Advances in AF Monitoring and Screening

Rod Passman MD discusses advances in AF monitoring and screening. He tells us about the research being done at the Center for Arrhythmia Research at Northwestern Medicine.

He shares his work with implantable and wearable technology, what advances are being made at Northwestern Medicine in this area and the clinical implications of these learnings.
Advances in AF Monitoring and Screening
Featured Speaker:
Rod Passman, MD
Rod Passman, MD is the director of the Center for Arrhythmia Research, Jules J. Reingold Professor of Electrophysiology and professor of Medicine in the Divsions of Cardiology and Preventive Medicine at Northwestern Medicine.  

Learn more about Rod Passman, MD
Advances in AF Monitoring and Screening

Melanie Cole (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And today, we're exploring advances in atrial fibrillation monitoring and screening.

Joining me is Dr. Rod Passman. He's the Director of the Center for Arrhythmia Research, a Jules J. Reingold Professor of Electrophysiology and a Professor of Medicine in the Divisions of Cardiology and Preventive Medicine at Northwestern Medicine. Dr. Passman, thank you so much for joining us today. As we get going, set the table a little bit for us. Tell us about arrhythmia, what we see in the trends and the different types you most commonly see.

Dr Rod Passman: Well, first of all, thank you very much for having me. I'm excited to tell you all the interesting things going on in this field. So I'm going to focus a lot on atrial fibrillation because this is the most common abnormal rhythm that we see in adults. The estimates are that there are maybe between three and five million people with atrial fibrillation that we know about, and it affects about 5% of the population over age 65 and about 10% of the population over age 80. And of course, what's most concerning about atrial fibrillation is the fact that for many people, it impacts their quality of life, it makes them feel tired, it makes them feel dizzy, it gives them palpitations. But the most concerning consequences of atrial fibrillation is that it is a major cause of heart failure, dementia, and stroke. And really the strokes are the most important because these tend to be severe strokes, severely debilitating or life-ending.

Melanie Cole (Host): Thank you so much for that. So why don't you tell us about the Center for Arrhythmia Research at Northwestern Medicine? Tell us about the research that you're doing. Tell us a little bit about this center.

Dr Rod Passman: So the center started about, oh, two and a half years ago, and really the goal was to leverage all of the breadth and depth of talent that we have across this institution, and sort of focus it on of a common goal. So for example, there are people working in biomedical engineering, radiology, genetics, preventive health, are all in the field of our rhythm research, but we weren't really coalesced before. And I think that lot of good things happen in medicine when you look outside your own silo.

So the center is really a collaborative effort where we integrate with people from across the university, both the medical school campus and the undergraduate campus, to sort of forward research in these areas. So for example, we work with John Rogers, from biomedical engineering who works on sensors for abnormal rhythms, and has made some great progress in the field of absorbable pacemakers that can temporarily pace someone then degrade over time. We work with our colleagues in MRI scanners who have developed methods to look at what's called four-dimensional blood flow. We can actually see the flow of blood inside the heart in real time to try to understand why some people with atrial fibrillation are at higher risk of stroke than others. We have nine full-time faculty in the electrophysiology section, and we're doing interesting work with things like pulsed-field ablation, which are new methods of ablating abnormal rhythms, like atrial fibrillation, and then my own work centers on a lot of wearable technologies and you're probably familiar with Apple Watches and Fitbit and whatnot that not only are health monitors, but as you may know, can now sense and record abnormal rhythms of the heart.

Melanie Cole (Host): Well, I would like you to expand if you would on your work with implantable and wearable technology, because the fact is that we've seen with monitoring, technology has played a huge role in all of these things and the ability of healthcare providers to be more creative in helping their patients and certainly during these COVID times. So, tell us a little bit about your work. Expand for us.

Dr Rod Passman: So, you raised great points. I mean, I think that this whole field, remember, didn't exist 15 years ago, really. I mean, we had no ability to easily monitor people for atrial fibrillation. Maybe we could have them wear a monitor for a day or two, more recently for a week or two. But still, those are snapshots in time. And this really is an unusual situation.

When you think about a lot of other diseases that we're concerned about, high blood pressure, high cholesterol, those things will be there every time you visit your doctor, right? If you have high blood pressure, every time someone takes your blood pressure, it's going to be high unless you're on medication. But atrial fibrillation is an unusual disease, right? Not only may it cause absolutely no symptoms, but it can be intermittent or paroxysmal in nature. And therefore, when your doctor checks you out, you may not have atrial fibrillation at that moment in time, but that doesn't mean that you don't have atrial fibrillation. And what happens is, is that in many instances, stroke is the first manifestation of this disease. And in many cases, people have strokes, and we can't figure out why. And our studies have shown that, when you monitor these patients very intensively, you find atrial fibrillation in about a third of them. So monitoring for atrial fibrillation is a new field. And we're sort of still figuring out what to do with the data. Of course, the consumer electronics companies like Apple and Fitbit aren't waiting for us, they've come out with these tools that are now in the hands of people. And the question is, how do we use this technology to take better care of our patients?

Melanie Cole (Host): Well, I think that's happening across the board. Certainly, even people with diabetes, we're seeing this technology coming in to help providers with that monitoring and screening. What do you see as the clinical implications of these learnings as you talk about those companies, which are forging ahead and now the medical community is really finding huge benefit with this technology? Tell us little bit about some of those clinical implications.

Dr Rod Passman: Well, I think you raise a great point. Often in medicine, the medical question sort of drives the science, again, these companies have figured out ways to do this, and in some cases are partnering with us, but clearly have gone ahead and released this to the community at large. And yeah, we do see a lot of patients who come to us because their Apple Watch tells them that they have an abnormal rhythm of the heart, and that's usually quite valuable.

We are involved in one study called Heartline, which is basically asking the fundamental question, "Should we be screening the population for atrial fibrillation?" And since atrial fibrillation can be intermittent, since atrial fibrillation could be asymptomatic, in this trial, we are gaining access to Apple Watches for these individuals. It's a study with a very, very large sample size. And really the question is can we find AFib early in patients at risk and get those patients on anticoagulation and prevent them from having strokes? And you may think that this is a slam dunk, but it's not because most of what we know about atrial fibrillation and stroke come from individuals with a lot of atrial fibrillation, right? Come into their doctor's office with atrial fibrillation, not the kind of maybe lower burdens, more intermittent forms of AFib that you could pick up with a wearable device like an Apple Watch. So, this study is ongoing and I think that this will use these advances in technology to answer some really basic questions like screening for atrial fibrillation.

Melanie Cole (Host): Before we get ready to wrap up, and this is just such an interesting topic, Dr. Passman, and advancing all the time. Where do you see it going? Are there any game changers that you're excited about? Things down the line? Tell us anything about your research that you would like other providers who have patients with atrial fibrillation to know about everything that you're doing at Northwestern Medicine.

Dr Rod Passman: Well, first of all, I mean, let me just highlight the fact that, clinically, we have a really well rounded and renowned electrophysiology program. Ablations for atrial fibrillation, medical therapies for atrial fibrillation, surgical approaches to atrial fibrillation are things that we spend our lives doing here. And I think that this is getting to be a more and more complicated disease because the options are so much greater. So we're really eager to see all patients with atrial fibrillation, because there's so much more to offer today than we could 10 or 20 years ago.

My own research involves some of the things that we touched upon. Right now, the current standard of care is that people with what we call vascular risk factors, so high blood pressure, diabetes, prior heart attacks, if they're over the age of 65, those are considered risk factors for stroke. And if you have atrial fibrillation, regardless of how much atrial fibrillation you have, our guidelines say that you should be on an anticoagulant for the rest of your life. And while these drugs are quite effective at reducing the risk of stroke, they do carry the risk of major and minor bleeds. So, imagine if you're someone who had atrial fibrillation and is on a medication or had an ablation and has no more atrial fibrillation, yet your doctor tells you to take a blood thinner really for the rest of your life, expose yourself to the risks of those medications, and maybe even curtail your lifestyle because you're afraid of going skiing or going biking, because you're on a blood thinner.

The work that we're doing is using these wearable devices in a specialized form, to actually alert you when you've had a prolonged episode of atrial fibrillation. And the goal will be that you will take a blood thinner only for a fixed period of time, maybe a few weeks following a prolonged episode. So for example, if you had one six-hour episode of atrial fibrillation a year, maybe you will be on the blood thinner for a month and spare yourself the exposure to that dangerous medication the other 11 months out of the year. And if you've had an ablation done or on a medication and your AFib is no longer there, well, maybe you can get off the blood thinner for good.

Melanie Cole (Host): Wow, certainly an advancing field, Dr. Passman, and so interesting. Do you have any final thoughts you'd like to leave other providers with?

Dr Rod Passman: Well, I sort of want to circle back, you know, this is such a dynamic field, just when we thought that there was really no more that could be done. Twenty odd years ago, we had one blood thinner. We had a handful of medications. And now between ablation and different energy sources and management of the left atrial appendage with these occlusion devices, like a Watchman device, this is a field that's exploding, both in terms of technology, research, and really more fundamentally what we can offer for our patients.

So, we have spent our careers designing a clinical AFib center, that we believe can offer some really unique options for patients. So for the listeners out there, we want to see your patients. We believe that a center like this that can offer things that are unique and can really impact the quality of life of people with atrial fibrillation.

Melanie Cole (Host): What great points that you've made today here, Dr. Passman. Thank you so much for joining us. And to refer your patient or for more information, please visit our website at to get connected with one of our providers. And that concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. Please always remember to subscribe, rate and review this podcast and all the other Northwestern Medicine podcasts. I'm Melanie Cole.