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2024 AF Symposium
The Benefits of Ablation Across the AF Spectrum: From Early Intervention to Late-Stage Heart Failure: Part I
This important Friday session had five speakers: Dr. Stephen Willems, Dr. Jason Andrade, Dr. Philipp Sommer, Dr. Douglas Packer and Dr. Francis Marchlinski.
Dr. Stephan Willems of Asklepios Clinic St. Georg, Hamburg, Germany gave the first talk in what was described as the “most important session of the whole meeting.”
The Role of Catheter Ablation in Asymptomatic Atrial Fibrillation
Dr. Stephan Willems
Dr. Stephan Willems began by pointing out that 30%-40% of A-Fib is asymptomatic. He asked the audience, “Is it still justified to withhold rhythm control, especially catheter ablation, in 30% to 40% of patients seeking our attention who are asymptomatic?
Or shouldn’t we go for rhythm control and catheter ablation, since we know that catheter ablation is something good with good results, good outcome?
“If you look at the lectures [in this session], every one of them is Guideline changing This is the most important session of the whole [Symposium] meeting.”—Dr. Nassir Marrouche
Catheter ablation can be performed safely, with efficacy, and with the highest efficiency.” A-Fib is a progressive disease which can be stopped and/or attenuated.
He pointed out that “symptoms don’t influence outcome.” He asked, “Is an asymptomatic patient really non-symptomatic?”
Dr Willems continued, “On the other side we know that atrial fibrillation is something bad with severe prognosis at least in a subset of patients…AF can be deleterious and requires oral anticoagulation.”
Study with Asymptomatic Longstanding Persistent A-Fib Patients
Dr. Willems cited an important study by Dr. Andrea Natale and his colleagues in which they worked with asymptomatic longstanding persistent A-Fib patients [usually very difficult cases to cure].
They first cardioverted the patients, and 2/3rds of the patients improved significantly. Then they ablated them extensively, and more than 50% remained in normal sinus rhythm. These patients improved significantly, and their exercise capacity improved markedly.
Whereas the other 1/3 did not convert to normal sinus rhythm and went on to develop symptomatic A-Fib due to recurrence.
“Guidelines” refers to the ACC/AHA/ACCP/HRS Guideline for the Diagnosis & Management of Atrial Fibrillation (see Research tab below.)
What Should We Do When We Treat Asymptomatic A-Fib Patients?
Dr. Willems asked, “What then should we do?”
For newly diagnosed patients with A-Fib, we should treat, cardiovert and ablate those who are asymptomatic.
But he pointed out that current Guidelines do not yet recommend this.
To read other presentations in this series, go to My Summary Reports Written for Atrial Fibrillation Patients.
Editor’s Comments
Editor’s CommentsDr. Willems makes excellent points which are very important to A-Fib patients.
30% to 40% of A-Fib is asymptomatic! Let’s say your doctor does a routine heart test such as an ECG and discovers you have A-Fib. Many a primary care physician considers A-Fib a “nuisance condition”, nothing to worry about. Despite this erroneous attitude, A-Fib is a serious heart disease. (If we were diagnosed with a cancer, would we just ignore it?)
A-Fib is a Progressive Disease: A-Fib is a progressive disease that usually gets worse over time. To mention only a few of the bad effects of A-Fib, it produces a rapid, irregular heart rate which can become life threatening. A-Fib can enlarge your heart and make it more difficult to pump properly. There is an increased risk of stroke. A-Fib reduces blood flow which damages your heart, brain and other organs. A-Fib often requires that you take anticoagulants which themselves can be a health risk. All this happens even if someone is asymptomatic!
Newly diagnosed asymptomatic A-Fib patients should be treated as soon as possible. To ignore A-Fib, to just let someone live in A-Fib without doing anything about it verges on malpractice. We know that catheter ablation and other treatments work and can stop or attenuate the progression of A-Fib. (Over 1 million catheter ablations were done in the U.S. last year.)
The Guidelines need to be changed. As Dr. Willems points out, even if someone is asymptomatic, they still need treatment and as soon as possible when A-Fib is more likely to be cured or improved. (See the Research tab for the link to the Guidelines.)
