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Overview of the 2020 International AF Symposium

By Steve S. Ryan, PhD, March 2020

The attendance at the 25th Annual AF Symposium seemed much higher than that of last year in Florida. Perhaps being in Washington, DC made it easier for people to attend.

The weather was chilly, but no snow. There was some rain on Saturday.

Conference Venue: Gaylord National Hotel

Gaylord National Hotel, atrium; Wash DC

The Gaylord National Hotel (actually located in Maryland) was a great venue. It featured an incredible Atrium covered lobby with plants and walkways which felt like you were outside. It had a comfortable and friendly feeling. There were plenty of shops and restaurants (and bathrooms!) But it was quite a distance from the Washington DC airports with no hotel shuttle service.

The exhibit area was right next to the presentation hall which saved a lot of walking time and facilitated interaction with the exhibitors.

The General Mood

As the Symposium progressed, it began to feel like we were entering a new era of A-Fib treatment (i.e. Pulsed Field Ablation!). One could feel the excitement in the air.

Most Talked About

The most talked about topic was the new ablation treatment called Pulsed Field Ablation (PFA) by Farapulse, Inc.

Regarding PFA:“Both the efficacy and the safety…are significantly superior to the current standard of RF or cryo.” – Dr. Pierre Jais, Bordeaux University Hospital (Bordeaux, France)

There were three Pulsed Field Ablation (PFA) presentations, one pre-recorded patient case, and a special luncheon at the product theater that was packed (I couldn’t get a seat and missed some of the speakers’ talks.)

In addition, there were five abstracts on PFA included in the 53 presented in the AF Symposium brochure. There were so many presentations and so much attention on Pulse Field Ablation/Electroporation (PFA) that it justifiably dominated the Symposium.

Another important topic was Left Atrial Appendage closure (seven presentations).

A-Fib Experts’ Presentations, Discussions and Q&A

There were 72+ different talks presented over the  course of the 3-day AF Symposium. All talks were 10 minutes long with time for audience Question & Answer and discussion. The exceptions were the live cases which were usually 30 minutes and the Spotlight Session talks which were 5 minutes long. (As far as I could tell, not one presenter went over their minute limit.)

Each topic was moderated by leaders in the A-Fib field. Speakers included 2 representatives from the FDA.

As in previous Symposiums, attendees were given the opportunity to interact and answer questions posed by the presenters, this time via text. But the response by cell phone text was so poor that by the end presenters were just asking for a show of hands in response to their questions.

Spotlight Sessions, Lunchtime Learning and Late Breaking Clinical Trials

In addition to the scheduled talks, the AF Symposium featured 17 short talks on new and innovative technologies (14 on devices, 2 on drugs, and 1 on FDA approaches). These Spotlight Sessions were exciting and all too brief. (Last year there were 8 of these Spotlight Sessions, indicating how rapidly innovation and interest in the A-Fib field are progressing.)

There were two lunchtime learning sessions (not part of the official CME presentations). The first was on Pulsed Field Ablation and was so crowded that I couldn’t get in at first and missed part of the talk. The second was on Optimizing AF Management.

The last session of Friday featured Late Breaking Clinical Trials and First Report Clinical Investigations. One of the great things the AF Symposium does is include in their brochure abstracts of studies and clinical trials that are or could be important to the A-Fib field.

There were 53 such studies this year. Many of these studies were also presented in posters hung up just outside the presentation area.

Sponsored Sessions

I was surprised that there were two sponsored sessions, one by Abbott focused primarily on their HD Grid and the second by Biosense-Webster which was more broadly focused but featured their mapping system. Both were non-CME because of their sponsorship.

I frankly don’t know what to make of sponsors determining or so heavily influencing presentations, even if they are listed as non-CME. One presenter in particular seemed to go slavishly overboard in promoting a particular mapping system (it was embarrassing listening to this person).

Worldwide Live Patient Cases Via Streaming Video

The live cases sessions were again worth the price of admission and were the most well attended. We observed six live and one pre-taped presentation from:

• Royal Brompton Hospital, London, United Kingdom
• OLV Hospital, Aaist, Belgium
• Oxford University Hospitals, Oxford, United Kingdom
• St. Joseph’s Hospital, Tampa, Florida
• Texas Cardiac Arrhythmia Institute, Austin, Texas
• Massachusetts General, Boston, MA
• Homolka Hospital, Prague, Czech Republic and Mount Sinai Medical Center, New York, NY (pre-recorded)

I was amazed at how they were able to switch back and forth between various centers and overcome the inevitable technical challenges involving so many live presentations from around the world. In addition to the invaluable content, the technical achievement of so many live presentations was really impressive.

Talks on Left Atrial Appendage (LAA) Closure

There were six talks and one Live Case presentation on closing off the Left Atrial Appendage (LAA).

I was surprised that there was very little discussion of the functions of the LAA and whether or not it should be closed off in the first place.

In this context, Dr. Jais from the Bordeaux Group made what was probably the most important, quotable statement in the AF Symposium:

“We have ablated too much…Those patients when they have the (Left Atrial) Appendage taken out, they have very poor residual LA (Left Atrium) function. I don’t want that to happen anymore. If we can avoid it, I think we should.”

Dr. Jais later added:

“Sinus rhythm is by definition superior to persistent A-Fib. But the best ablation strategy is the one that restores sinus rhythm at the least tissue cost, thereby preserving as much as possible the LA function.”

Editor’s comment: Personally, even though I’m old (79 years young), I would not give up my LAA without a fight! I enjoy running/sprinting too much, especially in Masters Track Meets. I need all the heart pumping ability my heart can deliver. Read more at LAA Role and Removal Issues.

Daily Schedule: Topics Discussed

Thursday, January 23

♥ Risk Factors for Atrial Fibrillation – Pathophysiology, Clinical Impact and Therapeutic Strategies (4 talks)
♥ Spotlight Session: Early Stage and Emerging New Technologies and Drugs in Cardiac EP (17 talks)
♥ Abbott sponsored presentations, (non-CME). Novel Techniques and Technologies for Catheter Ablation of AF (6 talks)
♥ Stroke Prevention in AF: Session I – Screening and Anticoagulation (5 talks)
♥ Stroke Prevention in AF: Session II – Left Atrial Appendage Closure and Carotid Protection (4 talks). This session also included a 30 minute Live Case presentation featuring the real time installation of the Watchman FLX.
♥ Stroke Prevention in AF: Session II – Left Atrial Appendage Closure (Continued) (3 talks)

Friday, January 24

♥ Real-Time Case Transmissions: New Directions in Imaging, Mapping and Ablation – Panel and Audience Discussions (All Cases 30 Minutes). (The most well attended session.) (3 presentations)
♥ Real-Time Case Transmissions: New Directions in Imaging, Mapping and Ablation – Panel & Audience Discussions (cont.) (2 live cases, 1 pre-recorded)
♥ Biosense Webster sponsored presentations, (non-CME), State of the Art in Advanced Mapping and Catheter Ablation for AF: Improving Efficacy and Efficiency (4 talks)
♥ Advances in Pulmonary Vein Isolation (Session I) (7 talks)
♥ Advances in Pulmonary Vein Isolation (Session II) (Pulsed Field Ablation) (3 talks)
♥ Late Breaking Clinical Trials and First Report Clinical Investigations
♥ Best Abstract Award and Presentation

Saturday, January 25

♥ Beyond PVI – Anatomical vs Electrophysiological Targets for AF Ablation (Session I) (6 talks)
♥ Beyond PVI – Anatomical vs Electrophysiological Targets for AF Ablation (Session II) (3 talks)
♥ Improving the Safety, Effectiveness and Efficiency of AF Ablation (2 talks)
♥ Outcome Trials in Atrial Fibrillation Ablation (6 talks)
♥ Challenging Cases in AF Management: Anticoagulation, Arrhythmic Drugs and Catheter Ablation for AF (5 case presenters)

Why I Attend: Expect My Reports

I’ve been attending the AF Symposium for 16 years. This year’s presentations were some of the best, most exciting I’ve experienced, especially on Pulse Field Ablation. The AF Symposium provides info and discussions on A-Fib unlike any other conferences.

It’s a privilege to be able to attend presentations by the best clinicians and researchers working in A-Fib today. I learn more in three days than in a year of reading the various A-Fib research reports.

I’m especially blessed by being able to ask questions of the presenters and converse one-to-one with them. (I especially admire their patience when answering some of my questions.)

More to Come

Look for more of my reports from the 2020 AF Symposium in the next weeks and months. I will share the current state of the art in A-Fib research and treatments and what’s relevant to patients with Atrial Fibrillation.

And, as always, my reports will be written in plain language for A-Fib patients and their families.

P.S. WhY the Short List of Reports for 2019 AF Symposium

You may have noted the short number of reports for the 2019 AF Symposium. I apologize for not writing very many reports on last year’s AF Symposium.

2018 Malibu Fires and Floods: We came all too close to losing our home during the November 2018 Malibu fires and floods. The Malibu fire burned down both sides of our property all the way to the highway. The floods sent an avalanche of mud that blocked our driveway. We were over a month without electricity and eventually ran our home off of a generator.

But we are not complaining! We still love living in Malibu and will stick it out. Thanks to all for your messages of concern for us. Read about our experiences during the Malibu fires.

If you find any errors on this page, email us. Y Last updated: Sunday, April 26, 2020

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