Obstructive Sleep Apnea (OSA) is so common that at least 43% of patients with Atrial Fibrillation also suffer with it. For that reason alone, you should be tested for sleep apnea.
Aside from causing or triggering A-Fib, untreated sleep apnea can cause many other serious health threats.
Got Sleep Apnea? Your Life-Threatening Risks
Researchers at the U. of Wisconsin examined 22-years of mortality data on the study’s participants and found the following:
The Wisconsin Sleep Cohort Study
Beginning in 1989, the U. of Wisconsin study used a random sample of 1,522 Wisconsin state employees. The participants underwent overnight sleep apnea studies and many other tests at four-year intervals. They were not selected because they had known sleep problems. (After the testing, researchers contacted participants with severe sleep apnea and explained the health risks.)
The study reveals the numerous life-altering and life-threatening health issues associated with sleep apnea.
Sleep Apnea: a condition in which one or more pauses in breathing occur while sleeping, pauses can last a few seconds to minutes and can occur 30 times or more an hour.
More EPs are Sending Patients for Sleep Studies
So many A-Fib patients also suffer from sleep apnea that many Electrophysiologists (EPs) routinely send their patients for a sleep apnea study. Some A-Fib centers have their own sleep study program. (The patient just walks down the hall to an A-Fib sleep study area.)
For some lucky patients, normal sinus rhythm (NSR) can be restored just by controlling their sleep apnea and getting a good night’s sleep.
Take Action: Sleep Apnea Can be Lethal
The Wisconsin Sleep Study findings demonstrate just how lethal sleep apnea can be. Sleep apnea isn’t a minor health problem, and it’s a condition you can do something about. (Just like A-Fib, you don’t have to just live with it).
If your significant other tells you that you pause breathing when you sleep or that you snore, do something about it! (Not everyone with sleep apnea snores, but snoring may indicate sleep apnea.)
Talk with your doctors about testing for sleep apnea. You may need an in-lab sleep study (or the newer option of a home sleep test).
Learn More About Sleep Studies
Read about in-lab and in-home sleep studies in our article, Sleep Apnea: Home Testing with WatchPAT Device and the Philips Respironics
On a Personal Note: My wife has sleep apnea (but not A-Fib). While sleeping, she would actually stop breathing for what seemed like a long time, then suddenly gasp for air. It was very scary! But now she uses a CPAP machine, sleeps soundly and wakes up rested.
Sleep apnea may run in families. Her brother has sleep apnea also.
We can now say that CryoBalloon ablation is better than RF, at least according to a secondary analysis of a recent clinical study.
In the FIRE AND ICE clinical trial by Dr. Karl-Heinz Kuck and his colleagues, 762 patients with symptomatic paroxysmal A-Fib were randomized into two groups, either RF catheter ablation or CryoBalloon ablation.
Results: Many findings were comparable. Both groups had similar results in terms of primary efficacy and safety endpoints. Furthermore, both groups had improvement in quality of life over 30 months of follow-up.
Where Results Diverged: Re-Hospitalization and Recurrence
While many of the outcomes were similar between the two groups, there were some significant differences. The CryoBalloon group had lower rates of re-hospitalization (32% with CryoBalloon versus 41.5% with RF catheter ablation). In addition, the CryoBalloon patients had fewer:
• Cardiovascular re-hospitalizations (23.8% vs 35.9%)
• Repeat ablations (11.8% vs 17.6%)
• Direct current cardioversions (3.2% vs 6.4%)
According to lead researcher, Dr. Kuck:
“The secondary analysis (of the FIRE AND ICE study) favors CryoBalloon over (RF ablation), with important implications [for EPs] on daily clinical practice.”
Dr. Wilber Su of Banner-University Medical Center in Phoenix, who was not part of this FIRE AND ICE study, concluded:
“…for most operators, CryoBalloon may be a safer and more efficient approach… . In my practice, CryoBalloon has already become the preferred approach both from personal experience as well as patient demand.”
What Patients Need to Know
Which ablation procedure is better—RF or CryoBalloon? According to the FIRE AND ICE clinical trial, we can now say that CryoBalloon is better in terms of less re-hospitalizations, repeat ablations and recurrences within a 30 month period.
More important than the energy source used to perform the ablation, is the skill and experience of the operator (EP).
Don’t Avoid RF: In practical terms, the differences weren’t so great that you should avoid EPs who prefer to use RF.
Dr. Su points out that many electrophysiologists (EPs) may continue with RF ablation because being comfortable with their choice of technology is a critical factor.
Look for Skill and Experience: More important than the energy source used to perform the ablation, is the skill and experience of the operator (EP).
The Bottom Line: When researching an EP to do your ablation, look for the best, most experienced high volume operator you can find and afford, even if you have to travel.
Caveat About CryoBalloon Ablation
CryoBalloon ablation is much easier and faster to do than RF point-by-point ablation. Consequently, some operators are entering the field with little RF ablation experience on which to build or complement their Cryo skills.
Others are doing only “anatomical ablation”—only ablating the pulmonary vein openings and not looking for and ablating non-PV triggers. (Happily in many cases, this is often all that is needed, particularly in cases of recent onset or Paroxysmal A-Fib.)
For more critical information about choosing your EP for a Cryoballoon Ablation, read my posts:
Many surgeons performing Mini-Maze or other Maze operations for A-Fib routinely ablate/destroy the Ganglionic Plexus (GP) areas on the outside of the heart which contain clusters of nerve cells.
But recent studies show this strategy is not only ineffective but causes a lot of complications.
AFACT stands for Atrial Fibrillation and Autonomic modulation via Thoracoscopic surgery
The AFACT Trial: Mini-Maze Surgeries for Paroxysmal or Persistent A-Fib
The 2016 randomized clinical trial from Amsterdam in The Netherlands included 240 participants who underwent mini-maze surgeries: totally thoracoscopic pulmonary vein isolation for paroxysmal A-Fib or isolation plus Dallas lesion set for persistent A-Fib.
Approximately half also received ganglionic plexus ablation in which four major ganglionic plexus were ablated as well as the ligament of Marshall in the ganglionic plexus group. Patients were followed for one year.
Results: Ablating GPs—No Clinical Benefit, More Complications
The researchers found no clinical benefits associated with ganglion plexus ablation added to a thoracoscopic ablation strategy, and significantly more complications.
There were significantly more recurrences in the ganglionated plexus group (78.1%) than in the control group (51.4%). And what is worse, more than double the number of major adverse events occurred in the ganglionic plexus group such as major bleeding and sinus node dysfunction which required pacemaker implantation.
Presenting at 2016 Heart Rhythm Society scientific session, researcher Dr. Joris R de Groot stated that “ganglionic plexus ablation is associated with significantly more periprocedural major bleeding, sinus node dysfunction and pacemaker outcome, but not with improved rhythm outcome.”
He concluded that routine ganglionated plexus ablation offers “no clinical benefit” in this patient category, and “should not be performed.”
The 2016 AFACT trial may finally have determined that ablating GPs doesn’t work.
What Patients Need to Know
Surgery Not Recommended as First Choice Treatment for A-Fib: Current guidelines do not recommend surgery as a first choice or option for A-Fib. Surgery is generally more invasive, traumatic and risky than a simple catheter ablation procedure.
Routine ganglionated plexus ablation offers “no clinical benefit” and causes major permanent complications.
Most current surgical strategies have built in limitations. For example, if you have A-Flutter coming from the right atrium, current surgical techniques don’t access the right atrium or some other non-PV trigger sites. See Cox-Maze, Mini-Maze and Hybrid Surgeries. In such cases, one often needs a catheter ablation after the surgery.
Make Sure Your Surgeon Doesn’t Ablate Ganglionic Plexus Areas: If you have to have surgery for A-Fib, make sure your surgeon does not ablate the ganglionic plexus areas as part of his A-Fib surgery. Ablating the ganglionic plexus areas doesn’t improve ablation results and causes more major permanent complications. As Dr. de Groot unequivocally states, ganglionic plexus ablation “should not be performed.”
The Bottom Line if Having Mini-Maze Surgery
If you have to have surgery for A-Fib (versus a catheter ablation by an EP), make sure you ask the surgeon if they ablate the ganglionic plexus areas as part of your A-Fib surgery. (Don’t expect a surgeon to volunteer this info. You have to ask!)
If they say yes, hand them a copy of this post. Then find another surgeon.
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.
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.
Utah! What a wonderful winter venue for the Ninth Annual Western Atrial Fibrillation Symposium held February 26-27, 2016.
After having just attended the January 2016 AF Symposium in Orlando, FL, I was surprised at how much new, relevant 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.
A study of brain atrophy from Iceland found that A-Fib in the elderly caused accelerated loses of brain volume and cognitive function.
This is yet another study driving a stake into the heart of the notion that you can just leave patients in A-Fib with anticoagulants and rate control drugs, and they will live happily ever after.
“It’s better for the brain to remain in sinus rhythm than to pursue rate control of A-Fib” stated Dr. David O. Arnar, speaking of the AGES-Reykjavik Study results at the 2015 Euro Society of Cardiology Annual Congress.
The AGES-Reykjavik Study
Over two thousand elderly subjects without dementia (mean age 67 years old) were tested and followed for over 5 years. Participants had brain MRIs and structured cognitive function testing during the duration of the study.
The 2,472 elderly patients fell into three groups: those who remained A-Fib-free throughout the study, those with confirmed A-Fib at the start (121), and those who developed new-onset A-Fib (132) by the end of the study.
AGES Findings: Brain Matter
At the end of the follow-up period, all participants had a reduction in brain grey matter. The amount of reduction varied significantly by group:
• A-Fib-free: 1.8% decrease
• Ongoing A-Fib: 2.79% decrease
• New-onset A-Fib: 6.5% decrease
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.
You might want to start with two presentations by the A-Fib research pioneer1, Dr. Michel Haissaguerre of Central Hospital, Bordeaux, France (he cured my A-Fib in 1998):
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
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.
- 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.↵
by Steve S. Ryan, PhD
The Watchman device closes off the Left Atrial Appendage (LAA), the source of most clots and A-Fib strokes.
The Watchman has been available in other countries since 2009, but only since 2015 in the US.
Answers From Australia
A five-year study in Australia by Dr. Karen Phillips and her colleague, Dr. TW Walker, gives us ‘real world’ data and insights. Specifically, she studied combining the Watchman device with a catheter ablation for treating Atrial Fibrillation patients.
I’ve corresponded with Dr. Karen Phillips to help me answer your questions about the Watchman device.
“Can the Watchman be installed at the same time as my ablation?“
Yes. Dr. Karen Phillips and several Electrophysiologists (EPs) in Europe have been doing this for over five years with no complications. She hasn’t seen any downside to doing the two procedures together. There’s very little, if any, experience in the US of combining a PVI with a Watchman device (US approved in 2015).
“Should the Watchman be installed at the same time as my ablation?“
First answer: should the LAA be closed off? (Surgeons, unlike EPs, routinely remove the LAA in A-Fib surgery.) But the LAA isn’t a useless appendage and it has several functions. Younger people, especially the athletic, might be compromised by having their LAA closed off. (See LAA Important for Heart health.) There are many arguments for not routinely closing off the LAA in everyone. … Continue reading this report…->
Want the latest on emerging treatments for Atrial Fibrillation? The most recent research findings? From the best in the world? Me too! That’s why I attend the annual AF Symposium held each January in Orlando, FL.
The 2016 AF Symposium brought together the world’s leading cardiologists, medical researchers and scientists to share the most recent advances in the field. It is one of the most important medical conferences on Atrial Fibrillation in the world.
What this Means to You
My aim is to pare down the significant research findings to the essentials and ‘translate’ them into plain language (as much as possible) for A-Fib patients and their families. I then add my own comments and insights.
You won’t find this information in this format anywhere else.
My Overview and First Reports
Begin with my Overview. Find out what was the Most Discussed topic! And the Most Controversial topic! I also give you a few highlights and a list of conference topics. Look for my first summary reports starting later this week.
Start here: go to my AF Symposium Overview.
There have been few randomization trials directly comparing CryoBalloon ablation to RF ablation.
That’s why Dr. Armin Luik and his colleagues developed the FreezeAF clinical trial―to directly compare CryoBalloon ablation to RF ablation for treating patients with paroxysmal atrial fibrillation. Dr. Luik (U. of Freiburg, Karlsruhe, Germany) presented the study results at the May 2015 meeting of the Heart Rhythm Society.
FREEZEAF Trial: Patients and Method
In the FREEZEAF study, 315 paroxysmal A-Fib patients with a mean age of 60 years were randomized to either a CryoBalloon ablation (n=156) or a RF ablation (n=159) of the pulmonary veins. Clinical follow up was at three, six, nine and 12 months.
The FREEZEAF Study Results
The FreezeAF trial researchers noted that a number of CryoBalloon ablation studies have demonstrated its efficacy and safety for treatment of A-Fib, but few studies have compared the two techniques head-to-head.
How did Cryoballoon compare to RF Ablation? … Continue reading this report…->
Resveratrol is a natural and safe compound found in certain plants, has antioxidant properties and is known to improve cardiovascular health. It is found in red wine, red grape skins and seeds, peanuts and other foods.
A new medicine based on resveratrol, a ‘resveratrol derivative compound 1’ (C1), was effective in reducing the duration of A-Fib episodes in animal studies.
Dr. Peter Light of the University of Alberto, Edmonton, Canada published this study in the British Journal of Pharmacology. (This resveratrol research was funded by the Canadian Institute of Health Research and TEC Edmonton, with additional support from the Center for Drug Research and Development.)
How Does Resveratrol Work?
‘Resveratrol derivative C1’ seems to work by targeting multiple pathways involved in A-Fib, not just one or two as is the case with many current A-Fib drugs. These pathways include several ion channels as well as “pathways that cause adverse restructuring of the atria that may lead to A-Fib.”
Dr. Light thinks that the first in-human trials of ‘resveratrol C1’ may start in two-to-five years.
It’s highly unlikely that the ‘resveratrol derivative C1’ will be significantly better than natural resveratrol.
What This Means to A-Fib Patients
What’s important in this animal study is that a type of resveratrol reduced the duration of A-Fib episodes.
The beneficial effects of Resveratrol on cardiovascular health is well-documented. But, its usefulness for A-Fib patients requires more research. It’s possible Resveratrol could work as a ‘pill-in-the-pocket’ to reduce the duration or stop A-Fib episodes without the need for antiarrhythmic drugs.
Sources of Resveratrol
You don’t have to wait for Dr. Light’s trials to benefit from Resveratrol. (It’s highly unlikely that the ‘resveratrol derivative C1’ will be significantly better than natural resveratrol.) Resveratrol occurs naturally in red wine, red grape skins and seeds, grape juice, peanuts, mulberries, and some Chinese herbs. Resveratrol supplements are also available.
Caution: Resveratrol supplements could interact with medicines like blood thinners, blood pressure drugs, NSAID painkillers, and supplements like St. John’s wort, garlic, and ginkgo.
Talk with your doctor or healthcare provider before adding Resveratrol supplements to your diet.
To learn more about Resveratrol as a supplement, go the Memorial Sloan Kettering Cancer Center/Integrative Medicine database, About Herbs, Botanicals & Other Products, Resveratrol.
NOTE: In the US, substances found in nature like resveratrol cannot usually be patented by pharmaceutical companies and thus be under the control of the FDA. (This isn’t the case in other countries where natural substances are often regulated like drugs and consequently are often difficult to obtain.)
However, pharmaceutical companies can sometimes get around this restriction by making a change in the structure of a natural substance. Now it can be patented because it is no longer ‘natural’. Then it’s up to pharmaceutical reps to convince doctors to prescribe the patented version rather than the natural (and cheaper) substance.
An analysis of 50 years of data from the Framingham Heart Study reveals good news and bad news for A-Fib patients.
Sadly, the number of people with A-Fib has more than quadrupled over the last 50 years!!!
But happily there was a 75% reduction in stroke rate (1998-2007 compared to 1958-1967). And, there was a 25% reduction in mortality after diagnosis of A-Fib.
What This Means to Patients: The Good News
Thanks in large part to warfarin (and the development of catheter ablation procedures), stroke rates over the years have declined by an amazing 75%. (Note: the new anticoagulants weren’t in use until after this study.)
As much bad press as warfarin has received and with all of warfarin’s bad side effects, we have to recognize that warfarin kept a lot of people from having a stroke. For years warfarin was the only game in town. Warfarin saved a lot of lives and disabling strokes.
New Therapies to Stop A-Fib and Prevent Stroke
The authors of this study talk about “therapeutic successes for atrial fibrillation” which have increased survival. Catheter ablation (and surgery) have certainly given A-Fib patients hope of a cure, when before all they could do is live with A-Fib and die from it.
New Anticoagulants (NOACs) Likely to Further Reduce Stroke Rate
The new anticoagulants (NOACs) will likely further reduce the A-Fib stroke rate. Eliquis, in particular, may be a major improvement over warfarin. Eliquis tested better with a better safety record than the other NOACs.
What This Means to Patients: The Bad News
Four times more people are developing A-Fib compared to the last five decades. A-Fib has rightly been called an epidemic. One out of four people over 40 will develop A-Fib in their lifetime. Today 1 out of 10 people over 80 years old has A-Fib.
Silent (no symptoms) A-Fib has emerged as a major killer. Of those who suffer a stroke, 20% later discover that they had silent A-Fib which probably caused their stroke.
The Good, the Bad and the Ugly
But even if all the EPs were perfectly trained and could work 24-hour days 7 days a week, they would barely put a dent in the huge number of new people developing A-Fib.
We may be facing a future where many new A-Fib patients may have to rely on drugs to cope with A-Fib.
But the current record for drug therapy isn’t good. There haven’t been any new antiarrhythmic drugs developed to stop A-Fib (with the possible exception of Tikosyn). Almost all current antiarrhythmic drugs either have bad side effects or aren’t effective for most patients. And if they do work, they often lose their effectiveness over time.
Don’t let this data discourage you. Seek your cure NOW. See an electrophysiologist about treatment options to cure your A-Fib.
Much media attention has been paid to the importance of testosterone in men and how testosterone levels tend to decrease with aging. But few studies have looked at how low testosterone affects A-Fib and A-Fib stroke risk.
Low Testosterone Can Cause or Trigger Stroke
Low Testosterone can be responsible for or trigger acute ischemic stroke, stroke severity, and related death in men, according to Dr. George Eby of the George Eby Research Institute. Low testosterone is also associated with coronary disease, myocardial infarction (heart attack) in men, and with all-cause mortality in men.
Case Studies: Testosterone Cures A-Fib in Aging Men
In an article in the journal, Cardiology, Dr. Eby described cases where Testosterone Therapy (TT) made aging men A-Fib free.
|Case #1:||A 59-year-old man with a low Testosterone level of 361 ng/dl had daily A-Fib episodes for the last year. Other than PACs, he had no other heart problems.|
|Within 45 days of daily Testosterone Therapy (TT), his serum Testosterone rose to 1,489 ng/dl, and he had no instances of A-Fib and very few PACs. (After the second week of TT, his INR increased from 2.5 to 5.4 which required his Warfarin dosage to be lowered.)|
|Case #2:||A 59-year-old man had strongly symptomatic nocturnal paroxysmal A-Fib and depression. His serum Testosterone was only 150 mg/dl which is much lower than normal. Previously he had had congestive heart failure and persistent A-Fib which had been treated with ablation and cardioversion.|
|He received both DHEA (25 mg/day) and natural testosterone (50 mg/day) as a gel applied to his shoulders. After Testosterone Therapy, his depression and ectopics ended with only two observed instances of A-Fib after two weeks.|
Dr. Eby’s Conclusions
• “Testosterone Therapy (TT) is necessary, safe, and superior to antiarrhythmic drugs, and may prevent A-Fib and stroke in aging men.” According to Dr. Eby, “TT is a necessary, superior and safe natural rhythm treatment for A-Fib.” “TT may play an important role in treating A-Fib and preventing stroke in aging men.”
• “Testosterone is low in men with Lone A-Fib.” Testosterone has been shown to be low in men with lone A-Fib compared to non-A-Fib controls.
• “Beta-blockers lower testosterone [levels] in men.” Dr Eby also pointed out that beta-blockers lower testosterone in men.
• “Low Testosterone is a risk factor for stroke and death in men.” Testosterone is an independent risk factor for acute ischemic stroke, stroke severity, and related death in men. Low Testosterone is also associated with coronary disease and with myocardial infarction (heart attack) in men, and with all-cause mortality in men.
What This Means to Male A-Fib Patients
These may be the first reported cases of Testosterone Therapy for A-Fib and to prevent stroke in men. Obviously more research then a few case studies needs to be done on this subject.
If you are an aging man with A-Fib, you should have your Testosterone level checked. And for those with low Testosterone, raising your level, besides making you feel better and more youthful, may also prevent A-Fib and stroke.
My new 2015 AF Symposium report is of special interest for patients with persistent Atrial Fibrillation.
Dr. Sebastian Knecht from CHU Brugmann, Brussels, Belgium presented preliminary findings from the AFACART clinical trial testing the effectiveness of ‘Panoramic Electrographic Non-Invasive Mapping’, specifically the CardioInsight—ECVUE System, as compared to conventional mapping and ablation procedures.
In the clinical trial, patients with persistent A-Fib receive an ablation using the ECVUE mapping/ablation system, then there is a 12-month follow-up period.
In an important change to standard ablation procedures, Dr. Knecht described the first step in the ECGI/ECVUE ablation process as ablation of A-Fib drivers (rotors and foci). This is in contrast to the ‘step-wise’ approach that begins with ablation of the openings of the pulmonary veins.
To read more, see my 2015 AF Symposium article, AFACART Clinical Trial: Preliminary Results of the CardioInsight—ECVUE System in Multiple Centers.
Dr. John Day of the Intermountain Heart Institute, discussed how A-Fib doubles the risk of having a silent stroke. Many studies have shown that A-Fib is independently associated with dementia. “AF is associated with a higher risk for cognitive impairment and dementia, with or without a history of clinical stroke.”
In one study of 11,723 patients, those with arrhythmia were 4½ times more at risk of developing dementia.
Dr. Day described four possible mechanisms that may lead to A-Fib dementia:
1. Macro/Micro Thromboembolism (strokes)
2. Cerebral Bleeds
3. Weakened Cerebral Blood Flow
4. Systemic Inflammation
For more details about A-Fib and dementia, read my complete summary of Dr. John Day’s 2015 AF Symposium report.
Dr. Josef Kautzner’s presentation demonstrated that living with “AF is more dangerous than its ablation” because of the risks of cerebral lesions and cognitive impairment. Small cerebral lesions don’t seem to cause symptoms, but obviously doctors want to avoid creating any kind of lesions on the brain if at all possible.
In MRI tests, a high proportion of A-Fib patients before ablation had silent cerebral infarctions or lesions (60%-80%). But the problem is that similar lesions were detected by MRI even in patients without documented A-Fib.
Therefore, we still do not know how much A-Fib contributes to the development of such lesions. On the other hand, their presence may explain (at least in part) the association between A-Fib and dementia.
Read my AF Symposium summary on how silent brain lesions develop, and proposed strategies to minimize the risk of silent lesions.
Dr. Hugh Calkins from Johns Hopkins University discussed the new AHA/ACC/HRS Guidelines for the Treatment of Atrial Fibrillation and how they now differ somewhat from the European (ESC) Guidelines. The AHA/ACC/HRS Guidelines are an important reference for your cardiologist and electrophysiologist. Read my summary of his presentation including these key points:
• Aspirin no longer recommended as first-line therapy (downgraded in the 2006 and 2014 guidelines);
• Gender-bias in Guidelines?: Should every woman with A-Fib be given a point on the Guidelines risk scale?;
• What Happens to Someone Taking Anticoagulants for Years?: Unlike what you hear in today’s advertising, anticoagulants are not like taking vitamins;
• Concern About Leaving Patients in A-Fib: If you leave someone in A-Fib, you may never be able to get them back into sinus rhythm.
Learn must more from Dr. Calkins presentation. Read my AHA/ACC/HRS Guidelines summary report.
A-Fib produces fibrosis (tissue that has fiber-like characteristics. Over time it makes the heart stiff, less flexible and weak). When Dr. Jose Jalife of the University of Michigan in Ann Arbor, MI, paced sheep into A-Fib, their hearts became fibrotic within a very short time and increased progressively as the sheep went from paroxysmal to persistent A-Fib.
Next, Dr. Jalife gave his sheep the a Gal-3 (protein) inhibitor. Learn the surprising results…Read more of my 2015 AF Symposium Report−>