8 New Atrial Fibrillation treatment guidelines and diagnosis options 2019.

Atrial Fibrillation treatment and diagnosis
Atrial Fibrillation treatment and diagnosis – New horizons?

Atrial Fibrillation treatment and diagnosis is getting better.

Why? Because we have an aging population, technology is getting better, we are learning more about atrial fibrillation, afibbers are increasing in number and therefore there is more data available and the segment of adult CHD(congenital heart defect) survivors is also getting bigger.

Do you know anything about: SK Channels, Biomarkers, Multi-electrode RF Balloon, CardioInsight Noninvasive 3D Mapping System, Your GP?, Genome-wide association study(GWAS), Smartwatch, Wireless, At-home patch?

Have you heard of these new atrial fibrillation treatment and diagnosis breakthroughs? Read on….

SK Channels

Currently, the first “in-man” randomized, double-blind, placebo-controlled single ascending dose study to assess the safety of a new drug called AP30663 is being carried out. It is done by The Centre for Human Drug Research (CHDR) in the Netherlands. 

The Danish biotech company Ascesion Pharma who is busy with the study says it is based on inhibition of SK Channels.

According to epmmagazine.com: “Through blocking these channels with a functionally atrial-selective drug helps to avoid the deleterious effects on the ventricles, thereby offers a novel and promising approach for an effective AF treatment with an anticipated higher safety and tolerability profile.”

Data from this study should be available at the end of August 2018, and then atrial fibrillation treatment and diagnosis will definitely benefit because of this study, but when a drug will be available is unknown.

New biomarker in Ablation

Data from 208 AFIB patients who were admitted to The Johns Hopkins Hospital was used in this study.

Heart imaging was used to predict the benefit or futility of catheter ablation. This study is not the final say in determining if someone would benefit from a catheter ablation or not, because a more randomized and controlled trial is needed.

But it indicates that there may be a way to show if a patient will benefit from catheter ablation or not. Thereby saving substantial costs and possible complications.

Not to mention the trauma, false hope, and discomfort that some patients will be saved from, when they have to undergo a 3rd or 4th ablation.

Multi-Electrode RF Balloon

With this device, there is no need for “touch-up” as was the case with traditional single point catheter ablation.

The “PV Isolation with a Novel Multi-electrode Radiofrequency Balloon Catheter that Allows Directionally-Tailored Energy Delivery (RADIANCE)” study was a multicenter, single-arm, first-in-human feasibility study conducted between Dec. 2, 2016 and March 8, 2017 in Europe.

The difficulty with the traditional catheter ablation was that it was difficult to complete “burn” a solid circle of ablation around the pulmonary veins in a beating heart. With the new Biosense Webster RF balloon and it’s 10 electrodes, it is much easier.

With this new RF balloon, the 10 electrodes can be programmed to deliver different energy levels so that damage to surrounding tissue can be prevented.

CardioInsight Noninvasive 3D Mapping System

The current way mapping is done, is by inserting a mapping catheter into the heart and then locating the origin of a patient’s arrhythmia.

With the new CardioInsight system a 252-electrode sensor vest is put on a patient. This noninvasive technology creates a 3-D electro-anatomic map of the heart. The vest also allows for continuous and simultaneous panoramic mapping of both atria or both ventricles, this was not possible with current invasive methods, according to the website DAIC(diagnostic and interventional cardiology).

Your GP?….Yes!

If you are in the UK for sure! This was found in a study were 5 million patient records were analyzed by the University of Birmingham’s Institute for Applied Health Research.

Atrial Fibrillation treatment and diagnosis usually begins at your general practitioner.

The proportion of patients with atrial fibrillation who were being prescribed anticoagulants rose from 35,4% in 2000 to 75,5% in 2016. That is a rise of 40,1%.

This shows that General Practitioners have become better at identifying and treating patients with atrial fibrillation. This could be true in other parts of the world also, but there is no evidence for that at this stage.

Genome-wide association study(GWAS)

By drawing on genomic data from more than one million individuals, researchers discovered as-yet unknown genetic risk factors for atrial fibrillation. This study conducted by the University of Michigan enabled scientists to identify 151 candidate genes for atrial fibrillation.

This study used data from many biobanks around the world, and this big-data approach was one of the main reasons why these genes could be discovered.

This very new study was published in Nature Genetics on 30 July 2018 and also reported in Science Daily on 2 August 2018.

Genetic variation may predispose the heart to atrial fibrillation during fetal development, and “high-risk individuals” could be identified and monitored accordingly.

This discovery could lead to better treatment and prevention, and according to the study author Cristen Willer,Phd, Associate  Professor at Michigan Medicine and head of U-M’s Willer lab  “We are hopeful that additional molecular biology experiments will determine how to create sustained regular heart rhythms by studying the genes we and others have identified,”

Can a Smartwatch detect AFIB automatically?

According to new studies Yes!

With a specifically designed App for the Apple Watch researchers of the UC San Francisco have shown that the smartwatch can detect Atrial Fibrillation(AFIB) or any arrhythmia. These findings appeared online on 21 March 2018 in JAMA Cardiology.

Some of the key factors at play here is that sometimes AFIB is not diagnosed because it is intermittent or there are no symptoms experienced by the patient. The smartwatch can provide “passive” detection, and that means there is no need for intervention by the user.

Some of the limitations were that only Apple Watch was used and no other smartwatch, less “tech-savvy” individuals could struggle with the watch and App setup and data only focused on those people who were known to have AFIB, so ability to identify new diagnosis was not proved.

Although the conclusion of the study is that further studies will help to identify the optimal role for smartwatch-guided rhythm assessment, there was proof of concept that a smartwatch can passively detect AF. For now, that smartwatch will obviously not be as sensitive as a criterion-standard ECG. But!  Atrial Fibrillation treatment and diagnosis can start by just looking at your watch!

~~~Could the future be as easy as your smartwatch detecting that you have AFIB, sending the report to your doctor, and him sending you your time for an appointment with him, and time for your cardioversion. All this without you even knowing about the AFIB?

…..I’m just dreaming now.~~~

Wireless, At-home patch

The Zio XT wireless patch is made by iRhythm, and it produced an almost threefold improvement in the rate of diagnosis of AFIB in those actively monitored compared to usual care.

This patch monitors electrocardiogram(ECG) readings through the skin and looks for signs of arrhythmia, AFIB included. The study involved 5200 patients from across the United States and many received this high-tech wireless patch by mail. Atrial Fibrillation treatment and diagnosis can, in the nearby future, start by receiving a patch through the mail!

With this patch, there could be immediate monitoring, higher rates of AF diagnosis and faster initiation of anticoagulants.

What’s available now?

In a previous post, I described some of the options available right now, and you can check it out HERE.

Also, look at Rooibos Tea, and if you have never heard off it, you surely have to, at least,  investigate it HERE.

Please comment if you know of any other new Atrial Fibrillation treatment and diagnosis options, and also mention if anyone has used any of the above-mentioned technology or treatments.
Thank you for reading!

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