Joey Wahler (Host): It addresses arrhythmia, also known as an irregular heartbeat. So, we're discussing cardiac ablation. Our guest is Dr. Tamjeed Arshad. He's a cardiologist with Jackson Hospital. This is Vital Signs, candid conversations with providers who care from Jackson Hospital. Thanks so much for joining us. I'm Joey Wahler. Hi, Dr. Arshad. Welcome.

Tamjeed Arshad, MD: Thank you. How are you, Joey?

Host: I'm good. Yourself?

Tamjeed Arshad, MD: I'm fine. Thank you.

Host: Excellent. I appreciate the time. So first, what exactly in a nutshell, Doctor, is heart ablation for those unfamiliar with it?

Tamjeed Arshad, MD: Heart ablation is a procedure that causes disruption of the heart tissue by various technologies. Most commonly, radiofrequency energy, but more recently, pulse field ablation and cryoablation.

Host: And so, there are different types of irregular heartbeats. Am I right? So, what are those exactly?

Tamjeed Arshad, MD: That is correct. So, the heart arrhythmia or irregular heartbeat, as you said, consists of supraventricular tachycardia or arrhythmia and ventricular tachycardia or arrhythmia, depending on what part of the heart they're originating from. Supra means above the ventricle, and ventricular means from the bottom chamber or the ventricle part of the heart.

Host: And so, that being said, which patients are candidates for an ablation and are there any for whom it's not recommended?

Tamjeed Arshad, MD: More or less, most of the arrhythmias can be ablated these days. So, the technology has advanced that most of these arrhythmias can be ablated using one of the technologies that are available now.

Host: And so, what's the benefit of an ablation for both the patient and for the physician like yourself?

Tamjeed Arshad, MD: So for most arrhythmias originating from the atrium or the supraventricular part of the heart, it is a curative procedure. So if it's done, it means that arrhythmia is gone for good. There is a rate exception, which is the atrial fibrillation, which still has a high rate of recurrences even after ablation. Having said that, it does provide better outcomes as compared to medical treatment. Regarding the ventricular tachycardia arrhythmia, again, the ablation provides better outcomes as compared to medications alone.

Host: And how about for the physician? What are the advantages there?

Tamjeed Arshad, MD: First and foremost is the fact that you can cure somebody, which is very welcoming. So, that's a positive feedback from that procedure, and also to improve the quality of life for that person as well. So, that's always something that's hardly you see in some other branches of medicine. I mean, for cardiac arrhythmia, it's very successful in that arena.

Host: And so, how would you say ablation compares with, say, getting a pacemaker instead?

Tamjeed Arshad, MD: So, different procedures, pacemaker usually is for somebody with a slow heart rate. Ablation on the other hand is somebody with a faster heart rate. So, it's totally different ways of approaching a cardiac arrhythmia.

Host: Gotcha. And so when we talk about ablation, can you describe the procedure itself? What's involved, how long it takes? What should patients know about this?

Tamjeed Arshad, MD: So, most of these procedures are done under conscious sedation, which means that you don't undergo a general anesthesia procedure. It involves accessing blood vessels on either the legs or the arms and putting catheters through the blood vessels inside the different chambers of the heart, recording electrical signals, pacing the heart, trying to induce that particular arrhythmia, then mapping its source, confirming that source, and then ablating that area. So, it's a stepwise procedure. It can take anywhere from an hour to maybe two to three hours, depending on the site from where it's originating from and the nature of the heart disease.

Host: And then, how about recovery time and rehabbing afterwards?

Tamjeed Arshad, MD: Again, for most arrhythmia, it's a same-day procedure. So, they have it done, go home later that day. However, depending on the underlying heart conditions, and especially with the ventricular tachycardias, they may have to stay overnight to recover.

Host: But you say many do go home the same day. I mean, When you kind of take a step back and think about that, it's pretty amazing.

Tamjeed Arshad, MD: Yeah, it is. Oh, yes. The way the technology has advanced, most of these patients get to go home five hours later.

Host: So, how about risk? Obviously, there are risks associated with most any medical procedure. How about here?

Tamjeed Arshad, MD: Absolutely. I mean, there's nothing risk-free in medicine. However, the risk is very small, especially with the common arrhythmias that we ablate on a day-to-day basis. The risk of any major, like major bleeding, requiring transfusion, heart damage, heart attacks, stroke et cetera, would be of the order of 1-2% or less.

Host: Wow. Interesting. So, how about the fact that when we're talking about the heart, Doctor, I would imagine patients are obviously concerned when they have to go through a procedure like this or any heart procedure, but there's also fear, isn't there? And understandably so. How do you walk patients through that to let them know that they're in great hands with you and yours and that this is all going to work out in the end?

Tamjeed Arshad, MD: Everybody has some level of anxiety and fear about the procedure. But with the data at hand from years of doing these procedures, we try to allay that fear that it's a low risk procedure with great benefits. And I think we certainly allay those fears in most of the cases.

Host: And so, you touched on it earlier, but if you could expand a bit please, when we talk about improving quality of life, what kind of a difference is the typical patient going to see in that after undergoing this procedure?

Tamjeed Arshad, MD: I think for some it's phenomenal because, you know, the arrhythmia can be debilitating. You're having their heart beating fast almost on a daily basis, as with associated symptoms like dizziness, shortness of breath. And to be arrhythmia-free, it's night and day for some of them. Oh, absolutely. I mean, they feel a hundred percent better.

Host: And we just talked about fear. I would imagine it's scary to have to live with that condition knowing that there's an unpredictability to it.

Tamjeed Arshad, MD: That's right. That's true. I mean, especially with arrhythmias where heart rate beating fast and irregular, some folks do pass out. And so, that's another serious side effect associated with some of these arrhythmias.

Host: And when we talk about quality of life as well, how about a few of the things from your experience that after undergoing this, patients tell you they're most happy about being able to return to, because they had to stay away from certain things until this was done.

Tamjeed Arshad, MD: Oh yeah. I mean, they can go back driving for somebody who couldn't drive or, they can take trips now. They were scared to go outside the house or to another city. Now, they're enjoying their life. They're traveling. So, yes, several of my patients have said that.

Host: A healthy heart, doctor, it's something that most of us probably take for granted until it's not so healthy, right?

Tamjeed Arshad, MD: That's true, especially with the way the culture is in terms of diet, less exercise. And of course, most our population is aging, so causes more heart conditions, which we see on daily basis.

Host: How about the importance of, to your point, getting your heart checked on a periodic basis, especially when you may be at risk because you're either getting older as you point out and/or aren't the healthiest in terms of weight, not enough exercise. How about the importance of at least making sure you know what's going on with your heart?

Tamjeed Arshad, MD: Yeah, absolutely. I think it's very important, especially if you do have a family history and if you, again, are obese, overweight, and other risk factors, diabetes, hypertension, smoking, all of those. I think it's important to seek a specialized evaluation from a cardiologist getting at least a baseline, EKG, sometimes stress, or other studies to see where things stand.

Host: A couple of other things for you. If left untreated, what are some of the most common dangers of an irregular heartbeat?

Tamjeed Arshad, MD: You know, it could be minor to severe. Minor would be heart palpitations, dizziness, lightheadedness. And then, as you expand further, passing out spells, and some people can even die from arrhythmia, sudden death.

Host: So, yet another reason for people to stay on top of it, as we touched on a moment ago. How about personally for you, why cardiology for you? Where did you initially get an interest in treating heart patients?

Tamjeed Arshad, MD: Well, it was due to my residency time in Boston. That's how I got interested in cardiology and from cardiology into electrophysiology, which deals with the arrhythmia part of cardiology. Working with some of my mentors over there, I developed this interest. And I'm happy that I stuck with it.

Host: Yeah, talking to doctors in recent years, I find that those early mentors are so influential, aren't they?

Tamjeed Arshad, MD: Oh yes. Absolutely. I agree a hundred percent. That initial impression and guidance from a good mentor carries a long way, you know?

Host: no question. And then finally, Doctor, in summary here, for those joining us that may be candidates for this ablation procedure, what's their first step?

Tamjeed Arshad, MD: I think first step is sure you don't ignore your symptoms and seek help. The sooner, the better. Because most of these arrhythmias can be cured, and if not cured, can be made less burdensome.

Host: Yeah, great advice. Don't ignore the symptoms. Well, folks, we trust you are now more familiar with cardiac ablation. Dr. Arshad, keep up all your great work, and thanks so much again.

Tamjeed Arshad, MD: thank you for having me.

Host: Absolutely. And for more information, please visit jacksonclinic.org/specialtycare/heartfailure. Now if you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks so much again for being part of Vital Signs, candid conversations with providers who care from Jackson Hospital.