What does it mean to have an irregular heart problem?
Your heart is driven to beat by electrical activity, which usually comes from a specific location within the heart itself. When cells fire outside of this area, irregular heartbeats and sometimes sustained arrhythmias can occur. There are a variety of arrhythmias. Atrial fibrillation, or AFib, is one of the most common, affecting approximately 50 million worldwide and more than 6 million in the U.S. AFib is associated with stroke and potential weakening of heart muscle function. Arrhythmias in the heart’s lower chambers, or ventricles, can present in a variety of ways. In more serious cases, they may result in sudden death.
Treatment options vary depending on the arrhythmia and may include medications, device implants (pacemakers or defibrillators) or ablation therapy. Ablation is an invasive, non-surgical procedure in which catheters are inserted into the heart. Once the arrhythmia sources are identified, they are targeted with energy to eliminate or contain them. Traditionally, heating or freezing energy is delivered, although newer energy sources are also being developed and are in clinical use.
What do we know about the people impacted by heart arrhythmias?
Arrhythmias present in different ways. In many, the structure of the heart is normal, but the electrical impulses are abnormal. Usually treatment is associated with a good prognosis. There are also people with an abnormal heart structure, and the prognosis varies depending on ability to control the arrhythmias. People of all ages can present with arrhythmias, including children. Symptoms may include palpitations (fluttering or heart racing sensation), chest discomfort, shortness of breath, lightheadedness and even fainting.
AFib, one of the most common arrhythmias affecting adults, used to develop primarily in middle age or older. But increasingly, people are presenting at younger ages. High-intensity endurance exercises (such as cycling) seem to predispose people to AFib and other arrhythmias, especially in younger- and healthier-than-expected adults. Being here in Colorado and at altitude, we see a fair number of healthy patients in this category with AFib.
We are still trying to understand atrial fibrillation. We don’t know why some people get it and others don’t. We can identify where the triggers for the irregular beat come from within the heart itself, which allows us to target those triggers with ablation. But we don’t know why these triggers exist. A whole host of factors may be driving this, such as genetics, and general health factors, such as sleep apnea and being overweight.
How does this inform your research here at CU Anschutz?
Atrial and ventricular arrhythmias are specific areas of research interest for me and my colleagues. Currently, we are involved in a number of multi-center trials, as well as home-based projects, to improve our ability to diagnose and treat these often complex arrhythmias.
Our projects have a wide range of focus, from analyzing signals we collect from the heart during invasive procedures to developing protocols for improving efficiency and efficacy of arrhythmia treatment in the clinic. We're also exploring how artificial intelligence can assist with EKGs, medication initiation and predicting risk. And we're working to optimize personalized care by educating trainees and patients.
What’s your big dream for your work here at CU Anschutz?
Our dream is to establish an Arrhythmia Center of Excellence at CU Anschutz. Clinically, the center would provide streamlined, multidisciplinary care for arrhythmia patients, particularly those with AFib. Even five years ago, research supported minimal AFib treatment, so the center would overcome existing inertia. While we have always worked to reduce stroke risk and control heart rate to prevent structural damage, now we’re more proactive.
The Center of Excellence would offer patients “one-stop shopping”: A patient with AFib receives treatment and connects to care for related conditions such as sleep apnea and obesity. We also aim to offer options for athletes, ideally in partnership with CU Sports Medicine. Research is another key component, from clinical trials to patient registries. We’re focused on diagnosing AFib earlier, so a big part of our center will focus on basic science and collaborations with CU researchers to uncover arrhythmia’s mechanistic underpinnings and develop new treatments.
Fast forward five years. How will you be living your dream at CU Anschutz?
I can’t say enough about the support I receive at CU Anschutz. I have an amazing team of people working with me. The energy that is involved in our day-to-day and the collaborative spirit that exists in this network is tremendous. In the next five years, I can see us all talking about what we've accomplished with our Center of Excellence. My hope is that we will have gained enough traction to expand and build out a space where we can have a multidisciplinary clinic specific to arrhythmias and arrhythmia research. I believe this dream is possible, and it’s because of this amazing team here at CU.
This interview was edited for length and clarity.
