10/10/19 Ablation for Atrial Fibrillation Disclosures Should all patients have ablation? Research NO! Medtronic Zoll Asian Health Symposium 2019 Boston Scientific Consulting Biotelemetry Byron K. Lee MD Professor of Medicine W ebb Reeves Endowed Chair in Arrhythmia Research Cook Medical Director of the EP Laboratory and Clinics Division of Cardiology University of California, San Francisco 1 2 Reasons why all patients SHOULD NOT have ablation Dr. B. Lee vs. Dr. R. Lee 5’8’’ 5’5’’ MD MD, PhD 70 publications 119 publications Bench press 200 lbs Bench press 120 lbs 3 4 1
10/10/19 Reason#1: Risk of Complications Reason#1: Risk of Complications Deshmukh et al. Circ 2013 Calkins et al. Heart Rhythm 2017 5 6 Reason#1: Risk of Complications Reason#1: Risk of Complications Deshmukh et al. Circ 2013 Deshmukh et al. Circ 2013 7 8 2
10/10/19 Reason#1: Risk of Complications Reason#1: Risk of Complications Romero et al. JCE 2019 Romero et al. JCE 2019 9 10 Reason#2: Can worsen atrial arrhythmias AF Ablation by Anatomic PV Isolation 76 yo M History of HTN AF every few weeks HR up to 100-110 Uncomfortable but still functional. Able to work Wanted to avoid taking drugs daily Pappone, et al. JACC 2003 11 12 3
10/10/19 Reason#2: Can worsen atrial arrhythmias Reason#2: Can worsen atrial arrhythmias 13 14 Reason#2: Can worsen atrial arrhythmias Reason #3: Cannot stop anticoagulation 15 16 4
10/10/19 Clots in Left Atrial Appendage Cause Embolic Clots can form in the left atrial appendage even Strokes after successful AF ablation 17 18 17 18 Reason # 4: Does not cure AF 20 19 20 5
10/10/19 Long Term Success After 1 Long Term Success After 1-3 ablations Ablation 21 22 Ouyang et al. Circulation 2010 Ouyang et al. Circulation 2010 21 22 Success Based on Type of Atrial Reason #5: Does not reduce CV outcomes Fibrillation Cappato et al. Circ Arrhythm Electrophysiol. 2010 23 24 6
10/10/19 Reason #5: Does not reduce CV outcomes Reason #5: Does not reduce CV outcomes Packer et al. JAMA 2019 Packer et al. JAMA 2019 25 26 5 Reasons….why all patients SHOULD NOT have ablation Risk of Complications Can worsen atrial arrhythmias Cannot stop anticoagulation Does not cure AF Does not reduce CV outcomes Packer et al. JAMA 2019 27 28 7
10/10/19 My True Feelings? 29 30 8
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