Overview 27th Annual International AF Symposium 2022

The 2022 AF Symposium was held in New York City at the Marriott Marquis hotel at Times Square (the musical “Hamilton” was playing next door). The A-Fib presentations started Thursday, January 13 through Saturday, January 15.

Everyone was wearing masks due to the Covid-19 pandemic. (Almost all the New Yorkers I saw were wearing a mask, including the cab drivers.)

Marriott Marquis NYC

To get into the hotel you had to show proof of vaccination. They checked you in at the top of the third-floor escalator and gave you a wrist band which I had to show every day. The presentations were held on the sixth floor, while the exhibits were on the fifth.

Security was very tight at the Marriott Marquis. To get to a room, you had to show your room key to a guard who put you on an elevator and sent you to your floor. Those particular elevators didn’t have floor buttons you could punch yourself. (I stayed at a different, cheaper hotel.)

As one would expect in January in New York City, it was very cold.

18^th Time to Attend AF Symposium

This is the 18^th AF Symposium I have attended. It provides a unique learning experience about Atrial Fibrillation (A-Fib) not matched by any other conference. Each year I shared my reports on A­-Fib.com.

Overall Theme or Emphasis

With Steve (L) Prof. Michael Keane (R) Dr. David Keane

The overall theme or emphasis of this AF Symposium seemed to be focused on new tools and technology.

For example, there were 17 “Spotlight Sessions” on products and treatments spread over 2 days which featured 5-minute talks on new and innovative technologies in development or not yet FDA approved. These were very exciting—like getting a glimpse into the future of A-Fib.

One couldn’t help noticing how the Atrial Fibrillation devices and pharmaceutical industries seemed to dominate the AF Symposium. Even some sessions were “Supported by an Educational Grant” from companies like Abbott, Boston Scientific (2 sessions), and Medtronic. This is not necessarily a bad thing.

Most Talked About

Like last year, the most talked about subject was Pulsed Field Ablation (PFA). Saturday featured two full sessions on PFA:

1. Pulsed Field Ablation: Mechanisms and Techniques
2. Pulsed Field Ablation for Atrial Fibrillation

In addition, 8 of the 15 live and prerecorded cases were on Pulsed Field Ablation. They were among the most well attended.

Most Thought-Provoking Statement

Dr. Mintu Turakhia

“CHA2DS2-VASc is a stain on our field!” Dr. Mintu Turakhia of Stanford Health Care, California made this statement in the panel discussion following the first Thursday session. His opinion seemed to be shared by many of the Symposium’s participants.

(I have long been a critic of the CHA2DS2-VASc guidelines since they were first published in 2014. For more see my reports: the CHA2DS2-VASC: Risks of Life-Long Anticoagulation and Women, Anticoagulants, CHA2DS2-VASc and Risk of Bleeding)

AF Symposium Structure and Subject Presentations

There were 74 presenters scheduled for the 3 days of the AF Symposium. Most presenters from overseas weren’t able to make it in person (due to Covid-19 travel restrictions) but instead gave their talks remotely live or were pre-recorded.

• Most presentations were 7 minutes long followed by a lively panel discussion. (If a presenter went over time, they heard a music cue which got progressively louder.)
• Panel and Audience Discussions were 25 minutes long.
• The “Spotlight Sessions” were 5 minutes long.
• There were 15 “Real-Time and Prerecorded Case Transmissions” which could run as long as 20 minutes.

All went generally very smoothly. One has to compliment the organizers who did a remarkable job scheduling so many remote presentations as well as 15 live and pre-recorded cases.

Scientific Program

Thursday, January 13

▪ AF Screening, Detection, Monitoring and AI (Artificial Intelligence) in Cardiac Rhythm Management (5 talks)
▪ Spotlight Session I: Early Stage and Emerging New Technologies and Drugs in Cardiac EP (Electrophysiology) (9 talks)
▪ Real-Time and Prerecorded Case Transmissions – Session 1 (5 cases)
▪ AF Ablation and Stroke Risk Management (Supported by an Educational Grant from Abbott) (5 talks)
▪ Left Atrial Appendage Closure and Stroke Prevention (Supported by an Educational Grant from Boston Scientific) (5 talks)
▪ Stroke Prevention in AF – Left Atrial Appendage Closure (5 talks)

Friday, January 14

▪ Early Rhythm Control in Atrial Fibrillation (5 talks)
▪ Spotlight Session 2: Early Stage and Emerging New Technologies and Drugs in Cardiac EP (8 talks)
▪ Real-Time and Prerecorded Case Transmissions – Session 2 (5 cases)
▪ Evolving Trends in Catheter Ablation for Atrial Fibrillation (Supported by an educational grant from Biosense Webster) (5 talks)
▪ New Directions in AF Management: The Impact of First-Line Indication and Innovations in Catheter Ablation Technology (Supported by an educational grant from Medtronic) (5 talks)
▪ Late Breaking Clinical Trials and First Report Clinical Investigations
▪ Challenging Cases in AF Management (Drugs, Ablation, and Stroke Prevention) (6 cases: 5 minutes per case followed by discussion)

Saturday, January 15

▪ Pulsed Field Ablation: Mechanisms and Technologies (5 talks)
▪ Pulsed Field Ablation for Atrial Fibrillation (5 talks)
▪ Real-Time and Prerecorded Case Transmissions – Session 3 (5 cases)
▪ Beyond Pulmonary Vein Isolation (5 talks)

Note: The AF Symposium adjourned at 3:00 pm (which allowed us to catch planes home that day).

International Real-Time and Prerecorded Cases Transmissions

The Cases Transmissions were again the highlight of the AF Symposium and the most well attended. It’s like “You Are There” in the lab with the EPs doing the procedure.

(In addition to the invaluable content, one couldn’t help but be amazed at the technical achievement of scheduling so many presentations from around the world. I didn’t notice a single technical problem.)

Thursday, January 13

• From Bruges, Belgium “High-Power Ultra-Short Duration Ablation for AF”
• From Frankfort, Germany “Pulsed Field Ablation for AF Using 5S Strategy”
• From Prague, Czech Republic “Pulsed Field Ablation for AF Using an Integrated Mapping and Ablation Spherical Array Catheter”
• From Kansas City, Kansas “Surgical Left Atrial Appendage Exclusion”
• From the Langone Center in New York City “AF Ablation Using a New Generation 3-D Electroanatomical Mapping System”

Friday, January 14

• From Aalst, Belgium “Pulsed Field Ablation Using a Circular Multielectrode Catheter”
• From Mount Sinai in New York City “”Mitral Isthmus Ablation with Ethanol Injection in the Vein of Marshall in Persistent AF”
• From Massachusetts General in Boston, MA “Pulsed Field Ablation Using a Multielectrode Catheter”
• From Santa Maria, California “AF/AFL Ablation Guided by 4-D ICE and High-Density Mapping”
• From Austin, Texas “LAA Closure Using the Watchman FLX”

Saturday, January 15

Steve with his own EP, Dr. Shephal Doshi

• From Prague, Czech Republic “Pulsed Field Ablation Using a Multielectrode Catheter”
• From Kansas City, Kansas “LAA Closure Using the Amulet Device”
• From Toronto, Ontario, Canada “Pulsed Field Ablation Using a Focal Electrode Catheter”
• From Toronto, Ontario, Canada “Combined Pulsed Field & Cryo Ablation for AF”
• From Prague, Czech Republic “Focal Pulsed Field Ablation Guided by Contact & Noncontact Mapping”

Awesome AF Symposium! More Reports to Come

Attending the AF Symposium and adequately reporting on it is both a challenge and a privilege. The AF Symposium brings together the world’s leading medical scientists, clinicians, and researchers who share recent developments in the A-Fib field.

Look for more of my reports from the 2022 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 treatments, what’s relevant to A-Fib patients and their families and friends.

In the weeks and months, I’ll post more reports from the 2022 AF Symposium. In the meantime, you may want to browse my reports from the 2021 AF Symposium.

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