- Hey everyone, I'm Dr. Morales,
and I'm here at the Heart Rhythm Society Conference.
I'm here with Dr. Firas Zahwe who's an electrophysiologist
based off of near Dearborn, Michigan,
and we're gonna talk about patients who have
congestive heart failure and atrial fibrillation.
Dr. Zahwe, thank you for being here.
I really appreciate you
taking the time during your - Thank you.
- conference to come and have
an interview with us. - Thank you very much.
- Thank you. - So patients who have
atrial fibrillation as well as congestive heart failure
can be a very difficult patient population to manage.
How do you approach that?
When you first meet a patient who has a-fib
and congestive heart failure,
what are some of the first steps that you try to do
when you meet a patient? - All right.
Those two diseases are pretty common to come together.
We see a lot of patient with congestive heart failure
will develop atrial fibrillation and vice versa.
First time that I meet the patient I usually try to
identify which comes first,
if the patient has congestive heart failure first
and they'll develop atrial fibrillation,
or if the have atrial fibrillation
and the congestive heart failure.
Then we try to talk about their symptoms,
what their concern, address those,
and try to educate them about the disease,
about the combination and how can we handle it.
Sometimes there is no cure for atrial fibrillation,
but for most probably we're able to manage it
and help patient with their symptoms.
I'll talk about what the risk factors,
how we can adjust it, how we can modify it,
how we can help them with that.
We talk about all study in terms of medication,
in terms of blood thinner as well.
- Right. - And we offer most
of our patients and ablation strategy
which has been shown that to improve the survival,
they live better, longer and they get less symptoms
from atrial fibrillation.
- And that's actually been
a fairly significant change lately.
There's been some more articles.
They're showing that people who have heart failure
and you treat their a-fib more aggressively,
they're out of the hospital and they live longer.
Has any of this newer data changed
how you approach a patient?
Or would you say it's been the same way this whole time?
Or you think it's actually changed
some of how you influence it.
- No, it has changed our strategy.
Typically, those patient has little harder to treat
and we thought ablation may not help them,
but with all the new studies and new research
showed that treating them aggressively,
early enough, would help them with their symptoms,
with their survival and even with
their congestive heart failure,
especially if the atrial fibrillation is
causing the congestive heart failure.
When we put them back in normal rhythm
and see a normal rhythm,
they have a really good chance of getting back and
recovering from the congestive heart failure
and have normal heart function for the rest of their life.
- And I agree with that obviously rhythm control
is very important for people
who have congestive heart failure,
but as far as optimizing somebody,
getting them ready for an ablation procedure,
do you have methods you usually do?
Do you try to cardiovert somebody first
and then do an ablation later on?
Is there some strategy you get to kinda optimize
that patient with congestive heart failure?
- Yeah, sometimes we try to optimize their medication first,
make sure they are not having a lot of fluid
in their body before ablation,
make sure they have been on a quick duration
of a blood thinner as well.
Depends on their symptoms, if they are urgent,
we do a cardioversion.
We wait a few weeks and then we do full ablation.
Sometimes if they are symptom-stable,
then can just schedule them as an out-patient.
- What about the ablation procedure itself.
When somebody has congestive heart failure,
how much does it factor in what you're gonna do
during the ablation procedure?
Do you counsel people more, say,
"Well, I have to kind of be minimalistic and then
"I might have to do more than one procedure
"because of your congestive heart failure."
Does your procedure approach change
when somebody has congestive heart failure?
- It does, because with the patient with
congestive heart failure, I understand that they have
a more aggressive disease.
So I have to do a little bit more
than what I do in patient with a normal heart function.
- Yeah. - I try to be aggressive
more with ablation, cover all the areas,
so they don't have to come back
for a re-do ablation.
And then we try to optimize their medication afterwards
so they can stay in normal rhythm, as well.
- Do you find that it's harder for people
with congestive heart failure to recover
after an ablation procedure?
Think it's a longer recovery process
compared to somebody who doesn't?
- I don't notice that because most of our procedure,
right now, are short.
Usually we do the ablation procedure
within two hours, two hours and a half,
even with the difficult cases.
So we shorten the duration of the procedure.
We optimize their blood thinner
and their water pill before and after procedure.
Typically, I keep them overnight.
They go home next-day without an issue.
- Now we touched about it a little bit at the beginning,
but for people out there who have a-fib
and they have congestive heart failure,
there are many people who are just being managed
with medications and they may not even be aware
that there are other options as well.
So what would you say to those types of patients?
That really, that approach hasn't been given to them,
or their doctor said, you know, nothing's gonna work.
How would you, I guess, recommend to people
to kinda seek other options for them?
- Yeah, I recommend to them to seek
a formal consultation from electrophysiology
to think about all their options
and to understand it and consider it.
I see some patient, they don't have an option of ablation,
which I understand, but those are my (murmurs) patient.
We can have a lot of patient improve their symptoms,
have them live longer, live better life
and hopefully minimize all the effect
of their atrial fibrillation.
- And that's something that I've talked about plenty
in my website and on my articles, is that
I don't think patients are sent
to electrophysiologists enough.
There is so much devastating consequences of
a-fib with congestive heart failure,
and there's so many things that
electrophysiologists like yourself and myself
can do to help improve people's lifestyle and
keep them out of the hospital,
and potentially help them live longer.
And I think that getting that education out there,
getting the people to know that
the sooner you see an electrophysiologist,
the sooner you realize what options
you have to manage a-fib,
the better people do. - Absolutely.
- But Dr. Zahwe, go ahead, I'm sorry.
- You know, I can't agree anymore.
That's a really good point, a little (murmurs)
consideration for all the options.
And understand your options, I think
that's a word due - Yeah.
to the patient. - Yes.
Well Dr. Zahwe, I really appreciate you coming by,
taking a few minutes while your conference.
I'm really pleased that you're having it.
Thank you. - Thank you very much.