Back on Beat: Knowing your Heart Rhythm and How to Treat Atrial Fibrillation (AFib)

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. I'm Deborah Howell and today's guest is Dr. Thuy Le, a cardiologist and electrophysiologist with the MemorialCare Heart and Vascular Institute at Orange Coast Memorial. Today we'll be talking about AFib and its complications. Welcome, Dr. Le.

Thuy Le, MD: Thank you for being here, thank you for having me on your show.

Deborah Howell (Host): The pleasure is all ours. Let's begin. What is AFib?

Thuy Le, MD: Atrial fibrillation is actually a type of arrhythmia or an abnormal heart rhythm. The abnormal heart rhythm for atrial fibrillation originates in the top chambers of the heart. So for most patients, everyone has four chambers. The top two chambers are called the atrium, the bottom two is called the ventricle. Normal rhythm normally originates from the right atrium, then moves towards the center of the heart to the AV node, and then on to the ventricle. Patients who have atrial fibrillation does not have an organized rhythm and instead, you have multiple focus bombarding the middle of the heart, the AV node, and hence they'll end up with an abnormal heart rhythm. Atrial fibrillation, the heart twitches or fibrillates in a rapid and unorganized fashion.

Deborah Howell (Host): Got it. Is it a condition you can acquire over time or one that you're born with?

Thuy Le, MD: So it's actually a condition that you do acquire over time, and there are some patients who are born with it. So if you have uncontrolled high blood pressure or valvular heart disease, some patients who have sleep apnea or thyroid, are more predisposed to atrial fibrillation. And we're also finding that there are some patients who have no risk factors and they do have a family history, so it's something that you can acquire as well as be born with it.

Deborah Howell (Host): Interesting. Roughly how many people have AFib and how do they know they have it?

Thuy Le, MD: So it's estimated that about two to three millions of Americans have atrial fibrillation and most of these patients have symptoms. These symptoms can include palpitations, fatigue, shortness of breath, chest pain, or dizziness. And then there are a subset of patients who have atrial fibrillation for which they have no symptoms whatsoever.

Deborah Howell (Host): Hmm. What is the best way then in your opinion to treat AFib?

Thuy Le, MD: So in terms of treatment, it actually varies on the, there are several factors that goes into the treatment plan for atrial fibrillation. Whether or not the patient is symptomatic from their atrial fibrillation, the type of atrial fibrillation they have, as well as the cause of atrial fibrillation. So for example, if you have a young person who has paroxysmal atrial fibrillation, meaning that the AFib comes and goes and they have no other structural heart disease, these patients may prefer a procedure to treat their atrial fibrillation as opposed to a more elderly patient who may have chronic atrial fibrillation who may not be aware of the atrial fibrillation. And for these subset of patients, medication may be the best way of treating them.

Deborah Howell (Host): Got it. Okay, now I understand there are some new procedures available for someone living with AFib. How do they work?

Thuy Le, MD: So if you're interested in having a procedure for atrial fibrillation, there is a procedure called ablation. Now ablation can be performed using heat energy or cold energy. We started off with heat energy. There's two types of ablation that we perform. There's the AV node ablation, and this type of ablation is mainly for rate control. You still have the underlying atrial fibrillation, but with an AV node ablation, you're blocking the signal from the atrium going to the ventricle and in this particular procedure, you would actually need a pacemaker with the AV node ablation. If you're looking for heat ablation for rhythm control, which means restoration of normal sinus rhythm, radiofrequency ablation is aimed at isolating the pulmonary veins, which are veins originating from the left side of the heart in the top chamber, the left atrium. Radiofrequency ablation can be cumbersome because it's a point-by-point ablation trying to isolate each of the pulmonary veins and that can take six to eight hours. There is a newer type of ablation that is available within the last few years called cryoablation, and with this type of ablation, we use cold energy instead of heat energy. And this technology is great because instead of doing point-by-point, we actually deliver the cold energy through a balloon and the balloon is inserted into the pulmonary vein. The balloon is then inflated and then you would make one circumferential freeze. This type of procedure takes about two to three hours and the success rate with this type of ablation is on the order of 80%.

Deborah Howell (Host): That is fantastic. I love to hear that. Now, if left untreated, can AFib do long-term damage, and if so, what would some of the outcomes be?

Thuy Le, MD: So the main two conditions that we're concerned with in terms of atrial fibrillation is stroke and congestive heart failure. During atrial fibrillation, the atrium is not contracting vigorously and as a result, the blood does not flow or empty as well. It becomes stagnant and can form a clot, and if this clot breaks off and goes to the brain, the patients then develop a stroke as a result of it. The other condition that we're most concerned with in terms of atrial fibrillation is that if the patient has a rapid rate as a result of their atrial fibrillation, over time you can cause the heart to become weakened and develop congestive heart failure.

Deborah Howell (Host): I see. I think I know how you're going to answer this next question, but I'm going to ask it anyway. Is a procedure always necessary to correct the heart rhythm or can people just live with AFib if monitored?

Thuy Le, MD: Correct. In terms of management of atrial fibrillation, it really depends on the individual, their symptoms, and the type. There are many patients that we do manage with medications, and if the medication does not work, then they would go on to have some sort of procedure for the management of their atrial fibrillation.

Deborah Howell (Host): Got it. Okay, now since sometimes an irregular heartbeat and a heart rhythm is unnoticeable to a patient, when is it most appropriate to see your physician to get checked for this condition?

Thuy Le, MD: I think that if you have certain conditions that would predispose you to atrial fibrillation, you should be monitored for it. Some conditions, as I've already mentioned, sleep apnea. If you have an uncontrolled thyroid problem, if you have diabetes or high blood pressure, if you have any type of structural heart disease such as congestive heart failure or valvular heart disease, a lot of these conditions puts you at higher risk for atrial fibrillation. And so when you go and see your doctor, you may want to ask for an EKG which can pick up the atrial fibrillation.

Deborah Howell (Host): Okay, so you just really ask your doctor to check for these symptoms and for any irregularities during your routine annual exam to ensure they don't have AFib. Okay. Do you have any advice you'd give to someone who has atrial fibrillation?

Thuy Le, MD: I think it's important that if you do have atrial fibrillation that you actually see a specialist in atrial fibrillation. That way, the specialist would have a better idea in terms of what would be the best treatment for that individual, whether it's medication, for stroke prevention, he or she can determine what your stroke risks are, they can control your risk for developing congestive heart failure, they can determine whether you would need rate control or different types of medications for rhythm control, and then can make the determination in terms of what type of ablation would be best for you.

Deborah Howell (Host): Okay, so keep up with your annual checkups, ask the right questions, get the tests your doctors recommend, and then if necessary go see a specialist.

Thuy Le, MD: Correct.

Deborah Howell (Host): Okay. Is there anything else we should know about what's on the horizon for AFib?

Thuy Le, MD: Yes, there is a new procedure on the horizon for atrial fibrillation where they occlude a small appendage in the atrium to reduce the risk of stroke. It's not universally available, but we're always coming up with new technology to try to manage patients with atrial fibrillation.

Deborah Howell (Host): Is that currently available in the US?

Thuy Le, MD: Yes, it is. It's called the Watchman.

Deborah Howell (Host): The Watchman. I like it. Well, we want to thank you very, very much, Dr. Le, for being on the program with us. It's been great to have you, learned a lot. In your opinion, where should people go to get more information?

Thuy Le, MD: I think you should go see your cardiologist and then he or she can always refer you to an electrophysiologist.

Deborah Howell (Host): Fantastic. And to listen to the podcast or more info of this show, please visit memorialcare.org. That's memorialcare.org. Dr. Le, it's been a pleasure.

Thuy Le, MD: Thank you.

Deborah Howell (Host): I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have a wonderful day.