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Amanda Wilde (Host): This is Community Connect: presented by Tampa General Hospital. I'm Amanda Wilde. Joining me is Dr. Chris Cook, Assistant Professor of Cardiovascular Sciences at the University of South Florida College of Medicine at Tampa General Hospital. Dr. Cook, welcome.

Dr. Chris Cook: Thank you for having me, Amanda.

Host: We're talking about atrial fibrillation, which is affecting increasing numbers of adults. And whether you show no symptoms or you're feeling drum solos beating in your chest, AFib can be dangerous. So to start us off, Dr. Cook, can you explain what atrial fibrillation is and why it's important to catch it early?

Dr. Chris Cook: Absolutely. No problem. And actually, this is the perfect time to talk about atrial fibrillation because September is atrial fibrillation or AFib-- even I call it AFib. It's just easier. But September's AFib Awareness Month. So, great time to talk about it. Like you kind of alluded to, not only is it the most common heart rhythm problem that people get, so it's kind of interest to everybody, but catching it early can definitely be important. We know that long-term heart health is dependent on catching it early. And preventing strokes, it was a major goal in this disease process. And the earlier you catch it, the more likely you are to prevent a stroke.

There's definitely a lot, I would say, confusion about what even AFib is. And it can be confusing at first for sure. So normally, the top and the bottom of chambers of the heart work like a team. Top chamber squeezes, bottom chamber squeezes right after. They work in sequence to pump blood throughout your body. But if you have atrial fibrillation, what happens is the top chamber basically stops squeezing all together. And as a result, the heartbeat becomes irregular and often too fast. And like you mentioned, some people feel bad when this happens. They get symptoms, they feel their heart pounding, or they get dizzy or lightheaded. But other people either have such subtle symptoms like just being tired or fatigued or no symptoms at all. And I think that's why awareness is so important, and I appreciate you having me on the podcast to highlight AFib Awareness Month is because awareness of the condition can help you recognize it early, even if you don't have symptoms so you can protect your heart and prevent strokes.

Host: Is AFib something you manage or can it be cured?

Dr. Chris Cook: So with atrial fibrillation, we usually don't talk about cure because it's usually sort of like a global disease process of the top chamber, but it can absolutely be managed. And a lot of patients that come to me with atrial fibrillation have had frustrating courses, either they've had this rhythm coming and going, affecting their quality of life for a while, or they just haven't settled on the right treatment plan. So, that can definitely be an issue. But one of the my favorite things about taking care of this process and helping patients through it is it can absolutely be managed. And so, it's very rare that we don't have a solution that really can improve quality of life, get people more functional again, improve energy levels and all that. And so, absolutely, it can be managed, but we don't usually talk about cure.

Host: When I mentioned showing no symptoms, I was thinking of a friend's mother-in-law. She did not know she had an irregular heartbeat. She did have AFib, and she found it out through her smartwatch. So, that technology, like smart watches, has changed the way we detect and manage AFib. Do you use this kind of technology to help care for patients with AFib?

Dr. Chris Cook: Absolutely. I think nowadays you have to if you want to really be expert at helping people through this issue. Like you kind of mentioned, it used to be the case where to even know you have this problem, AFib, you either had to have symptoms so bad you're presenting to the emergency department, getting an EKG, coming to your doctor's office or by chance you would just have to have a heart rhythm test or EKG done while you happen to be in this rhythm. So, we really sort of moved the goalposts in early detection with these consumer smartwatch devices. And a lot of people may not know this, but most of the most commonly used popular consumer devices that people think of in this area actually have FDA clearance for detecting AFib. So, this includes like newer generation Apple Watches. Fitbits, the Samsung Galaxy, a platform called KardiaMobile, which was one of the earlier innovators in this space. These are actually all FDA cleared for detecting atrial fibrillation. So, not only are people coming to me instead of us just finding them in the community because they're being alerted by their smart watches, but they're coming to me earlier in the disease process where a lot of things can be more effective and where we can reduce strokes better. So, this has definitely become a big part of my practice.

Host: Now once someone's diagnosed with AFib, how do you then work with them to figure out their best treatment plan?

Dr. Chris Cook: That's a really good question. And one of my favorite parts of helping people through atrial fibrillation is that, yes, it could be a frustrating disease because, like we mentioned, there's no cure. There's no treatment where you get rid of it, it just never comes back, but very manageable. And as part of that, there just is no one-size-fits-all treatment plan for atrial fibrillation.

So for each patient, the right approach is going to depend on that person, what symptoms they're experiencing, what's going on with their health overall, and what their goals are. Like, I'll give you an example. So when I see new patients with atrial fibrillation, one of the first things we will always talk about is stroke prevention, because that's really the part of this rhythm that's really dangerous, is the stroke risk.

For a lot of people, that means starting a blood thinner. Now, that can be very anxiety-provoking. People may have a relative that was on one of the older blood thinners, had a lot of problems with it like bleeding or blood frequent lab tests. They were very frustrating to use. When I mentioned tailoring the treatment plan to the patient, a lot of patients are really relieved to hear how well the new blood thinners work, how well tolerated they are. And even for those patients who maybe either don't tolerate blood thinners because like, say, they've had bad bleeding problems in the past and it's not safe, or even just difficulty staying on a blood thinner, like insurance doesn't cover it or maybe they have a job or a hobby that puts them at real high risk for bleeding, and they worry about "What would happen if I was out sailing, and I hit my head?" So for patients like that, we also have other options to reduce the risk of stroke. And one of the newer ones over the last few years is instead of taking a daily blood thinner, we can actually implant a small device in the heart to basically close off the area where clots usually form in AFib. And if we're able to do that successfully in the vast majority of cases we can. Patients don't have to rely on strong blood thinners long term. So, this is just an example of how we are able to tailor treatments to the individual patient. And that's really the way our field has moved. And it's one of the, I think, the rewarding things about it.

Host: Well, medications are improving, you've said, and technology's constantly involving. Are there recent advancements or ones you're looking forward to in treatment options for AFib patients?

Dr. Chris Cook: Definitely. Medications can be effective for this problem. And like I mentioned, you have to tailor the plan to individual patient because it's a complex disease and it interfaces with so many other aspects of patient's lives. So for some people, medicines work great. And when they work great, we keep using them. But many other people, either medications don't work, they're not effective, or many people simply don't want to take a medicine every day if a procedure could also be more effective.

And so, ablation is a type of a heart rhythm procedure. It's one of the most common things we do for this problem. And we used to have methods of ablation where we would try to target that heart muscle that tends to be responsible for the abnormal rhythm with either heating the tissue or freezing the tissue. But a newer technique has emerged that we've really embraced over the last year or so called pulsed field ablation, where instead of heating or cooling the tissue, we actually use very short-duration electric fields to selectively target just that tissue that we want to treat. And so, this has actually made ablation procedures safer and faster, and that translates to patients being able to recover more quickly and to undergo overall less risk. And so, it's really been a win for patients.

Host: Keeping the impacts of treatment as low as possible.

Dr. Chris Cook: Absolutely. And when you're treating a disease like atrial fibrillation, where the dangerous part is the stroke part, but otherwise it's not a life-threatening problem, but boy can it affect quality of life. It's very important to have treatment options that are both very effective and very safe. You have to thread that needle in a situation like this. And pulsed field ablation is something that I think really has advanced our field.

Host: Well, Dr. Cook, for someone listening who might be living with AFib or has a loved one who is, what would you say sets the care at TGH apart?

Dr. Chris Cook: One of the things that I like the most about working in our system is working with people who are passionate about the latest technology, bringing that latest technology to our patients, but also tailoring our care to the individual patient. And the personalized approach to AFib, that is really one of the reasons that I got into this field, and I'll kind of explain why. It's that I talked a lot about technology and we're a field where technology increases very rapidly. And as a consequence, as the technology improves, we're no longer locked into a single approach. Every new tool, every new treatment allows us another sort of arrow in the quiver to better tailor the treatment to the individual patient. So, I think we are at an institution where people that we treat not only benefit from access to the very latest options, but a team that really personalizes the plan to their unique goals and lifestyle. And those are not intention, they actually work together. And that's one of, I think, the really fun things about treating this disease here and one of the most rewarding parts about helping patients through it.

Host: Well, Dr. Cook, thank you so much for explaining AFib, the treatments and your personalized approach for AFib patients.

Dr. Chris Cook: Thank you very much.

Host: That was Dr. Chris Cook, Assistant Professor of Cardiovascular Sciences at the University of South Florida College of Medicine at Tampa General Hospital. For more information, please visit tgh.org/afib. If you enjoyed this episode, please be sure to like, subscribe, and follow Community Connect: presented by TGH on your favorite podcast platform. Thanks for listening to Community Connect: presented by Tampa General Hospital.