Sept. 1, 2024
Calgary experts transforming atrial fibrillation care
Atrial fibrillation is the most common form of irregular heartbeat, or arrhythmia, impacting as many as a million Canadians. It’s a chronic, progressive condition that causes symptoms like heart palpitations, light-headedness, extreme fatigue and shortness of breath. Atrial fibrillation (AF) is also linked with serious problems like blood clots, stroke, sudden cardiac death and heart failure.
The Libin Cardiovascular Institute is a well-established centre of excellence in the areas of atrial fibrillation research and clinical care. Early on, our members, such as Dr. Anne Gillis, MD, Dr. George Wyse, MD, and Dr. Brent Mitchell, laid the groundwork with innovative research, and each received national and international renown for their work in redefining the care of atrial fibrillation in Canada and beyond. Building on this strong foundation, researchers like Dr. Robert Rose, PhD, and Dr. Derek Exner, MD, PhD, continue to puzzle out the mysteries of arrhythmias with an eye towards improving outcomes for future patients.
Calgary’s Atrial Fibrillation clinic: A national first
The Atrial Fibrillation clinic, located at the Foothills Medical Centre was established in 2005. Founded by Dr. Anne Gillis, MD, Dr. George Wyse, MD, and nurse clinicians Beverly Arnburg, RN, and Laurie Burland, RN, the clinic was the first clinic in Canada created for the management of atrial fibrillation.
According to Gillis, an emeritus professor in the Department of Cardiac Sciences at the Cumming School of Medicine, the clinic was a huge success, allowing the team to see patients sooner and more efficiently. The Calgary clinic became a model for other atrial fibrillation clinics across the country.
“It was an exciting time,” says Gillis. “Our clinic led to the development of a working group across the country. That led to the founding of clinics in Vancouver and Toronto,” she says.
Arnburg and Burland were heavily involved in creating teaching resources and informing patient care for this population. The Calgary team published a 2008 article in the Canadian Journal of Cardiology showcasing their model, which integrated research and clinical care. The group was also integral in rewriting the Canadian atrial fibrillation guidelines in 2010, with Gillis cochairing the writing committee. Calgary’s clinic was used as a model in these guidelines.
Dr. Anne Gillis: Shaping health care delivery
Dr. Anne Gillis, a distinguished clinician-researcher and emeritus professor at the Cumming School of Medicine, is internationally respected for her outstanding contributions to cardiac electrophysiology.
The first woman in the Department of Medicine at the University of Calgary to be promoted to professor, Gillis’s career spanned 30 years. She has published over 200 articles and book chapters, delving into the mechanisms of cardiac arrhythmias and innovative approaches for their treatment, and
Her ground-breaking research includes studies on cardiac defibrillation, atrial pacing for atrial fibrillation management, and collaboration with Dr. Wayne Chen on calcium-triggered activity and the ryanodine receptor's role in arrhythmia initiation. Beyond research, Gillis has shaped health care delivery, setting standards for nurse clinician-led device clinics and introducing remote monitoring for implantable devices.
As an international leader in cardiac electrophysiology, Gillis has served as president of the Heart Rhythm Society and held key positions on the Canadian Cardiovascular Society Academy board. She received the prestigious 2021 Annual Achievement Award from the Canadian Heart Rhythm Society for her lifetime of achievements. Learn more here.
PAPABEAR study: Putting Libin on the map
After heart surgery, many patients develop atrial fibrillation, which can lead to longer hospital stays and negative impacts on quality of life, due to symptoms like shortness of breath, heart palpitations, dizziness and a general feeling of being unwell.
Several types of drugs can be used to treat the condition, but amiodarone, a beta blocker, has proven to be the most effective. However, 20 years ago most surgeons shied away from using the drug, because of its associated side effects and the length of time it takes to become effective in the body.
In 2005, electrophysiologist, researcher and first director of the Libin Cardiovascular Institute, Dr. Brent Mitchell conducted a randomized clinical trial that proved the safety and efficacy of oral amiodarone for preventing atrial fibrillation after surgery. The study, published in the prestigious Journal of the American Medical Association, showed that a short (13 day) course of amiodarone, taken orally, lowered the risk of post-operative atrial fibrillation by 50 per cent.
“We showed it was a wonderful therapy with very little risk,” says Mitchell, adding the clinical trial, nicknamed PAPABEAR, was a group effort, with much of the hands-on work conducted by Carol Connelly, RN.
The study helped put the then newly formed Libin Institute on the map. It was cited 377 times and Mitchell received requests from all over the world to share the protocol of how to use amiodarone in a clinical setting.
He explains the trial, nicknamed PAPABEAR had a mascot: a stuffed bear wearing a sweater called Papa Bear.
“The bear was Carol’s brainchild,” says Mitchell. “All the participants in the trial were given a bear that they could take into the hospital. Not only did the bear attract a lot of interest from people who wanted to be in the trial, but when I presented at the American Medical Association, I took one of the bears on stage to the delight of the 4,000 to 5,000 conference attendees.”
Established in 2013, the J.L. Sam and Beverly Mozell Heart Rhythm Treatment, Research and Education Laboratory at the Foothills Medical Centre was a game-changer for the treatment of atrial fibrillation. Made possible by a generous donation from Sam and Beverly Mozell, long-time supporters of the Institute, the new lab provided the cutting-edge equipment needed for ablation therapy, a common treatment for atrial fibrillation, and for conducting clinical trails.
It also allowed the Libin Institute to recruit more electrophysiologists and ultimately increase the number of patients receiving treatment. The lab is still in use and has expanded service to include the implantation of cardiac devices, such as pacemakers. Since it’s development, about 5,000 patients have undergone treatment at the centre.
2020 Atrial Fibrillation Guidelines: Members weigh in on gold standard for treatment of atrial fibrillation
Several members of the Libin Cardiovascular Institute were involved in the development of the Canadian Cardiovascular Society/Canadian Heart Rhythm Society 2020 Comprehensive Atrial Fibrillation Guidelines replacing the 2010 version.
The 2020 guidelines were adapted using the latest science and are intended to be used by physicians treating patients with atrial fibrillation. Guidelines panel members are chosen for their expertise. Libin members involved on the guidelines panel include respected electrophysiologists and researchers Dr. Brent Mitchell, Dr. Roopinder K. Sandhu, and Dr. George Wyse.
Dr. Robert Rose: Lending insight into the mechanisms behind atrial fibrillation
Patients with diabetes are more likely to develop atrial fibrillation, but scientists aren’t clear why. Dr. Robert Rose, PhD, is a professor in the Department of Physiology and Pharmacology at the Cumming School of Medicine with a particular interest in this area. In 2020, he published a study unveiling insights into the causes of AF in Type 1 diabetes.
The research, conducted using mouse models, reveals the significant impact of blood sugar levels and insulin production on AF susceptibility. Maintaining proper insulin levels was found to reduce the occurrence and severity of AF, offering potential new treatment avenues for this condition.
Currently, Rose, deputy director of the Libin Institute, is co-leading a study alongside Dr. Stephen Wilton, MD, looking at blood biomarkers and patterns of change in the heart’s function and physiology.
The goals of this study are to devise strategies to increase the likelihood of positive outcomes after ablation and to find ways to better predict those who are likely to benefit from ablation, and who may be the best candidates for exercise and behavioural modifications to treat risk factors like overweight and inactivity.
The study is part of a cross-Canada clinical trial, RASTA-AF.
Dr. Derek Exner: Identifying people with heart rhythm problems
Dr. Derek Exner, MD, a professor in the Cumming School of Medicine, is dedicated to improving the health of Albertans with heart problems by using clinical trials to test therapies, then bringing those safe and effective treatments to the bedside. His focus is on identifying people with heart rhythm problems.
As the executive director of the Life Sciences Innovation Hub (LSIH), he leads the unique IMPACT program, accelerating market approval for healthcare innovations. Exner also serves as the associate dean of Clinical Trials at CSM, collaborating on initiatives like Clinical Trials Alberta to establish the province as a premier destination for high-quality clinical trials.
An esteemed cardiologist and researcher specializing in arrhythmias, Exner holds the Canada Research Chair in Cardiovascular Clinical Trials, leads multiple large international trials and has published hundreds of peer-reviewed articles in journals that include the New England Journal of Medicine and the Journal of the American Medical Association.
One international multi-site trial that remains a focus for Exner is REFINE ICD. It is the culmination of discoveries made by Exner and his colleagues at the Libin that have the potential to save lives after a heart attack.
Using a heartbeat recording device called a Holter monitor, Libin researchers are better able to identify individuals at high risk of serious heart rhythm problems that lead to a cardiac arrest, which kills thousands of Canadians every year.
“Our REFINE Holter test triples a cardiologist’s ability to predict which patients will develop dangerous rhythms after a heart attack,” says Exner. “The ongoing clinical trial will determine whether an implantable defibrillator, a modified pacemaker device, can save lives. This work is leading edge and has the potential to change how cardiologists treat patients after a heart attack.”
A spinoff from the REFINE Holter project and the REFINE ICD study uses machine learning and artificial intelligence in the analysis of the heartbeat data.
This work will help hospitals and clinics to implement the REFINE Holter test, allowing cardiologists to better identify patients who need more testing, changes to their medications or additional therapies. Read more here.
Read more about the Libin Cardiovascular Institute's Top 20 Achievements of the last 20 years here.