Welcome everyone.
My name is Steve Mizek,
and I'm the host of our live events
at Rush University Medical Center.
Today our guest is Dr. Parik Sharma,
the section chief of electrophysiology at Rush
and an associate professor at Rush Medical College.
Thank you so much for joining us today.
Thank you, Steven and thanks for having me.
Absolutely.
To get things started,
tell us a little bit about your roles here at Rush.
So I'm a cardiac electrophysiologist.
In simple terms, I'm a heart rhythm specialist
or in more lay terms, I'm the electrician of the heart.
So we are,
we are physicians or cardiologists
that specialize in rhythm management.
So patients that deal with various slow heart rhythms,
or fast abnormal rhythms of the heart,
patients that need pacemakers, defibrillators,
or patients that need procedures,
such as ablation procedures,
to fix some of these abnormal rhythms.
Gotcha.
And you also are a professor as well,
and what do you teach?
So, so I'm an associate professor,
so we are responsible for the education
for cardiology fellows or trainees, residents.
We have fellows under us that are already cardiologists,
that are wanting to become specialists in this space.
And so they're called electrophysiology fellows.
So we are responsible for the education
for a lot of those trainees.
Gotcha.
And so September is Atrial Fibrillation Awareness month,
and that's when we want to bring more attention to this
health problem that affects millions of Americans every
year.
Can you briefly describe what atrial fibrillation or AFib is
and some of the symptoms maybe?
Yeah. So like you highlighted,
I think atrial fibrillation is one of the most common
rhythm disturbances that affects Americans.
Close to about four to five million Americans suffer
from atrial fibrillation at the present time,
based on reported data.
And projections are that by the year 2030,
over 12 million Americans will be suffering
from this rhythm disorder.
So atrial fibrillation, as the term implies,
the top chambers of the heart are called the atria.
So when these top chambers of the heart go into an abnormal,
chaotic, disorganized rhythm or fibrillation,
it's referred to as atrial fibrillation or AFib,
and this is a condition in which typically the top chambers
of the heart are beating at about 60 to a hundred
beats per minute, and that's what drives our heart rate.
When the cells in the top chambers of the heart,
get abnormally, irritable,
and get disorganized in their activity,
they go into put these chambers into atrial fibrillation and
then these chambers are beating
on an average rate of about 500 to 600 beats per minute.
Oh gosh.
As opposed as opposed to 60 to a hundred beats per minute.
So that's, that's the abnormal rhythm.
And this rapid beating of the top chambers
then tries to drive the beating of the bottom chambers,
which are the main pumping chambers of the heart.
And that's why patients can have heart rates that can be
extremely fast, a hundred and fifty,
a hundred and sixty, a hundred eighty beats per minute,
depending on how quickly these electrical impulses
can make it from the top to the bottom chambers.
And how does it affect the body when you're experiencing
atrial fibrillation?
So as you can imagine, the,
the abnormal beating of the top chambers at the heart
does make the functioning of the heart quite inefficient.
Typically with each heartbeat, the top chambers squeeze
and pump blood from the top to the bottom chambers.
When the top chambers are beating at about
500 to 600 beats per minute in atrial fibrillation,
they're essentially not doing that pumping function
and squeezing blood to the bottom chambers.
That makes the functioning of the heart
relatively inefficient,
and that then produces a variety of symptoms.
If the patient has a very rapid heart rate,
they can experience palpitations.
Most patients, particularly older individuals,
tend to experience fatigue.
They feel like their days, they don't have as much energy
and cannot do as much.
Lack of the ability to exercise or exert yourself,
or exercise intolerance as we call it.
And some patients might experience Dyspnea,
or short shortness of breath with exertion as well.
So, so the lack of the efficient functioning
of the heart itself translates into a lot of these symptoms.
Right. That makes sense.
But how does someone develop AFib?
Cause that seems like something,
it seems so to sort of random,
but I imagine there's probably something
that leads up to that as well.
Yeah. So it is very well known in the past,
we used to consider atrial fibrillation
as the disease of the aging heart,
or the disease of the elderly.
And we try to shy away from using that term elderly
because it's all relative.
Right?
But it used to be considered
the disease of the aging heart.
This is a disease process that occurs given the stress
and strain the heart goes through over a number of years.
And so as, as the heart gets older,
it starts getting stiffer as well,
and as that happens, as it stiffens up,
the stress and strain on the top, chambers
continues to worsen with time.
And that increases the irritability of some of these cells
that then degenerate into atrial fibrillation.
I see.
But it's not just the age.
Age is a, is a risk factor that's non-modifiable,
which means we can't change it.
Right?
What we can change our other risk factors.
And these include high blood pressure or hypertension.
Patients that have high blood sugars or diabetes.
So better control of these conditions can help decrease
some of that stress and strain.
Other conditions, such as obesity
that causes a stress and strain on the heart.
There is another condition that is highly under appreciated
and that is referred to as obstructive sleep apnea.
And so we ensure that all of our patients
that have atrial fibrillation,
get evaluated with a sleep study for that.
And then other risk factors in general,
which are not heart-healthy,
which are smoking, alcoholism.
These are all of the risk factors that eventually increase
the stress and strain in the heart
and can lead to the development of atrial fibrillation
at a much younger age than what is considered traditional.
Right.
And so, how is AFib distinct from other arrhythmias?
Cause, cause I know that it's just one of several types.
Yeah.
There are multiple rhythm disturbances we deal with,
with regards to the heart,
and they can be slow rhythms
or Brady arrhythmias, as we refer to them.
And those are the ones that patients end up needing
pacemakers for.
They could be very rapid rhythms,
especially if they're coming from the bottom chambers of the
heart.
Those can be life-threatening
or can lead to a cardiac arrest,
and patients need defibrillators for those.
Atrial fibrillation, on the other hand is a disease process,
as opposed to a simple rhythm disturbance,
because it represents the stress and strain the
heart has been through over the years.
Right.
And it can, it can lead to many other comorbidities,
such as an increased risk of stroke.
Atrial fibrillation has been associated,
by at least about a four to five fold,
increased risk of stroke,
as compared to the general population
that does not have atrial fibrillation.
It can also lead to heart failure,
which is weakening of the heart muscle.
And certainly as we discuss the symptoms
that are associated with it,
these are not typical for most other rhythms
that we see with the heart.
Right. And so you,
we talked about some of the risk factors for AFib,
but are there some people who are more at risk just because
of, you know, their,
their race or their sex or other genetic factors?
Well, the, there are certain genetic predispositions
to atrial fibrillation, although they are rare.
The bigger things that we usually go looking for
are the risk factors that we discussed.
There is also some data that suggests that,
that female gender or women,
might be at a slightly higher risk for developing a stroke,
if they were to have atrial fibrillation,
as compared to their male counterparts.
I see.
Now people who have AFib, I wonder, you know,
we've talked a lot about comorbidities,
especially around COVID.
Are people who have AFib, are they more at risk for COVID
or more risk for it being more damaging
if they were to get it?
Yeah, I think that the contrary might be true.
So a lot of patients that develop COVID infections,
because of the inflammatory state,
can actually develop atrial fibrillation
or going into atrial fibrillation,
even if they don't have a history of this abnormal disease
process.
I see.
And the reason for that is because COVID results in a
extreme inflammatory surge throughout the body,
and the heart is not is,
is also part of that inflammatory reaction.
So published literature suggested anywhere between 15 to 40%
incidents of developing atrial fibrillation amongst patients
that develop us more extreme form of the COVID infection,
Wow.
And average being about 20%.
It happens.
So, that's more common.
On the flip side,
patients that have a history of atrial fibrillation,
like I said,
atrial fibrillation represents a stress
and strain on the heart.
So yes,
they are probably more likely to struggle a little bit if
they were to develop a severe form of the COVID infection,
but there's not a lot of data to suggest
that they have a higher mortality rate or death rate.
I see.
It's very interesting though,
that people are developing AFib as a result of COVID
because I feel like that's one of the things
that we're not hearing about.
There's obviously lots to talk about about COVID,
but that part doesn't come up so much.
Sure.
What are some of the ways that AFib is treated?
So I think the drive or for,
for the treatment of atrial fibrillation,
really depends on multiple factors.
Is the patient symptomatic?
Are they experiencing any of the symptoms we talked about?
Right.
And there is a subset of patients that don't really feel
atrial fibrillation at all,
which is what makes it really tricky to diagnose
and treat.
But in terms of what we do for management,
I think the first thing is to protect these individuals
from the risk of developing a stroke.
And so blood thinner is oftentimes
part of the medical regimen
to manage this disease condition.
And subsequent to that,
we have to do things to try and get them back to a normal
rhythm, which is a normal heart rhythm.
And that can be accomplished through medications referred to
as antirrhythmic drugs
or through minimally invasive procedures,
such as catheter-based ablation procedures,
or even surgical ablation procedures.
And that gets more involved as time goes on,
but there may be one therapy that suits one patient better
than the other, and so it's a,
it's a conversation back and forth between the
electrophysiologist and the participating cardiologists
with the patient to figure out,
what is the best treatment strategy for a given patient.
Right.
So what you said just now about how sometimes people don't
even realize they have AFib,
that seems like it'd be quite dangerous,
but what screenings are available to detect something like
this, that kind of goes a little under the radar?
Yeah. So that, that's the challenge.
You know, the,
one of the big things is that oftentimes the first
presenting symptom of atrial fibrillation is a stroke.
Oh gosh.
And so we do see patients from time to time,
in the hospital that come in with a stroke,
and then we find out that they have atrial fibrillation.
It's just that they never felt the symptoms.
And so, you know, I think there's,
there is no recommended screening tool.
Although, you know,
when patients go in to see their primary care physician
or their family doctors.
By them listening to their heart,
checking the heart rate, the pulse, all of these are, are,
are markers that will tell us whether things are normal
or in the normal range or is something off.
And does the patient need an ECG,
which would be the best way to diagnose atrial fibrillation.
The other thing that the other thing
that is also becoming really popular,
and I think a lot of the people that are tech savvy
are leaning towards it, are variable technologies.
Right.
So for example, the Apple Watch and there are many others,
the Samsung has its own watch.
And then there are other devices,
but these devices are smart enough to be able to pick up
abnormalities in the rhythm and suggest that
there may be a possibility
the patient has atrial fibrillation,
which you can then bring to the attention of your physician
and appropriately diagnose it early.
Yeah.
So there are more options.
I was just going to ask if technology is,
is aiding in this in a consumer way,
and it sounds like some of the devices
have gotten smart enough to do so.
Yeah. There are pros and cons to all of these,
but certainly I think that it is a step in the right
direction and will require further sophistication
as time goes on.
Certainly. So we've talked about this a little bit,
but generally speaking, what happens if AFib goes untreated?
Obviously you said that, you know,
stroke can lead you to realizing even have AFib,
but what happens if this just goes untreated?
Yeah, so, I think most individuals that
don't recognize they have atrial fibrillation,
first off don't get protected with a blood thinner.
And so that puts them at a higher risk of stroke
and that risk increases with increasing age as well.
The other issue is if the heart rate
with the atrial fibrillation is really rapid
for long periods of time,
it can start making the heart muscle weak
and they can develop signs and symptoms of heart failure,
which is their lungs start filling up with fluid,
their legs start swelling up.
Those are all consequences of long durations of uncontrolled
atrial fibrillation.
And that is another way patients present
in atrial fibrillation for the first time.
So it does lead to an increased morbidity,
which is poor quality of life overall.
And there may be some very preliminary data that suggests
that there could be an associated,
increased risk of mortality,
if this remains uncontrolled for a long period of time.
I see.
But on the con on the converse, if AFib is detected early,
can it be more effectively treated?
Absolutely. There's a,
there's a term we use in the medical literature that says
atrial fibrillation begets atrial fibrillation.
The more atrial fibrillation you have,
the more it is poorly controlled.
The more likely it is going to be more difficult to manage.
And I use the analogy of high blood pressure
or diabetes a lot with my patients, right?
So patients understand that.
If you come into your physician with a blood sugar of 150,
it might be easier to manage that,
than if you go into your family doctor
with a blood sugar of 500, right?
So the same concept applies to atrial fibrillation.
The longer it is, it is uncontrolled or poorly controlled,
the more difficult it becomes,
in the sense that you have to apply many more medical
or procedural therapies to get it under control
and prevent the disease process from
continuing to get worse with time.
Is there anything that people can do themselves,
to help themselves prevent AFib or, or things like it?
Yeah.
I think like we talked about a lot of the risk factors,
right?
I think it's very important to recognize that
obesity is a big risk factor for atrial fibrillation.
So ensuring diet and exercise,
which is important for heart health in general,
and the same applies to atrial fibrillation.
Minimizing or moderating intake of things like alcohol.
In fact, there is a lot of data that has emerged,
that any alcohol may be bad
for patients that have atrial fibrillation,
but I do ensure that we limit the amount of alcohol intake,
of smoking.
So all of these are the risk factors that patients
that we talked about earlier,
the patients should recognize and start working on,
that can decrease the rate at which the disease progresses
and can keep it better controlled
for a longer period of time
And maybe even prevent them from developing it
early on in the course of their life.
So as we approach the end of our session, I wonder,
is there anything else that you would really like our
viewers at home to know about atrial fibrillation
fibrillation that we haven't covered here?
Any other like facts that are, you know,
might be spurring people on to take more care about their
health and look more into this with their doctors?
Yeah. I, I think it's important to realize that, you know,
there,
there are various rhythm disorders that can cause symptoms.
The biggest challenge with this particular rhythm rhythm
disorder is that it can be asymptomatic.
So it's important to get, to see your physicians,
your cardiologists on a regular basis,
so they can diagnose this condition in a timely fashion
and prevent complications associated with it.
And the other piece that I really want to drive home is that
like we always say prevention is better than cure.
So realizing some of the risk factors associated
with this disease process, which are also overlapping
with general heart health prevention are really important.
And so paying more attention to a lot of those would help
you decrease the likelihood of developing some of these
abnormal rhythms.
Well, we have to wrap it up, but thank you, Dr.
Sharma so much for taking the time to chat with us today and
thanks to everyone out there for watching and participating.
Please visit rush.edu for more information
about our cardiology program
and all our great live events that are coming up.
Thanks again.
Thanks Steven. Thank you guys for watching.