According to the Centers for Disease Control and Prevention (CDC), atrial fibrillation, often called AFib, is the most common type of heart arrhythmia. An estimated six million people in the United States have AFib. With the aging of the U.S. population, this number is expected to increase.
There are many treatment options that can help treat and monitor AFib. They may involve medications, procedures or both.
Listen in as Nader Nashaat Attia, D.O, cardiologist and member of the Medical Staff at Temecula Valley Hospital, discusses the treatments to help you manage and live with your atrial fibrillation.
Living With Atrial Fibrillation
Featured Speaker:
Learn more about Nader Nashaat Attia, DO
Nader Nashaat Attia, DO
Nader Nashaat Attia, DO is a cardiologist and a member of the medical staff at Temecula Valley Hospital.Learn more about Nader Nashaat Attia, DO
Transcription:
Living With Atrial Fibrillation
Melanie Cole (Host): According to the CDC, atrial fibrillation, often called “AFib”, is the most common type of heart arrhythmia. An estimated 6 million people in the United States may have AFIB. With the aging of the US population, this number is expected to increase. My guest today is Dr. Nader Attia. He's a cardiologist and a member of the medical staff at Temecula Valley Hospital. Welcome to the show, Dr. Attia. Tell us first, what is atrial fibrillation?
Dr. Nader Attia (Guest): Hi, how are you? Thanks for having me this afternoon on your podcast. It's a pleasure to be a part of the community at Temecula Valley. Atrial fibrillation is actually one of the most common arrhythmias that we treat in cardiology. As you already alluded to, it is very common in our aging population and it is an arrhythmia that can be treated properly once diagnosed.
Melanie: Does somebody know that they have it? Are there any symptoms or might they not feel it?
Dr. Attia: Frequently, some patients do feel symptoms and sometimes can vary between patients. However, in some instances, patients can be asymptomatic for months or even years at a time until they finally end up having an EKG that ultimately diagnoses the arrhythmia. Some symptoms that they may have include shortness of breath, irregularity or palpitation. They may also feel dizziness or lightheadedness. Some patients may even develop chest discomfort in some instances when the rate of the atrial fibrillation accelerates. A rare and sometimes overseen or overlooked side effect or symptom is an increase in urinary frequency with no evidence of urinary tract infections or intrinsic bladder issues.
Melanie: If AFib is not caught and treated, are there complications to not getting it treated?
Dr. Attia: There can be and the most worrisome complication of atrial fibrillation, especially if patients have certain risk factors such as congestive heart failure, hypertension, age, diabetes, and previous stroke, is a large and major debilitating stroke. Additionally, if atrial fibrillation is not controlled, in terms of its rate of acceleration, over time, this can potentially weaken the heart muscle causing a process called “cardiomyopathy”, additionally can lead to congestive heart failure and valvular heart disease.
Melanie: So, Dr. Attia, when you do diagnose somebody with AFib, what is the first line of defense? What do you do for them first?
Dr. Attia: Depending on their age and risk factors, I think the most important thing to do is to start them on a blood thinner and that blood thinner can vary depending on the patient and their comfort level with taking blood thinners, but there are various ones on the market that we have at our disposal and that's all individually tailored to that patient. Secondarily, if their heart rates are rapid, I try to start them on medications that can better control their heart rate, and if not control them, maybe even possibly convert them to a normal sinus rhythm. As part of my clinical practice, I do like to ensure that patients return to normal sinus rhythm and, oftentimes, will perform a procedure called the “transesophageal echo” to look for any clots or thrombus within the heart structure and if none are found, these patients can have a second procedure called a “cardioversion” in which we employ electricity to resynchronize their heart back to a normal rhythm.
Melanie: If you use cardioversion and you do resynchronize or use of the rate control methods, can it come back, or is this a permanent solution?
Dr. Attia: Unfortunately, atrial fibrillation is one of those arrhythmias that is very complex and very stubborn to treat. The success rate of cardioversion is about 60% in terms of its permanence; however, a lot of times, patients may require a second or third cardioversion, and the same holds true for patients that undergo a more invasive procedure called “radiofrequency ablation” in which cautery is used to isolate the focus of atrial fibrillation and eradicate it within the heart. And then, that procedure as well, there's a recurrence rate of about 40-50% of patients needing a second or third radiofrequency ablation.
Melanie: So, for the rhythm control in cardioversion, you're sort of shocking their heart back into normal sinus rhythm. Speak a little bit more for us, if you would, Dr. Attia, about the catheter ablation and what this actual procedure is?
Dr. Attia: This procedure is one that's performed by a sub-specialist in the field of cardiology called an “electrophysiologist”. Their main focus of treatment is the electrical system of the heart and what they do is they pass a few catheters through the venous system, most commonly through the jugular vein in the neck as well as the femoral vein in the groin and they guide those catheters up to the heart and oftentimes across the septum, which is the partition between the two upper chambers of the heart to reach the left side of the heart called the “left atrium”. That's where the most common site for atrial fibrillation is, either within the actual heart muscle tissue, or in another area surrounding what we call the “pulmonary venous circulation” and those are the areas based on the 3D map that's created of each individual patient's heart where the electrophysiologist focuses a cauterizing tool to help basically burn out the areas of electrically active tissue to reduce the frequency and location of any potentially pro-arrhythmic areas in that part of the heart.
Melanie: And, as you said, AFib is quite stubborn and complicated. If they've had the ablation, do they still need to be on a blood thinner and is this something that works in the long-term?
Dr. Attia: Oftentimes, again, 60% of patients will have a successful ablation on the first try, but second and third opportunities do arise in about 50% of the population that doesn't undergo radiofrequency ablation. They do have to remain on blood thinners for at least 30 days following the procedure. Now, if patients have been on blood thinners for six months, especially the ones that are asymptomatic and haven't experienced any symptoms, then, oftentimes, those patients we will take of blood thinners and monitor very closely. With the newer medications, that have a very quick on/off mechanism of action, it's not unheard of that we use these medications almost as a pill-in-pocket form, where, if they start to feel their symptoms, we encourage them to take their blood thinner immediately which will give them coverage and will prevent strokes, prevent the formation of clots, because we know clots take about 24-48 hours to form, and these medications have an onset of about 6 hours. So, you can see, by the time the patient feels their symptoms, takes their medication, they're well-covered in terms of stroke reduction with regards to recurring atrial fibrillation.
Melanie: Can people with AFib live long, healthy lives, and what would you like to tell them about doing that and possible prevention or healthy lifestyle information?
Dr. Attia: I have a tremendous number of patients in my practice that have atrial fibrillation, some of which we have kept in what we call “rhythm control” where they are in normal sinus rhythm using medication, radiofrequency ablation, or cardioversion, or a combination of all three, and others we've maintained the rate control population, both of which have been substantially researched and are both adequate responses to the atrial fibrillation. In my clinical practice, both types of patients can thrive even with multiple risk factors. However, we have to prevent the main risk factors for atrial fibrillation, the ones that we can control, at least, and that would be high blood pressure, diabetes, and patients with history of coronary artery disease. The other risk factors that we can't control, obviously, are reverse our age and being a female. Females, unfortunately, have a higher propensity to develop atrial fibrillation, especially as they age. So, if we can do a better job of controlling high blood pressure, avoiding excessive swings and blood pressure as well as blood sugar, oftentimes, these patients can do well and live a long and healthy lifestyle. With regards to our younger patient population in which atrial fibrillation is less common, there are very specific risk factors that they need to avoid and that includes binge drinking and excessive alcohol intake, drugs, and smoking, all of which can potentially bring on that arrhythmia, making it very difficult to control because of the underlying neural/hormonal influences.
Melanie: And, why should they come to Temecula Valley Hospital for their care? Tell us about your team.
Dr. Attia: Our team consists of seven cardiologists that focus their practice throughout the different facets of cardiology. Myself, I'm a general cardiologist. I do invasive, non-interventional cardiology as well as nuclear medicine echocardiography. Our partners are interventionalists and can perform multiple interventional cardiologic procedures, including heart stents and other structural heart procedures. We have an electrophysiologist that is capable of doing the type of work that some atrial fibrillation patients may need, including pacemakers and radiofrequency ablation. Temecula Valley offers all of those types of services all in one place without needing to travel further or outside the Temecula Valley area.
Melanie: Thank you so much for being with us today. It's great information. You're listening to TVH Doc Talk with Temecula Valley Hospital. For more information, you can go to www.temeculavalleyhospital.com. That's www.temeculavalleyhospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks for listening.
Living With Atrial Fibrillation
Melanie Cole (Host): According to the CDC, atrial fibrillation, often called “AFib”, is the most common type of heart arrhythmia. An estimated 6 million people in the United States may have AFIB. With the aging of the US population, this number is expected to increase. My guest today is Dr. Nader Attia. He's a cardiologist and a member of the medical staff at Temecula Valley Hospital. Welcome to the show, Dr. Attia. Tell us first, what is atrial fibrillation?
Dr. Nader Attia (Guest): Hi, how are you? Thanks for having me this afternoon on your podcast. It's a pleasure to be a part of the community at Temecula Valley. Atrial fibrillation is actually one of the most common arrhythmias that we treat in cardiology. As you already alluded to, it is very common in our aging population and it is an arrhythmia that can be treated properly once diagnosed.
Melanie: Does somebody know that they have it? Are there any symptoms or might they not feel it?
Dr. Attia: Frequently, some patients do feel symptoms and sometimes can vary between patients. However, in some instances, patients can be asymptomatic for months or even years at a time until they finally end up having an EKG that ultimately diagnoses the arrhythmia. Some symptoms that they may have include shortness of breath, irregularity or palpitation. They may also feel dizziness or lightheadedness. Some patients may even develop chest discomfort in some instances when the rate of the atrial fibrillation accelerates. A rare and sometimes overseen or overlooked side effect or symptom is an increase in urinary frequency with no evidence of urinary tract infections or intrinsic bladder issues.
Melanie: If AFib is not caught and treated, are there complications to not getting it treated?
Dr. Attia: There can be and the most worrisome complication of atrial fibrillation, especially if patients have certain risk factors such as congestive heart failure, hypertension, age, diabetes, and previous stroke, is a large and major debilitating stroke. Additionally, if atrial fibrillation is not controlled, in terms of its rate of acceleration, over time, this can potentially weaken the heart muscle causing a process called “cardiomyopathy”, additionally can lead to congestive heart failure and valvular heart disease.
Melanie: So, Dr. Attia, when you do diagnose somebody with AFib, what is the first line of defense? What do you do for them first?
Dr. Attia: Depending on their age and risk factors, I think the most important thing to do is to start them on a blood thinner and that blood thinner can vary depending on the patient and their comfort level with taking blood thinners, but there are various ones on the market that we have at our disposal and that's all individually tailored to that patient. Secondarily, if their heart rates are rapid, I try to start them on medications that can better control their heart rate, and if not control them, maybe even possibly convert them to a normal sinus rhythm. As part of my clinical practice, I do like to ensure that patients return to normal sinus rhythm and, oftentimes, will perform a procedure called the “transesophageal echo” to look for any clots or thrombus within the heart structure and if none are found, these patients can have a second procedure called a “cardioversion” in which we employ electricity to resynchronize their heart back to a normal rhythm.
Melanie: If you use cardioversion and you do resynchronize or use of the rate control methods, can it come back, or is this a permanent solution?
Dr. Attia: Unfortunately, atrial fibrillation is one of those arrhythmias that is very complex and very stubborn to treat. The success rate of cardioversion is about 60% in terms of its permanence; however, a lot of times, patients may require a second or third cardioversion, and the same holds true for patients that undergo a more invasive procedure called “radiofrequency ablation” in which cautery is used to isolate the focus of atrial fibrillation and eradicate it within the heart. And then, that procedure as well, there's a recurrence rate of about 40-50% of patients needing a second or third radiofrequency ablation.
Melanie: So, for the rhythm control in cardioversion, you're sort of shocking their heart back into normal sinus rhythm. Speak a little bit more for us, if you would, Dr. Attia, about the catheter ablation and what this actual procedure is?
Dr. Attia: This procedure is one that's performed by a sub-specialist in the field of cardiology called an “electrophysiologist”. Their main focus of treatment is the electrical system of the heart and what they do is they pass a few catheters through the venous system, most commonly through the jugular vein in the neck as well as the femoral vein in the groin and they guide those catheters up to the heart and oftentimes across the septum, which is the partition between the two upper chambers of the heart to reach the left side of the heart called the “left atrium”. That's where the most common site for atrial fibrillation is, either within the actual heart muscle tissue, or in another area surrounding what we call the “pulmonary venous circulation” and those are the areas based on the 3D map that's created of each individual patient's heart where the electrophysiologist focuses a cauterizing tool to help basically burn out the areas of electrically active tissue to reduce the frequency and location of any potentially pro-arrhythmic areas in that part of the heart.
Melanie: And, as you said, AFib is quite stubborn and complicated. If they've had the ablation, do they still need to be on a blood thinner and is this something that works in the long-term?
Dr. Attia: Oftentimes, again, 60% of patients will have a successful ablation on the first try, but second and third opportunities do arise in about 50% of the population that doesn't undergo radiofrequency ablation. They do have to remain on blood thinners for at least 30 days following the procedure. Now, if patients have been on blood thinners for six months, especially the ones that are asymptomatic and haven't experienced any symptoms, then, oftentimes, those patients we will take of blood thinners and monitor very closely. With the newer medications, that have a very quick on/off mechanism of action, it's not unheard of that we use these medications almost as a pill-in-pocket form, where, if they start to feel their symptoms, we encourage them to take their blood thinner immediately which will give them coverage and will prevent strokes, prevent the formation of clots, because we know clots take about 24-48 hours to form, and these medications have an onset of about 6 hours. So, you can see, by the time the patient feels their symptoms, takes their medication, they're well-covered in terms of stroke reduction with regards to recurring atrial fibrillation.
Melanie: Can people with AFib live long, healthy lives, and what would you like to tell them about doing that and possible prevention or healthy lifestyle information?
Dr. Attia: I have a tremendous number of patients in my practice that have atrial fibrillation, some of which we have kept in what we call “rhythm control” where they are in normal sinus rhythm using medication, radiofrequency ablation, or cardioversion, or a combination of all three, and others we've maintained the rate control population, both of which have been substantially researched and are both adequate responses to the atrial fibrillation. In my clinical practice, both types of patients can thrive even with multiple risk factors. However, we have to prevent the main risk factors for atrial fibrillation, the ones that we can control, at least, and that would be high blood pressure, diabetes, and patients with history of coronary artery disease. The other risk factors that we can't control, obviously, are reverse our age and being a female. Females, unfortunately, have a higher propensity to develop atrial fibrillation, especially as they age. So, if we can do a better job of controlling high blood pressure, avoiding excessive swings and blood pressure as well as blood sugar, oftentimes, these patients can do well and live a long and healthy lifestyle. With regards to our younger patient population in which atrial fibrillation is less common, there are very specific risk factors that they need to avoid and that includes binge drinking and excessive alcohol intake, drugs, and smoking, all of which can potentially bring on that arrhythmia, making it very difficult to control because of the underlying neural/hormonal influences.
Melanie: And, why should they come to Temecula Valley Hospital for their care? Tell us about your team.
Dr. Attia: Our team consists of seven cardiologists that focus their practice throughout the different facets of cardiology. Myself, I'm a general cardiologist. I do invasive, non-interventional cardiology as well as nuclear medicine echocardiography. Our partners are interventionalists and can perform multiple interventional cardiologic procedures, including heart stents and other structural heart procedures. We have an electrophysiologist that is capable of doing the type of work that some atrial fibrillation patients may need, including pacemakers and radiofrequency ablation. Temecula Valley offers all of those types of services all in one place without needing to travel further or outside the Temecula Valley area.
Melanie: Thank you so much for being with us today. It's great information. You're listening to TVH Doc Talk with Temecula Valley Hospital. For more information, you can go to www.temeculavalleyhospital.com. That's www.temeculavalleyhospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks for listening.