Sometimes, the rhythm of your heart is trying to tell you something is wrong, and it may be speaking to you in a language different from the “classic” symptoms like palpitations, shortness of breath, dizziness, or chest discomfort.
“Some people only feel generalized anxiousness, fatigue, or intolerance to exertion,” said Dr. Eric Good, a cardiologist and electrophysiologist (heart rhythm specialist) at McLaren Greater Lansing. “However, for many patients, there are no symptoms at all. That’s where home monitoring technologies, such as smartwatches, automated blood pressure cuffs, oxygen saturation monitors, and mobile EKG recorders, can prove especially helpful. I can’t tell you how many times I’ve seen someone who had a serious rhythm issue, and their Apple Watch was how they first were made aware of it.”
What is the most common rhythm issue?
“The landscape of cardiac arrhythmias that I treat is broad: Twenty years ago, when atrial fibrillation (AFib) ablation was in its infancy, the relative proportion of patients I was seeing for atrial fibrillation was lower than for other rhythm issues,” says Dr. Good. “Now the number of patient referrals for atrial fibrillation, or its related arrhythmias, is much, much higher— it’s almost at epidemic levels.”
The reason for the surge in the number of patients with atrial fibrillation may be due to more public awareness and better monitoring and screening technologies. However, Dr. Good also sees a lot of patients who were diagnosed during a routine physical by their primary care provider.
“Not infrequently, these patients are fast-tracked to see me and get an ablation before things get too far out of hand, or should I say, too far out of rhythm,” said Dr. Good.
What are the treatment options for atrial fibrillation?
“I tailor treatment options for AFib to the unique goals and clinical circumstances of each patient. There are often several paths to rhythm health, so getting patients informed and educated about the type of AFib they have is paramount,” said Dr. Good.
In general, when you meet with Dr. Good, discussions tend to focus on two main themes: first, dealing with the arrhythmia itself; and second, dealing with the patient’s risk for forming clots and risk of stroke. These are closely related but not necessarily tied to a particular therapeutic option.
For example, discussions with someone who has absolutely no symptoms might focus on treatments that make sure they are protected from strokes and bleeding risk. So, placing a device in the heart that prevents blood clots from forming, such as a left atrial appendage closure device, might be their best option.
In contrast, someone who feels much better in a normal rhythm might be best treated initially by utilizing medications and cardioversion, a procedure that “reboots” the heart rhythm just like a smartphone or computer.
“For an increasing number of people, however, catheter ablation has become the treatment path of choice, because it aims to cure AFib, making drugs and blood thinners eventually unnecessary,” says Dr. Good. “Catheter ablation is a minimally invasive procedure, performed with the aid of exquisitely sensitive and sophisticated electronic and computer systems, where the actual electrical currents coursing through the heart are mapped in the virtual reality space of a real-time, 3-D computer rendering of the heart that guides catheter navigation with pinpoint accuracy. Different forms of energy can then be applied in very specific ways to precisely block the abnormal electrical signals that disrupt the patient’s regular rhythm.”
Are there things that patients can do themselves to help their atrial fibrillation?
“Modifying risk before even developing AFib is perhaps the single most important thing people can do,” said Dr. Good. “Fortunately, most of these interventions have cascading health benefits, since they also reduce risks of heart attack, stroke, and other major medical problems, not to mention make people feel better in general. Things like weight loss, exercise, aggressive control of blood pressure and blood sugar, as well as smoking cessation, are all things people can do to improve their heart health.”
“Sleep quality also is often overlooked by people,” said Dr. Good. “We spend roughly a third of our lives asleep and, as it turns out, problems with sleep can be devastating to health, wellbeing, and particularly AFib. So important in fact is the impact that we help arrange screening for and treatment of sleep apnea in all patients with atrial fibrillation. Studies have shown that if we focus only on treating just AFib and ignore treating significant sleep apnea, it’s like using a bucket to bail water out of a sinking boat that has a giant hole in the bottom; it’s ultimately just not going to work: Better to plug the hole and then start bailing water.”
What about nontraditional risk factors and treatments for atrial fibrillation?
“Some exciting investigations into nontraditional risk factors and treatments for AFib are now being done,” said Dr. Good. “This moves the paradigm from a ‘one-size fits-all’ generalized box of treatment recommendations to a more precise, holistic approach, which says: okay, what is the unique clinical profile of this person and how do we tailor treatment precisely for them?”
It might surprise you that things like working the night shift, an imbalance in your gut bacteria, or even gout aren’t just isolated issues. They could all be linked to an increased risk of developing AFib. It's also interesting to note that simple things like a lack of certain vitamins or electrolytes might also play a role.
“Each of dozens of factors that might influence AFib in one individual might not in another,” said Dr. Good. “In other words, your AFib is not your neighbor’s or friends’ AFib, and you deserve the treatment that is right for you.”
If you, or someone you know, have AFib (or another rhythm disorder), remember, you aren’t alone. The rhythm experts at McLaren Greater Lansing are highly trained, have decades of experience, and are here to help. Call for questions or to schedule an appointment with Dr. Good.
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