Highlights From the 2023 Western Atrial Fibrillation Symposium

Interviews with Philipp Sommer, MD; Jill Schaeffer, CRNP; and Edward J Schloss, MD

In this episode of The EP Edit, we share some highlights from the annual Western Atrial Fibrillation Symposium, which took place February 24-25, 2023 in Park City, Utah. Included here are some of our featured interviews with faculty from #WAFib2023. Transcripts for these interviews can be found below.

You can also listen to this episode on Spotify and Apple Podcasts!

Interview With Philipp Sommer, MD

My name is Dr Philipp Sommer. I am the director of the Clinic of Electrophysiology at the Herz- und Diabeteszentrum NRW in Germany.

The question I was addressed was “Do we need a new classification for AFib?” Of course, if I am addressed a question like that, the answer must be yes, there must be a new classification needed! Right now, we basically categorize AFib according to this clinical presentation: when the episodes are very short, we call it paroxysmal, and when they are longer or if cardioversion is needed, which means an electrical shock of the heart, we call it persistent. However, this is a really rough estimate of what is going on in the heart. Today, we still know the most about AFib once we have the heart examined with our catheters. We are currently looking for better methods to predict those findings with our catheters, because this would allow us to exclude patients from an ablation procedure, identify optimal candidates for certain technologies (eg, a single-shot device creating cryo lesions), or identify patients who would be optimal for a pulse field ablation procedure or radiofrequency ablation (ablating with heat). So, we have different tools available, and the task and challenge for the coming years will be to assign the individual patient to his or her optimal technology.

The take-home message is that classifying our patients into paroxysmal and persistent is just not detailed enough. It is not coming close to the truth. We need better information and tools in our hands to classify our patients and get a better idea of what is going on in these individual patients. That means we have to include parameters such as the electrocardiogram or imaging data from computed tomography or magnetic resonance imaging, and all of this cannot be done by ourselves. We need the help of artificial intelligence to get all this information. Meaning, we will feed this information into some sort of a computer, and it will tell us whether this patient is good to go.

Interview With Jill Schaeffer, CRNP

My name is Jill Shaeffer, I am a nurse practitioner at the Heart Group at Penn Medicine Lancaster General Health. I am excited to be here at Western AFib! I am a nurse practitioner who works with both inpatients and outpatients, and my clinical specialty is electrophysiology.

We are excited to talk about digital health, and how nurse practitioners and advanced practice providers administer care to patients with AFib. I will be sharing the roundtable with Erica Zado from Penn, Monique Young from Tulane University, and William Cho from the University of Utah. I have not actually met all of them yet, so we are hoping to share individual stories of how digital health is gradually increasing and how we take care of our patients.

For me, digital health helps me take care of my patients by monitoring in between visits. We use low-tech methods such as pulse checks all the way up to Apple Watches and Kardia devices (AliveCor). And this field continues to grow. So not only do we have our medical ways of monitoring AFib, but my goal is always to get my patients to monitor themselves and manage their symptoms in-between their visits to the AFib clinic, and know when to notify us that something needs to be changed vs reassurance that everything is okay. The challenges to that is everyone is a little concerned that we do not have the ability to have 4000 Apple Watch tracings come in every day—we do not have the resources for that. So that is where the hope is in the future—that we will have more artificial intelligence to help. But I see that happening already. For example, the other day I had an elderly patient say to me, “I check my Kardia every day, but it always says green, so I know that is good.” It was really amazing to me that she understood, she was checking herself, and was pleased and reassured her treatment was working. So, I know there are a lot of concerns that maybe this is a technology for younger generations, and there are certainly some patients that are low tech and not interested in digital health. But more and more, we are seeing our elderly folks embrace these technologies, including with the help of their family. It is very exciting.

Interview With Edward J Schloss, MD

Hello, I am Edward J Schloss. On Twitter, I am @EJSMD. I am a cardiac electrophysiologist working out of Cincinnati, Ohio. I just had my 25th year at The Christ Hospital. I mainly do devices, but I enjoy all aspects of electrophysiology (EP).

The hashtag #EPeeps was coined by a colleague, Steve Zweibel, who is an electrophysiologist in Connecticut. He was smart enough to realize as this nascent community of electrophysiologists was forming on Twitter that we needed something to bring us together. So that became a hashtag that has become pretty universal; when people want to find each other, that is the way we do it. On a bigger scale, it is basically electrophysiologists who share as a community on Twitter. There are just barely people heading into Mastodon now, but I think we are pretty much going to stick with Twitter—it feels that way. In the early days, there was Wes Fisher, John Mandrola, and Janet Han. I remember meeting Janet during late breakers. There only used to be like 4 people doing tweets at Heart Rhythm Society (HRS) meetings. We found @netta_doc (Janet) and she became an early part of the community, which just grew and grew after that. So, that is what the #EPeeps community is.

It started out as a very small group of people. We would see each other in person at HRS meetings where we would have a tweetup, and we still do, where people meet each other. But it started out very tiny. I remember the year when HRS actually told us they would go ahead and give us badges so we could sit up front. There were only like 6 of us there. That was maybe 2012 or 2013, and then it really took off. What I also found is that it interfaced nicely with other forums, such as what became #medtwitter with the interventional community as well as the broader community of people that are interested in study design and interpretation. I think there is so much we could talk about, but so much grew out of that beyond just interactions with colleagues, it also kind of turned into a post-publication, peer review where things get hashed out. It is an opportunity to meet with experts. It gave me access that I would never have had as a community electrophysiologist with minimal academic credentials to actually be able to come to meetings like this and know people—that all grew out of Twitter.

#ASKWAF is a roundtable that takes place at the end of the meeting. It has been the tradition for at least 6 years. I participated in it for the first time 5 years ago. I think John Mandrola was doing it before I ever got started. Nassir Marrouche has been very pioneering in a lot of things, and one of those things is needing social media at meetings. I do not even ablate AFib—I am a device doctor. I see people with AFib, but it is not the focus of my practice. So when I come to Western AFib, it is more about enrichment and meeting colleagues than it is practical information that I am going to use tomorrow. Before I began attending this meeting, I found I was watching the Twitter stream blow up with information from this meeting, and it was so well crafted and the people that were here were providing such good material. I remember talking with John Mandrola about how great this meeting is. So I ended up coming, and not long after that, I got invited to be on the panel. The idea of #ASKWAF is to take what grows out of social interactions, put it in the real world, and talk about the ideas and things that come out of this meeting, the things that bubbled up to the top of the conversation, and put it to a panel, and get it archived on Twitter. The dialogue can then continue long after the meeting.