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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 More Reports: Obesity & A-Fib and Increasing Fibrosis

Another two summary reports from the January 2017 AF Symposium. Here’s the entire list of my reports from the 2017 AF Symposium.

Report 7: A-Fib Increases Fibrosis by 5%-10% Per Year

Dr. Nassir Marrouche of the University of Utah (CARMA), Salt Lake City, UT continued his ground-breaking work using MRI to investigate Atrial Fibrillation. Some of the major contributions Dr. Marrouche’s MRI research has made include that patients with high fibrosis levels are at greater risk of stroke and that they may be precluded from a successful catheter ablation.

He showed how current MRI testing also measures fibrosis in 3D to better gauge its thickness. Read about his latest research on A-Fib patients and fibrosis.

Report 8: New Insights into the Effects of Obesity on Atrial Fibrillation

Dr. Jose Jalife of the University of Michigan, Ann Arbor, MI, discussed the “Obesity Paradox”, a hypothesis that obesity may be protective and associated with greater survival with certain chronic diseases. Dr. Jalfie showed how and why this is not the case with A-Fib.

Under normal conditions, the surface of the heart is covered by fat stored in the tissue. A-Fib is often associated with increased volume of epicardial fat… Continue reading Dr. Jalife’s research findings.

See the entire list of my reports from the 2017 AF Symposium.
Look for another report soon.

2017 AF Symposium Video Streaming: Ablation using CardioFocus Laser Balloon

2017 AF Symposium

Live Case: Ablation using CardioFocus Laser Balloon

Video clip: :16 sec view of pulmonary view opening during ablation with HeartLight System; from ‘Ablate What You See & See What You Ablate’.

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

Direct Visualization

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.) (Watch :13 video clip)

Laser Energy For Ablation

CardioFocus HeartLight Laser Balloon at A-Fib.com

CardioFocus HeartLight Laser Balloon

In the center of the catheter is an optical fiber which produces an arc of laser (near infrared) energy. When they applied this laser energy, it looked like a green flashing light that circled the PV.

The doctors said that watching this circulating green arc allowed them to visually see if they were making complete circular lesions of the PV.

They later used a regular Lasso catheter to check for ablation integrity.

Variable Diameter Compliant Balloon

The doctors also showed how the CardioFocus HeartLight system uses a variable diameter compliant balloon which can be sized to fit into a wide range of PV openings.

See our library of videos about Atrial Fibrillation

One preliminary research article suggested that the Laser Balloon system clinical outcomes were an improvement over CryoBalloon ablation. 

VIDEO ANIMATION: For a one-minute animation of how the CardioFocus HeartLight system works, see Visually Guided Ablation.

Editor’s Comments:
The CardioFocus HeartLight Laser Balloon catheter seems like a major advance in the treatment of A-Fib, To be able to look directly at the PV opening instead of using fluoroscopy, etc. should make an EP’s ablation task much easier and potentially more effective. And having a variable diameter compliant balloon is an added plus.
But when I talked with the CardioFocus rep at the AF Symposium exhibit hall, he said they were in the process of rolling out the Laser Balloon system to various centers. It may be a short while till the system is up and operational nationwide in the U.S. (It’s already in use in Europe.) We will try to list which centers use the Laser Balloon system.
If real world experience proves its effectiveness, the CardioFocus HeartLight Laser Balloon system may eventually make CryoBalloon ablation a secondary player.

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If you find any errors on this page, email us. Last updated: Sunday, February 12, 2017

Resources for this article

2017 AF Symposium: New Reports on Reversing Fibrosis and Hypercoagulability & NOACs

I’ve been a busy writer since attending the 2017 AF Symposium in January. Here are two more summary reports.

Report 5Some Forms of Fibrosis May Be Reversible: Research with Overweight Sheep 

In a very hopeful study for Atrial Fibrillation patients, Dr. Stanley Nattel of the University of Montreal, Montreal, Canada concluded that some forms or types of fibrosis are indeed reversible.

Steve with Shannon Dickson, editor of The A-Fib Report

Steve with Shannon Dickson, editor of The A-Fib Report

He described his experiments with overweight sheep. A 30% weight lost reduced fibrosis as well as inflammation and incidence of A-Fib. Continue reading….

Report 6: Hypercoagulability May Cause A-Fib, NOACs May Prevent It 

Novel oral anticoagulants (NOACs) may both prevent and stop A-Fib, according to a thought-provoking hypothesis by Dr. Ulrich Schotten of the University of Maastricht, Maastricht, The Netherlands.

His different, somewhat contrary hypothesis flips the current thinking― that hypercoagulability increases and promotes A-Fib (versus A-Fib increasing hypercoagulability).

Working with specially designed mice with increased thrombin activity (hypercoagulated mice), Dr. Schotten found that these mice had increased atrial fibrosis and A-Fib, and a hypercoagulated state promotes atrial fibrosis…Continue reading….

See the entire list of my reports from the 2017 AF Symposium.
Look for three more reports soon.

2017 AF Symposium: LIVE VIDEO! Two Procedures—Different Left Atrial Appendage (LAA) Occlusion Devices

AF Symposium 2017

LIVE VIDEO! Two Procedures—Different Left Atrial Appendage (LAA) Occlusion Devices

This live streaming video session from Milan, Italy, featured two Left Atrial Appendage occlusion devices: the Amplatz Amulet from St. Jude Medical and the LAmbre from LifeTech Scientific.

LAA Closure Using the Amplatz Amulet (St. Jude Medical)

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

Amplatz Amulet occlusion device by St. Jude Medical

Live from Milan, Drs. Claudio Tondo, Antonio Dello Russo, Gaetano Fassini, and Massimo Moltrasio inserted an Amplatz Amulet (St. Jude Medical) into the Left Atrial Appendage of a 78-year-old women who had a high risk of bleeding. (The LAA is the origin of 90%-95% of Atrial Fibrillation-related clots).

Model of Patient’s LAA: 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 isn’t done in all cases of LAA occlusion, but was very helpful for the AF Symposium attendees to see how the Amplatz Amulet actually worked.

Illustration of placing the Amplatz Amulet (St. Jude Medical) in the left atrial appendage

Illustration of placing the Amplatz Amulet (St. Jude Medical) in the left atrial appendage

The doctors also demonstrated how they could easily retract and recapture the device (which isn’t easy to do with the Watchman occlusion device [Boston Scientific]).

Like the Watchman device, the Amulet also has hooks to hold the device in place.

VIDEO ANIMATION: showing how the Amplatz Amulet device is installed (1:14 min.) from St. Jude Medical.
Watchman device - A-Fib.com

Watchman occlusion device by Boston Scientific

It seemed very easy to insert the Amplatz device. It closed off the LAA opening with the bottom part completely covering the LAA opening into the left atrium.

For most patients, this might be an advantage of the Amplatz device over the Watchman occlusion device which doesn’t have this overlap and can sometimes leak around the edges.

But, on the other hand, once the Amplatz device is in place, the overlap of the LAA would prevent ablation and electrical isolation of the LAA should that be necessary. But in most cases, this isn’t often required.

Second LAA Closure Using the LAmbre (LifeTech Scientific)

LAmbre (LifeTech Scientific) occlusion device - A-Fib.com

LAmbre (LifeTech Scientific) occlusion device

Later in the session when the moderators cut back to the live video stream from Milan, the EPs inserted a LAmbre (LifeTech Scientific) device in the LAA of a second patient. She was a 50-year-old woman who had a very small LAA. She had suffered two ischemic strokes within a month of each other, but she had bleeding problems when she took warfarin and dabigatran (Pradaxa).

[She was definitely between a rock and a hard place. Ischemia refers to a restriction or blocking of blood supply as by A-Fib clots. She needed to be on blood thinners to prevent A-Fib clots from forming particularly in her LAA, but couldn’t tolerate blood thinners which caused her bleeding problems. An LAA occlusion device was pretty much her only option.]

The LAmbre LAA occlusion device (LifeTech Scientific) seems similar to the Amplatz (St. Jude Medical) as both are fully recapturable and repositionable within the LAA. But each has its own anchor design to hold the device in place. But the LAmbre can fit into smaller size Left Atrial Appendages.

Both the Amplatz Amulet and the LAmbre occlusion devices are approved for use in Europe, but neither is approved yet in the U.S. (Not surprising since the U.S. approval  of the Watchman device also lagged the European approval.)

I predict the Amplatz Amulet from St. Jude Medical will soon be approved by the FDA for use in the U.S.

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If you find any errors on this page, email us. Last updated: Monday, February 6, 2017

2017 AF Symposium: World-Wide Studies on Genetic A-Fib

Patrick Ellinor, MD

P. Ellinor, MD

AF Symposium 2017

World-Wide Studies on Genetic A-Fib

Dr. Patrick Ellinor of Massachusetts General Hospital, Boston MA, updated everyone on the world-wide effort to identify the genetic basis of A-Fib.

What are the genetic variants associated with A-Fib? In previous research Dr. Ellinor showed, among other findings, that A-Fib is inheritable and that there is a 40% increased risk of developing A-Fib if a relative has it. (See my earlier report: Genetics of A-Fib 2012 AF Symposium.)

World-Wide Effort to Study A-Fib Genetics and Genome Sequencing

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.

There’s a 40% increased risk of developing A-Fib if a relative has it.

A-Fib Genetic “Fingerprint” May Help Identify Those at Risk of Stroke

Dr. Ellinor reported that using a genetic “fingerprint” of A-Fib helps to identify those patients at the greatest risk of a stroke. While still a research tool, this approach could be used to identify those patients at risk for either developing A-Fib or a stroke.

A-Fib genetic research and genome sequencing could someday identify the pathways and potential therapeutic targets of A-Fib.

In the future, genetic research may refine stroke risk models such as CHA2DS2-VASc and HAS-BLED to better target who may actually need anticoagulants and who can safely take them.

Participate in A-Fib Genetic Studies

Familia Atrial Fibrillation at A-Fib.comIf you and at least 3 other members of your family have A-Fib, you can become involved in this potentially very important research. Contact the studies at Mass. General Hospital or Vanderbilt University.

Patrick T. Ellinor, MD, PhD, Director, Cardiac Arrhythmia Service
Marisa Shea, RN,  Research Nurse
Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
617-724-7780, Email: mshea1(at)partners.org

Vanderbilt University also welcomes families with A-Fib for their genetic studies. Contact the Vanderbilt Atrial Fibrillation Registry (they also have an AF Ablation Registry)

Diane Crawford, RN
Vanderbilt University Medical Center, 1266 MRB IV, Nashville, TN 37232-0575
(615) 322-0067, Email: Diane.n.crawford(at)vanderbilt.edu

Recent Post: For more about genetic Atrial Fibrillation, see my post, Inherited A-Fib? Is it More Risker for Family Members?

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If you find any errors on this page, email us. Last updated: Monday, February 6, 2017

2017 AF Symposium: New Insights into the Effects of Obesity on Atrial Fibrillation

Jose Jalife, MD

Jose Jalife, MD

AF Symposium 2017

New Insights into the Effects of Obesity on Atrial Fibrillation

Dr. Jose Jalife of the University of Michigan, Ann Arbor, MI, discussed the “Obesity Paradox”. The Paradox is a hypothesis that obesity may be protective and associated with greater survival with certain chronic diseases. Dr. Jalfie showed how and why this is not the case with Atrial Fibrillation.

Under normal conditions, the surface of the heart (epicardium) is covered by fat stored in the tissue (called adipose tissue).

A-Fib is often associated with increased volume of epicardial fat. This increased volume lengthens the duration of A-Fib episodes and results in fibrotic remodeling of the adipose tissue.

In addition, fatty acids both shorten the ‘action potential’ and increase the ‘dominant frequency’ (factors in the initiation and maintenance of AF signals). This leads to fibrosis (fibrofatty infiltration) of the epicardial fat. Altogether, they perpetuate Atrial Fibrillation signals and episodes.

“Obesity Paradox” Doesn’t Apply

Excessive epicardial fat is bad for those with A-Fib. Thanks to Dr. Jalife’s research, we can rule out the “Obesity Paradox” with regards to obesity and A-Fib. Increased epicardial fat:

• Increases the duration of A-Fib
• causes fibrotic remodeling of the adipose tissue
• Increases fatty acids

Thanks to Dr. Jalife we are beginning to understand how and why obesity affects the heart and A-Fib.

Surgery of Obese Patient―My Observations

At a 2016 conference in Zürich, I watched a live A-Fib surgery of an obese patient. It was incredible how many layers of yellow fat bundles the surgeon had to cut through before reaching the heart.

If a video of this surgery were shown to A-Fib patient who are significantly overweight, it could be quite motivating. When you actually see the epicardial fat layers Dr. Jalife talks about, it makes a frightening, ‘come-to-Jesus’ impression.

What Patients Need to Know

Weight Loss and A-Fib: Research has shown that just losing weight and exercising, by themselves, can reduce and even eliminate A-Fib.

Recurrence Rates: In addition, many EPs today won’t perform a catheter ablation on someone who is obese, because their recurrence rates are very high compared to normal patients.

If you have A-Fib and are significantly overweight (not just a few pounds), you can expect to hear a lecture from your EP/doctor that you should lose some weight.

For more, see Weight Loss Key to Reverse Atrial Fibrillation, Improve Ablation Success.

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A-Fib Increases Fibrosis by 5%-10% Per Year

Nassir Marrouche MD

N. Marrouche MD

AF Symposium 2017

A-Fib Increases Fibrosis by 5%-10% Per Year

Dr. Nassir Marrouche of the University of Utah (CARMA), Salt Lake City, UT continued his ground-breaking work using MRI to investigate Atrial Fibrillation.

Some of the major contributions Dr. Marrouche’s MRI research has made include that patients with high fibrosis levels are at greater risk of stroke and that they may be precluded from a successful catheter ablation.

(For more about stroke risk, see Dr. Marrouche’s High Fibrosis at Greater Risk of Stroke and Precludes Catheter Ablation: Lessons Learned from the DECAAF Trial.)

Magnetic resonance imaging (MRI) is a technique that uses a magnetic field and radio waves to create detailed images of organs.

Fibrosis Develops Rapidly, Within One Year

Dr. Marrouche’s latest research shows that about 35% of patients with A-Fib will experience more than 5%-10% of fibrotic changes within 1 year. (This is a frightening statistic, since fibrosis is currently considered irreversible.)

He also described how the more fibrosis a patient has, the more likely the patient will have a recurrence after an A-Fib ablation.

He also showed how current MRI testing also measures fibrosis in 3D to better gauge its thickness.

New Study Ablating Fibrosis

Dr. Marrouche also described a new clinical trial (DECAAF II) that will compare standard Pulmonary Vein Isolation (PVI) ablation to ablation of fibrosis areas.

The more fibrosis a patient has, the more likely the patient will have a recurrence after an A-Fib ablation.

What Patients Need To Know

A-Fib produces fibrosis quickly and harms your heart permanently. This fibrosis produces collagen and scarring in the heart which is a permanent remodeling effect of A-Fib.

And what a wake-call for A-Fib patients―that A-Fib fibrosis can and does develop so rapidly! Within one year of living in A-Fib, your heart can become 10% fibrotic which is irreversible. How truly frightening!

Dr. Marrouche’s Message: Don’t live in A-Fib! The message from Dr. Marrouche’s research is obvious. Don’t live in A-Fib!!! Do everything you can to be restored to normal sinus rhythm.

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2017 AF Symposium: Some Forms of Fibrosis May Be Reversible

Dr. Stanley Nattel, U of Montreal

S. Nattel, MD

AF Symposium 2017

Some Forms of Fibrosis May Be Reversible

Background: Fibrosis is tissue with fiber-like characteristics; over time it makes the heart stiff, less flexible and weak, overworks the heart, reduces pumping efficiency and leads to other heart problems.

Dr. Stanley Nattel of the University of Montreal, Montreal, Canada discussed whether fibrosis is reversible. In a very hopeful study for Atrial Fibrillation patients, he concluded that some forms or types of fibrosis are indeed reversible.

Heart Attack Fibrosis

Dr. Nattel described a typical heart attack victim who experiences actual heart tissue damage and areas of heart tissue death. In these damaged heart areas, fibrous tissue replaces dead cardiomyocytes (scarring). This form of fibrosis may be irreversible.

A 30% weight lost reduced fibrosis in overweight sheep, as well as inflammation and incidence of A-Fib.

Interstitial (A-Fib) Fibrosis

But A-Fib fibrosis is often “purely interstitial” or reactive to the A-Fib. (“Interstitial” refers to the space between cells or myocytes.) This type of fibrosis may indeed be reversible.

Dr. Nattel described his experiments with overweight sheep. A 30% weight lost reduced fibrosis (collagen formation) in these overweight sheep, as well as inflammation and incidence of A-Fib.

(For more research findings, see Dr. Jose Jalife’s experiments in sheep which reduced fibrosis by 50%: The Holy Grail: Preventing A-Fib by a GAl-3 Inhibitor.)

What Patients Need to Know

Some A-Fib Fibrosis May Be Reversible: This is encouraging for A-Fib patients. Even if you develop fibrosis from being in A-Fib, some of this fibrosis may be reversible.

Returning to normal sinus rhythm may reverse a good deal of fibrosis in your heart.

But much more research needs to be done to figure out how best to reverse A-Fib fibrosis. And some long-term A-Fib fibrosis may indeed be irreversible when it produces lasting scarring (dead fibrotic tissue).

Don’t Live in A-Fib and Develop Fibrosis: If you have A-Fib, you are most likely developing a fibrotic heart. The good news from Dr. Nattel (and Dr. Jalife) is that returning to normal sinus rhythm may reverse a good deal of fibrosis in your heart.

In spite of what you hear in today’s media and advertisements, don’t just live in A-Fib and develop fibrosis! Seek your cure!

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HEART TEAM: Multidisciplinary Arrhythmia Meeting (MAM) 2016

Multidisciplinary Arrhythmia Meeting 2016

With Dr. Stefano Benussi, my host in Zurich

Totally 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”.

My Summary Reports

Report Topic Publication Date
3 Fantastic 3-D Experience of the Heart, Dr. Joris Ector,
U. of Leuven, Belgium
Oct 7, 2916
2 My Challenge to Doctors – Transcript of My Speech Oct. 6, 2016
1 MAM 2016: Moving A-Fib Care to a New Level (Overview) Oct 3, 2016
Steve Ryan: Multidisciplinary Arrhythmia Meeting (MAM) ,Zurich, Switzerland in October 2016

Steve Ryan: Multidisciplinary Arrhythmia Meeting (MAM), Zurich, Switzerland in October 2016

Return to Reports of A-Fib Medical Symposiums & Conferences
Last updated: Tuesday, January 24, 2017

Archive: Steve’s Reports of Atrial Fibrillation Medical Conferences

♥  International AF Symposium

Reports grouped by year (2002 to present)

♥  Other Atrial Fibrillation Medical Meetings and Conferences
HEART TEAM: Multidisciplinary Arrhythmia Meeting (MAM) 2016 Multidisciplinary Arrhythmia Meeting 2016
Western Atrial Fibrillation Symposium 2016 western-af-symposium-rev-240-x-100-pix-at-96-res
International Symposium on Left Atrial Appendage 2015

Return to A-Fib.com home page
Last updated: Tuesday, January 24, 2017

2017 AF Symposium: Hypercoagulability May Cause A-Fib, NOACs May Prevent It

Dr Ulrich Schotten of the University of Maastricht - A-Fib.com

U. Schotten, MD

AF Symposium 2017

Hypercoagulability May Cause A-Fib, NOACs May Prevent It

Novel oral anticoagulants (NOACs) may both prevent and stop A-Fib, according to a thought-provoking hypothesis by Dr. Ulrich Schotten of the University of Maastricht, Maastricht, The Netherlands.

We know that untreated A-Fib increases the risk of stroke 4-5 times and causes decreased blood flow (ischemia). A-Fib also increases the heart’s tendency for blood to coagulate and form clots (hypercoagulability).

Hypothesis

Dr. Schotten presented a different, somewhat contrary, and thought-provoking hypothesis that flips current thinking― that hypercoagulability increases and promotes A-Fib (versus A-Fib increasing hypercoagulability).

The anticoagulant Nadroparin reduced hypercoagulabity…inhibited the development of A-Fib in these mice.

Research with mice: Working with specially designed mice with increased thrombin activity (hypercoagulated mice), Dr. Schotten found that these mice had increased atrial fibrosis and A-Fib, that a hypercoagulated state promotes atrial fibrosis and A-Fib. Coagulation factors produce profibrotic and proinflammatory responses which can both induce and maintain A-Fib.

The anticoagulant Nadroparin used primarily in surgery (brand name fraxiparine or fraxodi) was used in these mice to reduce their hypercoagulabity. This inhibited the development of A-Fib in these mice.

Dr. Schotten found that Novel Oral Anticoagulants (NOACs), but not warfarin, inhibit collagen synthesis (atrial fibrosis) by reducing the activity of Protease Activated Receptors (PARs).

What Patients Need to Know

No one should be taking an anticoagulant unless there is a real risk of stroke. Taking an anticoagulant is not like taking a multi-vitamin.
Anticoagulants, in general, are considered high risk drugs. They work by causing or increasing bleeding.  But the increased risk is certainly better than having an A-Fib stroke. However, no one should be taking an anticoagulant unless there is a real risk of stroke. Taking an anticoagulant is not like taking a multi-vitamin.

Dr. Schotten’s preliminary research indicates there may be a special benefit to taking NOACs. Not only do they reduce hypercoagulability and thereby work to prevent A-Fib strokes, but they may both prevent and stop A-Fib. This is a ground-breaking hypothesis which may lead to major advances in A-Fib research and treatments.

See our library of videos about Atrial Fibrillation - A-Fib.com

More About Dr. Ulrich Schotten

See a short video by Dr. Schotten: Digital tools for personalized therapy of cardiac arrhythmia presentation at the European Health Science Match, October 2016. (3:11 min.)

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If you find any errors on this page, email us. ♥ Last updated: Monday, February 6, 2017

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.

Links Between Inflammation, Oxidative Stress and A-Fib

AF Symposium 2017

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.

Recommended Further Study

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.

Second Dr. Van Wagoner Presentation: Prevention of A-Fib

In a second talk, Dr. Van Wagoner built on his earlier presentation and laid out a game plan for research priorities to prevent Atrial Fibrillation:

1. Find the mechanisms underlying ectopy (extra beats). Why does ectopy predominately result in A-Fib in older people?
2. Identify the genes. signaling pathways, and mechanisms that impact the risk of A-Fib. How are they modifiable?
3. Determine the stages in A-Fib progression where reducing risk factors (obesity, sleep apnea, etc.) can reverse remodeling or prevent A-Fib progression.
4. Develop preventive strategies based on A-Fib mechanisms (atrial ectopy, oxidant stress, proteostasis, fibrosis, etc.)

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.

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

AF Symposium 2017

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: Monday, February 6, 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

AF Symposium 2017

My Summary Reports Written for A-Fib Patients

Steve Ryan in Orlando Jan 2017 for AF Symposium

Steve Ryan in Orlando Jan 12-14, 2017

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.

Archive Link: How to find my reports from all Atrial Fibrillation-related medical conferences

REPORT TITLE PRESENTER (S) DATE POSTED
11. LIVE VIDEO: Ablation using CardioFocus HeartLight Endoscopic Visually Guided Laser Balloon Drs. Peter Neuzil, Jan Petru and Jan Skoda, Na Homolce Hospital, Prague, The Czech Republic. Feb. 11, 2017
10, LIVE VIDEO! Two Procedures—Different Left Atrial Appendage (LAA) Occlusion Devices Drs. Claudio Tondo, Antonio Dello Russo, Gaetano Fassini, and Massimo Moltrasio, Milan, Italy Feb. 3, 2017
9. World-Wide Studies on Genetic A-Fib Dr. Patrick Ellinor of Mass. General Hospital, Boston MA Feb. 1, 2017
8. New Insights into the Effects of Obesity on Atrial Fibrillation Dr. Jose Jalife of the University of Michigan, Ann Arbor, MI Jan 28, 2017
7. A-Fib Increases Fibrosis by 5%-10% Per Year Dr. Nassir Marrouche of the University of Utah (CARMA), Salt Lake City, UT Jan 27, 2017
6. Hypercoagulability May Cause A-Fib, NOACs May Prevent It Dr. Ulrich Schotten of the University of Maastricht, Maastricht, The Netherlands Jan 27, 2017
5. Some Forms of Fibrosis May Be Reversible: Research with Overweight Sheep Dr. Stanley Nattel of the U. of Montreal, Montreal, Canada Jan 23, 2017
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
Archive: Link to my 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: Saturday, February 11, 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.

For example, why should a man with hypertension be given 1 point on the stroke risk score, while a woman with hypertension is given 2 points? Even if under the new European Guidelines, a man with 1 point is treated the same as a woman with 2 points, does this make any sense? It sounds like the writers of the Guidelines recognize their error and bias against woman (probably influenced by drug companies), but won’t actually change the guidelines so as not to lose face and acknowledge their error.

Return to 2017 AF Symposium reports
If you find any errors on this page, email us. ♥ Last updated: Friday, January 27, 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, Jan. 17, 2017, updated Feb. 3, 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. (See below.)

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.

Live Ablation Cases via Streaming Video

As expected, the second day of the conference featured streaming video of live, in-progress case presentations. Watching LIVE catheter ablations on floor-to-ceiling display screens was one of the most interesting and exciting features of the AF Symposium.

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

• Na Homolce Hospital, Prague, the Czech Republic
• University of Milan Centro Cardiologica Monzino, Milan, Italy
• Massachusetts General Hospital, Boston, Massachusetts, U.S.
• Loyola University Medical Center, Chicago, IL, U.S.
• Texas Cardiac Arrhythmia Institute, Austin, TX, U.S.

The sheer technical complexity of producing these live videos 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.)

They didn’t simply present the live cases in order one by one. Rather, they would inter-cut between on-going ablations. As one center finished a particular stage in an ablation, they would cut to another center around the world.

The moderators, Dr. Jeremy Ruskin and Dr. Moussa Mansour from Mass General would talk with the various EPs doing the ablations, and even take questions from the audience (some answered by the moderators and some answered by the remote EPs). Then on-the-fly they would cut to another center or back to one ready to proceed further in their ablation task.

Tthe Friday ‘Morning Scientific Session’ (7am-10:30am) was the most well attended session.Agenda & Short Presentation Topics

In addition to the Featured Presentations, there were fifty-three short presentations (15 minutes), 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 2017 AF Symposium Reports
If you find any errors on this page, email us. Last updated: Monday, February 6, 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.

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