Doctors & patients are saying about 'A-Fib.com'...


"A-Fib.com is a great web site for patients, that is unequaled by anything else out there."

Dr. Douglas L. Packer, MD, FHRS, Mayo Clinic, Rochester, MN

"Jill and I put you and your work in our prayers every night. What you do to help people through this [A-Fib] process is really incredible."

Jill and Steve Douglas, East Troy, WI 

“I really appreciate all the information on your website as it allows me to be a better informed patient and to know what questions to ask my EP. 

Faye Spencer, Boise, ID, April 2017

“I think your site has helped a lot of patients.”

Dr. Hugh G. Calkins, MD  Johns Hopkins,
Baltimore, MD


Doctors & patients are saying about 'Beat Your A-Fib'...


"If I had [your book] 10 years ago, it would have saved me 8 years of hell.”

Roy Salmon, Patient, A-Fib Free,
Adelaide, Australia

"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su,
Cavanaugh Heart Center, 
Phoenix, AZ

"...masterful. You managed to combine an encyclopedic compilation of information with the simplicity of presentation that enhances the delivery of the information to the reader. This is not an easy thing to do, but you have been very, very successful at it."

Ira David Levin, heart patient, 
Rome, Italy

"Within the pages of Beat Your A-Fib, Dr. Steve Ryan, PhD, provides a comprehensive guide for persons seeking to find a cure for their Atrial Fibrillation."

Walter Kerwin, MD, Cedars-Sinai Medical Center, Los Angeles, CA


AF Symposium & other medical conferences articles

2022 AF Symposium Abstract: Inhaler Can Stop A-Fib Attack in Minutes

This abstract further elaborates on an 2021 AF Symposium Spotlight session by Dr. Jeremy Ruskin of Massachusetts General Hospital. He showed safety data from the InCarda Phase 2 study (INSTANT) which he thought very promising. This abstract details a small clinical trial.

This InCarda inhaler is an incredible medical innovation for A-Fib patients! (It’s still in development.)

Imagine: A patient is having an A-Fib episode. The patient self-administers the InCarda inhaler, it produces a flecainide-containing aerosol which the patient inhales. This results in a rapid absorption of flecainide via the lungs into the heart.

It can terminate an A-Fib attack in as little as 8 minutes. (The tablet form of Flecainide takes around 1−3 hours to work.)

For more read my short report: Trial II of InCarda Orally Inhaled Flecainide.

2022 AF Symposium: Spherical Array Catheter Case with Video

Note: This was a very early, first-in-human use of this Spherical Array PFA catheter not yet approved by the FDA.

Dr. Vivek Reddy from Mount Sinai Medical Center in New York City, NY, showed a fascinating video of how the spherical PFA catheter emerged from the catheter sheath and formed itself into a spherical array, then locked itself into shape.

Click image to see Spiral Array catheter open

It was like watching a magic trick. How could they design a catheter sheath from which would emerge a complex spherical shaped catheter that would come together so smoothly?

On the video, we watched as Dr. Reddy and his team performed a Pulsed Field Ablation using the Spherical Array Catheter. The patient was a 31-year-old male diagnosed with paroxysmal A-Fib in 2020.

How the Spherical Array Catheter Works

Once fully deployed, the spherical PFA catheter has a diameter of 30 mm. It contains 122 gold-plated electrodes on 16 splines around the sphere. Continue reading about the Spherical Array catheter and the Pulsed Field Ablation for this patient.

2022 AF Symposium Spotlight: Innovation in Development to Seal the Left Atrial Appendage

The CLASS LAAO

Sometimes the method to close off the Left Atrial Appendage, doesn’t make a complete closure. It can leak. I’m very excited about this new product. Dr. Jamie Kim of the Catholic Medical Center in Manchester, NH, presented one of the most innovative and promising new developments for patients to close off their LAA.

Instead of relatively hard, rigid structures which don’t always conform perfectly to the LAA opening and thus may leak, the CLASS LAAO system from Conformal Medical, Inc. uses a different type of conformable foam-based fabric to seal off the LAA. Read this short Spotlight summary for more about this promising new device.

Go to my 2022 AF Symposium page with all my reports.

2022 AF Symposium: Procedural Anticoagulation with LAA Closure Devices for A-Fib Patients

In this report from the 2022 AF Symposium, Dr. Luigi Di Biase of the Albert Einstein College of Medicine, Bronx, NY gave a presentation on “Peri and Post Procedural Anticoagulation with LAA Closure Devices―An Evolving Story”.

In particular, he is talking about the Watchman occlusion device to close off an A-Fib patient’s Left Atrial Appendage. His focus is on the anticoagulation protocol following the procedure involving, that is, the drug regime for patients in the months afterward. e.g., DOACs, aspirin and clopidogrel.

This is a short report, a quick read, go to Procedural Anticoagulation with LAA Closure Devices―An Evolving A-Fib Story.

2022 AF Symposium: Challenging Cases: The Patient has the Last Say

My new report from the 2022 AF Symposium is about one of the “Challenging Cases” presentations. This is when some of the world’s leading Electrophysiologists (EPs) describe the most difficult Atrial Fibrillation cases they had to cope with through the year. Frankness prevails.

Normal Ejection Fraction should be 50 to 75 percent to indicate the heart is pumping well.

Dr. Erik Prystowsky of St. Vincent’s Hospital, Indianapolis, IN, described a 65-year-old man with Atrial Fibrillation, shortness of breath, and a critically low Ejection Fraction (10%). And a severely enlarged left atrium (5.4 cm).

The patient was offered a catheter ablation procedure but would not accept even after the most persuasive attempts to convince him—it would likely fix his A-Fib, improve his Ejection Fraction, and reduce the size of his left atrium. To learn how this patient’s health evolved over the next 5-6 years, read my full report: Challenging Cases—The Patient has the Last Say.

Browse our Personal A-Fib Stories of Hope

2022 AF Symposium: Calculating Left Atrium Wall Thickness

Dr. Saman Nazarian

Spotlight Sessions feature products or devices still in development or not yet FDA approved. They give us a glimpse into the future of A-Fib treatments. This year 17 Spotlight products and treatments were presented in 5 minute talks. 

In this very short report from the 2022 AF Symposium, I summarize a 5-minute Spotlight session: “Personalization AF Ablation Based on CT Wall Thickness”.  Dr. Saman Nazarian, U of Penn, talks about use of Computerized Tomography (CT) to assist during a catheter ablation.

The Issue: The left atrium wall thickness varies from 1 mm to over 5 mm in the roof area. If one applies too much RF ablation power to a thin wall, this can produce steam pops, esophagus damage, or phrenic nerve damage. If too little RF energy is applied to thicker left atrium wall areas, this can lead to Pulmonary Veins (PV) reconnection….to continue reading, go to my very short report.

Personal A-Fib stories at A-Fib.com

Go to Personal A-Fib stories of Hope

AF 2022 Symposium: Pulsed Field Ablation—Integrated Mapping-Ablation Spherical Array Catheter for A-Fib

2022 AF Symposium

Pulsed Field Ablation for AF Using an Integrated Mapping and Ablation Spherical Array Catheter

Note: This was a very early, first-in-human use of this Spherical Array PFA catheter not yet approved by the FDA
Dr. Vivek Reddy, Mt Siani Hospital

Dr Vivek Reddy

Dr. Vivek Reddy from Mount Sinai Medical Center in New York City, NY and Dr. Petr Neuzil of Homolka Hospital, Prague, Czech Republic presented a pre-recorded case on “Pulsed Field Ablation for AF Using an Integrated Mapping and Ablation Spherical Array Catheter.”

The patient was a 31-year-old male diagnosed with paroxysmal A-Fib in 2020. His left atrium diameter measured 39 mm (normal size). His Ejection Fraction was 65% (normal). His CHA2DS2-VASc score was zero.

Innovative Spherical Array

Dr. Reddy showed a fascinating demo of how the spherical PFA catheter emerged from the catheter sheath and formed itself into a spherical array, then locked itself into shape. It was like watching a magic trick. How could they design a catheter sheath from which would emerge a complex spherical shaped catheter that would come together so smoothly? Kudos to whomever designed this innovative system (Kardium Globe).

How the Spherical Array Catheter Works

Once fully deployed, the spherical PFA catheter has a diameter of 30 mm. It contains 122 gold-plated electrodes on 16 splines around the sphere. Behind each electrode is a thermocouple to measure heat. (The system was originally designed for RF ablation. But this spherical catheter was not irrigated.) Because of the high number of electrodes, it also  produces high quality 3D activation maps of the left atrium. It can also be used for pacing.

Spiral Array Catheter at opening to Pulmonary Vein

As we watched, Dr. Reddy easily rotated and moved the Spherical Array catheter. It can map and ablate anywhere is the left atrium and produce continuous lesions. It doesn’t have to be manipulated as much as a point-by-point RF catheter. The next generation catheter will be smaller.

The system is bi-polar and biphasic in that the PFA signal is delivered using an electrode on one spline along with another electrode on an adjacent spline. Usually, Dr. Reddy said, he only required a 3-second PFA ablation to isolate a PV.

They used general anesthesia, but acknowledged that this system could work under simple conscious  sedation.

Single-Shot, Omni-Directional, Needs Tissue Contact

Dr. Reddy described it as a single shot system in that one PFA application should isolate an area. It is omni-directional in that the sphere can be positioned in any direction as long as there is contact, and the sphere is touching tissue. The system seemed to easily produce a voltage map of the left atrium. The system uses GPS 3D navigation and mapping to track the precise location of the Globe catheter inside the atrium.

“Flow” and “Contact” Mapping: Where to Apply the PFA Pulse

Dr. Reddy described the system as using two types of contact mapping: “Flow” Map and “Contact” Mapping.

The Flow Map gets contact info relatively fast by sensing how quickly the electrodes cool when electricity is applied to them, while Contact Mapping takes 10-15 seconds and calculates how high the temperature rises. If it touches tissue, the temperature should become higher. “Contact” mapping provides more high-fidelity info than “Flow” mapping.

Click image to see Spiral Array catheter open

Dr. Reddy would use both systems one after the other to determine where the actual PFA pulse should be applied. Dr. Reddy said that the Spherical Array catheter is in one sense a large focal catheter while also more forgiving in terms of precise positioning. When a green area appeared, this meant contact. While white represented areas not yet ablated. Blue areas represented completed PFA lesions.

We watched as the PVs were isolated. He showed both pre and post voltage maps side-by-side to document that the PVs were isolated. Some microbubbles were produced, but previous RF ablations using this system didn’t produce any problems. Dr. Reddy said that they haven’t seen any reconnection. In this case they only isolated the PVs and made no attempt to isolate the posterior left atrium wall or other areas of the heart.

Removing the Spherical Array Catheter

At the end we watched as Dr. Reddy forced the catheter shaft back over the Spherical Array which collapsed back into a linear form and was easily removed (another fascinating technical achievement).

Editor's Comments about Cecelia's A-Fib storyEditor’s Comments

Though this Spherical Array catheter is in very early stages of development, it seems to me to have the potential to challenge current leaders in the PFA field.
A streaming video-on-demand of Dr. Reddy’s case and presentation is available at https://player.vimeo.com/video/676797282. 28:48 min. (Published by the 2022 AF Symposium.)

VIDEO: Pulsed Field Ablation for AF Using an Integrated Mapping and Ablation Spherical Array Catheter

Click on image to watch the deployment of the Spherical Array catheter (Kardium Globe); 25 sec.

From the streaming video-on-demand of Dr. Reddy’s case and presentation is available at https://player.vimeo.com/video/676797282. 28:48 min. (Published by the 2022 AF Symposium.)

 

Spotlight Session: Clinical Experience with the CLASS LAAO System

2022 AF Symposium

Spotlight Sessions: Features products or devices usually still in development or not yet FDA approved. They give us a glimpse into what the future of A-Fib treatment may look like.

Spotlight Session: Clinical Experience with the CLASS LAAO System

Dr. Jamie Kim

Dr. Jamie Kim of the Catholic Medical Center in Manchester, NH, presented one of the most innovative and promising new developments for patients to close off their Left Atrial Appendage (LAA).

The CLASS LAAO

Instead of relatively hard, rigid structures which don’t always conform perfectly to the LAA opening and thus may leak, the CLASS LAAO system from Conformal Medical, Inc. uses a different type of conformable foam-based fabric to seal off the LAA.

Complete Seal

The CLASS is designed to conform to a broader range of LAA sizes and shapes.

In the animation we saw, the foam-like material expanded from the insertion catheter to fill the interior of the irregularly shaped LAA. Dr. Kim says the seal made by the CLASS is complete.

Easier To Use, Wider Applicability

The CLASS LAAO system catheter

The CLASS device is soft which allows for both easier positioning when inserted and greater conformability. It also didn’t seem to have any metal protrusions as one sees in the Watchman.

It comes in only two sizes. It also uses rows of anchors to lock the device in place in the LAA. It’s designed with a flexible Nitinol under skeleton. It can be re-captured, if necessary.

To compare the Watchman with the CLASS, see my report: The Watchman Device. There’s also a brief animation of how the Watchman is installed: The Watchman FLXTM Device: Closure of the Left Atrial Appendage.

Editor's Comments about Cecelia's A-Fib storyEditor’s Comments

Barring any problems in the clinical trials, the CLASS LAA closure device is a major medical advance for patients. The CLASS LAA closure device will likely become the choice of most EPs and will supersede both the Watchman and Amulet devices.

2022 AF Symposium: Pulsed Field Ablation Using a Focal Electrode Catheter

I’ve written a new report from the 2022 AF Symposium. The presentation included a video of the speaker performing the Pulsed Field Ablation. Note: PFA is not yet approved by the FDA, but is in clinical trials.

Dr. Atul Verma of Southlake Regional Health Center in Toronto, Canada presented his talk in a somewhat unusual format. He showed a pre-recorded case of him performing a Pulsed Field Ablation (PFA). Then while the video was playing, he would lower the volume and comment live to the audience. Several panelists and audience members also joined in offering comments during his presentation.

The Patient: Was in early persistent A-Fib, with a normal heart and normal-sized atrium. The goal was to isolate the patient’s Pulmonary Veins (PVs) and posterior wall using Pulsed Field Ablation (PFA).

The Ablation System: Dr. Verma performed an ablation of a patient using the Galaxy Centauri system. The Galaxy system allows EPs to use the same focal catheters and mapping systems they now use when they ablate using point-by-point Radio Frequency (RF) energy However, the Centauri generator produces PFA pulses instead of RF.

On the video, when Dr. Verma would make a point-by-point dot lesion using PFA…to continue reading my report. go to: Pulsed Field Ablation Using a Focal Electrode Catheter by Dr. Atul Verma.

For the background, concepts and treatment strategies associated with the evolving technology of Pulsed Field Ablation, see my 2020 AF Symposium report: Pulsed Field Ablation—Emerging Tech for Atrial Fibrillation.

Follow Us
facebook - A-Fib.comtwitter - A-Fib.comlinkedin - A-Fib.compinterest - A-Fib.comYouTube: A-Fib Can be Cured! - A-Fib.com

We Need You Help A-Fib.com be self-supporting-Use our link to Amazon  

A-Fib.com is a
501(c)(3) Nonprofit



Your support is needed. Every donation helps, even just $1.00.



A-Fib.com top rated by Healthline.com since 2014 

Home | The A-Fib Coach | Help Support A-Fib.com | A-Fib News Archive | Tell Us What You think | Press Room | GuideStar Seal | HON certification | Disclosures | Terms of Use | Privacy Policy