvement in ‘quality of life’ was the goal. The trial compared the Atrial Fibrillation treatment effects of ablation versus antiarrhythmic drugs.

One-year results were presented in August at the 2017 European Society of Cardiology (ESC) Congress.

The CAPTAF Clinical Study

The CAPTAF trial enrolled 155 symptomatic patients with paroxysmal or persistent A-Fib at four Swedish centers and at one center in Finland.

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

A-Fib Drug Therapies

All enrolled patients had to have failed one drug therapy (rate or rhythm control). The average age of the enrolled patients was 56 years. Nearly three-quarters had paroxysmal A-Fib. On average they had been diagnosed with A-Fib for about 5 years, and 70%-80% of the patients had severe or disabling symptoms.

Catheter ablation (RF)

Patients received a subcutaneously implantable cardiac monitor 2-m onths prior to the start of the study (to establish a baseline ‘burden’ of A-Fib, i.e. the proportion of time in A-Fib). Then participants were randomized to ablation with pulmonary vein isolation or antiarrhythmic drug therapy. (The study protocol required patients randomized to the ablation regimen to be completely off antiarrhythmic drugs by 6 months after their ablation procedure.)

The primary goal of the study was a change in general health-related quality of life.

CAPTAF Results: Overall Health & ‘Quality of Life’ Improved More after Ablation

Overall Health: After 12 months of follow-up, the ablation group showed a greater improvement in average overall health by 11.0 points versus 3.1 points improvement in the drug group (as measured by a standard survey instrument). The 8-point difference in gain between the two groups was statistically significant.

Quality of Life: The quality-of-life domains (general health, physical function, mental health, role-emotional, role-physical, and vitality) improved significantly more in the ablation group than in the drug group. No significant differences were shown in the remaining two domains (bodily pain and social functioning).

AF Burden: The AF burden of the ablation group was decreased by an average of 20% points versus 12% points among the group on antiarrhythmic drugs. The change from baseline did not reach statistical significance between treatment groups.

The complication rates were comparable between treatment groups.

Summarizing the Results

About the difference in quality of life, Dr. Carina Bloomstrom-Lindqvist, principal CAPTAF investigator, explained that continued treatment with an antiarrhythmic drug in the drug group of patients compared with no drug treatment in the ablated patients “is absolutely the explanation” for the observed difference in quality of life.

Regarding her findings, she said, “Using quality of life as the primary endpoint of a trial for the first time, we demonstrated that pulmonary vein isolation [PVI] is significantly more effective than antiarrhythmic drugs…even at an early stage of their disease.”

Want a Better Quality of Life? Get a Catheter Ablation

“Using quality of life as the primary endpoint…PVI is significantly more effective than antiarrhythmic drugs…”

The CAPTAF clinical study, though small, goes much further than previous studies and is a significant milestone for Atrial Fibrillation patients. This was one of the first studies to focus on quality of life after treatment.

The CAPTAF results prove scientifically that ablation works better for A-Fib patients than antiarrhythmic drugs (AADs).

If you have A-Fib and want to improve your quality of life―get a catheter ablation. It makes you feel better than a life on antiarrhythmic drugs.

Remember: Seek your Cure!
Anyone no longer in A-Fib can tell you how wonderful it is
to have a heart that beats normally again.

Resources for this Article

 

CASTLE AF Study: Live Longer―Have a Catheter Ablation!

Catheter ablation actually reduces death rates and hospital admissions. That’s the finding in the CASTLE AF trial, a key heart disease study, by Dr. Nassir Marrouche and his colleagues.

In a presentation at the 2017 European Cardiology Congress in Barcelona, Spain, Dr. Marrouche described CASTLE-AF study participants as having A-Fib, advanced heart failure (i.e., low ejection fraction) and an Implantable Cardioverter Defibrillator (ICD).

The multicenter CASTLE-AF trial focused on patients with A-Fib and systolic heart failure.

The CASTLE-AF trial enrolled 398 patients in 33 sites across Europe, Australia and the US between 2008 and 2016. Patients were randomized to receive either radiofrequency catheter ablation or conventional drug treatment.

The study set out to definitively test the ability of A-Fib ablation to improve hard outcomes in patients with symptomatic paroxysmal or persistent A-Fib and a left ventricular ejection fraction (LVEF) of ≤35 percent (dangerously low percent). Median follow-up period was 37.8 months.

Results: Ablation Improves Quantity Not Just the Quality of Life

After catheter ablation, the death rate of trial patients was lowered by an amazing 47%! This is a lot better result than research studies using ICDs with drug therapy to lower the death rate in similar patients.

Before this study, catheter ablation was known to improve quality of life, but unexpected it also improved life outcomes (the quantity of life, how long one lives).

In addition, there may be a “major impact” on reducing costs associated with hospitalizations.

Ablation Improves Ejection Fraction

Once we study the soon-to-be published CASTLE-AF results, we can document what we’ve often observed anecdotally, that catheter ablation improves lower-than-normal ejection fraction and consequently cures a major component of heart failure.

Dr. Marrouche recommends EPs treating heart failure patients with A-Fib to “ablate them early on, very soon in the disease stage.”

My Anecdotal Evidence: Just last month I advised a 73-year-old man in persistent A-Fib to have an ablation by Dr. Andrea Natale. After only one month in sinus, his ejection fraction improved from a low 35% to a normal 55% (normal range is 50 to 75 percent)!

The CASTLE-AF study could pave the way for wider adoption of catheter ablation for treatment of A-Fib.

Even though he’s only a month into his blanking period, he feels terrific.

Wider Adoption of Catheter Ablation?

The CASTLE-AF study results could be a game changer for Atrial Fibrillation patients! Results could pave the way for wider adoption of catheter ablation and may prompt changes in current guidelines for treatment.

CASTLE-AF stands for Catheter Ablation versus Standard conventional Treatment in patients with LEft ventricular dysfunction and Atrial Fibrillation

Resources for this Article

Genetics of A-Fib—40% Increased Risk of Developing A-Fib If Relative Has It

AF Symposium 2012

Summary by Steve S. Ryan, PhD, January 2012

Patrick Ellinor, MD

Patrick Ellinor,

Genetics of A-Fib—40% Increased Risk of Developing A-Fib If Relative Has It

Genetic research in A-Fib, though in its preliminary stages, has the potential to be a game changer for patients with A-Fib. Dr. Patrick Ellinor of Mass General, Boston gave a presentation on the “Genetics of A-Fib: How Will We Translate GWAS Findings to Clinical Practice?”

A-Fib Is Inheritable

“If you have any immediate family with A-Fib, you have a 40% increased risk of developing A-Fib yourself. And the younger that someone in your family gets A-Fib, the more likely you are to have A-Fib.”

Screen for A-Fib?

If someone has A-Fib, should all their immediate family members be screened for A-Fib? Since in the US alone over three million people have A-Fib, it isn’t possible or practical to screen all family members for A-Fib. And even if we could screen everyone, we don’t yet have the means to prevent A-Fib from developing or even to identify patients with pre-A-Fib.

Editor’s Comments: If anyone in your immediate family has A-Fib, you are very likely to develop A-Fib yourself. You have to be more aware and vigilant than the average person. If, for example, you feel palpitations or a racing heart rate, take it very seriously. Don’t hesitate or delay in going to an Electrophysiologist (EP) to have yourself checked out. Make sure you tell your EP or Cardiologist that your relative has A-Fib.

Specific Genetic Chromosomes Associated With A-Fib

Dr. Ellinor identified the specific genetic chromosomes currently found to be associated with A-Fib:

  • 1q21
  • 16q22
  • and particularly 4q25

People with a particular combination of 3 genetic variants on chromosome 4q25 are six times more likely to develop A-Fib.

Further Research Needed

But current research has only revealed “associations.” Further research is needed to determine:

  1. Are these chromosomes associated with and/or do they cause an increased risk of A-Fib stroke, heart failure and death?
  2. Are these genetic variants associated with or do they indicate that a certain treatment should be used or that a certain outcome is more likely?
  3. How important are these genetic variants in the development of A-Fib?
  4. How do these genetic variants affect what types of arrhythmia develop? Do Paroxysmal A-Fib, Permanent A-Fib, or A-Flutter have different genetic profiles?
  5. And most importantly, how do these genetic variants work? What Is the mechanism behind the association?

“Right now all we have is an association.” “We don’t have a fundamental understanding as to how the variants themselves lead to the (A-Fib) disease.”

Warn all Your Immediate Family Members

If you have A-Fib, you must warn all your immediate family members that they have a good chance of getting it also. Even though we don’t know yet how to definitively prevent A-Fib, there are some precautions your family members can take:
  1. Avoid binge drinking and heavy partying.
  2. Avoid antihistamines and anything that can stimulate or trigger A-Fib. (see A-Fib Triggers) (This doesn’t necessarily include coffee. Some research indicates coffee may prevent A-Fib.)
  3. Be more attentive to overall health. Obesity, for example, is often a contributing factor to A-Fib. Sleep apnea is known to lead to A-Fib.
  4. Check for deficiencies in essential minerals (electrolytes) like magnesium or potassium? Are calcium levels too high (which may be a trigger for A-Fib)?
  5. Avoid or learn to cope with stress (not always possible).
    There is a tendency in all of us to not tell others if we are ill, perhaps because we perceive it as somewhat humiliating and a weakness in ourselves. But no one should be ashamed of having A-Fib. Most likely it isn’t anything we brought on ourselves. It’s genetic! It’s nobody’s fault!

We are not being fair to our family members by not telling them about our A-Fib. Don’t just mention it in passing. Sit down with them and tell them what A-Fib is like, and that they are at risk.

If you love your family, you owe it to them. This applies particularly to your brothers and sisters with whom you may have a loving but somewhat competitive relationship. Anyone in your immediate family must be warned.

If you find any errors on this page, email us. Y Last updated: Monday, May 1, 2017

Back to: 2012 AF Symposium

2017 AF Symposium: FIRM Rotor Mapping System During Live Ablation

Dr David Wilber Loyola University

D. Wilber

In a live case from the 2017 AF Symposium, Dr. David Wilber from Loyola University Medical Center showed how he uses the Topera FIRM rotor mapping system to identify rotors in conjunction with a PVI. (‘FIRM’ stands for Focal Impulse and Rotor Modulation.)

Dr. Wilber described how he first does voltage mapping while the patient is in normal sinus rhythm. He started in the right atrium, then moved to the left; he used the FIRM system to map where rotors were coming from. (In patients with persistent A-Fib, he typically finds as many as 4-8 rotors.) He mapped and ablated until there were no more rotors.

Only after using the FIRM system did he do a Pulmonary Vein ablation…Continue reading my report.

2017 AF Symposium: Live Case of Ablation with FIRM Mapping System

Dr David Wilber Loyola University

D. Wilber, MD

In a live case, Dr. David Wilber from Loyola Un. Medical Center in Chicago, IL showed how he uses the Topera FIRM rotor mapping system to identify rotors in conjunction with a PVI. ‘FIRM’ stands for Focal Impulse and Rotor Modulation.

Patient background: The patient was a 54-year-old male in persistent A-Fib for 7 months, obese with a BMI of 31, hypertension, diabetes, and obstructive sleep apnea. He was symptomatic, with fatigue and decreased exercise tolerance. An MRI showed his Left Atrium was 15.5% fibrotic. (If using Dr. Nassir Marrouche’s Utah I–IV Classification System to rate the patient’s amount of fibrosis, this patient would be “Utah Stage 2”, i.e., a reasonable candidate for a catheter ablation.)

Voltage & FIRM Mapping: Rotors Ablated First

FIRM mapping display of left atrial rotor during atrial fibrillation.

FIRM mapping display of left atrial rotor during atrial fibrillation.

In live video streaming from Chicago, Dr. Wilber described how he first does voltage mapping while the patient is in normal sinus rhythm. He started in the right atrium, then moved to the left; he used the FIRM system to map where rotors were coming from. (In patients with persistent A-Fib, he typically finds as many as 4-8 rotors.) He mapped and ablated until there were no more rotors.

Only after using the FIRM system did he do a Pulmonary Vein ablation (PVI).

He explained that the concept of terminating A-Fib during a PVI ablation doesn’t work with the FIRM system. Instead, he looks to ablate rotational areas (which are usually 2.2 cm across). He does this by using a Contact Force sensing catheter usually at 35 watts for 30 sec.

During this ablation, he found one rotor at the base of the Left Atrial Appendage (LAA). (In the followup panel discussion, Dr. Andrea Natale commented that he and his colleagues now look first for A-Fib signals in the LAA.)

FIRM Rotors Hard to See

VIDEO examples: Dr. Wilber showed a video using FIRM in which [even to my untrained eye] it was easy to see a rotor. But he showed other videos where the overlapping, swirling waves made it difficult to see where exactly a rotor was coming from.

Editor’s Comments:
This patient was at great risk of recurrence after a catheter ablation, because of his various illnesses (comorbidities). By restoring him to normal sinus rhythm, he would be able to exercise and develop life-changing habits to reduce his obesity, diabetes, and hypertension.
ECGI CardioInsight system: Focal and re-entrant driver maps

ECGI CardioInsight system: Focal and re-entrant driver maps

Abbott Topera FIRM vs Medtronic ECGI CardioInsight:  In comparison to the ECGI CardioInsight system where the rotors and focal sources are very obvious (even to untrained observers), the FIRM system display of rotors are often confusing and hard to identify. Dr. Wilber acknowledged that it takes study and experience with the FIRM system to use it effectively.
To me, the Abbott Topera FIRM system seems hard to use. In head-to-head competition with the Medtronic ECGI CardioInsight system, I predict the FIRM system will probably not survive.
The Medtronic ECGI CardioInsight system has been in limited use in Europe and in 2017 has begun a limited rollout in the U.S.

For more on the Medtronic ECGI CardioInsight, see my article: ECGI Mapping Now Available in U.S.

For more about Dr. Nassir Marrouche’s Utah I–IV Classification System, see my article: Fibrosis Risk and the U. of Utah/CARMA website.

Reference for this Article

2017 AF Symposium: Preventing Esophageal Fistula

Report 14 from the 2017 AF Symposium summarizes a live ablation using a new tool to protect the esophagus.

The Problem: During an ablation, doctors take great precautions to not heat or injure the esophagus which lies behind the posterior wall of the left atrium. Injuring the esophagus can, in very rare cases, cause an atrial esophageal fistula which can be fatal.

Fear of causing esophageal injury can cause the EP to modify the ablation lesion set delivery, thereby reducing ablation success.

New Solution: an Esophagus displacement tool.

Use of the esophagus displacement tool, EsoSure Esophageal Retractor

The EsoSure Esophageal Retractor allows doctors to re-position a section of the esophagus away from the nearby heart tissue and avoid the heat generated during ablation.

Live streaming ablation: In this re-do ablation, entrainment (pacing) mapping was used to identify non-PV triggers.

Since they had to ablate in the posterior of the left atrium next to the esophagus, they simply moved the EsoSure Retractor up and down to displace the esophagus. The EPs remarked they could now ablate at a higher wattage without fear of harming the esophagus. …continuing reading my report…

2017 AF Symposium: Movin’ it—Protecting the Esophagus During Ablation

2017 AF Symposium

Movin’ it: Protecting the Esophagus During Ablation

Live case presenters: Drs. Rodney Horton, Amin Al-Ahmad and David Burkhardt from the Texas Cardiac Arrhythmia Institute at St. David’s Medical Center in Austin, TX. Moderator: Dr. Andrea Natale.

Patient background: A 79-year-old female needed a ‘re-do’ second ablation. She had persistent A-Fib and hypertension. Her first ablation was August 15, 2016 where they couldn’t terminate her Flutter. Because the temperature probe in her esophagus showed a rise in temperature when they tried to ablate certain areas, “we were not as aggressive as we would have liked.”

The Danger: Esophageal Fistula

During an ablation, doctors take great precautions to not heat or injure the esophagus which lies behind the posterior wall of the left atrium. Injuring the esophagus can, in very rare cases, cause an atrial esophageal fistula which can be fatal.

Fear of causing esophageal injury can cause the EP to modify the ablation lesion set delivery, thereby reducing ablation success by:

1. Reducing the wattage or amount of energy delivered to the left atrium wall which causes less complete scarring; and/or

2. Relocating the ablation lesion to a less desirable area

For this patient: During her first ablation: the doctors noticed a rise in temperature of the probe inserted in her esophagus, so her doctors stopped ablating in that area. Consequently, the A-Fib signal source(s) in that area were not isolated effectively. Result: her A-Flutter was not terminated.

Solution: Esophageal Displacement Tool

The esophagus is not a rigid, inflexible pipe but rather like a hose made out of flexible muscle fibers. It can naturally migrate side-to-side 2-3 cm on its own.

For this live streaming ablation, a new esophagus displacement tool was used: the EsoSure Esophageal Retractor. The tool allows doctors to re-position a section of the esophagus away from the nearby heart tissue and avoid the heat generated during ablation.

The inventor of the device, Steven W. Miller, RN and EP nurse, demonstrated his device to me at the AF Symposium Exhibit Hall.

EsoSure Esophageal Retractor: Shape adjusts to body temperature at A-Fib.com

EsoSure Esophageal Retractor: Shape adjusts to body temperature

At room temperature, the stylet is fairly straight which allows it to be easily inserted into a commonly used gastric tube which is routinely placed down the esophagus by the anesthesia staff. But as the stylet warms to body temperature, it takes on a greater curve. He inserted the stylet into warmed water. You could see how the stylet changed shape and developed a greater curve.

Depending on how the stylet is positioned, it can displace the esophagus up to 2-3 cm to the left or right depending on each person’s anatomy.

Using the EsoSure Retractor, the EP can easily and safely move the esophagus away from any area being ablated. It is FDA approved and has been used by different practitioners more than 700 times without damaging the esophagus.

Live Case Using the EsoSure Retractor

In this re-do ablation, the 79-year-old female patient was in A-Fib when the ablation started. They cardioverted her, but she went right back into A-Fib.

Entrainment (pacing) mapping was used to identify non-PV triggers. Since they had to ablate in the posterior of the left atrium next to the esophagus, they simply moved the EsoSure Retractor up and down to displace the esophagus. It seemed very easy to do.

The EPs mentioned that, with the use of this displacement device, they could now ablate at a higher wattage without fear of harming the esophagus. They also ablated the Left Atrial Appendage area to restore her to sinus rhythm.

What Patients Need to Know

Displacing the esophagus is a major medical advance: The EsoSure Esophageal Retractor is a major medical advance that will significantly improve not only the safety but the effectiveness of catheter ablations. Compared to any other gear in the ablation lab, the EsoSure Retractor is inexpensive ($365-$395 depending on quantity ordered). Any EP lab can and should use it, (or something similar).

Esophagus injury: All too often the esophagus lies behind the right pulmonary vein openings. Doctors have to limit both the placement and the power of their lesions out of fear of damaging the esophagus.

But being able to move the esophagus solves this problem. Ablations will be more effective, and the danger of producing an Atrial Esophageal Fistula (while rare) will be greatly reduced, if not eliminated. It will also reduce ablation procedure time.

Ask your EP: If you are scheduling an ablation, ask your doctors about their plan to prevent esophageal injury.

Return to 2017 AF Symposium Reports
If you find any errors on this page, email us. Last updated: Saturday, March 11, 2017

Reference for this Article

2017 AF Symposium LIVE VIDEO: Can Adding Fibrosis Improve Ablation Success?

Updated March 9: We added two new slides comparing the patient’s initial and subsequent DE-MRI images.

Report 13 from 2107 AF Symposium: In a live ablation from from Mass. General Hospital in Boston, Drs. Heist and Van Houzen demonstrated a pioneering strategy to treat Atrial Fibrillation patients with patchy fibrotic areas of tissue. This tissue perpetuates A-Fib.

First, a DE-MRI scan defines and measures the heart’s areas of fibrosis. Next, the doctors ablated (or filled in) these patchy areas with more fibrosis (i.e., ablation scarring) turning the patchy areas into dense fibrotic areas. Transforming patchy fibrotic tissue to dense fibrotic tissue stops A-Fib signals from perpetuating in that tissue.

It may seem counter-intuitive―create more fibrosis to make patients A-Fib free. Read more about this innovative strategy.

2017 AF Symposium Live Video: Adding Fibrosis to Improve Ablation Success?

2017 AF Symposium

Live Case: Can Adding Fibrosis Improve Ablation Success?

Updated March 13: We added two new slides.

Streaming video of an ablation by Drs. Kevin Heist and Nathan Van Houzen from Massachusetts General Hospital (MGH) in Boston, MA (moderator, Dr. Moussa Mansour).

Patient background: The case of a 62-year-old male with symptomatic persistent A-Fib, despite a previous ablation 8/9/2016. Propafenone, amiodarone, and an electrical cardioversion weren’t effective. The patient had been taken off amiodarone a week before this ablation. They cardioverted him into sinus rhythm to better measure areas of low voltage (areas of fibrosis). Low voltage areas were defined as less than 0.5 V.

Mapping Views: Lesions and Remaining Fibrosis From First Ablation

THE TOP SLIDE: The RF point-by-point ablation lesions from the patient’s first ablation done months before the live case.

RED dots represent a greater force or more time making the lesion; PINK dots represent a lower efficiency lesion due to proximity to the esophagus.

Some of these PINK dot area had reconnected and had to be re-ablated during the live case.

(“PA” is  the left atrium viewed from the back.)

THE BOTTOM SLIDE: The MRI done shortly before the live case. The BLUE areas are normal atrial tissue. The RED areas are fibrotic/scarred areas. Some of the red areas in this PA view were not ablated during the first procedure and represent spontaneous fibrosis.

Live: Ablating Areas of Fibrosis

In this live procedure from Boston, MA, Drs. Heist and Van Houzen did a normal PVI and found evidence that some areas from the patient’s previous ablation had reconnected.

The innovative aspect of this ablation is they also ablated areas of fibrosis. ‘Spontaneous fibrosis’ tends to be patchy in a way that perpetuates A-Fib.

Ablating or filling in these patchy areas with more fibrosis (i.e., ablation scarring) turns the patchy areas into dense fibrotic areas which can’t conduct or perpetuate A-Fib.

They first performed a Delayed Enhancement MRI (DE-MRI) scan of this patient’s heart in order to define and measure the areas of fibrosis.

The EPs then ablated (filled in) areas of this fibrosis, turning these patchy fibrotic regions into denser fibrotic areas. These dense fibrotic areas no longer conducted or perpetuated A-Fib.

Two months after the ablation the patient is doing well in sinus rhythm. Whereas after his first ablation, he experienced early recurrence.

What Patients Need to Know

Who Benefits from this Strategy? Adding or filling in patchy fibrotic areas with more fibrosis through ablation is a very innovative ablation strategy.

It is being applied to patients with persistent or persistent long-standing A-Fib who usually have more fibrosis, but is also being applied to paroxysmal patients who have had a durable (successful) PVI but are still in A-Fib (they often have some fibrotic areas).

The term ‘spontaneous fibrosis’ refers to fibrosis (scarring) which occurs naturally, that is, without a doctor’s procedural intervention.

Impractical for Diffused Fibrosis: This strategy doesn’t work if someone has a generalized distribution of fibrous tissue throughout their atrium. It would require ablation of the whole atrium creating too much fibrosis and causing other heart function problems.

Isn’t Creating More Fibrosis Dangerous for Patients? It certainly does seem counterintuitive―create more fibrosis to make patients A-Fib free. But we are looking at patients who already have patches of fibrosis. (If we could turn these fibrotic areas back into smooth heart muscle, then this strategy wouldn’t be necessary.)

This strategy can make people with difficult A-Fib cases A-Fib free, and make a huge difference for patients who have failed ablations.

While this strategy is exciting, we are only at the very beginning stages of this research.

Acknowledgements:

Nassir Marrouche MD

N. Marrouche MD

Dr. Nassir Marrouche: The concept of ablating areas of fibrosis was conceived by Dr. Nassir Marrouche of the University of Utah (CARMA). Dr. Marrouche has started DECAAF II, a clinical study on fibrosis to compare ablation of fibrosis areas to standard PVI ablation.

Known for the completed DECAAF study, Dr. Mansour is now collaborating with Dr. Marrouche on the DECAAF II study, and Massachusetts General Hospital (the originating site of this live streaming video) is one of the participating sites. For more, see my 2017 AF Symposium article A-Fib Increases Fibrosis.

Dr. Kevin Heist: I would like to thank Dr. Kevin Heist, Mass. General Hospital, for patiently explaining to me the concept, rationale and strategy of ablating areas of fibrosis. (I really needed his help!)

Return to 2017 AF Symposium Reports
If you find any errors on this page, email us. Last updated: Monday, March 13, 2017

Reference for this Article

2017 AF Symposium: LIVE Video Ablation With Non-Contact Catheter Mapping

The Acutus Medical Non-Contact basket catheter with multiple electrodes

The Acutus Medical Non-Contact basket catheter with multiple electrodes

Report 12 from 2107 AF Symposium: In a live case from Prague, the Czech Republic, the EPs used the non-contact basket catheter to generate a 3D anatomy of the patient’s left atrium.

They produced propagation maps which looked like rotor action seen in other mapping systems, but sharper and with high resolution.

During the ablation, they used Acutus Medical’s basket catheter to re-map the left atrium. This showed that there were gaps in the ablation of one of the right vein openings which they corrected. …Read my full report…

Live Case: Non-Contact Ultrasound Basket Catheter Dipole Density Mapping

2017 AF Symposium

Live Case: Ablation Using Non-Contact Ultrasound Basket Catheter Dipole Density Mapping

Illlustration: Acutus Medical Non-Contact Dipole basket catheter with multiple electrodes.

Acutus Medical Non-Contact Dipole basket catheter with multiple electrodes.

Video streaming of an ablation from Na Homolce Hospital in Prague, the Czech Republic with Drs. Peter Neuzil, Jan Petru, and Jan Skoda.

The doctors used a new high resolution mapping system from Acutus Medical to identify in real time where his A-Fib signals were coming from.

Patient background: A 68-year-old man in paroxysmal A-Fib had a CHA2DS2-VASc score of 4 with hypertension and a pulmonary embolism. He had had a PVI in January 2011 and a repeat PVI to fix gaps in April 2011. His A-Fib recurred in 2014. Electrical cardioversions didn’t work.

Non-Contact Mapping with Ultrasound-Electrode Catheter

VIDEO: For a more detailed explanation of the Non-Contact Dipole Density AcQ Imaging and Mapping, see the video from Acutus Medical.(1:54)

The Acutus Medical Non-Contact Dipole Density AcQ Imaging and Mapping catheter uses a basket catheter with multiple electrodes and ultrasound anatomy reconstruction.

‘Non-contact’ means the basket catheter can float freely in the left atrium and doesn’t have to be applied to the surface of the heart to generate A-Fib maps.

The basket catheter has six splines each with eight nodules that contain 48 ultrasound transducers and 48 electrodes. The ultrasound pings the atrium wall and rapidly produces a 3D left atrium anatomy.

Electrical Measurement: Dipole Density vs Voltage

For over one hundred years, voltage has been the major electrical measurement in cardiac medicine. The limitation with using voltage in electrophysiology is that the reading includes both the localized charge (Dipole Density) as well as the sum of the surrounding sources providing a broad, blended view of cardiac activity.

According to Acutus Medical, by eliminating these surrounding sources, and using dipole density (instead of voltage) the field of view becomes sharper and narrower.

This more precise electrical activation is displayed as a Dipole Density map on a 3D ultrasound reconstruction of the heart.

Acutus Medical Illustration: localized charge (Dipole Density) with the sum of the surrounding sources

Acutus Medical Illustration: localized charge (Dipole Density) with the sum of the surrounding sources

Live Streaming Video: Ablation from Prague

In the live case, the EPs used the non-contact basket catheter to generate a 3D anatomy of the patient’s left atrium.

They produced propagation maps which looked like rotor action seen in other mapping systems, but sharper and with high resolution.

During the ablation, they used the basket catheter to re-map the left atrium. This showed that there were gaps in the ablation of one of the right vein openings which they corrected. When they made a mitral isthmus line, the patient’s A-Fib terminated which restored him to normal sinus rhythm.

What Patients Need To Know

May Replace Contact Mapping: Non-contact mapping is a significant innovation in catheter ablation and may eventually replace existing contact mapping catheters and make ablations easier. It also seems to require less technical skill than in a traditional contact mapping system.

“Non-contact mapping is a significant innovation and may eventually replace existing contact mapping catheters.”—Steve Ryan

No Radiation & Instantaneous: Using ultrasound to produce a 3D rendering of the heart is innovative and could change the way the anatomy of the heart is generated for an ablation. And unlike a CT scan, it doesn’t use radiation. Also, unlike a CT scan, the ultrasound images of the heart are generated instantaneously in real-time.

Higher Resolution: Dipole Density mapping may prove to be a higher resolution system than current mapping systems.

Not Yet Available in U.S.: But don’t expect the Acutus Medical System to become available in the U.S. any time soon. It isn’t yet FDA approved or available for sale in the U.S.

Return to 2017 AF Symposium Reports
If you find any errors on this page, email us. Last updated: Thursday, March 2, 2017

Reference for this Article

2017 AF Symposium: Three New Reports—Genetic A-Fib and LIVE Streaming Video Ablations

Live Streaming Video from AF Symposium at A-Fib.com

To my 2017 AF Symposium Overview, I added how we observed in-progress A-Fib procedures via streaming video from five locations spanning the globe, and heard from the EPs performing the ablations. Continue to the Video Overview…

Report 11: LIVE! Ablation Using CardioFocus Laser Balloon

CardioFocus HeartLight Laser Balloon catheter

CardioFocus HeartLight Laser Balloon catheter

Video streaming from Na Homolce Hospital in Prague, The Czech Republic. Drs. Peter Neuzil, Jan Petru and Jan Skoda did an ablation using the CardioFocus HeartLight Endoscopic Visually Guided Laser Balloon (FDA approved April 4, 2016).

The doctors showed how they could directly see the Pulmonary Vein opening they were ablating (unlike RF and CryoBalloon systems). The center of the catheter has an endoscopic (looking inside) camera.

(To me, this is a major advantage and ground-breaking improvement for patients.)

Read more of my report, and see a short video clip with an actual view of the pulmonary veins during an ablation. …Continue reading my report….

Report 10: LIVE! Two Procedures—but Different Left Atrial Appendage Occlusion Devices

Featuring the Amplatz Amulet from St. Jude Medical and the LAmbre from LifeTech Scientific.

Amplatz Amulet occlusion device by St. Jude Medical - A-Fib.com

Amplatz Amulet occlusion device by St. Jude Medical

Live from Milan, we watched the doctors insert an Amplatz Amulet into the LAA of a 78-year-old women who had a high risk of bleeding.

These doctors did something I had never seen before. They made a physical model of the woman’s LAA, then showed how the Amplatz Amulet fit into the model. This helped AF Symposium attendees see how the Amplatz Amulet actually worked. …Continue reading my report…

Report 9: World-Wide Studies on Genetic A-Fib

DNA: Double helix graphic at A-Fib.com

Dr. Patrick Ellinor of Mass. General Hospital, Boston MA, reported the biggest news is that A-Fib genetic research is increasing exponentially. The AFGen Consortium website lists 37 different studies and world-wide institutions studying A-Fib genetics with over 70,000 cases. Within the next 10 years, Dr. Ellinor and his colleagues hope to identify over 100 different genetic loci for A-Fib.

Dr. Ellinor reported that using a genetic “fingerprint” of A-Fib helps to identify those patients at the greatest risk of a stroke. (There’s a 40% increased risk of developing A-Fib if a relative has it.)…Continue reading my report…

About the Annual AF Symposium

The annual AF Symposium brings together the world’s leading medical scientists, researchers and EPs to share recent advances in the treatment of atrial fibrillation. You can read all my summary reports on my 2017 AF Symposium page.

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