ABOUT 'BEAT YOUR A-FIB'...


"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

"Your book [Beat Your A-Fib] is the quintessential most important guide not only for the individual experiencing atrial fibrillation and his family, but also for primary physicians, and cardiologists."

Jane-Alexandra Krehbiel, nurse, blogger and author "Rational Preparedness: A Primer to Preparedness"



ABOUT A-FIB.COM...


"Steve Ryan's summaries of the Boston 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

"I love your [A-fib.com] website, Patti and Steve! An excellent resource for anybody seeking credible science on atrial fibrillation plus compelling real-life stories from others living with A-Fib. Congratulations…"

Carolyn Thomas, blogger and heart attack survivor; MyHeartSisters.org

"Steve, your website was so helpful. Thank you! After two ablations I am now A-fib free. You are a great help to a lot of people, keep up the good work."

Terry Traver, former A-Fib patient

"If you want to do some research on AF go to A-Fib.com by Steve Ryan, this site was a big help to me, and helped me be free of AF."

Roy Salmon Patient, A-Fib Free; pacemakerclub.com, Sept. 2013


AF Symposium & other Medical Conferences

2017 AF Symposium: Two New Reports on Rotors and Predicting A-Fib

My third and fourth reports from the 2017 AF Symposium:

The Virtual Heart - Dr Natalia Trayanova

“Virtual Heart” image

Report 3: 3D Virtual Heart’ Predicts Location of Rotors. You may recall my 2015 report about Dr. Natalia Trayanova of Johns Hopkins University, and her ground breaking presentation on the 3D “Virtual Heart”. Her 2017 presentation was a continuation of her innovative research, this time about Atrial Fibrillation signals from rotors and fibrosis.

Dr. Trayanova constructed three-dimensional computer models of the atria in A-Fib from MRI data and assessed the propensity of each model to develop arrhythmia. Read how the predictive ability of her models compare to actual ECGI mapping cases…continue reading…

Report 4: Links Between Inflammation, Oxidative Stress and A-Fib. One of the most important frontiers of A-Fib research is trying to determine why and how Atrial Fibrillation develops. Dr. David Van Wagoner of the Cleveland Clinic, Cleveland, OH talked about the mechanistic links between inflammation, oxidative stress, and A-Fib.

Stressors like sleep apnea and obesity impact arrhythmia substrate changes.

Preventing and Preventing A-Fib: Oxidative stress can cause oxidants to interact with lipids and proteins and cause previously functional proteins to become dysfunctional. Processing dysfunctional proteins is impaired as in diseases like Alzheimer’s.

A-Fib hemodynamic stress or ‘stress activated’ changes (for example, by stressors like hypertension or obesity) produce reactive oxygen species (ROS) generation…continue reading…

Look for more of my 2017 AF Symposium reports
in the coming weeks and months.

2017 AF Symposium: Links Between Inflammation, Oxidative Stress and A-Fib

Predicting and Preventing A-Fib

David Van Wagoner, PhD - A-Fib.com

David Van Wagoner, PhD

One of the most important frontiers of A-Fib research is trying to determine why and how Atrial Fibrillation develops. Dr. David Van Wagoner of the Cleveland Clinic, Cleveland, OH talked about the mechanistic links between inflammation, oxidative stress, and A-Fib.

Oxidative Stress

Oxidative stress can cause oxidants to interact with lipids and proteins and cause previously functional proteins to become dysfunctional. Proteostasis, the process of processing dysfunctional proteins, is impaired as in diseases like Alzheimer’s.

Stressors like sleep apnea and obesity impact arrhythmia substrate changes.

A-Fib hemodynamic stress or ‘stress activated’ changes (for example, by stressors like hypertension or obesity) produce reactive oxygen species (ROS) generation which can cause oxidized proteins to form amyloid aggregates like the tau proteins that accumulate in the Alzheimer’s brain. Stressors like sleep apnea and obesity impact arrhythmia substrate changes such as atrial hypertrophy and fibrosis.

Fibrosis/Inflammation

These stress activated changes also promotes myofibroblast activation (fibrosis), inflammatory cytotine production, and heat shock endoplasmic reticulum (ER) stress.

Atrial Ectopy (extra beats)

Hemodynamic stress increases sympathetic nerve activity which promotes ectopy (extra beats) that trigger the onset of A-Fib.

Mechanistic Pathways of A-Fib

Dr. Van Wagoner recommends targeting and researching certain pathways in order to treat and even prevent A-Fib:

• Atrial Ectopy
• Atrial Fibrosis
• Proteostasis Modulation

He suggests that further study of these mechanistic pathways may help us both predict and prevent A-Fib. For example, monitoring for atrial ectopy can be a powerful predictor of future A-Fib.

What A-Fib Patients Need to Know

Being able to predict who will develop A-Fib would be a major advance for patients. (See how research shows that, as Dr. Van Wagoner discusses, ectopic beats do predict the development of A-Fib: FAQ: Coping with A-Fib PVCs & PACs.)

But an even more important step in A-Fib research would be to develop ways to prevent A-Fib. Further study of Dr. Van Wagoner’s mechanistic pathways of A-Fib may bring us closer to actually preventing A-Fib.

Return to 2017 AF Symposium reports
If you find any errors on this page, email us. ♥ Last updated: Saturday, January 21, 2017

2017 AF Symposium: 3D Virtual Heart’ Predicts Location of Rotors

You may recall my 2015 report about Dr. Natalia Trayanova of Johns Hopkins University, Baltimore, MD and her ground breaking presentation on the “Virtual Heart”.

The Virtual Heart - Dr Natalia Trayanova

2015: “Virtual Heart” image

Her 2017 presentation was a continuation of her innovative research, this time about A-Fib rotors and fibrosis.

The Virtual Heart is a computerized model to simulate an individual patient’s heart that can be used to guide an individual patient’s therapy.

Dr. Trayanova constructed three-dimensional computer models of A-Fib atria from MRI data and assessed the propensity of each model to develop arrhythmia.

She found that reentrant drivers (rotors) persisted in areas of higher fibrosis density and entropy (lack of order or predictability). They didn’t persist in regions of non-fibrotic sites and regions of deep fibrosis.

Reentrant drivers (rotors) persisted in areas of higher fibrosis density and entropy (lack of predictability).

Dr. Natalia Trayanova

N. Trayanova

Dr. Trayanova compared the predictive ability of her models to actual ECGI mapping cases from the Bordeaux group. Overall, her prediction of where rotors would be found coincided with where rotors were actually found by ECGI.

But there wasn’t 100% agreement with the ECGI data. She hypothesized that, as she further develops these virtual heart models, they might someday be used, along with ECGI and other mapping strategies, to look for rotors where her models predict they should be found.

Return to 2017 AF Symposium reports
If you find any errors on this page, email us. ♥ Last updated: Saturday, January 21, 2017

New 2017 European A-Fib Stroke Risk Guidelines Changes

My second report from this month’s 2017 AF Symposium. Dr. John Camm from St. George’s Medical Center, London, UK discussed the new 2017 ESC (European) AF Stroke Risk Guidelines (i.e. CHA2DS2-VASc).

Dr. John Camm - A-Fib.com

Dr. John Camm

Gender Bias: The big news is that in the 2017 ESC Stroke Risk Guidelines for Atrial Fibrillation “gender is no longer an important consideration.”

The previous CHA2DS2-VASc risk scale automatically gave every woman an additional 1 risk point for just being female. Under the new 2017 Guidelines, anticoagulation recommendations are the same for men with 1 point and women with 2 points. (Sc stands for sex i.e. female gender). This is a major change in anticoagulation treatment for women.

Anticoagulant Therapy: Under the 2017 European Guidelines, the newer NOACs (Novel Oral Anticoagulants)…continue reading…

2017 AF Symposium: Reports for Patients by Steve S. Ryan, PhD

Steve S Ryan at 2017 AF Symposium, A-Fib.com

Steve in Orlando, FL, Jan 2017

AF Symposium 2017

My Summary Reports Written for A-Fib Patients

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.

Note: My most recent report is listed first.

REPORT TITLE PRESENTER (S) DATE POSTED
4, Links Between Inflammation, Oxidative Stress and A-Fib David Van Wagoner, PhD, the Cleveland Clinic, Cleveland, OH Jan 21, 2017
3. 3D Virtual Heart’ Predicts Location of Rotors Dr. Natalia Trayanova of Johns Hopkins University, Baltimore, MD Jan 21, 2017
2. 2017 European A-Fib Stroke Risk Guidelines Changes & No Gender Bias Dr. John Camm from St. George’s Medical Center, London, UK Jan 19, 2017
1. 2017 AF Symposium Overview by Steve S. Ryan, PhD – – – Jan 17,2017

“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: Saturday, January 21, 2017

AF Symposium: New 2017 European A-Fib Stroke Risk Guidelines Changes & No Gender Bias

AF Symposium 2017

New 2017 European A-Fib Stroke Risk Guidelines Changes & No Gender Bias

by Steve S. Ryan, PhD, Jan 19, 2017

Background: The controversy began with the HRS/ACC/AHA committee report, 2014 Guidelines for Management of Patients with Atrial Fibrillation. The rating scale, CHA2DS2-VASc, is used by doctors to assess an A-Fib patient’s risk of stroke. Magically, simply because of her gender, a woman is automatically given one point on the stroke risk scale―no matter how healthy she is otherwise.
Dr. John Camm - A-Fib.com

Dr. John Camm

Dr. John Camm from St. George’s Medical Center, London, UK discussed the new 2017 ESC (European) AF Stroke Risk Guidelines (i.e. CHA2DS2-VASc) compared to AF guidelines used around the world.

Gender Bias: The big news is that in the 2017 ESC Stroke Risk Guidelines for Atrial Fibrillation “gender is no longer an important consideration.”

The previous CHA2DS2-VASc risk scale automatically gave every woman an additional 1 risk point for just being female. Under the new 2017 Guidelines, anticoagulation recommendations are the same for men with 1 point and women with 2 points. (Sc stands for sex i.e. female gender). This is a major change in anticoagulation treatment for women.

Antiplatelet drugs like aspirin are not recommended.

Anticoagulant Therapy: Under the 2017 European Guidelines, the newer NOACs (Novel Oral Anticoagulants) are recommended over the anticoagulant warfarin (Comadin).

In addition, antiplatelet drugs like aspirin are not recommended. The guidelines explicitly state that bleeding risk should be considered.

Decisions previously dictated by the guidelines now read “patient choice”.

Patient’s choice: Another important change for European A-Fib patients is that many decisions previously dictated by the guidelines now read “patient choice.” For example, it’s now a patient/doctor decision to either try different antiarrhythmic drugs or catheter ablation.

What Patients Need To Know

For a further discussion of the gender controversy, see my article, The Controversy Continues: Women, Anticoagulants, CHA2DS2-VASc and Risk of Bleeding

Keep in mind: all anticoagulants are high risk medications. They work by increasing your risk of bleeding.

Why not drop the “Sc”? Removing the bias against women in the 2017 European A-Fib Stroke Risk Guidelines is a welcome change. But, one wonders why they didn’t just drop the extra point for being female? And make the acronym “CHA2DS2-VA? it’s confusing for women and even for their doctors.

Return to 2017 AF Symposium reports
If you find any errors on this page, email us. ♥ Last updated: Saturday, January 21, 2017

My First Report: Overview of the 2017 AF Symposium

I returned Saturday night from the annual AF Symposium held at the Hyatt Regency, Orlando, FL. The mood of the three-day atrial fibrillation conference seemed to be somewhat somber.

AF Symposium panel - A-Fib.com

AF Symposium panel

The coming Trump presidency seemed to cast a shadow of discouragement and even fear. Occasional discussions would reflect on the profound changes expected, especially about Obamacare.

The AF Symposium brings together the world’s leading medical scientists, researchers and cardiac electrophysiologists (EPs) to share the most recent advances in the treatment of atrial fibrillation.

Hot Topic: Left Atrial Appendage

Steve in Orlando

The most talked about topic at this year’s AF Symposium was the Left Atrial Appendage (LAA). This represents a major change in the way doctors now see the importance of the LAA and the LAA’s role in atrial fibrillation.

(For A-Fib patients, this is a most welcome change. All too many doctors still consider the LAA of little importance. For example, when doing an ablation, all too many EPs never look at the LAA to see if it is producing non-PV triggers.) Continue reading my first report

2017 AF Symposium: Overview

by Steve S. Ryan, PhD, Tuesday, January 17, 2017

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.

The three-day AF Symposium started early each day at 7:00 am and was 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). There were generous breaks and lunch times to allow attendees to interact with and visit the manufacturer’s exhibits to learn what’s new from the many vendors.

Somber Mood Pervasive

The overall mood of this year’s AF Symposium seemed to be somewhat somber. The upcoming Trump presidency seemed to cast a shadow of discouragement and even fear. Compared to other years, the presentations had very little humor. The presenters tried to stay on message, but occasionally in the discussions the profound upcoming changes would be acknowledged, especially about Obamacare.

Faculty and Feedback

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

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

The various presenters were a ‘Who’s Who’ of thought leaders in the A-Fib field. The 55 faculty members were from around the world (the U.S., England, Canada, France, Italy, Germany, Switzerland, Ireland, the Netherlands, Taiwan, South Korea, and the Czech Republic). Some did double duty and gave talks on different topics.

Again this year, the AF Symposium featured audience feedback devices at each seat. A presenter would ask a multiple choice question 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

The Hyatt Regency in Orlando hosted the AF Symposium January 12-14 and is a magnificent, vast venue more than capable of holding the many attendees (attendance seemed a bit down this year).

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

Left Atrial Appendage

The most talked about topic at this year’s AF Symposium was the Left Atrial Appendage (LAA). This represents a major change in the way doctors now see the importance of the LAA and the LAA’s role in A-Fib. (For A-Fib patients, this is a most welcome change. All too many doctors still consider the LAA of little importance. For example, when doing an ablation, all too many EPs never look at the LAA to see if it is producing non-PV triggers.)

FIRM Controversy

Several studies have come out questioning the efficacy of the FIRM mapping and ablation system. Some presentations and panels discussed these controversial findings. But they weren’t as heated as at previous AF Symposiums. See AF Symposium 2015: Critical Analysis of the FIRM Mapping System.

AF Symposium panel - A-Fib.com

AF Symposium panel

Featured Presentations

Presentations of live cases, via video transmissions, featured advances in catheter ablation and Left Atrial Appendage closure. This Friday morning session was particularly informative and innovative. It’s always the most attended session.

Also very popular is the series of panel presentations. The Challenging Cases in AF Management features world renowned doctors who discuss their year’s most difficult cases. The first panel dealt with Antiarrhythmic Drugs, Anticoagulants and Clinical Decision Making. The second with Catheter Ablation for A-Fib and Left Atrial Appendage Closure.

Agenda & Short Presentation Topics

In addition to the Featured Presentations, there were fifty-three short presentations (15 minutes) presentations each with time for audience questions and discussions. The following general topics included several presentations.

Day 1: Thursday Topics

• Mechanisms and Genetics of Atrial Fibrillation
• Screening for Atrial Fibrillation―Rationale, Results and Clinical Impact
• Clinical Trials, Guidelines and Regulatory Issues in AF Ablation
• Clinical Trials and Regulatory Issues in LAA Closure
• Challenging Cases in AF Management I: Antiarrhythmic Drugs, Anticoagulation and Clinical Decision Making
• Challenging Cases in AF Management II: Catheter Ablation for AF and Left Atrial Appendage Closure

Day 2: Friday Topics

• Live Case Transmissions: Advances in Catheter Ablation for AF and Left Atrial Appendage Closure
• Stroke Prevention in Atrial Fibrillation
• Mapping and Ablation of Atrial Fibrillation I: Lesion Formation and Durability in AF Ablation
• Late Breaking Clinical Trials and First Report Investigations

Day 3: Saturday Topics

• Mapping and Ablation of Atrial Fibrillation II: Beyond PVI Mechanistic Insights and Impact on Ablation Strategies
• Mapping and Ablation of Atrial Fibrillation II: Beyond PVI Mechanistic
• Mapping and Catheter Ablation for Atrial Fibrillation III: Outcomes, Safety, and Economic Impact

Why I Attend

Steve Ryan at 2017 AF Symposium at A-Fib.com

Steve Ryan at 2017 AF Symposium

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 weeks and months, I will post 15+ reports for readers of A-Fib.com.

To learn more about the AF Symposium see What is the ‘AF Symposium’ and Why it’s Important to Patients

Next Time: My Summary Reports

Return to AF Symposium Archives by Year
If you find any errors on this page, email us. Last updated: Friday, January 20, 2017

 

My First 3 Reports from MAM 2016

I’ve written and posted three short reports from the recent HEART TEAM: 2016 Multidisciplinary Arrhythmia Meeting (MAM) held in Zurich, Switzerland:

♥ MAM 2016: Moving A-Fib Care to a New Level (Overview)
This is an overview of the first MAM symposium which advocates for a team approach, a Hybrid Surgery/Ablation, in which EPs and surgeons work together on difficult A-Fib cases. 

 Transcript: My Challenge to Doctors Treating A-Fib Patients – My MAM Speech
As the only patient invited to speak, you may want to read the speech I gave to over 200 EPs and surgeons sharing the patient’s point-of-view.

 Fantastic Experience of the Heart, or Why we were wearing 3-D glasses! A presentation by Dr. Joris Ector, from the University of Leuven, Belgium.

The Hybrid Surgery/Ablation is becoming an increasingly important and effective strategy for highly symptomatic patients with persistent atrial fibrillation or longstanding persistent atrial fibrillation who have failed one or two catheter ablations, and for the patient with a significantly enlarged left atrium.

Learn more about Hybrid Surgery/Ablation on our Cox-Maze & Mini-Maze Surgeries Treatments page.

MAM 2016: Fantastic 3-D Experience of the Heart or Why We Were Wearing 3-D glasses!

fantastic-voyage-ship-in-vein-400-x-300-pix-at-300-res

The movie won an Oscar for Best Special Visual Effects; Image: Foresight Institute

by Steve S. Ryan, PhD

In 1966, the wide-screen movie Fantastic Voyage took viewers inside the human body by injecting a miniaturized submarine, its crew and a surgical team into the carotid artery. Their mission was to break up a clot and save the VIP patient. Traveling through the heart to the brain, reveals a world of dazzling color, a floating wonderland with huge red corpuscles, whirling globules, platelets and particles.

I had that same amazing experience when Dr. Joris Ector presented his incredible 3-D vision of a real heart. Just like when watching the movie, there were involuntary gasps and shocks as you felt what it was like to move through the heart.

And yes, we had to wear 3-D glasses! That’s got to be a first at an A-Fib conference.

Joris Ector MD, with 3D glasses at MAM 2016 - A-Fib.com

Joris Ector MD, wearing 3D glasses; Inset: the exterior of the 3-D heart

Starting with the exterior of a beating heart, Dr. Ector, from the University of Leuven, Belgium, showed every possible 3-D angle.

Next, he peeled away the exterior to reveal the movement of the heart from the inside. Next, he whisked you inside the heart so fast that you almost got dizzy.

Particularly interesting was the trip through the left atrium into the Left Atrial Appendage (LAA) with its trabeculations (thick muscular tissue bands) which looked like columns in close-up.

In some ways, Dr. Ector’s presentation felt more real and comprehensive than watching footage of an actual heart beating. It was an astounding experience (just like watching Fantastic Voyage in 1966). (I wish I had an interior of the 3-D heart to share with you.)

Image credit: Fantastic Voyage movie still from Foresight Institute

Return to Reports of A-Fib Medical Symposiums & Conferences

If you find any errors on this page, email us. Last updated: Friday, October 7, 2016

 

MAM 2016: My Challenge to Doctors of A-Fib Patients

Steve Ryan at the entrance to the MAM 2016 symposium - A-Fib.com

Steve at the entrance to the MAM 2016 symposium

In September, I was the only patient invited to present at MAM 2016 in Zurich, Switzerland. After dinner the first night, I spoke to over 200+ surgeons and electrophysiologists (EPs).

I tried to describe for the doctors what it’s like to live in Atrial Fibrillation. Here is what I told them.

You Never Forget Your First A- Fib Attack

“As most A-Fib patients will testify, you never forget your first A- Fib attack.
Mine was 19 years ago, but I can remember it like it was yesterday. All of a sudden my heart started going crazy! It felt like my heart was trying to jump out of my chest or like there was a live fish flopping around in there. I can still feel the sheer terror, fear, confusion, anxiety and worry it created.
I remember thinking, “Am I going to die?” “Is this a heart attack?” It was one of the most terrifying experiences of my life.
Most symptomatic A-Fib patients have a similar story.

Psychological and Emotional Effects of A-Fib

A-Fib doesn’t just affect you physically, it affects you emotionally as well.
A-Fib affects not just your heart—but also your head—and your quality of life.
It affects not just your heart—but also your head—and your quality of life.
By the way, I’ve never been to a medical conference where this aspect of A-Fib was studied.  (Today is a first, I guess.)
I wish there were some way to give you a one-minute episode of A-Fib. It would change your perception of A-Fib forever. The psychological and emotional aspects of A-Fib can be as bad as or even worse than the physical.

Living in Fear (and Anger)—A-Fib Wrecked My Life

In my case, I lived in fear of the next A-Fib attack. I went through all the emotional gamut—anxiety, fear, worry, confusion, uncertainty, frustration, depression, and finally anger at my own heart.
I went through all the emotional gamut—anxiety, fear, worry, confusion, uncertainty, frustration, depression, and finally anger at my own heart.
I’m a passionate runner. I used to run along Venice Beach. But my heart would go crazy and beat too fast. I’d have to stop and walk back to our apartment. Talk about frustration!
And A-Fib affected my work. I had a great job on the soap opera “Days Of Our Lives” as part of the technical crew. But I’d get dizzy and light headed and nearly lost my job. A-Fib wrecked my life!

Research—Then Going to Bordeaux for an Ablation

Steve Ryan before PVI, in Bordeaux, France, April 1998 at A-Fib.com

Steve Ryan before PVI, in Bordeaux, France, April 1998

To make a long story short, I locked myself in a medical library and read everything I could find about Atrial Fibrillation. During this time, I tried every drug known to man including the dreaded amiodarone which made me cough up blood. Nothing worked.
I found that doctors in Bordeaux, France, had discovered how to make people A-Fib free.
One of the doctors who treated me with catheter ablation is here today, Dr. Dipen Shah. Thanks to him, Dr. Haissaguerre and Dr. Jais I’ve been A-Fib free for 18 years. I was their first US patient.

My Challenge to Doctors treating A-Fib Patients

Today I want to challenge you. Just ask yourself:

What are you doing to help your patients deal with the Fear and Anxiety of A-Fib?

What are you doing to help them cope with the Psychological and Emotional effects of A-Fib?

Helping Your Patients Deal With Stress and Anxiety

Knowledge is Power and Control! Learning about A-Fib relieves worry and anxiety. Two ways to help your patients:
1. Reference books and websites. Give your patients a short list of web sites and books which you have read and recommend. If you do this, think of how much better informed your patients will be! 
Knowledge is Power and Control! Learning about A-Fib relieves worry and anxiety.
Hint: For distribution, list your recommendations on the back of a business card. If it comes from you, your patients will devour them.
2. Counseling and medication. You should have a list you can give out of several psychiatrists who understand A-Fib and how it affects patients.
You’ll know who needs this kind of help. Men, especially, may not admit to themselves that they need help.

Thanks for Making Us A-Fib Free

Steve S. Ryan - high jump at track meet

Steve, age 75; Making a high jump at track meet

Finally, I want to thank you on behalf of all the patients you’ve made A-Fib free. There are few medical procedures as transformative and life changing as going from A-Fib to Normal Sinus Rhythm.
There is simply no comparison between living in A-Fib and being A-Fib free! Normal Sinus Rhythm is wonderful!
There’s nothing like having a heart that beats normally again. No more tiredness, dizziness. being light headed. Your body feels alive. Your brain works. You can run and exercise again. [See the photo at right of me doing the high jump at age 75!]
Thank you for giving me my life back!”

After my talk I received enthusiastic complements and ‘fist bumps’.

I think I really made an impression. I don’t think anyone had ever talked to these doctors like that before.

My hope is that the effects of my talk will trickle down to helping others with Atrial Fibrillation.


Return to Reports of A-Fib Medical Symposiums & Conferences

If you find any errors on this page, email us. Last updated: Thursday, October 6, 2016

 

 

Reports: Atrial Fibrillation Symposiums & Conferences

AF Symposium - no year 300 pix wide at 96 res

AF Symposium
Steve’s Summary Reports for Patients 

♥ 2017 AF Symposium Reports – NEW
Archive: AF Symposiums Reports (2002-2016) By Year

♥ ♥ ♥

HEART TEAM: Multidisciplinary Arrhythmia Meeting (MAM):
Reports for PatientsMAM logo 200 pix wide at 96 res

 MAM 2016: Moving A-Fib Care to a New Level (Overview) 
 My Challenge to Doctors – Transcript of My Speech
 Fantastic 3-D Experience of the Heart, Dr. Joris Ector, U. of Leuven, Belgium

western-af-symposium-rev-240-x-100-pix-at-96-resWestern Atrial Fibrillation Symposium:
Brief Reports for Patients

 2016 Western AF Symposium Reports
 Archives

International Symposium on Left Atrial Appendage:
Report for Patients

 ♥  2015 ISLAA Symposium Report


Return to: Subject Index to A-Fib.com Articles

If you find any errors on this page, email us. Last updated: Saturday, January 21, 2017


Heart Team/MAM 2016: Moving A-Fib Care to a New Level

Multidisciplinary Arrhythmia Meeting 2016Totally historic! The MAM 2016 symposium set important goals for shaping the future of A-Fib care and showed how the emphasis on a ‘Heart Team’ is moving the field of patient A-Fib care to a new level.

This first Multidisciplinary Arrhythmia Meeting (MAM) was held in Zurich, Switzerland Sept 15-16, 2016 and advocated for a team approach―EPs, Surgeons, and other healthcare professionals working together to better help the A-Fib patient.

Leading cardiologists and surgeons explained why they favored the hybrid surgery/ablation referred to by several terms: “hybrid simultaneous,” or “hybrid staged,” or “multidisciplinary sequential approaches”.

MAM 2016 Hands-on demos at A-Fib.com

MAM 2016 Hands-on demos

Interactive Hands-On Workshops and Live Surgery

MAM 2016 featured interactive workshops with hands-on experiences in EP ablation, Surgical Ablation, and Mechanical Exclusion of the Left Atrial Appendage (LAA). Included were working examples of clinicians, electrophysiologists and surgeons teaming up to better help A-Fib patients.

MAM 2016 Live video feed of A-Fib surgery at A-Fib.com

Live video feed of A-Fib surgery by Dr. Stefano Benussi and staff

Observing via a live video feed, attendees watched Dr. Stefano Benussi and his colleagues perform a surgery of an A-Fib patient showing both the left side and right side approaches. (The patient had a huge amount of fat which first had to be cut away before the pericardium sac could be reached and cut into in order to access the heart and pulmonary veins.)

MAM 2016 Program and Faculty

Dr. Stefano Benussi and Steve Ryan in Zurich at A-Fib.com

Dr. Stefano Benussi and Steve Ryan, PhD

The  Multidisciplinary Arrhythmia Meeting was the brain child of the Course Director Dr. Stefano Benussi of the University Hospital Zurich, Switzerland. Course Co-Directors were Harry Crijins of Maastricht, the Netherlands and Firat Duru of Zurich, Switzerland.

The Program Committee and Scientific Faculty making presentations included 54 distinguished doctors from around the world including the famed inventor of the original Cox Maze operation, James L. Cox of Denver, USA. (The Cox Maze operation was the first treatment to make patients A-Fib free.)

A partial list of MAM 2016 participating doctors and countries:

Steve in front of MAM 2016 meeting site in Zurich - A-Fib.com

Steve in front of MAM 2016 meeting site in Zurich

Manuel Castella, Barcelona, Spain
Paolo Della Bella, Alberto Pozzoli, Claudio Tondo, Milan, Italy
Karl Heinz Kuck, Andreas Metzner, Hamburg, Germany
Bart van Putte, Utrecht, The Netherlands
Malcolm Dalrymple-Hay, Guy Haywood, Plymouth, UK
Joris Ector, Mark La Meir, Laurent Pison, Brussels, Belgium
Hans Kottkamp, Diana Reser and many more from Zurich, Switzerland
Gunther Laufer, Vienna, Austria
Randal Lee, Bing Liem, Steve S. Ryan, California, USA
Ju Mei, Shanghai, China
Peter Mueller, Dipen Shah, Geneva, Switzerland
Amiran Revishvili, Moscow, Russia
Timo Weimar, Stuttgart, Germany
Michael Zembata, Zabrze, Poland

Additional presenting doctors will be identified along with summaries of their individual presentations.

My presentation summaries will follow.

Return to Reports of A-Fib Medical Symposiums & Conferences

If you find any errors on this page, email us. Last updated: Monday, October 3, 2016

 

Report 2: Highlights from the 2016 Western AF Symposium

Second in a series by Steve S. Ryan

These are highlights from my second report covering six presentations from the Ninth Annual Western Atrial Fibrillation Symposium held February 26-27, 2016 in Park City, UT. Read my First Report with 9 brief summaries.

Contact Force sensing catheters. From the perspective of an A-Fib patient, the most exciting news was about developments to improve Contact Force sensing catheters. (They are already a huge improvement in RF catheter ablation). In addition to providing theelectrophysiologist (EP) with force and contact info, the new catheters will integrate duration, power, catheter stability and temperature to improve ablation quality.

Snow and skiing in Park City, UT

Park City, UT, site of the 2016 Western AF Symposium

The Laser Fiber Optic Balloon catheter seems also to have great potential. But we just don’t know if it will ever be approved for use in the U.S.

Successful A-Fib ablation=little stroke risk. Dr. Callans’s data showed that patients with a successful A-Fib ablation had very little stroke risk. Whereas, of those still taking anticoagulants after a successful ablation, 2% had an hemorrhagic stroke. Putting patients on anticoagulants after a successful catheter ablation is both ineffective and dangerous.

Continuous monitoring for A-Fib in all over 65? Dr. Mittal (and many at the Western Symposium presenters), expressed the increasing awareness that people over 65 need better monitoring than just an annual office ECG. The goal should be for everyone over 65 to have a practical form of continuous monitoring to detect A-Fib before it becomes a problem (i.e., causes a stroke). This is a major public health issue.

NOACs and Catheter Ablation. If you are on the NOACs Xarelto and Eliquis, Dr. Natale’s data is encouraging news. When having a catheter ablation, you don’t have to switch back to warfarin beforehand.

No Strokes among 2,618 ablations. Also very encouraging, was Dr. Natale’s data that there were no strokes among the 2,618 ablations performed by his groups. This is especially impressive because among their patients, there was a higher prevalence of nonparoxysmal A-Fib and higher CHADS2 scores. (Translation: Their patients had more severe cases of A-Fib and more risk factors for stoke.)

These are just the highlights. To read my entire second report, go to Report 2: 2016 Western Atrial Fibrillation Symposium.

Look for my third report in the series in the coming weeks.

Report 1: Brief Summaries from the 2016 Western AF Symposium

Utah! What a wonderful winter venue for the Ninth Annual Western Atrial Fibrillation Symposium held  February 26-27, 2016.

Skiing in Park City, UT

Park City, UT

After having just attended the January 2016 AF Symposium in Orlando, FL, I was surprised at how much new, relevant information was provided (sometimes by the same presenters). In all, there were 53 scheduled presentations of 15 minutes each.

My first report includes 9 brief summaries of technical presentations.

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.

To continue reading, go to Report 1: 2016 Western AF Symposium.

Steve Reporting from Western AF Symposium in Utah

Leading cardiologists and researchers are gathering this Friday and Saturday for The Ninth Annual Western Atrial Fibrillation Symposium in Park City, UT., co-sponsored by the Heart Rhythm Society.

Steve was invited to attend by the symposium organizer, Dr. Mousa Mansour, University of Utah, Salt Lake City, UT. (See Steve’s report of Dr. Mansour’s presentation from the 2016 AF Symposium, Orlando, FL.) I’m sure Steve’s WAFS reports will complement his growing list of reports from the recent 2016 AF Symposium.

Steve S. Ryan - high jump at track meet

Steve – high jump at Feb. 14 track meet

High Altitude and the High Jump

Steve loves to jog and compete in his age group in various track and field events (last weekend it was the high jump, long jump and 100 meter dash).

I was thinking about Park City, Utah, being at 6,000 feet above sea level. You see, we live at sea level in Malibu, CA.

So, I was wondering if Steve’s recent ‘high jump’ events might help him deal with the high altitude and thinner air? (Hee, hee.) What do you think?  (LOL)

Photo is by fellow week-end athlete, Ken Stone.

2016 AF: Four New Reports on Predictors, Protocols, Rotors & 2 Difficult Ablation/LAA Cases

New Reports by Drs. Haissaguerre, Wilber, Reddy & Valderrabano

I’ve been rather prolific with my summaries of key presentations from the recent 2016 AF Symposium (January, Orlando, FL). Four new reports have been posted at 2016 AF Symposium: My Summary Reports Written for A-Fib Patients.

Dr Michele Haissaguerre, The Bordeaux Group

Dr Michele Haissaguerre

You might want to start with two presentations by the A-Fib research pioneer1Dr. Michel Haissaguerre of Central Hospital, Bordeaux, France (he cured my A-Fib in 1998):

Predictors of Unsuccessful Ablations: It’s All About Remodeling
• Bordeaux New ECGI Ablation Protocol—Re-Mapping during Ablation

Then move on to the very HOT topic of Rotors, and two difficult cases of ablation with LAA closure:

• Rotors! Rotors! Rotors! Good News for Patients with Persistent A-Fib. presented by Dr. David Wilber of Loyola University Medical Center, Chicago, IL
• Two Challenging, Difficult Catheter Ablation Cases with LAA Closure by Dr. Vivek Reddy, Mount Sinai Hospital, New York, NY and Dr. Migel Valderrabano, Houston Methodist Hospital, Houston, TX

More Reports to Come

Steve at 21st Annual AF Symposium in Orlando FL

Steve at 2016 AF Symposium

 You can see a list of my first six reports at 2016 AF Symposium: My Summary Reports Written for A-Fib Patients.

For an introduction to the 2016 AF Symposium, don’t miss my brief Overview.

I expect to write 15 – 20 additional reports in the coming months. So visit the reports list often. Just use the left menu tab “2016 AF Symposium Reports” (found on every page) to go to my growing list of reports.

Citation for this article
References    (↵ returns to text)

  1. Pioneer in the Ablation of A-Fib: In 1997, a major breakthrough came to AF ablation as Dr. Michel Haïssaguerre and his researchers observed that a vast majority of A-Fib was initiated by triggers from a focal source in the Pulmonary Veins (PV) and ablation of the focal source in the PV eliminated Parosysmal A-Fib.

2016 AF: Thickening of Left Atrium and Fibrosis Amount Predicts Outcome of A-Fib Ablation

AF Symposium 2016

Thickening of Left Atrium and Amount of Fibrosis Predicts Outcome of A-Fib Ablation

by Steve S. Ryan, PhD

Dr. Nassir F. Marrouche

Dr. Nassir F. Marrouche

Dr. Nassir F. Marrouche, University of Utah (CARMA), is known for ground-breaking, thought-provoking research using MRI. His presentation was entitled “Atrial and Ventricular Myopathy: A Novel risk predictor for stroke and cardiovascular events.”

Amount of Fibrosis Better Predictor of Stroke Risk (and Heart Attack)

Dr. Marrouche began by showing how today’s stroke guidelines (CHADS2 or CHA2DS2-VASc) are mediocre predictive tools overall, according to most studies. Whereas atrial fibrosis detected by Delayed Enhancement-MRI (DE-MRI) is a better predictor of stroke risk.

DE-MRI stands for Delayed Enhancement Magnetic Resonant Imaging.

In Dr. Marrouche’s study, patients with more than 21% fibrosis had a 19.6% risk of stroke while those with under 8.5% fibrosis had only a 1% risk. The more fibrosis, the greater risk of clots forming in the Left Atrial Appendage (LAA).

In a study by King, higher levels of fibrosis were associated with ‘Major Adverse Cardiac Events’ (MACE), not only stroke but heart attack and deep vein thrombosis (a blood clot within a vein).

Cardiomyopathy and Fibrosis

Dr. Marrouche showed slides of normal atrial myocytes (muscle cells) vs. examples with extensive fibrosis where collagen replaced most of the red myocytes (which store oxygen until needed for muscular activity).

This is an important finding which may change the way we look at fibrosis.

This fibrosis correlated with abnormality of the atria (atrial myopathy) and deterioration of the ability of heart muscles to contract (cardiomyopathy). This is an important finding which may change the way we look at fibrosis.

(For further information on Dr. Marrouche’s work, see Higher Fibrosis at Greater Risk of Stroke and Precludes Catheter Ablation.)

Fibrosis/Myopathy Correlates with Atrial Strain

Dr. Marrouche showed slides of how the left atrium of an A-Fib patient with extensive fibrosis worked much harder to pump and had nearly three times more strain than a patient with mild fibrosis. (This may be why the left atrium often stretches and expands in remodeling.)

A-Fib Thickens Left Atrial Shape

In another ground-breaking observation, Dr. Marrouche showed slides of how the shape of the left atrium (LA) gets thicker as one progresses from no-A-Fib to paroxysmal to persistent A-Fib. In fact, in a study by Bieging, LA shape (thickness) is a strong independent predictor of outcome after AF ablation.

Left Atrial Appendage and Stroke Risk

Dr. Marrouche found that the Left Atrial Appendage (LAA) length, thickness and orientation correlate with stroke risk. These findings open up new avenues of research in A-Fib. Just looking at the LAA might produce an indication of stroke risk, which can be combined with other predictive measures.

Left Ventricular Disease Predicts Recurrence after Ablation Therapy

Some A-Fib patients also have a diseased Left Ventricle (LV) which shows up using ‘Late Gadolinium Enhancement- MRI’ (LGE-MRI). In a study by Suksaranjit, the recurrence rate after an ablation was 69% in patients with Left Ventricular LGE-MRI revealed disease, compared to 38% in patients without LV LGE-MRI. These patients also have more major adverse cardiac and cerebrovascular events.

Conclusion

Dr. Marrouche is now using both the amount of fibrosis and left atrial shape to stage and treat A-Fib patients. The main points we can learn from Dr. Marrouche’s research are:

Fibrosis makes the heart stiff, less flexible and weak, overworks the heart, reduces pumping efficiency and leads to other heart problems.

• Fibrosis puts you are greater risk of a stroke and other vascular problems.
• More fibrosis leads to thickened heart tissue, strains the heart and reduces the ability of the heart muscles to contract.
• A-Fib changes the thickness/shape of the left atrium.
• A-Fib can also change the length, thickness and orientation of the Left Atrial Appendage (LAA).
• Left Ventricular disease may accompany or be caused by A-Fib, be measured by MRI, and predict recurrence after catheter ablation..

What Patients Need To Know

Don’t delay! Your A-Fib leads to fibrosis! A-Fib produces fibrosis which is considered permanent and irreversible. Any treatment plan for A-Fib must try to prevent or stop remodeling and fibrosis.

Caveat: After reading Dr. Marrouche’s research and new insights that atrial fibrosis detected by DE-MRI is a better predictor of stroke risk (than CHADS2 or CHA2DS2-VASc), don’t rush into your EPs office asking about using MRI to diagnose your amount of fibrosis. Not every MRI technician and doctor has the special training and experience necessary to perform Dr. Marrouche’s testing. (And insurance companies may not want to pay for this testing. However, that may soon change.)

References for this article

Return to 2016 AF Symposium Reports by Steve Ryan, PhD

If you find any errors on this page, email us. Y Last updated: Monday, February 22, 2016

More FIRM Research: Mapping System Falls Short (Again)

Background: FIRM stands for ‘Focal Impulse and Rotor Modulation’; The FIRM mapping and ablation system uses a basket catheter, a panoramic contact-mapping tool by Topera/Abbott Laboratories. Rotors (rotational circuits or focal sources) are underlying drivers that sustain or perpetuate an A-Fib signal after it has been triggered (like an echo).
The FIRMap basket Catheter from Topera/Abbott Laboratories

The FIRMap basket catheter

A three-center 2015 study (Gianni) used FIRM-guided only ablation on 29 patients with persistent or long-standing persistent A-Fib. The centers were:

• The Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
• The Heart Center Bad Neustadt, Bad Neustadt, Germany
• Baptist Health, Lexington, KY, USA

Undergoing FIRM mapping, 20 patients had persistent A-Fib and 9 patients had long-standing persistent. Doctors found 4 rotors (on average) per patient (with 62% coming from the left atrium) and 1 focal impulse. All these signal sources were successfully ablated.

Follow-up Ablation Results

After a mean of 5.7 months of follow-up, single procedure freedom from A-Fib/Flutter without antiarrhythmic drugs was a low 17%.

Researchers concluded that the FIRM system was not effective in returning patients to normal sinus rhythm (or alternatively moving from the chaotic A-Fib rhythm to a more regular rhythm such as A-Flutter). And only ablating FIRM-identified rotors did not prevent recurrence (i.e., return of A-Fib).

Other Research on the FIRM System

AF Symposium logo

AF Symposium reports

This study confirms the January 2015 AF Symposium presentation, Critical Analysis of the FIRM Mapping System, by Dr. Ravi Mandapati of Loma Linda University,

From a different perspective, Dr. Vivek Reddy offers a real world application of the FIRM system (advantages and problems). See the 2016 AF Symposium presentation: Two Challenging, Difficult Catheter Ablation Cases.

Bottom line for Patients

Even though the FIRM mapping and ablation system seems to currently have built-in limitations, master EPs still use the FIRM basket mapping catheter because it provides a great deal of important information very quickly. It is especially useful in cases of Persistent A-Fib.

Note: The developer of FIRM, Topera/Abbott Laboratories, is working to address shortcomings by developing its own line of mapping basket catheters.
References for this article

2016 AF Report: Hot Topic—Rotors! Rotors! Rotors! Good News for Patients with Persistent A-Fib

AF Symposium 2016

Hot Topic: Rotors! Rotors! Rotors! Good News for Patients with Persistent A-Fib

by Steve S. Ryan, PhD

Rotors have become increasingly important in treating and ablating Atrial Fibrillation, particularly for Persistent A-Fib.

Rotors was such a hot topic, one could have called this year’s symposium the “2016 Rotor Symposium”.

If you have Persistent (or Long-standing A-Fib), you’ll want to seek out and be treated by EPs who understand rotors and recognize their importance.

Can Fibrotic Heart Tissue be Ablated?

Many EPs don’t ablate A-Fib patients with a high level of fibrosis and consider fibrotic areas as non-ablatable.

However, Dr. David Wilber of Loyola University Medical Center, Chicago, IL, found that patients with high levels of fibrosis can be successfully ablated by first examining the fibrotic areas for the presence of rotor circuits (i.e., A-Fib signal sources). Then, by ablating with both FIRM and high resolution optical mapping. This is a major new discovery.

Dr David Wilber Loyola University

Dr David Wilber Loyola University

In his presentation, “Impact of Atrial Fibrosis on Rotor Frequency and Location: Evidence from Combined Imaging and Mapping Studies,” Dr. Wilber beganby  examining a study by RS Oakes of 81 patients (50% had Paroxysmal A-Fib) which analyzed each patient using ‘Delayed-Enhancement Magnetic Resonant Imaging’ (DE-MRI).

Measuring Fibrotic Heart Tissue

Fibrotic heart tissue (scar tissue) is often found in patients with Atrial Fibrillation, particularly those with Persistent or Long-standing Persistent A-Fib.

DE-MRI is an MRI process which uses a metallic dye to see in 3D and identify fibrotic areas in the heart.

‘Delayed-Enhancement Magnetic Resonant Imaging’ (DE-MRI) can be used to precisely define scar tissue. As identified by DE-MRI, fibrotic heart tissue may be “low voltage”, that is, having little or no electrical activity.

In the Oakes research, “moderate” fibrosis was defined as heart tissue with 15%-35% fibrosis (low voltage) and was found in 30 patients. “Extensive’ fibrosis was defined as heart tissue with fibrosis greater than 35% and was found in 8 patients.

Fibrotic Patients and Persistent A-Fib

The Oakes study found that patients with moderate or extensive fibrosis were more frequently in Persistent A-Fib (70% vs 32%). This was true even when compared to factors such as expanded Left Atrium (LA) volume and having been in Persistent A-Fib before the ablation.

Intuitively, this makes sense. One would expect in the A-Fib remodeling process that patients with more fibrosis would be more likely to develop persistent A-Fib. (Perhaps extensive fibrosis is the reason Persistent A-Fib is harder to cure.)

Amount of Fibrosis and Recurrence Post Ablation

Dr. Wilber also discussed the DECAAF trial (see Marrouche High Fibrosis Precludes Catheter Ablation) which found fibrosis was the strongest predictor of recurrence after an ablation.

Rotors Anchored In or Located at the Edge of Fibrosis Regions

Dr. Wilber cited two additional studies. A study by BJ Hansen found that rotors are anchored to fibrotic areas of the heart. These rotor circuits can be identified and ablated by both FIRM and high resolution optical mapping. A study by McDowell found that the pattern or shape of fibrosis helps determine rotor formation.

Dr. Wilber’s Research on Left Atrium Rotors & Fibrosis

Dr. Wilber next presented his own research study. He and his colleagues used FIRM guided ablation in the examination of LA rotors and fibrosis. They first positioned the FIRM basket catheter in the right atrium and ablated rotors. They then moved to the left atrium and, after the FIRM rotor ablations, they performed a wide area circumferential Pulmonary Vein Isolation (PVI). They found more rotors (167) than focal sources (1).

Dr. Wilber and his colleagues found:

• 90% of rotor cores contained detectable fibrosis.
• The median regional fibrosis within individual rotor cores was only 13%.
• There was no relationship between the amount of fibrosis and both the number of rotors and the regional fibrosis of rotor cores.
• The mean amount of fibrosis in patients was 14.8%.

Summary and Conclusions

Summing up these research studies, Dr. Wilber concluded:

• The vast majority of rotor cores are associated with MRI detected fibrosis (90%)
• Measures of global atrial fibrosis do not predict number of identifiable rotors
• There is preferential location of rotor cores at the periphery of more dense regions of fibrosis
• Micro-anatomic distribution of fibrosis, and its impact on local electrophysiological properties, is likely to have additional influence on rotor formation, and specific sites of rotor stability.

Bottom-line for Patients with Persistent or Long-standing Persistent A-Fib

High Fibrosis Areas Can Be Ablated: While many EPs don’t ablate patients with a high level of fibrosis and consider fibrotic areas as non-ablatable, Dr. Wilber’s research shows that rotors (A-Fib signal sources) are located at or anchored in regions of fibrosis that can be ablated―particularly now that EPs know where to look for them. This may change the way mapping and ablations are done.

Good News: Patients with high fibrosis areas can be ablated.

The Amount of Fibrosis Doesn’t Predict the Number of Rotors: This is a surprising result (and needs to be confirmed by further study). This is good news for patients! Just because you have a lot of fibrosis doesn’t necessarily mean you have a lot of rotors (A-Fib signal sources). Your ablation won’t necessarily be more extensive than someone else’s.

What This Means to Patients: This fibrosis research is yet another reason for patients not to live in A-Fib! Living with A-Fib increases the risk of developing persistent A-Fib which is harder to cure. 

References for this article

Return to 2016 AF Symposium Reports by Steve Ryan, PhD

If you find any errors on this page, email us. Y Last updated: Monday, February 15, 2016

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