Transcription:
Heart Rhythm Disorders and Treatment

Introduction: This is Hello Healthy, a Dignity Health Podcast. Here's Bill Klaproth.

Bill Klaproth: So what are heart rhythm disorders and why are they dangerous, and what is treatment through ablation? Well, let's learn more with Dr. Michah Roberts, an Electrophysiologist and Cardiologist at Dignity Health. Dr. Roberts, thank you so much for your time. So first off, can you share some information on your background? Tell us about your time in the military and moving back to Bakersfield now to practice medicine.

Dr. Roberts: Thanks Bill. I was born and raised here in Bakersfield and so I'm happy to be back home. I'm close to my family and I was a student who grew up in Rosedale and attended Centennial high school. And then I went to Cal State Bakersfield here locally. After that I was accepted in medical school and I ended up on that, what's called a health profession scholarship program with the Army. So I went to medical school down at Western University in Los Angeles. And from there I did residency with the Army, with internal medicine out at Tripler Army Medical Center in Hawaii. And so that was for three years there. And then afterwards I served in the military as an internal medicine provider at various bases, Borderland, Fort Bragg, William Beaumont and El Paso. And then was also deployed to Afghanistan. Once I got out of the military, I went back to training and cardiology. So I did that at the UCFS program in Fresno, California. Just North of Bakersfield here. And while I was there I fell in love with heart rhythm disorders and decided that I wanted to pursue additional training beyond cardiology and become an electrophysiologist. And so I went to university of Wisconsin to complete my training there for an additional two years. And at that point we decided it was quite cold and decided to come back to Bakersfield, which was really the plan all along for me. So very happy to be back and practice in the community that I love and I'm surrounded by lots of friends and family that I still have here.

Host: Well first off, thank you so much for your service. We appreciate it and we're very happy you're back here practicing medicine. So you said you fell in love with heart rhythm disorders. Can you explain that to us? What are heart rhythm disorders?

Dr. Roberts: The audience may not know this but there takes electricity to cause all the muscles in their body to contract or to move, and your heart being a muscle, it has to have electricity that feeds it and tells it when to squeeze. Cause if it was squeezing all the time, there would be no blood movement and we wouldn't be alive. So just as there can be some plumbing issues where blood doesn't flow through the Heart well, there can also be electrical issues where the heart rhythm. We call it the heart rhythm because it's what drives the beating of your heart and it's what keeps the pace of your heartbeat. But when that is in disarray, you know you have a heart rhythm disorder, and those come in various shapes and sizes and we can get into some of that. But essentially I work on the electrical system of the heart.

Host: So with that electrical system of the heart, one of the treatment options is an ablation. Can you tell us what an ablation is and how it's performed?

Dr. Roberts: Yeah. So an ablation is where we use an energy technology to send the energy into the heart tissue itself so that the areas of the heart where we blate, if you will, don't conduct electricity. And so what we're doing with an ablation is we're trying to find the areas that are leading to one of the heart rhythm disorders that the patient might be experiencing. For example, there's a heart rhythm called a reentry tachycardia. And what that essentially means is that there's a loop of electricity, where electricity is traveling around a racetrack, if you will. And we don't want it traveling around the racetrack, we want it sort of traveling, you know, linear and more like a river from one side to the other. And so if the electricity gets stuck on a racetrack, this can cause your heart to race. And with an ablation, what we do is we identify where that race track is and then we ablate one limb of that race track.

So that circuit or that track doesn't exist anymore. And when we ablate that one area basically puts a roadblock on the racetrack so that it doesn't exist anymore. Now when we do an ablation, we're going in with a catheter from generally from the leg and from there we send a catheter up to the heart. And so you might say, well what is a catheter? Well a catheter in my lab is a tube that's filled with wires and at the end there's a little tiny electrode that is smooth, and it runs along the surfaces of the heart. And we can actually measure electricity within the heart itself on the inner walls of it. And then we're able to send electricity or radio frequency energy or you know, we can use a cooling catheter where we're actually able to cause the areas that we touch with that catheter not be able to conduct electricity anymore.

Host: Wow. This is fascinating. So what are the types of heart rhythm disorders that you can treat with an ablation?

Dr. Roberts: So the types of heart rhythm disorders that we can ablate generally are the fast heart rhythms. And so those include heart rhythms such as atrial fibrillation, Ventricular tachycardia, supraventricular tachycardia is, which is further broken down into things like 80 nodal reentry tachycardia or AV reentry tachycardia. There's some patients that have essentially extra pathways in their heart that cause these reentry loops to occur. There's also types of tachycardia's called atrial tachycardia is where the normal place that an impulse is formed in the heart, isn't driving the train, the electricity is coming from a different area in the atrium. And so we sort of hunt for that with our catheters and identify those cells that are causing it, and ablate those. So we generally is that the fast rhythms now we also ablate atrial fibrillation and that's become a much more common ablation for us to do nowadays. And in those cases we tend to be blating areas around the sites where atrial fibrillation generally originates. And what we do in those cases is essentially create a firewall that protects the sparks that come from those areas, from igniting the rhythm that is atrial fibrillation, generally atrial fibrillation and all of these catheter ablations can be very successful and safe as well.

Host: So when you do a cardiac ablation, how long does it last? Is it lifelong? Is it a year and a half? What can someone expect when they get a cardiac ablation?

Dr. Roberts: So SVTs, AB nodal reentry tachycardia, AVRT, those tend to be very successful and it's, you know, 96% or better where one ablation, you know, one procedure can cure a patient from ever having that again. So there's, you know, 21 year olds that come into my office with fast heart rhythms and they're popping into this rhythm and it's driving them into the ER on multiple occasions for, you know, a month. And so we can do one procedure and cure that so they never have to deal with it for the rest of their life. Earlier today I did a procedure on an 83 year old that had an SVT, you know, and, and she's been dealing with it for decades, but finally decided she would be, you know, willing to go through the procedure. And I think she's going to do quite well. So there are certain heart rhythm disorders where we think of it as very curative and because it's safe, it is generally the first line option for management. There's other heart rhythm disorders where it's more of a part of the management strategy. And generally when I say that it's a lot of times it's atrial fibrillation, and I would never try to tell you that atrial fibrillation ablation is a cure, although I think that's coming in the future.

But right now, atrial fibrillation ablation is part of the management strategy where I tell people, you know, look, you know, there might be a reoccurrence at some point in the future. And I can't say when that might be, but at about 18 months from now, 90% or more of people haven't had any AFib, you know, and so, you know, somebody who's dealing with a set of episodes multiple times a week, they would take that and run, you know, you're giving me 18 months of, of life without having to deal with this. I'm on board. What we do know is that the efficacy of an ACL ablation deteriorates over time. So out at about five years, about 50% of people have had a recurrence of atrial fibrillation. But even those people have had far less incidents or episodes of AFib. And even when they do have it, they tend to tolerate it better. And so the data is getting better and better for AFib ablations. But there are, there are for sure there is rhythm disorders that we cure with a catheter ablation. There's some that is just a part of the management strategy.

Host: Right. Well that makes sense. And then you mentioned doing a procedure on a 21 year old and then an ablation on an 83 year old. What type of patient should consider an ablation?

Dr. Roberts: So I think it really depends on how much the heart rhythm disorder is affecting your life. For example, if you're 80 years old and you still live a pretty active life and we diagnose you with ventricular tachycardia and you get a defibrillator, and this device is shocking you to save your life. But you know, shocks, we also know can increase mortality and we don't want you going into VT. So if we go in and we do an ablation, we could potentially, you know, prevent you from having VT and getting shocked from your device and you know, save your life. And so even if you're 80 years old, we might say, look, this is going to be worthwhile for you and worth the potential risk. Whereas others, you know, people who have atrial fibrillation, there's about 30% of people that don't ever even feel they're AFib and it's never really caused a problem for them. And they may have had it for years, you know, I don't think I would say, you know, we should take those patients for an ablation because you know, it's not impacting their quality of life and they're still being able to go about it. I wouldn't tell you that there is an age number as far as an ablation goes, the procedure generally, and depending on certain circumstances, it's about 5% or less. And as far as risks go and SVT ablation on a young patient, I might tell him it's probably closer to two to 3%, but generally people are walking the same day and sent home from the hospital the same day.

Host: Well, it's good to know that going in, but for the most part it sounds amazing. Most people are up and walking and even out of the hospital in the same day. So then let me ask you this. What other alternatives exist for the management of heart rhythm issues?

Dr. Roberts: Generally when we're talking about heart rhythm disorders, we oftentimes put patients on medications such as a beta blocker or calcium channel blocker. These are drugs that are very safe and they can help suppress some of the arrhythmias that we have, but they also can come with some side effects such as fatigue or weight gain, and they can slow down your heart rate. And a lot of times they don't work. There are more aggressive medications that we can also use. And we classify these as antiarrhythmic drugs, but all of them, they tend to change how electrolytes move in and out of the cells of your heart, such as sodium and potassium and calcium. And so when we do that, it can cause there to be some delays and how electricity moves through the heart, which can be a good thing for heart rhythm disorders, but it can also push you closer to the edge where you're potentially going to have a more risky arrhythmia as well.

So for example, for atrial fibrillation, we use a drug called Amiodarone and that's, that's the most potent drug that we can use for atrial fibrillation, but it is in itself only about 50% effective at preventing AFib at a year. And with potential side effects that can be fatal. And we're talking about scarring of the lungs, damaging of the thyroid or your vision or your liver. And so, you know, any antiarrhythmic drug has to be monitored pretty carefully. So patients don't get me wrong, we put them on these drugs to try to control their heart rhythm disorder. Then if they're working, the patients tolerate them and we think that it's safe, then great, we will use them. But it's actually really nice over the last 10 years that we've been able to do a lot more ablations for these things and not use some of the drugs that are classically come with some pretty serious side effects or on long-term risks.

Host: I imagined with an ablation, helping someone get off medications is always a benefit.

Dr. Roberts: Yeah. Then and patients, you know, when they come back to you at three months after the ablation, you know, and they're off their medications and they haven't had a single, you know, run of SVT. You know, they're as happy as can be, you know, and it's, it's very nice to be able to say, you know, look, you know, come back in a year or, you know, if you're feeling great, don't come at back at all, you know, up to you. I'll see you when you're 80 and you've got a AFib, you know, so have a great life. So it's really pretty rewarding field when we're able to successfully, you know, change this and cure some people. And then the others, we can usually make a significant impact in how it's affecting their life.

Host: Well, I can imagine helping someone improve the quality of their life while also helping them get off of medications has got to be very rewarding. Well, this has really been informative, Dr. Roberts. Thank you for your time.

Dr. Roberts: Absolutely a pleasure. Thank you.

Host: That's Dr. Michah Roberts. And to learn more, please visit dignityhealth.org/bakersfield/heart. And if you found this podcast helpful, please share it on social channels and be sure to check out the full podcast library for topics of interest to you. This is Hello Healthy, a Dignity Health Podcast. I'm Bill Klaproth. Thanks for listening.