Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): You might know that atrial fibrillation causes irregular heartbeats, but what else should we know about it? Welcome. I'm Deborah Howell. And since it's Atrial Fibrillation Awareness Month, today let's find out more about the symptoms, warning signs, how to stop an AFib episode and some treatment options. Our guest is Dr. Paul Drury, Associate Medical Director of Electrophysiology, Memorial Care Heart and Vascular Institute at Saddleback Medical Center. Welcome, Dr. Drury.

Dr Paul Drury: Thanks for having me.

Host: What's the significance of National Atrial Fibrillation or AFib Awareness Month?

Dr Paul Drury: I'm very excited that we have an Atrial Fibrillation Awareness Month because atrial fibrillation is by far the most common cardiac arrhythmia, which is an irregular heartbeat, that we have. Atrial fibrillation is associated with multiple comorbidities, including stroke, congestive heart failure, as well as a decrease in your quality of life. A lot of people aren't aware that their symptoms are due to atrial fibrillation, so making more awareness allows us to identify and then treat it to help improve people's quality of life and decrease their complications from atrial fibrillation.

Host: Fair enough. What are the most common symptoms of AFib that people should be aware of?

Dr Paul Drury: So, atrial fibrillation is a very interesting condition, and symptoms are variable. Symptoms can range from no symptoms, which is interesting, all the way to the sensation of having a heart attack or passing out. In between, most people will just notice their heart beating irregularly. They'll feel flutters in their chest. These may be accompanied by some shortness of breath or some dizziness, or just feeling that something's not right. In some extreme cases, when the heart goes really fast or really slow, the more significant symptoms such as dizziness, passing out or even chest pain can occur.

Host: I think you covered most of this, but I'm going to ask anyway, how can people recognize the warning signs of an AFib episode?

Dr Paul Drury: Yeah, they would recognize it by feeling these sensations. And then, it used to be, if you felt this, you'd have to seek medical attention, such as going to your primary care doctor, urgent care or the emergency room to then have a confirmatory test, which would be the EKG or electrocardiogram, where we look at the electrical activity of your heart.

But now, there are other options that you can do at home. A lot of people now have devices such as Apple Watches, Samsung Watches, Kardia, mobile devices that they can do themselves, which can give a preliminary diagnosis and give some hints that you may have an irregular heartbeat.

Host: Oh, it's so much easier than having to go in every time, right?

Dr Paul Drury: Yes, absolutely.

Host: What steps can someone take to stop an AFib episode when it occurs?

Dr Paul Drury: So, atrial fibrillation is a little tricky to stop, and in some people, it just doesn't. But there are others where the atrial fibrillation is really triggered by something like dehydration or stress, that just taking it easy, sitting down, getting hydrated, meditation can help, getting a good night's sleep if you're not feeling too bad, and those can all help stop the episode.

Host: Now, what are the potential complications of untreated AFib, particularly regarding blood clots and stroke?

Dr Paul Drury: So, I mentioned this earlier when I first started talking about the importance of atrial fibrillation, but the biggest complication is stroke, and people with untreated atrial fibrillation have about a five times higher risk of stroke than those without atrial fibrillation. Now, the good news is with adequate treatment, whether that's with blood thinners or some alternative methods, we can lower that risk back to the normal range, which is about 1% in those patients.

Also, atrial fibrillation that's uncontrolled, where the heart rate is not at a good level can actually lead to conditions such as congestive heart failure and treatment of that is very important to maintain normal heart function and normal quality of life.

Host: Now, are there any lifestyle changes people can make to reduce their risk of AFib or at least manage the condition?

Dr Paul Drury: Absolutely. We know that a lot of conditions increase someone's risk of having atrial fibrillation. One of them is age, and obviously, we can't control that one. But when we start looking at other ones, such as high blood pressure, diabetes, obesity and even more recently, just depression, insomnia and stress have been indicated as culprits for causing atrial fibrillation. Those can all be managed. It's very important to work with your doctor to control your high blood pressure and your diabetes. If you know you have trouble sleeping, to get evaluated and even treated for sleep apnea, which is a condition where people stop breathing in the middle of the night. And then if you're dealing with insomnia or mental health issues, addressing those also with your doctor are very useful to help decrease the amount of atrial fibrillation or prevent atrial fibrillation entirely.

Host: All right. Definitely check in with your doctor on all of these fronts. Now, I'm wondering, what are the current standard treatment options for managing AFib and how do they work?

Dr Paul Drury: All right. Well, this is a very big topic, but I'll try and keep it brief. So, when I meet someone who is diagnosed with atrial fibrillation, we always first try and determine what their stroke risk is. Now, some people who are really young and healthy who have atrial fibrillation have a very low stroke risk and don't require any additional treatment. However, the majority of people with atrial fibrillation do have an elevated stroke risk. And the first treatment is usually using a medication such as a blood thinner. And there are a few on the market that are out there.

After we assess their eligibility and need for a blood thinner, we start looking at symptoms. Patients who are highly, highly symptomatic with their atrial fibrillation will often require other therapies, such as medications. These medications can help control the heart rate or prevent atrial fibrillation episodes from happening. And if these aren't working or patients would like to stay away from medications, there are other treatments available, such as cardiac ablations, where we actually go into your heart with a minimally invasive procedure, that's usually an outpatient procedure, that can help stop the atrial fibrillation and prevent episodes from happening for years at a time.

Host: Okay. So, those are the normal or regular treatment options. Are there any new or emerging treatment options for AFib that people should know about?

Dr Paul Drury: Yes. Newer treatments that we have available include devices that help prevent stroke. One of those that has come to market in the last five years is something called the Watchman device. This is a device that we implant into your heart in the area that most strokes come from. It's called the left atrial appendage. This structure hangs off the heart. And when the heart goes into atrial fibrillation, no blood flows in or out, so blood clots can form. And by putting a plug in there, we do just as good of a job preventing stroke as we do with taking blood thinners. So, this device is very useful, especially in those patients who are unable to take blood thinners due to risk of bleeding or prior serious bleeds.

Additionally, cardiac ablation continues to change, and there are new innovations that are coming to the market constantly. Currently, we have two options, which include radiofrequency ablation and cryoablation. One is where we heat, the other is where we freeze the tissue that causes the atrial fibrillation.

Now, there is a new modality called pulsed field ablation, which is coming onto the market, which should make these procedures even faster and safer than our prior modalities. This modality will target only cardiac cells without risk of damaging the surrounding cells and also speed up the procedure to usually procedure times of well less than one hour.

Host: Wow. And does that use both heat and freezing techniques?

Dr Paul Drury: Pulsed field ablation is a new technique. It doesn't use heat or cold. It actually uses a certain type of energy that breaks little holes in the cell membranes and causes them to die that way. So no heat, no cold. And by doing that, you're not going to have any collateral damage with surrounding tissue.

Host: Fantastic. That's great news. Now, how does AFib affect daily life and the quality of life for those living with the condition?

Dr Paul Drury: So, this is an interesting question because it varies a lot patient to patient. There are those patients out there who have atrial fibrillation who are very minimally impacted. Interestingly, a large group are asymptomatic with their atrial fibrillation. They have it, but their heart rate is controlled. And as long as they're managing their stroke risk by taking a blood thinner or by having a Watchman done, they can live a normal life with little to no symptoms.

However, those that are symptomatic, this can often really impact their quality of life, both by having episodes at very inopportune times, or by having more persistent atrial fibrillation, which really can decrease their exercise tolerance, their enjoyment of life and their ability to keep up with their friends and loved ones.

Host: Yeah, which is so important. All right. Switching gears for just a minute. Can you tell us about the Heart and Vascular Institute at Saddleback Medical Center and its unique advantages?

Dr Paul Drury: Yeah. The Heart and Vascular Center at Saddleback Medical Center is a comprehensive cardiac center. We provide all modalities currently of treatment of atrial fibrillation and other cardiac conditions. For atrial fibrillation, we provide cardiac ablations. We do cryoablation and radiofrequency ablation, and on the horizon will be the pulsed field ablation, as I mentioned. We also offer Watchman devices. And through this, we can also offer other structural heart, including valve replacement surgeries and stress tests, as well as any cardiac diagnostic modality that's needed.

Host: Sounds like you got it all covered. We want to thank you so much, Dr. Drury, for your time and your expertise today. Really learned a lot. Enjoyed having you on the podcast.

Dr Paul Drury: I appreciate it. Thanks for having me.

Host: And to learn more about the Heart and Vascular Institute, visit memorialcare.org/heart or call 949-452-7191. For more information or to listen to a podcast of this show, please visit memorialcare.org. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.