Luigi Di Biase from Albert Einstein College of Medicine at Montefiore Health System in New York. I'm the System Director and Professor of Medicine.
Yes, I've been very happy to be here at the AFib Symposium 30th anniversary, and again this conference confirmed to be one of the top meetings for atrial fibrillation worldwide. A lot of new technology, a lot of science, a lot of information, a lot of late-breaking trials. So very hard to say what is top trials because I have to say a lot of good information, a lot of new technology, but thinking a little bit deeper in things that they caught my attention tiny bit more than the others because everything has been very good.
I would say, I would mention, I personally presented sub analysis of the admIRE trial. And the information I'm providing are not on PFA, but the trial provides information about the blanking period with the pulsed field ablation, irrespective of which tool is utilized. And it come out that with PFA the blanking period does not exist. We were used to wait two months, three months after ablation before saying the procedure worked or didn't worked. If it didn't work in the first three months, we were telling the patient just wait, it might be inflammation. You may not need another intervention, another procedure, another drug.
We know with PFA after one month, if the patient is having recurrent atrial fibrillation, it's a failure of the first ablation. Any intervention, from cardioversion to medication to more medication or reablation is necessary. We no longer can wait two or three months post procedure. I think this may change practice, this may change the way future this trial design will be designed because we will have to remove the so called blanking period.
Second trial that really caught my attention is the MANIFEST-REDO trial presented by Dr Scherr where all the patients underwent the FARAPULSE procedure in Europe, had a recurrence and they look at the outcome. Surprisingly, there was a high rate of pulmonary vein reconnection: up to 55% of the patients. It is a little, you know, upsetting for a new energy source like PFA. I was hoping something a little better.
On the other hand, it's fair to say that this is a new technology in the hands of operator first time. And the first time the overall outcome was good with some PV reconnection. European centres involved no use of intracardiac echo to assess contact. I think we learn over time that assessing contact with PFA is very important. So I think we need to learn that this new energy source, it's easy of use, but we need to improve the outcome and I think we learn how to do it.
Another trial that is worth mentioning is in the settings of pulsed field ablation was presented by Dr Atul Verma, with the simultaneous publication in Europace and goes back into we need to improve the contact for PFA is we don't know, after the first application of PFA, how many more applications we need to give because the signals go away immediately. So we're blinded to how many more applications are necessary to achieve a transmural lesion. And some investigators have presented last year and over the years maybe a surrogate of a transmural lesion like an ablation index similar the PFA index.
Dr Verma presented something innovative which is an optical way. So there is a new software that with an optical way to generate information about this is a good lesion, this is not a good lesion. This can be embedded or implement in any PFA system with a sensor. So I feel any tool that can improve the efficacy of the procedure by telling us this supposed to be a good lesion versus this not supposed to be a good lesion is welcome to our field and extremely important.
And last but not least is a trial presented by Dr Lakkireddy that will have a publication in JACC EP where he basically put together patient that arrived for stroke in the hospital, and they have a disabling problem, and they were not randomized because it was not a randomized study. But the outcome was let's do an EP early intervention with an ablation versus standard of care treatment without the consult of an EP, just patient is managed for stroke and a general cardiology consult without an EP involvement.
And surprisingly, the post management is completely different and the recovery of the patient in terms of stroke disability, cardiovascular mortality, and many other cardiovascular information such as readmission and the quality of life for the patient were extremely superior when the EP was consulted from day one of stroke patient. I think it's a very important contribution to the field that possibly may change practice.
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