Doctors & patients are saying about 'A-Fib.com'...


"A-Fib.com is a great web site for patients, that is unequaled by anything else out there."

Dr. Douglas L. Packer, MD, FHRS, Mayo Clinic, Rochester, MN

"Jill and I put you and your work in our prayers every night. What you do to help people through this [A-Fib] process is really incredible."

Jill and Steve Douglas, East Troy, WI 

“I really appreciate all the information on your website as it allows me to be a better informed patient and to know what questions to ask my EP. 

Faye Spencer, Boise, ID, April 2017

“I think your site has helped a lot of patients.”

Dr. Hugh G. Calkins, MD  Johns Hopkins,
Baltimore, MD


Doctors & patients are saying about 'Beat Your A-Fib'...


"If I had [your book] 10 years ago, it would have saved me 8 years of hell.”

Roy Salmon, Patient, A-Fib Free,
Adelaide, Australia

"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su,
Cavanaugh Heart Center, 
Phoenix, AZ

"...masterful. You managed to combine an encyclopedic compilation of information with the simplicity of presentation that enhances the delivery of the information to the reader. This is not an easy thing to do, but you have been very, very successful at it."

Ira David Levin, heart patient, 
Rome, Italy

"Within the pages of Beat Your A-Fib, Dr. Steve Ryan, PhD, provides a comprehensive guide for persons seeking to find a cure for their Atrial Fibrillation."

Walter Kerwin, MD, Cedars-Sinai Medical Center, Los Angeles, CA


Significant Research and Scientific Studies

AF Symposium ’21—New Report with Dr. Pierre Jais on Pulsed Electrical Field Ablation for Atrial Fibrillation

Pierre Jaïs, MD

My next report from the 2021 AF Symposium is on the short side.

Dr. Pierre Jais of the French Bordeaux Group (LIRYC) covers two topics; first, he briefly discusses pre-clinically testing of Pulsed Electrical Field ablation (PEF), Then he briefly covers the BEAT AF 5-year study which compares the effectiveness of PEF to standard RF ablation. Read it now, go to my report.

2021 AF Symposium Reports: More to Come

You’ll find my growing list of reports on the 2021 AF Symposium page. (You’ll find the link of the left menu of the website,)

As always, I write these summary 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.

2021 AF Symposium: Pulsed Field Ablation Using Multielectrode Catheters and PFA Compared to RF Study

2021 AF Symposium

Pulsed Field Ablation Using Multielectrode Catheters and PFA Compared to RF Study

Note: At last year’s AF Symposium, the term “Pulsed Field Ablation” (PFA) was used. This year Dr. Jais used the phrase “Pulsed Electrical Field ablation” (PEF).

Pierre Jaïs, MD, The Bordeaux Group

Presenter: Dr. Pierre Jais of the French Bordeaux Group (LIRYC) 

Topic 1: “Pulsed Electric Field Ablation and the Multielectrode Basket/Flower Array for Paroxysmal and Persistent AF”.

Farapulse catheter: Five Petal Flower Configuration

Farapulse catheter: Five Petal Flower Configuration

Background: Dr. Pierre Jais first explained how Farapulse, Inc. developed Pulsed Electric Field Ablation (PEF) by pre-clinically testing it on 700 swine to improve the device, delivery design, the generator, the catheters, to demonstrate safety, and the absence of unwanted lesions.

Testing on 121 paroxysmal patients: Next, he discussed recent human testing on 121 patients with paroxysmal Atrial Fibrillation at 3 different European centers . With 5 different operators, procedure times were about 1 hour with 35 minutes of LA dwell time. They used 20 minutes of mapping which is not required in routine practice.

Results: They had 4 (non-serious) adverse  events with no phrenic nerve damage, PV stenosis, stroke, or infarction. At 3 months they had a 96% success rate of durable PVI.

The PEF catheter does not require actual physical contact but only needs proximity to the tissue to be ablated. And it doesn’t cause scarring or char formation.

What is Pulsed Electric Field Ablation? PEF is a non-thermal energy system that uses a series of ultra-short electrical pulses to ablate heart tissue in seconds. More importantly, PEF works on the selected cell types while leaving others alone (like the esophagus).

Topic 2: The BEAT AF Study: PEF Compared to RF

According to Dr. Jais, one of the most important questions facing researchers: Is Pulsed Electrical Field ablation (PEF) indeed better than standard RF ablation?”

Farapulse open basket catheter configuration

From all the previous preliminary research on PEF, one would assume PEF is better than standard RF ablation. [See 2020 AF Symposium: Pulsed Field Ablation—Emerging Tech for Atrial Fibrillation] But answering a question this important can’t be assumed.

Dr Jais discussed the BEAT AF randomized five-year study. It will attempt to demonstrate that isolation of the Pulmonary Veins (PVs) by Pulsed Electrical Field ablation is more effective, faster, and safer than Radiofrequency (RF) ablation (the current standard or reference ablation treatment). It will involve 10  European centers.

Editor’s Comments:
BEAT AF Randomized Five-year Study: Normally I don’t discuss studies until the results have come out. But PEF is different. Pulsed Electrical Field ablation is a new technology that offers a real hope of a revolutionary, break-through strategy to cure A-Fib.
Even though PEF is not yet FDA approved, its potential is incredible and a real game changer both for doctors and patients.

If you find any errors on this page, email us. Y Last updated: Friday, March 12, 2021

Return to 2021 AF Symposium Reports

My First Reports: 26th International AF Symposium 2021–A Virtual Experience

The 2021 AF Symposium was held from January 29-31. Because of the COVID-19 virus, the AF Symposium was virtual, streamed live with over 6,200 attendees. (That’s got to be some kind of a record!)

The AF Symposium is a major scientific forum at which health care professionals (and journalists, like me) have a unique opportunity to learn about advances in research and treatment of Atrial Fibrillation directly from leading medical scientists, clinicians and researchers.

If you are new to reading my reports and summaries from the AF Symposium, I recommend you look at: “What is the Annual ‘AF Symposium’ and Why it’s Important to Patients.”

My First Two Reports

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

Overview: 26th Annual International AF Symposium 2021–A Virtual Experience.

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. Read my Overview of the 2021 AF Symposium.

Challenging Cases #1: “Torrential” Near Death Catheter Ablation Case

Challenging Cases is a popular forum where leading EPs talk frankly about their most difficult cases in past year. My first report is a near death catheter ablation complicated by the patient directive: in no case could blood transfusions be used. Read more.

Did you notice the new menu tab on the left? We’ve add: 2021 AF Symposium Reports. Click on the tab any time for a list of all my reports.

More of My Reports to Come

Look for more of my reports from the 2021 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.

Overview 26th International AF Symposium: A 2021 Virtual Experience

The 2021 AF Symposium was held from January 29-31. This highly focused virtual conference on Atrial Fibrillation was streamed live with over 6,200 attendees. (That’s got to be some kind of a record!)

With the COVID-19 virus and the need for social distancing, organizing and presenting this year’s AF Symposium was a major technological achievement.

Kudos to the A-Fib industry sponsors who footed the bill and made it possible for so many people to attend free of charge.

If you are new to reading my reports and summaries from the AF Symposium, I recommend you look at: “What is the Annual ‘AF Symposium’ and Why it’s Important to Patients.”

Why I Attend the Annual International AF Symposium

I’ve been attending the AF Symposium for 17 years. It provides info and discussions on Atrial Fibrillation (A-Fib) unlike any other conferences.

The annual International AF Symposium brings together the world’s leading medical scientists, clinicians and researchers to share the most recent advances in the field of atrial fibrillation.

This year there were 104 presenters providing a wider range and more in-depth discussions of A-Fib. And having 15 live and prerecorded cases was a memorable experience.

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.

But because of COVID-19 and the AF Symposium being virtual, I certainly missed being able to ask questions of the presenters and converse briefly one-on-one with them.

J. Ruskin

“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.” — Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

The General Mood

The threat and life-style disruptions of COVID-19 were intuitively felt by everyone. But thanks to the intrepid work of the AF Symposium organizers, potential problems due to COVID-19 were overcome. In fact, the structure and format of this year’s AF Symposium will probably be a model and inspiration for future Symposiums.

We were all amazed and astonished at how well the 2021 AF Symposium worked, despite the tremendous changes needed to make the Symposium virtual.

Most Talked About

The most talked about topic was, like last year, the ablation treatment Pulsed Field Ablation (PFA) by Farapulse, Inc. But unlike last year, Pulsed Field Ablation seemed like a done deal, even though it has yet to receive FDA approval. Speakers seemed to recognize how well PFA works  and that it will soon become the ablation treatment of choice for most A-Fib doctors and patients. I counted 9 talks, 5 pre-recorded or live case presentations, and 2 abstracts on PFA.

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

There were 84+ different talks and one debate presented over the course of the 3-day AF Symposium (more than last year’s Symposium). All talks were short with time for virtual audience Question & Answer and discussion.AF Symposium 2021

The exceptions were the 15 live and pre-recorded cases which were usually 30 minutes.  (Putting together 15 live and pre-recorded cases was another technological achievement and way more than in previous Symposiums.) And there were 22 Spotlight Session talks which were 5 minutes long spread over all three days. They featured talks by doctors discussing new and innovative products by the A-Fib industry (non-CME).

One of the innovations this AF Symposium developed was the use of two different moderators for each topic section. One was a regular Moderator, while the second was a Digital Moderator whose job was to keep track of and address questions posed virtually by attendees.

Daily Schedule and Topics Discussed

Friday, January 29

• AF Screening, Monitoring and Risk Factor Modification I (4 talks)
• AF Screening, Monitoring and Risk Factor Modification II (5 talks)
•  Real-Time and Prerecorded Case Transmissions I (4 cases)
•  Atrial Fibrillation in Patients with Heart Failure and Preserved Ejection Fraction (6 talks)
•  Early Stage and Emerging New Technologies and Drugs in Cardiac EP (7 industry talks)
•  Stroke Prevention in AF – Anticoagulation (4 talks)
•  Stroke Prevention in AF – Left Atrial Appendage Closure I (5 talks)
•  Stroke Prevention in AF – Left Atrial Appendage Closure II (4 talks, including one from the FDA’s Andrew Farb)
•  Late Breaking Clinical Trials and First Report Clinical Investigations (5 talks)

Saturday, January 30

• Early Rhythm Control in Atrial Fibrillation (5 talks plus 1 debate)
• Real-Time and Prerecorded Case Transmissions II (5 cases)
• Accelerating the Future of EP Programs and AF Ablation (4 talks)
• Early Stage and Emerging New Technologies and Drugs in Cardiac EP II (8 talks)
•  Clinical Outcomes of Catheter Ablation for Atrial Fibrillation (5 talks)
•  Pulmonary Vein Isolation: New Techniques and Technologies (4 talks)
•  Pulsed Field Ablation (PFA): Technology and Early Clinical Outcomes (5 talks)
•  Catheter Ablation for AF: Beyond Pulmonary Vein Isolation I (6 talks, 1 from Jun Dong of the FDA)

Sunday, January 31

• Catheter Ablation for AF: Beyond Pulmonary Vein Isolation II (5 talks)
• Real-Time and Prerecorded Case Transmissions III (6 cases)
•  Innovations in Catheter Ablation Technology and Clinical Workflow (5 talks)
•  Early Stage and Emerging New Technologies and Drugs in Cardiac EP III (7 talks)
•  Optimizing the Safety of Catheter Procedures for Atrial Fibrillation (5 talks)
•  Challenging Cases in AF Management (8 presenters with different cases)

Worldwide Live Cases Via Streaming and Pre-Recorded Video

These case sessions were certainly the highlight of the AF Symposium. It was like you were in the lab with the EPs doing the procedures.

I was amazed at how they were able to switch back and forth between various centers and overcome the inevitable technical challenges involving 15 live presentations from around the world.

In addition to the invaluable content, the technical achievement of so many live and pre-recorded presentations was really impressive.

We observed these “You-Are-There” presentations:

Friday, January 29:

• OVL Hospital, Aalst, Belgium. “Pulsed Field Ablation with a Circular Multielectrode Catheter”
• Southlake Regional Health Center, Toronto, Ontario, Canada. “Pulsed Field Ablation with an Over-the-Wire Catheter System”
• Massachusetts General Hospital, Boston, MA. “New Generation Left Atrial Appendage Closure Device”
• Oxford Un. Hospitals NHS Foundation Trust, Oxford, UK. “Global Substrate Mapping and Targeted Ablation with Novel Gold-Tip Catheter in De Novo Persistent AF”

Saturday, January 30:

• Un. of Milan Centro Cardiologico, Monzino, Milan, Italy. “Novel Cryoballoon System for Pulmonary Vein Isolation”
• HCA Midwest Health, Kansas City, KS. “Treatment of Incomplete Left Atrial Appendage Closure”
• Texas Cardiac Arrhythmia Institute, Austin, TX. “Ablation of Persistent AF – PVI Plus Adjunctive Ablation”
• Houston Methodist Hospital, Houston, TX. “Vein of Marshall Alcohol Ablation”
• HCA Midwest Health, Kansas City, KS (second presentation). “Non-contact Map Ablate Remap Strategy in Complex Atrial Arrhythmias.”

Sunday, January 31:

•State Research Institute of Circulation Pathology, Novosibirsk, Russia. “Renal Denervation for Atrial Fibrillation Using RF Energy”
• Mount Sinai School of Medical Center, New York, NY. “Ultra-HF Ultrasound Based Renal Denervation for Atrial Fibrillation”
• Homolka Hospital, Prague, Czech Republic. “3-D ICE with Left Atrial Appendage Closure”
• Homolka Hospital, Prague, Czech Republic (second presentation). “Pulsed Field Ablation for Atrial Fibrillation Using a Lattice-Tip Focal Catheter”
• Split, Croatia. “Pulsed Field Ablation for Atrial Fibrillation Using a Conventional Focal Catheter”
• Homolka Hospital, Prague, Czech Republic (third presentation). “Pulsed Field Ablation for Persistent AF Using Single-Shot and Focal Catheters”

Technical Problems

Audio Dropping Out and Skipping

When I first accessed the AF Symposium streaming presentations, I experienced major audio problems. The audio would drop out and skip over a presenter’s words all the time, to the point where I couldn’t follow a speaker’s comments. I of course complained and was told I was the only person reporting such audio problems. (I had checked the feed from our server which claimed to be not having any problems. All of their other feeds were fine.)

The next day Dr. Ruskin acknowledged they were having audio problems and were working on fixing them. The audio did improve to some extent but was far from perfect.

After much trial-and-error Friday, I wound up using my cell phone to access and record the Symposium’s audio. It wasn’t perfect, but it was understandable. I apologize to many of Friday’s presenters who I will not be able to report on due to these audio problems.

Technical Crew Talking Over the Speakers

Another very disturbing audio problem was I could hear the technical crew talking over the speakers. I sounded like they were both on the same channel. It was truly bizarre but sometimes intriguing. You could hear various male and female technical crew members doing things like counting down into a segment while a presenter was speaking.

The technical execution on this year’s AF Symposium obviously left a lot to be desired. But to give the technical staff credit where it was due, all the presentations were well edited and timed. For example, when one speaker would finish, immediately a second speaker would begin their presentation. There was no waiting for one speaker to sit down and another to get up to the podium.

Only Half of Vendors’ Sites Available

When I tried to access the Vendors’ sites online, I could only view the sites A through M. The rest didn’t seem to be available.

Well Worth it! More Reports to Come

Steve S Ryan PhD

Steve S Ryan, PhD

Even with the technical issues, attending the conference was well worth it. There’s no other conference that brings together the world’s leading medical scientists, clinicians and researchers to share recent developments in the field of atrial fibrillation.

Look for more of my reports from the 2021 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.

Archive: Link to all my AF Symposiums Summaries by Year

2021 AF Symposium: Reports for Patients by Steve S. Ryan, PhD

AF Symposium 2021

My Summary Reports Written for Atrial Fibrillation PatientsAF Symposium 2021

by Steve S. Ryan, PhD

Because of the COVID-19 virus, this year’s AF Symposium was held virtually January 29-31, 2021. I certainly missed being able to ask questions of the presenters and converse briefly one-on-one with them.

I consider it a privilege to attend presentations by the most eminent medical researchers, scientists, cardiologists and cardiac electrophysiologists working in A-Fib today. I learn more in three days than in a year of reading the various A-Fib research reports.

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.

Archive: Link to all my AF Symposiums Summaries by Year

REPORT TITLEPRESENTER (S)DATE POSTED
11.Spotlight Session: Javelin VINE Filter to Prevent StrokeDr. Stuart Connolly of McMaster University in Hamilton, Ontario, CanadaApril 23, 2021
10.Cerebral Amyloid Angiopathy (CAA) and Anticoagulants: Prevalence, Detection and ManagementDr. Mahmut Edip Gurol from Massachusetts General Hospital in Boston, MA,April 19, 2021
9.Spotlight Session: New Technologies and Drugs―Flecainide Inhaler by InCarda TherapeuticsDr. Jeremy Ruskin of Massachusetts General HospitalApril 19,2021
8.ATTEST Trial: Catheter Ablation to Modify Progression of AFDr. Karl-Heinz Kuck of the Asklepios Klinik St. Georg in Hamburg, GermanyApril 17, 2021
7.Another Study Finds Ablation Better First-Line Treatment Than MedicationDr. Jason Andrade of University of British Columbia Faculty of Medicine, CanadaApril 16, 2021
6.Spotlight Session: Drug in Development from Acesion PharmaDr. John Camm of St. George’s Hospital in Oxford, UKApril 16, 2021
5.Live Case: Pulsed Field Ablation for Atrial Fibrillation Using a Lattice-Tip Focal CatheterDrs. Vivek Reddy, Mt Sinai , NY, Petr Neuzil, Homolka Hosp., Prague, Czech RepublicApril 9, 2021
4.Pulsed Field Ablation Using Multielectrode Catheters and PFA Compared to RF StudyDr. Pierre Jais of the French Bordeaux Group (LIRYC)Feb 28,2021
3.Challenging Cases #2: Incessant Tachycardia Case by Dr. Andrea NataleDr. Andrea Natale of the Texas Cardiac Arrhythmia Institute in Austin, TXFeb 26, 2021
2.Challenging Cases #1:Torrential” Cather Ablation CaseDr. John Day of the Intermountain Heart Institute, Murray, UTFeb 22, 2021
1.Overview: 26th Annual International AF Symposium 2021: A Virtual Experience; written by Steve S. Ryan, PhD– – –Feb 22, 2021
Link to all 2020 AF Symposium Reports
Link to Archive of AF Symposiums Summaries by Year

J. Ruskin

“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.” — Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

If you find any errors on this page, email us. Y Last updated: Friday, April 23, 2021

2020 AF Symposium: Reports for Patients by Steve S. Ryan, PhD

AF Symposium 2020

My Summary Reports Written for A-Fib Patients

by Steve S. Ryan, PhD

Now in its 25th year, the annual AF Symposium is one of the most important scientific conferences on A-Fib in the world. (I attended my first AF Symposium in 2003.)

Each year at the Symposium, I learn about advances in research and treatments directly from the most eminent medical researchers, scientists, cardiologists and cardiac electrophysiologists. 

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.

REPORT TITLEPRESENTER (S)DATE POSTED
21.Live Case: AcQ MappingDr. Timothy Betts of Oxford Un. Hospitals, UK. January 10, 2020.
20.Challenging Case: 75-Year-Old, A-Fib Increases, Develops Bradycardia, 12-sec Heart PauseDr. Eric Prystowsky, St. Vincent Hospital, Indianapolis, INMay 2,2020
19.Abstract: Combination Device to Both Electrically Isolate and Occlude the Left Atrial Appendage (LAA)John Thompson, MD, MBA, MSC AuriGen MedicalMay 1, 2020
18.Abstract: High Hemorrhagic Risk Factors from NOACsMassachusetts General HospitalMay 1, 2020
17.Terminate Persistent A-Fib by Ablating Higher Frequency Modulation AreasDr. Jose Jalife, University of Michigan, Ann Arbor, MIMay 1, 2020
16.Protecting the Esophagus by Cooling ItDr. Mark Gallagher from St. George’s University Hospital in London, United KingdomApril 28, 2020
15.For A-Fib Patients Under Age 40: Genetic Testing Before Your Catheter Ablation?Dr. Patrick Ellinor of Massachusetts General HospitalApril 28, 2020
14.After Diagnosis, How Soon Should an A-Fib Patient Get an Ablation?Dr. Karl-Heinz Kuck of St. Georg Hospital in Hamburg, GermanyApril 28, 2020
13.Virtual Heart” Assists Actual AblationsProf. Natalia Trayanova of Johns Hopkins Un. in Baltimore, MD.April 26, 2020
12.Device-Detected AF and Stroke Risk as a Function of AF Burden-Clinical Implications Dr. Daniel Singer, Massachusetts General Hospital in Boston, MAApril 26, 2020
11.Live Case: LAA Closure with New  Watchman FLXDr. John Foran, Royal Brompton Hospital in London, UKApril 24, 2020
10.Live Case: Convergent AF AblationDrs. Andrew Makati and Andrew Sherman, St. Joseph’s Hospital, Tampa, FLApril 22, 2020
9.Live Case: Ultra-Low Temperature CryoablationDr. Tom De Potter, OLV Hospital, Aalst, BelgiumApril 21, 2020
8.PFA Abstract:
Lesion Durability and Safety Outcomes of Pulsed Field Ablation 
Dr. Vivek Reddy, Mount Sinai Medical Center, New York CityApril 17, 2020
7.PFA Abstract:
Pulsed Field Ablation with CTI Lesions Terminates Flutter in a Small Study
Dr. Ante Anic, University Hospital Center Split, CroatiaApril 17, 2020
6.PFA Abstract:
Durability of Pulsed Field Ablation Isolation Over Time: Preliminary Study 
Researchers at Mount Sinai Hospital in New YorkApril 17, 2020
5.PFA Abstract:
Pulsed Field Ablation vs RF Ablation: A Study in Swine
Dr. Jacob Koruth, Mount Sinai Medical Center, New York CityApril 17, 2020
4.PFA Abstract:
Using MRI to Check Pulsed Field Ablations (PFA)
The French Bordeaux GroupApril 17, 2020
3.Live Case: Difficult A-Fib Ablation of Atypical FlutterDr. Kevin Heist from Massachusetts General HospitalApril 10, 2020
2.Pulsed Field Ablation—Emerging Tech for Atrial FibrillationDr. Vivek Reddy, Mount Sinai Medical Center, New York City, USA; Dr. Petr Neuzil, Homolka Hospital in Prague, Czech Republic.April 6, 2020
1.Overview: The 25th Annual International AF Symposium 2020 by Steve S. Ryan, PhD– – –March 2020
Archive: Link to all my AF Symposiums Summaries by Year

J. Ruskin

“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.” — Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

If you find any errors on this page, email us. Y Last updated: Monday, February 22, 2021

About the Annual International AF Symposium

What is the Annual ‘AF Symposium’ and Why it’s Important to Patients

by Steve S. Ryan, PhD
Last updated: February 21, 2021

Introduction

The past two decades have witnessed dramatic advances in all areas of A-Fib research with major progress in our understanding of atrial fibrillation and the development of safer and more effective strategies for the treating and curing of atrial fibrillation.

The annual international AF Symposium (formerly called the Boston AF Symposium) is one of the most important conferences on A-Fib in the world. The Symposium is a major scientific forum at which health care professionals have a unique opportunity to learn about advances in research and therapeutics directly from many of the most eminent investigators in the field.

This intensive and highly focused three-day symposium brings together the world’s leading medical scientists to share the most recent advances in the field of atrial fibrillation.

Steve Ryan with Dr Michel Häissaguerre (inventor of the PVI ablation for A-Fib) at the 2019 AF Symposium presentation hall

Why I attend the Symposium

Each year I attend the Symposium to learn and ‘absorb’ the presentations and research findings.

Attending the annual AF Symposium gives me a thorough and practical view of the current state of the art in the field of A-Fib. I then apply this newly acquired knowledge and understanding to the publishing of A-Fib.com.

Look for 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. 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 usually ending up with about 12–20 articles. (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.

For the readers of A-Fib.com

My goal is to offer the most up-to-date A-Fib research findings and developments that may impact the treatment choices of patients seeking their A-Fib cure.

Caution: If you haven’t read and understood most of the articles on A-Fib.com, it may be difficult reading. (Hint: our Glossary of Terms may be helpful.)

 Return to AF Symposium Archives by Year
If you find any errors on this page, 
email us. Y Last updated: Sunday, February 21, 2021

2019 AF Symposium: Reports for Patients by Steve S. Ryan, PhD

Steve Ryan at 2019 AF Symposium sign; A-Fib.com

Steve Ryan at 2019 AF Symposium

AF Symposium 2019

My Summary Reports Written for A-Fib Patients

by Steve S. Ryan, PhD

Now in its 24th year, the annual AF Symposium is one of the most important scientific conferences on A-Fib in the world. I attend to learn about advances in research and treatments directly from the most eminent medical researchers, scientists, cardiologists and cardiac electrophysiologists. (My first Symposium was in 2003.)

My goal is to offer A-Fib.com readers the most up-to-date research and developments that may impact their treatment choices. And, as always, my reports are written in plain language for A-Fib patients and their families.

REPORT TITLEPRESENTER (S)DATE POSTED
6.Convergent Hybrid Ablation for Atrial Fibrillation―Live from Atlanta, GA

Drs. Michael Halkos,  David DeLurgio and Kevin Makati, Emory Heart and Vascular Center, St. Joseph’s Hospital, Atlanta, GA.

March 3, 2019
5.Common Fluoroscopy Technology Converted to Real-Time 3D Images―Live case from Milwaukee, WI

Drs. Sabir Jra and Mohamed Hani of Aurora Health Care, Milwaukee, WI

Feb 8, 2019
4.Multi-Electrode RF Balloon CatheterLive Case from Mass. General

Drs. Moussa Mansour, Andrea Natale and Kevin Heist, Mass. General, Boston, MA

Feb. 6, 2019
3.Ablation Without Touching the Heart Surface Using UltrasoundLive Case from Prague

Drs. Jan Petru, Moritoshi Funasako, and Petr Neuzil, Na Homolce Hospital in Prague,  the Czech Republic.

Feb. 5, 2019

2.New Product: Vascular Closure Device-Great News for Ablation Patients!

Drs. Al-Ahmed, Andrea Natale, Texas Cardiac Arrhythmia Institute in Austin TX; Dr Suneet Mittal, Arrhythmia & Cardiology Consultants, Paramus, NJ.

Jan 30, 2019

1.Overview: The 24th Annual International AF Symposium 2019 by Steve S. Ryan, PhD– – –Jan 30, 2019
Archive: Link to all my AF Symposiums Summaries by Year

Steve and Dr Michel Häissaguerre, The French Bordeaux group, who cured Steve’s A-Fib in 1998; AF Symposium 2019 presentations hall..

J. Ruskin

“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.” — Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

 If you find any errors on this page, email us. Y Last updated: Sunday, March 3, 2019

5-Year CABANA Trial: Compares Catheter Ablation with Antiarrhythmic Drug Therapy

The catheter ablation procedure for Atrial Fibrillation has been around for 20+ years.

In a randomized controlled trial, the 5-year CABANA study is the largest to compare the A-Fib treatments of catheter ablation (PVI) and antiarrhythmic drug therapy (AAD).

CABANA stands for Catheter Ablation versus Antiarrhythmic Drug Therapy.

CABANA Trial Design

Worldwide, 2,204 patients with new onset or undertreated Atrial Fibrillation were randomized between two treatments: catheter ablation (PVI) or antiarrhythmic drug (AAD) therapy. Patient participants were followed for nearly 5 years.

Patients details: Many patients had concurrent illnesses with Atrial Fibrillation: cardiomyopathy (9%), chronic heart failure (15%), prior cerebrovascular accidents or TIAs (mini-strokes) (10%).

Over half of participants (57%) had persistent or long-standing persistent A-Fib [i.e. harder types of A-Fib to cure].

Drug details: Antiarrhythmic drug (AAD) therapy was mostly rhythm control (87.2%), some received rate control drug therapy.

Anticoagulation drug therapy was used in both groups.

CABANA Trial Results

There was no significant difference between the two arms in the primary endpoint of the trial (the composite of all-cause mortality, disabling stroke, serious bleeding, or cardiac arrest), which occurred in 9.2% of patients in the drug group and 8% of patients in the ablation group (hazard ratio 0.86, CI 0.65-1.15, p =0.303).

Crossover a Major Problem: Many in the AAD therapy arm decided to have a catheter ablation instead (27.5%). And some in the ablation arm decided not to have an ablation (9.2%). [One can not blame patients or their doctors for making these life-impacting choices.] 

The problem arises when so many of the AAD therapy arm cross over. In the primary endpoint “intent to treat” group, those who wound up having an ablation were still included in the ADD arm. Whereas when researchers looked at actual “treatment received”, the CABANA results showed catheter ablation was significantly better than drug therapy for the primary endpoint (a composite of all-cause mortality, disabling stroke, serious bleeding or cardiac arrest). [See Additional Research Findings below.] Mortality and death rate were also significantly better for catheter ablation.

Additional CABANA Findings: Ablation vs AAD Therapy

▪ Catheter Ablation significantly reduced the recurrence of A-Fib versus AAD therapy.

▪ Catheter Ablation improved ‘quality of life’ (QofL) more than AAD therapy, though both groups showed substantial improvement.

▪ Catheter Ablation patients had incremental, clinically meaningful and significant improvements in A-Fib-related symptoms. This benefit was sustained over 5 years of follow-up.

▪ Catheter Ablation was found to be a safe and effective therapy for A-Fib and had low adverse event rates.

Take-Aways for A-Fib Patients

Ablation Works Better than Antiarrhythmic Drugs: Rather than a life on antiarrhythmic drug therapy, the CABANA trial and other studies show that a catheter ablation is the better choice over antiarrhythmic drug therapy.

For related studies, see CASTLE AF: Live Longer-Have a Catheter Ablation and AATAC AF: Catheter Ablation Compared to Amiodarone Drug Therapy.

In an editorial in the Journal of Innovations in Cardiac Rhythm Management, Dr. Moussa Mansour, Massachusetts General Hospital, wrote about the CABANA trial:

“It confirmed our belief that catheter ablation is a superior treatment to the use of pharmacological agents, and corroborates the findings of many other radomized clinical trials.” 

Lower Recurrence: What’s also important for patients is the lower risk of recurrence of A-Fib versus AAD therapy.

Reduced Ablation Safety Concerns: Ablation significantly improved overall mortality and major heart problems.

Immeasurable Improvement in Quality of Life! Perhaps even more important for patients on a daily basis, catheter ablation significantly improved quality of life.

Don’t Settle for a Lifetime on Drugs

Over the years, catheter ablation for A-Fib has become an increasingly low risk procedure with reduced safety concerns. (Ablation isn’t surgery. There’s no cutting involved. Complication risk is similar to tubal ligation or vasectomy.)

An ablation can reduce or entirely rid you of your A-Fib symptoms, make you feel better, and let you live a healthier and longer life (for people who are older, too). A catheter ablation significantly improves your quality of life (even if you need a second “re-do ablation” down the road).

For many, many patients, A-Fib is definitely curable. Getting back into normal sinus rhythm and staying in sinus rhythm is a life-changing experience, as anyone who’s free from the burden of A-Fib can tell you.

See also:  Does a Successful Catheter Ablation Have Side Benefits? How About a Failed Ablation?

Additional Study Findings
Primary endpoints: Results of the primary endpoints were not significant. This is probably due to the crossovers and the lower than expected adverse event rates (5.2% for ablation versus 6.1% for AAD therapy).

Deeper Analysis of Data: The researchers performed sensitivity analyses on the primary results using “treatment received” and “per protocol” rather than “intent to treat”.

Research Terms: Primary endpoint—specific event the study is designed to assess. Intent to treat—all assigned to the AAD group compared to the assigned ablation group (even though 1/4 crossed over to the ablation group). Treatment received—compared all who received an ablation to all who received AAD therapy.
References for this article
• Packer, Douglas. CABANA trial provides important new data on clinical and quality of life effects of ablation for atrial fibrillation. Cardiac Rhythm News: October 18, 2018, Issue 42. P. 1.

• Mansour, Moussa. Letter from the Editor in Chief. The Journal of Innovations in Cardiac Rhythm Management, June 2018. DOI: 10.19102/icrm.2018.090609.

Catheter Ablation vs Surgery For A-Fib: Finally an Apples-to-Apples Comparison

Update July 27, 2018 Which is better from a patient’s perspective―Catheter Ablation or Surgery (Mini-Maze)? A new study compares the two head-to-head.

An article in Cardiac Rhythm News (no author), describes the SCALAF trial (Surgical vs. Catheter Ablation of paroxysmal and early persistent Atrial Fibrillation).

SCALAF Trial Design

The SCALAF study is the first randomized control trial of patients with symptomatic A-Fib. In a 1:1 ratio, 52 patients received either a catheter ablation or surgery as their first invasive procedure. Follow-up data in all patients was collected for 2 years using implantable loop recorders (Medtronic Reveal XT).

The measurement of success was freedom from A-Fib (atrial tachyarrhythmia) and off antiarrhythmic drugs with safety measured by procedure-related complications.

PV Isolation Direct Comparison: The catheter ablation arm only isolated the PVs without additional lesion sets. The surgical arm (Mini-Maze) only isolated the PVs (and removed the left atrial appendage).

Trial Results

Efficacy: Catheter ablation vs. surgical patients (60% vs. 27%) were free from A-Fib without drugs.

Efficacy: After 2 years, a significantly greater number of catheter ablation patients (60%) were free from A-Fib without having to take A-Fib drugs compared to a much smaller number of surgical patients (27%).

Safety: Surgery patients had a higher procedure-related complication rate (34.8% vs. 11.1%) and a higher rate of major complications (22% vs. 0.0%) compared to catheter ablation patients. That’s about 1-in-4 surgical patients who had significant complications.

Safety: Surgery patients had a higher procedure-related complication rate (34.8% vs. 11.1%).

Hospital Stay: Hospitalization was longer for surgical patients with an average hospital stay of nine (6–10) days compared to three (2–3) days for catheter ablation.

Trial Conclusions

The investigators concluded that catheter ablation of the PVs in the treatment of paroxysmal and early persistent A-Fib is safer and results in higher long-term arrhythmia free survival compared to surgical (Mini-Maze) PV isolation. Follow-up with continuous monitoring using implantable loop recorders was important for true and accurate outcomes.

What Patients Need to Know

Don’t Make Surgery Your First Choice: Following the 2014 Guidelines for the Management of Patients with Atrial Fibrillation, your first treatment option should not be surgery (Mini-Maze).

Catheter Ablation Higher Success and Safer: Though this was a small study, this trial showed that catheter ablation is safer with better long-term freedom from A-Fib (and without medication) when compared head-to-head with surgical Mini-Maze. Follow-up monitoring of each patient with an implantable loop recorder (for 24/7, 365 days for two years) produced unbiased, non-disputable results.

The 2011 FAST Trial: The SCALAF trial results might be compared to the 2011 FAST Trial sponsored by AtriCure, Inc. The FAST trial compared AtriCure’s own system for Mini-Maze surgery to catheter ablation. The results favoring surgery don’t hold up under close scrutiny. More important was the high complication rate of the surgical approach. For more, see Surgical Versus Catheter Ablation―Flawed Study.

SCALAF: Catheter ablation is safer with better long-term freedom from A-Fib (and without medication) when compared head-to-head with surgical Mini-Maze.
The Bottom Line: We now have an unbiased clinical trial comparing catheter ablation with surgery.

According to the SCAFAL trial, catheter ablation has higher success for long-term freedom from A-Fib than the surgery approach. Just as important, data from both FAST and SCAFAL demonstrate that catheter ablation is much safer than surgery.

Update July 27, 2018: In response to this post about the SCAFAL trial, we received this statement from surgeon Dr. John H. Sirak who performs the “5 box surgery” for A-Fib. Especially relevant is his statement that surgical PVI alone tends to produce Flutter. (The FAST study did compare more complex surgeries to catheter ablation.)

“I must be direct and say this study is next to worthless. First, it isn’t clear how the cohorts compare in terms of AF chronicity. Surgical PVI should at least be no worse than percutaneous. PVI is the most foolproof step of a surgical maze. If the randomization were truly accurate, why was the surgical arm so much smaller? My suspicion is that the surgical arm had a significantly higher number of non-paroxysmal patients. And who were the orangutans operating with a 35% complication rate? Along the same lines, since surgical PVI alone is now widely known to be fluttergenic and thus contraindicated, no reputable surgeon would offer a patient such an outdated operation! This study is not only pathetically executed, but also has no relevance to current standard-of-care practice.”
-Dr. John H. Sirak

Resources for this article
• Surgical treatment of atrial fibrillation results in higher complication rates when compared to catheter ablation. Cardiac Rhythm News (no author). May 18, 2018, Issue 41, p. 9.

• Surgical or Catheter Ablation of Lone Atrial Fibrillation (AF) Patients (SCALAF). ClinicalTrials.gov Identifier: NCT00703157. Sponsor: Medtronic Bakken Research Center Note: Principal Investigators are NOT employed by the organization sponsoring the study. https://clinicaltrials.gov/ct2/show/results/NCT00703157.

• AHA/ACC/HRS 2014 Guideline for the Management of Patients With Atrial Fibrillation. Circulation. published online March 28, 2014, 4.2.1. Antiplatelet Agents, p 29.doi: 10.1161/CIR.0000000000000041 Last accessed Nov 23, 2014.URL: From http://content.onlinejacc.org/article.aspx?articleid=1854230

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