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 Marcus, MD, MAS • Coronary artery disease • Smoking Professor of Medicine in Residence Endowed Professor of Atrial Fibrillation • Heart failure Research University of California, San Francisco • Elevated BMI Disclosures To identify modifiable targets • Research: to prevent AF – NIH – PCORI – TRDRP – Medtronic – Jawbone – Eight Sleep – Baylis • Consulting and Equity: – InCarda Therapeutics – Talaria Therapeutics 1
9/12/2019 Model C-Stat for 95% CI 5 year AF risk 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 2
9/12/2019 What about caffeine? • 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%) Vivian Yang Kelsey Ogomori Sean Joyce Dr. David Rosenthal CVRI T32 Fitbit Flex 2 Dr. Robert Avram Quebec Research Funds UCSF Fellowship in Digital CV Research 3
9/12/2019 1. Kodama et al. J Am Coll Cardiol 2011 4
9/12/2019 Acute Effects? A Natural Experiment • Is it a clear acute effect? Is it a delayed effect? Does the rhythm change prior? Dukes JW et al. BMJ 2016 The HOLIDAY (HOw ALcohol InDuces A Natural Experiment Atrial TachYarrhythmias) Trial Electrophysiology outcomes: 1. Atrial ERP 2. Conduction times 3. Sustained AF Dukes JW et al. BMJ 2016 Funded by NIAAA R01AA022222 5
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9/12/2019 Sleep and Atrial Fibrillation Observational Studies • Obstructive sleep apnea is an established risk factor for AF – Why? • Can’t prove causality • Autonomic changes, hypopnea, hypertension, the • What kind of study would AF patients associated obesity like to do? • Anecdotally patients describe lack of sleep as a trigger • …maybe sleep disruption itself is important N=957 From 5,703 Cardiovascular Health Study participants Groh et al. Heart Rhythm 2019 FREE from AF at baseline. 1,588 developed incident AF over a median 11.6 years of follow-up. 7
9/12/2019 Individualized Studies of Triggers of Paroxysmal Atrial Fibrillation (I-STOP-AFib) AF event tracking only Assess quality of life N-of-1 Trials to Test Triggers and The Health e Heart Study Receive Results Conclusions: Why do we N-of-1 Study: AF Triggers care? • 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 8
9/12/2019 EP Faculty Mel Scheinman EP Fellows Ed Gerstenfeld EP nurses Thank You Byron Lee Zian Tseng Vasanth Vedantham Research Coordinators Nitish Badhwar Rachel Gladstone Randy Lee Josh Moss Emily Lee Shannon Fan Henry Hsia Christina Fang Tomos Walters Research Mentees Defne Yilmaz Jonathan Hsu Kelsey Ogomori Sean Joyce Statistical and Analytical Support Thomas Dewland Eric Vittinghoff Vivian Yang Jason Roberts Gregory Nah Jonathan Dukes Outside Collaborators Isaac Whitman Susan Heckbert (UW) Bruce Psaty (UW) Chris Groh David Siscovick (UW/ NYA Health eHeart and Eureka Team Jose Sanchez Medicine) Jeff Olgin Dante Solorio David Rosenthal Alvaro Alonso (U Minn) Mark Pletcher Oana Popescu Mala Mandyam Elsayed Soliman (Wake Carol Maguire Ryan Runge Patrick Maher Keetan Rutlege Shalini Dixit Forest) Noah Peyser Rodolfo Sanchez Emelia Benjamin (BU) Lisa Lim Kaylin Nguyen Shabir Sarwary Todd Parsnick Abel Sierra Matt Christensen Xochitl Butcher Jin Yu Tuomas Kerola Efren Carbajal Research Support Hollis Moore Emily Wilson Emina Seremet Mayank Sardana NIH (NIBIB, NHLBI, NIAAA) Vadim Ananyev Nancy Wu PCORI Kirstin Aschbacher Jose Sanchez Helena Eitel Robert Avram TRDRP David Wen Grace Furnari Alex Cabrera Cardiogram Armando Godinez Ricardo Barrera Chinye Ijeli Jawbone Jairo Vazquez Aldo Navarro Eight Sleep THE CIA (UCSF Cardiology) 9
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