Atrial Fibrillation Patients at Highest Stroke Risk Not Prescribed Necessary Medication

Researcher describes findings as major gap in treatment and “wake-up call” —

Nearly half of all atrial fibrillation (AF) patients at the highest risk for stroke are not being prescribed blood thinners by their cardiologists, according to a new study by researchers at University of California, San Diego School of Medicine and University of California, San Francisco.

The study was published online March 16, 2016 in JAMA Cardiology. … Read the Full Story from the UC San Diego Newsroom


Jonathan Hsu, MD, MAS

Jonathan Hsu, MD, MAS

Jonathan C. Hsu, MD, MAS, is lead author of the study report. Dr. Hsu is Assistant Clinical Professor of Medicine in the Division of Cardiovascular Medicine.

Cardiac electrophysiology is Dr. Hsu’s primary clinical interest.

Drs. Felipe Nascimento Kazmirczak and Stephen Vampola Present Their Research at Grand Rounds

Drs. Nascimento Kazmirczak and Stephen Vampola

Drs. Nascimento Kazmirczak (left) and Vampola field questions after their presentations.

Felipe Nascimento Kazmirczak, MD, and Stephen Vampola, MD, junior residents in the categorical track of the UCSD Internal Medicine Residency Program, presented results of their elective mentored research projects at Medicine Grand Rounds on March 20.

The Internal Medicine Residency Training program offers trainees two months of elective time during their second or third year to undertake a research project under the guidance of a faculty mentor.

Dr. David Krummen

The mentor for both residents was UCSD cardiac electrophysiologist Dr. David Krummen, right, who watched from front row center in the auditorium as they made their presentations.

Krummen, a ventricular fibrillation researcher, is associate professor of medicine with UC San Diego Sulpizio Cardiovascular Center and associate director of electrophysiology at the San Diego Veterans Affairs Medical Center.

Dr. Stephen Vampola

Vampola’s research project was “Mechanistic Implications of Tissue Rate Gradients in Human Ventricular Fibrillation.” He described the research experience as “fulfilling and formative.”

He said his longstanding goal has been to merge his interest in engineering — he studied electrical engineering as an undergraduate and biomedical engineering in graduate school — with his interest in medicine. He earned his MD degree at the University of Miami Miller School of Medicine.

“Now that I have a clinical background,” he said, “I was eager to participate in research that would allow me to combine my unique skill set. The field of cardiac electrophysiology, which by its very nature is analytical and mathematical, is just that.”

Dr. KazmirczakA career in academic medical research has been Nascimento Kazmirczak’s plan for many years.

He came to the United States from Brazil after he earned his MD degree at Universidade Lut Brasil because he was seeking the high-level academic investigators and research opportunities found at major American institutions such as the Mayo Clinic, Brigham and Women’s Hospital at Harvard or UC San Diego.

The project he presented at Grand Rounds was “Identification of Human VF Mechanism Using Surface ECG.”

As he designed his elective research rotation this year, Nascimento Kazmirczak’s interest in cardiology and his strong interest in cardiac electrophysiology led him to Drs. Krummen and Sanjiv M. Narayan and into the ventricular fibrillation research group.

Narayan, professor of medicine in cardiology, is director of electrophysiology at the VA San Diego Healthcare System.

“It was very interesting, and challenging too,” Nascimento Kazmirczak said. “A lot is not known about the mechanism of ventricular fibrillation. If you identify the mechanism, you can prevent it.”

Drs. Felipe Nascimento Kazmirczak and Wolfgang Dillmann.

Dr. Wolfgang Dillmann, Helen M. Ranney Distinguished Professor and chair of the Department of Medicine, comments on Dr. Felipe Nascimento Kazmirczak’s presentation.

Nascimento Kazmirczak and the other researchers devised a way to induce and study VF in humans rather than in explanted hearts or animal models. Theirs is one of the largest human VF studies now in existence.

Vampola described David Krummen as an outstanding mentor. Nascimento Kazmirczak said, “He dedicated a huge amount of time to helping us.”

Krummen also worked with the two residents to prepare and fine-tune their Grand Rounds presentations in technical detail and in overall clarity.

“This has been a very fulfilling experience,” Vampola said. “One of the unique features of being a physician is the ability to have a highly multifaceted career. I would strongly recommend that anyone with the opportunity to do so, at some point in their career, participate in research in a field that interests them.

“As a resident with access to the vast pool of research efforts at UCSD, it is hard for me to imagine a better place to do this.”

Asked whether he envisions a career as an academic physician-scientist, Vampola says it has been an evolving question for him. His mentored research experience has nudged him toward the affirmative.

“Having identified a field of research that suits my talents and interests well, I find it fulfilling and addictive,” he said. “Looking at my current trajectory and extrapolating to the future, I can definitely envision myself as a physician-scientist with a strong bent towards research.”