WESTERN AFIB 2026 SESSION

Session 14 Roundtable: AF in Special Clinical Scenarios: Where Evidence Meets Art (AF in Amyloidosis, Cancer, HCM, ESRD, Severe MR, etc.)

11/02/2026

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Edited by Jodie Elrod

Featured is the Session 14 Roundtable, entitled "AF in Special Clinical Scenarios: Where Evidence Meets Art (AF in Amyloidosis, Cancer, HCM, ESRD, Severe MR, etc.)," from Western AFib 2026. With moderator Kamala Tamirisa, MD, and panelists Wael Jaber, MD; Prashanthan Sanders, MBBS, PhD, FRACP; Mark Link, MD; Tina Baykaner, MD, MPH; and Stavros Stavrakis, MD, PhD.

Clinical Summary

Ibrutinib and end-stage renal disease: Panelists reported atrial fibrillation (AF) incidence of 5% to 20% with ibrutinib in cancer trials, potentially underestimated; drug interactions complicate anticoagulation and rate control. In hemodialysis patients, VALKYRIE found less bleeding with rivaroxaban 10 mg versus warfarin; RENAL-AF found similar bleeding with apixaban versus warfarin. Evidence remains limited; panelists emphasized nephrology collaboration.
Obesity and AF ablation: Panelists favored individualized timing of ablation alongside weight management. One approach sets achievable weight-loss goals of 1 to 2 kg over 3 months; severe symptoms may warrant proceeding with ablation.
Hypertrophic cardiomyopathy and cardiac amyloidosis: Persistent symptoms and rising biomarkers despite improved outflow gradients prompted amyloidosis evaluation in a presented case. Cleveland Clinic reported approximately 6% to 8% positive screening among older ablation candidates. Panelists emphasized recurrence counseling and cautioned against stopping anticoagulation solely after left atrial appendage closure.

Reviewed by Jodie Elrod, Managing Editor