Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop and welcome to my podcast station. Today I've got a couple of quick bits and pieces to share. Firstly, about atrial fibrillation, about left atrial occlusion devices, about heart failure with preserved ejection fraction, and a quick word about beta blockers. But atrial fibrillation first. We know this irregular rhythm is really common and... There's been a significant trial called the KABANA trial, which has looked at over 2,000 patients over five years, randomising them to drug therapy or ablation, electrophysiological ablation of their atrial fibrillation, which is a catheter technique or wire technique where we put wires into the heart and literally try and burn out the area where atrial fibrillation may come from. Having followed these individuals for five years, the outcomes are suggesting that about 6% of the individuals who were managed with ablation had recurrence of atrial fibrillation compared to about 14% who were on drug therapy. So certainly a tick to EP ablation if we're trying to. reduce recurrence of atrial fibrillation, but interestingly, the study showed no difference in final endpoints or outcome. So, if you were asymptomatic, for example, and you were assigned to drug therapy, you wouldn't have been any worse off. Well, a really important study, and one to bear in mind, and it supports our premise that really atrial fibrillation, ablation, is more about helping patients with symptoms rather than improving their outcome. Still on atrial fibrillation, we know that we use blood thinning agents and there are certain situations where people may be at really high risk of bleeding from being on drugs that thin the blood. Now, with that being the case, there have been devices developed that literally go into the heart and block off the small pouch within the left atrium called the left atrial appendage, which is where clot tends to form during atrial fibrillation. Well, these closure devices have been studied, as you might imagine, and a fairly recent trial was released where they looked at nearly 200 patients and followed them up for two years, left atrial appendage occlusive devices compared to blood thinners. Well, the outcome showed that there wasn't a great deal of difference, but the reality is that there's certainly been questions about the size of the trial and the way it was conducted and the outcomes that were being looked for. So we're not 100% sure that it's a robust study to clearly tell us that these... occlusion devices are as good as blood thinners. Having said that, if you think about it, these blood thinners also reduce the risk of individuals developing deep vein thrombosis and pulmonary embolism. So it's an interesting side benefit that might be seen by the medications. Nonetheless, it doesn't show that these devices are super dangerous concerning signal, and I think it's going to be a space we watch more and more because it is the case that some people are really at too high a risk to be using these devices that go into the heart, block off the left atrial appendage, i.e. the site where clot could form and therefore not take the blood thinning medications. The device, if you're interested, is called the Watchman device. That's the one that was being studied. A quick word on heart failure with preserved ejection fraction. Now this is a difficult area and if you've had the chance to hear about this, it's really a situation where the heart appears to contract normally but doesn't relax normally. So it's a stiff heart. It's been really notable as we see it more and more as patients age. It's closely linked to blood pressure. and obesity, and more prominent and prevalent in females. Well, trying to find something that helps people with this has been difficult, and a group in Melbourne used an agent called milrinone, which is a phosphodiesterase inhibitor to increase the way the heart contracts. Well, very early days, they've only run for a short period of time, it's only 20 odd patients, but there are some preliminary suggestions. that this may be a novel and helpful way to support people with heart failure with preserved ejection fraction. The last thing I'd like to touch on is beta blockers. We all know beta blockers. These are the things that slow the heart down. They block the fight and flight nervous system of the body. And we've used them. Historically, since the ISIS trials showed us that after heart attack, these agents were clearly beneficial for outcomes and major events in individuals who were given these medications. Now, there continues to be debate about how long you should run the beta blockers for, and a relatively recent nationwide cohort run through. A set of Korean researchers where they looked at national databases was able to shed a little bit more light on this forest. They came to the conclusion after evaluating over 28,000 people that if you've had a heart attack, then being on your beta blocker for over a year is better than being on your beta blocker for less than a year. They saw this benefit up until two years, but they didn't see it up to three years and beyond. So maybe there's a sweet spot for your beta blockade. Anyway, an interesting bit of information and certainly from my perspective it'll make me ensure that my patients who have had heart attacks are taking their beta blocker at least for a year, probably up to two years. So there you go, a quick run through atrial fibrillation ablation. Left atrial appendage occlusion to try and reduce risk of stroke without needing to take a blood thinner. Heart failure with preserved ejection fraction and milrinone as a novel agent to help it. And what do we do with our beta blockers after a heart attack? Well, I hope you found that interesting. If you have any queries or questions, please don't hesitate to be in touch. And I'm going to wish you the very best. Thank you for your attention. Thank you for listening. I look forward to you joining us next time. Take care. Bye for now. And please don't die from a heart attack. Goodbye. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
