Scott Webb (Host): Atrial fibrillation or AFib is the most common type of irregular heart rhythm, and my guest today is here to tell us about the signs and symptoms and treatment options for AFib. I'm joined today by Dr. Philip George. He's a board-certified cardiologist, subspecializing in electrophysiology at Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's nice to have you here today. We're going to talk about atrial fibrillation, AFib, easier to say it that way, of course. I know it's the most common type of irregular heart rhythm and just a lot of folks have it, a lot of folks are suffering from it. I just want to have you give us a foundation for me and for listeners, just really like explain AFib. Like, what is it exactly?

Dr. Philip George, Jr.: Atrial fibrillation is probably the most common abnormal rhythm disturbance that not only primary care physicians will encounter, but also cardiologists within their practice. It's exceedingly common. Fortunately, we don't consider it a dangerous or life-threatening rhythm, but if untreated, it can lead to essentially adverse outcomes.

And so, you know, in general, we consider atrial fibrillation any irregular rhythm that occurs in the top chamber of the heart, in the atrium. And individuals that have a history of atrial fibrillation can over their lifetime be at an elevated risk for strokes. And so, that's the main concern, particularly as it relates to that rhythm.

There are some other implications with regards to atrial fibrillation, and that patients that have atrial fibrillation can sometimes also be at an elevated risk of developing heart failure symptoms as well.

Host: Okay. Yeah, just wondering, it makes me think like, "All right, so how do folks get AFib?" Is this genetics, family history, behavior, lifestyle, bad luck, all the above perhaps? Like, how does one develop AFib?

Dr. Philip George, Jr.: Yeah. So, I would say much like anything in medicine, there's a handful of people that may have a genetic predisposition, but I would say the vast majority of people can develop atrial fibrillation over time, and in part due to other cardiovascular risk factors. So, we say that having a history of longstanding high blood pressure that's poorly controlled can sometimes contribute. Having underlying coronary artery disease can also contribute. And also, having a history of valve disease can also make patients more prone to having atrial fibrillation as well.

Host: Gotcha. So, some folks maybe just sort of dealt that hand. Others develop it over time, and it seems natural, Doctor, to want to talk about the signs and symptoms, like how does someone know if they have AFib? And why is it particularly important that women, just not ignore those signs and symptoms?

Dr. Philip George, Jr.: Yeah. It's a great question. And unfortunately, there are a number of patients that'll actually develop atrial fibrillation and not have any symptoms. So for some individuals, the first-time they actually get diagnosed with atrial fibrillation, unfortunately, is when they present to the hospital with a stroke or stroke-like symptoms. But for other individuals that have symptoms, oftentimes, patients will report that they can actually feel palpitations or the sensation of their heart racing or beating irregularly, especially now with advances in technology and a lot of people using smart wearables, like a smartwatch. A lot of these devices can actually detect or suggest that somebody is having atrial fibrillation. So, those are things that can sometimes clue patients in.

Sometimes patients, I sort of alluded to it before, but sometimes patients can have symptoms of heart failure when they have atrial fibrillation. So, sometimes they can be more prone to retaining fluid. They can start to develop symptoms of shortness of breath, sometimes even some chest discomfort in some instances. So, there's a sort of a spectrum of symptoms that patients may report. But probably, you know, if patients are reporting palpitations, fast irregular, heart rhythms, that's probably going to be the most, I would say, sensitive symptom.

Host: Yeah. And would it be a situation where they should speak with their providers at a normal visit or are those more concerning signs and symptoms and they should perhaps go to the ED?

Dr. Philip George, Jr.: Yeah. So generally speaking, I tell patients, if they can get into their primary care physician sooner rather than later, then that may be the path of least resistance. But, you know, if it's going to be weeks, before they can get in to see their primary care physician, if you're not sure what is going on, right? If something just feels off, then I say the safest thing to do is get into the ER so they can evaluate you, and then hopefully get you on appropriate medical therapy.

Host: Yeah. Get things moving in the right direction. So, Doctor, let's talk about treatment options. You talked about, you know, about how wearables are making a difference in people's lives. They might be able to sort of self-diagnose at least some early signs and symptoms of AFib. But let's talk treatment for AFib and, you know, why it's just so important to minimize that stroke risk.

Dr. Philip George, Jr.: Again, that to most physicians is probably the most worrisome association, is that risk of stroke. And so, there's a way that we can sort of determine if patients are at an elevated risk or at a low risk. And generally speaking, if patients are at an elevated risk of stroke, the best way that we can reduce that risk is by making sure that patients are on blood thinners. That's really the best way that we can help to reduce that risk. And as it relates to women in particular, women generally have a higher incidence of stroke as it relates to atrial fibrillation. So, their risk is slightly higher compared to men. And for that reason, we generally want to be a little bit more, I would say proactive, especially if we suspect that women have atrial fibrillation and generally encourage women to be on blood thinners, particularly if they are at a higher risk of stroke and that's indicated for them.

Host: Yeah. And we've been on a run here, Doctor, lately, talking about women's hearts and heart health and vascular and veins and all this good stuff for women. And final thoughts, takeaways, whether it's encouraging, if folks have any concerns to be seen, to be heard, whatever it might be.

Dr. Philip George, Jr.: Like I was saying before, you know, most individuals, they know their body better than anybody else. And if something feels off, if there's any suspicion that they may have atrial fibrillation, the best thing to do is to get in to see your primary care physician. If they have a cardiologist, great. You know, you can always try that approach as well, try to get into see your cardiologist. But if not, get into the ER.

Again, as it relates to women and atrial fibrillation, they do have a higher incidence of stroke. And generally speaking, their outcomes can be a little bit worse when compared to men if untreated. And so, that's why you want to be especially a little bit more proactive if there's any suspicion.

And so, as it relates to reducing that risk of stroke, you know, blood thinners, again, is one of the things that we can offer. But there's another procedure that I didn't mentioned before, it's called a Watchman procedure, where you can implant a small device in the atrium of the heart to help reduce an individual's risk of stroke. And that's another alternative to blood thinners. And there are certain things that would make a patient a candidate for that procedure. So, not everybody is a candidate, but again, that's another alternative to blood thinners. But generally speaking, those are the best ways that we can help reduce the risk of stroke in patients and, obviously, morbidity and mortality as it relates to atrial fibrillation in women.

Host: Right. Well, I appreciate your time and your expertise today. Good to hear about how it's being diagnosed, the importance of early diagnosis when possible, different treatment options depending on, you know, who's a good candidate. I appreciate your time. Thanks so much

Dr. Philip George, Jr.: All right. Thank you.

Host: And to learn more, visit franciscanhealth.org/heartcare. 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.