Do you sometimes feel your heart pounding or feel it racing?
It could be ATRIAL FIBRILLATION.
My guest today is Dr. Charles H. Koo MD, Interventional Cardiologist with Meridian CardioVascular Network, to discuss AFIB.
Selected Podcast
The Latest Advancements For The Treatments of Heart Arrhythmia
Featured Speaker:
Charles Koo, MD
Dr.Charles Koo's specialties are Cardiology -Clinical Cardiac Electrophysiology. Transcription:
The Latest Advancements For The Treatments of Heart Arrhythmia
Bill Klaproth (Host): Do you sometimes feel your heart pounding or feel it racing? It could be atrial fibrillation. My guest today is Dr. Charles H. Koo, cardiac electrophysiologist with Meridian Cardiovascular Network. Dr. Koo, thank you so much for being on with us today. So, let’s jump right in. What is atrial fibrillation or A-fib?
Dr. Charles H. Koo (Guest): Atrial fibrillation is a chaotic upper chamber heart disorder where the upper chambers beat so quickly the mechanical function of the heart doesn’t perform. What happens is that you lose that efficiency of the heart and it can sometimes make the heart beat very quickly. The heart rate is typically very irregular and patients can suffer from congestive heart failure.
Bill: What is the general cause of A-fib?
Dr. Koo: That is a good question. There are a lot of reasons. Most of it is related to age. You can have co-existing medical conditions that can be strongly associated with it. Things like sleep apnea, high blood pressure, diabetes, open heart surgery, congestive heart failure. Those are things associated with it. Thyroid condition, so on and so forth. The list is pretty broad. Most of it is related to some type of aging process of the heart.
Bill: Are there symptoms with this? I know you said it is a rapid, chaotic heartbeat. Do people feel this? Are there other symptoms?
Dr. Koo: Fair question. Patients can develop symptoms from this, for sure. Some patients develop the sensation that their heart is pounding out of control. They feel short of breath, dizziness, sometimes they can experience chest pain. It depends on the patient. Some patients are apathetic or what we consider to be highly a-symptomatic where they don’t really realize it at all. Some patients are totally unaware of their atrial fibrillation. I would say the majority of patients are aware, especially if it is relatively new. If it has been ongoing for a while, some patients make adjustments and they get accustomed to it. They don’t really report any symptoms for it.
Bill: How do you diagnose it? How do you find it out in someone who has it if they are not having any symptoms?
Dr. Koo: Generally, it’s a diagnosis made on an EKG. Once we have a confirmatory EKG, it will demonstrate it for us. Sometimes you can actually listen to the heart but that is a little bit difficult to do with most folks who don’t have cardiac training. But, for the most part it is an electrocardiographic diagnosis.
Bill: This sounds pretty scary. Anytime you hear about somebody with a heart condition, especially something like this where the heart is, it sounds like, beating out of control. How serious is this? Can people die from this?
Dr. Koo: There is a certain risk associated with it. It is mainly related to your other medical conditions. There is a risk stratification formula that we use to figure out whether folks are going to get sick from it, particularly when we talk about strokes. It depends on the individual, generally speaking. The big worry is the risk of stroke and/or heart failure. Those are the two big co-morbidities associated with atrial fibrillation.
Bill: Are there other complications from A-fib besides stroke or heart failure?
Dr. Koo: You can be very short of breath. It depends on the patient’s capacity and their ability to adjust for their change in physiology. Some patients feel extremely short of breath. Some folks can pass out, depending on how fast they are going. Those are the main side effects associated with it.
Bill: Dr. Koo, once someone is diagnosed with A-fib how do you treat it?
Dr. Koo: That’s a great question. Again, the two concerns are risk of stroke, heart failure and/or symptom controls. We have a point system that we use to decide whether the patient is worthy to have a blood thinner on their medical regimen. That consists of things like heart failure, high blood pressure, your age. There are two cutoffs for that--age 65 and 75. Diabetes, prior stroke, your gender. If you’re a female patient, your risk is higher. If you have prior vascular disease, your risk is higher. So on and so forth. In terms of symptom control, we generally ask the patients how they feel. If their burden is very high, that would mandate a more aggressive therapy, a more aggressive program to try to get them back within normal heart rhythm.
Bill: You mention medication such as blood thinners. Are there others? I’ve heard of electric shock or is there a situation where a pacemaker is used?
Dr. Koo: Correct. When we try to restore the heart rhythm out of atrial fibrillation back to normal, we can do that with a variety of ways. We can cardiovert or just gently shock the heart back to normal heart rhythm. There is a list of cardiac medications that we use specifically for this. It’s a very long list. All of them have good things and bad things associated with it. Certainly, most of us would try a couple of drugs first before we divert to a surgical strategy. There is an operation called an “ablation” that we do in some patients, if they qualify. Generally speaking, you can jolt the heart back to a normal heart rhythm. You can try to keep it out of atrial fibrillation or convert it with medications and if you need to you can physically go inside the heart and try to cauterize the electrical tissues responsible for atrial fibrillation.
Bill: For someone with A-fib, can it be cured? Are these one-time events or, once you have it, you have it and it’s got to be managed for a life time?
Dr. Koo: A small percentage of patients can have a curative ablation. That’s for sure. I’d say the majority of patients, you manage it or contain it. I think that is a more truthful statement. Regarding the ablation for atrial fibrillation, the surgeries work fairly well. They are not perfect operations but they are better than the heart rhythm medication that we do have at hand. That’s why some of us will try to convince patients that an ablation is probably worth their time, especially if they’ve tried a couple of medications and it hasn’t been terribly helpful.
Bill: With A-fib, what I’m getting here is that it comes and goes at times and you can manage it. Are there certain events that make it worse? Like somebody is having a normal day and all of the sudden, “Oh, it’s coming on. My A-fib is here. I feel my heart racing.” Is that true? Are there certain events that bring A-fib on?
Dr. Koo: In terms of triggers for atrial fibrillation, there is a list of things that can trigger atrial fibrillation. Things like intrinsic lung problems, congestive heart failure, high blood pressure, ischemic heart disease, heart attacks – technically. Thyroid condition can trigger atrial fibrillation. There are other heart rhythms that trigger atrial fibrillation that are not atrial fibrillation. There’s something called SVT or supraventricular tachycardia that can certainly trigger atrial fibrillation. There is a long list of things that can be the precipice for atrial fibrillation in some patients.
Bill: What about things like energy drinks?
Dr. Koo: That’s an interesting question. Energy drinks, depending on what you drink and how much you drink, contain a variety of substances including high levels of caffeine. There’s all sorts of energy boosters, vitamins, there is a mishmash of things that you have to be a little bit careful. It’s hard to get sick from caffeine unless you overdo it. There are certainly many, many examples of folks who have passed away or have gotten very sick because they were caffeine intoxicated. In energy drinks, if you kept it to a common sense level of consumption, you’re not going to get acutely ill but if you overdo it, there is a good chance you could get sick from the active ingredients inside these beverages.
Bill: I better put that third cup of coffee down then.
Dr. Koo: I think that’s probably not the case. I think if you’re addicted to this stuff and you drink it large volumes then, yeah, you can get pretty sick from it.
Bill: Let me ask you this. Are there things that people can do on their own for A-fib, such as eat a particular diet or exercise or quit smoking--things like that--that help prevent it?
Dr. Koo: That’s a very good question. There was a recent scientific trial from Australia that looked at precisely this question. Long story short—essentially, they took folks who were little heavy or very heavy and they committed them to a weight loss program. It turns out that just pure weight loss or weight control – and it’s not much; really, about 10-20% of your initial body weight. If you can lose that weight and keep it off, the incidence of A-fib drops quite a bit. More importantly, if you are able to lose that weight before your ablation, your ablation or your surgery tends to work better, which I find very interesting. So, in other words, if folks can keep themselves healthy through diet, exercise and common sense things, you can actually get your body to get rid of the A-fib, at least in part which I think is a very, very intriguing way of treating this without pills, without an operation, without some of that stuff we do in the hospital, then. Some forms of A-fib could be a marker of just an unhealthy lifestyle and an unhealthy patient.
Bill: Very interesting. Very interesting. That’s very good to hear. There is, I don’t want to say a bright side, but here is an upside to this that for taking care of yourself, eating a healthy diet, doing all the normal healthy things to stay healthy could potentially help someone with A-fib. That’s very interesting information. Dr. Koo, thank you so much for being on with us today. Why should people choose Jersey Shore University Medical Center for their care?
Dr. Koo: We’re fortunate to have a lot of great technology here in the laboratory. We have a high volume in the laboratory of experienced practitioners who do this operation every single day. The volume here has grown exponentially over the last three to four years due to the hard work of lots of people involved. A lot of us were classically trained in electrophysiology, so we know who to bring to the laboratory and who not to bring to the laboratory. Most of us have a very good philosophy in terms of committing folks to a healthy lifestyle first before thinking about a surgery. So, all in all, we have the experience, we have the practitioners, and the technology and we are more than happy to help folks with this condition.
Bill: Dr. Koo, thank you so much, again. We appreciate it. For more information, please visit MeridianHealth.com. That’s MeridianHealth.com. This is the Meridian Physician Podcast with Meridian Health. I’m Bill Klaproth. Thanks for listening.
The Latest Advancements For The Treatments of Heart Arrhythmia
Bill Klaproth (Host): Do you sometimes feel your heart pounding or feel it racing? It could be atrial fibrillation. My guest today is Dr. Charles H. Koo, cardiac electrophysiologist with Meridian Cardiovascular Network. Dr. Koo, thank you so much for being on with us today. So, let’s jump right in. What is atrial fibrillation or A-fib?
Dr. Charles H. Koo (Guest): Atrial fibrillation is a chaotic upper chamber heart disorder where the upper chambers beat so quickly the mechanical function of the heart doesn’t perform. What happens is that you lose that efficiency of the heart and it can sometimes make the heart beat very quickly. The heart rate is typically very irregular and patients can suffer from congestive heart failure.
Bill: What is the general cause of A-fib?
Dr. Koo: That is a good question. There are a lot of reasons. Most of it is related to age. You can have co-existing medical conditions that can be strongly associated with it. Things like sleep apnea, high blood pressure, diabetes, open heart surgery, congestive heart failure. Those are things associated with it. Thyroid condition, so on and so forth. The list is pretty broad. Most of it is related to some type of aging process of the heart.
Bill: Are there symptoms with this? I know you said it is a rapid, chaotic heartbeat. Do people feel this? Are there other symptoms?
Dr. Koo: Fair question. Patients can develop symptoms from this, for sure. Some patients develop the sensation that their heart is pounding out of control. They feel short of breath, dizziness, sometimes they can experience chest pain. It depends on the patient. Some patients are apathetic or what we consider to be highly a-symptomatic where they don’t really realize it at all. Some patients are totally unaware of their atrial fibrillation. I would say the majority of patients are aware, especially if it is relatively new. If it has been ongoing for a while, some patients make adjustments and they get accustomed to it. They don’t really report any symptoms for it.
Bill: How do you diagnose it? How do you find it out in someone who has it if they are not having any symptoms?
Dr. Koo: Generally, it’s a diagnosis made on an EKG. Once we have a confirmatory EKG, it will demonstrate it for us. Sometimes you can actually listen to the heart but that is a little bit difficult to do with most folks who don’t have cardiac training. But, for the most part it is an electrocardiographic diagnosis.
Bill: This sounds pretty scary. Anytime you hear about somebody with a heart condition, especially something like this where the heart is, it sounds like, beating out of control. How serious is this? Can people die from this?
Dr. Koo: There is a certain risk associated with it. It is mainly related to your other medical conditions. There is a risk stratification formula that we use to figure out whether folks are going to get sick from it, particularly when we talk about strokes. It depends on the individual, generally speaking. The big worry is the risk of stroke and/or heart failure. Those are the two big co-morbidities associated with atrial fibrillation.
Bill: Are there other complications from A-fib besides stroke or heart failure?
Dr. Koo: You can be very short of breath. It depends on the patient’s capacity and their ability to adjust for their change in physiology. Some patients feel extremely short of breath. Some folks can pass out, depending on how fast they are going. Those are the main side effects associated with it.
Bill: Dr. Koo, once someone is diagnosed with A-fib how do you treat it?
Dr. Koo: That’s a great question. Again, the two concerns are risk of stroke, heart failure and/or symptom controls. We have a point system that we use to decide whether the patient is worthy to have a blood thinner on their medical regimen. That consists of things like heart failure, high blood pressure, your age. There are two cutoffs for that--age 65 and 75. Diabetes, prior stroke, your gender. If you’re a female patient, your risk is higher. If you have prior vascular disease, your risk is higher. So on and so forth. In terms of symptom control, we generally ask the patients how they feel. If their burden is very high, that would mandate a more aggressive therapy, a more aggressive program to try to get them back within normal heart rhythm.
Bill: You mention medication such as blood thinners. Are there others? I’ve heard of electric shock or is there a situation where a pacemaker is used?
Dr. Koo: Correct. When we try to restore the heart rhythm out of atrial fibrillation back to normal, we can do that with a variety of ways. We can cardiovert or just gently shock the heart back to normal heart rhythm. There is a list of cardiac medications that we use specifically for this. It’s a very long list. All of them have good things and bad things associated with it. Certainly, most of us would try a couple of drugs first before we divert to a surgical strategy. There is an operation called an “ablation” that we do in some patients, if they qualify. Generally speaking, you can jolt the heart back to a normal heart rhythm. You can try to keep it out of atrial fibrillation or convert it with medications and if you need to you can physically go inside the heart and try to cauterize the electrical tissues responsible for atrial fibrillation.
Bill: For someone with A-fib, can it be cured? Are these one-time events or, once you have it, you have it and it’s got to be managed for a life time?
Dr. Koo: A small percentage of patients can have a curative ablation. That’s for sure. I’d say the majority of patients, you manage it or contain it. I think that is a more truthful statement. Regarding the ablation for atrial fibrillation, the surgeries work fairly well. They are not perfect operations but they are better than the heart rhythm medication that we do have at hand. That’s why some of us will try to convince patients that an ablation is probably worth their time, especially if they’ve tried a couple of medications and it hasn’t been terribly helpful.
Bill: With A-fib, what I’m getting here is that it comes and goes at times and you can manage it. Are there certain events that make it worse? Like somebody is having a normal day and all of the sudden, “Oh, it’s coming on. My A-fib is here. I feel my heart racing.” Is that true? Are there certain events that bring A-fib on?
Dr. Koo: In terms of triggers for atrial fibrillation, there is a list of things that can trigger atrial fibrillation. Things like intrinsic lung problems, congestive heart failure, high blood pressure, ischemic heart disease, heart attacks – technically. Thyroid condition can trigger atrial fibrillation. There are other heart rhythms that trigger atrial fibrillation that are not atrial fibrillation. There’s something called SVT or supraventricular tachycardia that can certainly trigger atrial fibrillation. There is a long list of things that can be the precipice for atrial fibrillation in some patients.
Bill: What about things like energy drinks?
Dr. Koo: That’s an interesting question. Energy drinks, depending on what you drink and how much you drink, contain a variety of substances including high levels of caffeine. There’s all sorts of energy boosters, vitamins, there is a mishmash of things that you have to be a little bit careful. It’s hard to get sick from caffeine unless you overdo it. There are certainly many, many examples of folks who have passed away or have gotten very sick because they were caffeine intoxicated. In energy drinks, if you kept it to a common sense level of consumption, you’re not going to get acutely ill but if you overdo it, there is a good chance you could get sick from the active ingredients inside these beverages.
Bill: I better put that third cup of coffee down then.
Dr. Koo: I think that’s probably not the case. I think if you’re addicted to this stuff and you drink it large volumes then, yeah, you can get pretty sick from it.
Bill: Let me ask you this. Are there things that people can do on their own for A-fib, such as eat a particular diet or exercise or quit smoking--things like that--that help prevent it?
Dr. Koo: That’s a very good question. There was a recent scientific trial from Australia that looked at precisely this question. Long story short—essentially, they took folks who were little heavy or very heavy and they committed them to a weight loss program. It turns out that just pure weight loss or weight control – and it’s not much; really, about 10-20% of your initial body weight. If you can lose that weight and keep it off, the incidence of A-fib drops quite a bit. More importantly, if you are able to lose that weight before your ablation, your ablation or your surgery tends to work better, which I find very interesting. So, in other words, if folks can keep themselves healthy through diet, exercise and common sense things, you can actually get your body to get rid of the A-fib, at least in part which I think is a very, very intriguing way of treating this without pills, without an operation, without some of that stuff we do in the hospital, then. Some forms of A-fib could be a marker of just an unhealthy lifestyle and an unhealthy patient.
Bill: Very interesting. Very interesting. That’s very good to hear. There is, I don’t want to say a bright side, but here is an upside to this that for taking care of yourself, eating a healthy diet, doing all the normal healthy things to stay healthy could potentially help someone with A-fib. That’s very interesting information. Dr. Koo, thank you so much for being on with us today. Why should people choose Jersey Shore University Medical Center for their care?
Dr. Koo: We’re fortunate to have a lot of great technology here in the laboratory. We have a high volume in the laboratory of experienced practitioners who do this operation every single day. The volume here has grown exponentially over the last three to four years due to the hard work of lots of people involved. A lot of us were classically trained in electrophysiology, so we know who to bring to the laboratory and who not to bring to the laboratory. Most of us have a very good philosophy in terms of committing folks to a healthy lifestyle first before thinking about a surgery. So, all in all, we have the experience, we have the practitioners, and the technology and we are more than happy to help folks with this condition.
Bill: Dr. Koo, thank you so much, again. We appreciate it. For more information, please visit MeridianHealth.com. That’s MeridianHealth.com. This is the Meridian Physician Podcast with Meridian Health. I’m Bill Klaproth. Thanks for listening.