Interview with Dr. Vivek Reddy at Boston Atrial Fibrillation Symposium 2010
January 23, 2010 5:05 AM CT
In this video from Boston Atrial Fibrillation Symposium 2010, Dr. Vivek Reddy discusses some of the new atrial fibrillation catheter ablation technologies and also talks about non-pharmacological approaches to stroke prevention in afib, such as the Watchman and Lariat suture.
Dr. Reddy is the Director of Electrophysiology at Mount Sinai Medical Center in New York City.
Mellanie True Hills: This is Mellanie True Hills, I’m at Boston Atrial Fibrillation Symposium 2010, and with me is Dr. Vivek Reddy. He is the Director of Electrophysiology at Mount Sinai Medical Center in New York City. We’re talking about some of the new things in ablation therapies. Dr. Reddy, thank you for joining us to talk about that.
Dr. Vivek Reddy: Mellanie, it’s great to be here. So, there are a lot of changes, certainly, that are happening in atrial fibrillation. Some of the things I’m most excited about are some of the balloon ablation technologies that are being used for atrial fibrillation. I should note [that] none of these are approved in the United States yet, though that probably will happen in the next couple of years. But they are approved in Europe, and we are getting a lot of clinical data on the use of these balloon ablation technologies. There are several—there’s one that uses a cryo balloon that freezes tissue; there’s another one that uses laser energy where you can visualize the tissue that you’re ablating and then deliver very targeted lesions to isolate the pulmonary veins.
Again, the data coming out of Europe is very exciting. Based on this, there are U.S. studies that are ongoing right now. Of course, all of these are FDA studies so it’s part of the protocol, but I think this is going to change how we do AF ablations. It’s going to make the procedure easier, it’s going to make the procedure safer, and I think probably most important, it’s going to make the procedure more effective. And I say that because—remember that the problem with pulmonary vein isolation right now is, yes, we isolate the pulmonary veins at the end of the procedure, there’s no doubt, almost everybody does that in over 95% of the cases—the problem is that when the patient leaves the lab, there may be areas where we ablated where it’s not completely healed, where you have resumption of conduction, meaning reconnection of the veins, and that’s what leads to second procedures and even third procedures, at least in the paroxysmal AF patient. So I think these new procedures are going to help prevent that.
MTH: So, what about the area of stroke prevention in afib? What are some of the new approaches there?
Dr. Reddy: I think that’s a very important point. In terms of new approaches, why new approaches? Well, I don’t think I have to tell your audience, Coumadin is not a fun drug to take, for all the reasons. And the point is there’s very good data that suggests that even older patients, the ones who are at most risk of having bleeding complications, the problem is they’re at even higher risk for having strokes. Starting at the age of 60, for every 10 years increase in your age, the risk of stroke increases by 40%. It’s extraordinary, so the need is incredible. Coumadin is not a great option. There are a number of new strategies, and I want to talk about the non-pharmacologic strategies.
Certainly a number of drugs are in various states of development, and we’ll have to see how those turn out. But in terms of non-pharmacologic approaches, it’s now pretty clear that the appendage—the little piece of tissue in the atrium where it’s like a blind pouch and blood can become stagnant and therefore make a clot and travel and cause a stroke—is the most important factor for stroke in most patients with afib, at least that’s what the studies are telling us. Importantly now there are approaches where we can use a catheter to either put a filter-type device, or something to occlude the appendage, or there are even newer approaches, where we can go and put a suture on the outside of the device, or other types of approaches to close it off.
I don’t want to spend too much time on the details of the procedure, but I think what is important is that there was a study called the PROTECT-AF study, which was published in Lancet earlier this year, and the data we’ve reported in several different studies, including at this Boston Afib symposium, that showed that using the strategy of closing the appendage is as good as Warfarin. And there is even some data, and we’ll have to see in the future whether it’s even better than warfarin. At least we know it appears to be as good as warfarin, meaning that instead of taking warfarin, this is a potential option.
I think that is very good, and ultimately it will be the only option for patients who can’t take anticoagulation because of the risk of bleeding. So I think this really bodes well for the options that we can give our patients. I should say again, however, that this is not yet approved in the United States, so we’re doing these as part of clinical studies here in the United States.
MTH: Absolutely. It’s great information. It’s something that afib patients can be watching for to come down the pike. Thank you so much, Dr. Reddy, for taking time to share with us today from Boston Afib. For StopAfib.org, this is Mellanie True Hills.