Western AF

Thank you to all the amazing faculty, sponsors, attendees, and everyone involved in the 11th annual Western Atrial Fibrillation Symposium! It has been one of our best yet, thanks to you all. Hope to see everyone again next year! 🎉🎉🎉 #wafib2018 @CARMACtr @nmarrouche

#WAFib2018 - @nmarrouche - Thank you!

Thanks for the great faculty that made #WAF2018 another major success! Best ever yet! See you next year! @drsuneet @dhaines901 @JonHsuMD @atulverma_md @andreanatalemd @deering_f @AndreaRussoEP @leftbundle @aalahmadmd @@omwazni @PrashSanders @JonPicciniSr @jobrachmann @WesternAF

#WAFib2018 - Q4: @stopafib - pt still feel miserable after AV node after they were promised they would feel better. @drjohndayMD - Amiodarone, maybe ablation Audience - difficult area. Missing data. Learning curve. Registry data may be useful for 80+ population.

#WAFib2018 Q4: David Hayes - Direct His bundle pacing @drjohnm - what we did - His bundle pacing w/ Av node ablation. Pt sx ⬆️. @DrKevinCampbell - be a doctor and do the best at what we do. @omwazni - Let’s do a study. @JonPicciniSr - Device infection is miserable for all.

#WAFib2018 Q4: case study - In light of CASTLE AF - do you ablate or not? CM: Is she sx? yes. @JonPicciniSr - Talk to her. She’s uses a cane. No. @drjohndayMD - Can ablate at this age but...5 yr outcomes aren’t good. @nmarrouche - not with #CKD Audience - Offer CRT w/ AV node

#WAFib2018 Q3: Audience: It’s a discussion with the active senior.

#WAFib2018 Q3: David Hayes - many ways to game the system. It was a select group of patients. Not equivalent to #OACs. Labeling leaves it open to lifestyle. @omwazni - If pt cannot take an OAC, then LAAO is an option. Audience: We still have pts with ⬆️ risk of #stroke & no OAC

@drsuneet @nmarrouche @WesternAF Fantastic meeting with great faculty. Congratulations to #WAFib2018 @nmarrouche

👏🏻 Welcome to #SoMe 😊 #WAFib2018 twitter.com/cardiologycode…

#WAFib2018 Q3: @EHylek_realMD - technology creep from the very frail & elderly. @JonPicciniSr - LAAO visit is a very long visit. Complicated decision. @stopafib - it is confusing for pts to make a decision. @omwazni - CMS has required shared decision making.

#WAFib2018 Q3 @EHylek_realMD - everything I just heard is scary. LAAO - we don’t have data. I feel the intellectual bias. It was never studied against DOACs. @omwazni - Maybe for younger but it hasn’t been studied. We’ve done >200 pts w/ 3 yr follow-up.

#WAFib2018 Q3: @JonPicciniSr - As the atrium gets sicker = more risk of #stroke @omwazni - ASA + Plavix = ⬇️ bleed is incorrect. Misperception. The ones who may get the most benefits are younger pt. Audience: As the CHADS2-VAsc score ⬆️ = DAPT

#WAFib2018 Q3: @drjohnm - If #Afib is less established risk factor for #stroke + sicker pt population = how do we select? @omwazni - Ablate CHADS2-VASc of 3 or higher + major bleed = Watchman @drjohndayMD - low hanging fruit. What about the avid biker/skier?

#WAFib2018 Q2: @leftbundle : Women have higher rate of re-hospitalizations. @JonPicciniSr - We’ll get more data and more studies. CM: We look at diseased tissue in the left atrium, not gender/age.

#WAFib2018 Q2: Audience - we have to explain this to the #HF community. There may be distrust. @drjohnm - Women have higher complication rates. Can we translate these results? @omwazni - In my experience, women do not have higher complication rates.

#WAFib2018 Q2: @nmarrouche - These are pts who fail tx. CASTLE-AF @omwazni - We don’t have many options. We have to do ablation safely/effectively. Show a good track record with very sick pts. @drjohndayMD - It is gratifying to correct the underlying cause.

#WAFib2018 Q2: @leftbundle - #HF MDs may not see small #HF studies as theirs. How are we going to scale #ablation globally? Can we get there? To make #Afib #ablation is a same day procedure. @omwazni - Ablate before they start #afib 😃

#WAFib2018 Q2: @drjohnm - Most of my pts are older women with comorbidities. How do we apply this trial? @drjohndayMD - That’s the challenge of any trial. @omwazni - Look at the pt and make a decision based on your experience. CM: which guidelines do we change? #HF or #AF

#WAFib2018 Q2: A: @drjohnm - translation is key CM: CASTLE-AF focus on pt we may not consider to ablate. @JonPicciniSr - We’re talking about multiple studies showing similar results. @DrKevinCampbell - we need to do a better job reaching across the aisle to our #HF colleagues.