Episode Transcript
[00:00:05] Speaker A: Life is about the moments that make your heart tick. And we're here to keep it ticking strong. I'm Dr. Barry Bertolet, and this is We're All Heart, where we dive into the latest cardiac care with the experts who live it every day. From breakthrough procedures to the most cutting edge treatments, we're putting heart health front and center. We're All Heart is brought to you by North Mississippi Health Services in partnership with Cardiology Associates of North Mississippi. Let's get to it.
Hi there, I'm Dr. Barry Bertolet. And welcome back to another episode of We're All Heart. Today we're joined by cardiac electrophysiologist Dr. Jim Stone, who's going to talk to us today about arrhythmias. Thank you, Dr. Stone, for being here today. Why don't you introduce yourself to our audience?
[00:00:56] Speaker B: Thanks, Barry. I'm Jim Stone. I'm a. Like I said, I'm a cardiac electrophysiologist. I'm a native of northeast Mississippi, grew up in Middlewoman County. I've been in practice here for 26 years.
[00:01:08] Speaker A: So it's a big word. Electrophysiologist. What does that mean? What is that?
[00:01:12] Speaker B: I'm a cardiac electrician.
You know, we have cardiac plumbers and we have cardiac electricians. You're a plumber and I'm an electrician. And it takes a combination team effort to manage all that these days because each.
Each part of that has gotten so technical that we sub specialize in those areas.
[00:01:31] Speaker A: So Hart is sort of like a house where there may be plumbing and there may be electrical issues, and when there's short circuits and wires get crossed. You're the man.
[00:01:41] Speaker B: Absolutely. That's exactly right. And there are short circuits, there are shorts and breaks in the circuitry, and that's what we deal with.
[00:01:52] Speaker A: So what's a cardiac arrhythmia?
What is that?
[00:01:56] Speaker B: So a cardiac arrhythmia is just an irregular heartbeat. And cardiac arrhythmias can be fast heartbeats that are abnormal. They can be slow heart rates that are abnormal. And you've heard of tachycardia, you've heard of bradycardia. All those are just doctor terms, which means abnormal heartbeat that's either fast or slow or. Or irregular.
[00:02:20] Speaker A: Can those be dangerous for people to have?
[00:02:22] Speaker B: They can.
Especially depending on the type of tachycardia or the type of arrhythmia. Excuse me.
The ones that we fear the most in my line of work are ventricular fibrillation and ventricular tachycardia. And those are the catastrophic arrhythmias that we deal with. And everyone has had a family member that has died suddenly. And that's usually the mechanism. And there are warning signs or things that we can see that would lend someone to have a higher risk for that.
The most common arrhythmia we deal with is atrial fibrillation. And people hear about that a lot. And there's a lot of advertisements on television for various things, but those can cause your heart to weaken over a period of time. But the main problem with atrial fibrillation is stroke.
So they can be benign, they can be just a nuisance, but they can have serious consequences if not dealt with appropriately.
[00:03:29] Speaker A: So it could go anywhere from having nothing to having a stroke to even dying?
[00:03:34] Speaker B: Absolutely. Absolutely.
[00:03:35] Speaker A: And I guess a weak heart too, right?
[00:03:36] Speaker B: Absolutely.
[00:03:38] Speaker A: As a result of that. Wow. And then what if people have arrhythmias? A how do they know that they have them and what do they need to do?
[00:03:48] Speaker B: Well, it's a great question. And the answer to that has changed over the last few years especially they may not know it.
The proliferation of smart watches and wearables have really increase people's awareness of their cardiac rhythm. And you may have a smartwatch and wake up one morning and see that you were in a fib two hours last night and had no idea. And that could be consequential to your health. Some people feel the arrhythmia.
If you feel an irregular heartbeat, people say they feel their heart racing or they feel a hard heartbeat or a thump in their chest.
That can be a sign of arrhythmia too. So they can be asymptomatic.
And in the clinic we do things like put wearable monitors on people, that type thing. But we get a lot of patients that self diagnosed because they're wearing a smartwatch or something like that.
[00:04:47] Speaker A: So I've heard of this thing called a wake up stroke. So people go to bed, well, and then they wake up, and then they've had some catastrophic neurologic event. Is that related to these heart arrhythmias that could happen in the middle of the night?
[00:05:01] Speaker B: Yeah, it can be. And that's a complex picture. It can be related to atrial fibrillation for sure.
And you know, one ailment that we deal with a lot is obstructive sleep apnea, which can predispose people to afib as well. And so those can play play a role. But yes, asymptomatic afib can definitely cause a stroke. And unfortunately, Sometimes the first time we diagnose people with atrial fibrillation as they present with a stroke. So yes, they can be related.
[00:05:36] Speaker A: So if somebody has an arrhythmia, what are the options of trying to fix those for folks?
[00:05:42] Speaker B: Well, it depends on what type of arrhythmia, and some are curable.
There's an arrhythmia called SVT that is common in younger people and people are born with that.
That's due to a short circuit, as you mentioned earlier, where the electrical impulse gets trapped in a re entrance cycle. And we can do an ablation procedure and those people can be normal for the rest of their life and be cured.
And that's a really valuable part of my practice and a really satisfying part of my practice. You take a young child that's suffering from this and you can cure them.
The medications can, can be used for some of these arrhythmias.
Sometimes simply a beta blocker is enough and people do well with that and choose to continue to do that.
The, the dangerous arrhythmias, obviously sometimes we can't cure those, but we can protect people from the consequences.
If you have a weak heart and you tend to have a higher risk for these dangerous rhythms, you might need a defibrillator.
Atrial fibrillation nowadays has really undergone a paradigm shift in how we can deal with atrial fibrillation. And you've been in practice a long time, and you know how technological advances tend to kind of plateau for a few years at a time, and then you'll see one of these nice paradigm shifts. And we're having one of those with atrial fibrillation now due to some new technology called PFA technology, which has made AFIB ablation much safer.
It was already fairly safe, but it's much safer now. And our chances of cure and AFIB have really increased as well because of that.
[00:07:45] Speaker A: So you mentioned ablation. Sort of give us the easy definition of what an ablation is.
[00:07:52] Speaker B: Well, the simple definition is you're looking for abnormal cardiac tissue and you want to eliminate its adverse effects.
And for years we did radiofrequency ablation for everything. We still use radio frequency ablation for SVTs and VTS, but for afib, we've moved to something called pulse field ablation. And I have a catheter here.
This is the new type catheter that we use for afib.
It's really nice because you see it has multiple electrodes on it and we can change the configuration to customize the Shape and area that we ablate inside the heart.
And that's really improved our ability to take care of some of these more complex and persistent atrial fibrillations.
[00:08:52] Speaker A: When you opened it all the way up, it looked like a flower.
[00:08:55] Speaker B: That's exactly what we call it in the lab, Barry. This is a flower formation. And we can ablate.
We can ablate along the atrial wall here, and then we can actually change it to what we call a basket formation and go inside the veins to ablate those as well. So this has been a. This has been a really nice improvement in our technology.
And the difference is radio frequency uses heat to cauterize abnormal tissue, and that works very well. The problem is, sometimes it works too well, and you can damage adjacent tissue, collateral damage, so to speak.
And the problem with afib ablations are things like the esophagus or the phrenic nerve around that area, and you can damage those, and those can be catastrophic. So we spend a lot of time protecting those areas and avoiding those areas.
With this technology, it doesn't use heat. It uses an electrical impulse to render that abnormal tissue unable to conduct electrical signals, and it doesn't heat up surrounding tissue. So we no longer worry about esophageal fistulas, phrenic nerve damage, pulmonary vein stenosis, all those things which I lay awake at night worrying about. You know, I sleep a lot better now because they've taken those out of the equation.
But basically, to answer your question, an ablation is removal of abnormal tissue by going up through the leg into the heart with a catheter, like a heart catheterization.
Very similar. Very similar. Now you guys are on the outside of the heart, the epicardium with the coronary arteries. For the most part, we're on the inside a lot of the times.
And from the patient standpoint, it may seem like a heart cath. The procedures last a little bit longer. Sometimes they're under general anesthesia for the longer procedures, and sometimes they may have multiple catheters in their groin. But, yes, it's a percutaneous procedure.
We don't cut people open for that.
And it's an outpatient procedure, usually.
[00:11:17] Speaker A: So if you were a young person, if your options are medical therapy or an ablation that basically, say it takes an hour to do an ablation procedure, why would you ever choose medicines?
[00:11:31] Speaker B: Well, that's a good question. If you're a young person with svt, there's not a real good reason to choose medication, because if you look at the lifetime Risk of antirhythmic medication, it's probably higher than the lifetime risk of an ablation. All your risk is uploaded is up front with the ablation and the risks are very low. They're not zero, but nothing is.
Sometimes if you have other comorbidities, for instance, you wouldn't tolerate sedation very well because your lungs are an issue, or you have some other medical reason, you might choose to use medication. But for the most part, ablation has become the first line treatment for most of these.
In the past, for atrial fibrillation, one might have chosen medication because of some of the things that I talked about earlier. But I think that's different now. I think that now with our new technology, afib ablation has really moved to the forefront of the first line therapy.
[00:12:40] Speaker A: Yeah. To that point I know that the heart failure guidelines have changed so that if you're in atrial fibrillation, consideration for AFIB ablation become a first choice.
[00:12:50] Speaker B: That's right.
[00:12:51] Speaker A: As opposed to maybe a last choice.
[00:12:54] Speaker B: That's right. That's right.
[00:12:55] Speaker A: That's very interesting. Now we hear about this heart rhythm called atrial flutter. And then there's. You mentioned atrial fibrillation. A lot of times people think those are the same or cousin, kind of the same.
Is that the same thing? Are they different? Particularly from electrophysiology standpoint?
[00:13:14] Speaker B: Great question, and really interesting question.
Generally speaking, they're cousins.
Like you said, atrial flutter generally is a right atrial problem and atrial fibrillation generally is a left atrial problem. Now, there's some overlap. There's some atypical flutters from the left and some afibs from the right. But generally speaking, the characteristics of the right atrium tend to cause a longer circuit.
And so the atria, the top chambers of the heart, will beat at a fixed rate, for instance, 300 beats a minute.
Now, with atrial fibrillation, the characteristics of the left atrium are such that it doesn't have a fixed circuit, it has a chaotic circuit and it may beat at five or six hundred beats a minute.
But you bring up a really great question because that's in the forefront of our mind when we go to do an ablation. Do they have both? Because oftentimes they have both. Because this process of change in the heart because of age occurs in both atriums, it just manifests itself differently.
So if a 65 year old person came in with atrial flutter, I would go through his chart to see if there were any afib in there. Because they go together. Because I would fix both at the same time.
[00:14:45] Speaker A: So those are like two different spots in the heart?
[00:14:48] Speaker B: Oh, absolutely. Now, atrial flutter is very straightforward. I can do an atrial flutter ablation in 15 minutes because it's a defined circuit at everybody's circuit's the same. The ablation in everyone's the same. It's on the right side. So I'll do it with sedation. But you have to be careful because you don't want to go in and fix the flutter. And then when they get out to the floor, they're demonstrating their atrial fibrillation.
[00:15:11] Speaker A: Yeah, they could have both.
So we talked a little bit earlier about AFIB could cause heart failure.
And we can now go in with their PFA catheter and we can quote, cure the AFIB in a lot of people.
If I correct that afib, what happens to the heart failure?
[00:15:33] Speaker B: Well, it depends on the underlying etiology. There are some people that it appears that the atrial fibrillation itself is a major contributor to the congestive heart failure. I had a patient last night that was exactly that patient that a few months ago had a normal heart. He's been in AFIB at home and kind of didn't really know about it. And his heart was extremely weak. And we did an ablation on him last night and he's up walking around in the hospital. So in some people the atrial fibrillation is very important.
We used to ignore it back in the old days because we couldn't do that much about it. And we figured, ah, it's just some afib, we'll control their heart rate. And that was incorrect. We didn't have the information back then, but we see that in people now. If we're very aggressive and as I said earlier now we can be safely aggressive with ablation to control that afib, their heart failure oftentimes.
Now if they've had heart attacks and things like that, you know, you have to put that in perspective. But non ischemics like you say, people who haven't had heart attacks and people whose heart's weak and the coronaries look normal, those people can really improve with restoration of sinus rhythm or normal rhythm with an ablation.
[00:17:02] Speaker A: So quite interesting is that you may could fix their AFIB and their heart.
[00:17:06] Speaker B: Failure at the same time.
[00:17:08] Speaker A: Procedure. Right now I understand vtac, vfib, that's an emergency. Those people are going to present differently. But if somebody's at home and they got arrhythmias, their smartwatch says that they're in afib. How would that person get in touch with y'?
[00:17:23] Speaker B: All?
[00:17:23] Speaker A: How would they get evaluated?
[00:17:25] Speaker B: Well, the usual route is you talk to your primary care physician, and he can refer refer you to our clinic.
We don't require referral.
If you're concerned that you have an abnormal heart rhythm and you call our office, they'll get you in to see one of us. So self referral is fine. In our practice, usually the primary care physician will make that referral. So just talk to your primary care physician or call our office either way.
[00:17:57] Speaker A: So you may have heard that with north Mississippi, they've used this slogan now, is that you're our true north.
Question for you. What's your true north? What got you to north Mississippi? What makes you so passionate of taking care of these patients?
[00:18:14] Speaker B: Well, I don't want to get too personal, but I grew up here, this community, and these people helped raise me.
They gave me so much when I was a young person that I really want to give something back to the people that were so generous to me when I was growing up. And if I can do that in the form of fixing a few abnormal heart rhythms, then that's kind of my true norm.
[00:18:43] Speaker A: That's wonderful. Well, thank you so much for spending some time with us today. Thank y' all so much.
[00:18:52] Speaker B: Sam.
