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Baltimore, MD


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


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Significant Research and Scientific Studies

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
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: Saturday, May 2, 2020

About the Annual International AF Symposium

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

by Steve S. Ryan, PhD
first published Jan. 2014, updated Jan 2015  Last updated: February 6, 2019

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: Wednesday, February 6, 2019

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

Catheter Ablation Compared to Amiodarone Drug Therapy in Heart Failure Patients with A-Fib

Background: I previously reported on the ground-breaking CASTLE-AF study published in 2018 which compared treatment with conventional antiarrhythmic drugs (both rate and rhythm control) versus treatment with catheter ablation. I recently came across another, similar study. While the 2016 AATAC study pre-dates the CASTLE-AF study, it also contributes to our understanding of treatment choices for heart failure patients with A-Fib.

Treating Patients with Both Heart Failure and A-Fib

Heart failure is very common in patients with A-Fib (estimated at 42%). These are very sick patients. For people with advanced heart failure, nearly 90% die within one year.

In patients with both conditions, a cardiologist’s first treatment is most often drug therapy with an antiarrhythmic drug. But is this an effective strategy? Is this really in the patient’s best interest? A 2016 study says NO!

AATAC stands for: Ablation vs Amiodarone for Treatment of Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted ICD/CRTD

AATAC: Catheter Ablation vs. Amiodarone Antiarrhythmic Drug Therapy

In the powerful AATAC multicenter worldwide randomized trial, catheter ablation was compared to drug treatment with amiodarone (the most effective but also the most toxic of the antiarrhythmic drugs).

The 203 enrolled patients had persistent A-Fib and heart failure with an Ejection Fraction of less than 40%. Patients also all had either a dual-chamber implantable cardioverter defibrillator or cardiac resynchronization therapy defibrillator.

All patients in the AATAC study were given optimal medical therapy for congestive heart failure such as ACE inhibitors, etc.

Patients were randomized to receive either a catheter ablation or drug treatment with amiodarone.

Note: The AATAC study should be read in conjunction with the more significant CASTLE-AF study which found similar results.

Group 1: Catheter Ablation

The first group received a catheter ablation of the pulmonary veins (PVI) along with roof lines and extensive ablations on the left atrial posterior wall; if non-PV potentials were found, the superior vena cava was isolated. At their discretion, EPs could ablate complex fractionated electrograms and non-PV triggers.

A ‘re-do procedure’ could be performed during the 3-month blanking period.

Group 2: Amiodarone (AMIO) Drug Treatment

The Amiodarone (AMIO) group was given 400 mg twice a day for 2 weeks followed by 400 mg each day for the next 2 weeks, then they were given a maintenance dose of AMIO 200 mg/day for the balance of the 24 month study period.

Study Follow-up and Results

All patients were followed for a minimum of 24 months. Recurrence was measured by the implantable devices with device interrogation at 3, 6, 12, and 24 months follow-up. Key findings at the end of the trial period include:

Recurrence: 70% of patients in the ablation group were recurrence and A-Fib free (after an average of 1.4 procedures) vs. only 34% of the Amiodarone (AMIO) group.

PVI with/without posterior wall isolation: Higher success was reported in patients undergoing PVI with posterior wall isolation compared to PVI alone (79% vs. 8%).

Amiodarone therapy was found to be significantly more likely to fail.

Cardioversion: During the 3-month blanking period 51% of the Amiodarone (AMIO) group needed cardioversion vs. 3% of the ablation group.

The unplanned hospitalization rate was 31% in the ablation group vs. 57% in the AMIO group. This is a 45% relative risk reduction of hospitalization.

A significantly lower mortality was observed in the ablation group: 8% vs. AMIO 18%.

Summary: Catheter Ablation Superior to Amiodarone Drug Therapy

Heart failure and A-Fib are common cardiac conditions that often coexist.

The AATAC study, the first randomized study of heart failure patients with persistent A-Fib, found that catheter ablation is superior to amiodarone drug therapy in achieving freedom from A-Fib long-term.

In addition, treatment with catheter ablation improved mortality in these patients, increased exercise capacity and Quality of Life (QofL) along with reduced unplanned hospitalizations.

Acknowledging My Bias
I admit to being biased against amiodarone drug therapy due to personal experience and from what others have shared. (For example, see Karen Muccino’s A-Fib story.) I am horrified that anyone would be put on such a high initial dosage of amiodarone as in this study. I would never participate in such a study. But obviously all doctors don’t share my concerns.
If a less potent (and less dangerous) antiarrhythmic drug had been used, it’s probable the study results would have been even more favorable for the ablation group.

What This Means to A-Fib Patients

These patients were in persistent A-Fib along with heart failure. These are some of the most difficult patients to make A-Fib free.

The EPs and A-Fib centers in this study were some of the best in the world. That there was a 70% success rate and no recurrences after 2 years is a testimony to the advanced mapping and ablation skills of these EPs. It’s remarkable how far catheter ablation strategies have improved over the years.

On the downside, not all EPs are equal. The single procedure success rate varied greatly from 29% to 61%. (See Huge Growth in Number of EPs Doing Catheter Ablations, But All EPs Are Not Equal.)

Catheter Ablation Group: Improved Ejection Fractions

Among the 203 enrolled patients, it’s not surprising that there were 26 deaths during this study. These were very sick patients with congestive heart failure and Ejection Fraction below 40%. (An EF below 50% indicates a weakened heart muscle that is no longer pumping efficiently; an EF in the normal range is 50% to 75%.)

The good news is that for many in the catheter ablation group, their ejection fraction was significantly improved and they were no longer in heart failure.

Catheter Ablation Outperforms Antiarrhythmic Drugs

We now have 2 studies which demonstrate that compared to antiarrhythmic drug therapy, catheter ablation lowers death rate among A-Fib patients (with heart failure), improves QofL and lets patients live longer and healthier lives. Other major benefits of ablation include reduced unplanned hospitalizations and increased exercise capacity.

Take-Away for A-Fib Patients

I think we can draw conclusions from the AATAC and the CASTLE AF studies that also apply to A-Fib patients (not in heart failure).

Rather than a life on antiarrhythmic drug therapy, the AATAC and CASTLE AF studies encourage A-Fib patients to seek a catheter ablation (including a second “re-do ablation”, if necessary.)

Bottom-line: Hard research data shows that a catheter ablation is the better choice over drug therapy. An ablation can rid you of your A-Fib symptoms, make you feel better, and let you live a healthier and longer life.

Don’t just live with A-Fib. Seek your cure.

 

Resource for this Article
Di Biase, L., et al. Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device. Results From the AATAC Multicenter Randomized Trial. Circulation. 2016;133:1637-1644. March 30, 2016. http://circ.ahajournals.org/content/133/17/1637 DOI  https://doi.org/10.1161/circulationaha.115.019406

2018 AF Symposium: Reports for Patients by Steve S. Ryan, PhD

AF Symposium 2018

My Summary Reports Written for A-Fib Patients

by Steve S. Ryan, PhD

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 scientists and doctors. 

My goal is to offer A-Fib.com readers the most up-to-date research and developments that may impact their treatment choices.

REPORT TITLEPRESENTER (S)DATE POSTED
11.Findings from the CASTLE-AF Clinical TrialDr. Nassir MarroucheMar. 21, 2018
10.Live Case: CryoBalloon Catheter for Isolation of the LAADr. Bradley Knight from Northwestern Un. in Chicago, ILMar. 1, 2018
9.REAFFIRM Trial—Kiss of Death for FIRM Mapping?Dr. John Hummel from the Ohio State University Wexner Medical CenterFeb. 28, 2018
8.Live Case: Installing an Amplatzer™ Amulet™ LAA OccluderDr. Claudio Tondo from Milan, ItalyFeb. 28, 2018
7.Live Case: Isolating the Left Atrial Appendage using RF EnergyDr. Rodney Horton, Texas Cardiac Arrhythmia Institute, Austin, TXFeb. 25, 2018
6.Live Case: RADAR―A Software Breakthrough in Identifying A-Fib Rotors and Drivers?Dr. Petr Neuzil from Prague, Czech RepublicFeb. 24, 2018
5.Live Case: Installing a Coherex WaveCrest LAA Occlusion DeviceDr. Tom De Potter from Aalst, BelgiumFeb. 24, 2018
4.Live Case: The DV8 Retractor: an Esophageal Deviation Tool from Manual Surgical SciencesDrs. Kevin Heist, Conor Barrett and Moussa Mansour from Massachusetts General in Boston, MAFeb. 22, 2018
3.A Friendly Debate: “Can Anticoagulants Be Stopped After AF Ablation?Dr. Francis Marchlinsk, Un. of Pennsylvania Health Center and Dr. Elaine M. Hylek, Boston Un. Medical CenterFeb. 21, 2018
2.New Product: Innovative iCLAS Cyro Catheter by Adagio MedicalHugh Calkins, MD moderator; Panelists: Drs. James Cox, Michel Haissaguerre, Tom de Potter, Lucas Boersm and Alex BabkinFeb. 7, 2018
1.2018 AF Symposium Overview by Steve S. Ryan, PhD– – –Feb. 4, 2018
Archive: Link to my 2017 AF Symposium reports of all Atrial Fibrillation-related medical conferences

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

Return to AF Symposiums Summaries By Year

 If you find any errors on this page, email us. Y Last updated: Wednesday, March 21, 2018

Atrial Fibrillation Hospitalizations: Urban-Rural Differences in Mortality Rates

A new study suggests U.S. patients hospitalized for atrial fibrillation in rural areas may be more likely to die than those hospitalized in urban areas. 

In-hospital mortality was defined as death due to any cause during hospitalization.

Researchers examined nationwide information on 248,731 adults hospitalized for atrial fibrillation between 2012 and 2014. Mean age was 69 years; 78% white; 48% women. Of these, 218,946 (88%) were from urban hospitals and 29,785 (12%) were from rural hospitals.

Study Results: Urban vs. Rural

Patients admitted to rural hospitals had a 17% increased risk of death as compared with those admitted to urban hospitals. (Around 1.3 percent of atrial fibrillation patients died in rural hospitals, compared and 1 percent in urban facilities.) The study accounted for differences in patient characteristics including high blood pressure, diabetes, heart failure and kidney damage.

“…appropriate anticoagulation and…advanced options such as ablation, are lower in rural than urban settings.” Dr. Thomas Deering

According to lead study author Dr. Wesley O’Neal of Emory University School of Medicine: “Presumably, a higher risk of death in patients from rural regions was related to differences in practice patterns and access to specialists.” 

From a related editorial: “There is also some limited data suggesting that several atrial fibrillation outcomes, for example appropriate anticoagulation usage and appropriate referral for advanced procedural options such as ablation, are lower in rural than urban settings,” wrote Dr. Thomas Deering of Piedmont Heart Institute in Atlanta.

This study examination wasn’t a controlled experiment. Further research is needed to understand these findings.

What This Means to A-Fib Patients

Atrial Fibrillation is not a one-size fits all type of disease. Don’t choose your Atrial Fibrillation healthcare provider just because their office is nearby with local hospital privileges.

When seeking treatment for your Atrial Fibrillation, your first step is to see a heart rhythm specialist (a cardiac electrophysiologist) who specializes in the electrical function of the heart (and the best you can afford). You may need to travel, but it may be worth it to you for your peace of mind.

For more see Finding the Right Doctor for You and Your A-Fib and the A-Fib.com Directory of Doctors Treating A-Fib: Medical Centers and Practices.

Resources for this Article
O’Neal, W.T., et al. Urban-rural differences in mortality for atrial fibrillation hospitalizations in the United States. Heart Rhythm online December 10, 2017. DOI: http://dx.doi.org/10.1016/j.hrthm.2017.10.019

Rapaport, L. Atrial fibrillation more deadly in rural U.S. hospitals. Reuters Health, Jan. 2, 2018 https://www.reuters.com/article/us-health-afib-survival/atrial-fibrillation-more-deadly-in-rural-u-s-hospitals-idUSKBN1ER1NP

Patients With Atrial Fibrillation More Deadly In Rural U.S. Hospitals. PharmaInsider. January 3, 2018. http://pharmainsider.in/patients-atrial-fibrillation-deadly-rural-ushospitals/

Inherited A-Fib? Is it More Risky for Family Members?

Many A-Fib patients wonder if they will pass their Atrial Fibrillation on to their offspring. Called Familial A-Fib, your first-degree family members are at higher risk of developing A-Fib.

A-Fib accounts for one-third of all strokes in patients above the age of 65 and is also associated with an increased mortality.

Several studies have shown an association of genetic variants with A-Fib and indicated that Familial A-Fib increases the risk of developing A-Fib. Familial A-Fib may account for as many as 20% of A-Fib patients.

But there is good news. A Danish registry study found that a diagnosis of Familial A-Fib carries no greater risk of death and stroke than in the general Atrial Fibrillation population.

The Danish Familial A-Fib Study

The study from Danish nationwide registry data included 8,658 patients diagnosed with A-Fib from 1995 through 2012 with both parents known, matched 1:1 for familial A-Fib status as well as age, year of A-Fib diagnosis, and sex.

Familial A-Fib is more common in men than women and with median age of 50.

Study Findings: Compared with the entire A-Fib registry population, the familial A-Fib patients were less likely to be female (21% women versus the overall registry’s 47% women) and were younger at diagnosis (median age 50 vs 77).

An element to be taken into account is that families with long life expectancy, for any reason, may be at higher risk for familial A-Fib due to the longevity of relatives.

What Patients Need to Know

We have heard of many fathers and sons and sets of brothers with A-Fib as well as three-generations with A-Fib.

If you have Atrial Fibrillation, your first-degree family members (parents, siblings, offspring) may have Atrial Fibrillation and not know it. They may have ‘silent A-Fib’ with no or few apparent symptoms but with an increased risk of stroke.

Encourage family members to discuss Familial A-Fib with their doctors.

Be your family’s health advocate. Encourage family members to discuss Familial A-Fib with their doctors. A-Fib is usually easy to detect by taking your pulse and/or by an electrocardiogram (EKG or ECG). Early detection and treatment may avoid early health complications and prevent a cardiovascular event (i.e. A-Fib-related stroke).

For more about Familial A-Fib, see FAQs: Can I Prevent Familial A-Fib with Diet? Supplements?

A-Fib Personal Story on A-Fib.comDoes A-Fib Run in Your Family? 

Would you share your A-Fib story with our readers? We would love to hear from you. Our Personal Experiences stories are one of the most visited areas of A-Fib.com. Email me and tell me your story. (Or, read how to write and submit your A-Fib story.)

Resources for this article
Phend, C.  Afib in the family not riskier for outcomes death, thromboembolism rates similar to cases with no family history. Cardiology/MedPage Today. November 29, 2016. http://www.medpagetoday.com/cardiology/arrhythmias/61722

Kirchhof P, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS: the Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2016. URL: http://eurheartj.oxfordjournals.org/content/ehj/early/2016/08/26/eurheartj.ehw210.full.pdf. Accessed November 18, 2016.

Gundlund A, et al “Outcomes associated with familial versus nonfamilial atrial fibrillation: A matched nationwide cohort study” J Am Heart Assoc 2016; DOI: 10.1161/JAHA.116.003836, http://jaha.ahajournals.org/content/5/11/e003836

Fauchier L, et al “Prognosis in familial atrial fibrillation” J Am Heart Assoc. 2016; DOI: 10.1161/JAHA.116.004905

Jurkko R, et al. Characteristics of atrial fibrillation and comorbidities in familial atrial fibrillation. J Cardiovasc Electrophysiol.2013;24:768–774. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5210330/

2017 AF Symposium: Reports for Patients by Steve S. Ryan, PhD

AF Symposium 2017

My Summary Reports Written for A-Fib Patients

Steve Ryan in Orlando Jan 2017 for AF Symposium

Steve Ryan in Orlando Jan 12-14, 2017

by Steve S. Ryan, PhD

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 scientists and doctors. My goal is to offer A-Fib.com readers the most up-to-date research and developments that may impact their treatment choices.

Archive Link: How to find my reports from all Atrial Fibrillation-related medical conferences

REPORT TITLEPRESENTER (S)DATE POSTED
15.Live Case of Ablation with FIRM Mapping SystemDr. David Wilber from Loyola Un. Medical Center in Chicago, ILMarch 16, 2017
14.Movin’ it: Protecting the Esophagus During Ablation – LIVE VIDEODrs. Rodney Horton, Amin Al-Ahmad and David Burkhardt, Texas Cardiac Arrhythmia Institute, Austin, TX.March 11, 2017
13.LIVE VIDEO: Can Adding Fibrosis Improve Ablation Success?Drs. Kevin Heist and Nathan Van Houzen, Mass. General Hospital, Boston, MAMarch 8, 2017
12.LiVE VIDEO: Ablation Using Non-Contact Ultrasound Basket Catheter Dipole Density MappingDrs. Peter Neuzil, Jan Petru and Jan Skoda, Na Homolce Hospital, Prague, The Czech Republic.Feb. 23, 2017
11.LIVE VIDEO: Ablation using CardioFocus HeartLight Endoscopic Visually Guided Laser BalloonDrs. Peter Neuzil, Jan Petru and Jan Skoda, Na Homolce Hospital, Prague, The Czech Republic.Feb. 11, 2017
10,LIVE VIDEO! Two Procedures—Different Left Atrial Appendage (LAA) Occlusion DevicesDrs. Claudio Tondo, Antonio Dello Russo, Gaetano Fassini, and Massimo Moltrasio, Milan, ItalyFeb. 3, 2017
9.World-Wide Studies on Genetic A-FibDr. Patrick Ellinor of Mass. General Hospital, Boston MAFeb. 1, 2017
8.New Insights into the Effects of Obesity on Atrial FibrillationDr. Jose Jalife of the University of Michigan, Ann Arbor, MIJan 28, 2017
7.A-Fib Increases Fibrosis by 5%-10% Per YearDr. Nassir Marrouche of the University of Utah (CARMA), Salt Lake City, UTJan 27, 2017
6.Hypercoagulability May Cause A-Fib, NOACs May Prevent ItDr. Ulrich Schotten of the University of Maastricht, Maastricht, The NetherlandsJan 27, 2017
5.Some Forms of Fibrosis May Be Reversible: Research with Overweight SheepDr. Stanley Nattel of the U. of Montreal, Montreal, CanadaJan 23, 2017
4.Links Between Inflammation, Oxidative Stress and A-FibDavid Van Wagoner, PhD, the Cleveland Clinic, Cleveland, OHJan 21, 2017
3.3D Virtual Heart’ Predicts Location of RotorsDr. Natalia Trayanova of Johns Hopkins University, Baltimore, MDJan 21, 2017
2.2017 European A-Fib Stroke Risk Guidelines Changes & No Gender BiasDr. John Camm from St. George’s Medical Center, London, UKJan 19, 2017
1.2017 AF Symposium Overview by Steve S. Ryan, PhD– – –Jan 17,2017
Archive: Link to my reports of all Atrial Fibrillation-related medical conferences

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

Return to AF Symposiums Summaries By Year

 If you find any errors on this page, email us. Y Last updated: Thursday, June 1, 2017

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