Investing in healthy hearts with support from the Maritime Heart Centre Innovation Fund
Atrial Fibrillation (Afib) is the most common type of heart rhythm disorders – affecting 200,000 Canadians, and causing one in four strokes after the age of 40.
Most often experienced as arrhythmia, symptoms include shortness of breath, palpitations, dizziness, fainting and chest pain, though some patients exhibit no symptoms at all.
Untreated, Afib can lead to blood clots, stroke and ultimately heart failure.
Dr. Ratika Parkash MD MS FRCPC, director of research, Division of Cardiology has been studying Afib for more than a decade.
“There are some patients that are so symptomatic, it debilitates their entire quality of life. It’s quite common.”
One of effective treatments for Afib is ablation. Abnormal heart rhythms can be triggered by areas of abnormal electrical activity. Ablating, or destroying these areas has been shown to stop the abnormal electrical signals, allowing the heart to return to normal heart rhythm.
But even with ablation, the recurrence rate can be significant, according to Dr. Parkash, “The ablation procedure works, but we’ve experienced high recurrence rates, 30 to 40 per cent or higher,” leading her to postulate that there are other factors that need to be controlled.
Dr. Parkash’s current research is being funded by the Maritime Heart Centre Innovation Fund, which is made possible through generous donations to the QEII Health Sciences Foundation Campaign, From the Heart.
The research focuses on the external factors that trigger and maintain Afib, other than what goes on in the heart itself.
“This study is about examining all of those risk factors that aggravate atrial fibrillation – activity level, blood pressure, alcohol consumption, smoking, uncontrolled diabetes, untreated sleep apnea – we target them all.”
It is a randomized trial funded by a Maritime Heart Centre Innovation Fund. Half the patients get intensive intervention, and the other half get the standard guidelines-based treatment.
“Our intervention is a home-based rehab program that we’re running out of the University of Ottawa Heart Institute. We wanted to be able to deliver this to anybody, regardless of where they live or how much money they have, to make it universally available, so we chose to do it in patients’ homes rather than bringing them to rehab facilities that aren’t always accessible.”
During the study, an exercise physiologist will guide Afib patients through the physical activities they can do in order to reach the recommended guidelines of 150 minutes of exercise per week. Pedometers will help guide their exercise and provide feedback to the research team.
The Maritime Heart Centre Innovation Fund is also helping Dr. Parkash and her team examine the effect sleep apnea has on Afib, allowing them to set up an independent core lab to study sleep apnea and provide unbiased interpretation of the results.
Dr. Parkash’s team includes specialists across the country who see patients for ablation.
She is also working with a former Dalhousie University professor, Dr. Robert Rose, who is now at the University of Calgary, on a sub-study that looks at all of the factors that affect the mechanisms of atrial fibrillation, including atrial imaging, bio-markers and how genes affect a person’s response to physical activity.
According to Dr. Parkash, “the simple part of the study is the randomization of intensive activity program versus nothing. But then there are all of these other things we will look at that will allow us to learn more about Afib.”
The results they find over the next couple of years of study will provide volumes of data that could result in fewer ablations, and overall healthier patients. “So that’s where the excitement and enthusiasm come from.”
This article was originally published in Nova Scotia Health Research and Innovation annual report 2020 (pdf)