Steve Ryan in Boston at the 2023 AF Symposium

2023 AF Symposium

My Summary Reports Written for Atrial Fibrillation Patients

By Steve S. Ryan, PhD

This 28^th annual AF Symposium was held in Boston (where the AF Symposium originally started back in 1995). This intense 3-day seminar took place Feb. 2nd through 4th at the new Omni Hotel at the Seaport, a well-designed, ultra-modern conference venue. This Symposium featured presentations by 82+ leaders in AF Research and Clinical Practice from all over the world.

This is the 19th AF Symposium I have attended. It provides a unique learning experience about Atrial Fibrillation (A-Fib) not matched by any other conference. Attending the AF Symposium and adequately reporting on it is both a challenge and a privilege. I learn more in three days than in a year of reading the various A-Fib research reports.

The Pulsed Field Ablation (PFA) Meeting

We might call this Symposium the Pulse Field Ablation (PFA) meeting. Thirty of the 93 presentations were on PFA. 10 of the real time case presentations and 15 of the pre-recorded cases were on PFA. But most of the PFA strategies were not new and had been presented at previous AF Symposiums.

AF Symposium Turning Into a Tech Conference?

Compared to other AF Symposiums, this was primarily a tech conference heavily influenced by the industry. There were two  informative Spotlight sessions on Thursday and Friday with 19 short presentations featuring new and future technology.

Sessions of 5+ presentations were sponsored by industry leaders such as Abbott, Boston Scientific, Medtronic, and Biosense Webster. (I personally miss the more patient-focused Seminars of previous years. But it’s hard to argue with the amount of money now provided by the industry to support the AF Symposium.)

Somewhat surprisingly there was only one presentation on drugs for treating Atrial Fibrillation.

Three representatives from the FDA attended and participated in the presentations and panel discussions.

Major Medical Breakthrough

Laminar LAA closure device

There was at least one major medical breakthrough and possible game changing presentation at the Friday Spotlight session. Dr. Saibal Kar of the Cardiovascular Institute of Los Robles Health System in Thousand Oaks, CA described a new Left Atrial Appendage (LAA) closure device from LAMINAR.

In an animation, Dr. Kar showed the LAMINAR device being inserted into the LAA, then twisted till it not only closed off but actually eliminated the LAA. Once the LAA was closed off, the device was locked in place so that you could barely see where the LAA had been.

This LAMINAR device could potentially revolutionize how the LAA is closed off. It seemed relatively easy to use and looked like it worked really well. But it’s still a long way from getting FDA approval.

Artificial Intelligence and Consumer Monitoring Devices

This AF Symposium documented how Artificial Intelligence is being applied to various treatments of Atrial Fibrillation. It also documented how consumer monitoring devices such as the Apple Watch and Kardia System are increasingly being used by patients and even their doctors.

But not always effectively. One EP (Electrophysiologist) described getting a call from an anxious patient at 2 a.m. alarmed that his Apple Watch showed he was having a short episode of AF.

Most Noteworthy Quote

Perhaps the most noteworthy quote of the Symposium was about the stroke-risk grading system (CHA2DS2-VASc) to help estimate the risk of stroke in patients with atrial fibrillation.  Dr. Daniel Singer of Massachusetts General Hospital in Boston, MA commented: “CHA2DS2-VASc is an embarrassment.”

For further info on this topic, see our article The CHADS2 & CHA2DS-VASc Stroke-Risk Grading Systems.

The Omni Hotel Venue

The Omni Hotel is brand new and one of the best conference sites around. The staff was very competent and friendly. The Presentation and Exhibit halls were huge, architecturally well designed, and very impressive. The Exhibit hall was on the second floor with escalators to take you to the fourth floor Presentation hall.

(For some reason they shut down the escalators on Saturday, but one could still use elevators or stairs. Then late Saturday when most attendees had left, they turned the escalators back on. Go figure?)

One minor though annoying problem was that next to the Presentation hall was what seemed like a kind of kitchen. At times people working there made a lot of noise and talked/shouted so loud that at times they were as loud as or even occasionally louder than the presentation speakers. But this wasn’t a major distraction.

As one would expect in Boston in February, it was very cold. The temperature dropped to 9°F. To save money, I stayed at a (cheaper) hotel aways from the venue and thought my face would freeze off when I had to go outside. I won’t do that again.

AF Symposium Structure and Subject Presentations

Most presentations were 7 minutes long followed by a lively panel discussion. (If a presenter went over time, they heard a music cue which got progressively louder.)

• Panel and Audience Discussions were 25 minutes long.
• The “Spotlight Sessions” were 5 minutes long.
• There were 15 “Real-Time and Prerecorded Case Transmissions” which could run as long as 20 minutes.
• There were two debates.

My personal favorite session was the “Challenging Cases in AF Management (Drugs, Ablation, and Stroke Prevention)” which was the last Saturday presentation before the Symposium adjourned at 2:30 pm.

All went generally very smoothly. One has to compliment the organizers who did a remarkable job scheduling so many remote location presentations as well as 15 live and pre-recorded cases.

Program

Thursday, February 2

• Managing the AF Epidemic: From Prediction to Prevention and Access (5 talks)
• Spotlight Session I Early Stage and Emerging Technologies in Cardiac EP (10 talks)
• Real-Time and Prerecorded Case Transmissions-Session I (5 cases)
• Optimizing Lesions for RF Ablation in Atrial Fibrillation (5 talks) (Sponsored by an educational grant from Abbott)
• Stroke Risk Management in Atrial Fibrillation-Session I (5 talks) (Supported by an educational grant from Boston Scientific)
• Stroke Risk Management in Atrial Fibrillation-Session II (5 talks)

Friday, February 3

• Early Intervention for Prevention of AF Progression (5 talks)
• Spotlight Session II (9 talks)
• Real-Time and Prerecorded Case Transmissions-Session II (5 cases)
New Developments in RF Ablation for Atrial Fibrillation (3 talks plus a debate) (Supported by an educational grant from Biosense Webster)
• Innovations in Catheter Ablation for AF: Enhancing Efficiency, Effectiveness, and Workflow (3 talks plus a debate) (Supported by an educational grant from Medtronic)
• Pulsed Field Ablation Session I: Mechanisms and Technologies (5 talks)
• Late Breaking Clinical Trials and First Report Investigations and Best Abstract Award (5 talks followed by Best Abstract Award 2023)

Saturday, February 4

• Real Time and Prerecorded Case Transmissions-Session III (5 cases)
• Pulsed Field Ablation Session II: Clinical Outcomes of Pulsed Field Ablation for AF (5 talks)
• Pulsed Field Ablation Session III: Efficacy, Safety, and Future Directions of Pulsed Field Ablation (5 talks)
• Challenging Cases in AF Management (Drugs, Ablation, and Stroke Prevention)
• 2:30 PM Adjourn

International Real-Time and Prerecorded Cases Transmissions

The Cases Transmissions were again the highlight of the AF Symposium and the most well attended. It’s like “You Are There” in the lab with the EPs doing the procedure.

Thursday, February 2

• From Brussels, Belgium The Heart Rhythm Management Center “AF Ablation Using a Radiofrequency Balloon Catheter”
• From the Kansas City Heart Rhythm Institute, U.S. “Left Atrial Appendage Closure with the Amulet Device”
• From Mount Sinai Medical Center, New York, NY “Ultra-High Power Short Duration AF Ablation”
• From Sharp Memorial Hospital, San Diego, CA “Pulsed Field Ablation for AF Using a Circular Multielectrode Catheter”
• From Massachusetts General Hospital, Boston, MA “Pulsed Field Ablation for AF Using a 9mm Lattice-Tip Multielectrode Catheter”

Friday, February 3

• From Cologne, Germany University Hospital “AF Ablation with a New Generation Mapping System”
• From the Texas Cardiac Arrhythmia Institute, Austin, TX “Left Atrium Closure with Watchman and 4-D Interactive Ultrasound”
• From Brugge-Oostende, Belgium, St. Jan Hospital “Pulsed Field Ablation for AF Using a Multispline Catheter PFA”
• From Massachusetts General Hospital, Boston, MA “Pulsed Field Ablation for AF Using a Circular Multielectrode Catheter”
• From Homolka Hospital, Prague, Czech Republic “Pulsed Field Ablation for AF Using a Large Diameter Lattice-Tip Catheter”

Saturday, February 4

• From Dublin, Ireland, Mater Private Hospital “Pulsed Field Ablation for AF Using a Multispline Catheter”
• From Massachusetts General Hospital, Boston, MA “Left Atrial Appendage Closure with Watchman and a One-Step Transseptal Platform”
• From Tampa, FL, St. Joseph’s Hospital “AF Ablation Using a New Cryoballoon Catheter”
• From Hamburg, Germany “Pulsed Field Ablation for AF Using a Focal Tip Catheter”
• From Homolka Hospital, Prague, Czech Republic “Pulsed Field Ablation for AF Using a Spherical Multielectrode Catheter”

Awesome AF Symposium! More Reports to Come

Attending the AF Symposium and adequately reporting on it is both a challenge and a privilege. The AF Symposium brings together the world’s leading medical scientists, clinicians, and researchers who share recent developments in the A-Fib field.

Look for more of my reports from the 2023 AF Symposium in the next weeks and months. I’ll try to share with you the current state of the art in A-Fib research and treatments, what’s relevant to A-Fib patients and their families and friends.

In the meantime, you may want to browse my reports from the 2022 AF Symposium, or
the Archive of AF Symposiums Summaries by Year

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