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

5 comments

  1. Was there anything from Utah to help aging endurance athletes? I’m just finishing your book and it seems that “de-conditioning” is the best strategy for preventing AF. I’ve had 8 episodes in 10 years with varying intervals in between, but my type requires cardioversion to get back to sinus rhythm. At 62, I’m done racing but I like to train. I enjoyed the book, but some of the technical descriptions went over my head. I’ve never had an ablation and I’m not sure that I ever would. Thanks

    1. Bill, I just had a RF ablation yesterday. Put it off for 10years and used tikosyn and cardioiversion. I’m 74 and like you was an endurance athlete. I keep my self in shape by walking and hiking when I could no longer run due to afib and the accompanying breathlessness. Afib is progressive. At some point in time the longer episodes and accompanying fatigue will interfere with your lifestyle and prompt you to consider an ablation (a big decision for me). Recovery for me will take a month and then slowly I’ll increase my workouts. For now easy walking and stretching. I’ll keep you (and this blog) posted on my progress. Todays pain level 3 for burning in the chest area and 0 for the groin insertion point. (scale 1-10).

    2. Bill, I’m 55 and an endurance athlete who had 1-2 AF episodes in 2015 and 7 episodes last year including one that required cardioversion. I haven’t had an ablation yet. Thinking about it but trying every potential reversible option first.

      I read the column on the Utah conference and the second bullet point refers to research by Dr. Prash Sanders from Australia on the effectiveness of risk-factor management. Most of the risk factors (diabetes, hypertension, untreated sleep apnea) aren’t relevant for me. But two risk factors (weight and stress) are. Those are the two I’m focusing on. Current BMI of 27 and working to get to 25. Taking yoga twice a week for the stress.

      I had six episodes in November and December of 2016. I stopped riding/running with the second episode in early November. I started yoga in January. Started riding again (lower duration and intensity) in February. I’ve now lost the 5 pounds I gained over the holidays and no more episodes so far. My plan is to ramp up to the AHA recommended minimum weekly exercise duration and intensity (admittedly not close to what I used to do). If I can’t do that without experiencing AF, then it’s time for the ablation.

  2. Hi Dr. John/readers,

    I would like to know about the potential increase in the likelihood of AF in people with the following condition.

    I’m a 39 year old recreational cyclist who has PACs/PVCs on and off, they are not related to exercise (seem to be related to stomach gas, stress, posture). However, I was recently found to have an ASD 6mm (ostium secundum), the Qp/Qs is low 1.17. They have recommend to not operate right now and to just monitor it and I have been cleared for all sports/training, all measurements normal/very good.

    My question is are adult ASD sufferers condemned to AF? I’ve read conflicting reports i.e. they should get it fixed as soon as possible (which could cause AF, I would probably need a patch and the stitches and cutting could cause this), or should suffers wait for any symptoms to start which could cause right side remodeling leading to AF further down the line.

    Maybe the higher incidence of AF in 40+ years could be because of small ASD defects that go unnoticed.

    I would appreciate your thoughts on this.

    Thanks.

  3. IF SOMEONE 73yo gets all the lifestyle changes fixed: Bp controlled, weight
    ideal, no alcohol, moderate recommended exercise , no coffee, little stress,
    LDH low but episodes of a fib continue , how likely is it that the a fib will then go away by just being patient and waiting? Has anyone ever had the a fib cured with lifestyle ( upstream) therapy alone?

Comments are closed.