Risk Factors for AF Predictors of Atrial Fibrillation Age OSA - - PDF document

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Risk Factors for AF Predictors of Atrial Fibrillation Age OSA - - PDF document

Mar 16, 2023 192 likes •293 views

9/12/2019 Risk Factors for AF Predictors of Atrial Fibrillation Age OSA (and Why it Matters) Male sex PACs European Ancestry P wave duration Hypertension PR interval Diabetes Alcohol Gregory M

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9/12/2019 1 Predictors of Atrial Fibrillation (and Why it Matters)

Gregory M Marcus, MD, MAS Professor of Medicine in Residence Endowed Professor of Atrial Fibrillation Research University of California, San Francisco

  • Research:

– NIH – PCORI – TRDRP – Medtronic – Jawbone – Eight Sleep – Baylis

  • Consulting and Equity:

– InCarda Therapeutics – Talaria Therapeutics

Disclosures

  • Age
  • Male sex
  • European Ancestry
  • Hypertension
  • Diabetes
  • Coronary artery disease
  • Heart failure
  • Elevated BMI

Risk Factors for AF

  • OSA
  • PACs
  • P wave duration
  • PR interval
  • Alcohol
  • Smoking

To identify modifiable targets to prevent AF

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9/12/2019 2

Model C-Stat for 5 year AF risk 95% CI

Framingham

0.68 0.62-0.72 PACs 0.73 0.68-0.77 Combined 0.76 0.72-0.79

A greater PAC frequency explained about 20% of the relationship between less exercise and incident AF

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9/12/2019 3

What about caffeine?

Fitbit Flex 2

  • Dr. David Rosenthal

CVRI T32 Kelsey Ogomori Sean Joyce Vivian Yang

  • In-person pilot (n=22):

77% sensitivity (95%CI 55-92)

  • Remote:
  • 3,443 participants

in all 50 US states

  • 243 hospitalizations

detected over ~1 year

  • PPV 65% (95% CI

65-72%)

  • Dr. Robert Avram

Quebec Research Funds UCSF Fellowship in Digital CV Research

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9/12/2019 4

  • 1. Kodama et al. J Am Coll Cardiol 2011
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9/12/2019 5

A Natural Experiment

Dukes JW et al. BMJ 2016

A Natural Experiment

Dukes JW et al. BMJ 2016

Acute Effects?

  • Is it a clear acute effect? Is it a delayed effect?

Does the rhythm change prior?

The HOLIDAY (HOw ALcohol InDuces Atrial TachYarrhythmias) Trial

Electrophysiology

  • utcomes:
  • 1. Atrial ERP
  • 2. Conduction times
  • 3. Sustained AF

Funded by NIAAA R01AA022222

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9/12/2019 6

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9/12/2019 7 Sleep and Atrial Fibrillation

  • Obstructive sleep apnea is an established risk

factor for AF

– Why?

  • Autonomic changes, hypopnea, hypertension, the

associated obesity

  • Anecdotally patients describe lack of sleep as a

trigger

  • …maybe sleep disruption itself is important

From 5,703 Cardiovascular Health Study participants FREE from AF at baseline. 1,588 developed incident AF over a median 11.6 years of follow-up.

Observational Studies

  • Can’t prove causality
  • What kind of study would AF patients

like to do?

N=957 Groh et al. Heart Rhythm 2019

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9/12/2019 8

Individualized Studies of Triggers of Paroxysmal Atrial Fibrillation (I-STOP-AFib)

AF event tracking only N-of-1 Trials to Test Triggers and Receive Results Assess quality of life

The Health eHeart Study

N-of-1 Study: AF Triggers

  • To identify modifiable targets to prevent

AF

– We are finally starting to focus on this – More definitive answers will be forthcoming as we test these in rigorous, prospective studies

Conclusions: Why do we care?

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9/12/2019 9

Thank You

EP Faculty Mel Scheinman Ed Gerstenfeld Byron Lee Zian Tseng Vasanth Vedantham Nitish Badhwar Randy Lee Josh Moss Henry Hsia Tomos Walters Statistical and Analytical Support Eric Vittinghoff Gregory Nah Health eHeart and Eureka Team EP Fellows Research Support NIH (NIBIB, NHLBI, NIAAA) PCORI TRDRP Cardiogram Jawbone Eight Sleep THE CIA (UCSF Cardiology)

Research Mentees Jonathan Hsu Thomas Dewland Jason Roberts Jonathan Dukes Isaac Whitman Chris Groh Jose Sanchez David Rosenthal Mala Mandyam Shalini Dixit Kaylin Nguyen Matt Christensen Tuomas Kerola Mayank Sardana Jose Sanchez

EP nurses Research Coordinators Rachel Gladstone Emily Lee Shannon Fan Christina Fang Defne Yilmaz Kelsey Ogomori Sean Joyce Vivian Yang Outside Collaborators Susan Heckbert (UW) Bruce Psaty (UW) David Siscovick (UW/ NYA Medicine) Alvaro Alonso (U Minn) Elsayed Soliman (Wake Forest) Emelia Benjamin (BU) Jeff Olgin Mark Pletcher Carol Maguire Patrick Maher Noah Peyser Lisa Lim Todd Parsnick Xochitl Butcher Efren Carbajal Emily Wilson Vadim Ananyev Kirstin Aschbacher Robert Avram Grace Furnari Armando Godinez Chinye Ijeli Aldo Navarro Dante Solorio Oana Popescu Ryan Runge Keetan Rutlege Rodolfo Sanchez Shabir Sarwary Abel Sierra Jin Yu Hollis Moore Emina Seremet Nancy Wu Helena Eitel David Wen Alex Cabrera Ricardo Barrera Jairo Vazquez