Napa Valley Atrial Fibrillation Symposium

In this interview, EP Lab Digest speaks with Gan Dunnington, MD about this upcoming conference taking place August 24th to 27th. 

When and why was the Napa Valley Atrial Fibrillation (Afib) Symposium created? How did it come about? 

This August marks the first Napa Valley Afib Symposium. I’m certainly hoping it will become an annual event, as I think the field of Afib management and ablation is really evolving at an astonishing rate. As a surgeon who dedicates much of his time to Afib ablation, I found that there is alarmingly little education among physicians around Afib management. The concept of multidisciplinary care and comprehensive care for this common and complex disease has been fairly lacking. I wanted to create a forum for experts from both surgical and EP sides of the aisle to come together so that practicing doctors, nurses, and other allied health providers could “see behind the curtain” and experience what the experts do when taking on patients with Afib. To be honest, this conference is really a continuation of a program that Dr. Andy Kiser has done at UNC for the last two years, as well as a program by Dr. Stefano Benussi in Zurich that I attended last year. These programs focused on multidisciplinary care for atrial fibrillation. I decided to create a program with similar content, but put it in a setting that may attract more attendees, as well as supplement the lectures with features such as cadaver labs and Virtual Reality in order to reinforce the educational content.

How does it differ from other AF-related conferences? What will be some of the topics covered?

The conference will be “Napa casual” and will provide some lively but collegial debate around the many approaches to treating Afib patients. I want the attendees to hear all sides of the treatment strategies, from rate control and anticoagulation, to hybrid ablation and left atrial appendage management. The faculty are truly world class, with leading electrophysiologists and surgeons from both the U.S. and Europe. In fact, I think it’s the most impressive assembly of faculty to speak on the topic that I’ve ever seen. Not everyone does everything the same way … there are many ways to “skin a cat” (so to speak) with Afib, and I want the conference to expose all the tricks, tips, and techniques that it can. 

This faculty will provide the diversity with a passion that promises to be infectious for those in attendance.

In addition to the core lectures, we will have a revealing segment given by the Advisory Board on how hospitals of different sizes can build arrhythmia and left atrial appendage programs. We also have talks on the future of ablation, post-op management, and an assortment of “real-world” scenarios that sometimes differ from the perfect patients that the guidelines help us make decisions about. There will be numerous different models of hybrid programs that will also be very illuminating.

Tell us about some of the key highlights to be included at the Napa Valley Atrial Fibrillation Symposium. For example, can you tell us more about the use of Virtual Reality and cadaver lab environments during the symposium?

I’m really excited about these two features of the symposium. One of my passions is surgical education, but the reality is that much of the education acquired in practice is on patients, through case observation, proctoring, etc. What’s more, the referring doctors have very little idea of what exactly is happening when one of their patients is taken for “ablation” or a “Maze” procedure. Both the cadaver lab and the Virtual Reality experience aim to more fully explain the physical process of the various ablation procedures. 

In the cadaver lab, we will have a big rig with pop-outs that can become the equivalent of four full operating rooms. We will have multiple stations with patients set up for open Maze, video-assisted thoracoscopic surgery (VATS) ablation, and even catheter ablation. I want the attendees to understand the devices we use, the “knobology”, if you will. I want them to be able to stand at the table and feel the anatomy — explore the transverse and oblique sinuses, and understand the difficulties sometimes encountered with surgical exposure. From the catheter side, I’d like attendees to be able to understand how minute maneuvers at the level of the groin can be translated to catheter deflections and movements that allow for near-miraculous endocardial ablation.

The Virtual Reality experience is one that promises to be a big hit. Through a company that I work with called Boon VR, we have been able to film a catheter ablation, an open Maze, and a VATS Maze. This is not some ordinary 2D experience in which you just see images on the screen. Every attendee will be given VR goggles to be able to experience these cases, just as if he or she was standing in the shoes of the operator. I think Virtual Reality truly is the future of practical medical and surgical education. In this context, not only can the participant see what the surgeon sees, he or she can look around the room and see what anesthesia is up to, how the scrub tech moves, and what music is playing on the radio! It’s completely immersive and has such higher impact than just watching a video of a case. As the field of Virtual Reality explodes over the next 10 years, I truly think physicians will be more prepared and fully educated on new procedures that they want to learn. Even beyond the operators, the supporting staff will be so much more prepared when the first case comes around.

Tell us about the extensive faculty presenting at this year’s meeting.

To be honest, when I look at the faculty, I still can’t believe it. It’s really a dream team of presenters that I am so honored to have in Napa Valley. When I first started extending some invitations (via text) to icons like Drs. Ralph Damiano, Andrea Natale, DJ Lakkireddy, Mark La Meir, John Day, or Paul Wang, I really hoped for some of them to agree to participate. Imagine my surprise when 100% of my invited faculty showed interest in coming! Even the Europeans that have pioneered much of hybrid ablation agreed to take the long flight out. While I think that a trip to Napa Valley was probably enticing, I truly think that this assembly of faculty is visionary as well as interested in moving the field forward, together. From a bunch of text messages, to a dream team faculty on a jam-packed agenda, it just couldn’t have worked out any better.

Will there be opportunities for attendees to interact with vendors during the conference?

Many! In fact, I have been so pleased with our vendors’ willingness to support a brand-new conference with little more than a list of faculty and an early agenda. I strongly believe that medicine and industry are truly symbiotic, and this conference will hopefully highlight the beneficial aspects of this relationship. Many these days seem to be afraid of the interaction of business and medicine, but I feel that this relationship has driven medicine and technology forward so much faster than it ever could have if they were kept isolated from another. I want the participants to see what the vendors have to offer, and I want the vendors to be able to hear what the practitioners really need as we all strive to best treat our patients.

What CME opportunities are available at this meeting?

While there is no formal CME at this time, the content of the meeting will be packaged into CME material post hoc. In reality, whether somebody can “submit” CME for the event is secondary to the actual “Continuing Medical Education” that will be provided by attending this conference. 

How many attendees are expected to attend this year’s conference? 

The Marriott in Napa where the event is being held can hold up to 300 attendees in the conference room, so that has been our main limitation. I am fairly confident that it will be a full house. 

How does the destination factor into this meeting? Will there be opportunities for attendees to explore the Napa Valley area? 

Absolutely! I have intentionally set the program on a Friday and Saturday, hoping that attendees will extend their stay on the front or back end. I have also stuffed the agenda full of rapid-fire, 10-minute presentations so that we can have some time at the end of the day to enjoy Napa’s offerings. In a beautiful setting during peak season, I’d hope that our attendees will be able to enjoy one of the world’s finest wine regions. There are more quality restaurants in this small rural area than many large metropolitan areas. The organizers of the meeting are fully prepared to curate the experience for attendees and their guests, as well as offer guidance on how to best experience the Napa life.

What are some of the most exciting advances today in the treatment of atrial fibrillation? 

Honestly, I am totally biased, but I really think the coming together of cardiologists and surgeons to tackle Afib in a multidisciplinary approach is game changing. Much in the same way that heart teams are required for TAVR or coronary disease, I’d like to hope that the same trend will follow with Afib management. 

I am also extremely excited at the advances in mapping ability with higher resolution and greater ability for electrophysiologists to seek and destroy triggers or breaks in ablation lines. Additionally, the improved technologies for monitoring in the outpatient setting are really quite significant. We will only be able to improve our outcomes and better understand the natural course of Afib after ablation if we improve our ability and commitment to monitoring. There are numerous options coming out that will shine a light on some of the questions of durability, stroke risk, and progression of disease in patients after Afib ablation.

Why should people attend this meeting? 

The main reason to attend is that it will be fun! With the world-class faculty, rapid-fire talks, cadaver labs, Virtual Reality experience, large-scale vendor participation, and a top-notch wine dinner at Silver Oak, what else is missing? I think attendees will leave with a new appreciation for Afib and its many treatments. They will also hopefully be energized and excited to educate their patients and offer new insights and treatments with a better understanding of all the possibilities.

Is there anything else you’d like to add?

I’d just like to say that it has been tremendously rewarding to get to work with such excellent people — from faculty, to industry reps, to Boon VR, or our wonderful organizing company Gather Napa Valley, to the hotel staff at the Marriott. When this many good people come together, the results cannot be anything less than spectacular. I’m excited for the event, and I hope others will take the opportunity to come join us in Napa on August 24-27th!