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How is Atrial Fibrillation Diagnosed and Treated? · Flourish- A Prisma Health Podcast

• 0:03
  Maggie McKay (Host): Welcome to Flourish, a podcast from Prisma Health.
• 0:06
  I'm your host, Maggie McKay.
• 0:08
  Joining us today is Dr.
• 0:10
  Paras Patel, board-certified electrophysiologist and cardiologist,
• 0:15
  to discuss understanding AFib, from warning signs to advanced care.
• 0:20
  Thank you so much for being here.
• 0:22
  Paras Patel, MD: Thank you for having me.
• 0:23
  Host: So, what exactly is atrial fibrillation, and why is it something
• 0:28
  people should pay attention to?
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  Paras Patel, MD: So, atrial fibrillation or AFib in short is
• 0:34
  the most common abnormal heart rhythm or arrhythmia that we see.
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  Approximately ten million people in the United States have AFib.
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  And what it is is an abnormal rhythm in the top chamber of the heart.
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  And so, normally, the top chamber beats followed by a beat in the bottom chamber.
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  And when people are in AFib, the top chamber starts beating erratically
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  and very fast, often three to four hundred beats a minute, which
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  sometimes causes the bottom chamber to also beat erratically and fast.
• 1:02
  And so, ultimately, this results in an abnormal or irregular
• 1:06
  heart rhythm, which can lead to long-term sequelae in the heart.
• 1:10
  Host: How might someone know they have AFib?
• 1:13
  Paras Patel, MD: So, AFib is often diagnosed with an EKG, sometimes
• 1:17
  with a heart monitor, and nowadays even sometimes with things
• 1:20
  like Apple Watches and Fitbits.
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  But people often have symptoms, things like shortness of breath,
• 1:26
  feeling like their heart is racing, getting tired, getting fatigued,
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  shortness of breath at rest or when they're trying to exert themselves,
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  and sometimes even like a brain fog.
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  So, the symptoms can be very variable.
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  Host: Wow.
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  And how is it usually diagnosed?
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  Paras Patel, MD: Yeah.
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  So, we generally diagnose patients with an EKG either in
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  the clinic or in the hospital.
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  Sometimes we find out that patients have AFib when they're
• 1:48
  wearing a heart monitor at home.
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  And other times things like their Apple Watch or their Fitbits may tell them
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  that they have an irregular rhythm, and patients come to see us in clinic, and
• 1:59
  we get an EKG and diagnose them that way
• 2:01
  Host: Once someone is diagnosed, what are the typical treatment options?
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  Can you walk us through, like, medications and what patients should know about them?
• 2:10
  Paras Patel, MD: Sure.
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  So, there are a couple of important things to know about treating AFib, and it kind
• 2:15
  of falls into three different categories.
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  The first category is stroke risk.
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  So, one of the main complications that we worry about for patients
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  with AFib is having a stroke.
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  And so for patients who are at an increased risk of stroke, which is
• 2:28
  calculated by their other risk factors, we put them on blood thinners, and that
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  normally entails one of three medicines.
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  The purpose of being on blood thinners is to help minimize your risk of
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  stroke down to the same level as if you didn't have AFib at all.
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  So after that has been dealt with, the second two steps that we like to treat
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  are patient's symptoms and then getting them to a better quality of life.
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  And also deciding whether we want to control their rhythm, meaning
• 2:53
  getting them back in normal rhythm or just controlling their heart rates.
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  And that is kind of a step-by-step and patient-by-patient approach that we
• 3:01
  take, and it's somewhat individualized rather than same thing for everybody.
• 3:07
  Host: And what about medications?
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  What do patients need to know about that?
• 3:12
  Paras Patel, MD: In terms of medicines, in terms of stroke risk reductions, there are
• 3:15
  blood thinners that we put patients on.
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  And the purpose of being on a blood thinner is to
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  minimize your risk of stroke.
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  The reason that patients are at increased risk of stroke with AFib is because when
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  the top chamber of the heart is beating three, four hundred beats a minute and
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  very erratically, the blood doesn't move like it's supposed to in the heart, and
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  that puts you at risk of developing a clot in the top chamber of the heart, which can
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  then go to your brain and cause a stroke.
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  So, blood thinners like Eliquis or Apixaban, Xarelto, rivaroxaban, and
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  even things like Warfarin are added to patients' medication lists to help
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  them hopefully not have a stroke.
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  In terms of medications of treating AFib, the options are medicines that
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  slow down the heart, which are beta blockers or calcium channel blockers
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  or anti-arrhythmic medicines, which the goal of those medicines are to try
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  to keep people in a normal rhythm and preventing them from having AFib at all.
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  Host: Dr.
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  Patel, at what point do you consider procedures like catheter ablation?
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  And how do those treatments help?
• 4:13
  Paras Patel, MD: Catheter ablation over the last ten or fifteen years has
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  come a long way and has become kind of a mainstay treatment for patients
• 4:18
  with symptomatic atrial fibrillation.
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  And so when patients have symptoms of some of the things that we've
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  already previously mentioned, or if they've had heart failure or have
• 4:28
  been admitted to the hospital due to very rapid heart rates that could
• 4:32
  not be controlled at home, those are great candidates for an ablation.
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  A catheter ablation for AFib entails us putting catheters in the veins of the
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  legs and running them up to the heart.
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  And then, from that point, we're able to target areas
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  where AFib generally comes from.
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  And for most people, the first place we start is called the pulmonary veins.
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  And so, we use these catheters with using technology like PFA or
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  pulsed field ablation, sometimes radiofrequency ablation, which
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  is heat, or cryo, which is ice.
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  So, we can use basically electricity, heat, or ice to treat
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  these areas of the heart where the electrical abnormalities are.
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  And then, we check to make sure that we don't see any electrical
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  conduction in those areas to confirm that we have treated it appropriately.
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  And then, after that, we take all the catheters out, and most patients are able
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  to go home a few hours after the procedure
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  Host: How long has it been like that?
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  Like 10 years, five years, or has that been around for a long time
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  that you could go home the same day?
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  Paras Patel, MD: So yeah, being able to go home the same day is
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  probably a more recent thing.
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  I think it really became commonplace once the COVID pandemic happened because we
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  really didn't want to keep patients in the hospital longer than we really needed to.
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  And so, we worked on kind of workflows that helps us take care of
• 5:44
  patients in a more efficient manner.
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  And we now have devices and tools that we can use to help close the veins
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  so the risk of bleeding and vascular complications is significantly lower.
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  And so, we get patients up, we let them walk up and down the hall, make
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  sure they don't have any issues.
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  As long as they're doing well, we're able to get them home and walking the same day
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  Host: That is amazing.
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  Well, for some patients, devices can be part of treatment.
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  What kinds of implantable options are available and
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  who might benefit from those?
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  Paras Patel, MD: In terms of implantable options, the two major things that
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  patients with AFib end up with either a pacemaker, which is generally
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  the end of the line for treatment of AFib, or something like a left
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  atrial appendage occlusion device.
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  And that's for patients who cannot tolerate blood thinners or cannot
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  be on a blood thinner safely.
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  And we are able to put a device that closes off the little appendage in the
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  heart called the left atrial appendage, where blood clots tend to form.
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  So pacemakers, what we essentially do is for someone whose AFib is no longer
• 6:43
  able to be controlled, and patients are very symptomatic, we're able to
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  put a pacemaker in and then disconnect the electrical activity that goes
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  from the top chamber to the bottom chamber of the heart with a simple
• 6:53
  ablation called an AV node ablation.
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  And from that point on, the patient is paced with the pacemaking wires,
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  but no longer is the top chamber arrhythmia able to affect the
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  bottom chamber, making it go fast.
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  And that's a great option for patients who've kind of exhausted ablation
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  options or medication options, or they have heart failure symptoms
• 7:12
  that we can no longer control.
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  In terms of the left atrial appendage occlusion device, that is done
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  similarly to an AFib ablation, where we go through the vein in the leg
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  and enter that area of the heart.
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  And then, we implant this device in the left atrial appendage.
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  And after about six months, that device becomes a part of the heart, and it closes
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  off that appendage, so blood clots can no longer form in the left atrial appendage.
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  Ultimately, what that does is it's similar to being on a blood thinner, but
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  you can no longer be on a blood thinner and reduce your risk of stroke similarly
• 7:44
  as if you were on a blood thinner.
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  Host: And beyond medical treatments, what lifestyle changes can make
• 7:49
  a real difference when you're managing AFib or reducing episodes?
• 7:54
  Paras Patel, MD: Lifestyle changes can not only make a difference in
• 7:56
  terms of managing your AFib burden or amount of episodes you have, but they
• 8:00
  can also help in prevention of AFib.
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  And so, some of the main things that I try to talk to patients about are
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  things like, you know, your weight.
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  Morbidly obese patients or obese patients, a 10% reduction in
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  weight can reduce significantly the amount of AFib or even chance of
• 8:16
  recurrence in AFib after an ablation.
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  Managing things like blood pressure, managing things
• 8:21
  like coronary artery disease.
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  If patients have sleep apnea or if you're someone who snores or stops breathing in
• 8:26
  the middle of the night, getting treated for sleep apnea with something like CPAP.
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  And then, also very importantly, reduction in alcohol intake or even
• 8:34
  abstinence from alcohol, all those things can reduce your risk of getting AFib
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  or reduce your reoccurrence of AFib.
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  Host: Is it hereditary?
• 8:43
  Paras Patel, MD: There is some hereditary component of atrial fibrillation.
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  It is not like some hereditary diseases where you can do a gene test
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  and say, "Well, you know, because of this specific gene, you'll definitely
• 8:53
  have AFib or you won't have AFib."
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  We often see that patients who have family members that have AFib or
• 8:59
  siblings that have AFib, they have increased likelihood of potentially
• 9:03
  getting it at some point in their life.
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  Host: So looking long-term, what should patients focus on to stay
• 9:08
  healthy and lower their risk of complications like stroke, and where
• 9:12
  can they go to learn more or get care?
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  Paras Patel, MD: Yeah.
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  So if you're a patient who has a diagnosis of atrial fibrillation, I
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  think one of the most important things you can do is take your blood thinner or
• 9:21
  the medications that are prescribed to manage the AFib like they are prescribed.
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  If you're taking your blood thinner, you're working on some of those things
• 9:28
  that we kind of previously mentioned, like weight reduction, you know,
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  exercise—I think I forgot to mention that, but exercise is very important.
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  And kind of keeping in track of your symptoms and letting your doctor
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  know when you notice a change or a difference can certainly decrease
• 9:41
  your risk of complications and also decrease your risk of stroke.
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  In terms of, you know, learning more about AFib or getting some more
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  information, I think, the HRS or the Heart Rhythm Society website has a
• 9:52
  lot of good information about AFib, as well as the American Heart Association.
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  And they have a lot of pamphlets and kind of informational documents that
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  can help patients learn a little bit more about the disease and where
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  they fit into the the treatment plan.
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  Host: That's great.
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  In closing, is there anything else you'd like to add?
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  Paras Patel, MD: I think the most important thing to realize
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  is atrial fibrillation is different from person to person.
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  Everyone has different symptoms.
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  It affects people differently.
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  And so, the best option for patient A may not be the best option for patient B.
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  And that's why it's really important to have a patient-centered
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  discussion when we're talking about treatment for this condition,
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  because it may be very different.
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  And so, talking to your doctor, letting them know how you feel, letting them
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  what's going on, what your goals are in terms of your treatment will help guide
• 10:39
  management and how we take care of folks
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  Host: Well, thank you so much for sharing your expertise.
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  This has been so informative.
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  We really appreciate your time.
• 10:47
  Paras Patel, MD: Yeah.
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  Thank you so much for having me.
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  Host: Again, that's Dr.
• 10:50
  Paras Patel.
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  To learn more, please visit prismahealth.org/podcast.
• 10:54
  And if you found this podcast helpful, please share it on your social channels
• 10:59
  and check out our entire podcast library for topics of interest to you.
• 11:04
  Thanks for listening to Flourish from Prisma Health.