Looking ahead to AFIB2021

Mark O’Neill

Far from being the first event in the electrophysiology calendar now to make the switch to a digital-only format, the 2021 edition of the Atrial Fibrillation Symposium (AFIB2021, 18 March, virtual) will be the latest to make its digital debut in light of the pandemic. A two-day event spread across dates in March and May, with additional sessions later in the year, AFIB2021 features discussion and debate on latest European Society of Cardiology (ESC) guidelines on catheter ablation, early rhythm control therapy and electroporation, as well as a practical session covering heart anatomy and electrophysiology lab safety among other topics.

Cardiac Rhythm News spoke to Mark O’Neill (St. Thomas’ Hospital and King’s College London, London, UK),  a member of the event’s scientific committee, to discuss the disruptive qualities of digital learning, highlights from the 2021 programme, and the future of the event.

The format of this year’s event is a little different to previous editions, what will attendees recognise from previous years, and what will be new?

We had our last symposium (19th Atrial Fibrillation Symposium, 12–14 February 2020, Madrid, Spain) just before the pandemic really took off. We then had to put the pieces back together a couple of months later and think about what was going to happen the following year.

We decided quite early on to go for a fully virtual experience, but at the same time we wanted to keep the identity of the meeting. I do not think it is the right way forward to take a face-to-face meeting and then just put it onto a screen—it is an opportunity to try to do something differently, but retain the theme of the meeting.

We decided that we would downsize the meeting, reducing what would normally be around 20–25 presentations over the course of two days into a split programme starting with a session in March over three hours, and a second three-hour component to come later.

The March meeting is as close to the original spec as we can get—which is always to encourage discourse and discussion around the theme of the latest scientific and clinical information available in the field of AF ablation. The first part is broken into evidence and therapy—those are the two big themes in the meeting each year. We want to look at the scientific evidence and how we apply that to a patient in a clinical environment, and we want to look at therapies and how effective they are for a patient.

We thought about how we could condense that down into something that would tempt someone to sit in front of a screen for a few hours and follow the whole meeting from start to finish. One of the things that has clearly come out of online meetings is that you get lots of attendees who register and log on but you have no idea if they are participating in the meeting or not. Our goal is to have everybody participate.

Using the digital format, how will you seek to encourage interaction from the audience?

What we have asked each of our speakers to do is to prepare and record between seven and nine minutes of presentation, but they are not doing it on a screen at home with the dog barking in the background! It is recorded to a professional standard and kept quite short. The point of that is that the presenter really has to think about what the key messages are that they want to get across to this audience and that it is in a bite sized chunk.

The remainder of the 30-minute slot will be spent in one-to-one discussion with the presenter to tease out some of the themes that we have thought about through the last few months, that we have seen in the literature over the last year, and to encourage our audience to participate. There is a special platform that attendees will be able to use to participate, to have their questions put straight to that expert in an environment where you do not have a crowd of people on a screen panel, where it is a little difficult to mediate or curate a conversation.

Given the focus on tailoring content to a digital platform, do you anticipate that will influence future conference planning and programming?

I think there are probably many answers, but to put it into perspective, there is a piece in Nature from a few days ago in which they have polled their readers and asked if they think conferences should continue to be virtual or have a virtual component to them after the pandemic. The answer to that was ‘yes’ for 74% of people.

There are big advantages and disadvantages to a virtual platform depending on the type of conference that you are trying to run. For the bigger conferences the major advantage is accessibility, so students, folks who just cannot travel to the conference due to cost, lack of time etc; you can do away with that for many people by having a virtual meeting, and obviously the carbon footprint is another really important point.

But the biggest drawback is that the networking opportunities are very limited. It does not matter what software product you create, it is always going to be difficult to substitute for a face-to-face meeting with someone in a corridor over a cup of coffee. It has made us realise that conferences are about way more than the content of the conference, in fact that is almost a secondary aim. Conferences are about bringing a community together, because the community together is much more valuable to advance the field than the community separated and working in its individual pieces.

For me, therefore, the conferences of the future definitely have to embrace a virtual component.

If you had to condense the AFIB2021 programme into a few sentences, what would you hope to be the core messages for attendees?

Looking at it as two halves—for the ‘Evidence’ session, we have a couple of key messages that will come out over the course of the discourse with Gerhard Hindricks, Paulus Kirchhof, Doug Packer and Christina Blomstrom-Lundqvist.

From the 2020 ESC Guidelines session, one of the key things is we need to challenge people to think differently about atrial fibrillation. The message there is to think of it not just as something that we treat by catheter ablation or drugs, but to think of it as a condition that requires a much broader approach, in the same way that other areas of medicine have seen happen over the last 20 years.

The ‘Prognosis’ session will focus on early rhythm control therapy, based around the EAST-AFNET trial published last year, one of the highest impact trials in our field, showing that in patients with AF, intervening early is key. Once a diagnosis of atrial fibrillation is made, make sure that the treatment, if possible, is a rhythm control treatment.

Then, on the ‘Therapy’ part, there is a change in gear to one in which most electrophysiologists are much more comfortable. We will focus on the evolution from delivering radiofrequency energy at relatively low power, to delivering at high power for much shorter periods of time. While that may have an impact on duration of procedures—and if you can do more procedures you can treat more patients—we will put that into perspective with a discussion around safety and efficacy.

We will also ask the question: is electroporation the future of catheter ablation? Electrophysiology is a melting pot of bioengineering and clinical medicine, and electroporation is a new disruptive technology in that pot. Electroporation is a form of energy delivery that is relatively tissue selective in that certain tissues are more sensitive to its effects than others. So, it is in theory possible to create very thorough lesions in heart muscle, but have no penetration into other tissues around it that might cause injury to those tissues.

With electroporation, at the moment it looks like it has a lot of promise to displace some of the other technologies that are out there and the question we will explore is if that promise is justified? And, if it is not, how can we incorporate the real strengths of this technology with the very evident strengths of other technologies?

The practical session on 22nd May is intended for folks in an earlier stage of their careers, and it is traditionally a smaller, less intimidating environment although we expect to see a surge in its popularity with the virtual format this year.

There will be a review of the anatomy of the heart for the electrophysiologist, a practical session about how to access blood vessels and cardiac chambers safely and easily. Finally there will be a session on building a safer and more involved, and probably evolved, electrophysiology lab.

One of the biggest challenges facing us now in electrophysiology is that it is mostly an elective specialty, and most patients with atrial fibrillation do not need their procedures urgently. COVID-19 has created greater delays for patients being able to access their care than has been the case for those with other urgent medical conditions. That means that there are now huge waiting lists around the world for many of our patients, and new ways of working are going to be key to managing those waiting lists effectively.

At the close of the 2020 AFIB Symposium, Mattias Duytschaever, Dipen Shah and I promised that the 2021 symposium would be a special occasion for all involved in the care of patients with AF. We hope that you will not be disappointed and look forward to seeing you there!


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