Can atrial fibrillation be cured?

Until recently, we tended to look at atrial fibrillation (AF), a common abnormal heart rhythm, as 1 condition, when in fact there could be many different types.

Now, scientists across the world are using imaging and studies in cells, blood and genes to unravel these different types.

In future, we might be able to see which types of atrial fibrillation may put you at greater risk of heart failure or stroke, and whether it matters at what age you develop the condition or if you experience it for short or longer periods of time.

With this knowledge, we’ll be able to give more targeted and personalised treatments, instead of the current more 1-size-fits-all approach.

That’s important because, for example, medicines that prevent blood clotting (anticoagulants) are often given to people with atrial fibrillation to reduce the risk of stroke, but they do come with their own risks, so we need to make sure the right people are taking them.

Why is this research important?

Atrial fibrillation can be very unsettling: your heart rate can feel out of control, you can feel dizzy and short of breath and may even get chest pain.

If your atrial fibrillation comes and goes (known as paroxysmal), not knowing when you might experience an episode can really affect your confidence and quality of life.

With the right treatment, atrial fibrillation is not life-threatening and you can still live well with it, but it does link to other serious conditions.

It can both cause heart failure and be caused by heart failure. It’s a vicious circle that creates a lot of trouble. It’s also linked to an increased risk of strokes and dementia.

The chances of getting atrial fibrillation increase as you get older.

So, with more of us living longer lives, there’s even more reason to find new and better treatments for it.

What’s your research looking at?

We know there are people out there with atrial fibrillation that have not been diagnosed.

This is because the condition can be symptomless (asymptomatic or silent atrial fibrillation).

And because the abnormal heartbeat can come and go, people might not be picked up when they have a routine ECG (electrocardiogram, used to record heart rhythms).

My team and I are working with UK Biobank, a database of people who have generously provided heart, body and brain scans, blood samples and other information about their health to be used in research.

In our study, over 26,000 UK Biobank participants, aged over 65, will wear a skin patch ECG monitor for two weeks to spot silent episodes of atrial fibrillation and other irregular heart rhythms (arrhythmias).

This will help answer whether silent atrial fibrillation, detected by the patch, has the same risks as the kind of atrial fibrillation with symptoms that is picked up by GPs or at hospitals.

We’re not just looking at the risk of large strokes. We’re also seeing whether smaller events, which may go unnoticed, might cause damage to the brain and dementia.

I am also involved in the Active Monitoring for Atrial Fibrillation (AMALFI) study.

This is looking at whether screening for atrial fibrillation by sending a skin patch ECG monitor through the post, for people to wear for two weeks, could lead to more people being picked up earlier.

Hugh Wybrew, a participant in the AMALFI trial, is pictured below examining the patch which is designed to be placed on the skin.

About 5,000 people aged over 65, who are not known to have atrial fibrillation but have heart and circulatory risk factors, were either given the skin patch or their usual treatment.

The beauty of this approach is that hassle for the participants is minimal. Instead of having to come into hospital, they get the skin patch through the post and put it on themselves at home.

They only need to see their GP if the patch shows they have atrial fibrillation. This could be scaled up to form a nationwide screening programme for atrial fibrillation.

But before that investment is made, we need to understand whether having, say, 5 minutes of atrial fibrillation over 2 weeks, picked up in this way, puts you at enough risk to be treated.

Will we find a cure for atrial fibrillation?

Current treatments to stop atrial fibrillation, such as cardioversion and ablation, focus on correcting the heart’s abnormal electrical activity.

But atrial fibrillation is often not just an electrical problem. For example, we know that ablation is unlikely to be successful and atrial fibrillation is more likely to come back in people who have heart scarring (fibrosis).

My colleague Dr Svetlana Reilly at the University of Oxford is doing cell-based studies to better understand the link between heart scarring and atrial fibrillation, which I hope may lead to new treatments.

We are also building up evidence that inflammation and the immune system play an important role in the development of atrial fibrillation, and this could open up new treatments for atrial fibrillation and heart scarring too.

This is what medical research is. There’s rarely a ‘eureka moment’ where 1 scientist with a pen and paper suddenly finds a cure.

To reach a breakthrough, you need researchers working together who can tackle a problem from different angles, with fresh eyes and the latest technology.

Professor Barbara Casadei, Professor Louise Bowman and Guilherme Amorim are working together on the AMALFI trial.

How did you first get interested in atrial fibrillation?

When I was a medical school, atrial fibrillation was such a fascinating black box of questions.

We did not understand why people had abnormal heart rhythms, why they could sometimes lead to sudden cardiac death and how to identify people at risk.

The only tool to treat it at the time was to apply an electric shock to the heart. You did not even have ablations at that time.

I was working with some physicists that were looking at chaos theory, and the idea that you might be able to influence a chain of events with a small intervention. I thought there must be a more subtle way to intervene and stop atrial fibrillation.

Even today, atrial fibrillation is still something of a black box. 

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