NO! Medtronic Zoll Asian Health Symposium 2019 Boston Scientific - - PDF document

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NO! Medtronic Zoll Asian Health Symposium 2019 Boston Scientific - - PDF document

Sep 19, 2023 271 likes •373 views

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

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SLIDE 1

10/10/19 1

Ablation for Atrial Fibrillation

Should all patients have ablation?

Byron K. Lee MD Professor of Medicine W ebb Reeves Endowed Chair in Arrhythmia Research Director of the EP Laboratory and Clinics Division of Cardiology University of California, San Francisco

NO!

Asian Health Symposium 2019

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Disclosures

šResearch

šMedtronic šZoll šBoston Scientific

šConsulting

šBiotelemetry šCook Medical

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  • Dr. B. Lee

vs.

  • Dr. R. Lee

š 5’5’’ š MD š 70 publications š Bench press 120 lbs š 5’8’’ š MD, PhD š 119 publications š Bench press 200 lbs

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Reasons why all patients SHOULD NOT have ablation

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SLIDE 2

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Reason#1: Risk of Complications

Deshmukh et al. Circ 2013

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Reason#1: Risk of Complications

Calkins et al. Heart Rhythm 2017

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Reason#1: Risk of Complications

Deshmukh et al. Circ 2013

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Reason#1: Risk of Complications

Deshmukh et al. Circ 2013

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SLIDE 3

10/10/19 3

Reason#1: Risk of Complications

Romero et al. JCE 2019

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Reason#1: Risk of Complications

Romero et al. JCE 2019

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Reason#2: Can worsen atrial arrhythmias

š 76 yo M š History of HTN š AF every few weeks š HR up to 100-110 š Uncomfortable but still

  • functional. Able to work

š Wanted to avoid taking drugs daily

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AF Ablation by Anatomic PV Isolation

Pappone, et al. JACC 2003

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SLIDE 4

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Reason#2: Can worsen atrial arrhythmias

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Reason#2: Can worsen atrial arrhythmias

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Reason#2: Can worsen atrial arrhythmias

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Reason #3: Cannot stop anticoagulation

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SLIDE 5

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Clots can form in the left atrial appendage even after successful AF ablation

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Clots in Left Atrial Appendage Cause Embolic Strokes

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Reason # 4: Does not cure AF

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SLIDE 6

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Long Term Success After 1 Ablation

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Ouyang et al. Circulation 2010

21 Long Term Success After 1-3 ablations

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Ouyang et al. Circulation 2010

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Cappato et al. Circ Arrhythm Electrophysiol. 2010

Success Based on Type of Atrial Fibrillation 23

Reason #5: Does not reduce CV outcomes

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SLIDE 7

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Reason #5: Does not reduce CV outcomes

Packer et al. JAMA 2019

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Reason #5: Does not reduce CV outcomes

Packer et al. JAMA 2019

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Packer et al. JAMA 2019

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5 Reasons….why all patients SHOULD NOT have ablation

šRisk of Complications šCan worsen atrial arrhythmias šCannot stop anticoagulation šDoes not cure AF šDoes not reduce CV outcomes

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SLIDE 8

10/10/19 8

My True Feelings?

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