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Caring for Your Heart: Treating A-Fib and Arrhythmias

February 9, 2018 11:00 AM with Dr. Mark Metzl

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Atrial fibrillation is one of the most common heart conditions today. Millions experience irregular heartbeats (also known as arrhythmias), which can appear as a skipping heartbeat, an increased heartbeat or through symptoms like nausea, difficulty breathing and lightheadedness. It’s not always easy to catch, and some don’t even experience symptoms, but the impacts can be long-lasting. Get some expert information on a-fib from Dr. Mark Metzl, NorthShore Cardiologist. He will be taking your questions about a-fib and arrhythmias, and sharing his insight on current diagnosis techniques and treatments for these heart conditions.

Kathryn (Moderator) - 11:00 AM:
Our chat on a-fib and arrhythmias is now open. You can submit questions at any time during this chat.

Dr. Mark Metzl (NorthShore) - 11:01 AM:
Thank you for coming to our online chat today on atrial fibrillation!

  G - 11:02 AM:
Are there symptoms of a-fib that the average person would be able to recognize?
Dr. Mark Metzl (NorthShore)
Thanks for asking. I think all a-fib symptoms are recognizable. Interestingly, a minority of patients have palpitations. Much more commonly, fatigue and not feeling our best are the presenting symptoms.

Dr. Mark Metzl (NorthShore) - 11:04 AM:
Greater than 80% of patients can tell the difference symptomatically between normal rhythm and atrial fibrillation.

  Barbara (New Madrid, MO) - 11:04 AM:
I feel like I have a fluttering heartbeat all the time. Does that mean I have a-fib or could it be something else? What could I do next?
Dr. Mark Metzl (NorthShore)
If it is really constant, a simple ECG would give us the answer. If it comes and goes, an outpatient heart monitor would be best. Do make an appointment with your doctor.

  Linda (Gary, IN) - 11:06 AM:
Does a-fib ever go away? How effective are ablations?
Dr. Mark Metzl (NorthShore)
I am not a believer that we ever "cure" atrial fibrillation; rather, we are able to slow the progression of the disease and put if off for (sometimes many) years. The success of an ablation depends on many factors: how long the patient has had a-fib, contributing factors like drinking, weight, sleep apnea and others. For most of our patients, we quote a success rate of about 70-80%.

  Elle (Northbrook, IL) - 11:10 AM:
What is the difference between a-fib and a heart attack?
Dr. Mark Metzl (NorthShore)

A heart attack is when a blood vessel that supplies blood to the heart (coronary artery) is blocked, resulting in a sudden loss of blood supply to the heart muscle. The classic symptom of a heart attack is chest pain radiating to the left shoulder, as we often see on TV. This is a "plumbing" issue.

Atrial fibrillation is when the top chambers of the heart (the atria) quiver, resulting in irregular and often fast heartbeats. This is an "electrical" issue.

Atrial fibrillation raises the risk of stroke and heart failure (weakening of the heart muscle), and has the symptom of not feeling our best.

  Jordan (Glenview, IL) - 11:13 AM:
How do you decide when to use anti-arrhythmic medications vs. procedures to help reduce symptomatic atrial fibrillation?
Dr. Mark Metzl (NorthShore)
Great question! We often have the option of an anti-arrhythmic medication. However; some of these medicines are not well-tolerated, have significant side effects, are not effective or our patients do not want to take them. We discuss both medical and procedural options at every visit.

  Link (Glenview, IL) - 11:17 AM:
Does NorthShore sponsor any first aid programs that talk about what to do with something like arrhythmias?
Dr. Mark Metzl (NorthShore)

We have many educational programs at Northshore that center around arrhythmia, like this one :).

You can find a list of our upcoming cardiac care events here.

  Elizabeth (Chicago, IL) - 11:21 AM:
Hello, I was diagnosed with mitral valve prolapse years ago when I took part in a research study of triathletes. They said it wasn't serious, but I don't exercise cardio-wise as much as I did then (I do yoga 3 x per week). My dad died of heart disease. My aunt and his sister also had MVP. Is there a test my primary care physician can administer during my next physical exam? Should I give up meat? Beer? Cheese? I cook my own meals and do eat vegetables and fruits daily. Thank you.
Dr. Mark Metzl (NorthShore)

I would recommend an echocardiogram (an ultrasound of the heart) to evaluate the mitral valve.

We have many excellent physicians here at the Cardiovascular Institute at Northshore that your can see to discuss healthy eating to reduce your risk of heart disease.

There is a great study on yoga reducing episodes of atrial fibrillation. So, keep it up and keep moving! :)

  Grace (Skokie, IL) - 11:27 AM:
Over time, will arrhythmia/a-fib weaken the heart?
Dr. Mark Metzl (NorthShore)
Atrial fibrillation can weaken the heart, both from its fast rate and from its irregularity. A study published in the New England Journal of Medicine this week showed that an ablation procedure in patients with atrial fibrillation and weakened heart muscles improves long-term survival.

  Patty (Chicago, IL) - 11:29 AM:
What are ways to combat PVCs naturally? Why do they occur after menopause, and will they ever stop? Thank you.
Dr. Mark Metzl (NorthShore)

Developing symptomatic PVCs at certain times in our lives can point to an underlying cause. Stress, hormonal changes, alcohol and caffeine can all contribute to PVCs. Medications, such as beta-blockers, anti-arrhythmic medications and ablation are all options when we run out of "natural" remedies.

Interestingly, there are many "natural" contributors to a-fib as well, such as alcohol, high blood pressure, sleep apnea, stress, obesity and lack of excercise.

  Patrick (Schaumburg, IL) - 11:34 AM:
What is the difference between a-fib and occasional (few times a year), short palpitations that last a few seconds?
Dr. Mark Metzl (NorthShore)
Palpitations that last a few seconds can be many things, including atrial fibrillation. There are many excellent options for diagnosing intermittent rhythm abnormalities, including implantable monitors (about the size of a paper clip), a flat attachment for a smartphone and even a band for an iWatch.

  Debbie (Des Plaines, IL) - 11:37 AM:
What are the new treatments/trials being done for a-fib for both new heart disease patients and those with existing heart disease? Does it differ for those with congenital heart disease? Thank you.
Dr. Mark Metzl (NorthShore)

We are currently enrolling patients in several trials for a-fib. Over the last year, we have seen a few major advancements in ablation for a-fib. We are using cryo-ablation in patients to isolate the pulmonary veins. We are using advanced mapping systems to better understand the substrate of a-fib. We are using a new "Hybrid" approach for some patients, ablating both the inside and outside of the left atrium.

As far as congenital heart disease, differences depend on the specific condition. We are lucky at Northshore to have experts in congenital heart disease that can address those specifics.

  Teresa (Chicago, IL) - 11:44 AM:
My 49 year old husband was just diagnosed with a-fib. He is taking Eliquis and Metoprolol. He has had a few episodes since he was diagnosed a month ago. Are episodes after treatment common?
Dr. Mark Metzl (NorthShore)


Your husband is being treated with a rate-control medication, Metoprolol. The goal of that medication is not to prevent the episodes, but to make the rate of them slow enough that it does not bother him as much.

If he remains bothered, a rhythm control strategy might be a better solution.

The Eliquis is a blood thinner. The goal of that medication is to lower the risk of stroke.

  Kathy (Chicago, IL) - 11:46 AM:
What causes a-fib?
Dr. Mark Metzl (NorthShore)
There are many contributors to atrial fibrillation. Most of the contributors raise the pressure in the heart. Some of the causes can be treated, such as high blood pressure, sleep apnea, alcohol, stress, thyroid disease, lung disease and heart valve abnormalities. Other causes are out of our control, like simply getting older.

  Angela (Chicago, IL) - 11:48 AM:
Dr. Metzl, I've been experiencing a fast heartbeat for the last couple of years. It comes and goes every 4 to 6 months and lasts for 3-4 hours and always at night, never during the day. Heart rate is way over 100. I was given medication from a cardiologist to take as needed, and they really help in stopping the palpitations. The cause of these episodes was never determined, and I experience no other symptoms. There is a strong history of heart disease in my family on my father's side. Could this be a-fib or something else? What can I do?
Dr. Mark Metzl (NorthShore)
I am glad that the medication is helping, but it would be nice to know what is really going on. The episodes could be atrial fibrillation or another heart rhythm abnormality. The intermittent nature of your episodes does make a diagnosis more difficult. I think an implantable monitor or a smartphone monitor would be a great option for you.

  Debbie (Des Plaines, IL) - 11:52 AM:
After an ablation, is there any way or anything that can be done to prevent the lesions/arrhythmia from coming back? Also, have your patients mentioned to you that after feeling their heart race, they cough as if to catch their breath? Is this a sign/symptom of a-fib?
Dr. Mark Metzl (NorthShore)

We take a comprehensive approach to treating our patients with atrial fibrillation. In addition to an ablation, there are often many complementary issues to address to reduce the risk of recurrence.

Shortness of breath is a common symptom of atrial fibrillation.

  Joe (Buffalo Grove, IL) - 11:54 AM:
Are arrhythmias something to look out for in student athletes? Is this kind of condition common among athletic people?
Dr. Mark Metzl (NorthShore)

We have a great interest in your question here at Northshore.

True endurance athletes do actually have an increased risk of developing atrial fibrillation. Though, I would not want our patients to use that fact as an excuse to avoid exercise, which is always good for you.

There are several ECG screening programs in the area that evaluate student athletes for an increased risk of arrhythmia. We are not typically looking for a-fib on these ECGs, but rather signs of other issues (such as long QT syndrome and hypertrophic cardiomyopathy).

Kathryn (Moderator) - 12:00 PM:

This will be the end of our chat. Thank you for all of your questions!

For more information about atrial fibrillation and arrhythmias, or to speak to a specialist like Dr. Metzl, please contact the NorthShore Cardiovascular Institute


This chat has ended.

Thank you very much for your participation.