Atrial Fibrillation (AF) is the most common sustained heart rhythm abnormality.
It affects nearly 5 million people in the United States.
AF is an irregular and often rapid heartbeat that can cause poor blood flow to the body.
During AF, the upper chambers of the heart (Atria) begin to quiver and beat chaotically-out of synch with the lower chambers of the heart (Ventricles).
Some of the more common signs of AF include palpitations, shortness of breath, dizziness and fatigue.
With the help of your healthcare team, AF can be treated.
Andrew Brenyo MD is here to discuss AF, its diagnoses and treatments.
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The Latest in Atrial Fibrillation Diagnosis and Treatment Options
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Learn more about Dr. Brenyo
Andrew Brenyo, MD
After earning his medical degree from the State University of New York Buffalo School of Medicine, Dr. Brenyo completed his residency in internal medicine at Duke University Medical Center. He then went on to receive fellowships in cardiovascular disease and in electrophysiology from the University of Rochester. His special interests include complex arrhythmia therapy. Dr. Brenyo is board certified in internal medicine and cardiovascular disease and board eligible in Electrophysiology.Learn more about Dr. Brenyo
Transcription:
Melanie Cole (Host): Have you ever felt that your heart flip-flops, skips a beat, or feels like it is banging against your chest wall? Well, it could be atrial fibrillation. My guest today is Dr. Andrew Brenyo. He is a heart rhythm doctor at Greenville Health System that is also board certified in internal medicine and cardiovascular disease. Welcome to the show, Dr. Brenyo. Tell us a little about atrial fibrillation. What exactly is it?
Dr. Andrew Brenyo (Guest): Atrial fibrillation is an abnormal rhythm that is primarily characterized by a racing of your heart along with irregularity in the pulse. As a result of this racing, the top chambers of the heart called the atrium don’t contract normally. This causes blood to pool and can also increase your risk of having a stroke. Variably, some patients will feel this rhythm; other patients will not be able to feel it. As a result, atrial fibrillation is the most common cause of stroke within the United States and westernized countries.
Melanie: What’s the most common cause of atrial fibrillation? Are there some risk factors or some lifestyles that contribute to this?
Dr. Brenyo: That’s a great question. The most common associated factors are high blood pressure, conditions like sleep apnea and being overweight. Those are the three most common conditions that we see and even for some patients, absent those symptoms, they still can develop atrial fibrillation. For the patients that have those risk factors, we can counsel them on lifestyle modification including, most importantly, weight loss, which will reduce the need for blood pressure medications, diabetes medications, improve the quality of life and also usually make their atrial fibrillation much easier to control with medication.
Melanie: If someone doesn’t get that feeling--that palpitation and anxiety feeling that goes for some people--how do they know if they have it? It’s something that increases their risk for stroke. Is it something that you would pick up on an annual physical? Is it something they have to have a stress test or an EKG to find out that they even have? How do you know?
Dr. Brenyo: This comes up a lot in terms of trying to minimize paranoia that patients have that they are not aware of a condition that could potentially affect their lives. For the patients that don’t have symptoms associated with their a-fib, I usually counsel them on assessing their heart rate at rest. If your heart rate at rest is typically 60-70 beats a minute, in atrial fibrillation it should be higher. It should be 90-100 beats per minute at rest, for the most part. This can be a great indicator, along with irregularities, since the pulse should be regular--almost like a metronome. If the pulse is irregular or faster than usual, that is typically atrial fibrillation. When we see patients referred in to us, oftentimes atrial fibrillation is diagnosed incidentally. When you’re going to your primary doctor or when you go to the emergency department because of a urinary infection, those are often times when we’ll see these kinds of rhythms be diagnosed just through routine evaluation of another problem.
Melanie: If you detect that somebody has this, what’s the first line of defense? What do you do for them?
Dr. Brenyo: We usually assess the patients in terms of whether or not they have symptoms and whether or not they have other risk factors for stroke. If patients have no symptoms associated with the rhythm, we usually don’t get real excited about using a lot of medications or talking about procedures for atrial fibrillation. We just try to minimize heart rate racing that can cause the heart to weaken over time. For patients with stroke risk factors, we will usually initiate a blood thinner to minimize that stroke risk and counsel them on how atrial fibrillation may or may not affect their life for the long term. No matter what the story for our a-fib patients, there are things that we are assessing and modifying to minimize their risk of having complications or medical issues as a result of atrial fibrillation going forward.
Melanie: If you put them on Coumadin, blood thinners, is this something now that they have to stay on for the rest of their life?
Dr. Brenyo: The answer is usually yes. However, there are situations where patients risk factors, which are things like high blood pressure, diabetes, those are modifiable, actually. Getting patients to a point where they can come off blood pressure medications because they’ve managed to lose weight or they lose their diabetes as a result of losing weight, those are the things that are modifiable. However, other risk factors include things like age, gender, or prior history of a stroke--all of which are not modifiable. So, for the most part when we look at patients who meet criteria for a blood thinner they are on it indefinitely.
Melanie: Then, what do you do? If this is something that needs intervention and the heart is basically an electrical machine, what do you do to sort of stop this from happening which really ends up causing anxiety in the person suffering from it as well because they are worried about stroke and other problems?
Dr. Brenyo: Right.When we try to treat the atrial fibrillation and prevent it from coming back, the first line of therapy is usually the initiation of rhythm drugs that are specific to suppressing the atrial fibrillation and prevent it from occurring along with shortening the time that the patients are out of rhythm. When patients actually have breakthrough through those medications, we then, through subsequent visits, talk about the role of ablation therapy to prevent atrial fibrillation. When we sit and talk with the patient about ablation, we usually let them know that it is a procedure that is done under general anesthesia. It can take up to four hours. It is a good procedure and can minimize their risk of having more atrial fibrillation in the future and can often result in them coming off of their rhythm medications that we had prescribed previously.
Melanie: What do you tell people if they’ve gone through these procedures about living the rest of their life and not worrying about this so much and behavior modifications—lifestyles--that you want them to adhere to help them deal with this for the rest of their lives?
Dr. Brenyo: I think one of the most important things about patient care in general is feeling like you have a partner in your physician and knowing that if you have difficulties with your atrial fibrillation that you have somebody that you can reach out to who can, no matter what the situation, can help you with regard to your symptoms and answer the questions that you have. Everybody’s a-fib story is a little bit different, so the questions that patients have are usually similar, but then there are outliers who are individual to the patient’s own life. In helping patients deal with this condition, the important part is not only as physician, but as a patient, trying to make sure that they find a provider that is going to help them with regard to taking care of their a-fib and fitting that care into their lifestyle. If patients feel like the cure for their atrial fibrillation, in terms of medicine, is worse than the disease, it’s not really going to sit well with them if they are taking these medications or talking about these procedures and they are not getting any benefit out of it when it comes to quality of life. So, when I counsel patients, usually we will provide them and arm them with knowledge surrounding what atrial fibrillation is and how it can and can’t affect them and lay a plan forward. If you have more issues with atrial fibrillation, we’ll plan on doing this. If that doesn’t work, we will plan on doing this subsequent step after that. So that they know there is a plan there such that if they have difficulties, they have my phone number; they call me; they come in to be seen and they know based on my last discussion, we will be doing this. Having that reassurance there for them about the fact that both we’re listening and, too, we have a plan, that seems to go a long way.
Melanie: In just the last minute, Dr. Brenyo, if you would, give us your best advice for people suffering from atrial fibrillation and why they should come to Carolina Cardiology and GHS for their care.
Dr. Brenyo: I think the hardest element of atrial fibrillation as it stands today is appropriate diagnosis. When you have patients who have short episodes and they are not getting diagnosed appropriately, they never come to us. They never come to a cardiologist or their internist because it’s never actually detected. It can take a long time to diagnose atrial fibrillation with ambulatory monitoring. However, we have actually seen the expanding use of apps for smart phones to detect atrial fibrillation and this alone can provide nidus of conversation with an internist or a cardiologist to get them in and get them treated appropriately to minimize their symptoms. The reason why I think patients should come to see us at Greenville Health System, both for a cardiovascular evaluation or an electrophysiological evaluation, is we have a full comprehensive program of physicians that care about atrial fibrillation patients; they care about heart rhythm patients and can take care of any manner of illness that is seen from the very garden variety to the very esoteric. We have ablationists who can do anything from extensive robotic ablation to ablations around the heart on the outside of the heart. So, we can take care of any rhythm disturbance that a patient has in a way that still maintains the small family feel that patients really enjoy and, as a result, aren’t hesitant to come on back and see us.
Melanie: Thank you so much. That’s great information. You're listening to the Inside Health with Greenville Health System. For more information, you can go to GHS.org. That's GHS.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Have you ever felt that your heart flip-flops, skips a beat, or feels like it is banging against your chest wall? Well, it could be atrial fibrillation. My guest today is Dr. Andrew Brenyo. He is a heart rhythm doctor at Greenville Health System that is also board certified in internal medicine and cardiovascular disease. Welcome to the show, Dr. Brenyo. Tell us a little about atrial fibrillation. What exactly is it?
Dr. Andrew Brenyo (Guest): Atrial fibrillation is an abnormal rhythm that is primarily characterized by a racing of your heart along with irregularity in the pulse. As a result of this racing, the top chambers of the heart called the atrium don’t contract normally. This causes blood to pool and can also increase your risk of having a stroke. Variably, some patients will feel this rhythm; other patients will not be able to feel it. As a result, atrial fibrillation is the most common cause of stroke within the United States and westernized countries.
Melanie: What’s the most common cause of atrial fibrillation? Are there some risk factors or some lifestyles that contribute to this?
Dr. Brenyo: That’s a great question. The most common associated factors are high blood pressure, conditions like sleep apnea and being overweight. Those are the three most common conditions that we see and even for some patients, absent those symptoms, they still can develop atrial fibrillation. For the patients that have those risk factors, we can counsel them on lifestyle modification including, most importantly, weight loss, which will reduce the need for blood pressure medications, diabetes medications, improve the quality of life and also usually make their atrial fibrillation much easier to control with medication.
Melanie: If someone doesn’t get that feeling--that palpitation and anxiety feeling that goes for some people--how do they know if they have it? It’s something that increases their risk for stroke. Is it something that you would pick up on an annual physical? Is it something they have to have a stress test or an EKG to find out that they even have? How do you know?
Dr. Brenyo: This comes up a lot in terms of trying to minimize paranoia that patients have that they are not aware of a condition that could potentially affect their lives. For the patients that don’t have symptoms associated with their a-fib, I usually counsel them on assessing their heart rate at rest. If your heart rate at rest is typically 60-70 beats a minute, in atrial fibrillation it should be higher. It should be 90-100 beats per minute at rest, for the most part. This can be a great indicator, along with irregularities, since the pulse should be regular--almost like a metronome. If the pulse is irregular or faster than usual, that is typically atrial fibrillation. When we see patients referred in to us, oftentimes atrial fibrillation is diagnosed incidentally. When you’re going to your primary doctor or when you go to the emergency department because of a urinary infection, those are often times when we’ll see these kinds of rhythms be diagnosed just through routine evaluation of another problem.
Melanie: If you detect that somebody has this, what’s the first line of defense? What do you do for them?
Dr. Brenyo: We usually assess the patients in terms of whether or not they have symptoms and whether or not they have other risk factors for stroke. If patients have no symptoms associated with the rhythm, we usually don’t get real excited about using a lot of medications or talking about procedures for atrial fibrillation. We just try to minimize heart rate racing that can cause the heart to weaken over time. For patients with stroke risk factors, we will usually initiate a blood thinner to minimize that stroke risk and counsel them on how atrial fibrillation may or may not affect their life for the long term. No matter what the story for our a-fib patients, there are things that we are assessing and modifying to minimize their risk of having complications or medical issues as a result of atrial fibrillation going forward.
Melanie: If you put them on Coumadin, blood thinners, is this something now that they have to stay on for the rest of their life?
Dr. Brenyo: The answer is usually yes. However, there are situations where patients risk factors, which are things like high blood pressure, diabetes, those are modifiable, actually. Getting patients to a point where they can come off blood pressure medications because they’ve managed to lose weight or they lose their diabetes as a result of losing weight, those are the things that are modifiable. However, other risk factors include things like age, gender, or prior history of a stroke--all of which are not modifiable. So, for the most part when we look at patients who meet criteria for a blood thinner they are on it indefinitely.
Melanie: Then, what do you do? If this is something that needs intervention and the heart is basically an electrical machine, what do you do to sort of stop this from happening which really ends up causing anxiety in the person suffering from it as well because they are worried about stroke and other problems?
Dr. Brenyo: Right.When we try to treat the atrial fibrillation and prevent it from coming back, the first line of therapy is usually the initiation of rhythm drugs that are specific to suppressing the atrial fibrillation and prevent it from occurring along with shortening the time that the patients are out of rhythm. When patients actually have breakthrough through those medications, we then, through subsequent visits, talk about the role of ablation therapy to prevent atrial fibrillation. When we sit and talk with the patient about ablation, we usually let them know that it is a procedure that is done under general anesthesia. It can take up to four hours. It is a good procedure and can minimize their risk of having more atrial fibrillation in the future and can often result in them coming off of their rhythm medications that we had prescribed previously.
Melanie: What do you tell people if they’ve gone through these procedures about living the rest of their life and not worrying about this so much and behavior modifications—lifestyles--that you want them to adhere to help them deal with this for the rest of their lives?
Dr. Brenyo: I think one of the most important things about patient care in general is feeling like you have a partner in your physician and knowing that if you have difficulties with your atrial fibrillation that you have somebody that you can reach out to who can, no matter what the situation, can help you with regard to your symptoms and answer the questions that you have. Everybody’s a-fib story is a little bit different, so the questions that patients have are usually similar, but then there are outliers who are individual to the patient’s own life. In helping patients deal with this condition, the important part is not only as physician, but as a patient, trying to make sure that they find a provider that is going to help them with regard to taking care of their a-fib and fitting that care into their lifestyle. If patients feel like the cure for their atrial fibrillation, in terms of medicine, is worse than the disease, it’s not really going to sit well with them if they are taking these medications or talking about these procedures and they are not getting any benefit out of it when it comes to quality of life. So, when I counsel patients, usually we will provide them and arm them with knowledge surrounding what atrial fibrillation is and how it can and can’t affect them and lay a plan forward. If you have more issues with atrial fibrillation, we’ll plan on doing this. If that doesn’t work, we will plan on doing this subsequent step after that. So that they know there is a plan there such that if they have difficulties, they have my phone number; they call me; they come in to be seen and they know based on my last discussion, we will be doing this. Having that reassurance there for them about the fact that both we’re listening and, too, we have a plan, that seems to go a long way.
Melanie: In just the last minute, Dr. Brenyo, if you would, give us your best advice for people suffering from atrial fibrillation and why they should come to Carolina Cardiology and GHS for their care.
Dr. Brenyo: I think the hardest element of atrial fibrillation as it stands today is appropriate diagnosis. When you have patients who have short episodes and they are not getting diagnosed appropriately, they never come to us. They never come to a cardiologist or their internist because it’s never actually detected. It can take a long time to diagnose atrial fibrillation with ambulatory monitoring. However, we have actually seen the expanding use of apps for smart phones to detect atrial fibrillation and this alone can provide nidus of conversation with an internist or a cardiologist to get them in and get them treated appropriately to minimize their symptoms. The reason why I think patients should come to see us at Greenville Health System, both for a cardiovascular evaluation or an electrophysiological evaluation, is we have a full comprehensive program of physicians that care about atrial fibrillation patients; they care about heart rhythm patients and can take care of any manner of illness that is seen from the very garden variety to the very esoteric. We have ablationists who can do anything from extensive robotic ablation to ablations around the heart on the outside of the heart. So, we can take care of any rhythm disturbance that a patient has in a way that still maintains the small family feel that patients really enjoy and, as a result, aren’t hesitant to come on back and see us.
Melanie: Thank you so much. That’s great information. You're listening to the Inside Health with Greenville Health System. For more information, you can go to GHS.org. That's GHS.org. This is Melanie Cole. Thanks so much for listening.
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