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VIDEO: AF treatment challenges persist

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SAN FRANCISCO — At the Heart Rhythm Society Annual Scientific Sessions, President John D. Day, MD, FHRS, discusses persistent challenges in the treatment of chronic atrial fibrillation, but he says “exciting” new research and technologies may result in change.

In this video exclusive, Day, director of the Heart Rhythm Specialist Group at Intermountain Healthcare in Salt Lake City, focuses on four late-breaking clinical trials conducted in patients with AF.

The AFACT trial evaluated the efficacy and safety of additional ganglionic plexus ablation in patients who were undergoing thoracoscopic surgery for advanced AF. “We’ve often thought that perhaps treating the autonomic nervous system may be a way to improve outcomes,” he said. According to results presented here, additional ganglionic plexus ablation did not provide improved rhythm outcomes and may cause complications.

Another late-breaking clinical trial examined rotor-only ablation and found that it was associated with poor outcome in patients with nonparoxysmal AF.

Day also discusses a study on the effect of left atrial appendage (LAA) exclusion in patients with persistent AF undergoing surgical ablation. “We’ve often thought that since the LAA can compromise such a large mass of tissue, particularly in these more advanced patients, if we can get rid of that we can have a better outcome of AF treatment,” he said. Data presented here demonstrated no improvement in outcome.

Finally, Day highlights research on pulmonary vein isolation, which “only works in about half of the patients with longstanding persistent AF.” Recently, new technologies have been developed to study whether contact force can improve outcomes. At HRS 2016, one late-breaking clinical trial showed that contact force may help prevent reconnection but at 1 year did not make a difference in long-term success rates, he said.

“There is a lot of exciting research and a lot of exciting new technologies. Hopefully, next year we will have a lot of success to report in this area,” he said.