#WAFib2018 - @nmarrouche - Thank you!

#WAFib2018 - Q4: @stopafib - pt still feel miserable after AV node after they were promised they would feel better. @drjohndayMD - Amiodarone, maybe ablation Audience - difficult area. Missing data. Learning curve. Registry data may be useful for 80+ population.

#WAFib2018 Q4: David Hayes - Direct His bundle pacing @drjohnm - what we did - His bundle pacing w/ Av node ablation. Pt sx ⬆️. @DrKevinCampbell - be a doctor and do the best at what we do. @omwazni - Let’s do a study. @JonPicciniSr - Device infection is miserable for all.

#WAFib2018 Q4: case study - In light of CASTLE AF - do you ablate or not? CM: Is she sx? yes. @JonPicciniSr - Talk to her. She’s uses a cane. No. @drjohndayMD - Can ablate at this age but...5 yr outcomes aren’t good. @nmarrouche - not with #CKD Audience - Offer CRT w/ AV node

#WAFib2018 Q3: Audience: It’s a discussion with the active senior.

#WAFib2018 Q3: David Hayes - many ways to game the system. It was a select group of patients. Not equivalent to #OACs. Labeling leaves it open to lifestyle. @omwazni - If pt cannot take an OAC, then LAAO is an option. Audience: We still have pts with ⬆️ risk of #stroke & no OAC

👏🏻 Welcome to #SoMe 😊 #WAFib2018 xitter.cf/cardiologycoder/status…

#WAFib2018 Q3: @EHylek_realMD - technology creep from the very frail & elderly. @JonPicciniSr - LAAO visit is a very long visit. Complicated decision. @stopafib - it is confusing for pts to make a decision. @omwazni - CMS has required shared decision making.

#WAFib2018 Q3 @EHylek_realMD - everything I just heard is scary. LAAO - we don’t have data. I feel the intellectual bias. It was never studied against DOACs. @omwazni - Maybe for younger but it hasn’t been studied. We’ve done >200 pts w/ 3 yr follow-up.

#WAFib2018 Q3: @JonPicciniSr - As the atrium gets sicker = more risk of #stroke @omwazni - ASA + Plavix = ⬇️ bleed is incorrect. Misperception. The ones who may get the most benefits are younger pt. Audience: As the CHADS2-VAsc score ⬆️ = DAPT

#WAFib2018 Q3: @drjohnm - If #Afib is less established risk factor for #stroke + sicker pt population = how do we select? @omwazni - Ablate CHADS2-VASc of 3 or higher + major bleed = Watchman @drjohndayMD - low hanging fruit. What about the avid biker/skier?

#WAFib2018 Q2: @leftbundle : Women have higher rate of re-hospitalizations. @JonPicciniSr - We’ll get more data and more studies. CM: We look at diseased tissue in the left atrium, not gender/age.

#WAFib2018 Q2: Audience - we have to explain this to the #HF community. There may be distrust. @drjohnm - Women have higher complication rates. Can we translate these results? @omwazni - In my experience, women do not have higher complication rates.

#WAFib2018 Q2: @nmarrouche - These are pts who fail tx. CASTLE-AF @omwazni - We don’t have many options. We have to do ablation safely/effectively. Show a good track record with very sick pts. @drjohndayMD - It is gratifying to correct the underlying cause.

#WAFib2018 Q2: @leftbundle - #HF MDs may not see small #HF studies as theirs. How are we going to scale #ablation globally? Can we get there? To make #Afib #ablation is a same day procedure. @omwazni - Ablate before they start #afib 😃

#WAFib2018 Q2: @drjohnm - Most of my pts are older women with comorbidities. How do we apply this trial? @drjohndayMD - That’s the challenge of any trial. @omwazni - Look at the pt and make a decision based on your experience. CM: which guidelines do we change? #HF or #AF

#WAFib2018 Q2: A: @drjohnm - translation is key CM: CASTLE-AF focus on pt we may not consider to ablate. @JonPicciniSr - We’re talking about multiple studies showing similar results. @DrKevinCampbell - we need to do a better job reaching across the aisle to our #HF colleagues.