Project

Personalized Therapeutic Strategies for Patients with Atrial Fibrillation

Short Summary

Atrial fibrillation (AF) is the most common arrhythmia observed in clinical practice. Catheter ablation (CA) has emerged as a valuable, minimally invasive treatment for AF. Persistent AF, the advanced stage of AF, is less easily treated with CA and may require multiple procedures. Of course, this translates into higher risks and costs. There is therefore a strong interest in improving the understanding of AF dynamics to identify non-invasively (typically using the electrocardiogram, ECG) patients with persistent AF more likely to benefit from catheter ablation.

Goals

The project aims at developing a totally non invasive tool based on the electrocardiogram (ECG) to assess the severity level of AF in patients. This tool will allow the cardiologists to stratify patients more accurately, and to take a decision regarding the clinical opportunity of a catheter ablation on a subject in persistent AF based a non-invasive and simple procedure. This project also gives the opportunity to optimize ECG lead placement for AF investigation.

Significance

Most patients who receive catheter ablation treatment experience a long-term reduction in the number of episodes of arrhythmia and the severity of symptoms. Many achieve a permanent return to normal heart rhythm. Nevertheless, for persistent AF, the patient recurrence rate is not negligible: 41-56% after one procedure and 28-42% after two procedures. The AF recurrence rate needs to be reduced because of the: • Benefit/Risk profile. Even if considered relatively safe, cardiac ablation is related to cardiac intervention complications (life-threatening 1% with death 0.18%) • Procedure repeatability. In order to achieve acceptable results in the long term, patients need to undergo several redo procedures (2-4 on average). Therefore, this lowers patient’s quality of life, and is costly for the healthcare system. There is thus a clear incentive, in terms of patient well-being and healthcare costs, to better select the patients more likely to benefit from catheter ablation.

Background

Atrial fibrillation (AF) is one of the most disabling disorders affecting millions of individuals in Europe. It is responsible for stroke, heart failure, and decreased quality of life. AF is also responsible for significant healthcare costs as patients are much more likely to be hospitalized. Importantly, AF is responsible for 78% of cases of hospital admission with a mean hospital stay of 6.7 days. Epidemiological projections regarding AF predict at least a doubling of its prevalence by 2050 because of the ageing of the population but also as a consequence of growing obesity and metabolic syndrome.