Joey Wahler (Host): It's a common condition among adults, so we're discussing arrhythmia, also known as irregular heartbeat. Our guest is Dr. Lu Chen. She's a cardiologist specializing in electrophysiology with MyMichigan Health. This is Health Dose, the podcast from MyMichigan Health. Thanks for joining us. I'm Joey Wahler. Hi there, doctor. Welcome.

Lu Chen, M.D.: Hello.

Host: Great to have you aboard. We appreciate the time. So first, just how common is a fast or fluttering heartbeat, and what are the most typical causes that people should be aware of?

Lu Chen, M.D.: Yeah, So, It is actually very, very common, more common than I think most people realize. In my clinic, I would say the vast majority of my patient's come in with palpitations. So there are a lot of different causes of palpitations. So you have your top two chambers and your bottom two chambers. So we'll start with the top two chambers.

Most commonly it's from atrial fibrillation or it's cousin atrial flutter. And that's by far the most common thing that I treat. And it actually does have a connection with stroke as well, based off of your risk factors. There's also another entity called Supra Ventricular Tachycardia.

We commonly call it SVT. And that usually happens in younger patient's, but it happens in older patient's as well where you have it can be very, very fast heart rates up to 200 beats per minute. And then there's other ones called ventricular tachycardia, ventricular fibrillation, which come from the bottom chambers of your heart, and that could potentially be a deadly arrhythmia.

So sometimes people present just in the emergency room.

Host: So you mentioned risk factors, what are the major ones that can lead to a greater chance of this happening?

Lu Chen, M.D.: Yeah. So in terms of risk factors of providing AFib or atrial flutter, there are things like smoking, alcohol use. Sleep apnea is a big one and being overweight. Those are all things that can actually contribute to atrial fibrillation and atrial flutter.

Host: And so certainly these lifestyle factors along with stress, right, can certainly impact heart rhythm. What would be your main piece of advice? Some people fail to check all those boxes when it comes to keeping those factors in line. If you had to point to the one thing someone should try first as job one to get it together and try to avoid this, what would it be?

Lu Chen, M.D.: Yeah, so one thing that I actually address very often is actually sleep apnea, which I actually didn't mention before, but un undiagnosed sleep apnea can actually trigger atrial fibrillation. But in terms of lifestyle in particular, I think one of the bigger things is alcohol, even a little bit of alcohol can sometimes trigger atrial fibrillation.

Host: And so when should someone seek medical attention for an irregularly fast heartbeat? And along with that, I'm wondering how would someone know?

Lu Chen, M.D.: Yeah, so the most important thing is if you pass out, definitely seek medical attention right away. If you start feeling lightheaded, that's another warning sign that something might be going on. But even things like really sustained, shortness of breath, palpitations, really extended fatigue that seems kind of out of the ordinary.

Usually people should get checked out. For those minimal symptoms, probably see a doctor in the clinic, whereas, you know, if you're passing out, having lightheadedness, more so going to the emergency room.

Host: Absolutely. Now, when concerned about arrhythmia, how would you say patient's and their families in some cases can best prepare for a cardiology appointment with an expert like yourself, what should they be prepared to share, for instance?

Lu Chen, M.D.: Yeah. So I think the most important thing for me when I see patients is trying to tease out their symptoms. Because if they don't have any symptoms, for example, and it was just incidentally found because they went to their doctor's office, then you know, less likely that we're going to actually do something about it.

But it's very important for us to know their symptoms. So things like palpitations is the most common thing that people think about. However, there are other symptoms that people, might think are something else. So things like shortness of breath or even shortness of breath with activity.

So sometimes people tell me, Hey, I shovel and I seem to notice that I'm not able to shovel as much as I used to, or, I can't go up the stairs as easily, or sometimes it's just fatigue. So people are just more tired and sometimes that lasts for a few minutes, but sometimes it can last for a few days as well.

Host: So what are some common diagnostic tools that you and yours use to evaluate a patient with an irregular heartbeat? How do you check it And what are you looking for?

Lu Chen, M.D.: Yeah, so in my clinic, the first thing I do is get an EKG on every patient. So that involves them getting stickers placed on them and just getting a few second snapshot of their heart. However, that is only a few seconds. So, you know, if someone goes in and out of an arrhythmia, it's probably not going to catch it.

So if that doesn't show me anything, I might order a heart monitor. And the duration of that can kind of depend on how often they get their symptoms. And if that doesn't show anything, let's say they, they have very rare cases of an arrhythmia, then I might do a implantable loop recorder, which is a little device that just sits under the skin and just, watches their heart for a few years.

Host: So let's talk about technology here. What role do wearable devices like smart watches, for example, play in monitoring heart health and detecting any abnormalities?

Lu Chen, M.D.: Yeah, I think it's actually very important it, and I think, watches such as the Apple Watch have actually gained education in some senses for the patient. So there are some people who don't know that they have an arrhythmia and their Apple watch tells them, Hey, you might have atrial fibrillation.

And so I think it's a really good diagnostic tool. And sometimes patient's really like that. They want to know, Hey, am I in atrial fibrillation right now? Am I not? And then it actually helps them see what their symptoms are. So they'll be like, Hey, it's telling me I have AFib. I actually am feeling more short of breath right now.

And so I think that's really helpful even before we do any treatment. And then after we do treatment, that's also very helpful because then it can kind of track how much that treatment is helping. There's also other devices. There's a thing called a Kardia mobile. It's a little device that is about $80 or so, and that is a little bit different because you have to put your fingers on it and that you have to feel the symptoms first and then kind of check to see what your rhythm is. I think it's helpful for some people, but for other people it's not so helpful. I think the Apple Watch and other watches that track arrhythmias are sometimes better just because it's mindless. You wear it all the time and it kind of tracks you all the time.

Host: Switching gears, you led me beautifully into my next question. You mentioned treatment. What's the latest and best treatment for arrhythmia?

Lu Chen, M.D.: Yeah, so the best treatment is an ablation. So what that is, it's a procedure that I do every single day. They basically come in from home, they get put to sleep by anesthesia. And then I go through the groin and put catheters up into the heart. That allows me to diagnose the arrhythmia and then treat as necessary.

So the technology that we use here more so involves kind of for lack of better words, burning the inside of the heart. And that ends up basically getting rid of those electrical pathways that are abnormal.

Host: And how about how often someone needs a procedure like that as opposed to medication?

Lu Chen, M.D.: Yeah, so I would say more often than not, people do end up going for the ablation procedure. There's medications that can kind of control your heart rate. And then there's also things called antiarrhythmic medications that are a little bit more potent and try to keep you in a normal rhythm. However, the likelihood of success for an ablation is probably 80 to 90%, And for antiarrhythmics it's probably around 50%.

So there's a lot of toxicities that can come with medications. So I find that a lot of people tend to go towards a procedure rather than medications, because it's low effort for them, high likelihood of success.

Host: Because a couple of the issues, correct me if I'm wrong with something like blood thinner, which is sometimes prescribed, right? You A, may have some serious side effects from that, and B, if you come off it, if you miss it, it could really lead to some much more serious problems. Right.

Lu Chen, M.D.: Right, right. Yeah. So the reason why we put people on blood thinners is because they may have an increased risk of stroke. So depends on a lot of risk factors such as high blood pressure, if they have heart failure, if they have coronary artery disease, or if they've had a stroke in the past. So, I would say most of my patient's are on a blood thinner.

And there are risks associated. So lots of bleeding and sometimes people can't tolerate it. There's also another procedure that we do in our field that actually kind of takes people off of blood thinners. But, I think a lot of people think that when they get an ablation, they treat their atrial fibrillation, they can come off of blood thinners, and that's not necessarily true based off of the information we have right now.

So usually, if they're needing to be on a blood thinner, they stay on the blood thinner unless they can't tolerate it.

Host: And in summary here, doctor, what are the dangers if a patient lets this go untreated?

Lu Chen, M.D.: Yeah, so there's a lot of different things. So if someone has atrial fibrillation or flutter, and their heart rate is super, super high for an extended period of time, they may develop a thing called heart failure, which essentially is just weakening of the muscle of the heart. Then they might come in with worsening shortness of breath, fluid retention. And so that can actually increase their mortality. So make them, you know, die sooner. So that is kind of the biggest thing that we fear. Another thing is actually strokes. So if someone has atrial fibrillation, doesn't come to the office, doesn't get on blood thinners if they need it, that's a big risk factor.

Host: Finally, I just want to ask you about how you deal with fear when going through these steps with patient's, because I would imagine, especially when they first learned that they have a heart condition like this, it could be very scary, right?

Lu Chen, M.D.: Yeah, so I reassure them, tell them, one big thing that they should be worried about is stroke. But if they're on a blood thinner, they should be protected by that blood thinner for stroke. And if someone is really fearful of procedures, I do not push them whatsoever. I think everyone has a different tolerance for procedures and there's no good that comes from me pushing any treatment that someone is not comfortable with. But I think the best thing that I can do is educate my patients on all of the facts about atrial fibrillation and reassure them that it is a treatable disease and something that we can manage.

Host: All right. Well folks, we trust you are now more familiar with an irregular heartbeat. Dr. Chen, keep up all your great work. Thanks so much again.

Lu Chen, M.D.: Thank you.

Host: And if you've been experiencing your heart racing, skipping beats or fluttering unexpectedly, do talk to your primary care provider. They can run some initial diagnostic tests and refer you to a cardiologist like Dr. Chen if additional follow-up is in fact needed. For more information, please visit MyMichigan.org.

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