6th joint AFNET / EHRA consensus conference
Integrating new approaches to atrial fibrillation in an era of digital evolution
17 - 19 January 2017, European Heart House, Sophia Antipolis, Frankreich
Scientific committee
Günter Breithardt (Münster, Germany)
John Camm (London, UK)
Paulus Kirchhof (Birmingham, UK / Münster, Germany)
Gregory Lip (Birmingham, UK)
Ulrich Schotten (Maastricht, The Netherlands)
Atrial fibrillation (AF) remains a major health challenge: Despite the progress made in the recent past, AF contributes to mortality and morbidity and the treatment of AF and its complications requires between 1-3% of the overall health care expenditure. We need innovative approaches to tackle this problem.
For this purpose, more than 70 specialists in atrial fibrillation – invited scientists from 15 European countries, Australia, Canada, Turkey and the USA, as well as industry representatives from eight companies – met in Sophia Antipolis in the south of France to participate in the 6th Joint AFNET/EHRA Consensus Conference.
The two-day expert meeting started with presentations in a plenary session. Thereafter, participants split into six workshop groups to work on specific questions. The results of these workshops were summarized and discussed in additional plenaries to achieve a consensus. This will be published in a consensus report.
Group picture taken during the conference
Presentations of the first plenary session
Challenges in the management of AF
- Death and morbidity in anticoagulated AF patients. John Camm, London, UK
- Big health record data and big knowledge: emerging approaches applied to AF. Harry Hemingway, London, UK
- Management of bleeding on anticoagulants – the ESC view. Hein Heidbuchel, Antwerp, BE
- Why is rhythm control not always successful? Thorsten Lewalter, Munich, DE
- AF detection in at risk populations (primary and secondary stroke prevention). Karl Georg Häusler, Berlin, DE
Solutions 1: Different types of AF require different forms of therapy
(CATCH ME Session)
- Biomarkers to refine stroke and bleeding risk estimation. Jonas Oldgren, Uppsala, SE
- Hypercoagulability in the atrial interstitium promotes AF. Ulrich Schotten, Maastricht, NL
- AF and heart failure. Dipak Kotecha, Birmingham, UK
- Clinical implications of an atrial cardiomyopathy classification. Andreas Goette, Paderborn, DE
- AF and cardiomyopathy: the chicken or the egg? Barbara Casadei, Oxford, UK
- SNPs, PITX2 and the response to antiarrhythmic drug therapy. Paulus Kirchhof, Birmingham, UK
- Obesity, fat tissue activation, and recurrent AF. Stéphane Hatem, Paris, FR
Solutions 2: Integrated AF care
- Integrated Care in Atrial Fibrillation. Jeroen Hendriks, Adelaide, AU
- Patient-centred care to ensure good quality. Deirdre Lane, Birmingham, UK
- What about the left atrial appendage – the interventionist’s view. Ulf Landmesser, Berlin, DE
- What about the left atrial appendage – the surgeon’s view. Manuel Castellá, Barcelona, ES
- AF Heart Team for rhythm control. Gerhard Hindricks, Leipzig, DE
- AF Heart Team for stroke prevention. Stefano Benussi, Zurich, CH
- CATCH ME tools for AF health care professionals and patients. Larissa Fabritz, Birmingham, UK
Special issues discussed in the break-out sessions
Detection of AF – the next frontier (population / high risk patients screening, validity of consumer products for AF detection, public health implications of screening for stroke prevention and beyond). What are the psychological problems to be overcome in early disease prevention, screening, etc.? Experience from other fields of medicine?
Integrated management of AF – opportunities and limitations. Role of nurses and other specialties, use and evaluation of IT tools, patient centred approaches, etc. Innovation for better and more efficient AF management, or “nice to have”? AF as a disease within the broad risk factor burden of cardiovascular disease may require approaches that integrate AF into the “25 to 25” programme of the WHF/WHO.
Stroke prevention in AF – exploring the boundaries in multidisciplinary approaches (discontinuation of therapy, what to do in patients who bleed or have a stroke on anticoagulation, low risk patients, biomarkers for stroke and bleeding, LAA occluders, is the link between bleeding events and death mediated by stopping anticoagulation)
Rate control – back to basics (role of digoxin, targets for rate control)
Rhythm control therapy for different types of AF: Should we abandon the “paroxysmal – persistent” differentiation and integrate markers for the major drivers of AF into our management algorithms? (genes, biomarkers, ECG markers, clinical conditions). Can this guide rhythm control therapy decisions now or in the future (antiarrhythmic drug selection, cryoballoon ablation, AF ablation “beyond PVI”, combination therapy, how to measure improvements in safety)?
The AF Heart Teams. When and how are they useful (e.g. complex stroke prevention, complex rhythm control), and which expertise is required?
Funding
The conference was co-financed by AFNET and EHRA and received additional financial support from CATCH ME (grant agreement No 633196), which is funded by the European Union’s Horizon 2020 research and innovation programme.
Publication
Kotecha D, Breithardt G, Camm AJ, Lip GYH, Schotten U, Ahlsson A, Arnar D, Atar D, Auricchio A, Bax J, Benussi S, Blomstrom-Lundqvist C, Borggrefe M, Boriani G, Brandes A, Calkins H, Casadei B, Castellá M, Chua W, Crijns H, Dobrev D, Fabritz L, Feuring M, Freedman B, Gerth A, Goette A, Guasch E, Haase D, Hatem S, Haeusler KG, Heidbuchel H, Hendriks J, Hunter C, Kääb S, Kespohl S, Landmesser U, Lane DA, Lewalter T, Mont L, Nabauer M, Nielsen JC, Oeff M, Oldgren J, Oto A, Pison L, Potpara T, Ravens U, Richard-Lordereau I, Rienstra M, Savelieva I, Schnabel R, Sinner MF, Sommer P, Themistoclakis S, Van Gelder IS, Vardas PE, Verma A, Wakili R, Weber E, Werring D, Willems S, Ziegler A, Hindricks G, Kirchhof P. Integrating new approaches to atrial fibrillation management: the 6th AFNET/EHRA Consensus Conference. Europace 2018 Jan 02 (first published online). doi.org/10.1093/europace/eux318