Hello everyone, thanks all for coming at that time. My name is Stavros Moutantonakis, I'm an electrophysiologist at Lenox Hill Hospital Northwell Health, and it's my true pleasure today to welcome you in this special session on atrial fibrillation. Today we're going to be focusing on monitoring for atrial fibrillation, what do we do with the data, where the new technology has gotten us, so in the last few years there's really been an explosion in the ablative treatment of atrial fibrillation, and also talk about things that, you know, we can do much better on in terms of delivering this care to our entire community. I'm very pleased to be joined by truly powerful colleagues here, Ijeoma Ekura from Texas, as well as Kamala Tambarisa, and Christy Coleman. We're going to, each of us starts up on the topics I mentioned before and allow some time to reflect. So we would like to thank our sponsors for this nice dinner, Bioscience Webster, Boston Scientific and Medtronic. This is an accredited program, so if you want to claim your credits for today, please join at accscientificsession.org credit, and you must complete the evaluation form in order for you to claim your credits. This is an active participation session, so we encourage your participation, and that wouldn't be a special session without it, so please scan the QR code and be ready to answer a few questions. Okay, so have your phones ready. There's going to be a few questions in the beginning of the session that I'm going to present. We're not going to give you the answers right away. And then there's going to be a few talks, and allow us to reflect on those questions and go back to the questions at the end of the session. And hopefully, most of us will be in agreement on the topics that are going to be mentioned today. So without further ado, I'm going to come up with the first question. Okay? So I'm just reading it out loud. Pulse field ablation, so-called PFA, was recently introduced as a novel energy source for the ablative management of atrial fibrillation. PFA uses an electrical field with specific characteristics that selectively causes apoptosis to the cardiac myocytes. So that's a statement, that's an opening statement. So which of the following is true? B, PFA has improved the procedure efficiency of our AFib ablation and decreased the rate of procedure-related complications. B, PFA has truly changed ablation targets for paroxysmal and or persistent atrial fibrillation. C, PFA is superior in efficacy of the ablation of paroxysmal atrial fibrillation. D, PFA is superior in efficacy for the ablation of persistent atrial fibrillation. And E, PFA technology has truly changed the guidelines, the current guidelines, we have the 2023 guidelines for performing ablation as a first-line therapy for paroxysmal atrial fibrillation. So if you can please use your phones to vote, we'll give a few seconds. Which of those statements you see are correct? Okay. All right. Okay. So the answers are locked. So question number two, a pretty long stamp, but pretty much a 55-year-old, very active triathlete individual with hyperlipidemia and no other past medical history presents for initial evaluation of paroxysmal atrial fibrillation after a recent emergency room visit for atrial fibrillation with rapid ventricular response. Two hours after presenting to the emergency room, that's a classic scenario that we often see, he's self-converted. The patient does report intermittent palpitations with increased frequency of irregular heart rate that were not actually documented in his Apple Watch. He denies any stimulants, the blood work is unremarkable, his echocardiogram shows also pretty normal ventricular function with no chamber dilatation. The patient in the emergency room was initiated on anticoagulation with apixabem, 5 mL twice a day, and metoprolol 25 twice a day on discharge. And he presents today in sinus rhythm, reporting fatigue, intermittent fatigue, a lack of exertional ability. So a young, active patient with palpitations diagnosed with atrial fibrillation in a setting of an emergency room. So what would be, according to your practice, what would be your appropriate next step? A, discontinue apixabem, 5 mL twice a day, and continue metoprolol, and use his Apple Watch for atrial fibrillation burden. B, discontinue apixabem, 5 mL twice a day, continue metoprolol 25 times a day, and order an event recorder. C, continue anticoagulation with apixabem, continue metoprolol, prescribe flecainide for symptomatic paroxysmal atrial fibrillation. D, continue anticoagulation, schedule the patient for a lactative catheter ablation. And E, continue anticoagulation, discontinue the current therapy, and follow up with him to see if those episodes become more frequent. Kind of a wordy kind of answer, basically, do we continue treatment, do we escalate to antiarrhythmics, do we stop everything, do we refer for an ablation? Before starting the countdown, I'll stay a few more seconds to look at the options, and there we go. Young patient with paroxysmal symptomatic atrial fibrillation. It's a tough question, because I don't think any of them is wrong, but okay, excellent. Okay, moving on to our third question. 65-year-old man with history of hypertension, diabetes, obesity, and end-stage renal disease on dialysis presents with new onset atrial fibrillation, kind of the opposite of the patient we had before. He's got left ventricular hypertrophy, normal IAF, creatinine 1.9, BNP 120, and hemoglobin 1C 8.2. So quite a different clinical picture with quite a few core morbidities in this condition. Which of the following would be the most appropriate initial therapy? Warfarin, metoprolol and cardioversion, apixabam 5 mg twice a day, metoprolol and cardioversion, aspirin metoprolol TE and cardioversion, apixabam half the dose, 2.5 twice a day, metoprolol, cardioversion in four weeks, or apixabam full dose, 5 mg twice a day, metoprolol and cardioversion in four weeks? Quite a few core morbidities, new onset atrial fibrillation, end-stage renal disease. What would be your answer? Okay, we've logged our answers and let's move on to the last question. So you're evaluating referral patterns for catheter ablation at your institution. Data analysis reveals underutilization of this procedure among eligible Medicaid patients from predominantly minority communities, despite controlling for clinical factors. Your institution implements an intervention to address these disparities. At the 18-month follow-up, which outcome would most strongly indicate that you're doing a good job, that your intervention successfully addressed the underlying social determinants affecting access to advanced atrial fibrillation treatment? A, equal rates of catheter ablation procedure completion across all demographic groups after controlling for clinical indications. B, increased number of electrophysiology referrals from primary care physicians participating in underserved areas. C, reduction in time from initial EP consultation to ablation procedure for Medicaid patients. D, improved quality of life scores among minority patients with atrial fibrillation regardless of whether they received ablation. And E, decreased 30-day readmission rates following catheter ablation procedures in previously underserved populations. What would be the indicator that you're doing a good job in offering lifesaving therapy to patients? »» Okay, excellent. I think, we hope that these were provocative questions and hopefully after a little bit of discussion and presentation we'll be able to maybe conclude on the same treatment options.

Atrial Fibrillation

Pulse Field Ablation

Healthcare Disparities

Advanced Therapies

Professional Development