2015 AF Patient Conference Catheter Ablation Panel w/ Drs. Kowal, Natale, Marrouche & Narayan

http://www.stopafib.org To be notified when new conference videos are posted, or for the latest afib news, sign up at http://www.stopafib.org. 2015 Get in Rhythm. Stay in Rhythm.™ Atrial Fibrillation Patient Conference The Catheter Ablation Panel at the 2015 Get in Rhythm. Stay in Rhythm.™ National Atrial Fibrillation Patient Conference included the following presentations: Robert C. Kowal, MD, PhD, FHRS spoke about pulmonary vein isolation, radiofrequency and cryoablation, including: • Pulmonary vein isolation: how did this all come about? [4:30] • THERMOCOOL Study to treat paroxysmal AF [10:25] • Force-sensing RF catheters [13:06] • Rationale for balloon-based approaches [13:35] • GAP-AF study • Why cryo energy [16:25] • Cryoballoon ablation of PAF [17:45] • Durability of PVI with the cryoballoon [19:08] • GAP-AF trial vs. SUPIR Study (cryoballoon) • Complications [20:45] • RF (radiofrequency) vs. cryoablation Andrea Natale, MD, FHRS spoke about ablation of AF: beyond PVI, including: • What is a successful AF ablation program? [22:58] • Procedural success: key determinants [24:55] • PV triggers initiating AF [25:28] • Thoracic veins [25:36] • Left atrial substrate modification [26:00] • Beyond ostial PV isolation: PV antrum isolation [26:38] • ICE guided antrum identification [26:55] • Circular mapping [27:19] • CPVA: no verification of PV isolation means no isolation [28:10] • Isolation vs. no isolation direct comparison [28:35] • Antral triggers disclosed by isoproterenol challenge [29:04] • Empirical isolation of the PW [29:34] • Why isolate the PW between the PVs [29:38] • Isolation of the entire PW [30:07] • Ablation of symptomatic paroxysmal AF using novel contact force catheter: SMART-AF trial [30:29] • European study on antral isolation [31:00] • Mode of recurrence [32:30] • No PV antrum reconnection + no non-PV triggers on isoproterenol [32:58] • Non-paroxysmal AF [33:13] • Posterior wall isolation [33:17] • RCT of ablation techniques in LPAF [33:46] • Attention to triggers [35:30] • Age and non-PV triggers [37:03] • How do we trigger non-PV foci? [38:08] • Drugs and maneuvers used to disclose non-PV triggers [38:10] • Isoproterenol induced CS Tachycardia [38:56] • Adenosine induced AF [39:24] • Superior vena cava [39:40] • Empirical isolation of the SVC [39:46] • Vein of Marshall [41:51] • Coronary sinus ablation [42:37] • Ablation at inferior left atrial rotor (focal impulse and rotor modulation, FIRM) [47:03] • Hybrid approach [48:19] Nassir Marrouche, MD, FHRS spoke about how to use MRIs to better help AF patients, including: • Imaging atrial fibrotic tissue [54:22] • Predicting treatment outcomes [57:51] • DECAAF participating centers [58:15] • Classification system based on degree of atrial fibrosis [58:48] • Degree of atrial fibrosis predicts AF treatment success [59:09] • DECAAF studies [1:00:46] • Progression of fibrosis after treatment [1:05:09] • The role of ventricular fibrosis in predicting treatment outcome [1:08:18] • Isolated atrial myopathy [1:09:37] • Detection of ventricular disease using LGE-MRI [1:10:21] • PV triggers initiating AF [1:12:24] • Non-invasive imaging and non-invasive mapping: delineate targets – stratify prognosis [1:13:20] • Rotors and fibrosis [1:14:14] • Isolating and ablating fibrotic tissue [1:15:16] • Better outcome when ablating fibrotic tissue (DECAAF) [1:15:45] • DE-MRI guided catheter ablation of AF (DECAAF II) [1:16:07] Sanjiv M. Narayan, MD, PhD spoke about ablating rotors beyond pulmonary vein isolation, including: • Beyond PVI: FIRM ablation: What is ablation? Why do more than PVI? • Problems with standard ablation (PVI) [1:21:32] • Long-term Outcome [1:22:56] • What to ablate beyond PVI… [1:23:56] • Focal Impulse and Rotor Modulation (FIRM)• FIRM reveals rotor and focal sources: eliminating them can treat AF [1:29:54] • Ablation – what it looks like [1:32:10] • FIRM-guided ablation: single procedure [1:34:12] • Am I a candidate? How do I choose a procedure? [1:35:11] • FIRM ablation trials [1:37:08] Video watching time is approximately 115 minutes. Transcript: http://www.stopafib.org/newsitem.cfm/...