Carl Maronich (Host): Meaningful Medicine is a Novant Health Podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to manage medical decisions and build a healthier future. Today, our guest is Dr. Taylor Bazemore. Doctor, welcome.

Taylor Bazemore, MD: Thanks for having me. Privilege to be here.

Host: Dr. Bazemore is a cardiac electrophysiologist, and we're going to be talking about heart rhythm disorders today. And, Doctor, maybe we should start by talking about what are some of the common types of heart rhythm disorders that folks should be aware of?

Taylor Bazemore, MD: Sure. So within Cardiology, electrophysiology deals with the electrical system in the heart. We deal with fast heart rhythms and slow heart rates. The most common arrhythmias that we deal with are atrial fibrillation or atrial flutter, which is an arrhythmia where the top of the heart goes really, really fast, the bottom often goes fast; increases with age and with different cardiac risk factors and, again, the most common arrhythmias that we deal with in our clinic.

Host: So are there kind of mild to moderate symptoms or symptoms that folks might recognize that indicate they could be heading down a heart rhythm issue or heading toward one?

Taylor Bazemore, MD: Yeah, that's a great question. So, everyone is different with how they feel AFib and arrhythmias. Some patients feel every heartbeat that they have, and other patients maybe go 150, 200 beats a minute in AFib and they don't know one way or another. The AFib can affect all the patients in the same way, but the manifestations of symptoms, again, are variable person to person, which the presence of symptoms and the absence of symptoms lead to earlier or later presentations to our clinic. But early management is important for all of them.

Host: Sure. And is there a symptom that might stand out that if somebody feels, they should really think, "Okay, this is more than just something I can let go. I really need to get this addressed"? Is there some symptom that falls in that category?

Taylor Bazemore, MD: Yeah. So classically, atrial fibrillation causes heart racing or palpitations where someone may feel their heart beating or beating rapidly. Other folks may get shortness of breath fatigue or just low energy may be the most common symptom of an AFib in other patients.

Host: Yeah. And if folks are having those kind of symptoms, I'm guessing they would want to start with the primary care provider, get it checked out, and see where that leads them.

Taylor Bazemore, MD: Right. I think, always being in touch with your primary care doctor is a great start. If something feels like an emergency, going to the emergency room. But any primary care usually has an EKG machine where they can diagnose AFib at that time.

Host: We could talk a little bit about treatment. If somebody is in this situation, what are the different types of treatments there are?

Taylor Bazemore, MD: Sure. So when we think of AFib, there's kind of two big buckets. One is for folks who have AFib, there's a risk of stroke and getting these patients on blood thinners if appropriate. And then, for the rhythm itself, trying to slow down the AFib or convert the AFib to normal rhythm. There's a whole slew of medicines and procedures that could be used. But in most patients, whereas the rhythm itself isn't dangerous, it's not going to stop the heart, protecting these patients from stroke is our priority. When the heart fibrillate or quivers rapidly, it doesn't efficiently squeeze blood and blood clots can form in the top of the heart and cause a stroke.

Host: That happens quite often to folks with AFib. That greatly increases your chance of stroke from what I understand.

Taylor Bazemore, MD: Absolutely.

Host: I want to talk a little bit about pulsed field ablation. Can you talk a little bit about that treatment and what that involves?

Taylor Bazemore, MD: So, we've been doing ablation for many years to treat AFib. There's no cure for AFib, but AFib originates from irritable electrical signals in the top chamber of the heart. And classically, we've used catheters, which are long IVs that go in through the blood vessels into the heart. And we deliver either hot or cold therapy to reduce those triggers from causing AFib.

We now have a newer energy modality called pulsed field ablation that can have a similar effect without heating or cooling the tissue. Whereas these other ablation modalities are certainly very safe and effective, pulsed field ablation has the benefit of affecting heart cells that we want to treat without the risk of the collateral damage to the nearby structures, the esophagus behind the heart, the nerves that feed the diaphragm, and some uncommon but serious circumstances that hot or cold therapy can affect those neighboring structures and cause other issues. So with pulsed field ablation, again, we can effectively and safely treat AFib within the heart without affecting any other organs around the heart.

Host: Doctor, maybe without getting too technical, an ablation is really what kind of procedure?

Taylor Bazemore, MD: So, ablation is a way that we can effectively destroy abnormal cardiac tissues, or create lines of electrical scar or block within the heart. So, our natural electrical system has a natural pathway, electricity taking the path of least resistance, top down to the bottom. There's a natural highway that the electricity takes in the heart, if you will, and ablation treats some these irritable signals in the peanut gallery over in left field that are trying to interfere with what the heart wants to do. So, with these catheters, we can effectively target and suppress these irritable signals that are interfering with the natural electrical system of the heart.

Host: Nowadays, there's a lot of technology available to folks when it comes to health, one of those being the smartwatch, which people are, you know, making sure they get their steps in and monitoring some other health things. Is a heart rhythm disorder something that can be detected possibly through the use of a smartwatch? Or if you have a smartwatch, what could you look for?

Taylor Bazemore, MD: That's a great question. So with our newer technologies, a lot of folks are wearing smart watches that are recording every heartbeat. And some of these watches, including the Apple Watch, are FDA approved to detect AFib. So, they are effective tools. They're not perfect, and it really depends on the person wearing them. So if you get an AFib alert, certainly talk to your doctor, but it's important to trust or verify before we trust the data. Some of these watches have EKG capabilities where you can put your finger on the watch and get an EKG. Those tend to be more effective than just the alerts itself. And then, there's the cardiac apps where you can put your fingers on it and get EKGs. Again, this data can be helpful, but we would certainly want to see the data ourselves and maybe confirm it with a heart monitor before we put our patients on medicines and certainly before we do procedures. So, I wouldn't write it off, and I would certainly seek further care if get an alert.

Host: So folks are being more conscious of their health. Certainly, there'd be other things when it comes to heart health that they should be mindful of; diet, exercise, those kind of things.

Taylor Bazemore, MD: Sure. Absolutely. So, atrial fibrillation, most common arrhythmia that we see. The biggest risk factor is age, just being alive one year after another. One in four people may get it in their lifetime. Other cardiac risk factors: high blood pressure, diabetes, sleep apnea can all contribute to AFib as well. But a lot of times it just happens in folks. Whereas risk factor modification can help reduce how much AFib we see, some people may just get it despite their best efforts.

Host: Are there any misconceptions related to heart health and heart rhythm issues, AFib, that you hear commonly from patients that you want to make sure people don't fall into victim to?

Taylor Bazemore, MD: Sure. I think, again, everyone is different with how they feel AFib. Some people don't know they have AFib until they have a stroke, which is a really unfortunate circumstance in some people. So, they may know when they think they're in AFib or when they don't have AFib. But whereas the symptoms may vary from person to person, that risk of stroke really is pretty consistent based on their risk factors. So, just because you don't feel anything doesn't mean that there's not a risk.

Conversely, there's a lot of different arrhythmias or non-cardiac issues that may cause palpitations and heart racing. So, someone may think they're in AFib, whereas they're not. So, getting plugged in with your doctor, doing heart monitoring to figure out what rhythm is going on, and presence or absence symptoms, figuring out the most appropriate treatment is important.

Host: And certainly, regular checkups and, doing the regular health things, not waiting till there's an issue certainly would be an important part of the health journey.

Taylor Bazemore, MD: Absolutely. We like to get ahead of things and, for AFib in particular, you know, that earlier intervention reduces progression. So again, whereas some arrhythmias we deal with, they're born with an extra wire in the heart, we zap and it's gone for good, AFib is all about these triggers that pop up in the heart. The more AFib someone has, the more they're going to get. And the earlier we do something with medicines or procedures to reduce their AFib, the less AFib they're going to have down the road.

Host: Doctor, what drew you to heart medicine and particularly Electrophysiology?

Taylor Bazemore, MD: I've always been interested in Cardiology within medicine. It's literally the core of who we are as people. And within Cardiology, there's a lot of different flavors of medicine. But I think the electrical system is really satisfying to work with. We get to see patients in clinic, follow up with them over long periods of time. And especially with our interventions like ablation, we can really definitively treat patients and help them feel better in real time.

Host: Are you from the Carolinas or where are you originally from?

Taylor Bazemore, MD: I grew up in Asheville, but I've had family in this part of the state, some over in Wilmington and a lot of family here. But I've lived across the state my whole life.

Host: Doctor, we appreciate your time today, all the great information. And, again, a reminder, see your doctor regularly. And if you're feeling any kind of issues, make sure, you get them taken care of, because as you mentioned, early intervention always, always the key.

Taylor Bazemore, MD: Absolutely. Thanks so much for having

Host: Absolutely. And to find a physician, visit novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org.