2025 AF Symposium Overview: Written for Atrial Fibrillation Patients and Their Families

By Steve S. Ryan. PhD

The 30^th annual International AF Symposium was held in Boston January 16-18, 2025. (This is where the AF Symposium originally started back in 1995. I’ve been attending since 2003—that’s 23 years!) This intense 3-day seminar took place at the Omni Seaport hotel, a well-designed, ultra-modern conference venue. Coming from California, the January weather in Boston was considered relatively mild with temperatures in the 30s.

This Symposium featured presentations by 87 leaders in A-Fib research and clinical practice from all over the world. These medical scientists, clinicians, and researchers shared recent developments in the A-Fib field in a forum unmatched by any other conference. This year the Symposium attracted around 1,400 worldwide participants.

AF = Atrial Fibrillation; also: AFib, A-Fib

The sessions were extensive and information-rich with each of the three days starting at 7:30 AM. Sessions continued until 6:30 PM on Thursday, 7:00 PM on Friday and ended early on Saturday at 4:00 PM (to allow attendees time to catch their plane home).

Dr. Jeremy Ruskin’s AF Symposium Goal Statement

Jeremy Ruskin, MD

In the words of Dr. Jeremy Ruskin, founding Director who started the AF Symposium back in 1995:

“This intensive, highly focused three-day symposium brings together the world’s leading medical scientists to share in a highly interactive environment the most recent advances in the field of atrial fibrillation…including real-time case presentations to share with attendees the most current basic, translational and clinical science in the field.”

It was great to see Dr. Ruskin once again starting each day’s sessions. (Due to illness, he wasn’t able to do that last year.)

Major Theme: Case Transmissions Take Center Stage

The major theme or emphasis of the 2025 AF Symposium was live and prerecorded ablation cases transmitted from EP labs/operating rooms from around the world. There were a record 24 cases presented in eight different sessions!

This Symposium had a record 24 live and prerecorded ablation cases presented in eight different sessions!

A majority of these cases were focused on Pulse Field Ablation (PFA). These case transmissions seemed to be among the most attended and popular sessions. A tip of the hat to all the people behind the scenes who made these seamless networking and streaming presentations work so well.

Main Emphasis: Pulse Field Ablation (PFA)

There were an incredible 42 presentations focusing on Pulsed Field Ablation (PFA) (that’s nearly half of the Symposium’s total 97 lectures). PFA has taken the Electrophysiology field by storm.

PFA has redefined the approach to catheter ablation.

This AF Symposium illustrates how PFA has been rapidly adopted and validated. By offering tissue selectivity, safety, and efficiency, PFA has redefined how we approach catheter ablation.

Noteworthy Quote

Dr. Pierre Jais

Dr. Pierre Jais of the Central Hospital at Bordeaux, France, expressed the sentiments of many of the AF Symposium attendees that “he was glad to no longer have to use RF point by point single shot ablation which often caused hemolysis [destruction of red blood cells] and other damage.” He said Pulsed Field Ablation is a welcome alternative.

One attendee pointed out that world-wide there were over 200,000 PFA ablations with no fistula.

Noteworthy Innovation: Combining AF Ablation with LAA Closure

Another noteworthy innovation that is very important for us A-Fib patients was the combination of Pulmonary Vein Isolation (PVI) ablation with closing off the Left Atrial Appendage (LAA) at the same time (i.e., Concomitant Ablation).

This was made possible in the U.S. by the FDA’s approval of a dedicated Diagnosis-related Group code for concomitant AF ablation and Left Atria Appendage Closure procedures (November 2024).

Effective A-Fib management isn’t a one-size-fits-all; Patients need personalized strategies.

This new code not only allows doctors and healthcare centers to get paid for concomitant ablations but also recognizes that patients need personalized strategies in A-Fib care. Comprehensive, effective A-Fib management isn’t a one-size-fits-all approach.

Impact of Concomitant Ablation Approach

How will the concomitant ablation approach influence clinical decision making and treatment strategies? Is a combined ablation a good course of action for A-Fib patients?

I personally think so. I predict that the combined approach will be what most patients choose. Who wants to go back to a hospital twice when a single procedure will both stop A-Fib and protect against stroke? Readers will recall how I have long been an advocate for a combined approach. (See 2023 AF Symposium: Innovative A-Fib Ablation Plus LAA Closure in One Procedure and A-Fib Catheter Ablation Combined with Left Atrial Appendage (LAA) Closure.)

Impressive: Dual Energy Ablation Systems

I was somewhat surprised at the Dual Energy ablation systems either in use or in development, such as the Flex Pulse Dual Modality system and the Dual Energy STSF catheter. With these systems the operator can switch between the non-thermal energy source of Pulse Field Ablation and thermal Radio-Frequency energy (RF) to form lesions.

Pulse Field Ablation uses non-thermal short, high-voltage electrical pulses to ablate tissue (form lesions).

In these systems the operator only has to press a foot pedal to switch between PFA and RF energy. Though PFA today is generally preferred to RF, there are times when it is useful to have RF as well.

About Contact Force Sensing: Importance of Lesion Depth and Durability

In the first descriptions of Pulse Field Ablation (PFA), contact force sensing didn’t seem to be very important. As long as the PFA catheter was close to the area to be ablated, the PFA lesions were effective. But five Symposium presentations showed that contact force is important in determining PFA lesion depth and durability.

Making a Comeback: Balloon Catheters

There were two presentations featuring balloon catheters, indicating renewed interest in this technology.

PFA Catheter Systems: Development and Proliferation

I was amazed at how many different PFA catheters are in development or in current use. The FDA has approved two new PFA systems (November 2024):

Varipulse Variable Loop Circular Catheter by Biosense Webster
Affera by Medtronic

I counted an additional 15 PFA systems introduced to AF Symposium attendees, some already FDA approved.

Sphere 9 Lattice Tip
Faraview Technology
Farawave
FlexPulse Dual Mode (RF & PFA)
PulseSelect Circular
Omnypulse Novel Large Footprint Focal Force Sensing
Globe PFA Catheter
Nanosecond
FieldForce PFA Technology
Sphere 360 Large Latice Tip
Volt Balloon in Basket
Dual Energy STSF Catheter (RF & PFA)
Small Focal Dual Energy
OptiShot Balloon
Pulse Select Circular Catheter

Worldwide Live Procedures & Case Presentations

We were treated to 26 various A-Fib ablation and device case demos both live and pre-recorded. The AF Symposium featured case presentations from the U.S. and around the world.

On Thursday January 16 there were case presentations from:

Univ Colorado, Colorado Springs, CO
Kansas City Heart Institute, Overland Park, KS (2)
Bernards Healthcare, Jonesboro, AR
Texas Cardiac Arrhythmia Institute. Austin, TX (2)
Homolka Hospital, Prague, Czech Republic

On Friday January 17 there were case presentations from:

Mount Sinai Medical Center, New York, NY (2)
Massachusetts General Hospital, Boston, MA (2)
Beth Israel Deaconess Medical Center, Boston, MA
NYU Langone Health Center, New York, NY
Lenox Hill Hospital, New York, NY
Texas Cardiac Arrhythmia Institute, Austin, TX
University of Arizona, Phoenix, AZ
Homolka Hospital, Prague, Czech Republic

Saturday January 18 there were case presentations from:

Homolka Hospital, Prague, Czech Republic (3)
OhioHealth Riverside Methodist Hospital, Columbus, OH
Heart Centre IKEM, Prague, Czech Republic
Heart Rhythm Management Ctr., Brussels, Belgium
NYU Langone Health Center, New York, NY
Westpfalz-Klinikum Hospital, Kaiserslautern, Germany
Bernards Healthcare, Jonesboro, AR

Steve Ryan with Dr. Francis Marchlinsku U of Penn; 2025 AF Symposium

Steve Ryan with Dr. Francis Marchlinski, U. of Penn.

I will be writing reports on many of these live and pre-recorded EP lab/operating room procedures as well as many of the cases demonstrating various devices.

More Reports to Come

Look for my reports from the 2025 AF Symposium in the next weeks and months.

In particular, look for a “Challenging Cases in AF Management” panel discussion in which Dr. Francis Marchlinski, U. of Penn., talks about “re-do” ablations. (See also his 2024 Symposium presentation, Medications vs Catheter Ablation for Initial Treatment of AF–Guidance for the Clinician.)

I will share with A-Fib.com readers the current state of the art in A-Fib research and clinical practice, what’s relevant to A-Fib patients and their families and friends.

All in an effort to help A-Fib patients make the best decisions on their treatment choices.

In addition, you may want to browse my reports from the 2024 AF Symposium, or
the Archive of AF Symposiums Summaries by Year