Today I’m speaking with Dr. Thomas A. Dewland, an EP with a focus on atrial fibrillation epidemiology (the study of which populations are affected by certain diseases and why). His goal is to identify ways to prevent atrial fibrillation before it occurs. Dewland earned his medical degree at the Yale School of Medicine. Currently at UC San Francisco, he has authored over 80 peer-reviewed papers. 

I recently listened to a symposium where Dr. Dewland spoke about the topic of “How much Afib is enough…” and so today we will be discussing it in depth.  Join us as we cover the use of monitoring devices (both implantable and non) to detect AFib and the widely varying thresholds that doctors feel is enough to refer their patients to an EP for further treatment or consult. We will dig into: using anti-coagulants, when left atrial appendage management is indicated, and what the future of monitoring looks like - with the constant improvement and ease of use in newer monitoring devices.

All Things Afib is hosted by me, Dr. Armin Kiankhooy. As a board-certified cardiothoracic surgeon, my focus is on advanced treatments for heart and lung failure and minimally-invasive surgical treatments for atrial fibrillation such as the Hybrid Maze procedure. You can find me on staff at Adventist Health Heart and Vascular Institute in St. Helena California.

Discussion points:

A patient comes in with AFib detected by their Apple watch– what do you do?

If a patient has a 10 second AFib occurence, what is your device of choice to monitor them for more AFib?

What is the threshold you use to determine if a patient should receive an implantable loop recorder?

The availability of low cost home monitoring such as the KardiaMobile

CHADVASC scores as an indicator for anticoagulants and/or further monitoring

What are your thoughts on surgically managing the left atrial appendage if a patient is low risk?

The incomplete closure of the left atrial appendage is worse than not closing it at all, so know if your skills are up to it

We need to see the results of the two trials that are underway– in one to two years they will be published.

Tech is improving to the point that we’re seeing AFib everywhere– is it a pathology or is it simply a bio marker of aging?

Resources:

Dr. Thomas Dewland at UCSF

KardiaMobile Device - personal EKG

Dr. Kiankhooy LinkedIn 

All Things AFib Website

All Things AFib Twitter

All Things AFib YouTube Channel