Overview 26th International AF Symposium: A 2021 Virtual Experience

The 2021 AF Symposium was held from January 29-31. This highly focused virtual conference on Atrial Fibrillation was streamed live with over 6,200 attendees. (That’s got to be some kind of a record!)

With the COVID-19 virus and the need for social distancing, organizing and presenting this year’s AF Symposium was a major technological achievement.

Kudos to the A-Fib industry sponsors who footed the bill and made it possible for so many people to attend free of charge.

If you are new to reading my reports and summaries from the AF Symposium, I recommend you look at: “What is the Annual ‘AF Symposium’ and Why it’s Important to Patients.”

Why I Attend the Annual International AF Symposium

I’ve been attending the AF Symposium for 17 years. It provides info and discussions on Atrial Fibrillation (A-Fib) unlike any other conferences.

This year there were 104 presenters providing a wider range and more in-depth discussions of A-Fib. And having 15 live and prerecorded cases was a memorable experience.

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

But because of COVID-19 and the AF Symposium being virtual, I certainly missed being able to ask questions of the presenters and converse briefly one-on-one with them.

J. Ruskin

The General Mood

The threat and life-style disruptions of COVID-19 were intuitively felt by everyone. But thanks to the intrepid work of the AF Symposium organizers, potential problems due to COVID-19 were overcome. In fact, the structure and format of this year’s AF Symposium will probably be a model and inspiration for future Symposiums.

We were all amazed and astonished at how well the 2021 AF Symposium worked, despite the tremendous changes needed to make the Symposium virtual.

Most Talked About

The most talked about topic was, like last year, the ablation treatment Pulsed Field Ablation (PFA) by Farapulse, Inc. But unlike last year, Pulsed Field Ablation seemed like a done deal, even though it has yet to receive FDA approval. Speakers seemed to recognize how well PFA works  and that it will soon become the ablation treatment of choice for most A-Fib doctors and patients. I counted 9 talks, 5 pre-recorded or live case presentations, and 2 abstracts on PFA.

A-Fib Experts’ Presentations, Discussions and Q&A

There were 84+ different talks and one debate presented over the course of the 3-day AF Symposium (more than last year’s Symposium). All talks were short with time for virtual audience Question & Answer and discussion.

The exceptions were the 15 live and pre-recorded cases which were usually 30 minutes.  (Putting together 15 live and pre-recorded cases was another technological achievement and way more than in previous Symposiums.) And there were 22 Spotlight Session talks which were 5 minutes long spread over all three days. They featured talks by doctors discussing new and innovative products by the A-Fib industry (non-CME).

One of the innovations this AF Symposium developed was the use of two different moderators for each topic section. One was a regular Moderator, while the second was a Digital Moderator whose job was to keep track of and address questions posed virtually by attendees.

Daily Schedule and Topics Discussed

Friday, January 29

• AF Screening, Monitoring and Risk Factor Modification I (4 talks)
• AF Screening, Monitoring and Risk Factor Modification II (5 talks)
•  Real-Time and Prerecorded Case Transmissions I (4 cases)
•  Atrial Fibrillation in Patients with Heart Failure and Preserved Ejection Fraction (6 talks)
•  Early Stage and Emerging New Technologies and Drugs in Cardiac EP (7 industry talks)
•  Stroke Prevention in AF – Anticoagulation (4 talks)
•  Stroke Prevention in AF – Left Atrial Appendage Closure I (5 talks)
•  Stroke Prevention in AF – Left Atrial Appendage Closure II (4 talks, including one from the FDA’s Andrew Farb)
•  Late Breaking Clinical Trials and First Report Clinical Investigations (5 talks)

Saturday, January 30

• Early Rhythm Control in Atrial Fibrillation (5 talks plus 1 debate)
• Real-Time and Prerecorded Case Transmissions II (5 cases)
• Accelerating the Future of EP Programs and AF Ablation (4 talks)
• Early Stage and Emerging New Technologies and Drugs in Cardiac EP II (8 talks)
•  Clinical Outcomes of Catheter Ablation for Atrial Fibrillation (5 talks)
•  Pulmonary Vein Isolation: New Techniques and Technologies (4 talks)
•  Pulsed Field Ablation (PFA): Technology and Early Clinical Outcomes (5 talks)
•  Catheter Ablation for AF: Beyond Pulmonary Vein Isolation I (6 talks, 1 from Jun Dong of the FDA)

Sunday, January 31

• Catheter Ablation for AF: Beyond Pulmonary Vein Isolation II (5 talks)
• Real-Time and Prerecorded Case Transmissions III (6 cases)
•  Innovations in Catheter Ablation Technology and Clinical Workflow (5 talks)
•  Early Stage and Emerging New Technologies and Drugs in Cardiac EP III (7 talks)
•  Optimizing the Safety of Catheter Procedures for Atrial Fibrillation (5 talks)
•  Challenging Cases in AF Management (8 presenters with different cases)

Worldwide Live Cases Via Streaming and Pre-Recorded Video

These case sessions were certainly the highlight of the AF Symposium. It was like you were in the lab with the EPs doing the procedures.

I was amazed at how they were able to switch back and forth between various centers and overcome the inevitable technical challenges involving 15 live presentations from around the world.

In addition to the invaluable content, the technical achievement of so many live and pre-recorded presentations was really impressive.

We observed these “You-Are-There” presentations:

Friday, January 29:

• OVL Hospital, Aalst, Belgium. “Pulsed Field Ablation with a Circular Multielectrode Catheter”
• Southlake Regional Health Center, Toronto, Ontario, Canada. “Pulsed Field Ablation with an Over-the-Wire Catheter System”
• Massachusetts General Hospital, Boston, MA. “New Generation Left Atrial Appendage Closure Device”
• Oxford Un. Hospitals NHS Foundation Trust, Oxford, UK. “Global Substrate Mapping and Targeted Ablation with Novel Gold-Tip Catheter in De Novo Persistent AF”

Saturday, January 30:

• Un. of Milan Centro Cardiologico, Monzino, Milan, Italy. “Novel Cryoballoon System for Pulmonary Vein Isolation”
• HCA Midwest Health, Kansas City, KS. “Treatment of Incomplete Left Atrial Appendage Closure”
• Texas Cardiac Arrhythmia Institute, Austin, TX. “Ablation of Persistent AF – PVI Plus Adjunctive Ablation”
• Houston Methodist Hospital, Houston, TX. “Vein of Marshall Alcohol Ablation”
• HCA Midwest Health, Kansas City, KS (second presentation). “Non-contact Map Ablate Remap Strategy in Complex Atrial Arrhythmias.”

Sunday, January 31:

•State Research Institute of Circulation Pathology, Novosibirsk, Russia. “Renal Denervation for Atrial Fibrillation Using RF Energy”
• Mount Sinai School of Medical Center, New York, NY. “Ultra-HF Ultrasound Based Renal Denervation for Atrial Fibrillation”
• Homolka Hospital, Prague, Czech Republic. “3-D ICE with Left Atrial Appendage Closure”
• Homolka Hospital, Prague, Czech Republic (second presentation). “Pulsed Field Ablation for Atrial Fibrillation Using a Lattice-Tip Focal Catheter”
• Split, Croatia. “Pulsed Field Ablation for Atrial Fibrillation Using a Conventional Focal Catheter”
• Homolka Hospital, Prague, Czech Republic (third presentation). “Pulsed Field Ablation for Persistent AF Using Single-Shot and Focal Catheters”

Technical Problems

Audio Dropping Out and Skipping

When I first accessed the AF Symposium streaming presentations, I experienced major audio problems. The audio would drop out and skip over a presenter’s words all the time, to the point where I couldn’t follow a speaker’s comments. I of course complained and was told I was the only person reporting such audio problems. (I had checked the feed from our server which claimed to be not having any problems. All of their other feeds were fine.)

The next day Dr. Ruskin acknowledged they were having audio problems and were working on fixing them. The audio did improve to some extent but was far from perfect.

After much trial-and-error Friday, I wound up using my cell phone to access and record the Symposium’s audio. It wasn’t perfect, but it was understandable. I apologize to many of Friday’s presenters who I will not be able to report on due to these audio problems.

Technical Crew Talking Over the Speakers

Another very disturbing audio problem was I could hear the technical crew talking over the speakers. I sounded like they were both on the same channel. It was truly bizarre but sometimes intriguing. You could hear various male and female technical crew members doing things like counting down into a segment while a presenter was speaking.

The technical execution on this year’s AF Symposium obviously left a lot to be desired. But to give the technical staff credit where it was due, all the presentations were well edited and timed. For example, when one speaker would finish, immediately a second speaker would begin their presentation. There was no waiting for one speaker to sit down and another to get up to the podium.

Only Half of Vendors’ Sites Available

When I tried to access the Vendors’ sites online, I could only view the sites A through M. The rest didn’t seem to be available.

Well Worth it! More Reports to Come

Steve S Ryan, PhD

Even with the technical issues, attending the conference was well worth it. There’s no other conference that brings together the world’s leading medical scientists, clinicians and researchers to share recent developments in the field of atrial fibrillation.

Look for more of my reports from the 2021 AF Symposium in the next weeks and months. I will share the current state of the art in A-Fib research and treatments and what’s relevant to patients with Atrial Fibrillation.

And, as always, my reports will be written in plain language for A-Fib patients and their families.

Archive: Link to all my AF Symposiums Summaries by Year

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