Molecular Markers of Atrial Fibrillation

Dr. Jeffrey Olgin, University of California San Francisco

Atrial fibrillation is the most common abnormal heart rhythm seen in practice and is a major cause of stroke and heart failure. Age, hypertension, heart failure, obesity and sleep apnea are all risk factors for the development of atrial fibrillation. Currently, we have no strategy for preventing atrial fibrillation. A major barrier is the lack of a way to identify patients at risk for developing atrial fibrillation or at risk for progression of their atrial fibrillation from rare episodes to persistent or permanent forms of atrial fibrillation. As a result, our current strategy for treating atrial fibrillation is to wait for people to develop the arrhythmia (the final manifestation of a disease process) and to try to control the abnormal rhythm (instead of the underlying “disease-causing” process) or control symptoms of the abnormal rhythm. To illustrate the current state of treatment, it may be helpful to contrast how we treat coronary disease. Prior to our understanding of the underlying “disease-causing” process for coronary disease, the main treatment was bypass surgery, angioplasty and medications to treat angina. With the understanding of the role of cholesterol in the disease process, biomarkers of the disease risk (LDL cholesterol, HDL) were developed allowing physicians and researchers to identify patients at risk before the disease developed. In addition, development of drugs to treat the underlying cause of coronary disease (eg. statins) now allow us to treat patients at risk for developing coronary disease to prevent coronary disease before it happens. No such strategy currently exists for atrial fibrillation; however, the proposed research is an important step in the process of developing strategies to prevent the progression of atrial fibrillation.

Research from Dr. Jeffrey Olgin, Gallo-Chatterjee Distinguish Professor of Medicine and Chief of Cardiology at University of California San Francisco, as well as others have demonstrated that atrial fibrosis (scarring) is an important underlying disease process that leads to atrial fibrillation in all of the at-risk conditions above. Dr. Olgin’s laboratory has identified a unique molecular “fingerprint” of the cells that cause fibrosis in the atria. The Mark Cuban Foundation is funding an innovation research study at the University of California San Francisco in which Dr. Olgin will leveraging this library of proteins to identify new markers of the development and progression of atrial fibrillation in patients. The study will be the first of its kind—not only leveraging these new findings from the basic laboratory, but also developing new techniques to image atrial function and using mobile technology to make it easier for patients to participate in this research. This important research could one day lead to a blood test that can determine whether someone is at risk for developing atrial fibrillation, before it develops, identify those with atrial fibrillation that will progress to persistent forms of atrial fibrillation and provide insights into new treatments that could prevent atrial fibrillation from developing.