Dr John M

cardiac electrophysiologist, cyclist, learner

  • Home
  • About
    • About Me
    • About the Blog
      • General Cardiology and Internal Medicine
    • Six Reasons why I Blog
    • What’s Electrophysiology?
    • ICD/Pacemaker
    • Electrophysiology Column / Medscape
    • Contact
  • Afib
    • AFib
    • AF in Athletes
    • The best tool to treat AF
    • Know your CHADS-VASC Score
    • 3 non-warfarin anticoagulants
    • AF ablation
      • 13 things to know about AF
      • Atrial Fib Ablation -2012 Update
      • Gender-Spec results of AF ablation
    • Female gender and stroke risk in AF
    • My AF Story
  • Heart Healthy
    • Heart Disease (by DrJohnM)
    • Healthy Living
    • Exercise
    • Nutrition
    • inflammation
  • Policy
    • Policy
    • Health Care
    • Health Care Reform
  • Doctoring
    • Doctoring
    • Knowledge
    • Reflection
    • General Medicine
      • Does your cholesterol level matter?
    • General Cardiolgy – Medicine
      • What is a normal heart rate?
      • Cardiology/Internal Med
      • General Cardiology
      • Athletic heart
        • The ECG of an athlete
      • General Medicine
      • Stroke
      • Statins
  • Cycling
    • DrJohnM on Cycling
    • How I became a bike racer
    • My top 12 Likes on Cycling
    • Cyclocross
      • A CX-Primer
    • Fitness
    • Athletic heart
    • The Mysterious Athletic Heart

Live Blog–Boston AF symposium

January 12, 2012 By Dr John

I’ve never tried this before: giving some brief snips of an AF symposium, on the fly. 

Maybe doing so will help me remember. My comments are in italics.

Little proofreads–consider these quick notes.

First talk: Dr Jalife. Molecular mechanisms AF: 

Think fibrosis, or the infiltration of scar tissue within the muscle of the heart. This is bad because it disrupts the normal propagation of electricity. The cells that make the scar are called Fibroblasts. I learned about them the first semester of med school; who knew they would be so involved as the root cause of my profession.

To quote, Dr Jalife, a very famous researcher…

“To prevent AF…start early!” Trest similarly to ChF and atherosclerosis.”  

This makes sense. 

—Next:

Dr Stanley Nattel: Obesity and sleep apnea. (OSA = Obstructive Sleep Apnea). Mechanisms in the generation of AF.

Dr Nattell presented data from rats. He compared sleep apnea models in obese vs lean rats. 

OSA increases AF inducibility, especially in obese rats. 

Why? Because the disordered breathing in OSA causes acute LA dilation and the effect was greater in obese rats, though still present in lean rats. 

“CPAP applied early may prevent acute effects of repeated episodes, as long as it is started early.” 

Early intervention again. Ask about sleep disorders. Sleep, the third prong of good health–the other two of course, exercise and nutrition. 

Next…

Dr Patrick Ellinor: Genetics of AF. How will GWAS (Genome wide association studies) findings apply to clinical practice? GWAS uses an entire population to look for genetic variants. 

Background: Parental history doubles AF risk. Any first degree relative with AF increases risk by 40%. Risk of inheritance higher with early onset of AF. Old data here. 

Variants on chromosome 4 increases AF risk. But the odds ratios are not high enough to be useful. “Right now, taking a history in the office yields better predicative value than any gene test,” Dr Ellinor adds.

Why the interest in genetics and AF then?

Dr Ellinor says, “Discovery tool…Science takes time.” 

Interesting topic–AF is definitely clustered in certain phenotypes and is markedly decreased is some populations, African-Americans for example have less AF than northern Europeans??? 

–Next…

Dr Charlie Antzelevitch — New directions in AF drug therapy.

Atrial-selective K-blockers thought to be good place to look for new drugs, but thus far, these drugs have not worked.

What about atrial-selective Na channel inhibition? 

Ranolizine: Maybe.

Vernakalent: Maybe + 

Wenxin Keli: Chinese herb with significant electrical effects on the atria, but not so much in the ventricle. intriguing. Stay tuned.  

Combinations of drugs: amiodarone and ranolizine. Effective but scary. 

Dronedarone and ranolazine. Not too bad. But again, a scary combination. 

I may be wrong, but the future of drug therapy for AF seems limited. Heck, you know how I feel about treating heart disease: drugs are always second or third choices. The chinese herb is worth a google search, if nothing else, for curiosity.  

—Next…

Final talk of the morning session: 

Dr Jalife: Best basic science papers in 2011.

Circ research 2011 108: 164 — AF induces myocardial fibrosis–role of angiotensin 2. Losartan, a commonly used blood pressure medicine may help reduce fibrosis reduced. Again, hope if one starts early.

Circ 2011 124 1212– Defects in ankyrin-based membrane proteins… Important in AF susceptibility. This protein plays a role in AF. Sorry. This was over my head. 

Circ cardiovascular Genet 2011 4: 269 On genetics, the role of a funny-sounding gene Pitx2. I have little to translate on this one as well. Basic science is tough for regular doctors. 

JMM









  • Email
  • LinkedIn
  • Facebook
  • Twitter
  • More
  • Reddit

Related posts:

  1. Highlights of the 2011 Boston AF Symposium
  2. Day 2: Atrial Fibrillation Symposium. Good doctoring…
  3. A cyclist at the Atrial Fibrillation Symposium- Day 1. Athletes and AFib get some press…
  4. "People of Size?" Really…

Filed Under: Atrial fibrillation Tagged With: Boston AF

John Mandrola, MD

Welcome, Enjoy, Interact. john-mandrola I am a cardiac electrophysiologist practicing in Louisville KY. I am also a husband to a palliative care doctor, a father, a bike racer, and a regular columnist at theHeart.org | Medscape

My First Book is Now Available…

Email Newsletter

Search the Site

Categories

Find me on theheart.org | Medscape Cardiology

  • Electrophysiology commentary on Medscape/Cardiology

Mandrola on Medscape

  • My Medscape column on general medical matters

For patients...Educational posts

  • 13 things to know about Atrial Fibrillation — 2014
  • A new cure of AF
  • Adding a new verb to doctoring: To deprescribe is to do a lot
  • AF ablation — 2015 A Cautionary Note
  • AF Ablation in 2012–An easier journey?
  • Atrial Flutter — 15 facts you may want to know.
  • Benign PVCs: A heart rhythm doctor’s approach.
  • Caution with early Cardioversion
  • Decisions of 2 low-risk cases of PAF
  • Defining success in AF ablation in 2014
  • Four commonly asked questions on AF ablation
  • Inflammation and AF — Get off the gas
  • Ten things to expect after AF ablation
  • The medical decsion as a gamble
  • The most important verb in our health crisis
  • Wellness Requires Ownership

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.