Scott Webb (Host): Atrial fibrillation, or AFib, is a heart rhythm condition that can increase the risk of stroke in patients. And though blood thinners work for many patients, some may need to explore other treatment options, like the revolutionary implant that my guest is here to tell us about today. And I'm joined today by Dr. Saifullah Siddiqui. He's an Interventional Cardiologist practicing at Franciscan Health. This is the Franciscan Health Doc Pod. I'm Scott Webb.

Doctor, thanks so much for your time today. We're going to talk about atrial fibrillation, better known as AFib. So let's talk about it. Let's talk about AFib and why it's important to treat.

Saifullah Siddiqui, MD: Atrial fibrillation, which I'll call AFib from now, is an irregular heart rhythm that becomes increasingly common as we age. It's also common to see during acute illnesses, such as a bad infection that lands somebody in the hospital or after someone has had surgery. After surgery is a very common time that patients have atrial fibrillation for the first time in their lives.

And that's when we look at things and make some changes to the medications, make other recommendations. It changes the way that the top of the heart functions in a way that increases the risk of blood clot formation. That's the reason we care about AFib. These blood clots are then at a risk of being transported to the brain, where they can cause a stroke.

Stroke risk, in addition to any symptoms that someone may have from the atrial fibrillation, are the main reason why we spend a lot of time thinking about this condition. AFib can be permanent, in that someone could be continuously in this irregular heart rhythm, or it can come and go in what some doctors will call paroxysmal AFib.

Both of these increase the risk of stroke. And stroke, is a very catastrophic event. It can leave someone incapacitated for the rest of their life, which is the worst case scenario. And this is a risk we take very seriously and work very hard to reduce as much as possible for any patient who has AFib.

Host: Yeah, so you really see the importance of treating AFib and you mentioned there that very common for folks after surgeries to experience AFib for the first time, but I want to find out as well, or in addition to that, who else is at risk for AFib?

Saifullah Siddiqui, MD: Really anyone is at risk for having atrial fibrillation. The risk is greatest though among those with advanced age, with high blood pressure, and with other underlying heart diseases such as heart failure or prior heart attacks. Patients who consume alcohol, who have a family history of AFib, or who have obstructive sleep apnea are also at risk for developing AFib, and patients with endocrine disorders like diabetes and hyperthyroidism also commonly are in the population that develop AFib.

Patients with chronic lung diseases such as COPD, patients who have smoked for over 10 to 20 years, and patients who have asthma are also at increased risk for AFib. So, looking at all these conditions, actually, is why it's so common is because there's so many people with these conditions that lead to the development of AFib.

Host: Yeah, I see what you mean. So let's talk about some of the treatments then to bring the heart back to a normal rhythm. And once it's been restored to that normal rhythm, what are the chances of AFib returning?

Saifullah Siddiqui, MD: Studies have shown that trying to restore a regular heart rhythm is the best strategy where and when it is possible for a patient. The initial treatment for AFib includes optimizing whatever underlying condition may be contributing to it. That's the long list of conditions I mentioned just before.

Medications can be tried to bring the AFib under control, under the supervision of a rhythm specialist. They're called cardiac electrophysiologists and their expertise and practice is only with dealing heart rhythms, abnormal heart rhythms. And they are the subject matter experts for AFib, and those are the doctors you want to see to help manage atrial fibrillation.

In addition to medications, direct cardioversion, which is a simple, painless, non-invasive procedure where a small amount of electrical energy is delivered to the heart while the patient is well sedated, can be used to restore a normal heart rhythm. This is oftentimes sufficient for many patients. Beyond this, there are more advanced techniques such as ablation which are done by the cardiac electrophysiologist to restore normal heart rhythm.

So there's a lot of options and there's a bit of an algorithm that we as cardiologists go through to help a patient restore normal heart rhythm.

Host: Yeah, we're going to talk about this revolutionary new implant in just a bit, just a little tease there for the audience. But after treatment, I've heard that a lot of patients with AFib are prescribed blood thinning medications, anticoagulants. What do those drugs do exactly and how do patients need to take them or what do they need to be aware of if they're taking them?

Saifullah Siddiqui, MD: Because of the increased risk of the blood to form blood clots in atrial fibrillation, as I mentioned before, we prescribe anticoagulation to thin the blood just enough to prevent this from happening. Now, we try to assess the patient's risk and decide whether aspirin will be sufficient, or if they need something a little bit more potent, a blood thinner. The more conditions somebody is suffering from, like the ones I mentioned above, the risk of stroke goes higher, not just because of the AFib, but because diabetes and high cholesterol and high blood pressure and prior history of heart attacks independently also increase the risk of stroke. Many people will be familiar with Coumadin or warfarin, which was the anticoagulant that was used in the past and is still used in many circumstances, but there are a lot of newer anticoagulants and blood thinners that are much easier to use and far more predictable in their activity, that don't require patients to get weekly blood sticks, or blood tests, like they used to with warfarin or Coumadin. These medications are prescribed and taken and work in such a predictable fashion that really no testing or follow up is needed.

Host: That's amazing to hear because I've heard about all the side effects, the side effect profile of some of the older stuff. Are there any risks, with this newer generation of blood thinners?

Saifullah Siddiqui, MD: Because they're blood thinners, there's always an increased risk of bleeding in some of the patients who take blood thinners. Before we prescribe patients blood thinners, the standard of care is to assess what is the patient's bleeding risk and there are tools to assess that using studies that we've performed in the population to help grade somebody's risk. In patients with a high bleeding risk who cannot take a blood thinner because of their lifestyle, there are other interventional options, mechanical options, to protect against a stroke.

Host: Yeah, let's talk about one of those options. I teased earlier, this revolutionary implant. And I don't know if that's just for folks who either can't or don't want to take anticoagulants, but either way, tell us about this revolutionary new implant.

Saifullah Siddiqui, MD: It's the left atrial appendage occluder device. It's a technology that's actually been around for some time, but is now gaining far more acceptance as we gather more data and more and more science into its efficacy, and as the technology improves in delivering this therapy. We know from experience that when a blood clot forms in the heart, in the context of atrial fibrillation, they almost always form in the part of the heart called the left atrial appendage, the unique anatomy of this part of the heart, which everyone has, makes it somewhat easier for blood clots to form here than anywhere else in the heart. The left atrial appendage occluder device is an implant that occludes the small part of the heart, eliminating the possibility of blood clots forming. It prevents blood flow from entering this part of the heart, which in turn prevents blood clots from forming here.

As a result, with the left atrial appendage occluder device, we can eliminate the risk for stroke with a well implanted device.

Host: Are there some folks that are just better candidates for this new device, or is it pretty much for everybody depending on what their preferances are, goals are, that sort of thing?

Saifullah Siddiqui, MD: Well, as the sign stands, and as the data suggests today, the device is perfect for patients who can't take blood thinners because of an elevated bleeding risk, or patients who work in places where the risk of trauma is high enough where they don't want to take or they can't take blood thinners because of the risk of bleeding and injury.

 These include patients who suffer falls from other conditions, such as Parkinson's disease or dementia. It also can be used for patients who just choose that they cannot tolerate a blood thinner for whatever reason that they have too much bruising that impairs the quality of life, or the way that they move or the way that they live their life, the blood thinner gets in the way of it.

So in those patients, in that patient population, the devices is perfect.

Host: Yeah, it's really awesome to hear about this today and just want to give you a chance here at the end, when we think about AFib, we sort of started things today; talked about, you know, how serious AFib is, especially if it goes untreated, that it can increase the risk of stroke. So just give you a chance here at the end, encouraging folks that if they think they have AFib or they've been diagnosed and they've been dragging their feet, that there are a lot of options, right? And you can help them. We just need them to make that phone call or come through the door. Right?

Saifullah Siddiqui, MD: Exactly. It's a very preventable disease, strokes, that is. Atrial fibrillation can be prevented with good control of these other conditions, but when some patients have it, it's still very manageable. And getting treatment is important so patients can continue to lead full, gainful, high quality, healthful lives, free of stroke and free of stroke risk. So for that reason, if there's any concern, please see your physician. You can come see us here at Franciscan. We'd be happy to take care of anybody.

Host: Absolutely. Well, doctor, thanks so much for your time today and you stay well.

Saifullah Siddiqui, MD: Thank you as well. Thank you so much for your time.

Host: And for more information about AFib care and treatments, visit franciscanhealth.org/restoretherhythm. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.