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Bill Klaproth (Host): So, what is atrial fibrillation or AFib? What are the symptoms and how is it treated? Well, let's get the facts about atrial fibrillation with Dr. Jim Zhang, a Cardiac Electrophysiologist at UPMC.

This is Healthier You, the podcast from UPMC in central Pennsylvania. I'm Bill Klaproth. Dr. Zhang, thank you so much for your time. It's great to talk with you. So, let's start out with this, just so we all understand it. What is atrial fibrillation or AFib?

Jim Zhang, MD (Guest): So, before we talk about AFib, I think it's good to talk about how the heart works when it's normal. So, the heart is an electrical system, as well as a pump. So, the current of the electrical current, the direction of the electric current tells it how to pump properly. So a normal heart rhythm, that starts in the top, right chamber goes off 60, 70 beats a minute. Top chambers squeeze would they get that signal. That signal then travels to the middle of the heart called the AV node, which slows it down a little bit. It's like a toll booth. It takes the signal and slows it down and then transmits to the lower chamber, the lower chambers squeeze.

Atrial fibrillation is extremely common. It's the second, most common heart rhythm after normal rhythm. And when your heart's in AFib, the top left chamber takes over. And instead of doing 60, 70 beats a minute, it goes crazy. It goes 400, 500, 600 beats a minute. And the top chambers kind of quiver instead of beating.

That signal then goes to the AV node, that middle of the heart, that toll booth, which will block a lot of them, slow them down. But enough will travel to the lower chambers and the lower chambers go typically faster and irregular. So AFib is an abnormal heart rhythm that then affects the heart's normal function. And the way that it pumps.

Host: So from what you're saying, this sounds like an electrical problem almost.

Dr. Zhang: Correct.

Host: Very interesting. So, then when you say that upper chamber is going crazy is that, that fluttering, that people feel sometimes?

Dr. Zhang: Typically people will feel the lower chambers, as the flutter. So, the heartbeat that you feel when you check your pulse, is usually the lower chambers cause that squeezes a bigger amount of blood and people feel that kind of pounding sensation. When the lower chambers are going faster and irregular from atrial fibrillation, that's what they're feeling, where they feel a fluttering or palpitations or anything like that.

Host: Okay. And the lower chamber is what pumps the blood out.

Dr. Zhang: Correct. The lower chambers pump the blood to the lungs and then also from the heart to the rest of the body.

Host: Okay. So, we just talked about this fluttering that some people may feel are there other symptoms of AFib?

Dr. Zhang: So symptoms tend to vary by patient. Some people really feel it. So, some people feel like I said, the fluttering and the palpitations, some people feel more subtle symptoms, like just being more tired. And more short of breath. Some people have very few symptoms and feel almost nothing at all. But the majority of people feel something.

Host: Okay. So, then who is at risk for AFib? How does this come on or develop?

Dr. Zhang: I think the biggest risk is probably age. As we age, the percentage of AFib in the population goes up dramatically. Other risk factors include high blood pressure, diabetes. Obesity is a big one. Alcohol use is a big one and sleep apnea is another one that's often under-recognized.

Host: So, you just said earlier, when we were talking about symptoms, most people feel something, some may not feel anything at all. So, then what is the main risk of AFib? What is the main problem caused by this fluttering or misfiring of the heart?

Dr. Zhang: So AFib by itself, is not deadly. It's not dangerous by itself. It won't make you die or drop dead, or anything like that. The major risk of AFib is that when the top chambers aren't squeezing properly, they're kind of fibrillating, they're quivering, blood clots can form and cause a stroke.

That risk of stroke goes up with other risk factors like diabetes, heart failure, high blood pressure, blockage of the arteries and certain ages. Other risks are a little bit more long-term and more theoretical. For some people, if you have AFib, a lot of the time, the heart gets weaker and you can have a cardiomyopathy from atrial fibrillation.

Host: Okay. So, how do we help people with AFib reduce their stroke risk?

Dr. Zhang: The main way we do is with blood thinners. There's older blood thinners, like Coumadin, which require blood draws. These have been proven to work over many decades. There is somewhat newer ones that have come out in the past 10 years or so that don't require blood draws. These names are called XARELTO, ELIQUIS, Pradaxa, things like this. There's also a certain procedure that we recommended for certain people that can't do blood thinners.

Host: So, blood thinners help reduce the risk of blood clotting during an AFib moment, if you will, is that kind of the theory behind this?

Dr. Zhang: Essentially, yeah. The blood thinners, if you are recommend for a blood thinner, depending on your risk of stroke, you take it every day. And the risk of stroke with atrial fibrillation is cumulative. It's not like you're going to have a stroke every time you have an episode of atrial fibrillation, but the amount does add up. That risk adds up over time, over years. The blood thinner, you take it every day to prevent clots from forming when you had AFib episodes.

Host: What about patients who can't take blood thinners, then what?

Dr. Zhang: There's a procedure called the Watchman procedure, which many had heard of. So, the top left chamber, the left atrium is where blood clots that cause stroke form. There's a small outpouching in that chamber called the left atrial appendage where 90% of blood clots form, they call it stroke.

For people that have nonvalvular atrial fibrillation, which means atrial fibrillation, not associated with a certain type of heart disease, rheumatic heart disease; for these people, if they have high bleeding risks, then, what we do is try to put a little device in that outpouching, in that appendage to close it off.

And these people get blood thinners for a shorter amount of time until that device heals. And the device is there to prevent blood clots from forming.

Host: So, we talked about blood thinners to reduce stroke risk. Is there another way to treat AFib besides blood thinners?

Dr. Zhang: So, besides the risk of stroke, which again is the most deadly part of atrial fibrillation our other treatment modalities are to make people feel better. So, like I said, most people that have AFib episodes tend to feel them, tend to be symptomatic. So, we give medications to slow the heart rate down during episodes of atrial fibrillation. There's also medication to keep you in normal rhythm.

And there's also another procedure called ablation. Where we take catheters inot the heart and treat the areas of the heart, typically the pulmonary veins, which are veins that drain blood from the lungs into the top left chamber, into the left atrium. And we burn or freeze the heart tissue around those veins. To the electrically silence them. So, that signals inside that might cause atrial fibrillation, can't get out.

Host: Does AFib ever go away? Are there ways to, to manage it?

Dr. Zhang: I would say it's a treatable condition rather than a curable condition. Just like blood pressure, just like diabetes. So, atrial fibrillation comes in stages. The earliest stages called paroxysmal atrial fibrillation, where people are in it for a minute, an hour, a couple of days, and they go out of it on their own. That have sometimes regress to a stage called persistent atrial fibrillation, where people stay in it for days and weeks and months, until we either shock the heart or do something else to get the heart back in a normal rhythm. And some people stay in AFib of all the time, which by itself, like I said, is not dangerous. Not deadly.

All those treatment modalities, the medications to keep you in a normal rhythm, the medications to slow the heart rate down, the ablation procedure, the earlier we do it in that progression of atrial fibrillation, the more successful it is long-term. Many people still have some AFib even after an ablation, but typically the amount of AFib goes down by a lot.

Host: And when you're in AFib for a long time, that's of course when your stroke risk goes up, is that right?

Dr. Zhang: Correct. So, persistent atrial fibrillation is a higher stroke risk. And then also, like I said, for some people that are always in AFib, they develop cardiomyopathy, their heart gets weaker. That also could increase the risk of stroke.

Host: Can you manage this or get rid of it through lifestyle changes, eating better, exercising regularly, getting that cardiovascular workout in, sleeping better, quitting smoking, those types of things? Can you minimize AFib through lifestyle changes?

Dr. Zhang: Absolutely. I think those things that you mentioned are as effective, if not more effective than procedures or medications for atrial fibrillation. So, I think the biggest thing that we see is, obesity as a risk factor for atrial fibrillation. And there are studies that show that losing 10% of your weight, if you are obese, could reduce your amount of AFib as much as an ablation procedure. So, weight loss is huge. Exercise is huge. Not smoking is huge. Sleep apnea treatment, like I mentioned, if you have sleep apnea, that's huge. Also there's newer studies in the past couple of years where binge drinking, drinking a lot of alcohol at one time can certainly trigger an AFib episode. So, drinking less for many people also helps.

Host: I would imagine the minute you feel something, if you feel this fluttering or flapping or skipping a beat, you should go see the doctor, right? You shouldn't just pass it off as ah, I'm fine.

Dr. Zhang: It depends. So, if you're having a second or two where your heart flip-flops a little bit, I don't think you have to run to the ER. But certainly bring it up with your doctor. Tell them how you're feeling. If your heart is feeling funny, then the next step is to try to figure out what your heart rhythm is doing when you're having these episodes and that's with, you could wear a monitor. There's also newer things for your phone. Apps that you could use to try to record an EKG, but if your heart's feeling funny, then, you should let your doctor know.

Host: Absolutely. Well, Dr. Zhang, this has been really informative. Is there anything else you want to add about our discussion about AFib?

Dr. Zhang: So, I work with UPMC and we work out of the Harrisburg Hospital for our procedures and and we have offices throughout the central Pennsylvania region. So, there's a lot of AFib specialists around for people to have AFib. Any more questions, ask your doctor and they can reach out to us as well.

Host: Dr. Zhang, really good stuff. Thank you so much for your time. We appreciate it.

Dr. Zhang: No problem. It's my pleasure.

Host: And that's Dr. Jim Zhang. And for more information, please visit upmc.com/centralPAheart. Once again, that's upmc.com/centralPAheart. And if you've found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier You, a podcast from UPMC. I'm Bill Klaproth.Thanks for listening.