The 5 Most Important Things You Need to Know About Atrial Fibrillation. John D. Day, MD

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1 The 5 Most Important Things You Need to Know About Atrial Fibrillation John D. Day, MD

2 Disclosures Consulting with St. Jude Medical, Boston Scientific, and Biotronik

Dementia may be the real risk of AF 3. AF drugs aren t perfect 4.

3 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

4 Global AF/Flutter Burden Chugh et al. Circulation. 2014;129:

5 Global Obesity Burden World Health Organization, 2011

Women Men 264.5 300 250 200 150 33.8 196.

6 Asia vs. North America Incidence per 100,000 Person-years Women Men Men 8x 0 Asia North America Women 10x Chugh et al. Circulation. 2014;129:

7 Incidence of AF in California Medicare patients per 1,000 Person Years 13,967,949 patients 375,318 incident AF episodes over 3.2 years White Black Hispanic Asian Circulation Dec 3;128(23):2470-7

8 Some Physical Activity ~50% Reduction n = 14,219 Circ Arrhythm Electrophysiol. 2014;7:

9 Yoga: 24% Reduction JACC Vol. 61, No. 11, 2013 March 19, 2013:

11 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 Well being up 200%!

12 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

13 Heart Rhythm 2010;7:

p<0.0001 No Atrial Fibrillation Atrial Fibrillation 37,026

confirmed diagnosis AF + Alzheimer s rapid decline p<0.

14 p< No Atrial Fibrillation Atrial Fibrillation 37,026 patients, 5 years follow-up Incidence (%) MRI/neurologist confirmed diagnosis AF + Alzheimer s rapid decline p< p< p< Dementia Type Heart Rhythm 2010;7:

15 Dementia and Alzheimer's Disease Odds Ratio Increased Risk Age (years) Heart Rhythm 2010;7:

16 Is 5 years of data enough???

17 Cognitive Changes Immediately No Afib Paroxysmal Afib Persistent Afib J Am Coll Cardiol 2013;62:1990 7

18 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

19 How good are antiarrhythmics? 100 Patients without recurrence (%) Amiodarone Sotalol Propafenone/flecainide Dofetilide Dronedarone Follow-up (days) Circulation 2000, 102: , J Cardiovasc Electrophysiol, 2010; Vol. 21, pp

20 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 J Am Coll Cardiol 2014;63:2141 7

21 Cerebral Microbleeds Lancet Neurol Feb;8(2):165-74

22 Annual Warfarin Microbleeds Charidimou, Front Neurol, 2012

23 Reverse CHADS-VASc Score 2014 AHA/ACC/HRS Atrial Fibrillation Treatment Guidelines

24 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

25 Ablation Success by Fibrosis 329 patients, 15 centers 85% 68% 54% 31% DEECAF Multicenter Study: JAMA. 2014;311(5):

26 AF Begets AF Fast... Electrical remodeling within 30 minutes Fibrosis within 5 weeks Circulation 1996;94: , Circulation 1999;100:87-95

27 AF Diagnosis to Ablation: Success Rates 82% 81% 80% 79% 78% 77% 76% 75% 74% 73% 72% 1-3 months 3-12 months > 1 year 81% 77% 75% Ablation Success Heart Rhythm Sep;10(9):

28 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

29 Lifestyle Medicine Improves Acute Success One Ablation 2 Ablations 100% 80% 60% 40% 20% 0% 87% 48% 62% 26% Lifesyle Changes No Changes n = Ablations One Ablation 2014 Annual Scientific Sessions of Heart Rhythm Society

30 Will lowering BMI improve long-term success? J Interv Card Electrophysiol Sep;46(3):259-65

31 A Lower BMI Improves Success n = 1,558

32 Losing Weight Improves Success n = 1,558

BMI and Long-term Success 1. Optimal BMI was 21-25 2. Any weight loss improves success 3.

33 BMI and Long-term Success 1. Optimal BMI was Any weight loss improves success 3. Most high BMIs recur long-term 4. BMI < 20 have a high risk of CV death J Interv Card Electrophysiol Sep;46(3):259-65

34 Questions? Mobile: facebook.com/drjohnday

The 5 Most Important Things You Need to Know About Atrial Fibrillation. John D. Day, MD Director, Intermountain Heart Rhythm Specialists

The 5 Most Important Things You Need to Know About Atrial Fibrillation John D. Day, MD Director, Intermountain Heart Rhythm Specialists None Disclosures The 5 Most Important Things You Need to Know About