Miller School Cardiac Electrophysiology Group Advances Personalized Medicine for Patients with Abnormal Heart Rhythms
Article Summary
- The Miller School’s cardiac electrophysiology team personalizes care plans for its patients with heart issues.
- Dr. Jeffrey Goldberger studied catheter ablation for atrial fibrillation and found success rates are stagnant at 60%.
- He recommends a deeper analysis of atrial fibrillation that could involve genetics, mapping the mechanisms of atrial fibrillation or better understanding the nervous system’s effects on the heart.
Personalizing treatments for people with irregular heart rhythms is the primary focus of patient care and innovative research in the cardiac electrophysiology group at the University of Miami Miller School of Medicine.
Faculty members are leading multiple national research studies and employing the latest tools – from artificial intelligence to genetic testing to weight-loss drugs — to customize and develop new treatments for patients who need care for abnormal heartbeats and other disorders related to the electrical biology of the heart.
“We are most proud of the fact that we are leading the way with this more thoughtful, personalized approach to patients, rather than using a one-size-fits-all strategy for everybody,” said Jeffrey Goldberger, M.D., M.B.A, professor of medicine and biomedical engineering at the Miller School, who directs the Center for Atrial Fibrillation to advance research on atrial fibrillation.
Personalized Targets for Atrial Fibrillation
In a review published online in the journal Circulation: Arrhythmia and Electrophysiology, Dr. Goldberger and his coauthors examined the successes and failures of the field’s latest clinical trials for catheter ablation, the primary treatment for patients with atrial fibrillation. In catheter ablation, medical teams insert a long tube into the blood vessel and guide the catheter into the heart, where hot or cold energy is applied to the area that is thought to cause abnormal electrical signals. If properly targeted and delivered, the heart once again beats at a regular rhythm.
Dr. Goldberger and his coauthors wrote that, despite research efforts across the field, average success rates for catheter ablation for persistent atrial fibrillation have remained stagnant (around 60 percent). To better help the other 40 percent of patients achieve optimal outcomes, Dr. Goldberger and his coauthors called for future work that advances treatments beyond a one-size-fits-all use of catheter ablation. Treatments need to be better tailored for age, body composition, risk for stroke and other factors.
“Our concept is to identify personalized targets for atrial fibrillation,” Dr. Goldberger said. “And that may be dealing with genetics or mapping the mechanisms of atrial fibrillation or better understanding the nervous system’s effects on the heart.”
Customized Treatment Plans
Dr. Goldberger’s coauthor and colleague, Raul Mitrani, M.D., director of cardiac electrophysiology and professor of clinical medicine in the Division of Cardiovascular Medicine, said the Miller School team sets an example for personalizing medicine for the full range of patients they see. With one of the only comprehensive risk factor management centers for atrial fibrillation in Florida, the team is not only researching targeted approaches for patient subgroups but also offering personal care to individuals.
“Together with a team of nurse practitioners, nurses and dieticians, we work with patients to customize a treatment plan to help patients who are overweight and obese lose weight, optimize blood pressure treatment, reduce alcohol intake for those patients who drink alcohol regularly, optimize blood sugar control for patients with diabetes and direct patients with obstructive sleep apnea to our sleep specialists for treatment,” said Dr. Mitrani. “Combining risk factor management with medical treatment and or catheter ablation really is the most effective way to improve patients’ quality of life and reduce their burden of atrial fibrillation.”
Drs. Goldberger and Mitrani, together with cardiac electrophysiologists Alex Velasquez, M.D., assistant professor in the Division of Cardiovascular Medicine and Litsa Lambrokos, M.D., associate professor of medicine in clinical cardiac electrophysiology, and nurse practitioner Natasha Garcia are available to evaluate patients with atrial fibrillation or other heart rhythm disorders at UHealth Tower, the flagship hospital of the University of Miami Health System, as well as satellite clinics in Coral Gables, Fort Lauderdale and Boca Raton.
“Heart rhythm abnormalities are indeed a common issue, and the electrophysiology section of the Division of Cardiovascular Medicine at the University of Miami takes a comprehensive and personalized approach to these problems,” said Yiannis Chatzizisis, M.D., Ph.D., professor of medicine in the Division of Cardiovascular Medicine at the Miller School and UHealth chief of cardiovascular medicine. “Our team of knowledgeable and skilled experts utilizes the latest software and state-of-the-art equipment to ensure that every patient receives top-notch care tailored to their specific needs. By focusing on holistic treatment options, we aim to enhance the overall health and well-being of our patients.”
Exceeding Patient Outcomes
The cardiac electrophysiology team is also making strides in personalizing medicine for subgroups of patients. Dr. Goldberger is leading a research program studying obese patients with atrial fibrillation. His clinical research team has shown that obese patients who receive catheter ablations and participate in his team’s risk modification program have higher success rates than the national average.
Participants were identified by reviewing electronic patient records for potential risk signs. Patients tracked their progress on several risk factors: weight, glycemic levels, smoking, blood pressure and sleep apnea.
Most recently, Dr. Goldberger’s clinical research team expanded on the risk modification approach by gathering data on whether prescribing the weight-loss drug liraglutide to participants in the risk modification program would improve outcomes for patients who were treated with catheter ablations.
“We had an almost doubling in the success rates for catheter ablation,” Dr. Goldberger said. “This is one of the first studies that will show that adjunctive approaches may actually be much more beneficial than empirically increasing the extent of the atrial tissue that is destroyed with catheter ablation.”
The research, titled Liraglutide Effect on Atrial Fibrillation (LEAF), is funded by the National Institutes of Health (NIH).
Top Federally Funded Research Projects
In addition to LEAF, the cardiac electrophysiology group’s federally funded research includes:
• Trans-omic Analysis of Epicardial Adipose Tissue in Atrial Fibrillation (OMICS): Multidisciplinary study investigating how epicardial adipose tissue around the heart affects the risk of atrial fibrillation.
• 4D Flow MRI: Dr. Goldberger co-developed 4D Flow MRI technology as a measure of left atrial stasis to better assess the risk of stroke in patients with atrial fibrillation. The team is launching its first clinical study to evaluate whether the technology can predict strokes.
• Machine Learning Analysis of the Atrial ECG in Patients With Persistent Atrial Fibrillation Predicts Long-term Outcomes: This AI analysis of patient ECGs predicted with 90.4% accuracy which patients would have successful outcomes after catheter ablation treatment. The team is now exploring further study with a larger patient pool.
• Rhythm Evaluation for Anticoagulation with Continuous Monitoring of Atrial Fibrillation (REACT-AF): Comparing outcomes between participants who take oral anticoagulants to those who take the medication for only 30 days following an episode of atrial fibrillation detected by a smartwatch.
• Catheter Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA): The team is planning sub-studies to explore personalized medicine by using data from this national sample of patients who received catheter ablation treatment for atrial fibrillation, including the relationship between blood pressure and clinical outcomes and how a pacemaker affects outcomes.
“There have been many real improvements in our approach to atrial fibrillation, but we still have a long, long way to go to get to optimal treatment,” Dr. Goldberger said. “And this is the focus of our program: to identify gaps and areas where we can have a major impact.”
Tags: atrial fibrillation, cardiac electrophysiology, cardiovascular, Cardiovascular Division, catheter ablation, Dr. Jeffrey Goldberger, Dr. Yiannis Chatzizisis, USNWR Cardiovascular