Transcription:
Heart Rhythm Disorders

Evo Terra: This is BayCare HealthChat. I'm Evo Terra. Heart arrhythmias are an irregular heartbeat. It feels like a fluttering or a racing heart sometimes and can often be harmless. However, some heart arrhythmias may be indicative of serious underlying conditions. To help us understand this better, today, I'm chatting with Dr. Rodrigo A. Bolaños, the electrophysiology lab director, director of Arrhythmia Services at Bostick Heart Center at Winter Haven Hospital, and the Co-chair of the Arrhythmia Committee for BayCare Health System. Dr. Bolaños, thanks for joining me.

Dr. Rodrigo Bolaños: Glad to be joining you, Evo, this afternoon.

Evo Terra: I always like to start these conversations with a level set. So, can I ask that you would define arrhythmia for us lay people?

Dr. Rodrigo Bolaños: An arrhythmia is basically a term that applies to an abnormal heartbeat, and that could be a beat that's abnormal because it's either too slow or irregular or too rapid.

Evo Terra: So, are irregular heartbeats always a concern?

Dr. Rodrigo Bolaños: Not always. And that's why it's important to see a trained specialist to help you differentiate something that you should be concerned about or something that can be expected in the general population, particularly somebody of your age or with your medical conditions, and then make the appropriate recommendations based on those factors.

Evo Terra: Okay. So, let's say that someone is experiencing something different that they haven't really experienced before, not just the standard heart flutters or racing heart because they ran a marathon, but something else. What should they be looking for? What should we be looking for in something that might need a doctor's attention?

Dr. Rodrigo Bolaños: So basically, a good general rule is, and this applies not only toarrhythmias, but other medical conditions, if it's something that continues to recur or it's becoming more frequent, then that's something that you shouldget assessed. If it's something that goes away on its own, then typically that's not something you got to worry about. But if it's a recurrent issue, then the next step would be to typically see your general doctor first. And often, he or she may order you a heart monitor to try to capture and see if there's a rhythm abnormality that's contributing to your symptoms. And oftentimes, they will refer you to a cardiologist or directly to an electrophysiologist to have that evaluated.

Evo Terra: The first stop with regular GP istypically the right answer. That's very good to know. Can we talk about some of the common disorders that you see? What's out there? And I guess also what's the most concerning, if not fatal?

Dr. Rodrigo Bolaños: Well, with aging population, a lot of rhythm disorders are becoming more frequent. And so, there's a spectrum. It could vary from rhythm disorders that require, for example, a pacemaker because the pulse is too slow to potentially life-threatening rhythm disorders such as ventricular tachycardia or ventricular fibrillation, which is essentially when you hear of somebody just dropping suddenly. And so, those people, if they're able to be resuscitated and so forth, often end up with, a defibrillator. You may have heard of athletes where that's occurred. There was a famous case recently with a, football player that had a cardiac arrest on the field. That was a more rare case, but that kind of arrhythmia can be, you know, life-threatening.

Otherwise, outside of those life-threatening arrhythmias, there's other more common arrhythmias, which can still havesignificant adverse effects. And probably one of the most common ones is atrial fibrillation, which is a very irregular rhythm from the top of the heart that can really manifest in a variety of ways. And it's probably one of the more challenging ones to manage for various reasons.

Evo Terra: Yeah. My mom has AFib and she's been through something, I think they called it ablation therapy. Can you talk about that for a moment?

Dr. Rodrigo Bolaños: Yeah. So, AFib, there's two things that we focus on with atrial fibrillation depending on risk factors. And we calculate something called a CHA2DS2-VASc score. And that takes into consideration things like your age and the presence of other existing conditions such as diabetes, high blood pressure, and a few others. And that helps guide our decision to recommend a blood thinner. Because atrial fibrillation, when associated with some of these other risk factors, increases your risk of stroke.

So, we focus, number one, on assessing that risk and appropriately protecting the patient typically with a blood thinner. And I should note that aspirin does not really count as a blood thinner. The second thing we focus on atrial fibrillation is the management of symptoms and preventing from it recurring, particularly if we think it's causing issues such as it's weakening the heart or making the patient feel poorly, and that involves a variety of methods ranging from medications to a procedure called an ablation, where we directly target in a minimally invasive fashion the abnormal parts of the heart that are causing it to go out of rhythm. And that's typically done by placing catheters, usually advanced through one of the vessels at the waist, and making an electrical map of the heart and looking for those areas where we know atrial fibrillation originates.

It's the most effective treatment that we have. It's actually most effective when it's done early in the disease process, meaning the atrial fibrillation hasn't been around for years, but it's not a hundred percent, neither is medication. Sometimes it has to be done a second time down the road, but the idea is to control the AFib and our ability to "cure" the AFib is best when it's done earlier in the disease process. Otherwise, really our goal is to control it.

Evo Terra: Thanks for that information. We're talking about AFib, we're talking about tachycardia and other sorts of interesting terms for people. Do all of these have a single underlying cause or are they from multiple causes?

Dr. Rodrigo Bolaños: Oh, absolutely not. The causes can be quite varied. But anything from genetic causes to, environmental causes, meaning the existence of other comorbidities, meaning other disease states such as diabetes, high blood pressure, coronary disease, things like that. There's multiple causes and different patients can have different presentations for the same arrhythmia. So, that's why it's particularly important to see a specialist and often really a subspecialist, such as an electrophysiologist like myself and others in the system.

Evo Terra: Thinking about treatment for just a moment, we've talked about doing the ablation with AFib. We talked about pacemakers. What sorts of treatments are out there? Not everybody gets the same thing, obviously. So, what can be done? And can any of those things be done without the use of medication or surgery?

Dr. Rodrigo Bolaños: So, there are instances where we will skip the medication option, particularly if the patient's younger or we need to try to keep the atrial fibrillation from recurring because it's already causing significant adverse events on that patient's heart and so oftentimes, we'll skip the medication or if the medication is not well tolerated. So, that's why every patient is different and the way that one approaches each patient not only can be variable from patient to patient, but it could vary depending on where in the disease process that particular patient is at that particular point in time. So for example, I've followed patients, for example, for the last eight years and what we did eight years ago, I probably would not recommend the same thing now, or we would take a slightly different course because they're at a different point in their life.

Evo Terra: Yeah, that makes sense. Also, medical advances as well, we all want to keep learning all these things that we're doing, right?

Dr. Rodrigo Bolaños: Yeah, correct. Our ability to get better results with ablation is improving. The medications, unfortunately, we haven't had any really new medications to treat the rhythm abnormalities. So, our progress has been made more on the procedure side to try to minimize their recurrences. And also pacemakers, have their role. They themselves don't keep the rapid rhythms from occurring, but they can allow us to manage the patient by giving medications that otherwise would not be tolerated without a pacemaker in place.

Evo Terra: So, you are an electrophysiologist? Did I get their name properly there?

Dr. Rodrigo Bolaños: That's correct. Yeah.

Evo Terra: I have a cardiologist. Can you tell me the difference between your two disciplines?

Dr. Rodrigo Bolaños: So as an electrophysiologist, you have to go through cardiology training first, and then you have to do an additional training fellowship of minimum of two years duration. And there's a completely separate board certification for electrophysiology. So to become an electrophysiology physician, you have to become proficient at the minimum of doing certain procedures such as pacemakers, defibrillators, resynchronization devices and, of course, a variety of ablations to deal with a gamut of rapid heart rhythms.

A cardiologist only has the ability to prescribe certain medications to help with the rhythm problems, but they can't do any procedures to actually address the problems directly. In fact, electrophysiology it's such a distinct field that once you become an electrophysiologist, it's not even required that you keep your board certification in cardiology up-to-date because it's such a distinct field.

Evo Terra: Interesting. Okay. All right. Got it.

Dr. Rodrigo Bolaños: They look at the patient as a whole and they manage the arrhythmias with medications to their best of their ability, often in conjunction with an electrophysiologist. But they also focus on other things like valvular abnormalities and making sure they're on the right medications, referring them for timely surgery and other interventions such as placing a stent and alike.

Evo Terra: Dr. Bolaños, thank you so much for all the information today.

Dr. Rodrigo Bolaños: No problem. It was my pleasure. If anything else comes up, let me know.

Evo Terra: Once again, that was Dr. Rodrigo A. Bolaños, the electrophysiology lab director, Director of Arrhythmia Services at Bostick Heart Center at Winter Haven Hospital, and the co-chair of the Arrhythmia Committee for BayCare Health System. And that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCareHeartRhythm.org for more information and to get connected with one of our providers.

Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share it on your social media and be sure to check out all the other interesting podcasts in our library. I'm Evo Terra. Thanks for joining us and stay well.