As far as eyes can see: CANet project sees old target in new light

Look once. Look twice. Look again.
Drs. Frank Prato and Allan Skanes are taking no chances when it comes to improving atrial fibrillation (AF) therapies.
The CANet Investigators and professors of Medicine at Western University is putting faulty heart tissues – one of the main culprits of AF – under microscopes, MRIs, X-rays, nuclear medicine procedures and myriad other imaging technologies to develop “a clear, rational approach to selecting the right kind of treatment for AF patients.”
In doing so, they are helping provide effective, efficient and accessible arrhythmia care in Canada and worldwide, all critical CANet targets.
Cardiac tissues called atria generate electric signals that subsequently produce heartbeats. Diseased tissues and/or faulty electric signals result in rapid, irregular heartbeats – or atrial fibrillation – with frequent symptoms of chest pain, shortness of breath, light-headedness, and palpitations.
Their pioneering project Atrial Image-guided Decision to Optimize Treatment of Atrial Fibrillation (AID-AF) scrutinizes diseased atria through a battery of medical imaging techniques utilizing, for example, microscopy, x-rays, and MRI. It also studies, among other things, those faulty electric signals.
In other words, they are looking at AF repeatedly, in a variety of ways.
“This more accurate understanding will help doctors pick the right AF treatment,” Prato says.
Currently, the go-to AF therapy is catheter ablation. The treatment locates and destroys (ablates) faulty cardiac tissues – by either burning or freezing them – restoring normal function.
But the procedure works only 50 to 70 percent of the time. Patients often undergo a second procedure, which may or may not be successful.
“We are unable to accurately predict AF ablation outcomes as the extent of atrial disease is often underestimated,” Skanes says.
So how does one measure the severity of AF prior to ablation? What kind of information would allow patients and their physicians to make better decisions?
Prato’s new imaging tools (along with information on electric signals) will be combined with other patient characteristics such as age and duration of AF to predict accurate outcomes for catheter ablation of AF.
“Our hope is to identify those patients who are both likely and unlikely to benefit from AF ablation, and provide alternative therapies,” Skanes explains.
He continues, “We expect that by identifying patients with severe atrial disease and poor outcomes predicted, other non-ablation treatments, such as pacemakers can be used to maintain a high quality of life without repeated ineffective ablation procedures.”
Canada’s increasing seniors population is one of the leading causes of growing AF cases in the country, with healthcare costs going into millions of dollars per year.
By recommending the correct AF therapy for seniors for example, the CANet-funded research can help achieve the Network’s goal to reduce hospitalizations and emergency department visits by 20 per cent.
“Our work is bringing together Canada’s most skilled heart imaging scientists from multiple centers – Ottawa, London and Calgary – to collaborate on multiple methods of atrial disease imaging,” Prato says. This is unlike most other large, well-known medical centres both in Canada and the US, who work independently and use a single imaging method.
Apart from a multi-disciplinary team of imaging scientists, engineers and clinician scientists, Prato is also working with industry partners such as Siemens, Medtronic, Biosense, St. Jude Medical and CUBE Medical Solutions to develop commercially viable novel imaging technologies.
These industry partnerships will help CANet move forward with its strategic business and capacity development targets.
This CANet-funded project also helps train and mentor Highly Qualified Personnel in arrhythmia research in Canada.
“Trainees in medical imaging and technology, junior clinician-scientists and early-stage research fellows will benefit from multi-disciplinary collaborations, and exposure to state-of-the-art technology,” Prato says.
The project contributes to CANet’s vision of creating highly qualified personnel at the forefront of arrhythmia research and management.
Importantly, Prato is collaborating with patients who bring with them a variety of experiences.
“Patients will give insight into tolerability, appropriateness, and acceptability of complex imaging studies as well as strategies for efficient patient engagement and enrolment,” he says.
Ultimately, Skanes hopes that the research will empower patients to predict their clinical course, avoid futile procedures, and select alternative therapies more appropriately.
For their part, Prato and Skanes will not stop looking for better solutions.