Maggie McKay (Host): Welcome to Wellness in Reach, a Mount Carmel podcast. I'm your host, Maggie McKay. Today, we're going to find out about AFib, what it is, why you need to know about it, and much more with cardiac electrophysiologist and Director of the Electrophysiology Lab, Dr. Laura Gravelin. Welcome, Dr. Gravelin. Thank you so much for making the time to be here.

Dr. Laura Gravelin: Well, thanks for having me, Maggie.

Host: So, let's just start with what is atrial fibrillation or AFib?

Dr. Laura Gravelin: I think it helps to understand how the heart functions normally, and its main goal is to be a series of pumping chambers. And to do that, it needs fuel or energy from the blood that gets delivered by the heart arteries, but the timing so that the top chamber squeeze and then the bottom chamber squeeze happens because we have a natural electrical highway in the heart.

An AFib is a short circuit of this electrical highway. You can imagine littleoff-ramps from this electrical highway where electricity can spin. And it makes the upper chambers go fast and the bottom chambers try to keep up. So, it's a fast heart rate, but it's also an irregular heart rate.

Host: I love that imagery that really paints the picture, the freeway and the off-ramps. What are the common symptoms of AFib that people should be aware of?

Dr. Laura Gravelin: Most commonly, people will feel heart palpitations, a skipping, a fluttering, a racing. Some people might feel fatigue, shortness of breath, particularly if they're trying to be active. Other people might have lightheadedness, weakness. And there are some people who have no symptoms at all. I do have a patient, the only way he can tell he's in AFib is if he's at a meeting and he can't quite follow what's happening. So, his AFib gives him a little bit of brain fog.

Host: Wow. Wow. That is unbelievable that some people don't even have any symptom. That's kind of scary. How is AFib diagnosed? What tests are typically involved in the diagnostic process?

Dr. Laura Gravelin: Since atrial fibrillation is an abnormal heart rhythm or an abnormality of the heart's electricity, we use electrical testing. So, some folks might have had a 12-lead EKG when they see their doctor. That's how we can see atrial fibrillation. We can also use wearable devices. So, an external heart monitor can be worn for a period of time to detect atrial fibrillation.

Some patients have identified it using a smartwatch or other wearable devices. And in some circumstances, we might decide to implant a loop recorder, which is a long-term heart monitor.

Host: So, what are the standard treatment options for managing AFib and how do they work?

Dr. Laura Gravelin: So when we manage AFib, we primarily do it based on how is the patient feeling. If someone has atrial fibrillation and they can't tell that they have it, it's not influencing their quality of life, our main goal is just to make sure that the heartbeat doesn't go too fast for that person. But for people who have significant symptoms, they're really uncomfortable with it, we try to keep the heart in regular rhythm, and we can do that in a number of ways. Sometimes we try what's called a cardioversion, so just like you see on the hospital TV shows where people run in and say "clear" and deliver a shock, well, we can do that using stickers on the skin and send an electric shock through the heart to reset, but that's typically just a temporary fix. It doesn't last forever. So, we will use sometimes medications. And going back to that off-ramp analogy, those medications can act as roadblocks to prevent the electricity from going into those off-ramps and kind of keep it shuttled on that highway. And then, in other instances, we'll use ablation procedures where we're trying to get rid of those off-ramps so they don't exist at all. And then, sometimes we'll use procedures or pacemakers. There are some people who have AFib and it goes too slow, and we need to support that with a pacemaker.

Host: Dr. Gravelin, how important are regular followups for patients with AFib and what should they expect during these visits?

Dr. Laura Gravelin: So, we do recommend routine followup for patients who have atrial fibrillation. One of the things we worry about for people who have AFib is their risk for stroke. Not everybody with AFib will have a stroke, but there's a certain calculation we do for people who are at higher risk for stroke, and we like them to be on blood thinners to prevent this clot-related stroke.

As we get older, our risk for stroke increases, so we like to make sure that we're having everybody appropriately treated to reduce their risk for stroke. And then, when patients have AFib, it can come and go. We call that paroxysmal, or it can happen all the time, be persistent. So, we want to make sure we're managing the patient's symptoms appropriately. And if it's persistent, that we're making sure again that the heart rate doesn't go too fast for them.

Host: So if left untreated, because like you said, some people don't even know they have it, what potential complications can come up and how can those be mitigated?

Dr. Laura Gravelin: For people who have atrial fibrillation and it makes the pulse go very fast, and maybe they don't feel it, they don't know they have it. Over time, that can weaken the heart muscle and that person could develop a heart failure. When we think about risk for stroke, if patients aren't treated for that, then a disabling event could happen and we'd like to prevent that. Two very serious things that can happen with atrial fibrillation.

Host: What are some common misconceptions about AFib that you encounter in your practice?

Dr. Laura Gravelin: I think people sometimes confuse the way the heart works. We're talking about the electric circuit, not the heart arteries, which we think about as the plumbing. And so, some people confuse the idea of a heart attack with atrial fibrillation. When we think about heart attack, typically, we're talking about a blockage in our arteries or a plumbing problem. That's unrelated to the atrial fibrillation, which is a short circuit of the heart's electricity.

Host: Is there anything else you'd like to add in closing that people should know about AFib?

Dr. Laura Gravelin: I think it's important to know that there are things that patients can do to reduce the burden of atrial fibrillation. Certainly, we want to make sure that your blood pressure is well controlled. We want to make sure you're not smoking, not drinking. If you have sleep apnea, we do like you to be screened for that and, if you have it, to have that treated.

Certainly eating a heart healthy diet following the principles of either the Mediterranean diet coupled with the DASH diet would be important. And the American Heart Association really recommends for everyone a minimum of 150 minutes of moderate exercise a week. Many of us are active in our jobs in our daily life, but exercise is really at least 10 minutes in a row where your heart rate is up and you're getting a little short of breath. And we'd like all of our AFib patients to be doing that to reduce their burden of AFib. So, we have some control over it. And the rest we trust with the doctors to take care of with medications and procedures.

Host: Well, thank you so much for sharing your expertise. This has been so helpful and informative. I learned so much in these few minutes. We really appreciate it.

Dr. Laura Gravelin: It was my privilege to be here. Thank you.

Host: Again, that's Dr. Laura Gravelin. To find out more, please visit mountcarmelhealth.com or more specifically mountcarmelhealth.com/services/atrialfibrillation, or call 614-627-2000 to schedule an appointment. Again, that's 614-627-2000. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Wellness in Reach, a Mount Carmel podcast.