Atrial fibrillation (AF) is a growing epidemic and there are many knowledge gaps including:
- Whether we can intervene early in the disease process and prevent AF (primary prevention).
- How to direct individual tailored therapy for patients with established disease.
Goals of the Cluster
- Elucidation of how to select patients for atrial fibrillation ablation.
- Genetic studies and use of biomarkers to direct atrial fibrillation treatment.
- Development of an inexpensive, always-on, remotely monitored miniature plethysmograph device capable of detecting AF.
- Targeted somatic gene transfer to identify, isolate and study autonomic ganglia which may be causal for AF.
- Collaborations with emergency room physicians on management of patients with AF.
- UOHI regional AF Program including the Effectiveness of a Multi-disciplinary Clinic in Reducing AF Related Outcomes - A Cluster Randomized Trial – The ERAF Trial.
Innovation Cluster Scientists
Lead: David Birnie, MD, University of Ottawa Heart Institute
Team members at the University of Ottawa Heart Institute:
Darryl Davis, MD, Rob deKemp, PhD, Sandy Dick, MD, Girish Dwivedi, MD, PhD, Martin Green, MD, Khanh Lam, MD, Robert Lemery, MD, Peter Liu, MD, Girish Nair, MD, Pablo Nery, MD, Andrew Pipe, MD, Calum Redpath, MD, PhD, Jennifer Reed, PhD, Diem Tran, MD, George A. Wells, PhD.
Correlation of Arrhythmia Mechanism and Substrate to Ablate Persistent Atrial Fibrillation (COAST-AF)
COAST-AF is a pilot project with the goal of evaluating the utility of an innovative strategy for catheter ablation of atrial fibrillation (AF) using a combination of non-invasive ECG mapping, left atrial fibrosis analysis assessed by cardiac magnetic resonance imaging (MRI), and autonomic innervation evaluated by HED-PET. This is a multi-disciplinary project involving the Atrial Fibrillation Cluster and the Cardiovascular Imaging Cluster.
Exercise Training in Patients with Permanent Atrial Fibrillation: A randomized controlled trial (Exercise-AF)
Exercise-AF is a pilot project designed to evaluate the impact of exercise training on clinical, exercise and behavioural outcomes in patients with permanent AF. This is a multi-disciplinary project involving the Atrial Fibrillation Cluster, the Division of Prevention and Rehabilitation and Family Health Teams in the Champlain Region of Ontario.
Project led by Jennifer Reed, PhD
Augmented Wide Area Circumferential Catheter Ablation For Reduction of Atrial Fibrillation Recurrence - A Randomized Vanguard Pilot Trial (AWARE Trial)
Project led by Girish Nair, MD
Toward a Continuous Monitor to Help Predict and Prevent AF
Project led by Calum Redpath, MD, PhD
- Redpath CJ, Backx PH. Atrial fibrillation and the athletic heart. Curr Opin Cardiol. 2015 Jan;30(1):17-23.
- Reed JL, Birnie DH, Pipe AL. Exercise training in patients with paroxysmal, persistent or permanent atrial fibrillation. CMAJ. 2014 Oct 7;186(14)
- Cameron C, Coyle D, Richter T, Kelly S, Gauthier K, Steiner S, Carrier M, Coyle K, Bai A, Moulton K, Clifford T, Wells G. Systematic review and network meta-analysis comparing antithrombotic agents for the prevention of stroke and major bleeding in patients with atrial fibrillation. BMJ Open. 2014 Jun 2;4(6):e004301.
- Birnie DH, Healey JS, Essebag V. Management of anticoagulation around pacemaker and defibrillator surgery. Circulation. 2014 May 20;129(20):2062-5.
- Nair GM, Nery PB, Redpath CJ, Lam BK, Birnie DH. Atrioesophageal fistula in the era of atrial fibrillation ablation: a review. Can J Cardiol. 2014 Apr;30(4):388-95.
- Verma A, Champagne J, Sapp J, Essebag V, Novak P, Skanes A, Morillo CA, Khaykin Y, Birnie D. Discerning the incidence of symptomatic and asymptomatic episodes of atrial fibrillation before and after catheter ablation (DISCERN AF): a prospective, multicenter study. JAMA Intern Med. 2013 Jan 28;173(2):149-56.
- Birnie DH, Ha A, Higginson L, Sidhu K, Green M, Philippon F, Thibault B, Wells G, Tang A. Impact of QRS morphology and duration on outcomes after cardiac resynchronization therapy: Results from the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT). Circ Heart Fail. 2013 Nov;6(6):1190-8
- Redpath CJ, Bou Khalil M, Drozdzal G, Radisic M, McBride HM. Mitochondrial hyperfusion during oxidative stress is coupled to a dysregulation in calcium handling within a C2C12 cell model. PLos One. 2013 Jul 8;8(7):e69165.
- Reed JL, Mark AE, Reid RD, Pipe AL. The effects of chronic exercise training in individuals with permanent atrial fibrillation: a systematic review. Can J Cardiol. 2013 Dec;29(12):1721-8.
- DH, Healey JS, Wells GA, Verma A, Tang AS, Krahn AD, Simpson CS, Ayala-Paredes F, Coutu B, Leiria TL, Essebag V; BRUISE CONTROL Investigators. Pacemaker or defibrillator surgery without interruption of anticoagulation. N Engl J Med. 2013 May 30;368(22):2084-93.
Funding to support the Atrial Fibrillation Innovation Cluster projects includes:
- the Canadian Arrhythmia Network (CANet), which was awarded $26.3 million from the Networks of Centres of Excellence Program. It is led by Dr. Anthony Tang, MD, from University of Western Ontario, with Dr. George Wells, PhD, at the University of Ottawa Heart Institute as Associate Scientific Director, along with Dr. Robert Sheldon, MD, PhD, at the University of Calgary.
- the Canadian Stroke Prevention Intervention Network (C-SPIN), which was awarded $4.3 million from the Canadian Institutes of Health Research, with additional funding from industry. The network is led by Dr. Jeff Healey, MD, at McMaster University, with Dr. David Birnie, MD, as an Ottawa-based co-Principal Investigator.
Atrial Fibrillation Innovation Cluster physicians and scientists are actively participating in both these networks.
- Additional funding for the Cluster comes from Investigator grants from the Canadian Institutes of Health Research (CIHR) and the Heart and Stroke Foundation of Canada (HSFC).