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2025 AF Symposium Video: The Genesis of the AF Symposium with Drs. Jeremy N Ruskin, Luigi Di Biase
The AF Symposium is celebrating its 30th anniversary in 2025. Three short videos give insight into its development, purpose and achievements.
They are hosted by Dr Luigi Di Biase, Editor-in-Chief of the Arrhythmia Academy, (Albert Einstein College of Medicine, US) who interviews founding director of the AF Symposium, Dr Jeremy Ruskin (Massachusetts General Hospital, Boston, MA, US).
The annual AF Symposium features live EP lab/operating room patient procedure cases, late-breaking data and up-to-date presentations related to the treatment of atrial fibrillation.
Via video conferencing, Dr Luigi Di Biase and Dr Jeremy Ruskin discuss:
Video 1: The history of the AF Symposium (started in 1995); 4 min.
Video 2: A-Fib research and the role of mentors in the development of young electrophysiologists; 8 min.
Video 3: The logistics of live patient procedure cases at large-scale cardiology events; 15 min.
…To play a video, continue to my page with the video links. Then, to play a video, just click on the image and a new browser window will open.)
Return to 2025 AF Symposium Reports
If you find any errors on this page, email us. Y
Last updated: Monday, March 17, 2025
2025 AF Symposium: My First Report “Challenging Cases in AF Management and Stroke Prevention”
One of the most interesting sessions at the 2025 AF Symposium was the “Challenging Cases in AF Management and Stroke Prevention” on Saturday January 17 at 3:00 pm.
The panelists this year were:
The moderator was Dr. David Keane of St. Vincent’s Hospital, Dublin, Ireland
• Edward Gerstenfeld of the Un. of California (UCSF Health), San Francisco, CA
• Francis Marchlinski of the Un. of Pennsylvania Health System, Philadelphia, PA
• John Day of St. Mark’s Hospital, Salt Lake City, UT
• Isabel Diesenhofer of the German Heart Center Munich, Germany
• Young-Hoon Kim of the Korean University Medical Center, Seoul, Korea
Each doctor made a 7-minute presentation of their case followed by a 5-minute discussion.
This is the first of my reports on these Challenging Cases.
Case #1: Patient with Bronchial Lesion
Dr. Edward P. Gerstenfeld
Dr. Edward P. Gerstenfeld, chief of the UCSF Cardiac Electrophysiology and Arrhythmia Service, described the tragic case of a man in his 50s who had received a standard Pulmonary Vein Isolation (PVI) procedure.
He had cardiomyopathy [making it harder for the heart to pump blood] and was prescribed the antiarrhythmic drug amiodarone. The ablation appeared to go well without any particular problems. No additional roof or other ablation lines were added to the PVI.
ER Visits for Left Lung Problems
Over the following three weeks the patient had repeated Emergency Room visits, chest pain, cough, shortness of breath, fever, and headache. <Continue reading this report…>
2025 AF Symposium Overview: Written for Atrial Fibrillation Patients
The 30th 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.
Steve Ryan at the 2025 AF Symposium
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.
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 and operating rooms from around the world. There were a record 24 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.
Staying Current with A-Fib Research: In Boston for the 2025 International AF Symposium
This past week I was once again in Boston for the annual International AF Symposium, one of the most important conferences on Atrial Fibrillation in the world. This intensive and highly focused three-day symposium brings together the world’s leading medical scientists, researchers and cardiologists to share the most recent advances in the field of atrial fibrillation.
Why I Attend the Symposium Every Year
Each year I attend the Symposium to learn and ‘absorb’ the presentations and research findings. It gives me a thorough and practical view about advances and progress in our understanding of atrial fibrillation and therapeutics directly from many of the most eminent investigators in the field.
For A-Fib.com readers, my goal is to offer the most up-to-date A-Fib research analysis and developments that may impact the treatment choices of patients seeking their A-Fib cure or best outcome.
Prof. Michel Häissaguerre (who invented the PV ablation) and Steve Ryan at 2019 AF Symposium.
Writing and Posting My Reports
On the plane ride home I start writing summaries of significant presentations and important research findings that are relevant to A-Fib patients and their families.
I strive to ‘translate’ as much of the medical jargon into everyday language. (My wife, Patti, keeps an eye out for this). I add my own comments and insights to help interpret the information for A-Fib.com readers.
In the months following the Symposium, I write and post three or four reports each month. (Why does it take so long? I send each of my summaries to the presenter inviting their feedback, so it takes some time to get each article written, reviewed, and posted.)
I announce each posting on my A-Fib News Blog with a link to each article.
You can review my previous reports by going to AF Symposium Archives by Year.
Look for my first 2025 AF Symposium summaries in the weeks ahead.
OUR MISSION: At A-Fib.com, we offer hope & guidance to empower patients to find their A-Fib cure or best outcome. A-Fib.com is the patient’s unbiased source of well-researched information on current & emerging Atrial Fibrillation treatments.
Abbott’s LAA Closure Device Amplatzer Amulet FDA Approved for A-Fib
Atrial Fibrillation patients now have a second effective way to close off the Left Atrial Appendage (LAA) to prevent strokes and to no longer be required to take anticoagulants for life. Abbott’s Amplatzer Amulet Left Atrial Appendage closure device was approved by the FDA in August 2021.
Amulet Clinical Trial
In a clinical trial sponsored by Abbott, the Amplatzer Amulet was compared head-to-head with the earlier version of the Watchman device, (not with the more recent Watchman FLX commonly in use today).
Amplatzer Amulet Occluder device positioned in Left Atrial Appendage (LAA)
The Amplatzer Amulet device features a lobe which fills the body of the Left Atrial Appendage (LAA) and a disc to close off the opening into the LAA.
In the Amulet LAA Occluder clinical trial, 80% of Amulet patients were discharged without anticoagulant therapy. Only 20% were discharged on anticoagulants (usually dual antiplatelet therapy, clopidogrel plus aspirin). The FDA-approved label recommends this to prevent clot formation before the device is completely closed off by heart tissue growing over the device (reendothelialization).
In this study most Watchman patients (82%) were discharged requiring anticoagulant therapy. The Watchman usually requires a short course (45 days) of warfarin followed by dual antiplatelet therapy anticoagulants (usually clopidogrel plus aspirin) until 6 months after LAA closure.
Major Advantage of Amulet Over Watchman
Why is the Amulet important for some Atrial Fibrillation patients? The Amulet doesn’t usually require the use of anticoagulants after it is inserted. (Some patients can’t take anticoagulants, others don’t want to be on anticoagulants, even for a short period.)
No Data Yet on Amulet vs. Newest Watchman FLX
The Amulet did close off the LAA better than the 2015 version of the Watchman, but not by much (98.9% vs. 96.8%).
We don’t have data comparing the current Watchman FLX to the Amulet.
Editor’s Comments
Atrial Fibrillation patients considering an Amulet should probably wait till after they are free of Atrial Fibrillation and after a thorough mapping and isolation of all non-PV triggers, especially those coming from the LAA.
Metal Exposure: The Watchman FLX features reduced metal exposure, whereas the Amulet outside disc is a large protruding piece of metal inserted into the heart. (I personally would not want that huge piece of metal disc in my heart.)
Occluders: Watchman on left; Amplatzer Amulet on right
What if one’s LAA continues to produces A-Fib signals? It’s difficult or impossible to isolate the LAA if the Amulet disc covers the LAA opening. The Watchman doesn’t protrude into the heart like the Amulet does.
No or Reduced Need for Anticoagulants with Amulet: The Amulet doesn’t usually require anticoagulants. This is great news for those who can’t tolerate anticoagulants. One of the major motivations to getting one’s LAA closed off is to no longer have to take anticoagulants which are high risk drugs.
It’s Great for A-Fib Patients to Now Have a Choice of LAA Closure Devices: It’s amazing how research has improved for patients with A-Fib. Who would have thought that we would now have two effective ways to close off the LAA to prevent strokes−with no requirement of anticoagulants therapy for life?
Which is Better―the Amulet or Watchman? Which Should I Choose? Unless you can’t tolerate anticoagulants for 6 months, stick with the Watchman FLX. We know it works in the real world after years of experience. While the Amulet is used in Europe, it has just been FDA approved in the US. We need more real-world experience with it.
On a Personal Note: As many readers know after 21 years, my A-Fib returned. Not to worry. I’m once again A-Fib free after two catheter ablations by Dr. Shephal Doshi and Dr. Andrea Natale. But Dr. Natale did recommended I close off my Left Atrial Appendage (LAA). So in a few months, I’ll be getting the Watchman FLX occlusion device. I’ll write about the experience.
Additional reading: Don’t Want to Take Anticoagulants? Three Alternatives for A-Fib Patients; and Anticoagulants Increase Risk of Hemorrhagic-Type Strokes
A-Fib & Anticoagulants: Bleeding Risk If combined with OTC meds, Supplements
More than a third (33%) of people taking anticoagulants also take at least one nonprescription drug daily or most days of the week. This combination can cause dangerous side effects.
If you are taking an anticoagulant, such as Eliquis, Xarelto, Pradaxa or Savaysa, be aware that taking it along with some over-the-counter drugs and supplements can cause dangerous internal bleeding.
These over-the-counter drugs include painkillers such as aspirin, Advil (ibuprofen), and Tylenol (acetaminophen) and dietary supplements such as fish oil, turmeric, ginger and other herbs.
Internal Bleeding Risk: NOACs/DOACs Hard to Measure
The older anticoagulant, warfarin, required regular blood tests of INR (International Normalized Ratio) to measure how much warfarin was actually working in a patient’s blood to prevent a stroke.
But the newer anticoagulants (NOACs, DOACs), such as Eliquis, Xarelto, Pradaxa or Savaysa, aren’t normally measured by anticoagulation clinics or health care professionals using standardized tests such as INR. (The FDA, under pressure for new anticoagulants, approved the NOACs without there being any established or universally recognized method of determining their clot preventing effectiveness.)
Be aware that your doctor probably doesn’t test to see how much your NOAC is actually working in you. They hope it is, but doesn’t know for sure. Blood levels of your NOAC depends on factors such as how well or how poorly your kidneys are functioning.
Not all of your NOAC may actually be working for you. Pradaxa, for example, is 80% cleared by the kidneys. This means there may be lower anticoagulant levels in your blood stream, and a lot of your clot prevention is being flushed away by your kidneys. (Eliquis, Xarelto and Savaysa fare better with only 25%, 33% and 35% being cleared by the kidneys, respectively.)
Check With Your Doctor About Increased Internal Bleeding Risk
If you take an anticoagulant along with over-the counter drugs and supplements, ask your doctor which combinations to avoid. But be aware that many doctors are clueless about natural dietary supplements.
(Don’t ask them how effectively your NOAC is working in you. They probably don’t know and can’t easily test for that.)
New FAQ: What is Atypical Flutter?
“I have Atrial Flutter that my EP describes as “atypical”. What does that mean? Is it treated differently than typical Flutter? (I’ve had two ablations, many cardioversions, and a Watchman installed to close off my LAA.)”
Atrial Flutter is similar but different from Atrial Fibrillation. Atrial Flutter is characterized by rapid, organized contractions of individual heart muscle fibers (see graphic below).
In general, there are two types of Atrial Flutter:
• Typical Flutter (from the right atrium)
• Atypical Flutter (can come from anywhere)
Typical Flutter originates in the right atrium (whereas A-Fib usually comes from the left atrium).
Atypical Flutter can come from anywhere and is one of the most difficult arrhythmias to map and ablate.
To learn more, read my full answer, go to: “I have Atrial Flutter that my EP describes as “atypical”. What does that mean?”
A-Flutter usually comes from the right atrium (A-Fib usually comes from the left atrium).
2020 AF Symposium: 5 Abstracts on Pulsed Field Ablation
The 2020 AF Symposium abstracts are one-page descriptions of A-Fib research, both published or unpublished. The abstracts are supplemental to the Symposium live presentations, panels discussions and spotlight sessions. This year the printed digest contained 55 abstracts. I choose only a few to summarize.
My Summaries of Select PFA Abstracts
Pulsed Field Ablation (PFA) was the single most important topic at this year’s Symposium. I summarized five of the PFA abstracts of most interest to A-Fib patients.
• Lesion Durability and Safety Outcomes of Pulsed Field Ablation
The durability of PFA lesions is the focus of Dr. Vivek Reddy’s abstract. His research study followed 113 patients who each received a PFA ablation.
• Pulsed Field Ablation with CTI Lesions Terminates Flutter in a Small Study
The use of Pulsed Field Ablation (PFA) may significantly improve CTI ablation lesions to block the Flutter signal. (CTI: Cavo-Tricuspid Isthmus)
• Durability of Pulsed Field Ablation Isolation Over Time: Preliminary Study
Pulsed Field Ablation (PFA) is a new treatment. This study asked the question of whether PFA electrical isolation (lesions) regresses over time.
• Pulsed Field Ablation vs RF Ablation: A Study in Swine
PFA is “tissue-specific”. This study tested if surrounding non-heart tissue (the esophagus) would be affected. PFA ablation was compared to RF ablation. Swine (pigs) were used so tissue could be dissected and examined.
• Using MRI to Check Pulsed Field Ablations (PFA)
Normally, during a RF or cryo ablation, doctors move the esophagus as far away as possible from where they are ablating. In this study they took no such precautions.
My Summary Reports
For more from the 2020 AF Symposium, go to My Summary Reports Written for A-Fib Patients. Remember, all my reports are written in plain language for A-Fib patients and their families.
COVID-19: White House Pushes Unproven Drugs—Risk of Arrhythmias and Sudden Death
by Steve S. Ryan
Note: I have already written about the risk of COVID-19 for patients with A-Fib (and other cardiovascular diseases). See my post: COVID-19 Virus: Higher Risk for A-Fib Patients.
In recent coronavirus pandemic press conferences, President Donald Trump has repeatedly advocated the use of the drugs hydroxychloroquine (HCQ) and azithromycin (Z-Pak) to treat the COVID-19 virus.
He often says, “What have you got to lose?” About treating patients, he also said these drugs can “help them, but it’s not going to hurt them.” (Really?)
Hydroxychloroquine & Azithromycin Danger―“What Have You Got to Lose?”
The drugs hydroxychloroquine and azithromycin are currently gaining attention as potential treatments for COVID-19. Hydroxychloroquine sulphate (Plaquenil) is an antimalarial medication. Azithromycin (Z-Pak) is an antibiotic. (Antibiotics in general are ineffective against viruses.)
Each has potential serious implications for people with existing cardiovascular disease.
Contrary to Mr. Trump’s statements, you do have a lot to lose. Medical groups warn that it’s dangerous to be hawking unproven remedies.
Recently, three U.S. heart societies published a joint statement to detail critical cardiovascular considerations in the use of hydroxychloroquine and azithromycin for the treatment of COVID-19.
According to the “Guidance from the American Heart Association, the American College of Cardiology and the Heart Rhythm Society”:
Complications include severe electrical irregularities in the heart such as arrythmia (irregular heartbeat), polymorphic ventricular tachycardia (including Torsade de Pointes) and long QT syndrome, and increased risk of sudden death.
The effect on QT or arrhythmia of these two medications combined has not been studied.
With these increased dangers in mind, we must not take unnecessary (or foolish) risks in the rush to find a treatment or cure for COVID-19.
What We Know So Far About These Drugs and COVID-19
COVID-19 Virus: Higher Risk for A-Fib Patients
COVID-19, the disease caused by the new coronavirus SARS-CoV-2, has sickened hundreds of thousands and continues to kill large numbers of people worldwide.
Typically, it’s considered a threat to the lungs, but COVID-19 also presents a significant threat to heart health, according to recently published research.
“But It’s Just the Flu, Right?”
“During most flu epidemics, more people die of heart problems than respiratory issues like pneumonia,” according to Dr. Mohammad Madjid, McGovern Medical School at UTHealth. He expects similar cardiac problems among severe COVID-19 cases.
In addition, COVID-19 can worsen existing cardiovascular disease. For example, Atrial Fibrillation patients may develop myocarditis, an inflammation of the heart muscle. If left untreated, myocarditis may lead to symptoms of heart failure.
And for otherwise healthy people, COVID-19 can cause new heart problems.
Comorbid Conditions Increase Fatality Rate
Many A-Fib patients also suffer from other chronic conditions such as diabetes and hypertension. With comorbid conditions, COVID-19 can increase the severity and fatality of the virus.
According to research from the Chinese Center for Disease Control and Prevention (CCDC), COVID-19 patients from mainland China who reported no comorbid conditions had a case fatality rate of 0.9%.
While patients with the following comorbid conditions had much higher rates:
+ 10.5% for those with cardiovascular disease
+ 7.3% for diabetes
+ 6.3% for chronic respiratory disease
+ 6.0% for hypertension
+ 5.6% for cancer.
Among critical cases, the case fatality rate is unsurprisingly highest at 49%.
Take Away: A-Fib Patients at Higher Risk for COVID-19
Patients with underlying cardiovascular disease (i.e., A-Fib) are at higher risk for developing COVID-19 and have a worse outlook. Prior heart disease is a risk factor for higher mortality from COVID-19. Cardiovascular patients are encouraged to take additional, reasonable precautions to avoid contact with the COVID-19 virus. And to stay current with vaccinations, especially for influenza and pneumonia. Since people can spread the COVID-19 virus before they know they are sick, it is important to stay away from others when possible, even if you or they have no symptoms. • Stay at least 6 feet (2 meters) from other people Social distancing is especially important for people who are at higher risk of getting very sick including older adults and people of any age who have serious underlying medical conditions. For more information: see the article “How to Protect Yourself & Others” from the Centers for Disease Control and Prevention (CDC).A-Fib Patients: Practice Social Distancing and Stay Safe at Home
• Do not gather in groups
• Stay out of crowded places and avoid mass gatherings
