the 5 most important things you need to know about atrial ... · the 5 most important things you...
TRANSCRIPT
![Page 1: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/1.jpg)
John D. Day, MD Director, Intermountain Heart Rhythm Specialists
The 5 Most Important Things You Need to Know About
Atrial Fibrillation
![Page 2: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/2.jpg)
Disclosures
• None
![Page 3: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/3.jpg)
The 5 Most Important Things You Need to Know About Atrial Fibrillation
1. Lifestyles cause, prevent, or reverse AF 2. Dementia may be the real risk of AF 3. AF drugs aren’t perfect 4. Ablation often curative in early AF 5. Must change lifestyle for late AF
ablations
![Page 4: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/4.jpg)
Chugh et al. Circulation. 2014;129:837-847
Global AF/Flutter Burden
![Page 5: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/5.jpg)
Global Obesity Burden
World Health Organization, 2011
![Page 6: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/6.jpg)
Asia vs. North America Incidence per 100,000 Person-years
Women
Men0
50100150200250
300
AsiaNorth America
19.8
196.3 33.8
264.5
Women Men
Chugh et al. Circulation. 2014;129:837-847
8x
10x
![Page 7: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/7.jpg)
Incidence of AF in California Medicare patients per 1,000 Person Years
Circulation. 2013 Dec 3;128(23):2470-7
35.7 28.2 26.9 26
05
10152025303540
White Black Hispanic Asian
• 13,967,949 patients • 375,318 incident AF episodes over 3.2 years
![Page 8: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/8.jpg)
Some Physical Activity ~50% Reduction
Circ Arrhythm Electrophysiol. 2014;7:620-625
n = 14,219
![Page 9: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/9.jpg)
![Page 10: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/10.jpg)
LEGACY Study • 355 overweight A-Fib patients • Average baseline weight: 220 pounds • 38% successful, lost average of 36 pounds • Kept weight off for 1-2 years
![Page 11: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/11.jpg)
How Important is Losing 36 Pounds? • 46% of A-Fib patients went into remission • Systolic blood pressure down 18 mmHg • Inflammation decreased 76% (CRP) • Diabetes into remission: 88% • LDL down 16%, triglycerides 31% • Heart disease reversed
![Page 12: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/12.jpg)
The 5 Most Important Things You Need to Know About Atrial Fibrillation
1. Lifestyles cause, prevent, or reverse AF 2. Dementia may be the real risk of AF 3. AF drugs aren’t perfect 4. Ablation often curative in early AF 5. Must change lifestyle for late AF
ablations
![Page 13: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/13.jpg)
Heart Rhythm 2010;7:433-437
![Page 14: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/14.jpg)
Dementia Type
Inci
denc
e (%
) p<0.0001
p<0.0001 p<0.0001 p<0.0001
No Atrial Fibrillation
Atrial Fibrillation
• 37,026 patients, 5 years follow-up
• MRI/neurologist confirmed diagnosis
• AF + Alzheimer’s rapid decline
Heart Rhythm 2010;7:433-437
![Page 15: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/15.jpg)
Dementia and Alzheimer's Disease Odds Ratio
Age
(yea
rs)
Increased Risk
Heart Rhythm 2010;7:433-437
![Page 16: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/16.jpg)
Heart Rhythm. 2012 Nov;9(11):1761-8
![Page 17: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/17.jpg)
Is 5 years of data enough???
![Page 18: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/18.jpg)
Cognitive Changes Immediately
J Am Coll Cardiol 2013;62:1990–7
No Afib
Paroxysmal Afib
Persistent Afib
![Page 19: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/19.jpg)
The 5 Most Important Things You Need to Know About Atrial Fibrillation
1. Lifestyles cause, prevent, or reverse AF 2. Dementia may be the real risk of AF 3. AF drugs aren’t perfect 4. Ablation often curative in early AF 5. Must change lifestyle for late AF
ablations
![Page 20: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/20.jpg)
Patients without recurrence (%)
Follow-up (days)
Amiodarone
Propafenone/flecainide Sotalol
0
20
40
60
80
100
0 100 200 300 400 500 600
Circulation 2000, 102:2385-2390, J Cardiovasc Electrophysiol, 2010; Vol. 21, pp. 597-605
Dofetilide
How good are antiarrhythmics?
Dronedarone
![Page 21: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/21.jpg)
J Am Coll Cardiol 2014;63:2141–7
• Definition: 2 units PRBCs at a critical site or death • Brain, eye, spine, joint, pericardium, retroperitoneal • 18,140 patients, average CHADS score of 2.1 • Warfarin: 3.09% per year • Apixaban: 2.13% per year
![Page 22: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/22.jpg)
Cerebral Microbleeds
Lancet Neurol. 2009 Feb;8(2):165-74
![Page 23: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/23.jpg)
Annual Warfarin Microbleeds
Charidimou, Front Neurol, 2012
![Page 24: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/24.jpg)
Reverse CHADS-VASc Score
2014 AHA/ACC/HRS Atrial Fibrillation Treatment Guidelines
✔ ✔
✔ ✔
![Page 25: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/25.jpg)
The 5 Most Important Things You Need to Know About Atrial Fibrillation
1. Lifestyles cause, prevent, or reverse AF 2. Dementia may be the real risk of AF 3. AF drugs aren’t perfect 4. Ablation often curative in early AF 5. Must change lifestyle for late AF
ablations
![Page 26: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/26.jpg)
Ablation Success by Fibrosis
DEECAF Multicenter Study: JAMA. 2014;311(5):498-506
329 patients, 15 centers
85%
54%
68%
31%
![Page 27: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/27.jpg)
AF Begets AF…Fast... • Electrical remodeling within 30 minutes • Fibrosis within 5 weeks
Circulation 1996;94:2968-74, Circulation 1999;100:87-95
![Page 28: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/28.jpg)
AF Diagnosis to Ablation: Success Rates
81%
77%
75%
72%73%74%75%76%77%78%79%80%81%82%
Ablation Success
1-3 months 3-12 months > 1 year
Heart Rhythm. 2013 Sep;10(9):1257-62
![Page 29: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/29.jpg)
The 5 Most Important Things You Need to Know About Atrial Fibrillation
1. Lifestyles cause, prevent, or reverse AF 2. Dementia may be the real risk of AF 3. AF drugs aren’t perfect 4. Ablation often curative in early AF 5. Must change lifestyle for late AF
ablations
![Page 30: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/30.jpg)
![Page 31: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/31.jpg)
Lifestyle Modification After AF Ablation
One Ablation
2 Ablations
0%
20%
40%
60%
80%
100%
Lifesyle ChangesNo Changes
62%
26%
87%
48%
One Ablation 2 Ablations
n = 165
Sanders P. 2014 Annual Scientific Sessions of Heart Rhythm Society
![Page 32: The 5 Most Important Things You Need to Know About Atrial ... · The 5 Most Important Things You Need to Know About Atrial Fibrillation 1. Lifestyles cause, prevent, or reverse AF](https://reader036.vdocuments.mx/reader036/viewer/2022070720/5ee02e69ad6a402d666b6a4a/html5/thumbnails/32.jpg)
Increased AF Recurrence Risk Following AF Ablation:
If Unable to Lose 3% of Weight
0% 20% 40% 60% 80% 100%
Yo yo
Gained
Maintained
AHA 2015
• n=407 • 3 Year Follow Up