Western Atrial Fibrillation Symposium 2025: What to Expect, and Future Perspectives in Electrophysiology

Podcast discussion with Bradley Knight, MD, and Nassir Marrouche, MD 

© 2025 HMP Global. All Rights Reserved.

Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of EP Lab Digest or HMP Global, their employees, and affiliates. 

In this episode, EP Lab Digest features a discussion with Bradley Knight, MD, and Nassir Marrouche, MD, about the upcoming Western Atrial Fibrillation Symposium, taking place February 27-March 1, 2025, in Salt Lake City, Utah. 

Bradley Knight, MD: Welcome everybody! I am Dr Brad Knight, Director of Electrophysiology at Northwestern. I am also the editor-in-chief of EP Lab Digest, published by HMP Global. I am delighted to be joined by my friend and colleague, Dr Nassir Marrouche, Director of Cardiac Electrophysiology and Director of the Heart and Vascular Institute at Tulane University. We are very excited to talk to Nassir about the upcoming Western Atrial Fibrillation (AF) Symposium. Welcome Nassir, thank you for joining us.

Nassir Marrouche, MD: Brad, it is always good to see you. 

Bradley Knight, MD: So, I know this meeting has evolved over time. Can you update us on the dates and location of this year’s meeting?

Nassir Marrouche, MD: As you know, being one of the founding faculty of this meeting, the Western AF Symposium will always be at the end of February. On the last Friday of every February, we have been in Park City every year for the last 16 years. This year will be in Salt Lake City for the first time, from February 27th to March 1st. We added an extra day this year, so the meeting will take place from Thursday through Saturday.

Bradley Knight, MD: That is exciting—the growth. I know that developing these programs can be a lot of work, time, and energy. Can you tell me how you approach putting together the agenda every year? Do you have different people helping? How does that work?

Nassir Marrouche, MD: You are editor-in-chief of the Journal of Cardiovascular Electrophysiology and EP Lab Digest. You read a lot of papers to learn about what our colleagues and partners are doing in the world of EP. Every week I am meeting people, and when the time comes, I contact them about Western AF. Brad, you are also aware that the last lecture gets changed 3 times and is only confirmed by the end of January, because Western AF always remains fresh. It is something we are proud of. If you were to call me on February 2nd to let me know you just published a paper and want to talk about it, we will change it in the agenda. That is what has kept us unique. The final program is usually established 4-6 weeks before the meeting. 

Bradley Knight, MD: All year you are thinking about it and putting ideas together, but you try to keep the topics fresh. Let's talk about some of the changes in the format. You are doing live cases this year. I have been to some meetings now with prerecorded cases and live cases, and I do see the advantage of that. It is a lot more work, and probably a lot more expense. What led to your decision to add live cases to the program?

Nassir Marrouche, MD: It is because of people like you and your fellows. Again and again over the years, I ask the fellows who attend what they want to see more of every year. The major changes that I put into the program are based on their requests, because they are unbiased, fresh, and their opinion is very useful. In the last 3 years, I have consistently been hearing that they want to see more live cases, so that is why we decided to add these cases to Thursday of this year’s program.

Bradley Knight, MD: I think that is an exciting change in the format. It will make it a very different meeting. The topics that you picked during the year, you want to have a diverse group of topics. You are just talking about AF, but you could have an entire 3-day program on any one company's pulsed field ablation (PFA) tool. How do you avoid talking too much about PFA and some of the new technologies that are out?

Nassir Marrouche, MD: Western AF has always been from A to Z, we are proud of that. And it is not only the “A to Z” in the subjects that we put on the program, but also in the speakers and attendees. We include the “Brad Knights” as well as the “Uli Schottens” of the world, meaning the basic scientists like Uli and EPs like you who do everything, and we try to keep them in the same room the whole time. We never focus on ablation only. We are not an ablation meeting. There are other meetings in the country based on interventions. We kept this meeting focused on A-to-Z AF. It remains up to date about all things related to AF. For example, artificial intelligence (AI) is now more visible. We are doing lectures on AI, bleeding, closure devices, and new drugs coming such as factor XI inhibitors. There are also a lot of topics being tackled outside of PFA. Nevertheless, when you do live case interventions, you see a lot of PFA because this is what is taking place in the lab, including more closure devices as well. So yes, we see PFA a lot in the live cases, but in terms of the program itself, it is really about AF as a center point and everything around it.

Bradley Knight, MD: As you mentioned, there are a lot of topics going over AI. Can you talk about what you think AI is going to bring to the table in EP? It is something we have been hearing about for years. There is very little I do in the EP lab right now that is AI based except for maybe some investigational devices. What is your take on AI in AF?

Nassir Marrouche, MD: I think we could do a lecture and maybe we should do a lecture or webcast sometime on this, trying to put this in a different setting. Everybody talks about AI, it is an exciting topic. Everybody shows off and tries to impress with AI. It is becoming a big deal. But you are right, AI is still having a hard time penetrating daily life. I remind people that the software we use is already AI. The software that predicts the shell in our catheter ablation systems, or the 12-lead ECG used in the clinic, is AI. It has already been done, but now we are trying to apply it to be proactive in treatment. The AI topics we are putting into Western AF are to exactly answer your question. Show us the data. We invited people to Western AF who have been working in this field for a long time. We are asking them how to use it in our practices. I do not want hypothetical scenarios; for the people talking about AI at Western AF this year, we have asked them specifically to tell us how to implement it into the clinic today. What is the threshold? What are the challenges we are facing to implement AI? We do not want theoretical stuff. Practical AI, which is what I call it, is what you are going to see at Western AF this year. More actionable AI. When you go home, how can you implement what you learned about AI into your clinic or EP lab the next morning? That is what we are trying to achieve at this year's Western AF.

Bradley Knight, MD: You have pioneered the use of imaging to detect atrial fibrosis as a way to guide therapy and also to image ablation lesions. What do you think is the future of left atrial imaging with regard to patient selection and lesion identification in the PFA world? 

Nassir Marrouche, MD: Sooner or later it is going to pop up and be useful. For the last 20 years, we have been busy delivering the lesion and understanding the physiology of AF. But now everybody can ablate, such as the interventional cardiologists, for example. We are now using intravascular ultrasound more and more as well as fractional flow reserve. That is a way for us. Especially for a center like yours, I predict within 12 months from now, 70% of your patients will be sent to you from other places. Going in, you need to know what you are dealing with, including lesion formation and transmurality, and how the imaging is getting better and becoming implemented. Now, the challenge we are going to face here is how to scale MR. Unfortunately, industry has not worked on this with us in terms of making MR useful and scalable. That is a challenge. So, we are trying to find, for example, if an echo algorithm can replace it or if CT can replace it. These are ideas we are testing at Tulane. But this is going to be used more and more, because imaging PFA lesions is not the same as imaging RF lesions; we realize that the wall is thinner, the wall becomes thinner and thinner sooner, and there is less edema. So, this is going to be implemented. We have some data now to finally figure out how to image those. You are going to see we are doing a lot of lesions and this “messy atrium” as they call it. If they come back with AF, we would like to see that image before we go in and target it, because voltage alone is not enough, especially the way we know it. So, there is a big role. The prediction and the premodel is becoming more and more of a different idea. It is more about stroke prevention and stroke prediction rather than AF treatment. Instead of a focus on AF treatment and management, it is rather about the bigger picture of predicting stroke, hospitalization, and heart failure. That is what is being used more and more now, and it is continuing. That is why the work we are doing is really more and more with the heart failure physicians. By the way, your center has great people there working on that, and I pledge for you to work with them and integrate them into your lab. You have great tools there.

Bradley Knight, MD: Yes, we have great partners Drs Dan Lee and Dan Kim at Northwestern. Just to shift gears a little, I worked very closely with Dr David Haines on a variety of things, including the American Board of Internal Medicine (ABIM). I see that the EP fellows research competition is named after him. Can you tell me the background of that?

Nassir Marrouche, MD: Dave, every time I mention his name, there are still tears in my eyes. It was a sudden loss. He was a founding member of Western AF, him and his family. His kid grew up skiing here every year. His family is very connected. They were a major support of Western AF. He built the fellowship program with me. Dave was always an educator. He loved education and he loved his fellows. He was a chair of the ABIM. People looked to him to educate and teach them about EP. So, we wanted to do something symbolic and name the Western AF fellowship competition after him. I wish I could do more.

Bradley Knight, MD: Good for you. Thank you for doing that. I was very happy to see his name associated with that. So, I am very excited about this meeting. It is always a great meeting to see incredible people and topics in a spectacular venue. What do you predict will be different this year?

Nassir Marrouche, MD: The venue is in Salt Lake City, so it is a new place. The reason is because it is a larger space. While Park City was amazing for everybody, a lot of people unfortunately could not make it there because of the growth. We grew more than the city, that was the bottom line. So hopefully, we can commit more people this year and we will try it. Everything else outside the meeting will stay in Park City, including after-hours events and dinners, and everyone can still enjoy the mountains. But the 3 days will be in Salt Lake City this year!

Bradley Knight, MD: Well, I am very excited about the meeting. I am sure everybody planning to attend is excited to be there. Congratulations again on putting together a great agenda and I look forward to seeing you. Thanks for joining us on this podcast, Nassir. 

Nassir Marrouche, MD: Thank you, Brad. 

The transcripts were edited for clarity and length.

Spotify | Apple Podcasts

To register for the Western Atrial Fibrillation Symposium, please visit wwww.westernaf.com!