AF ablation Atrial fibrillation General Ablation General Medicine ICD/Pacemaker

2017 European Heart Rhythm Meeting Update

I attended the European Heart Rhythm Association meeting last week in Vienna. Here is an update on the stories I found most interesting–the ones I wrote about on the | Medscape Cardiology.

Brain Lesions after AF ablation: 

Electrophysiologists do not talk much about the small brain lesions that appear after procedures in the left atrium. MRI brain scans done before and after procedures such as AF ablation reveal the presence of “white sports” in a not insignificant number of patients. These lesions usually do not cause symptoms and mostly resolve over time. The cause of the brain lesions is not known, but the most likely explanation is northward spread of debris from catheters and or the burns/freezes of the ablation.

Two studies presented at EHRA shed light on these lesions. One dealt with AF ablation; the other with left atrial appendage occlusion. My report is titled: EHRA 2017: Brain Imaging and the Trade-offs of AF Procedures

Should we screen for asymptomatic AF? 

People who feel their AF episodes have trouble believing that many patients with AF don’t know they have it. But it’s true: in about 1 in 3 cases, AF causes no symptoms.

Digital technology will surely increase the amount of asymptomatic AF that we find. In the old days, it took a formal ECG to find asymptomatic AF. Now, with the advent of fancy BP devices (the type that can signify an irregular rhythm), smart watches, iPhone ECGs, and long-term ECG monitors, it’s easier to find AF.

One thing I learned at EHRA is that asymptomatic AF may confer a higher risk of stroke. A study presented in Vienna found that the incidence of prior stroke was more than twofold higher in patients who do not feel their AF. And this finding aligns well with previous observational studies.

The importance is obvious: it provides a rationale for screening for AF.

But I am not convinced. Read why in my post titled: The Danger of AF Without Symptoms.

Ventricular Tachycardia (VT) Ablation:

Another nugget I learned at EHRA is that VT ablation procedures are increasing more than AF ablation procedures–in percentage terms.

I went to a session at EHRA called strong statements and controversies. The format was cool: a young doctor presented less than 10 slides in 5 minutes and purposefully came to a provocative conclusion. Then a panel of the world’s biggest names spent 15 minutes discussing their views.

One of these of provocative conclusions was VT ablation does not reduce mortality.

This is true. Many authors have published studies on VT ablation, and none of these papers have shown that the procedure extends life. VT ablation reduces the number of shocks patients get from their ICDs, improves quality of life and reduces the chance of being re-admitted to the hospital but it does not lower the death rate.

Are these outcomes enough to forge ahead with increasing numbers of VT ablation procedures? Read my thoughts here:  EHRA 2017: Should VT Ablation Be on the Rise Without Mortality Data?

Clots on left atrial appendage occluders? 

I have another post coming out early next week on the matter of clots forming on left atrial appendage occlusion devices, such as the Watchman. Clots on these devices, and the risks they pose were topics of two late-breaking clinical trials presented in Vienna. This is significant because organizers designate late-breaking trials as the most important to the field.

I found it notable that two of these featured studies came to cautionary messages concerning left atrial appendage closure–which I believe will be one of cardiology’s biggest mistakes.


2 replies on “2017 European Heart Rhythm Meeting Update”

Ah, Vienna, setting for the best movie of all time, The Third Man.
I concur with skepticism about the wisdom of treating brief, asymptomatic episodes of AF detected incidentally from implanted devices.
However, screening with pulse, BP or smartphone devices makes sense to me for detecting the asymptomatic , persistent or permanent AF that often presents with stroke.

Dear John,

concerning the silent afib screening I have doubled interest. Myself is silent afibber and we are developing a smartphone connected wearable ECG. My afib is so silent that likely without this device we never would find it. So the funny case, that my problem is my work.

I have two comments conerning the stroke risk
a) one option that undiscovered silent afibber will not make the life style changes, those offered for patients with diagnosed atrial fibrillation.
b) Stroke prediction scoring systems are from good, but still we dont have better. Therefore some very peculiar controversis has been published. One interesting example is that on a large database it was found that stroke risk scoring systems perform better for non-afibbers than for afibbers:

Kind regards:


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