Transcription:
Silent and Possibly Deadly - Atrial Fibrillation and Stroke

Intro: Here's another edition of the Northwestern Medicine Pod Talk with Melanie Cole.

Melanie Cole: Welcome to Northwestern Medicine Pod Talk. I'm Melanie Cole, and I invite you to listen as we discuss atrial fibrillation and stroke, this silent and possibly deadly combination. Joining me is Dr. Rod Passman. He's the Director in the Center for Arrhythmia Research at Bloom Cardiovascular Institute of Northwestern Medicine.

Dr. Passman, it's a pleasure to have you join us today. I'd like you to start by telling the listeners a little bit about atrial fibrillation. What is it?

Dr. Rod Passman: Well, first of all, I want to thank you very much for allowing me to join you today. You know, atrial fibrillation is incredibly common. In fact, it's the most common abnormal rhythm in adults. And there are millions of people who have atrial fibrillation. And this is an abnormal rhythm of the heart with the top portion and can be very rapidly and irregularly.

And this can have several manifestations. Some people may feel their heart racing. They may feel short of breath. They may feel lightheaded. And what's interesting is that many people may have no symptoms at all. The problem is that whether you feel your atrial fibrillation or not, atrial fibrillation can increase your risk of stroke.

So blood clots can form in the heart during episodes of AFib and those blood clots can break off and go to the brain. And atrial fibrillation increases the risk of stroke by 500%. And these tend to be major strokes, ones that cause severe debilitation or can even be life-threatening.

Melanie Cole: Wow. That was an excellent explanation about the connection between stroke and AFib. Thank you, doctor. So stroke is a neurologic condition and you're a cardiologist. Tell us a little bit about the connection here.

Dr. Rod Passman: Well, you know, we've known for a long time that people with atrial fibrillation, because the upper chambers of the heart are not beating regularly, that that loss of that sort of squeezing function of the heart can promote blood clots from forming. And these blood clots, if they break off and go to the brain, can cause stroke. So cardiologists and stroke neurologists work together on this problem. And this is a really big problem because, for many people, they may not know they have atrial fibrillation until they present with a stroke. So, you know, it's really almost like high blood pressure and that you could have it and not know it and still suffer the consequences.

Melanie Cole: Well, then let's talk about that. How would somebody know? Are there any symptoms? Would we feel that fast heartbeat or anxiety or palpitations? And while you're telling us that, how is it diagnosed? What would even send someone to the doctor to get this checked?

Dr. Rod Passman: Well, you raised really excellent questions. For many people, they do feel it. They feel like their heart is racing. Some people described a "bag of worms" in their chest where it's really jittery and jumpy. And then some people may not feel it in their heart, but they may feel that their exercise capacity is reduced. They may feel more tired or short of breath particularly when they exert themselves and some people feel dizzy and lightheaded.

But as I said, even those people who feel episodes and, by the way, atrial fibrillation can come and go, or it can come and stay and be there all the time, but even people who feel their episodes may only feel a minority of their episodes. And many people may feel nothing at all until they present with some of the consequences of atrial fibrillation. And while stroke is the most major, we know that patients with atrial fibrillation are more likely to develop congestive heart failure and actually more and more data that they are more likely to develop dementia as well.

Melanie Cole: Wow. So it's a pretty serious conditions. So tell us a little bit about treatments. If you have diagnosed that someone has AFib, coming and going, whatever it is, tell us a little bit about what you would do first to reduce that risk of stroke, as that would seem to be one of the biggest complications of AFib. So what do you try first, Dr. Passman? And then you can tell us some interventional things that you might try, some procedures that can really help to save a life.

Dr. Rod Passman: Well, you know, when we think about the treatment of atrial fibrillation, first obviously you need to diagnose it. And as I said, while many people may have symptoms that cause them to go to the doctor and they may get an EKG done or they may be asked to wear a monitor that makes the diagnosis, you know, because this disease can come and go, you can imagine it may be very difficult to find. So in some people, we use long-term monitors that they wear. We're taking advantage of some consumer technologies like wearables and Apple watches and other devices that you could turn your smartphone into an EKG machine. So making the diagnosis is the first step.

And then the treatment is really a four-pronged approach. Number one, we want to reduce the risk of stroke. And the most common way to do that is by using blood thinners also called anticoagulants. And for about 70 years, we had one drug called Coumadin or warfarin. And over these last 10 years or so, we have a new group of medications that are as effective, if not more effective, certainly easier to take and probably safer than Coumadin. So stroke prevention is key.

The other issue is that in some patients, we want to make sure that the heart rate isn't too fast during their episodes of atrial fibrillation. And then in some people where they're really bothered by their atrial fibrillation, we may want to make efforts to control the rhythm of the heart. And the way we do that is either with medication, these drugs are called antiarrhythmic drugs or with a procedure called ablation, where we go into the heart with a catheter and eliminate the source of the atrial fibrillation.

We've also come to appreciate that there's a fourth line of approach and that's lifestyle modification. We've come to appreciate more and more that patients can do things to limit their risk of developing AFib and to help treat their atrial fibrillation. So for example, moderate exercise we know is good for you. If you have sleep apnea, treating it is good for you. Trying to minimize your alcohol is an important feature and something as simple as getting a good night's sleep may also help reduce the burden of atrial fibrillation.

Melanie Cole: That's all great advice. And as an exercise physiologist, I really hear you because that can help. For the people that do some of these interventions that you mentioned, Dr. Passman, do they still need their blood thinners? Do they still need their medications? Is this something that is curative or just symptomatic?

Dr. Rod Passman: Well, you know, that's an area of intense research. I should say that not all people with atrial fibrillation are at equal risk of stroke. And we have ways of sort of using the patient's history to figure out whether they should be on a blood thinner or not. To date, even if we make an effort to control the rhythm of the heart, the goal is really to reduce symptoms.

We don't stop blood thinners, even though we think we've controlled the rhythm of the heart and because we understand that we have no absolute cures for atrial fibrillation, and you could have episodes that you don't feel even on medication or even after an ablation. So it's the area of my research to try to figure out whether there are some people where we can stop blood thinners.

I should also mention that today there are options for patients who should be on blood thinners, but can't take them. There are devices called left atrial appendage occlusion devices. Watchman device is the one that's approved by the FDA. And this is like a little umbrella that we place inside the heart through the blood vessels, and this can block off the areas where blood clots form and therefore prevent strokes without the need for long-term blood thinners. So Northwestern and other places do offer this interesting and exciting option.

Melanie Cole: It certainly is. And I've done shows on Watchman and it's fascinating. So listeners, check out some of those. Dr. Passman, and before we wrap up, you mentioned technology to help monitor their AFib because that's very important, is to know when you're having these episodes and so that your doctor sees this pattern, so that helps with deciding on treatment options. Tell us about some of the exciting technology. You just briefly mentioned it, but what do you want patients to think about if they're looking for some of this out there, whether it's an Apple watch or something that helps monitor their heart rate and their rhythm?

Dr. Rod Passman: Yeah. So it's a really an exciting time. You know, it used to be the doctor would order a test and then get the result. But we're living in an era where consumers can go to their store and buy a device that could monitor the rhythm of the heart. So there are two ways of doing it. One, you can buy an attachment to your smartphone, and there's a device called Kardia, which allows you to record a 30-second EKG and it will read a few at that time. So people have shown that this is an effective way to find atrial fibrillation.

And then I'm involved in a really important study called Heartline. And this is sponsored by Johnson and Johnson as well as Apple. And in this study, we're looking at patients over the age of 65, and a good number of them will be randomized to receive an Apple watch, which can now look for atrial fibrillation. The new generation of watches will intermittently check your pulse throughout the day and will let you know if your pulse is irregular, which may be a sign of atrial fibrillation. And it will actually allow you to record an EKG just like the Kardia device from your wrist.

So whether these devices will allow us to find atrial fibrillation and treat patients before stroke occurs is still the subject of intense research. But I think this is really an exciting time from the consumer perspective that allows them to monitor their own health.

Melanie Cole: That's so cool that we could see what's going on with our hearts. So let us know, come back and update us about some of that research as you know more. Dr. Passman, wrap it up. Give us your best advice about atrial fibrillation, the increased risk of stroke as a result of AFib and what you would like patients to know about lifestyle behaviors, monitoring their own health and being their own best health advocate.

Dr. Rod Passman: Well, you know, I think that as we get older, we're all at risk of atrial fibrillation. This is a disease of aging, but I think that there are things that we could do. You know, stay active, minimize your alcohol, get a good night's sleep, you know, keep your weight down. All of those things are going to minimize your chances.

I think we should all have routine doctor visits and all be aware of even subtle signs and symptoms that can be evidence of ongoing atrial fibrillation and to seek medical attention. And then if your doctor does feel that you're at increased risk of stroke and recommends a blood thinner, take it. You know, these new drugs, while they have some risks, the benefits far outweigh the risks.

And, you know, this can be devastating disease, but there are amazing treatments out there. And I think, you know, coming to a center that focuses on these diseases and speaking to experts in cardiology and my area, cardiac electrophysiology, will make people people aware of some of those amazing options.

Melanie Cole: What an informative episode. Great guest. Dr. Passman, thank you so much for joining us today. And you can call (312) NM-HEART or you can visit heart.nm.org to make an appointment and to learn more.

That concludes this episode of Northwestern Medicine Pod Talk. Please remember to download, subscribe, rate, and review these episodes and all the other Northwestern Medicine podcasts. Share these shows with your friends because we're learning from the experts at Northwestern Medicine together, and it could save someone's someone's life. I'm Melanie Cole.