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Stretch Induced Pulmonary Vein Remodelling: Implications For The Initiation And Maintenance Of Atrial Fibrillation
Funder
National Health and Medical Research Council
Funding Amount
$569,823.00
Summary
Atrial fibrillation (AF) is the most common heart rhythm disorder to affect humans, occurring in 2% of adults. It is a chaotic rhythm disorder of the top chambers of the heart that results in frequent hospitalization for falls, chest pain, palpitations, heart failure and stroke. In addition, it is associated with an increased mortality. Evidence suggests an important role of the pulmonary veins (PV; veins draining blood from the lungs back to the heart) in the initiation and maintenance of AF. H ....Atrial fibrillation (AF) is the most common heart rhythm disorder to affect humans, occurring in 2% of adults. It is a chaotic rhythm disorder of the top chambers of the heart that results in frequent hospitalization for falls, chest pain, palpitations, heart failure and stroke. In addition, it is associated with an increased mortality. Evidence suggests an important role of the pulmonary veins (PV; veins draining blood from the lungs back to the heart) in the initiation and maintenance of AF. However, why these structures promote AF remains unknown. Several conditions predisposing to the development of AF are associated with atrial stretch (such as heart failure). These conditions have documented abnormalities within the atria but the changes that occur within the PVs are unknown. It has even been suggested that pulsatile stretch, as caused by blood flow, in the appropriately predisposed patient, may be enough to trigger AF. As such there has been an intensive search to identify the abnormalities that occur within the PVs. In patients with AF, the PVs demonstrate distinctive electrophysiological properties compared to those without AF. However, the effect of stretch, a common predisposing factor, on the electrophysiological properties of the PV is not known. Preventing electrical activity from the PVs interacting with the heart by ablation has provided a glimpse at our ability to cure AF. However, further improvements in our procedural technique, the ability to prevent the occurrence of this rhythm disorder, and the development of noninvasive strategies to cure AF, hinges on the better understanding of the mechanisms initiating and maintaining this condition. In particular, the electrophysiological changes within the PVs that predispose patients to the development of AF need to be investigated. This series of studies will evaluate the effect of acute and chronic stretch on the PVs in humans to determine why these structures promote AF.Read moreRead less
Analysis Of Atrial Electrical Remodelling In Patients With Paroxysmal And Persistent Atrial Fibrillation
Funder
National Health and Medical Research Council
Funding Amount
$127,516.00
Summary
I am a cardiologist undertaking further training in the management of electrical abnormalities of the heart. My research will focus on the mechanisms responsible for atrial fibrillation, the most common serious heart rhythm disorder. I intend to do this by examining the nature of the electrical activity in patients with atrial fibrillation and comparing this to electrical activity in patients without this disorder, who are undergoing treatment procedures for their electrical disorder.
Atrial fibrillation (AF) is the most common cause for an irregular heart beat. Catheter ablation is the only potential cure and involves passing wires via veins in the leg into the heart to deliver discrete small burns(ablation) around the pulmonary veins (PV), the major source for AF. Unfortunately 30-50% of patients have recurrent arrhythmia due to reestablishment of electrical connections. This multicentre internation trial examines whether more (maximal) ablation will improve the outcomes of ....Atrial fibrillation (AF) is the most common cause for an irregular heart beat. Catheter ablation is the only potential cure and involves passing wires via veins in the leg into the heart to deliver discrete small burns(ablation) around the pulmonary veins (PV), the major source for AF. Unfortunately 30-50% of patients have recurrent arrhythmia due to reestablishment of electrical connections. This multicentre internation trial examines whether more (maximal) ablation will improve the outcomes of the procedure.Read moreRead less
Characterisation Of CFAE Wavefront Propogation In Human Persistent AF
Funder
National Health and Medical Research Council
Funding Amount
$418,612.00
Summary
Atrial fibrillation can be eliminated by a relatively new treatment called catheter ablation, which involves modification of the electrical properties of the heart using thin wires (catheters) passed up from the leg. Targeting areas where catheters record abnormal electrical activity improves results of catheter ablation, although it is uncertain what these recordings represent. The aim of this study is to characterize these abnormal electrical signals in an attempt to improve ablation outcomes.
Structural And Functional Determinants Of Spatiotemporal Periodicity In Cardiac Impulse Propagation
Funder
National Health and Medical Research Council
Funding Amount
$211,320.00
Summary
Abnormal heart rhythms (cardiac arrhythmias) are responsible for much morbidity and excess mortality in Australia. Although many abnormalities leading to an abnormal heart rhythm may be successfully treated by medications or minimally invasive operative procedures there are several important ones which are not. These include the most common significant cause of an abnormal heart rhythm, atrial fibrillation, and the arrhythmias responsible for approximately half of sudden deaths, ventricular tach ....Abnormal heart rhythms (cardiac arrhythmias) are responsible for much morbidity and excess mortality in Australia. Although many abnormalities leading to an abnormal heart rhythm may be successfully treated by medications or minimally invasive operative procedures there are several important ones which are not. These include the most common significant cause of an abnormal heart rhythm, atrial fibrillation, and the arrhythmias responsible for approximately half of sudden deaths, ventricular tachycardia and ventricular fibrillation. Atrial fibrillation is a leading cause of stroke. Sudden death is associated with aging and is an increasing problem because of the rising mean age of the population. Recent negative attention on the side effects of medications used for the treatment of cardiac arrhythmias has appropriately increased interest in curative approaches requiring no onging medications. These procedures usually rely on mapping electrical activity in the heart and interrupting abnormal electrical pathways using radiofrequency electrical current. The procedures are unsuccessful when existing techniques fail to identify the underlying mechanism responsible for the abnormal heart rhythm or when the source of the abnormal beating cannot be localised within the heart. In this project we investigate the fundamental basis for a new approach to these problems. By examining the variability of the beat rate and the variability of the beat rate at different points within the heart we may be able to identify arrhythmia mechanisms and localise arrhythmia sources. In this project we will examine in groups of cells the structures and types of electrical circuits which give rise to certain types of beat-to-beat variability in the heart. This information will be essential for the interpretation of information obtained in later human studies and the subsequent development of new curative procedures for these problems.Read moreRead less
CAPLA Study: Catheter Ablation For Persistent Atrial Fibrillation. A Multicentre Randomised Study Of Pulmonary Vein Antral Isolation (PVAI) Alone Vs PVAI With Posterior Left Atrial Wall Isolation (PWI)
Funder
National Health and Medical Research Council
Funding Amount
$124,676.00
Summary
Atrial fibrillation (AF) is a common heart rhythm abnormality that affects quality of life with added health care costs. A minimally invasive procedure called catheter ablation (CA) is effective in controlling simple AF (paroxysmal AF) but the best ablation strategy to control a more resistant form of AF (Persistent AF) is unknown. This trial has been designed to address this key gap in knowledge by assessing if adding specific additional ablation to CA will improve outcomes.
Effects Of N-3 Polyunsaturated Fatty Acids On Post Surgical Atrial Fibrillation: A Prospective Randomised Study
Funder
National Health and Medical Research Council
Funding Amount
$536,529.00
Summary
Consumption of fish and fish oil has been associated with protective effects for deaths from heart disease in many studies. The effects are consistent and quite strong and appear to be unrelated to blood cholesterol levels. The effects are more likely due to the possibility that fish oil, which contains n-3 fats, can suppress abnormal heart rhythms which can cause 'sudden cardiac death'. This has been shown in animal studies, and recently we have shown that they can also suppress abnormal heart ....Consumption of fish and fish oil has been associated with protective effects for deaths from heart disease in many studies. The effects are consistent and quite strong and appear to be unrelated to blood cholesterol levels. The effects are more likely due to the possibility that fish oil, which contains n-3 fats, can suppress abnormal heart rhythms which can cause 'sudden cardiac death'. This has been shown in animal studies, and recently we have shown that they can also suppress abnormal heart rhythms in humans. Patients undergoing coronary bypass surgery are particularly susceptible to abnormal heart rhythms in the upper chambers of the heart in the days immediately following surgery. While these abnormal rhythms are rarely life threatening, they can result in increased post-surgical complications and a longer hospital stay with associated increased costs to the health system. In this study we will determine whether providing high dose fish oil for 3 weeks immediately preceding coronary bypass surgery, will result in a reduction in the proportion of patients experiencing post-surgical abnormal heart rhythms. We will also examine the effects of n-3 fats on the incidence of other complications following bypass surgery and also the length of hospital stay. In addition, we will gather data which will provide insight into the mechanisms by which n-3 fatty acids produce their well documented benefits to patients with cardiovascular disease. The significance of this study is its ability to provide a protective strategy in heart disease in which the mechanism is understood, which is effective, and importantly, which will have the potential to provide savings to the health care system through a reduction in hospital stay.Read moreRead less
A Prospective Multicentre Randomized Study To Evaluate The Impact Of OSA Treatment With CPAP On Atrial Electrical And Structural Substrate And On Long Term Maintenance Of Sinus Rhythm Following Catheter Ablation Of Atrial Fibrillation
Funder
National Health and Medical Research Council
Funding Amount
$128,224.00
Summary
Atrial fibrillation(AF) is the commonest heart rhythm disorder causing stroke, heart failure and increased mortality. Similarly, obstructive sleep apnea(OSA) is increasingly recognised as a modern epidemic. Epidemiological data have demonstrated an independent association between the two conditions. We will conduct a prospective multicenter randomized study to evaluate the impact of OSA treatment on: (i)maintenance of sinus rhythm after catheter ablation of AF, (ii)atrial structure and function
Epicardial Mapping Of Persistent Atrial Fibrillation. Identifying AF Mechanisms In Different Atrial Substrates.
Funder
National Health and Medical Research Council
Funding Amount
$654,341.00
Summary
Atrial fibrillation (AF) is a very common heart rhythm disturbance (arrhythmia) which carries with it an increased risk of having a stroke and a twofold risk of dying. At present, we still have only a limited understanding of the mechanism of AF when it becomes persistent. The aim of this study is to determine the critical mechanism of persistent AF in patients with different types of heart conditions. This knowledge is fundamental to the development of more successful curative approaches.
Circumvenous Ablation For Treatment Of Atrial Fibrillation
Funder
National Health and Medical Research Council
Funding Amount
$341,844.00
Summary
Atrial fibrillation is the most common abnormal heart rhythm. It causes symptoms that may be disabling but also increases the risk of stroke and death. The lifetime risk of developing atrial fibrillation is 20-25%. Treatment with medications is often unsuccessful and is never curative. Recently a new minimally invasive procedure was developed that may cure some patients. The purpose of this clinical trial is to improve the curative technique to broaden the application of the new procedure.