Dr. Michael Spooner On Causes And Treatment Options For AFib

May 13, 2022

Atrial fibrillation, also known as AFib, is an irregular and oftentimes very rapid heart rhythm, and can commonly cause poor blood flow. AFib can lead to blood clots in the heart, and increase your risk of stroke, heart failure, and other heart-related complications.

In this podcast Dr. Michael Spooner explains what AFib is, what the symptoms are, how you can get diagnosed, and what the different treatment options are for it.

AFib may have no symptoms, but when symptoms do appear, they may include (but are not limited to):

*  Sensations of a fast, fluttering or pounding heartbeat (palpitations)
*  Chest pain
*  Shortness of breath
*  Fatigue
*  Dizziness
*  Lightheadedness
*  Inability or reduced ability to exercise

If you are experiencing any of these symptoms or have a family history of heart problems, you should consult your doctor and make an appointment with a cardiologist.

Transcript

Carol Gifford:

Welcome to Mason City Docs On Call, a podcast series with North Iowa specialists who educate us about how to stay healthy. I’m your host Carol Gifford.

Okay, so today’s topic on our Mason City Clinic Healthcare podcast is atrial fibrillation, better known as AFib, which is an irregular and oftentimes very rapid heart rhythm, which can lead to blood clots in the heart. So having AFib can increase your risk of stroke, heart failure, and other heart-related complications. And with us today is board-certified cardiologist and electrophysiologist at Mercy One North Iowa Heart Center at the Mason City Clinic, Dr. Michael Spooner, to help us understand more about AFib, how you can get diagnosed. And if you have it, what the different treatment options are for it. So welcome to the program, Dr. Spooner.

 

Michael Spooner, MD, Cardiologist:

Well, thank you. Thank you very much. It’s very nice to be here with you and to talk about something that’s obviously very important to us and something we can have, I think, a lot to offer patients.

 

Carol Gifford:

So, tell us what AFib is specifically. What causes the irregular and rapid heart rhythm in certain people? And you said it’s a very common condition, is that right?

 

Michael Spooner, MD, Cardiologist:

Yes, that’s very true. And being involved with, in my specialty, heart rhythm disorders or issues, it is the most common heart rhythm issue that we see, and that being atrial fibrillation. And so, it’s actually a very complex rhythm issue, even though it’s very common. And what we believe happens is that as the top part of the heart, which we call the atrium, as it starts to become stretched, there are cellular changes that start to occur. Because there’s little cells in there, we call fibroblast. They get activated. They start laying these little fibers down in the chamber, which then causes, these fibers then can allow these currents to start forming in that chamber. These very irregular currents that start happening. And at the same time, we have triggers inside the heart. So, areas that get activated causing a lot of electrical signals. Those coming primarily from something we call pulmonary, the pulmonary veins, which are these veins that drain blood from the lungs back into the heart.

So, when you combine those two things, you have an area that’s activating or sending all these signals, and then you have the ability for the chamber to send these signals kind of irregularly and chaotically throughout that upper chamber. You’re led to this problem where you get these very irregular heart rhythms. But you also, and they certainly, they have this tendency to want to go very rapid because of how it’s sort of sending all these signals as kind of a barrage into the heart. And it does become an issue for many patients, as you kind of already alluded to.

 

Carol Gifford:

So, who is at most risk of getting AFib? Is this something, it sounds like it develops over time, but are people more at risk for getting AFib or is there a way to sort of prevent it?

 

Michael Spooner, MD, Cardiologist:

Yeah, that’s great, great question. So, I would argue probably a good amount of AFib is what we would say is acquired. So, there are things that you can do to help prevent yourself from getting AFib, I would say. And then a certain amount of it is hereditary. We know probably about 30% of AFib does carry in families. But a lot of AFib, there’s so many things and factors that go into it, it’s sometimes hard for us to pinpoint which of the factors is the cause. However, I will tell you, there’s a few things we do know. First of all, we know sleep apnea. If you have sleep apnea, you snore a lot in your sleep. You’re very, you’re tired throughout the day. That can be a huge risk for AFib and treatment of that can be very helpful for AFib.

The second thing is weight. We certainly know that as people start putting on the pounds and things, that can start to lead to more risk of AFib. And taking some of those pounds off can also help prevent future AFib events.

We know alcohol has some impact, especially heavier alcohol use. So, we try to counsel our patients to try to avoid heavy alcohol as best we can. And then we also know all the other, a lot, basically most every other heart problem you can imagine as that, and even some lung problems as well, as that starts to cause the stretching that I was talking about earlier. Those problems in and of themselves can also be contributors to why a person would get AFib.

And then the last thing is along with that would be just high blood pressure. Certainly, having high blood pressure is going to lead to more stretching in the heart. And that also, those are some of the things I think we know are contributors. But sometimes we don’t always figure it out. Matter of fact, I was saying earlier, I did a practice in the Navy for a lot of years, and we took care of a lot of younger patients. And we actually found that sometimes if people were involved with very high endurance athletics, we saw a higher risk of AFib, but that’s a smaller subset. And most of what we’re dealing with are the things I mentioned earlier.

 

Carol Gifford:

So, it is important to get diagnosed properly, correct? Because the risk of having AFib, it sounds like it’s not life threatening in and of itself, but it increases your risk of stroke and other heart related issues. Right?

 

Michael Spooner, MD, Cardiologist:

Absolutely true, absolutely true. That’s one of the first things that I discuss with people when they come see me. Is I mention to them, first of all, take a deep breath because AFib in of itself is not necessarily a life threatening rhythm. And as long as we can address and treat it, it isn’t, it’s not the AFib that’s going to likely cause, to be life threatening or cause you problems.

But I will say two things and you are hinting upon them. One is that we do know that patients who have AFib have a higher risk of stroke. So, it is those patients, and we can, but we can address that. And we do that primarily through the use of blood thinning drugs. And we have a number of those available to us now that can help alleviate that risk of having a stroke.

And then of course the second issue is that if you have AFib, of course it can make some of the other heart problems that you might have worse. Because your heart’s now racing, it’s going faster than it should. And so we do want to try to address that. We want to try to get that heart rate down, so it isn’t just putting your heart under so much stress all of the time. And then of course I think one of the big issues with AFib too is how people feel. Certain people will notice it. They’ll be more out of breath. They may be feeling their heart racing all the time. We want to help those people because it can lead to a very poor quality of life. Now there are other people who don’t feel it at all and they aren’t really impacted much by the AFib, but we still want to diagnose it because of the reasons that you mentioned. We want to address those issues because there are some of them are rather concerning. And so we want to get on top of it.

 

Carol Gifford:

And so how do people get the proper diagnosis? Are they having some of these symptoms of being out of breath or fatigued or not feeling like themselves? And so they come in and see their primary care doctor and get referred into a cardiologist. How can people actually be almost advocates for themselves in terms of getting the diagnosis so they can get the proper treatment, to manage it is what it sounds like.

 

Michael Spooner, MD, Cardiologist:

Yes. So that’s very good. I mean, I think if you are feeling more out of breath, if you’re feeling your heart racing or skipping, these are things that you’ll want to see your primary care physician about. You’ll want to address them and say, “Hey, you know, I’m not myself, there’s something out of whack.” And then it is ultimately for them to listen to your heart, to check your pulse rate, and then do an EKG, an electrocardiogram. And that will tell us if you have AFib. Now these days we have another kind of tool out there. And I don’t advocate this for all of our patients, but some people who like to really be on top of everything with their body and their heart, there are a couple of now over the counter type of devices that a person can actually purchase or utilize.

And one of those, the new Apple watches actually, and I won’t just, Apple watch is one, there are other manufacturers who have similar type of devices. I believe the Fitbit type also has similar. But they will give you actually some diagnostics about whether you have AFib or not. There’s another product called Kardia. You’ll see that advertised sometimes. That also can be, sometimes people can, it will help diagnose AFib. Usually if that happens, we ask that they follow up with their physician and ultimately with us, and then we can look at some of those and sometimes help that diagnosis as well.

 

Carol Gifford:

So some of these devices you’re talking about, if someone has AFib, then they can sort of monitor their symptoms. And if something is going a little wrong or their heart is racing, then what? It will show it on this device and then they get their medication tweaked? How does that all work?

 

Michael Spooner, MD, Cardiologist:

Yeah, so that’s somewhat true. Again, I don’t advocate it for every person, every patient, not everyone’s the same. But I think, there’s certain people out there who like to kind to be on top of everything on their own.

 

Carol Gifford:

On top of it. Right.

 

Michael Spooner, MD, Cardiologist:

And then it’s us working with them closely on how we can do it. But I also just reinforce the idea that those devices aren’t always a hundred percent accurate.

 

Carol Gifford:

Right.

 

Michael Spooner, MD, Cardiologist:

And so it’s very important that they come to us so we can look at and say, “Hey, this looks right. This, I don’t think this is.” Or maybe you don’t have AFib, it’s just showing up as that because that’s important as well. But it is a tool and it’s like many things, a tool, but I think some, for most patients they don’t need that. They can come see us. We’ll diagnose it. We’ll be, we have our own monitoring that we can do if we need to. That they don’t, that would be covered under insurance that we can monitor them to make sure that we’re achieving the goals of treatment that we described.

 

Carol Gifford:

And so, right. And so it sounds like a lot of the treatment for AFib is through medications, correct? Are there surgeries that are recommended as well, or can you kind of list some of the options?

 

Michael Spooner, MD, Cardiologist:

Sure, absolutely. So, as we talk, we’ve talked a lot about medications already and obviously I talked about preventing strokes. That’s done through medications. We’ve talked about slowing the heart rate down. That’s typically done through medications. But ultimately for many patients, we want to try to do what we can to get you and keep you out of AFib. We want to treat that rhythm so that we can keep you out of AFib. And there’s a lot of exciting advancements in that area. And even as complex of a rhythm issue as it is, there are things that we can do. And there are actually medications that you can take. Some of those require you to come in the hospital to get started, but that can help keep you out of AFib.

Secondly, there’s a huge level of advancement in the area of procedures, as you’ve mentioned. One of those procedures is what we do here, and that being Dr. Koranne and myself, is what’s called catheter ablation. And in catheter ablation, we actually will put through, we have the patient under general anesthesia, we actually go in with catheters through a vein, so it’s all very minimally invasive. And we go in and we map out the inside of the heart and the atrial fibrillation. And then we make a series of what we call ablations, which are basically like small little burns is how I like to describe it, that can help disrupt the atrial fibrillation. And the studies will show for many that’s up to about 70% effective at preventing AFib. So it can be a very good strategy.

Another thing that we’ve started doing here, and we’re one of the, I believe one of the only sites in Iowa right now that’s doing this, is something called the Convergent Procedure. And this is a procedure that we do in joint with our cardiac surgeons. And it is another step that we can do for people who have very more progressed, their AFib is progressed to a greater degree. And what we do is the surgeons start by going from the outside of the heart through a minimally invasive approach. So they are using a laparoscopic technique to make burns from the outside of the heart. And then we, as the electrophysiologist, we come in after that and finish the procedure from the inside. And then that allows us to get at a little bit thicker amount of ablation there, so we can help control that AFib a little bit better for people who have more persistent or more difficult to control AFib.

So there are definitely options. And that is one of the parts of this podcast that I think I want to get across the most, is that there are definitely options available to patients. We just really need to, people should not hesitate. Come see us. There are things we can do to help them and help them feel better.

 

Carol Gifford:

It sounds like as soon as you can get the diagnosis, then there’s just all these different ways to treat people. And it’s not a one size fit all. There’s a lot of different ways that you can help people either through minimally invasive surgeries you just talked about. But a lot of the treatment just sounds like trying to keep people out of AFib and medication is a good option.

 

Michael Spooner, MD, Cardiologist:

Yep. I think I completely agree. And I always tell people that as well, is that there’s is no one size fits all for atrial fibrillation. There’s not a standard cookbook way to treat it. It is, that’s why we spend a lot of our time with patients with atrial fibrillation. Matter of fact, we do an AFib clinic every week on Wednesday. And it’s really, that’s why, it’s such an important clinic because we work together with patients individually to tailor a strategy or an approach that is going to work best for them. And because there is no one size fits all.

 

Carol Gifford:

Right. We’re all unique, right? We’re not cookie cutter. I have one last question. So it sounds like people can have some of these symptoms and they should go to their doctor and talk to them. But is it also some people, is there a situation where people wouldn’t have any symptoms at all? And so it’s just important to keep your annual appointments with your primary care physician or your cardiologist, just to check everything out. Because this would not be a good disease to not have any symptoms and then not know you have it.

 

Michael Spooner, MD, Cardiologist:

That’s absolutely true. And in that you’re absolutely correct. And probably one of the biggest risk factors for AFib is just age, as people get older.

 

Carol Gifford:

I see. Okay.

 

Michael Spooner, MD, Cardiologist:

So again, I think you’re right. I think keeping those appointments every year, I won’t tell you, I mean how many times have we seen in our practice patients go in for something like a routine, like a colonoscopy or even a dental appointment sometimes. And they’re told, “Hey, something’s irregular or fast about your heart.” And then you need to get that looked at because they’re right. They don’t feel any symptoms at all. And that’s often sometimes how it comes to light.

 

Carol Gifford:

Right. So keep those annual appointments.

 

Well, thank you, Dr. Spooner, is there anything else you’d like to say about AFib or about your practice at Mercy One?

 

Michael Spooner, MD, Cardiologist:

No, not really. I mean, it’s been a, it’s exciting field to be involved with because of the evolution of it and all the tools that we have. And so I feel like we have a lot to offer. It’s just a matter of getting in touch with people who have it and seeing what we can do to help them.

 

Carol Gifford:

Great. And welcome back to Iowa. We understand you have relocated back home again, after many years in the Navy.

 

Michael Spooner, MD, Cardiologist:

I did. Yeah. And it’s been wonderful. We’re very, my family and I honestly couldn’t be happier to be back in Iowa and be closer to family. And it’s been great so far out here in the Midwest.

 

Carol Gifford:

Thank you so much for being on the program and we will get this message out because it’s so important.

 

Michael Spooner, MD, Cardiologist:

Oh, perfect. Thank you so much.

 

Carol Gifford:

Okay. Thank you, Dr. Spooner.

 

Thank you for listening to Mason City Docs On Call. For more episodes, go to mcclinic.com/radio-podcast.