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Controversial issues in atrial fibrillation management

During this session, dedicated to atrial fibrillation (AF), two debates were scheduled. The first one was dedicated to AF ablation in long term persistent AF, and the second one to potential indications of left atrial appendage (LLA) closure device.

  • Catheter ablation is indicated in long-term persistent atrial fibrillation: Pro, presented by C de Chillou (Vandoeuvre Les Nancy, FR) - Slides, Rebuttal Slides

  • Catheter ablation is indicated in long-term persistent atrial fibrillation: Contra, presented by A J Camm (London, GB) - Slides, Rebuttal Slides

  • Antithrombotic therapy will eliminate the need for closure devices: Pro, presented by E Hylek (Boston, US) - Slides, Rebuttal Slides

  • Antithrombotic therapy will eliminate the need for closure devices: Contra, presented by B Schumacher (Bad Neustadt A. D. Saale, DE) - Slides, Rebuttal Slides

Atrial Fibrillation

Prof. de Chilloux (Nancy – France) was the speaker “pro”, defending the role of ablation in long lasting persistent AF. His talk was essentially based on the need for treatment, as patients are clinically invalidated by AF, and on the lack of efficacy of drug treatment. He also discussed the results of AF ablation in these specific patients and the acceptable rate of success in the absence of alternatives when drugs have failed. He pointed out the predictive value of sinus rhythm on survival of the patients successively treated, comparable to the rate of patients without history of AF and, on the contrary, the bad prognosis of permanent AF patients.

Prof. Camm (London, GB), “contra”, highlighted the total absence of proof of the overall benefit of AF ablation in long lasting persistent AF without data on long term follow up, the low success rate and the risk of complications related to complex procedures.

During the second debate, E. Hylek (Boston, USA) demonstrated the absence of need for LLA occluder. According to her, these devices are only indicated in patients with a contra-indication of oral anticoagulation treatment, and these patients do not really exist if we consider the overall risk/benefit ratio of this therapy, especially after the presentation of the ARISTOTLE trial. LAA occluder implant is associated with acute complication and Dr. Hylek highlighted the weakness of the data on LLA occluder clinical validation.

Dr. Schumacher (Bad Neustad – DE) has shown the results of the Protect trial and concluded to acceptable results in terms of feasibility, of acute adverse events and mid-term clinical benefit.


As a comment of this session, we may conclude that both interventional procedures need to be more deeply clinically evaluated to really demonstrate a positive benefit/risk ratio. Even if we may expect large improvement in AF ablation techniques, the results observed with the new OAC drugs may constitute a new obstacle for the development of LLA occluders.




Controversial issues in atrial fibrillation management

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.