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AF Symposium & other medical conferences articles

2024 AF Symposium: An Overview For Atrial Fibrillation Patients and Families

The 29th annual AF Symposium was held in Boston Feb. 1-3, 2024.

This is the 20th time I have attended the annual AF Symposium. Observing and adequately reporting on it is both a challenge and a privilege. I learn more in three days than in a year of reading A-Fib research reports.

This intense 3-day seminar featured presentations by 85 leaders in A-Fib Research and Clinical Practice from all over the world.

Click on image to read my full report.

These stellar medical scientists, clinicians, and researchers shared recent developments in the A-Fib field in a major scientific forum unmatched by any other conference. This year the Symposium attracted over 1200 participants from all corners of the globe.

Why I Attend Every Year

As always, I attend and write my reports to offer A-Fib.com readers the most up-to-date research and developments that may impact their treatment choices. All reports are written in plain language for A-Fib patients and their families. (Look for more of my reports in the coming weeks and months.)

Exciting Breakthroughs: A New World of A-Fib Care

The predominant mood or tone of this year’s Symposium was one of excitement about the extraordinary amount of new and more effective tools now (or soon to be available) to Electrophysiologists (EPs) for treating us patients.

To me the sheer number of new catheters, devices, etc. presented was almost overwhelming. As Dr. Pierre Jais of the French Bordeaux group (LYRIC) said, this a “great era!” There is now an incredible number of new tools EPs can choose from.  -> click to read my full report.

2024 AF Symposium: Reports for Patients by Steve S. Ryan, PhD

2024 AF Symposium

My Summary Reports Written for Atrial Fibrillation Patients

by Steve S. Ryan, PhD

The 29th annual AF Symposium was held in Boston Feb. 1-3, 2024. (This is where the AF Symposium originally started back in 1995). This intense 3-day seminar took place at the Omni Seaport hotel, a well-designed, ultra-modern conference venue (one of the best I’ve ever attended).

This Symposium featured presentations by 85 leaders in A-Fib Research and Clinical Practice from all over the world. These stellar medical scientists, clinicians, and researchers shared recent developments in the A-Fib field in a major scientific forum unmatched by any other conference. This year the Symposium attracted over 1200 participants from all corners of the globe.

Read about the Annual International AF Symposium: Why I Attend Every Year & Why it’s Important to A-Fib Patients

REPORT TITLE  DATE PRESENTER(S)POSTED
1.Overview: 28th Annual International AF Symposium 2024 written by Steve S. Ryan, PhD– – –March 10, 2024
Link to last year’s reports: 2023 AF Symposium
Link to Archive of AF Symposiums Summaries by Year

J. Ruskin

From Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School:

“Steve Ryan’s summaries of the A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation.”

If you find any errors on this page, email us. Y Last updated: Sunday, March 10, 2024

2024 AF Symposium Overview of My Summary Reports Written for Atrial Fibrillation Patients

2024 AF Symposium

My Summary Reports Written for Atrial Fibrillation Patients

By Steve S. Ryan, PhD

The 29th annual AF Symposium was held in Boston Feb. 1-3, 2024. (Where the AF Symposium originally started back in 1995). This intense 3-day seminar took place at the Omni Seaport hotel, a well-designed, ultra-modern conference venue (one of the best I’ve ever attended).

This Symposium featured presentations by 85 leaders in A-Fib Research and Clinical Practice from all over the world. These stellar medical scientists, clinicians, and researchers shared recent developments in the A-Fib field in a major scientific forum unmatched by any other conference. This year the Symposium attracted over 1200 participants from all corners of the globe.

In the words of Dr. Jeremy Ruskin 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.”

Why I Attend Every Year

As always, I attend and write my reports to offer A-Fib.com readers the most up-to-date research and developments that may impact their treatment choices. All reports are written in plain language for A-Fib patients and their families. Look for my reports here with links to the specific reports.

The sessions were intense with each of the three days starting at 7:30 AM. Sessions continued until 7:00 PM on Thursday, 6:30 PM on Friday and 3:30 PM on Saturday (to allow attendees time to catch their plane home).

My 20th AF Symposium

This is the 20th time I have attended the annual AF Symposium. Observing and adequately reporting on it is both a challenge and a privilege. I learn more in three days than in a year of reading A-Fib research reports.

The Conference Venue

The Omni Seaport hotel has become one of the best convention centers in the US. The hotel features 100,000 square feet of indoor/outdoor meeting and event space. The facility is well designed and very accommodating to convention participants. The room rates for attendees were reasonable. The rooms themselves were well designed with little wasted space. The staff was top notch, very helpful and friendly.

To welcome guests, The hotel gave out tickets for free drinks. As part of the Symposium package, we were given tickets for lunches which were excellent. We also got snacks and plenty of coffee, etc. The convention meeting hall was huge and easily fit in the 1,200+ Symposium attendees.

The well-designed exhibit hall was on the floor below and was easily accessible via escalators and elevators. And there was another huge hall where the many abstract session “posters” were displayed. The Omni hotel was easily accessible from Logan airport via a free shuttle (Silver Line), though one did have to walk a short distance to the Omni hotel entrance. (Going back to Logan airport on the same shuttle cost $2.50.)

Exciting Breakthroughs: A New World of A-Fib Care

Pierre Jais MD

Pierre Jais MD

The predominant mood or tone of this year’s Symposium was one of excitement about the extraordinary amount of new and more effective tools now (or soon to be available) to Electrophysiologists (EPs) for treating us patients.

To me the sheer number of new catheters, devices, etc. presented was almost overwhelming. As Dr. Pierre Jais of the French Bordeaux group (LYRIC) said, this a “great era!” There is now an incredible number of new tools EPs can choose from.

BTW: Dr. Pierre Jais is one of the Bordeaux EPs who cured my A-Fib back in 1998.

One may wonder, will some of these new tools fall by the wayside and not become industry accepted? I personally don’t think this will happen to any great extent. All the ones I saw presented were well designed and looked very effective, even if they were still in some development stage.

Dr Andrea Natale

Andrea Natale, MD

As Dr. Andrea Natale from Texas Cardiac Arrhythmia Institute asserted “the future is looking bright.” This symposium featured major breakthroughs and signaled the arrival of a whole new world of A-Fib care.

Artificial Intelligence and Contact Force Sensing

As at last year’s AF Symposium, we saw how Artificial Intelligence (AI) is being applied to various treatments of Atrial Fibrillation.

One major change at this year’s AF Symposium was that Contact Force Sensing, to a limited extent, is now being applied to Pulse Field Ablation (PFA). (This was surprising to me. I didn’t think actual contact was necessary for good PFA lesions. But it seems that good contact does make for better PFA ablations.)

Major Focus: Pulsed Field Ablation Again

As at last year’s AF Symposium, Pulsed Field Ablation (PFA) was a major focus. This year, I counted 26 talks on PFA.

Most Noteworthy Quote

Perhaps the most important quote of the AF Symposium was about the future and potential of Pulse Field Ablation (PFA). In the words of Dr. Moussa Mansour of Mass General, the various research and clinical studies such as at this year’s AF Symposium “will lead to the adoption of PFA as the only energy source for PVI”.

It certainly looks like this is the direction A-Fib catheter ablation is moving towards, if not already there now (as it is in Europe).

In this context it was announced the day before the Symposium opened that the FDA had approved the Farapulse PFA catheter system January 31, 2024 (Boston Scientific). The FDA had previously approved the PulseSelect PFA system (Medtronic) December 13, 2023. Several other PFA systems are currently in the FDA pipeline waiting approval. (It’s discouraging how slow the FDA moves as compared to PFA systems approved for years in Europe and elsewhere.)

Public Health Red Flag Alert

Shaan Khurshid MD

Dr. Shaan Khurshid of Mass General declared what I would consider a public health and red flag alert. He reiterated the fact that “25 percent of A-Fib is undiagnosed”. In practical terms, many people are suffering strokes, A-Fib arrhythmias, heart damage, etc. without being aware that they are suffering from a major heart disease (such as A-Fib) and without being treated for it. This is a major public health disaster.

The tragedy is that A-Fib today is treatable and curable. How do we identify those 25% of patients with undiagnosed A-Fib? Perhaps an added test during annual physical exams? I wonder if it’s possible during annual physical exams for persons of a certain age to automatically be tested for heart arrhythmias such as A-Fib? (This seems achievable, especially considering how good monitoring devices are today, including DIY devices like the Apple Watch or Kardia system!)

Too Much of a Good Thing?

Dr. Pierre Jais of the French Bordeaux group (LYRIC) expressed a concern and a warning that “it’s possible to kill the left atrium” by too much ablation so that it no longer contracts and functions properly. One reason for possibly using too much ablation is how relatively easy PFA is to perform.

From Spotlight Session to Center Stage

At last year’s AF Symposium, I reported on a Spotlight presentation about the Laminar Left Atrial Appendage (LAA) closure/elimination device. I wrote back then that it was perhaps the most innovative and potentially ground-breaking presentation at the 2023 Symposium.

Imagine my surprise when at this year’s AF Symposium, the Laminar device was featured in a case presentation by Dr. Devi Nair of St. Bernard’s Heart & Vascular Center, Jonesboro, AR. In talking with attendees, many were already well aware of the Laminar device.

Illustration: Laminar LAA Closure/Elimination Device

In just one year, the Laminar device has moved from a Spotlight session to being accepted as an important tool for EPs. I don’t think I’ve ever seen an innovation get mainstream acceptance so fast.

The Laminar device features what is called a “rhythm ball”. It is inserted into the LAA, then twisted counterclockwise to the point where the LAA opening (ostium) is screwed together so tightly that the ostium and LAA disappear. Then, this ball is locked in place to prevent it from unwinding.

2024 Spotlight Sessions

The Spotlight sessions are often fascinating and reflect what the future may hold for A-Fib treatment. The ones that stood out to me were:

  1. A nasal spray (Etripamil) which uses a calcium channel blocker to quickly reduce heart rate within minutes.
  2. A holographic system (Santiar) for viewing ablation screens which can then be projected and referenced from anywhere in the cath lab.
  3. An innovative esophageal deviation device (S4 Medical) to move the esophagus away from the back of the posterior wall where an EP may be ablating.
  4. A technology (Vector Vmap) used outside the body to locate where in the heart A-Fib signals are coming from.

Tribute to Dr. Albert Waldo

For those of us who have been attending the AF Symposium for years, we appreciated the tribute to Dr. Albert Waldo who passed away in 2023. He was a wonderful, warm person as well as a pioneer researcher and clinician. He will certainly be missed.

Live and Pre-recorded Transmissions

We were treated to 19 various A-Fib ablation and device case demos both live and pre-recorded. These events seemed to go off without any problems, even though many of the cases were from overseas. It was a marvel of technology.

I was in awe of the session moderator, Dr. Moussa Mansour, who made everything flow seamlessly. He made sure the presenters stayed on schedule and at the same time helped the attendees understand the presenters and their objectives. A master showman.

A Year in the Planning

We later learned about the year-long planning it takes before each symposium. Throughout the year, Dr. Mansour and Dr. Jeremy Ruskin would meet on weekends to analyze and select which talks and subjects for the upcoming Symposium.

Dr Moussa Mansour

Moussa Mansour. MD

Jeremy Ruskin, MD

They have done a terrific job at this for many years. We are most grateful to them for the incredible amount of time and effort they have put into making each AF Symposium so insightful and relevant. Dr. Mansour and others made a point of thanking Executive Directors Muriel Corcoran and Robert Matthews for their great work in setting up and organizing the AF Symposium.

Challenging Case by Dr. Young-Hoon Kim

The last presentations on Saturday were the Challenging Cases in AF Management and Stroke Prevention. Dr. Young-Hoon Kim from Korea University in Seoul, South Korea gave a noteworthy presentation on how he saved a patient from an Atrial Esophageal Fistula even though there was no surgeon available to care for the patient. As Dr. Kim explained, normally that patient would have died. But Dr. Kim saved the patient’s life. How? I’ll describe that in an upcoming report.

More Reports To Come

Look for more of my reports from the 2024 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 clinical practice, what’s relevant to A-Fib patients and their families and friends.

In the meantime, you may want to browse my reports from the 2023 AF Symposium, or
the Archive of AF Symposiums Summaries by Year

If you find any errors on this page, email us. Y Last updated: Sunday, March 10, 2024

2023 AF Symposium Spotlight: Ground-Breaking LAA Elimination Device

For A-Fib patients, perhaps the most innovative and potentially ground-breaking presentation at this year’s AF Symposium was by Dr. Saibal Kar of Cardiovascular Associates at Los Robles Hospital in Thousand Oaks, CA.

Laminar LAA closure device

In a Spotlight Session on Friday, he described a new device for closing off (“eliminating”) the Left Atrial Appendage (LAA). The LAA is where 90%-95% of Atrial Fibrillation clots and strokes come from.

The Laminar LAA elimination device is a potential medical breakthrough innovation! It takes little time to insert, it could be positioned at the same time as a catheter ablation. This could revolutionize the way LAAs are closed off today.. Learn all about it in my report: Spotlight Session: Laminar LAA Closure/Elimination Device.

 

2023 AF Symposium: Live Case from Dublin using Pulsed Field Ablation and Multispline Catheter

LIVE live from Dublin, Ireland—it was like we were in the EP lab with Drs. Joseph Galvin and Gabor Szeplaki from Mater Private Hospital in Ireland.

They perform 800-900 ablations/year and have done 268 cases of Pulsed Field Ablation (PFA) using the Boston Scientific Farapulse system. Amazingly, these ablation average 40 minutes in length—a very short time to perform an ablation (and no complications).

The patient was a 66-year-old woman who had developed symptomatic paroxysmal A-Fib three years ago, medications were poorly tolerated.

The first thing we noticed was, instead of the typical Lead apron shields to protect against Fluoroscopy radiation, they were wearing what looked like plastic vests which were leadless (but did provide radiation protection).

As we watched from Boston… . Read my full blow-by-blow report, see Live Case Presentation from Dublin, Ireland. Pulsed Field Ablation for AF Using a Multispline Catheter.

2023 AF Symposium Challenging Case―“Doc, I’m still having A-Fib. You’ve got to fix it.”

“According to my Apple watch, Doc, I’m still having A-Fib. You’ve got to fix it.”

That’s how Dr. John Day began relaying this challenging case at the 2023 AF Symposium. The patient was a 56-year-old young man in otherwise good health.

Dr. Day, from the Heart Center of St. Mark’s Hospital in Salt Lake City, UT, describes the patient’s BMI as normal. He had had an ablation but was still in A-Fib. He had mild or moderate left atrium enlargement but no clear A-Fib triggers. He didn’t want to be on drugs. He had tried Flecainide which lowered his heart rate too much. He couldn’t exercise on Flecainide. How did Dr. Day proceed?

Dr. Day and his colleagues may have developed a new method of making patients with difficult cases A-Fib free.

To learn more, read my report, Challenging Case―Ablates Low Voltage High Frequency Areas.

2023 AF Symposium: Challenging Case―An EP’s Nightmare

This is a tragic case of a 77-year-old male, a retired Cardiologist and a personal friend of the speaker for over 40 years. This case resonated emotionally with both the doctors, panelists and the audience who seemed to have experienced similar experiences with their patients.

Dr. Karl-Heinz Kuck of the University of Lubeck, Lubeck, Germany, described what lead up to a fatal climax.

The story starts in 2014 when his patient developed Persistent Atrial Fibrillation. He had a successful PVI (Pulmonary Vein Isolation/ablation) and roof line ablation in 2015.

A couple of weeks later, the patent had a repeat ablation including an isthmus line. He was doing well for 6 years. But then he came back with… Read the whole story at Challenging Case―An EP’s Nightmare.

2023 AF Symposium: Innovative A-Fib Ablation Plus LAA Closure in One Procedure

This report from the 2023 AF Symposium is about an innovative treatment for A-Fib patients―combining A-Fib ablation with the insertion of a Left Atrial Appendage (LAA) occlusion device in a combined procedure.

Closing off the Left Atrial Appendage has become an important topic for patients looking to be A-Fib free.

Many A-Fib stokes originate in the Left Atrial Appendage. And many recurrences of A-Fib come from the Left Atrial Appendage, too.

Inserting a Watchman occlusion device to close off the LAA has become a relatively simple and fast process. Combining it with a catheter ablation doesn’t add much time to the ablation procedure.

This treatment strategy is currently in use in many countries overseas, but isn’t yet common practice in the U.S.

Dr. Walid Saliba of the Cleveland Clinic Foundation in Cleveland, OH explained how patient selection is important in this combined procedure. To learn more read my report…

 

2023 AF Symposium: Challenging Case―An EP’s Nightmare

2023 AF Symposium

Challenging Case―An EP’s Nightmare

Dr. Karl-Heinz Kuck, Lubeck, Germany

Dr. Karl-Heinz Kuck of the University of Lubeck, Lubeck, Germany described the tragic case of a 77-year-old male who was a retired Cardiologist and a personal friend of his for over 40 years. This case resonated emotionally with both the panelists and the audience who seemed to have experienced similar experiences with their patients.

Persistent A-Fib―Successful Ablation

Dr. Kuck’s patient was suffering from persistent A-Fib since 2014. He had had a successful PVI (Pulmonary Vein Isolation/ablation) and roof line ablation in 2015.

A couple of weeks later, the patent had a repeat ablation including an isthmus line and was doing well for 6 years. But then he came back in with Tachycardia (high heart rate).

Dr. Kuck did another ablation in 2021. He found using voltage mapping that the patient had slow conduction around the scarring on the roof of the anterior wall. Among other techniques, Dr. Kuck made a roof line from the scar area to the annulus. He was able to terminate the tachycardia.

The patient was scheduled for a Left Atrial Appendage (LAA) closure procedure in 6 weeks. He was OK with that but didn’t want to come back for another ablation. He was told to continue taking anticoagulation.

Stops Taking Anticoagulation―Dies in 3 Days!

The patient stopped taking the anticoagulant apixaban (Eliquis) within a week of his ablation for fear of bleeding. He thought or was told by others or by his reading that he could substitute high dose aspirin for taking Eliquis. He was admitted at another hospital. A CT scan showed ischemia (an inadequate blood supply to the heart) and severe edema (swelling). He died 3 days later.

How to Prevent Patients Stopping Their Anticoagulation?

The audience was stunned.

An intense discussion among the panelists and the audience talked about why patients go off of anticoagulants when they shouldn’t.

People suffer a fall, develop cancer, have to have surgery, etc. and for various reasons are taken off of anticoagulants. Then they often develop a stroke.

During the discussion, some suggested closing off the LAA as soon as possible, even during an initial PVI ablation. The session’s last thought: “Should closing off the LAA be a first line procedure?”

Editor's CommentsEditor’s Comments

Nightmare of Patients Not Taking their Anticoagulant: Dr. Kuck’s case struck an emotional chord that resonated with attendees. A major nightmare EPs face is their patients not taking their anticoagulants, then having a  stroke. This happens all too often and has probably occurred or will occur to every EP.
But, except for insisting that patients take their anticoagulants and other meds, there isn’t much an EP can do.

Closing Off the LAA May Be the Solution: Closing off the LAA does work and prevents stroke. It’s an effective substitute for a lifetime on anticoagulants. Then patients (and their doctors) don’t need to be preoccupied about a patient going off of anticoagulants. Instead of being a last resort procedure, many attendees seemed to think that LAA closure should be a first-line treatment for many patients.

If you find any errors on this page, email us. Y Last updated: Thursday, May 11, 2023

Return to 2023 AF Symposium Reports

2023 AF Symposium: Live Case from Dublin, Ireland. Pulsed Field Ablation for AF Using a Multispline Catheter

2023 AF Symposium

Dr. Joseph Galvin, Dublin, Ireland

Live Case Presentation from Dublin, Ireland. Pulsed Field Ablation for AF Using a Multispline Catheter

The presenters of this live presentation were Drs. Joseph Galvin and Gabor Szeplaki from Mater Private Hospital in Ireland. They perform 800-900 ablations/year and have done 268 cases of Pulsed Field Ablation (PFA) using the Boston Scientific Farapulse system.

As we watched this live ablation, they used the optimized biphasic wave form for the PFA ablations. Dr. Szeplaki did the actual ablation while Dr. Galvin commented.

Dr. Gabor Szeplaki, Dublin, Ireland

No Lead Aprons

The first thing one noticed was that, instead of the typical Lead apron shields to protect against Fluoroscopy radiation, they were wearing what looked like plastic vests which were leadless. (Zero Gravity system by Biotronik.) These shields attach via a magnet to the operator who wears a vest with a magnet at the front.

66-Year-Old Female with Common Right Atrium

The patient was a 66-year-old woman who had developed symptomatic paroxysmal A-Fib three years ago. She had been taking Sotalol but tolerated it poorly. They also had tried dronedarone, but she had symptoms.

Her CHA2DS2-VASc score was 3. She had hypertension. Her left atrium was otherwise healthy. She had a somewhat unusual pulmonary vein anatomy with what looked like a huge common right ostium. They used general anesthesia rather than conscious sedation.

Ablation Procedure

NOACs (Novel Oral Anticoagulants) were discontinued the morning of the procedure.

A TEE (Transesophageal Echocardiogram) was used to make sure there was no thrombus (clot) in the heart.

They used Ultrasound to position the catheter to puncture the vein. In the heart they used a single transseptal puncture to access the left atrium. They used the Orion catheter for 3-D mapping and paced from the Coronary Sinus.

The mapping software was integrated into the Farapulse system in real time, which is a great help to the EPs. The catheter sheaths were transparent so that they could better see and eliminate bubbles on the catheters.

Farapulse catheter Open-Basket configuration

Farapulse catheter – Five Petal Flower configuration

Each vein to be ablated received four basket and four petal ablations rotating the catheter each time for better coverage. (For a more detailed description of the Farapulse system, see my 2020 report, Pulsed Field Ablation—Emerging Tech for Atrial Fibrillation.) 

They made sure that both exit and entrance block were achieved in each vein. As they ablated, the heart tissue on the screen changed from light red to dark red.

Even with the large common right ostium, they still used the 31mm catheter rather than the larger size. The patient was successfully ablated and returned to normal sinus rhythm.

Overall their results in their center are 96% vein isolation and 84% curable PVI.

Dr. Galvin commented that when they first started, PFA ablations were taking 6-7 hours. But now they are doing them in 40 minutes.

Editor's CommentsEditor’s Comments

PFA Ablation Easy, Safe and Effective: The Farapulse ablation protocol has become relatively easy and safe to do. The operators in Ireland seemed very proficient, confident, and experienced. For them this was no big deal and almost routine. This is great news for patients. 40 minutes is a very short time to perform an ablation. And with no complications.
PFA Not Yet Approved in U.S.―But Will Be Soon. PFA ablation is not yet approved in the U.S., but has been approved overseas and has been in use for some time. Panelists from Germany pointed out that PFA ablation is now done on an out-patient basis with no need to stay in a hospital overnight. This is all good news for U.S. patients with Atrial Fibrillation.
Transparent Radiation Shields Great Advance: And using these transparent shields to protect against radiation exposure is a huge advance for EPs doing ablations.

I’ve been in operating rooms and had to wear those lead aprons used today by most EPs. They are really heavy and wear you down by the end of the day. All too many EPs develop slipped disks or other back problems. And reducing or eliminating radiation exposure improves EPs health and peace of mind. Good news for EPs!

If you find any errors on this page, email us. Y Last updated: Saturday, August 12, 2023

Return to 2023 AF Symposium Reports

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