Top-ten 2017 Update on Atrial Fibrillation News

I recently served on the faculty of the tenth annual Western AF Symposium in Park City, Utah.

Dr. Nassir Marrouche of the University of Utah has grown Western AF into a huge gathering of global experts in atrial fibrillation.

During the intense two-day meeting, I took notes and put together a post of top-ten highlights. The title of the post and link to it on theHeart.org are below:

10 Highlights from the 10th Annual Western AF Symposium

The 900-word column includes short-writing notes on…

• Big themes in AF — this includes thoughts on prevention of AF, the fourth pillar of AF care, and the ceiling of AF ablation success.
• Problems with AF-mapping technologies — two leaders in basic science presented reasons to be skeptical of mapping systems’ ability to show the ever-elusive rotors. In fact, the term “rotor” is becoming a politically charged term. The safer phrase now is “rotational activity.”
• Brand new ideas on stroke and AF — this section introduces Dr. Hooman Kamel, a stroke researcher from New York, who is changing the way we think about AF and stroke. Namely, that AF episodes recorded on an ECG may not be a very good surrogate marker for stroke. Go read my post and follow the references. His work will change the field–IMHO.
• The limits of the CHADS-VASC score — it turns out that this much beloved easy-to-use risk score predicts stroke only slightly better than a coin flip.
• More humble goals for predicting stroke –– given our lousy ability to predict stroke, perhaps we should shoot for trying to predict stroke one-year in advance rather than 5-10 years, argued one leader in the field.
• The many uncertainties of subclinical AF — “subclinical” AF refers to all these short non-symptomatic AF episodes we are able to detect on advanced monitors, e.g. pacemakers, implantable loop recorders and long-term ECG monitors. Remember, the studies showing that anticoagulant drugs reduce the rate of stroke were done in people with clinical AF, which is AF recorded on an ECG in a doctor’s office or hospital because of symptoms. It’s not clear that treating short-duration symptomatic AF episodes improves outcomes.
• New proposals for defining success after AF ablation — numerous presenters argued for changing the definition of success of AF ablation from the absence of 30-seconds of AF to simply an improvement of quality of life–or palliation.
• The folly of trying to pick the superior NOAC drug — differences in trial design make it impossible to pick the superior new oral anticoagulant drug, argued an expert in anticoagulant drugs.

My post on theHeart.org is free but it requires you to register with an email.

JMM