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2025 AF Symposium: Real-World Problems of Stroke Patients with Atrial Fibrillation
2025 AF Symposium
Dhanunjaya Likkireddy MD
Real-World Problems of Stroke Patients with Atrial Fibrillation
One presenter during the Thursday afternoon’s “Late Breaking Clinical Science Session II” was Dr. Dhanunjaya Likkireddy of the Kansas City Heart Institute, Overland Park, KS.
Dr. Likkireddy described the predicament and challenges for Atrial Fibrillation patients who suffer a stroke.
After discharge, they often don’t have follow-up with a neurologist [a specialist who treats disorders including stroke]. “They lose their job, their friends, their family and they ultimately die.”
The Sober Facts About Stroke
Dr. Likkireddy pointed out that stroke is the number one cause of disability and the fifth leading cause of death in the U.S.
Strokes are either ischemic [blood clots which block blood flow] or hemorrhagic [bleeding in the brain].
Eighty percent of strokes are ischemic. Within 6 months, 20% of stroke victims experience repeated strokes. Recurring hospitalizations are common.
Atrial Fibrillation is an important risk factor for stroke and accounts for 25% of ischemic strokes.
The Kansas City Heart Institute found that more than 70 percent of these stroke victims experience some form of disability.
Yet Widely Inadequate Management After Stroke
Functional recovery after stroke is an important part of restoring people’s lives.
– Dr. Dhanunjaya Lakireddy
Inadequate management after stroke is widely prevalent. In Dr. Lakireddy’s words, there’s a “therapeutic black hole of A-Fib and stroke management.
This is something we should be able to really pick up on by making simple tweaks to their management.”
RESCUE-STROKE Pilot Study
Dr. Likkireddy described the RESCUE-STOKE study that looked at A-Fib patients who survived a stroke and the impact of subsequent treatments, i.e., Catheter Ablation versus conventional drug treatment.
In this small pilot study, researchers performed a retrospective, observational study of patients hospitalized with stroke and new-onset A-Fib from 2021 to 2023. They created two different study groups of stroke survivors who were diagnosed with A-Fib at the time of their stroke. (Anyone with a hemorrhagic stroke was excluded from the study.)
The first group had treatment with catheter ablation aimed at restoring and maintaining normal sinus rhythm. The second employed routine drug management (oral anticoagulants, antiarrhythmic drugs). Each group contained 36 patients for a total study population of 72.
Researchers followed the study patients for 12 months. They also collected data using loop recorders. They incorporated the results in a Modified Rankin Scale.
Study Results
Dramatic differences were found between the Catheter Ablation group and the Drug Management group. The Catheter Ablation group findings were significantly better including:
1. The number of repeat strokes decreased considerably (25% vs 8.3%).
2. Major bleeding decreased (25% vs 11%).
3. A-Fib-related hospitalizations decreased in a major way (69.4% vs 25.0%).
4. And most importantly, cumulative cardiovascular outcomes showed a major improvement (78.6% vs 25.0%).
Graphic: Early Catheter Ablation for Incident Atrial Fibrillation Post-Stroke Appears Associated With Improved Outcomes (RESCUE-STROKE)
In other words: Those that underwent Catheter Ablation reached rhythm control faster, with continued A-Fib freedom at 12 months; had fewer repeat strokes; and less major bleeding, number of hospitalizations, and mortality.
In Dr. Lakkireddy’s words, the Catheter Ablation group was significantly better “by a huge score”. The Catheter ablation group of patients benefited from early intervention, more directed care, and guided therapy.
Researchers Note: Because of important differences in the study populations, additional studies are needed.
Editor’s Comments
Editor’s CommentsThis study gives new hope to these unfortunate patients with both stroke and Atrial Fibrillation. According to Dr. Lakkireddy “it gives them an opportunity for a meaningful recovery.”
Stroke Survivors at Great Risk: Survivors of a stroke who also have or develop A-Fib are in a difficult situation (vs. A-Fib patients without stroke). Most have experienced some form of disability (70%). In addition, 20% of stroke survivors will have another stroke within 6 months.Early intervention with catheter ablation results in significant improvement in neurological outcomes, adverse events, and A-Fib-related outcomes.
For stroke survivors, A-Fib adds to their stroke risk. Dr. Lakkireddy paints a grim picture of their future. “They lose their jobs, their friends, their family, and they ultimately die.”
There is Real Hope for Stroke Survivors with A-Fib: The key is early intervention with catheter ablation which results in significant improvement in neurological outcomes, adverse events, and A-Fib-related outcomes.
Patients with early intervention had a faster time to rhythm control, continued freedom from A-Fib at 12 months, fewer repeat strokes, less major bleeding, less hospitalizations, and a major improvement in mortality (0% vs 11.1%).
We patients are most grateful to Dr. Lakkireddy and his colleagues for the hope he has provided to stroke survivors with A-Fib who often have a challenging road to recovery.
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Last updated: Monday, September 15, 2025
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 | |
| 13. | Challenging Cases in AF Management: Fixing an Atrial Esophageal Fistula Without Surgery | Dr. Young-Hoon Kim, Korea University Anam Hospital, Seoul, South Korea
| July 18, 2024 |
| 12. | Spotlight: Intranasal Etripamil in AF-RVR: Data on Efficacy for Acute Rate Control (Milestone Pharmaceuticals) | Dr. Jonathan Piccini from Duke University Medical Center | July 18, 2024 |
| 11. | Is Force Sensing Useful and Necessary for Pulsed Field Ablation? | Dr. David Haines, Heart Rhythm Center, Corewell Health Beaumont, MI | July 18, 2024 |
| 10. | In Memoriam: Dr. David Haines and Dr. Albert Waldo | — | July 18, 2024 |
| 9. | Spotlight: Unlocking Arrhythmias: vMap’s AI-Driven Revolution (Vektor Medical) | Dr. Jagmeet Singh of Mass General, Boston, MA | July 18, 2024 |
| 8. | Spotlight Video: A Case of Closing Off the LAA with the LAMINAR Device with Pre-Recorded Video | Dr. Devi Nair from St. Bernards Medical Center in Jonesboro, AR | July 18, 2024 |
| 7. | The Benefits of Ablation Across the AF Spectrum: From Early Intervention to Late-Stage Heart Failure: Summary of All Five Talks | Dr. Stephen Willems, Dr. Jason Andrade, Dr. Philipp Sommer, Dr. Douglas Packer and Dr. Francis Marchlinski. | July 17, 2024 |
| 6. | The Benefits of Ablation Across the AF Spectrum: From Early Intervention to Late-Stage Heart Failure Part V: Medications vs Catheter Ablation for Initial Treatment of AF–Guidance for the Clinician | Dr. Francis Marchlinski of the Un. of Pennsylvania, Philadelphia, PA | July 17, 2024 |
| 5. | The Benefits of Ablation Across the AF Spectrum: From Early Intervention to Late-Stage Heart Failure Part IV: Ablation in A-Fib Patients & Heart Failure & Preserved Ejection Fraction | Dr. Douglas Packer of the Intermountain Institute, Murray, UT | July 16, 2024 |
| 4. | The Benefits of Ablation Across the AF Spectrum: From Early Intervention to Late-Stage Heart Failure Part III: AF Ablation in Patients with Advanced Heart Failure– CASTLE-HTx Study | Dr. Philipp Sommer of the University of Bochum, Bad Oeynhausen, Germany | July 16, 2024 |
| 3. | The Benefits of Ablation Across the AF Spectrum: From Early Intervention to Late-Stage Heart Failure Part II: Impact of Ablation on AF Progression: Implications for Timing and Type of Ablation | Dr. Jason Andrade of the University of Montreal, Montreal, Canada | July 15, 2024 |
| 2. | The Benefits of Ablation Across the AF Spectrum: From Early Intervention to Late-Stage Heart Failure Part I: The Role of Catheter Ablation in Asymptomatic Atrial Fibrillation | Dr. Stephan Willems of Asklepios Clinic St. Georg, Hamburg, Germany | July 15, 2024 |
| 1. | Overview: 29th 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.”
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Last updated: Friday, February 21, 2025
Your Doctor’s “2023 Guideline for the Diagnosis & Management of Atrial Fibrillation”
Important for all A-Fib patients: The newly issued 2023 Guideline for the Diagnosis and Management of Atrial Fibrillation. The guideline includes new evidence to guide your cardiologist and electrophysiologist in the treatment of your Atrial Fibrillation. It was last updated in 2014 and supplemented in 2019.
Cardiologists, electrophysiologists, surgeons, pharmacists, patient representatives and other stakeholders all collaborated on the updated recommendations.
First issued in 1980, the American College of Cardiology (ACC) and the American Heart Association (AHA) develop and publish these guidelines without commercial support, and members volunteer their time to the writing and review efforts.
ACC/AHA develop and publish these guidelines without commercial support, and members volunteer to write and review them.
ACC/AHA/ACCP/HRS: The 2023 Guideline is endorsed by four medical organizations: American College of Cardiology (ACC), American Heart Association (AHA), American College of Clinical Pharmacy (ACCP), and Heart Rhythm Society (HRS).
A Few of the Important Updates for Patients: I am still reading/studying this document—it’s 171 pages long. Here are a few updates that reflect important shifts in the treatment of A-Fib patients:
• Stages of atrial fibrillation: recognizes A-Fib as a disease continuum that requires a variety of strategies at the different stages;
• A-Fib risk factor: recognizes lifestyle and risk factor modification as a pillar of A-Fib management to prevent onset and progression;
• Catheter ablation of A-Fib: can be first-line therapy; Recognizes the superiority of catheter ablation over drug therapy for rhythm control;
• Left atrial appendage occlusion devices: recognized for safety and efficacy.
Steve Ryan at the 2023 AF Symposium
If you read A-Fib.com regularly, you know these topics have filled my posts for years. I write about these topics after reading the newest research, evidence and findings, querying the experts and learn the latest innovations at the annual AF Symposiums from presentations by leading electrophysiologists, cardiologists, scientists and researchers (read my 2023 AF Symposium posts).
I’ll write more about these changes.
You Can Read it Yourself. It’s available on the websites of the American College of Cardiology (JACC.org) and the American Heart Association (ahajournal.org).
Newly released: 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines; Issued by American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines; See www.jacc.org or www.aha.org.
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 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
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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 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
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2023 AF Symposium: Challenging Case―Ablates Hot Spots in Low Voltage Areas
2023 AF Symposium
Dr John Day, Salt Lake City, UT
Challenging Case―Ablates Low Voltage High Frequency Areas
Dr. John Day of the Heart Center of St. Mark’s Hospital in Salt Lake City, UT presented the case of a 56-year-old young man in otherwise good health. His BMI was normal. He had had an ablation but was still in A-Fib, according to his Apple watch. “Doc, I’m still having A-Fib. You’ve got to fix it.” 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.
Dr. Day gave the audience the following choices and asked their opinion.
1. End the case [with no further treatment]
2. Change the antiarrhythmic.
3. Ablate again.
Mapping illustration: Low-voltage high frequency areas targeted for ablation
The consensus of the audience was to ablate again. And this was indeed how Dr. Day proceeded.
Second Ablation of Hot Spots
In this patient’s second ablation, all the PVs (pulmonary veins) remained isolated. A-Fib was induced with pacing and Isoproterenol. Dr. Day used electrogram guided ablation.
When in both sinus rhythm and atrial fibrillation, the patient had low-voltage zones (suggestive of left atrial fibrosis) on the posterior wall of the left atrium.
Dr. Day targeted very high frequency signals (hot spots) appearing in low voltage areas. He remarked:
• “We only mark low voltage zones (diseased tissue) if it is low voltage in both sinus rhythm and atrial fibrillation.”
• “We only treat confirmed low voltage zones with high frequency signals…basically with this approach we are only treating diseased tissue with intense abnormal electrical activity which often corresponds to atrial fibrillation driver sites.”
Dr. Day admitted this doesn’t always work. But he has done over 5,000 ablations where this technique is effective.
The patient’s A-Fib didn’t terminate during the ablation, but it did later. Sometimes these patients have to be cardioverted to get them back into normal sinus rhythm.
This patient has been A-Fib free for 18 months and is off of Flecainide.
Editor’s Comments
Dr. Day and his colleagues may have developed a new method of making patients with difficult cases A-Fib free.
Innovation approach. Instead of looking for “potentials”, he ablates areas of low voltage and high frequency. This is an innovative approach and could help many patients with difficult cases.
If you find any errors on this page, email us. Y Last updated: Thursday, May 11, 2023
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2023 AF Symposium: Spotlight Session on Laminar LAA Closure/Elimination Device
2023 AF Symposium
Dr. Saibal Kar of
Cardiovascular Associates
Spotlight Session: Laminar LAA Closure/Elimination Device
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.
In a Spotlight Session on Friday, he described a new device for closing off (“eliminating”) the Left Atrial Appendage (LAA) where 90%-95% of Atrial Fibrillation clots and strokes come from.
2023 AF Symposium presentation session: Dr. Saibal Kar of Cardiovascular Associates at Los Robles Hospital in Thousand Oaks, CA.
Disappearing the LAA
In an animation by the company Laminar (Laminarlaa), Dr. Kar showed what he 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 disappears.
Then, this ball is locked in place to prevent it from unwinding. The closure/elimination is checked for leaks, then the catheter is released while the device remains locked in place.
Laminar LAA closure device
Dr. Kar refers to this process as not just closing off the LAA but eliminating it (in the animation, the LAA disappeared).
Quick to place: The whole process takes 16 minutes with testing taking only 60 seconds. All this can be done in real time.
Repositionable: If not satisfied with the original insertion, the device can be untwisted and repositioned.
Dr. Kar also showed implanted devices and how they look after 45 days. The LAA is closed off with only a very small ball left inside the LAA, much smaller than current LAA closure devices.
Two Years Testing, Two Centers in U.S.
The Laminar LAA Closure/Elimination device has been used in Europe for 2 years and is now in its third generation. European patients have had as many as 2 years of follow-up.
In the US, there are currently two centers performing this procedure, one at Los Robles hospital in Thousand Oaks, CA and a second in Tucson, AZ. In the U.S., 15 patients have received this device which has been 100% successful in closing off the LAA.
Editor’s Comments
Medical Breakthrough! The Laminar LAA elimination device is a potential medical breakthrough innovation!
Like many great innovations, the Laminar LAA elimination device seems remarkably simple and easy to use. It could revolutionize the way LAAs are closed off today. And because it takes so little time to insert, it could be positioned at the same time as a catheter ablation.
Most importantly, by actually eliminating the LAA rather than simply closing it off, it may be much better for patients offering fewer leaks, complications, intrusive metal devices in the heart, etc. Also, by actually eliminating the LAA, it could prevent non-PV triggers in the LAA from affecting a patient’s A-Fib.
In the future, current LAA closure devices such as the Watchman (Boston Scientific) and Amulet (Abbott) may be superseded by the Laminar device.
If you find any errors on this page, email us. Y Last updated: Friday, May 12, 2023
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2023 AF Symposium: Ablation Combines with LAA Closure in One Procedure
2023 AF Symposium
Ablation Combines with LAA Closure in One Procedure
Walid Saliba, MD
Dr. Walid Saliba of the Cleveland Clinic Foundation in Cleveland, OH, discussed 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. (This treatment strategy is currently in use in many countries overseas, but isn’t yet common practice in the U.S.)
Patient Selection
Dr. Saliba explained how patient selection is important in this combined procedure.
The idea patient with atrial fibrillation needing an ablation would also have a high risk of stroke but couldn’t tolerate anticoagulants because of a high risk of bleeding.
Advantages of Combining PVI with LAA Closure
While these two procedures (A-Fib ablation and LAA closure) are typically done separately, combining them in one procedure has many potential advantages. Both procedures:
• require access from the groin to the left atrium
• initiating oral anticoagulation around the time of the procedure
Dr. Saliba made the following points:
1.Combining these two procedures reduces the risk of complications. (For example, one only has to make a transseptal puncture once rather than at two different times.)
2. Patients prefer only having to have one procedure rather than the hassle of going to the hospital twice for two different steps.
3. Combining these two procedures reduces the potential risk of bleeding.
Reimbursement Problem in U.S.
Dr. Saliba described how in the beginning (2015) it was difficult to be reimbursed for combining two different procedures at the same time. But eventually he was able to convince the powers that be that this was good for certain patients and actually saved the hospital money.
Source of A-Fib Recurrences
Dr. Natale and Dr. Saliba discussed that many A-Fib recurrences come from the Left Atrial Appendage. Inserting an LAA occlusion device when performing an ablation might prevent the mapping and ablating of non-PV triggers in or around the LAA. (This is less of a problem with the Watchman than with the Amulet device which actually masks off the LAA area with a metal disc.)
High Success, Low Complication
Dr. Saliba and his colleagues at the Cleveland Clinic have performed this combined procedure on more than 240 patients with one-year follow-up. Their success rate is high with low complications. Patients stayed in the hospital for a day. Over 95% of their patients are eventually off of anticoagulants.
Half of their patients received the original Watchman, while the other half got the Watchman FlX. Leaks around the Watchman were only around 2.2% and were less than 2mm. At 90 days leaks were around 25% with less than 3mm. Dr. Saliba hasn’t noticed any problems with LAA remodeling, pressure, or scarring of the Left Atrium wall.
OPTION Trial Revelations to Come
The OPTION Trial is a clinical study of patients with non-valvular A-Fib. It compares outcomes of a combined ablation + LAA occlusion procedure versus catheter ablation alone followed with anticoagulation.
Specifically, the study is to determine if the WATCHMAN FLX occlusion device placed at the time of the ablation is a reasonable alternative to continuation of oral anticoagulation following catheter ablation. The results of this trial will be available in 2024.
Editor’s Comments
Combining PVI with LAA Closure Medical Breakthrough! Combining a catheter ablation for A-Fib (PVI) with the insertion of a Watchman occlusion device seems a major improvement for patients, as well as reducing or eliminating a major source of worry for electrophysiologists (EPs).
One day, hopefully soon, everyone getting a catheter ablation will also have an occlusion device inserted in one procedure.
Free from Most Stroke Risk: Inserting a Watchman device to close off the LAA has become a relatively simple and fast process. Combining it with a PVI doesn’t add much time to the ablation procedure. And Dr. Saliba’s research demonstrated that it works!
The Left Atrial Appendage (LAA) is where most clots and strokes come from in patients with non valvular A-Fib. Patients getting a catheter ablation generally leave the hospital A-Fib free.
Nevertheless, they are still considered at some risk of stroke. Current guidelines dictate continuation of stroke prevention with oral anticoagulation despite a successful ablation. Having the LAA closure device offers protection against stroke without the ongoing bleeding issues of oral anticoagulation.
Patients Would Choose/Prefer This Combination Procedure: If you offered the average A-Fib patient the chance to be protected from a stroke at the same time they are made A-Fib free by a catheter ablation, most patients would choose the combination procedure.
They would only have to be hospitalized once and wouldn’t have to return weeks later to have their LAA closed off, as is common practice in the U.S. today.
They would have better peace of mind and quality of life knowing they are largely protected from having an A-Fib stroke.
And their doctor wouldn’t have to worry about them going off their anticoagulant and developing a clot in their LAA.
If you find any errors on this page, email us. Y Last updated: Thursday, May 11, 2023
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2023 AF Symposium: Reports for Patients by Steve S. Ryan, PhD
2023 AF Symposium
My Summary Reports Written for Atrial Fibrillation Patients
by Steve S. Ryan, PhD
The 28th Annual International AF Symposium took place Feb. 2-4, 2023 at the new Omni Hotel at the Seaport in Boston. Featured were presentations by 82+ leaders in AF 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.
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 my reports are written in plain language for A-Fib patients and their families. Look for my reports here with links to the specific reports.
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 | |
| 6. | Challenging Case―An EP’s Nightmare | Dr. Karl-Heinz Kuck of the University of Lubeck, Lubeck, Germany | May 11,2023 |
| 5. | Live Case: Dublin, Ireland. Pulsed Field Ablation for AF Using a Multispline Catheter | Drs. Joseph Galvin and Gabor Szeplaki from Mater Private Hospital in Ireland | May 10, 2023 |
| 4. | Spotlight Session: Laminar LAA Closure/Elimination Device | Dr. Saibal Kar of Cardiovascular Associates at Los Robles Hospital in Thousand Oaks, CA. | May 10, 2023 |
| 3. | Challenging Case: Ablates Hot Spots in Low Voltage Areas | Dr. John Day of the Heart Center of St. Mark’s Hospital in Salt Lake City, UT | May 10. 2023 |
| 2. | Ablation Combines with LAA Closure in One Procedure | Dr. Walid Saliba of the Cleveland Clinic Foundation in Cleveland, OH | May 9, 2023 |
| 1. | Overview: 28th Annual International AF Symposium 2023 written by Steve S. Ryan, PhD | – – – | April 27, 2023 |
| Link to last year’s reports: 2022 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: Wednesday, June 21, 2023
2023 AF Symposium: My First Report for Atrial Fibrillation Patients
The 28th Annual International AF Symposium took place Feb. 2-4, 2023 at the new Omni Hotel at the Seaport in Boston. Featured were presentations by 82+ leaders in Atrial Fibrillation research and clinical practice from all over the world. These stellar medical scientists, clinicians, and researchers share recent developments in the A-Fib field in a major scientific forum unmatched by any other conference.
It’s a jam packed 2 1/2 days and affords me a unique opportunity to talk with and learn directly from many of the most eminent investigators in the field.
As always, I do this to offer A-Fib.com readers the most up-to-date research and developments that may impact their treatment choices. All my reports are written in plain language for A-Fib patients and their families.
Conference Snapshot: We might call this year’s Symposium “The Pulse Field Ablation” meeting.”
Most Noteworthy Quote: Dr. Daniel Singer of Massachusetts General Hospital in Boston, MA commented: “CHA2DS2-VASc is an embarrassment.”
Read my 2023 AF Symposium Overview and Introduction for highlights on this year’s conference. Other reports will follow shortly and will be announced here first.
You might want to visit and review my 2022 AF Symposium Reports.
