Scott Webb (Host): Heart arrhythmias are very common, especially AFib. And my guest today is here to discuss arrhythmias, their symptoms, treatment options, and when monitoring is needed. I'm joined today by Dr. Tina Sichrovsky. She's an electrophysiologist with the Valley Health System

Welcome to Conversations Like No Other: Heart Care, presented by the Heart and Vascular Institute of Valley Health System in Paramus, New Jersey. Our podcast goes beyond broad everyday cardiac topics to discuss very real and very specific subjects that impact your heart health. We think you'll enjoy our fresh take. I'm Scott Webb. Thanks for listening.

Doctor, it's nice to have you here today. We're going to talk about the different types of arrhythmias, symptoms, treatment options, when monitoring might be needed. So, I've got a lot of questions for you, and I'm glad to have your time. Let's just start here. Maybe you could break down, you know, what an arrhythmia is, how common of a condition it is, and also some of the common conditions associated, AFib, SVT, PVCs, how they all kind of differ from one another. I know that's a lot for one question, but do your best.

Dr. Tina Sichrovsky: So, arrhythmia basically means an abnormal heart rhythm. It's not a specific diagnosis. It's just an umbrella term for all the different rhythm abnormalities. It could be too fast, too slow, irregular. And as you mentioned, three of those include SVT, PVCs, atrial fibrillation.

Atrial fibrillation or AFib is by far the most common rhythm abnormality. So, it's not that common in young patients, even though we see it once in a while, but it really increases in frequency as we get older. So if you look at patients in their 80s, about 20% of people have AFib. So one in five, that's how common it is.

Other arrhythmias that you mentioned, SVT and PVCs, they're not that frequent. It's hard to get a number to quantify them because many patients are asymptomatic. Those may be very short episodes that people don't feel, but it's much less frequent than atrial fibrillation.

Host: I see. Yeah, that checks out in my layperson brain. Of course, like AFib, we hear about that a lot. As you say, it's very common. The others not as common. And, Doctor, I know that a lot of people feel maybe occasional heart flutters. So, how can someone tell the difference between something benign, let's say like a PVC, and a more serious rhythm issue?

Dr. Tina Sichrovsky: It's a good question. So in general, the longer the symptoms last, the more severe the symptoms are. And if there are other symptoms like dizziness or chest pain associated, that's likely more serious then. But every patient is different. So, some people feel every single heartbeat. They're very in tune with their body, and a few PVCs a day will make them very uncomfortable and nervous.

And then, on the other hand, there may be patients who have a more serious arrhythmia and have no idea what's going on. But if you feel something for a second here and there and that's it and no other symptoms, it's usually benign. PVCs can actually be more serious if they're very frequent and if there are certain heart conditions. But a low number of PVCs is very common. Pretty much everybody has them once in a while, and most people don't even feel them.

Host: All right. As you say, some of these things like SVT, PVCs, maybe folks essentially are, in many cases, asymptomatic, right? So then, maybe what are some of those common symptoms that patients do report with arrhythmias, and are there cases where someone just might not feel anything at all? Is that possible?

Dr. Tina Sichrovsky: Yeah. So, the most common symptom that I hear about is palpitations. So, palpitations means the patient is aware of their heartbeat. It's either pounding, stronger than usually. It can be irregular or very fast. So, that's the most common symptom. But there are other symptoms that are also quite frequent, like fatigue, decreased energy. Some people can't exercise, shortness of breath. Some people get dizzy.

PVCs specifically can cause very strange symptoms. They can cause anxiety and weakness, and often patients get misdiagnosed and get put on Xanax or something until they come to us. So, it's very variable what patients feel, and it's not always indicative how serious their arrhythmia really is.

Host: So when it comes to AFib specifically, why is it so important, Doctor, that, if possible and when possible, diagnose early, manage it early, get on this as early as we can?

Dr. Tina Sichrovsky: So, multiple reasons. The main reason is that AFib has potential serious complications. The most common serious complication is a stroke. And then, congestive heart failure is also one of the potential complications. So when patients have those symptoms, it's important to present to their cardiologist or to us early. So if needed, we can start a blood thinner or slow down their heart rate so they don't get one of those complications.

But it's also important in terms of treating them because the cure rate is much higher if you treat those conditions early compared to late. Especially atrial fibrillation, when you're in it, the heart gets used to it. And the longer you're in it, the more used to it the heart gets. It's called remodeling when the muscle fibers in the upper chamber, which are usually parallel, start to get disorganized. And the longer you're in it, the more this remodeling takes place, and it begets more AFib. So, it's like this snowball effect.

Host: Yeah, I see what you mean, yeah.

Dr. Tina Sichrovsky: The more likely you're going to be in it. And treatment options, especially ablation that can potentially cure AFib, the success rate will go down if you're in a more advanced stage of the disease. So, we prefer to see people early even after one episode so we can intervene early and the outcome is much better.

Host: Yeah. Yeah, I see what you mean. And let do that. Let's see, you mentioned treatment options and ablation there. So, let's talk about the current treatment options for arrhythmias and how do you decide what's right for each patient?

Dr. Tina Sichrovsky: So, it really depends on the arrhythmia, obviously. For slow arrhythmias, people get pacemakers. But if you talk about AFib or SVT, in general, there are usually three ways we can deal with this. One way is just to observe, see if it progresses, and maybe treat some risk factors. Atrial fibrillation is very dependent on treating the whole patient, not just the heart. Obesity is a trigger. Alcohol is a trigger. Sleep apnea is a trigger. So, there are a lot of things that can make AFib come back. And if you don't treat those other factors, you may not be successful fixing AFib. So, that's one important aspect.

Then, the second category is medication. So, there are medications that can suppress rhythm problems. They're called antiarrhythmic drugs. Or medications that just slow it down. And that's called rate control. They just slow down arrhythmia. They don't convert, but they make it less serious and less dangerous.

And then, the third way of treating this is with a procedure, mainly catheter ablation, which can cure those arrhythmias, AFib, SVT, PVCs. Many of those are eligible for ablation, and that's the only potential cure. All the other things are just suppressive therapy, basically.

Host: Yeah, suppressive, just kind of managing, managing the symptoms, living with the symptoms. So then, Doctor, at what point should we seek medical evaluation or monitoring for a suspected arrhythmia? And what does the monitoring typically involve? What does that look like?

Dr. Tina Sichrovsky: So, I mean, if you have frequent symptoms that last longer than like half hour or especially if it lasts a couple of hours, if you have more severe symptoms, I would definitely seek attention either with a cardiologist or directly with us with an electrophysiologist. The way we monitor arrhythmias is many people actually come with a diagnosis. They have a smartwatch and get notified that they have AFib and they come to us and it's pretty accurate. So, a smartwatch is an option. We usually apply an external monitor for two weeks just to catch everything that's going on for the first two weeks if you're not sure what the arrhythmia is or how prevalent it is.

And then, also, implantable monitors like a loop recorder. It's a small computer chip that we put under the skin overlying the heart that records everything. That's the most comprehensive way of treating patients. Again, it depends what the situation is, if this is warranted or not.

Host: Right. Yeah. So, many of us have smartwatches and these smartphones and things. So, you know, as you say, early diagnosis is key. You're treating as soon as possible. It possibly can be cured depending on the patient with ablation. So, lots of good information today. And Doctor, I like to do a little myth-busting when possible.

So just wondering, like what are some misconceptions you commonly hear about heart rhythm disorders? And maybe just to wrap up here, a key message you want listeners to take away from this when it comes to recognizing and managing arrhythmias.

Dr. Tina Sichrovsky: So, I think many patients think that if they have no symptoms, they're fine. And that unfortunately is not always true, especially for atrial fibrillation. And often they're reluctant to do anything because they have no symptoms, but that doesn't mean they're not at risk for a stroke or other complications. So, that's one of the misconceptions.

And the opposite is true also. Patients who are very sensitive and in tune with their body, they may get very nervous if they have one or two PVCs every few hours. There's really not much we would do about it, but it really affects them. So, we often have to like reassure those patients and educate the other patients who may think they don't need anything done.

And another frequent misconception is that when I do recommend an ablation, especially for AFib, since AFib is so common, everybody knows somebody who has AFib.

Host: Of course.

Dr. Tina Sichrovsky: Then, I always hear that, "Oh, my friend had an ablation, it didn't work, so why should I do it?" And it depends what the situation is. Maybe that patient was in AFib for five years and the success rate is lower or they're very obese or they drink a lot of alcohol. So, you can't really compare one patient to another. And just because somebody has a bad experience doesn't mean that's the case. Actually, the success rate is very high now for ablations, usually in the 90% range if we treat risk factors and pick the right patient.

Host: Right.

Dr. Tina Sichrovsky: And maybe one thing that's important is alcohol is really bad for arrhythmias, especially for AFib. So, less is better.

Host: That's great. Yeah, I hear that a lot from experts. It used to be alcohol in moderation. Now, most experts say just skip the alcohol. And I mean, it's probably easier said than done. But especially when it comes to arrhythmias, as you say, ablation is effective 90% perhaps. But also, we have to treat the risk factors, smoking, drinking, all those sort of things that are bad for us, right?

Dr. Tina Sichrovsky: Right. And drinking, it also causes sleeping problems. It can make sleep apnea worse. It also causes cancer. So, we recommend no more than three drinks a week. But if you can stop completely, it's probably the safest.

Host: That's right, yeah. Well, listen, I appreciate your time and your expertise today. Really helpful, a little myth-busting, all good stuff. Thank you so much.

Dr. Tina Sichrovsky: You're welcome.

Host: And we hope today's conversation has helped you to better understand heart rhythm disorders and when they may require medical attention. While some irregular heartbeats can be harmless, others may signal a condition that deserves evaluation and treatment. If you have concerns about palpitations, an irregular heartbeat, or other symptoms, talk with your healthcare provider.

To learn more about heart rhythm disorders and the services available at Valley, visit valleyhealth.com/heart. And as always, be sure to subscribe, share this episode, and take good care.