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AF Symposium & other medical conferences articles

2020 AF Symposium: Live Case—AcQMap 3D Imaging, Mapping and Navigation System

2020 AF Symposium Abstract

Live Case—AcQMap 3D Imaging, Mapping and Navigation System2021 AF Symposium Live Streaming Video

by Steve S. Ryan

In a live case entitled “Dipole Density Mapping of Atrial Fibrillation”, Dr. Timothy Betts of Oxford University Hospitals in Oxford, United Kingdom, demonstrated the Acutus Medical AcQMap 3D Imaging, Mapping and Navigation System.

AcQMap 3D Imaging, Mapping and Navigation System

We first saw a live case demonstration of the Acutus AcQ Imaging and Mapping system (Non-Contact Dipole Density) at the 2017 AF Symposium 

The Acutus Medical Non-Contact Dipole Density AcQ Imaging and Mapping catheter uses a basket catheter with multiple electrodes and ultrasound anatomy reconstruction.

‘Non-contact’ means the basket catheter can float freely in the left atrium and doesn’t have to be applied to the surface of the heart to generate A-Fib maps.

The basket catheter has six splines each with eight nodules that contain 48 ultrasound transducers and 48 electrodes. The ultrasound pings the atrium wall and rapidly produces a 3D left atrium anatomy.

Electrical Measurement: Dipole Density vs Voltage

Dipole Density map on a 3D ultrasound reconstruction of the heart

For over one hundred years, voltage has been the major electrical measurement in cardiac medicine.

The limitation with using voltage in electrophysiology is that the reading includes both the localized charge (Dipole Density) as well as the sum of the surrounding sources providing a broad, blended view of cardiac activity.

According to Acutus Medical, by eliminating these surrounding sources, and using dipole density (instead of voltage) the field of view becomes sharper and narrower.

This more precise electrical activation is displayed as a Dipole Density map on a 3D ultrasound reconstruction of the heart.

Acutus Medical Illustration: localized charge (Dipole Density) with the sum of the surrounding sources

Patient with A-Fib Since 2001

The patient was a 62-year-old man (BMI 27) with persistent A-Fib. He first had developed persistent A-Fib back in 2001 which was controlled by drugs and cardioversion.

In 2015 he had a PVI and a left atrial roof line using the Hansen Robotic ablation system which they were using at that time. He was OK for around 18 months.

Then in 2018 he developed organized tachycardia/Flutter. He was cardioverted, but still developed recurrent palpitations which were very long lasting. He had an enlarged left atrium and high blood pressure.

This ablation by Dr. Betts and his colleagues was a “re-do”.

Ensite contact force sensing catheter

Dr. Betts explained that the patient was under general anesthesia and that they were using Jet Ventilation for stability. (see Jet Ventilation Live case. ) Along with the Acutus mapping system, they were using the Ensite contact force sensing catheter for ablations.

The Acutus Medical AcQ mapping system received FDA approval Feb. 19, 2020. The second generation received FDA approval September 18, 2020.

Acutus AcQ Mapping System Very Fast, Real Time, and Non-Contact

It was amazing to watch them using the Acutus AcQ basket mapping catheter which moves around the left atrium without having to be in contact with the atrium wall (SuperMap program). It took them only two minutes to produce the left atrium 3D geometry and structure (and one minute of processing time). That was definitely the highlight of the live case.

The Acutus system uses non-contact global mapping (real time ultrasound) to collect high density points throughout the atria. For each SuperMap, they showed a two-screen display with a sinus “bin” on one side and a tachycardia bin on the other.

Flutter, High-Density Activation Mapping

Acutus Medical image of AcQ Mapping System

They initially found right atrium Flutter in the patient which they ablated with a caviotricuspid isthmus ablation line. Then a right atrial SuperMap with Acutus confirmed caviotricuspid isthmus block.

They also found that one of the patient’s right pulmonary veins had reconnected which they fixed.

They paced the LAA. The Acutus SuperMap showed that the previous roof line was still blocked/isolated.

They induced a non-sustained flutter which degenerated into A-Fib after 90 seconds. The SuperMap was able to produce a high-density activation map that showed the transient flutter rotated clockwise around the mitral annulus. As these arrhythmias were not sustained, they were not targeted.

Time ran out before they could do much more. This case of long-standing persistent A-Fib was a real challenge, even with the best of equipment.

Follow-up to Live Case

After the AF Symposium, Dr. Betts emailed me that his patient was discharged from the hospital the following morning in sinus. “He has done very well, with no arrhythmia recurrences after 11 months follow-up. He is off all antiarrhythmic medications.”

Editor’s Comments:

Editor's Comments about Cecelia's A-Fib story
Acutus AcQMap Importance: This case of a re-do ablation for multiple arrhythmia circuits showed how quickly the Acutus mapping system could create chamber geometry and collect high-density activation maps of sustained and non-sustained arrhythmias as well as assessing linear lesion conduction block with pacing.
May Replace Contact Mapping: Non-contact mapping is a significant innovation in catheter ablation and may eventually replace existing contact mapping catheters and make ablations easier. It also seems to require less technical skill than in a traditional contact mapping system.
No Radiation & Instantaneous: Using ultrasound to produce a 3D rendering of the heart is innovative and could change the way the anatomy of the heart is generated for an ablation. And unlike a CT scan, it doesn’t use radiation. Also, unlike a CT scan, the ultrasound images of the heart are generated instantaneously in real-time.
Higher Resolution: Dipole Density mapping may prove to be a higher resolution system than current mapping systems.

“Non-contact mapping is a significant innovation and may eventually replace existing contact mapping catheters.”—Steve Ryan

More Reports from the 2021 AF Symposium

Each year you’ll find me at the annual AF Symposium. It’s a unique experience. I attend presentations by the most eminent medical researchers, scientists, cardiologists and cardiac electrophysiologists working in A-Fib today.

I’ve published two more summary reports from the 2021 AF Symposium:

Spotlight Session: Javelin VINE Filter to Prevent Stroke

The idea behind the Javelin Medical VINE filter is to catch and stop clots (emboli) trying to travel up into the brain. This is done by inserting the VINE filter into both carotid arteries.(Of all the 5-minute Spotlight Session talks, this is my personal favorite.)

That’s incredibly good news for many A-Fib patients! It’s simple, ingenious, and very effective. Javelin Medical is an Israeli company located in Yokne’am Illit, Israel. Read more.

Live Case: Vein of Marshall Alcohol Ablation2021 AF Symposium Live Streaming Video

The AF Symposium audience watched live streaming video from Houston as Dr. Miguel Valderrabano demonstrated an innovative treatment for A-Fib using Alcohol Ablation of the Vein of Marshall.

In difficult A-Fib cases (persistent, long-term persistent), the Vein of Marshall can contain A-Fib signals (potentials, triggers) which are hard to reach and ablate. Adding ablation of the Vein of Marshall using Ethanol has been proven effective.

Using a 3 mm balloon catheter containing ethanol, he distributed ethanol into the Vein of Marshall starting distally (at the far end of the vein). Read more.

To browse through my other reports, go to 2021 AF Symposium Reports. For reports from other years go to Archive of AF Symposiums Summaries by Year

 

2021 AF Symposium Live Case: Vein of Marshall Alcohol Ablation

2021 AF Symposium

Live Case: Vein of Marshall Alcohol Ablation

by Steve S. Ryan

2021 AF Symposium Live Streaming VideoBackground: In difficult cases of A-Fib (persistent, long-standing persistent), catheter ablation has had limited success. Adding ablation of the Vein of Marshall using Ethanol has been proven effective. In the VENUS clinical trial, the ethanol infusion ablation patients had significantly improved “AF burden, freedom from AF after multiple procedures, and peri-mitral flutter block” versus the ablation-only patients.

Dr. Miguel Valderrabano

Live from Houston

The AF Symposium audience watched on live streaming video as Dr. Miguel Valderrabano of the Methodist DeBakey Heart Center in Houston, Texas, demonstrated an innovative treatment for A-Fib using Alcohol Ablation of the Vein of Marshall.

The Patient: A 69-year-old male had been in persistent A-Fib for 3 years, He had been cardioverted and was on amiodarone. He was mildly symptomatic. He came to Dr. Valderrabano in June 2020 in persistent A-Fib for at least 7 months.

When the Symposium audience first saw Dr. Valderrabano in Houston, he had already performed a standard Pulmonary Vein Isolation (PVI) of the PVs when the patient went into peri-mitral atrial Flutter. He also had worked on the posterior left atrium wall.

The Vein of Marshall

Location of Vein of Marshall

The Vein of Marshall is a vein connected to the Coronary Sinus near its opening (ostium).

In difficult A-Fib cases (persistent, long-term persistent), it can contain A-Fib signals (potentials, triggers) which are hard to reach and ablate. It’s located within the mitral isthmus.

Mapping and Diagnostic Catheter

In this live case, Carto mapping had revealed that this patient’s Vein of Marshall did have A-Fib signals.

Dr. Valderrabano had a sheath in the coronary sinus and a LIMA catheter engaged in the vein of Marshall ostium. (A LIMA catheter can be bent into various shapes.) He advanced a miniaturized octapolar Baylis diagnostic catheter (which specializes in reaching previously inaccessible areas of the heart) into the vein of Marshall.

Innovative Treatment: Ethanol Ablation

Dr. Valderrabano demonstrated an innovative ablation treatment called Ethanol Ablation.

Using a 2 mm balloon catheter containing ethanol, he distributed ethanol into the Vein of Marshall starting distally (at the far end of the vein). He would deflate the balloon and re-inflate it with ethanol to continue the ablation.

Using a 2 mm balloon catheter containing ethanol, he distributed ethanol into the Vein of Marshall. 

He stressed that the Vein of Marshall is somewhat delicate and frail.

He very gently injected the ethanol and did it in stages (distal to proximal), 1 cc over 2 minutes. He was able to achieve peri-mitral atrial flutter block by ethanol to achieve mitral Isthmus ablation. The patient’s Flutter terminated after the first ethanol injection!

He wound up doing 5 injections to cover the entire Vein of Marshall and its branches.

The ethanol basically scars (denervates) the Vein of Marshall eliminating any potentials (A-Fib signal sources or triggers).

He did this in graduated stages to make sure the ethanol didn’t affect the left atrium. He pointed out that this ablation technique done properly is safe.

Editor’s Comments

Ethanol Ablation Difficult to Perform: This is the first time I had seen an Ethanol Ablation. It’s obviously not the easiest procedure to perform.
In the VENUS trial, 30 of 185 patients weren’t able to achieve ethanol ablation, even though the operators and A-Fib centers involved were some of the best in the world.
Ethanol Ablation—Potential Breakthrough Treatment! When you consider how difficult it often is to cure more challenging cases of A-Fib (persistent and long-standing persistent), Ethanol ablation as demonstrated by Dr. Valderrabano is a major breakthrough!
EPs now have a way to ablate previously inaccessible areas of the heart!
All too often before this, some patients with persistent/long-standing persistent A-Fib could not be cured and had to resign themselves to live with A-Fib for the rest of their lives.

Now there is hope for even the most difficult A-Fib cases. We may have reached a beginning stage in A-Fib research where no one has to live permanently in A-Fib!

Resources for this article

• Valderrabano, M et al. Effect of Catheter Ablation With Vein of Marshall Ethanol Infusion vs Catheter Ablation Alone on Persistent Atrial Fibrillation― The VENUS Randomized Clinical Trial. JAMA. 2020;324(16):1620-1628. doi:10.1001/jama.2020.16195 https://tinyurl.com/VENUS-Clinical-Trial

• Virtual ACC: Ethanol infusion in vein of Marshall improves catheter ablation outcomes. Cardiac Rhythm News, March 29, 2020. https://tinyurl.com/Ethanol-Infusion

If you find any errors on this page, email us. Y Last updated: Tuesday, June 8, 2021

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2021 AF Symposium Spotlight Session: Javelin VINE Filter to Prevent Stroke

2021 AF Symposium

Spotlight Session: Javelin VINE Filter to Prevent Stroke

Dr. Stuart Connolly

Dr. Stuart Connolly

Dr. Stuart Connolly of McMaster University in Hamilton, Ontario, Canada gave a 5-minute Spotlight Session talk on the Javelin Medical’s Filter to prevent stroke. Javelin Medical is an Israeli company located in Yokne’am Illit, Israel.

(Of all the 5-minute Spotlight Session talks, this is my personal favorite. Inserting the Javelin Filter can stop most clots from getting to the brain and causing a stroke. That’s incredibly good news for many A-Fib patients! It’s simple, ingenious, and very effective.)

Filtering Out Clots Before They Get to the Brain

The idea behind the Javelin Medical VINE filter is to catch clots (emboli) trying to travel up into the brain. This is done by inserting the VINE filter into both carotid arteries.

Insertion of the Javelin Medical VINE filter

Insertion of the Javelin Medical VINE filter using Ultrasound probe

How it works: The VINE filter is inserted under the skin using ultrasound and usually without need for general anesthesia. It is a super-elastic thread-like Nitinol filter. When it’s inserted, it expands into a helical shape that fills and blocks the carotid artery while still allowing for normal blood flow to the brain.

Any clots are caught in the dense cone-like filter. Over time these trapped clots dissolve due to normal blood flow through the filter. Internal and external anchors lock the filter in place inside the carotid arteries. The VINE is intended to last for a lifetime.

Diagram: Side view Javelin Medical VINE filter

Diagram: Side view Javelin Medical VINE filter

Preliminary Studies: In early studies with sheep, the VINE filter was successfully inserted and deployed with at least a 94% success rate.

Now in Phase II Trials

The VINE is now in preliminary Phase II trials (Capture II). There have been no adverse events. But it will probably take years to get U.S. FDA approval before it’s available.

Editor’s Comments

Even when taking anticoagulants, some A-Fib patients are still at risk of an ischemic stroke. The Javelin VINE Filter could change that. Insertion of the VINE would make it improbable for a clot to make its way through the carotid arteries to the brain.
Having this extra protection would  give A-Fib patients greater peace of mind.
For patients unsuitable for oral anticoagulants, development and approval of the Javelin VINE Filter could be life-changing.
Less Need for Anticoagulants? Can the Javelin VINE Filter eventually replace the need for A-Fib patients to take anticoagulants at all? That probably isn’t likely, at least not in the near future. (Clots may still reach the brain through the vertebral arteries.) But imagine a time when no one would ever have to take anticoagulants!
Public Health Implications Beyond A-Fib: Could the Javelin Filter be used, not just in A-Fib patients, but in anyone at risk of stroke? According to Dr. Connolly, over 800,000 people a year suffer a stroke, 1 out of 3 of those due to A-Fib.
Major Healthcare Break Through? Can we dream of a world where anyone reaching, for example, age 65 would go in for a simple procedure that would forever protect them from having a clot or stroke?

The Javelin VINE Filter may make this possible. It may become a major breakthrough in health care.

Added 4/28/21: Please be advised that the above Editor’s Comments are probably way too optimistic at this time. These are very early days in the research and development of the Javelin filter. We need more data. It hasn’t been proven safe yet, let alone effective.

If you find any errors on this page, email us. Y Last updated: Wednesday, April 28, 2021

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2021 AF Symposium: 5 New Summary Reports Posted

I’ve completed several new reports on presentations made at the 2021 AF Symposium. With each report, I strive to share the current state of the art in A-Fib research and treatments and what’s relevant to patients with Atrial Fibrillation. Symposium presenters are the best clinicians and researchers working in Atrial Fibrillation today. My new reports include:

Two Spotlight Sessions on New Technologies/Drugs: A new antiarrhythmic drug in development, and an inhaler that delivers Flecainide for fast results.

Two Clinical Trials: Results comparing the effectiveness of CryoBalloon ablation vs. Drug Therapy; and Findings from the ATTEST trial.

Research: The role of anticoagulants in A-Fib patients who develop cognitive impairment, cerebral microbleeds and dementia entitled “Cerebral Amyloid Angiopathy (CAA).

The new reports (with links):

Spotlight Session: New Technologies and Drugs―Flecainide Inhaler by InCarda Therapeutics
Spotlight Session: Drug in Development from Acesion Pharma
Anticoagulants and Cerebral Amyloid Angiopathy (CAA): Prevalence, Detection and Management
ATTEST Trial: Catheter Ablation to Modify Progression of AF
Another Study Finds Ablation Better First-Line Treatment Than Medication

Look for more of my reports from the 2021 AF Symposium in the next weeks and months. And, as always, my reports are written in plain language for A-Fib patients and their families.

Go to my list of all 2021 AF Symposium Reports

2021 AF Symposium: New Technologies and Drugs―Flecainide Inhaler by InCarda

2021 AF Symposium

New Technologies and Drugs―Flecainide Inhaler by InCarda Therapeutics

Jeremy Ruskin, MD, Mass. General Hospital and AF Symposium

Jeremy Ruskin, MD

Dr. Jeremy Ruskin of Massachusetts General Hospital gave a 5-minute Spotlight Session talk on InCarda Therapeutics’ flecainide inhaler. InCarda is a privately held biopharmaceutical company in Newark, CA.

Dr. Ruskin described the InCarda inhaler which uses flecainide, a well-established antiarrhythmic agent.

Flecainide Inhaler from Carda Therapeutics

When a patient with recent onset A-Fib self-administers the breath-activated inhaler, it produces a flecainide-containing aerosol when the patient inhales. This results in a rapid absorption of flecainide via the lungs into the heart. An A-Fib attack can be terminated in as little as 8 minutes.

By contrast, if flecainide is taken as a pill-in-the-pocket, it often takes much longer for the pill to work (20-30 minutes).

Aside from the problems associated with flecainide, this inhaler is generally safe and well tolerated.

“Cmax ” is a pharmacology term meaning the peak serum concentration of a therapeutic drug. 
It’s “Cmax dependent” which means its peak plasma concentration is a function of dose and speed of administration, but primarily determined by dose.

According to Dr. Ruskin, “Inhaled Flecainide has the potential to be a practical, cost effective option for rapid conversion of AF to sinus rhythm.”

Editor’s Comments

The InCarda flecainide inhaler is already in FDA Phase II trials. But it will probably still be a couple of years before it’s generally available to doctors and patients.
InCarda Inhaler Better Than Pill-In-The-Pocket: The InCarda flecainide inhaler is or will be a welcome addition to Pill-In-The-Pocket therapy where patients only take a drug when it’s needed, not all the time. Today’s antiarrhythmic drugs can have bad side effects and be poorly tolerated if taken all the time. Think of how  liberating it would be to just use an inhaler to quickly get out of an A-Fib attack.

One wonders if the InCarda inhaler can be developed for anticoagulants as well. Anticoagulants are high risk drugs especially for older patients. 

f you find any errors on this page, email us. Y Last updated: Monday, April 19, 2021

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2021 AF Symposium: ATTEST Trial—Catheter Ablation to Modify Progression of AF

2021 AF Symposium

ATTEST Trial: Catheter Ablation to Modify Progression of AF

Dr. Karl-Heinz Kuck

Dr. Karl-Heinz Kuck of the Asklepios Klinik St. Georg in Hamburg, Germany, gave a presentation on the findings from the ATTEST Trial. (He also spoke on this topic at the 2020 AF Symposium).

Patient Risk: Progressing from Paroxysmal to Persistent A-Fib

Dr. Kuck pointed out that within one year, 4% to 15% of paroxysmal A-Fib patients become persistent.

In addition: they are at a higher risk of dying, they have more risk of stroke, and it’s more difficult to restore them to normal sinus rhythm. (In the Rocket AF trial, the mortality rate of persistent A-Fib was triple that of paroxysmal patients.)

The ATTEST Trial: RF Ablation vs Antiarrhythmic Drugs

The ATTEST clinical trial included 255 paroxysmal patients in 36 different study locations. They were older than 60 years and had to have been in A-Fib for at least 2 years (mean age 68). They had failed up to 2 antiarrhythmic drugs (either rate or rhythm control).

Patients were randomized to two groups: radiofrequency ablation (RF) (128) or antiarrhythmic drugs (127). They were followed for 3 years (ending in 2018).

ATTEST Findings

Significant data about the progression of A-Fib was learned from this trial.

• At 3 years, the rate of persistent A-Fib or atrial tachycardia was lower (2.4% ) in the RF group vs the antiarrhythmic drug group (17.5%).

• The RF group was approximately 10 times less likely to develop persistent A-Fib compared to the antiarrhythmic drug group.

• For patients in the antiarrhythmic drug group, 20.6% progressed to persistent A-Fib or atrial tachycardia compared to only 2.2% in the RF group.

• Recurrences occurred in 49% of the ablation group vs. 84% in the drug group. Repeat ablations were done on 17.1% of the ablation group.

Dr. Kuck’s advice: “Ablate as early as possible.”

Dr. Kuck’s Conclusions

Early radiofrequency ablation was superior to antiarrhythmic drugs to delay the progression to persistent atrial fibrillation among patients with paroxysmal A-Fib.

Dr. Kuck’s advice: “Ablate as early as possible.”

Editor’s Comments

The EAST-AFNET 4 Trial: The ATTEST Trial findings dovetailed with results from the EAST-AFNET 4 Trial.

Dr Paulus Kirchhof

In another ’21 AF Symposium presentation, Dr. Paulus Kirchoff (Institute of Cardiovascular Sciences, U. of Birmingham, UK) reported that EAST-AFNET 4 trial findings supported early initiation of rhythm therapy in cases of recent onset A-Fib. (See 2021 AF Symposium: EAST-AFNET 4 Trial—Early Rhythm Control Therapy in AF)
Research by both Dr. Kuck and Dr. Kirchhof came to the same conclusion: “ablate as early as possible” and the need for “early initiation of rhythm therapy.”
Why Risk Progressing into Persistent A-Fib? There are so many bad things that can happen to you when left in A-Fib. As Dr. Kuck points out, you’re at a higher risk of dying, there’s more risk of stroke, it’s more difficult to restore you to normal sinus rhythm.
And we haven’t even talked about heart damage from fibrosis, the risk of electrical remodeling of the heart, and the all-too-real dangers of taking antiarrhythmic drugs over time.
And what about quality of life? Who wants to live in A-Fib? There are few medical procedures so transformative and life changing as going from A-Fib to normal sinus rhythm.
Don’t Leave Someone in A-Fib―Ablate as Early as Possible: Dr. Kuck’s (and Dr. Kirchhof’s)  research answers once and for all whether or not A-Fib patients should be left in A-Fib, whether seriously symptomatic or not (e.g., leaving A-Fib patients on rate control drugs but still in A-Fib.)
These patients are 10 times more likely to progress to persistent A-Fib. That’s why today’s Management of A-Fib Treatment Guidelines lists catheter ablation as a first-line choice. That is, A-Fib patients have the option of going directly to a catheter ablation.
Research supports the same conclusion: “ablate as early as possible” and the need for “early initiation of rhythm therapy.”
Time for a Second Opinion? I occasionally hear of Cardiologists who refuse to refer patients for a catheter ablation, who tell patients a catheter ablation is unproven and dangerous. Not true!
When you hear something like that, it’s time to get a second opinion and/or change doctors.
Know Your Rights—Be Assertive: Your doctor may try to talk you into first trying antiarrhythmic meds before offering you the option of a catheter ablation.

As an A-Fib patient, know your rights and be assertive. According to the Management of Atrial Fibrillation Treatment guidelines, you have a right to choose catheter ablation as your first choice.

If you find any errors on this page, email us. Y Last updated: Friday, April 16, 2021

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2021 AF Symposium: Another Study Finds Ablation Better First-Line Treatment Than Medication

2021 AF Symposium

Another Study Finds Ablation Better First-Line Treatment Than Medication

To date there have been many research studies demonstrating the superiority of ablation versus drug therapy for A-Fib.

Dr. Jason Andrade

EARLY-AF is a Canadian study of CyroBalloon ablation by lead author Dr. Jason Andrade of the University of British Columbia Faculty of Medicine and colleagues. According to study researchers, CryoBalloon ablation “is a more effective first-line treatment for (A-Fib) patients than medication.” (The full name of the EARLY-AF study is “Early Aggressive Invasive Intervention for Atrial Fibrillation”.)

Cryoballoon ablation was better at preventing symptoms of A-Fib from recurring at all, and reduced the amount of time some patients experienced A-Fib.

The Study: CryoBalloon Ablation Halved Rate of Recurrence vs. Drugs

All 303 patients were treated for A-Fib for the first time in their lives. Half were randomized to receive CryoBalloon ablation (Medtronic Arctic Front Advance), while the other half were treated with antiarrhythmic drugs (AADs)(flecainide, sotalol, propafenone, or dronedarone). (Flecainide was the most frequently prescribed.) All patients received an implantable loop recorder (Medtronic Reveal LINQ) which allowed for continuous monitoring and the assessment of atrial fibrillation burden. .

Of the Cryo-Balloon group, 57.1% didn’t have a recurrence of some form of an irregular heartbeat by the one-year mark [not as high a success rate compared to other studies]. While the success rate of the AAD group was only 32.2%.

CryoBalloon ablation halved the rate of recurrence compared to usual drug therapy.

Additional Benefit: CryoBalloon Ablation Improved Quality-Of-Life

Ablation outperformed the drug group in terms of quality-of-life improvement. Eighty-nine per cent of CryoBalloon patients were free of symptomatic arrhythmia episodes.

According to Dr. Andrade, “Patients who received cryoballoon ablation were more likely to be symptom-free and not require hospitalization for their atrial fibrillation.”

Editor’s Comments

Choose Ablation Over Drugs: Dr. Andrade states explicitly that A-Fib patients should think of catheter ablation as first-line therapy, not something you do after trying multiple antiarrhythmic drugs (AADs).
This is in accordance with current best practices i.e., Guidelines for the Management of Patients with Atrial Fibrillation. AADs don’t work half as well as catheter ablation. In the real world, AADs are ineffective, cause bad side effect, or lose what effectiveness they had over time. And while you’re wasting a year or two trying various AADs, you’re usually still miserable in A-Fib and your A-Fib has gotten worse (remodeling).
Catheter Ablation Transforms Your Life: An A-Fib attack can totally incapacitate you. Even mild to moderate A-Fib can make you feel unwell, produces shortness of breath, brain fog, etc. You may be unable or reluctant to pursue normal activities like traveling and exercise. And you often live in fear of the next A-Fib attack. Or you’re angry and frustrated at your out-of-control heart.
A catheter ablation can change all that.

There are few medical procedures so transformative and life changing as a successful catheter ablation. Ask any former A-Fib patient who is now A-Fib free.

Resources for this article

• A procedure, not medication, may be a more effective first-line of treatment for common heart rhythm problem. UBC Faculty of Medicine, November 24, 2020. https://www.med.ubc.ca/news/a-procedure-not-medication-may-be-a-more-effective-first-line-of-treatment-for-common-heart-rhythm-problem/

• Minimally invasive procedure beats meds for atrial fibrillation. Bottom Line Personal, Volume 42, Number 8, April 15, 2021.

• Andrade, J. et al. Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation. The New England Journal of Medicine, January 28, 2021, https://www.nejm.org/doi/full/10.1056/NEJMoa2029980. DOI: 10.1056/NEJMoa2029980.

f you find any errors on this page, email us. Y Last updated: Monday, May 31, 2021

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2021 AF Symposium Spotlight Session: Drug in Development from Acesion Pharma

2021 AF Symposium

Spotlight Session: Drug in Development from Acesion Pharma

At this year’s AF Symposium, there were 22 Spotlight Session talks 5 minutes long spread out over 3 days. Normally I don’t report on them in detail, since they usually aren’t currently available (and may never make it through development and regulatory hurdles into the marketplace). But here’d one that may be of interest to patients.
Dr. John Camm - A-Fib.com

Dr. John Camm

Dr. John Camm of St. George’s Hospital in Oxford, UK discussed a drug in development from Acesion Pharma, a Danish biotech company.

This new drug (AP30663) is highly atrial specific and works as an SK channel inhibitor [to suppress A-Fib]. SK channel inhibitors are ion channels present in the heart which regulate the cardiac rhythm.

Acesion’s new drug is designed for IV cardioversion of A-Fib to normal sinus rhythm.

Editor’s Comments:

Just the fact that Acesion is working on a new antiarrhythmic drug is news in itself. It’s been years since any new antiarrhythmic drugs have come on the market. And the antiarrhythmic drugs currently available to patients leave a lot to be desired.

Plus, the Acesion drug being developed is highly atrial specific which is an important advantage over most other antiarrhythmics.

If you find any errors on this page, email us. Y Last updated: Monday, April 19, 2021

Return to 2021 AF Symposium Reports

’21 AF Symposium Report: Pulsed Field Ablation for Atrial Fibrillation with Lattice-Tip Catheter

I’ve posted a new report about an ablation for a patient with persistent A-Fib who had been cardioverted and was now in Atrial Flutter. Drs. Reddy and Neuzil demonstrated a new, innovate strategy of using Pulsed Field Ablation (PFA) combined with RF ablation developed by AFFERA, Inc.

The AFFERA lattice catheter

The AFFERA lattice catheter

Symposium attendees watched the ablation live via streaming video from the Czech Republic.

The AFFERA system uses a single lattice-tip catheter but two different energy generators, one for PFA and another for RF ablations.

One of the great advantages of Pulsed Field Ablation (PFA) is that the PF energy doesn’t damage adjacent tissue or structures such as the Phrenic nerve or the esophagus. So the doctor can switch back and forth between energy sources depending on the lesion location and surrounding tissue/organs.

When the AF Symposium audience joined the live video feed, the doctors and their team had started the procedure. The Pulmonary Veins (PVs) were already isolated and they had created a Flutter map. To continue reading…go to “Pulsed Field Ablation for Atrial Fibrillation Using a Lattice-Tip Focal Catheter”.

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