30 Seconds is the Proper Endpoint for AF Ablation YES. Hugh Calkins MD. Professor of Medicine
|
|
|
- Roberta Dorsey
- 5 years ago
- Views:
Transcription
1 30 Seconds is the Proper Endpoint for AF Ablation YES Hugh Calkins MD Professor of Medicine Director of Electrophysiology Johns Hopkins Medical Institutions
2 COI Disclosures Dr Calkins is a consultant to St Jude Medical, AtriCure, and Boehringer Ingelheim.
3 Professor Prash Sanders 1. World Famous Rock Star 2. Chief of EP in Adelaide 3. Charismatic with a British / John Camm like accent
4 I Have Only One Request At The End of This Debate Ask Yourself One Question Has the field of AF ablation been moved forward by the 2007 and 2012 HRS Consensus Documents, Which Established a Level Playing Field and Common Language We Can Use to Compare Outcomes of AF Ablation Techniques and Technologies?
5 Outline Case presentations HRS Consensus Document Review What has the impact of the document been? What would you suggest? Conclusion
6 Outline Case presentations HRS Consensus Document Review What has the impact of the document been? Are we better off today than we were in 2006? Be careful what you ask for.
7 Outline Case presentations HRS Consensus Document Review What has the impact of the document been? Are we better off today than we were in 2006? Be careful what you ask for.
8 Case Presentation #1 65 year old man with symptomatic paroxysmal AF undergoes AF ablation at Center X. 8 months later he is seen in follow-up. He tells his MD he feels great and has had no atrial fibrillation. He brings with him a bottle of fine wine which he gives to his EP. A 12 lead ECG is obtained and reveals atrial fibrillation. A 24 hour Holter is obtained which reveals 24 hours of continuous AF.
9 Case Presentation #1 Was this patient s AF ablation successful? A. No B. Yes C. Not sure
10 Case Presentation #1 Should the EP Give the Bottle of Wine Back to the Patient? A. Yes B. No C. Not sure
11 Case Presentation #2 65 year old man with symptomatic paroxysmal AF undergoes AF ablation at Center X. 8 months later he is seen in follow-up. He tells his MD he feels great and has had no atrial fibrillation. A 12 lead ECG is obtained and reveals atrial flutter with a controlled ventricular response. A 24 hour Holter is obtained which reveals 24 hours of continuous atrial flutter.
12 Case Presentation #2 Was this patient s AF ablation successful? A. Yes B. No C. Not sure
13 Case Presentation #3 69 year old man with symptomatic persistent AF undergoes AF ablation at Center Y. 6 months later he has recurrent AF. He is started on amiodarone and cardioverted. 4 months later he has recurrent AF and undergoes a second ablation procedure. Amiodarone is continued. 2 months later he has recurrent AF and is cardioverted. He remains on amiodarone. 5 months later he has recurrent AF and is cardioverted. A month later he is seen in follow-up and he is in sinus rhythm. He tells you he feels great.
14 Case Presentation #3 Was this patient s AF ablation successful? A. Yes B. No C. Not sure
15 Case Presentation #4 58 year old man with symptomatic paroxysmal AF undergoes AF ablation at Center Z. 8 months later he is seen in follow-up. He tells his MD he feels great and has had no atrial fibrillation. A 12 lead ECG is obtained and reveals sinus rhythm. At 12 months follow-up he remains asymptomatic. An ECG shows sinus rhythm. And a 7 day continuous Holter shows no atrial fibrillation.
16 Case Presentation #4 Was this patient s AF ablation successful? A. Yes B. No C. Not sure
17 Outline Case presentations HRS Consensus Document Review What has the impact of the document been? Are we better off today than we were in 2006? Be careful what you ask for.
18 Heart Rhythm, EuroPace, JICE March 1, 2012
19 2012 HRS/ EHRA/ ECAS EXPERT CONSENSUS STATEMENT ON CATHETER AND SURGICAL ABLATION OF ATRIAL FIBRILLATION Comprehensive state of the art review of the field of catheter and surgical ablation of atrial fibrillation Reports the findings of a Task Force convened by HRS, EHRA, and ECAS charged with defining the indications, techniques, and outcomes of these procedures This document also makes recommendations concerning research trial design and definitions for use in clinical trials and in the reporting of outcomes of AF ablation Written as a joint partnership between HRS, EHRA and ECAS Written in Collaboration with / endorsed by APHRS, AHA, ACC, STS 47 authors, 86 pages, 3 figures, 6 tables, 736 references
20 HRS/ EHRA/ ECAS EXPERT CONSENSUS STATEMENT ON CATHETER AND SURGICAL ABLATION OFATRIAL FIBRILLATION The Process Fall 2010: Initiative launched Jan and February 2011: Section writing groups prepared first drafts March and April: weekly conference calls and frequent surveys May: meeting at HRS to review second draft June, July, and August: document edited, additional surveys September: Final draft approved by writing committee Oct and November: peer review by HRS, EHRA, and ECAS November 2011: > 300 reviewer comments received, doc revised December 2011: Final Document sent out for Endorsement December 2011: Final Document endorsed by HRS, EHRA, & ECAS December 2011: Document sent to APHRS, STS, AHA, and ACC March : Date of publication on line
21 HRS/ EHRA/ ECAS EXPERT CONSENSUS STATEMENT ON CATHETER AND SURGICAL ABLATION OF ATRIAL FIBRILLATION 11 SECTIONS AF Definitions, Mechanisms, and Rationale for Ablation Indications for Catheter and Surgical Ablation of Atrial Fibrillation Techniques and endpoints for AF ablation Technologies and tools Other technical aspects; anticoag, anesthesia, esoph monitoring Follow-up considerations Outcomes and efficacy of AF ablation Complications Training requirements and competencies Surgical ablation of AF Clinical trial considerations and definitions
22 HRS/ EHRA/ ECAS EXPERT CONSENSUS STATEMENT ON CATHETER AND SURGICAL ABLATION OF ATRIAL FIBRILLATION 11 SECTIONS AF Definitions, Mechanisms, and Rationale for Ablation Indications for Catheter and Surgical Ablation of Atrial Fibrillation Techniques and endpoints for AF ablation Technologies and tools Other technical aspects; anticoag, anesthesia, esoph monitoring Follow-up considerations Outcomes and efficacy of AF ablation Complications Training requirements and competencies Surgical ablation of AF Clinical trial considerations and definitions
23 AF Definitions, Mechanisms, and Rationale for Ablation
24 Definitions and Clinical Trial Considerations
25 Definitions of Success
26 Definitions of Recurrent AF
27 Other Endpoint Definitions
28 Documentation Recommendations
29 Minimum Effectiveness Recommendations
30 Outline Case presentations HRS Consensus Document Review What has the impact of the document been? Are we better off today than we were in 2006? Be careful what you ask for.
31 What Has the Impact of the Document Been? The recommendations have been accepted worldwide and provide a common language. The FDA requires that outcomes be reported in this way. AF ablation success rates have fallen from a 90% range to the current 60-80% range. The issues of late recurrence have been uncovered and cure has vanished from our terminology. I believe we are better off today than we were in Do You?
32 Outline Case presentations HRS Consensus Document Review What has the impact of the document been? What would you suggest? Conclusion
33 What Would You Suggest? Increase 30 seconds to what? 10 minutes, 2 hours, 2 days? 1 year? Use AF burden as the endpoint. How do you plan to measure AF burden? Consider asymptomatic AF a success? Switch to a quality of life endpoint? Require hard endpoints for AF ablation like stroke and death?
34 What Would You Suggest? Increase 30 seconds to what? 10 minutes, 2 hours, 2 days? 1 year On what basis? Use AF burden as the endpoint. How do you plan to measure AF burden? Does everyone get a Linq? Consider asymptomatic AF a success? Really? Switch to a quality of life endpoint? How are you going to correct for the placebo affect? Require hard endpoints for AF ablation like stroke and death? Have you followed the state of the CABANA trial? Sometimes perfect is the enemy of good.
35 Conclusions The 30 second definition of success of AF ablation is now well established and widely accepted. I believe it is here to stay. The HRS Consensus document allows for an unlimited number of additional clinically relevant definitions of success that can be prospectively specified when a trial is launched. Our field has been advanced significantly as a result of the 30 second definition. Although it is easy to throw stones and complain about the non clinical relevant definition of success, I would ask you what would be better?
36 I Have Only One Request At The End of This Debate Ask Yourself One Question Has the field of AF ablation been moved forward by the 2007 and 2012 HRS Consensus Documents, Which Established a Level Playing Field and Common Language We Can Use to Compare AF Ablation Techniques and Technologies?
37 Thank You
Atrial Fibrillation Ablation: in Whom and How
Update on Consensus Statement on Management of Atrial Fibrillation: EHRA 2012 Atrial Fibrillation Ablation: in Whom and How Update of HRS/EHRA AF/ECAS Ablation Document 2012 Anne M Gillis MD FHRS Professor
Does AF Ablation Lower Stroke Risk? Hugh Calkins MD Professor of Medicine Director of Electrophysiology Johns Hopkins Medical Institutions
Does AF Ablation Lower Stroke Risk? Hugh Calkins MD Professor of Medicine Director of Electrophysiology Johns Hopkins Medical Institutions Relationships! Consultant: Medtronic, St Jude, Atricure, Boherringer
EP WIRE on Management Preexcitation syndromes
EP WIRE on Management Preexcitation syndromes 1. Is your Institution: A University Hospital 70.7% 41 A Private Hospital 13.8% 8 Other Type of Hospital 15.5% 9 Institution name: 50 answered question 58
What s New in the Guidelines for Surgical Ablation for Atrial Fibrillation?
What s New in the Guidelines for Surgical Ablation for Atrial Fibrillation? Vinay Badhwar, MD Gordon F. Murray Professor and Chairman Department of Cardiovascular & Thoracic Surgery West Virginia University
20% 10/9/2018. Fluoroless Ablation relinquishing an old habit. Prevalence of Atrial Fibrillation. Atrial Fibrillation is a Progressive Disease
Fluoroless Ablation relinquishing an old habit Robert Percell, MD, FACC Cardiac Electrophysiologist, Bryan Heart Institute Lincoln, NE Prevalence of Atrial Fibrillation 3.1 Million + 1 Million by 2020
Jay Simonson, MD, FACC, FHRS Medical Director, Cardiac Electrophysiology Park Nicollet Heart and Vascular Center
Jay Simonson, MD, FACC, FHRS Medical Director, Cardiac Electrophysiology Park Nicollet Heart and Vascular Center A-Fib Facts Yes, you may be able to blame your parents It is more of a nuisance than a
La terapia non anticoagulante nel paziente con FA secondo le Linee Guida F. CONROTTO
La terapia non anticoagulante nel paziente con FA secondo le Linee Guida F. CONROTTO Rhythm or rate control strategy? N Engl J Med 2002;347:1834 40 Rate Control versus Electrical Cardioversion for Persistent
PVI and What Else for Persistent AF Lessons Learned from STAR AF 2 CCCEP 2015 October 31, New York
PVI and What Else for Persistent AF Lessons Learned from STAR AF 2 CCCEP 2015 October 31, New York Atul Verma, MD FRCPC FHRS Director, Arrhythmia Services Southlake Regional Health Centre Faculty of Medicine
Recent observations have focused attention on the PVs as a source of ectopic activity i determining i AF
Atrial Fibrillation in 2010 Panos Vardas Professor of Cardiology President of EHRA Atrial Fibrillation Pathophysiology of AF Triggers Recent observations have focused attention on the PVs as a source of
Atrial Fibrillation: Rate vs. Rhythm. Michael Curley, MD Cardiac Electrophysiology
Atrial Fibrillation: Rate vs. Rhythm Michael Curley, MD Cardiac Electrophysiology I have no relevant financial disclosures pertaining to this topic. A Fib Epidemiology #1 Most common heart rhythm disturbance
AATS STARS Meeting Miami Beach November 17, 2017
The New Surgical The Heart Ablation Hospital Guidelines AATS STARS Meeting Miami Beach November 17, 2017 The Heart Hospital Baylor Plano Plano, Texas James R. Edgerton, MD, FACS, FACC, FHRS Surgical Director
Debate PRO. Dronedarone is an important drug in the management of paroxysmal atrial fibrillation. John Camm
ESC ICM - Internationales Congress Center München 2012 Atrial Fibrillation Controversies in Medical Treatment Debate Dronedarone is an important drug in the management of paroxysmal atrial fibrillation
A Cryo Anatomical Procedure to Everyone? Saverio Iacopino, FACC, FESC
A Cryo Anatomical Procedure to Everyone? Saverio Iacopino, FACC, FESC AF Clinical/Referral Challenge Asymptomatic 40% 3 Rx Effective 30% Failed Rx Ablation Atrial fibrillation (AF) is the most common Candidate
Topic: Outpatient Cardiac Telemetry Date of Origin: April Section: Medicine Last Reviewed Date: December 2014
Medical Policy Manual Topic: Outpatient Cardiac Telemetry Date of Origin: April 2010 Section: Medicine Last Reviewed Date: December 2014 Policy No: 135 Effective Date: February 1, 2014 IMPORTANT REMINDER
Make the Connection A clinical compendium on the relationship between AF, stroke, and early intervention
Make the Connection A clinical compendium on the relationship between AF, stroke, and early intervention Data that date back to the 1970 s have illustrated the strong relationship between atrial fibrillation
Ablation Should Not Be Used as Primary Therapy for Treatment of Patients with Atrial Fibrillation
Ablation Should Not Be Used as Primary Therapy for Treatment of Patients with Atrial Fibrillation 25 October 2008 Update in Electrocardiography and Arrhythmias Zian H. Tseng, M.D., M.A.S. Assistant Professor
Minimally Invasive Stand Alone Cox-Maze Procedure For Patients With Non-Paroxysmal Atrial Fibrillation
Minimally Invasive Stand Alone Cox-Maze Procedure For Patients With Non-Paroxysmal Atrial Fibrillation Niv Ad, MD Chief, Cardiac Surgery Inova Heart and Vascular Institute Disclosures Niv Ad: Medtronic
Atrial fibrillation: Who should be referred for ablation therapy for atrial fibrillation?. September 12 th, 2015
Atrial fibrillation: Who should be referred for ablation therapy for atrial fibrillation?. September 12 th, 2015 MMMMMMM MMMMMMM MMMMMMM Sohail Hassan MD FACC, FHRS Director, Cardiac Electrophysiology
ESC Stockholm Arrhythmias & pacing
ESC Stockholm 2010 Take Home Messages for Practitioners Arrhythmias & pacing Prof. Panos E. Vardas Professor of Cardiology Heraklion University Hospital Crete, Greece Disclosures Small teaching fees from
Contemporary Strategies for Catheter Ablation of Atrial Fibrillation
Contemporary Strategies for Catheter Ablation of Atrial Fibrillation Suneet Mittal, MD Director, Electrophysiology Medical Director, Snyder Center for Atrial Fibrillation The Arrhythmia Institute at The
2017 HRS/EHRA/ECAS/APHRS/SOLAECE Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation
Summary of Expert Consensus Statement for CLINICIANS 2017 HRS/EHRA/ECAS/APHRS/SOLAECE Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation This is a summary of the Heart
AF Ablation in 2015 Why, Who, What and How? Steve Wilton ACC Rockies, Banff March 10, 2015
AF Ablation in 2015 Why, Who, What and How? Steve Wilton ACC Rockies, Banff March 10, 2015 Disclosures Research grant: St. Jude medical Speaking: Boehringer-Ingelheim Consulting: Arca Biopharma Learning
EHRA Position Documents on new technology or standards of care
EHRA Position Documents on new technology or standards of care Prof. Laurent Fauchier Cardiologie, Centre Hospitalier Universitaire Trousseau Tours, France Disclosures Laurent Fauchier: Lecture fees: Bayer,
Consensus document: Screening and Prevention of Atrial Fibrillation
Consensus document: Screening and Prevention of Atrial Fibrillation Yong-Seog Oh, M.D.,Ph.D. Division of Cardiology, Department of Internal Medicine, Seoul St. Mary s Hospital, College of Medicine, The
Rate Control: What is the Goal and How to Achieve It? Steve Greer, MD, FHRS, FACC BHHI Primary Care Symposium February 28, 2014
Rate Control: What is the Goal and How to Achieve It? Steve Greer, MD, FHRS, FACC BHHI Primary Care Symposium February 28, 2014 Financial Disclosures Boerhinger Ingelheim Research Support Boston Scientific
What s new in my specialty?
What s new in my specialty? Jon Melman, MD Heart Rhythm Specialists McKay-Dee Hospital some would say some would say my specialty 1 some would say my specialty First pacemaker 1958 some would say my specialty
AF#in#pa(ents#with#CAD# Is#dronedarone#a#good#choice?!
AF#in#pa(ents#with#CAD# Is#dronedarone#a#good#choice?! DRUG#PROPHYLAXIS#OF#AF:# FOCUS#ON#DRONEDARONE# Friday#16C10C2015# Harry%JGM%Crijns% Maastricht,%The%Netherlands% Disclosures Harry Crijns - research
How Do I Balance Bradycardia with Rate Control in Atrial Fibrillation?
How Do I Balance Bradycardia with Rate Control in Atrial Fibrillation? Thang Nguyen MD FRCPC Assistant Professor Section of Cardiology Department of Internal Medicine University of Manitoba Objectives
Long-Term Outcome and Risks of Catheter Ablation for Atrial Fibrillation
Long-Term Outcome and Risks of Catheter Ablation for Atrial Fibrillation Carlo Pappone, MD, PhD, FACC EP Director, Villa Maria Hospital Group How many times AF can increase mortality DO MORTALITY REALLY
Treatment of Atrial Fibrillation in Heart Failure
Stockholm, September 1st 2010 Treatment of Atrial Fibrillation in Heart Failure Rhythm control: Which drugs? Stefan H. Hohnloser J.W. Goethe University Frankfurt, Germany Presenter disclosure information:
Implantable Cardiac Monitors for Atrial Fibrillation (AF) Detection: Ready for Routine Use?
Implantable Cardiac Monitors for Atrial Fibrillation (AF) Detection: Ready for Routine Use? Helmut Pürerfellner, MD, Assoc. Prof. Saint Elisabeth s Sisters Hospital Academic Teaching Center Linz/Austria
Can Catheter Ablation of AF Reduce the Risk of Stroke? CCCEP 2015 October 31, 2015
Can Catheter Ablation of AF Reduce the Risk of Stroke? CCCEP 2015 October 31, 2015 Atul Verma, MD FRCPC FHRS Director, Heart Rhythm Program Southlake Regional Health Centre Newmarket, Ontario, Canada Chair,
Catheter Ablation for Treatment of Atrial Fibrillation 2010 and Beyond
Catheter Ablation for Treatment of Atrial Fibrillation 2010 and Beyond John M. Miller, MD Professor of Medicine Indiana University School of Medicine Director, Clinical Cardiac Electrophysiology Krannert
Atrial Fibrillation and Heart Failure
Date Clinical Title Atrial Fibrillation and Heart Failure Raul Weiss MD, FAHA, FACC, FHRS and CCDS Director, Electrophysiology Fellowship Program Professor of Medicine The Ohio State University Wexner
National Heart Foundation of Australia consensus statement on catheter ablation as a therapy for atrial fibrillation
University of Wollongong Research Online Faculty of Science, Medicine and Health - Papers Faculty of Science, Medicine and Health 2013 National Heart Foundation of Australia consensus statement on catheter
Atrial Fibrillation Ablation Recent Clinical Trials That Changed (or not) My Practice
Atrial Fibrillation Ablation Recent Clinical Trials That Changed (or not) My Practice Walid Saliba, MD, FHRS Director, Atrial Fibrillation Center Director EP laboratory Heart and Vascular Institute Cleveland
AF and arrhythmia management. Dr Rhys Beynon Consultant Cardiologist and Electrophysiologist University Hospital of North Staffordshire
AF and arrhythmia management Dr Rhys Beynon Consultant Cardiologist and Electrophysiologist University Hospital of North Staffordshire Atrial fibrillation Paroxysmal AF recurrent AF (>2 episodes) that
National Horizon Scanning Centre. Dronedarone (Multaq) for atrial fibrillation and atrial flutter. December 2007
Dronedarone (Multaq) for atrial fibrillation and atrial flutter December 2007 This technology summary is based on information available at the time of research and a limited literature search. It is not
Can the UK afford ablation for persistent AF? cost efficacy analysis. Dr Derick Todd Liverpool Heart & Chest Hospital
Can the UK afford ablation for persistent AF? cost efficacy analysis Dr Derick Todd Liverpool Heart & Chest Hospital Conflicts of Interest Speaker fees / Consultancy / Travel support: Bayer Boehringer
8/16/2016. Disclosures. Is Uninterrupted OAC Standard of Care for AF Ablation? CHRS 2016, San Francisco. Risk of Stroke Peri-Ablation
Disclosures Is Uninterrupted OAC Standard of Care for AF Ablation? CHRS 2016, San Francisco Atul Verma, MD FRCPC FHRS Director, Heart Rhythm Program Southlake Regional Health Centre Newmarket, Ontario,
Atrial Fibrillation and Heart Failure: Rate vs. Rhythm Control Time for Re-evaluation
Atrial Fibrillation and Heart Failure: Rate vs. Rhythm Control Time for Re-evaluation ANIL K. BHANDARI, M.D, Director, Electrophysiology and EPS Fellowship Program Good Samaritan Hospital/ Harbor UCLA
Post-ablation Management: Drug therapy, Anticoagulation and long-term Monitoring
Catheter Ablation of Atrial Fibrillation: State of the Art Post-ablation Management: Drug therapy, Anticoagulation and long-term Monitoring Dipen Shah Service de Cardiologie Hospital Cantonal de Genève
Biatrial Maze or PVI to Ablate Afib? Marc Gillinov, MD
Biatrial Maze or PVI to Ablate Afib? Marc Gillinov, MD Disclosures Consultant/Speaker AtriCure Medtronic CryoLife Edwards Abbott Research Funding Abbott Equity Interest Clear Catheter Cleveland Clinic
» A new drug s trial
» A new drug s trial A placebo-controlled, double-blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular Hospitalization or death from any cause
Catheter ABlation vs ANtiarrhythmic Drug Therapy in Atrial Fibrillation (CABANA) Trial
Catheter ABlation vs ANtiarrhythmic Drug Therapy in Atrial Fibrillation (CABANA) Trial Douglas L. Packer MD, Kerry L. Lee PhD, Daniel B. Mark MD, MPH, Richard A. Robb PhD for the CABANA Investigators Mayo
Rebuttal. Jerónimo Farré MD 2010
Rebuttal 1.We do not know what are the types of AF in which ablation is worthless or most effective 2.Waiting implies to consider the ablation at an older age and when the duration of the history of AF
Gianluca Botto MD, FESC, FEHRA
Gianluca Botto MD, FESC, FEHRA Electrophysiology Unit Sant Anna Hospital Como, Italy Antiarrhythmic drugs in AF Still a challenge When And How To Apply Rate Control Therapy AFIB ESC/EACTS/EHRA GLs 2016
AF ABLATION Concepts and Techniques
AF ABLATION Concepts and Techniques Antony F Chu, M.D. Director of Complex Ablation Arrhythmia Services Section Division of Cardiology at the Rhode Island and Miriam Hospital HIGHLIGHTS The main indications
The RealiseAF registry:
The RealiseAF registry: An International, observational, cross-sectional survey evaluating atrial fibrillation management and the cardiovascular risk profile of AF patients initial results PG.Steg on behalf
ARCA biopharma. Investment Community Webcast: Top-line Data from GENETIC-AF Phase 2B Clinical Trial
ARCA biopharma Investment Community Webcast: Top-line Data from GENETIC-AF Phase 2B Clinical Trial February 26, 2018 Safe Harbor Statement This presentation contains "forward-looking statements" for purposes
WPW in Athletes Should we treat all? age? RAMI FOGELMAN SCHNEIDER CHILDREN MEDICAL CENTER OF ISRAEL
WPW in Athletes Should we treat all? age? RAMI FOGELMAN SCHNEIDER CHILDREN MEDICAL CENTER OF ISRAEL W.P.W Clues in sinus rhythm No Q in Lt chest leads (WPW 88%, control 5%) PR < 100msec (WPW 80%, control
Dronedarone for the treatment of atrial fibrillation and atrial flutter
National Institute for Health and Clinical Excellence Dronedarone for the treatment of atrial fibrillation and atrial flutter Comment 1: the draft remit Appropriateness Sanofi-aventis Sanofi-aventis believe
Why to monitor AF ablation success?
Why to monitor AF ablation success? Why to monitor AF ablation success? CASTLE-AF Primary Endpoint All-cause mortality Worsening heart failure admissions Secondary Endpoints All-cause mortality Worsening
SUBCLINICAL ATRIAL FIBRILLATION IN PATIENTS WITH IMPLANTABLE DEVICEs ORAL ANTICOAGULANT THERAPY: TO GIVE OR NOT TO GIVE, THIS IS THE PROBLEM!!
SUBCLINICAL ATRIAL FIBRILLATION IN PATIENTS WITH IMPLANTABLE DEVICEs ORAL ANTICOAGULANT THERAPY: TO GIVE OR NOT TO GIVE, THIS IS THE PROBLEM!! Atrial tachycardia «ATRIAL HIGH RATES EPISODES» (AHREs) Episodes
Causal relationship between AF & stroke
7 AP-HRS Scientific Session, New Dehli, India - Oct 29 to Nov 1, 2014 Causal relationship between AF & stroke Antonio Raviele, MD, FESC, FHRS President ALFA Alliance to Fight Atrial fibrillation - Venice,
Dysrhythmias 11/7/2017. Disclosures. 3 reasons to evaluate and treat dysrhythmias. None. Eliminate symptoms and improve hemodynamics
Dysrhythmias CYDNEY STEWART MD, FACC NOVEMBER 3, 2017 Disclosures None 3 reasons to evaluate and treat dysrhythmias Eliminate symptoms and improve hemodynamics Prevent imminent death/hemodynamic compromise
Should hybrid ablation be the standard of care instead of transcatheter ablation techniques?
Should hybrid ablation be the standard of care instead of transcatheter ablation techniques? Christian Shults, MD Assistant Professor, Georgetown University School of Medicine Cardiac Surgeon, Medstar
Management of atrial fibrillation in heart failure
Nationale hartfalendag 2017 Zeist Management of atrial fibrillation in heart failure Isabelle C Van Gelder University of Groningen University Medical Center Groningen The Netherlands Disclosures Grant
Debate-STAR AF 2 study. PVI is not enough
Debate-STAR AF 2 study PVI is not enough Debate about STAR AF 2 trial STAR AF trial Substrate and Trigger Ablation for Reduction of Atrial Fibrillation EHJ 2010 STAR-AF 2 trial One Size Fits All? PVI is
The EP Perspective: Should We Do Hybrid Ablation, and Who Should We Do It On?
The EP Perspective: Should We Do Hybrid Ablation, and Who Should We Do It On? L. Pison, MD PhD FESC AATS Surgical Treatment of Arrhythmias and Rhythm Disorders November 17-18, 2017 Miami Beach, FL, USA
AF Today: W. For the majority of patients with atrial. are the Options? Chris Case
AF Today: W hat are the Options? Management strategies for patients with atrial fibrillation should depend on the individual patient. Treatment with medications seems adequate for most patients with atrial
CASE STUDY: THE CLINICAL BENEFIT OF MOBILE CARDIAC OUTPATIENT TELEMETRY. June 22, 2009
CASE STUDY: THE CLINICAL BENEFIT OF MOBILE CARDIAC OUTPATIENT TELEMETRY June 22, 2009 Sanjeev Wasson, MD, FACC, Medical Director, Department of Electrophysiology Skagit Valley Medical Center and Skagit
How Should we Select Patients for Catheter Ablation? Douglas Esberg, MD, FHRS
How Should we Select Patients for Catheter Ablation? Douglas Esberg, MD, FHRS November 2, 2018 2 3 4 5 Atrial Flutter Typical isthmus dependent flutter Success rate ~95% Complications 1% (mostly groin
ATRIAL FIBRILLATION: REVISITING CONTROVERSIES IN AN ERA OF INNOVATION
ATRIAL FIBRILLATION: REVISITING CONTROVERSIES IN AN ERA OF INNOVATION Frederick Schaller, DO, MACOI,FACP Adjunct Clinical Professor Touro University Nevada DISCLOSURES I have no financial relationships
Antiarrhythmics for Atrial Fibrillation: Practical Implications of Latest Clinical Developments CME
Antiarrhythmics for Atrial Fibrillation: Practical Implications of Latest Clinical Developments CME A. John Camm, MD; Stuart J. Connolly, MD; Jean-Yves F. Le Heuzey, MD CME Released: 12/08/2011; Valid
Catheter Ablation of Arrhythmias: Are the Results Different in the Elderly Patients?
Catheter Ablation of Arrhythmias: Are the Results Different in the Elderly Patients? Eleftherios M. Kallergis MD, PhD, FESC Cardiology Department Heraklion University Hospital 8th IICE Thessaloniki 2015
SUPPLEMENTARY INFORMATION
Table S1 Sex- specific differences in rate- control and rhythm- control strategies in observational studies Study region Study period Total sample size Sex- specific results Ozcan (2001) 1 Mayo Clinic,
ICD THERAPIES: are they harmful or just high risk markers?
ICD THERAPIES: are they harmful or just high risk markers? Konstantinos P. Letsas, MD, PhD, FESC LAB OF CARDIAC ELECTROPHYSIOLOGY EVANGELISMOS GENERAL HOSPITAL ATHENS ICD therapies are common In a meta-analysis
When does enhanced monitoring for atrial fibrillation add value?
When does enhanced monitoring for atrial fibrillation add value? Jonathan P. Piccini, MD, MHS, FHRS Associate Professor of Medicine Duke Clinical Research Institute Duke University Medical Center jonathan.piccini@duke.edu
Planning study for minimally invasive cardiac arrhythmias ablation with intensity modulation proton therapy Vennarini Sabina
Planning study for minimally invasive cardiac arrhythmias ablation with intensity modulation proton therapy Vennarini Sabina (sabina.vennarini@apss.tn.it) Introduction Atrial Fibrillation (AF): most common
Dipen Shah Cardiology Service, University Hospitals, Geneva Switzerland
Dipen Shah Cardiology Service, University Hospitals, Geneva Switzerland Disclosures Research Grants: Biosense Webster, St. Jude, Bard, Endosense, Biotronik Speakers Honoraria: Biosense Webster, Endosense,
EHRA Accreditation Exam - Sample MCQs Cardiac Pacing and ICDs
EHRA Accreditation Exam - Sample MCQs Cardiac Pacing and ICDs Dear EHRA Member, Dear Colleague, As you know, the EHRA Accreditation Process is becoming increasingly recognised as an important step for
Are Drugs Better? Dr Mauro Lencioni. Drugs or ablation as first line treatment for AF? Consultant Cardiologist & Electrophysiologist
Are Drugs Better? Drugs or ablation as first line treatment for AF? Dr Mauro Lencioni Consultant Cardiologist & Electrophysiologist The Philosophical Issue What do we mean by Better? Outcome measures Measurement
Atrial Fibrillation Community of Practice Audioconference November 14, 2012
Atrial Fibrillation Community of Practice Audioconference November 14, 2012 MODERATOR: Welcome to the Community of Practice interactive clinical discussion in atrial fibrillation management with faculty
Indicatie voor ablatie bij voorkamerfibrillatie. Andrea Sarkozy Cardiologie Universitair Ziekenhuis Antwerpen
Indicatie voor ablatie bij voorkamerfibrillatie Andrea Sarkozy Cardiologie Universitair Ziekenhuis Antwerpen Definition and Classification of AF - Practical aspects Classification of AF Paroxysmal, persistent,
There are future perspectives in the pharmacological treatment of arrhythmias
There are future perspectives in the pharmacological treatment of arrhythmias George Andrikopoulos, MD, PhD, FESC, Cardiologist, Director, 1st Department of Cardiology/ Department of Electrophysiology
Management of Atrial Fibrillation in the Hospitalized Patient
Management of Atrial Fibrillation in the Hospitalized Patient Gregory M Marcus, MD, MAS Associate Professor of Medicine Division of Cardiology University of California, San Francisco Disclosures Research:
Original. Key words : atrial fibrillation, pulmonary vein isolation, external loop recorder. Introduction
Showa Univ J Med Sci 26 2, 109 119, June 2014 Original Recurrence of Atrial Fibrillation within Three Months after Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation : Analysis Using
Surgical Ablation for Lone AF: What have we learned after 30 years?
Surgical Ablation for Lone AF: What have we learned after 30 years? Ralph J. Damiano, Jr., MD Evarts A. Graham Professor of Surgery Chief of Cardiothoracic Surgery Vice Chairman, Department of Surgery
Half Moon Bay Treatment of Atrial Fibrillation. Dr. Roger A. Winkle MD. Silicon Valley Cardiology, PAMF, Sutter Health Sequoia Hospital
Half Moon Bay 2018 Treatment of Atrial Fibrillation Dr. Roger A. Winkle MD Silicon Valley Cardiology, PAMF, Sutter Health Sequoia Hospital Disclosures: Investor Farapulse Things a Primary Care Doctor Should
2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process
Quality ID #326 (NQF 1525): Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS F INDIVIDUAL MEASURES: REGISTRY
AF in the ER: Common Scenarios CASE 1. Fast facts. Diagnosis. Management
AF in the ER: Common Scenarios Atrial fibrillation is a common problem with a wide spectrum of presentations. Below are five common emergency room scenarios and the management strategies for each. Evan
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE SCOPE. Clinical guideline for the management of atrial fibrillation
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE 1 Guideline title SCOPE Clinical guideline for the management of atrial fibrillation 1.1 Short title Atrial fibrillation 2 Background a) The National Institute
Combined catheter ablation and left atrial appendage closure as a. treatment of atrial fibrillation
Combined catheter ablation and left atrial appendage closure as a hybrid procedure for the treatment of atrial fibrillation Giulio Molon, MD FACC, FESC, Fellow ANMCO Card Dept, S.Cuore hospital Negrar
Causal relationship between AF & stroke
7 AP-HRS Scientific Session, New Dehli, India - Oct 29 to Nov 1, 2014 Causal relationship between AF & stroke Antonio Raviele, MD, FESC, FHRS President ALFA Alliance to Fight Atrial fibrillation - Venice,
Treating Atrial Fibrillation. Richard Schilling. St Bartholomew's Hospital, Queen Mary s University of London
Treating Atrial Fibrillation Richard Schilling St Bartholomew's Hospital, Queen Mary s University of London AF burden Framingham Lifetime risk of developing AF = 25% Mortality: SMR =1.9 1.5 NHS audit 1%
Is cardioversion old hat? What is new in interventional treatment of AF symptoms?
Is cardioversion old hat? What is new in interventional treatment of AF symptoms? Joseph de Bono Consultant Electrophysiologist University Hospitals Birmingham Atrial Fibrillation (AF) Affects 2% of the
Long-Term ECG Monitoring Using an ILR. Evgeny Pokushalov, MD, PhD
Long-Term ECG Monitoring Using an ILR Evgeny Pokushalov, MD, PhD Long- Term ECG Monitoring Using an ILR Evgeny Pokushalov, MD, PhD, FESC State Research Ins;tute of Circula;on Pathology, Novosibirsk, Russia
Modifiable Up-Stream Risk Factors:
Modifiable Up-Stream Risk Factors: Recent Studies in AF Prevention Behzad Pavri, MD, FACC, FHRS Professor of Medicine Director, CCEP Fellowship Thomas Jefferson University Hospital, Philadelphia, USA Disclosures
Surgical Ablation of Atrial Fibrillation. Gregory D. Rushing, MD. Assistant Professor, Division of Cardiac Surgery
Surgical Ablation of Atrial Fibrillation Gregory D. Rushing, MD Assistant Professor, Division of Cardiac Surgery Midwestern Conference on Optimizing Electrophysiology Patient Care and Procedural Success
ABLATION OF CHRONIC AF
ABLATION OF CHRONIC AF A PISAPIA ST JOSEPH HOSPITAL MARSEILLE MEET 2008 Atrial Fibrillation The most common significant heart rhythm disturbance Incidence increases with age and the development of structural
Rate or Rhythm Control? Epidemiology. Relevant Advances in Atrial Fibrillation 6/20/2011. Stroke Prophylaxis
Relevant Advances in Atrial Fibrillation Stroke Prophylaxis Managing Atrial Fibrillation: Tips for the Generalist Antiarrhythmic Drug Therapy Ablation Gregory M Marcus, MD, MAS Assistant Professor of Medicine
Special health. guide. Hugh Calkins, M.D., and Ronald Berger, M.D., Ph.D. Guide to Understanding. Atrial Fibrillation WITH
Hugh Calkins, M.D., and Ronald Berger, M.D., Ph.D. Guide to Understanding Atrial Fibrillation WITH Table of Contents Atrial Fibrillation: An Introduction... 1 How AF Affects the Heart... 2 Who Gets AF?...
Dronedarone: Need to Perform a CV Outcome Safety Study
Dronedarone: Need to Perform a CV Outcome Safety Study Gerald V. Naccarelli M.D. Consultant: Glaxo-Smith-Kline, Pfizer, Sanofi, Boehringer-Ingelheim, Daiichi-Sankyo, Bristol Myers Squibb, Otsuka, Janssen
Dronedarone For Atrial Fibrillation: Unbridled Enthusiasm Or Just Another Small Step Forward?
Dronedarone For Atrial Fibrillation: Unbridled Enthusiasm Or Just Another Small Step Forward? James A. Reiffel, M.D. Introduction In July 2009, the federal Food and Drug Administration (FDA) approved the
Arrhythmias and Heart Failure Dr Chris Lang Consultant Cardiologist and Electrophysiologist Royal Infirmary of Edinburgh
Arrhythmias and Heart Failure Dr Chris Lang Consultant Cardiologist and Electrophysiologist Royal Infirmary of Edinburgh Arrhythmias and Heart Failure Ventricular Supraventricular VT/VF Primary prevention
Intro to Science & Quality. Prepared for Emerging Faculty September 2014 Julia Chang, VP Science & Quality
Intro to Science & Quality Prepared for Emerging Faculty September 2014 Julia Chang, VP Science & Quality jchang@acc.org Science & Quality A division within the College ACC Science & Quality Education
Amiodarone Prescribing and Monitoring: Back to the Future
Amiodarone Prescribing and Monitoring: Back to the Future Subha L. Varahan, MD, FHRS, CCDS Electrophysiologist Oklahoma Heart Hospital Oklahoma City, OK Friday, February, 8 th, 2019 Iodinated benzofuran
Ablation of persistent AF Is it different than paroxysmal?
Ablation of persistent AF Is it different than paroxysmal? Steven J. Kalbfleisch, MD Medical Director Electrophysiology Laboratory Ohio State University Wexner Medical Center Ross Heart Hospital Columbus,
MANAGING ATRIAL FIBRILLATION: BEYOND ANTICOAGULATION December 9, 2017
MANAGING ATRIAL FIBRILLATION: BEYOND ANTICOAGULATION December 9, 2017 1 Faculty Disclosure Faculty: Peter Leong-Sit MSc, MD, FRCPC, FHRS Associate Professor, Western University Cardiologist, London Heart