The Strategy of AF Management: Navigating the Right Treatment from Patient’s Condition

On the second day of the 13th Annual Scientific Meeting of InaHRS 2026, the Paris Room hosted the “Device Forum: Conduction System Pacing, Is It for Everyone?”, moderated by Haikal, MD. The forum explored the expanding role of Conduction System Pacing (CSP) and the clinical considerations involved in selecting appropriate pacing strategies.

The first presentation, “Beyond Traditional Pacing: The Rise and Necessity of Conduction System Pacing,” was delivered by Giky Karwiky, MD, who discussed the clinical implications of Left Bundle Branch Area Pacing (LBBAP) compared with conventional atrioventricular pacing, including their potential impact on long-term outcomes. Ardian Rizal, MD, continued with “CSP in Primary Pacing: Should We Abandon RV Pacing Completely?”, comparing the benefits and limitations of CSP and Right Ventricular Pacing (RVP) and emphasizing the importance of individualized device selection.

The session concluded with Dian Andina Munawar, MD, PhD, presenting “No EP Lab, No Problem? Conduction System Pacing Simplified.” The presentation highlighted how CSP, particularly LBBAP, can provide a more physiological alternative to conventional RV pacing and discussed its practical application beyond specialized electrophysiology laboratories.

The forum then shifted focus to Atrial Fibrillation (AF) with “Atrial Fibrillation Forum: Contemporary Challenges in Atrial Fibrillation: Choosing the Right Strategy for the Right Patient,” moderated by Dony Yugo Hermanto, MD.

Opening the session, Tze Fan Chao, MD, PhD, delivered an online presentation, “Silent AF, a Serious Risk: Oral Anticoagulation in Device-Detected AF.” The discussion addressed the potential role of Direct Oral Anticoagulants (DOACs) in selected patients with device-detected subclinical AF, while emphasizing the importance of individual thromboembolic and bleeding risk assessment.

Next, Rerdin Julario, MD, presented “Rate or Rhythm Control in Elderly AF Patients: Balancing Efficacy and Safety,” highlighting the need to avoid overtreatment with rate-control strategies and discussing the shift toward earlier rhythm control in appropriate patients.

The session concluded with Hamed Oemar, MD, PhD, who presented “Mechanical Staging of Atrial Myopathy for Long-Term Management of Atrial Fibrillation,” exploring the use of echocardiography to identify atrial myopathy and structural changes that may precede the development of AF.