Recently, Dr. John Phillips and I had the pleasure of interviewing electrophysiologist Dr. Joseph Bumgarner from UNC Rex Healthcare in North Carolina about atrial fibrillation (AFib) - a condition that affects millions of Americans.
You might be surprised to learn that even Olympic athletes - the epitome of health and fitness - can be at risk for this common heart rhythm disorder. But you are, too. As Dr. Bumgarner shared with us, AFib is actually “the fastest growing sort of public health epidemic around the planet.”
What Exactly is AFib?
Dr. Bumgarner explained AFib using a wonderful analogy that makes it easy for anyone to understand:
“I describe our hearts kind of like a house with an upstairs and a downstairs. The downstairs are the ventricles, the big muscular chambers that are beating, but they really don’t beat on their own very well. They need a pacemaker. They need instruction from the top floor of the house.”
In AFib, those top chambers don’t beat in an organized way. Instead, they quiver, causing the heart to beat too quickly, too slowly, or irregularly.
“And what happens is those top chambers, rather than beating in a very organized way, like they normally do when we’re in normal rhythm, they just sort of quiver because that electricity is beating in a very erratic way.”
Do You Know If You Have AFib?
One of our listeners asked a great question: How would you know if you have AFib? It’s a critical question since many people don’t realize they have it.
Dr. Bumgarner told us: “For AFib, the most common symptom is fatigue, is feeling tired. And that is a hard symptom because there are so many things in our life that make us feel tired, you know? And you can kind of brush off fatigue for weeks and months and maybe years and not react to it.”
This really hits home for me, as we see the same pattern with PAD patients who don’t realize they’re slowing down or making lifestyle adjustments to manage symptoms. As I reminded our audience, “Asymptomatic is not necessarily asymptomatic. It’s the doctor not asking the right questions to determine if the patient is in fact asymptomatic.”
Dr. Bumgarner shared a perfect example of this: “I saw a patient this week, completely asymptomatic, of course, super athletic, great guy. We did a cardioversion and I saw him five days later and he says, ‘I feel like a new person. I realized I was carrying a backpack on my back for the last three months and I had no idea.’”
Athletes and AFib: Too Much of a Good Thing?
We know exercise is good for our hearts, but can athletes actually be at higher risk for AFib? I asked Dr. Bumgarner if there’s such a thing as “too much of a good thing.”
“I think at some level, it probably is too much of a good thing,” he replied. “Our heart is a muscle. Our heart is an electrical system. It has a certain optimal running speed.”
He explained that most cardiac benefits come from getting your heart rate into the 50-70% peak heart rate range for 30-60 minutes most days. Many athletes push well beyond this.
“A lot of athletes are really outside of that range. And I think over time, like any muscle, it puts it under extra stress.”
He also pointed out another interesting factor: “Most athletes have a really low resting heart rate in the thirties and the forties. And so there’s just a lot of time between each heartbeat where another pacemaker in the heart can wake up and start to fire electricity.”
Treatment Options: From Medications to Cutting-Edge Procedures
When it comes to treating AFib, Dr. Bumgarner emphasized two main priorities:
“I always tell my patients, look, AFib is not a life-threatening rhythm. It might be a quality of life altering rhythm, but I always tell them there are two rules. The first one is no strokes allowed… And then the other rule that I have is no heart failure allowed.”
For stroke prevention, blood thinners are often prescribed, but not everyone can tolerate them. That’s where a device called the Watchman comes in.
“Imagine a plug in your bathtub, or your kitchen sink. That’s what it is,” Dr. Bumgarner explained. “There’s this part of the heart called the left atrial appendage… It doesn’t serve any function except that it has a lot of nooks and crannies and blood clots form in there.”
The Watchman seals off this appendage, creating “a scaffolding where the body, the human heart, regrows a layer of tissue over the top… It’s durable for the rest of the patient’s life.”
For managing the irregular rhythm itself, Dr. Bumgarner spoke about ablation procedures:
“For someone that has short episodes, a single ablation with current technology, the success is above 90%. One ablation, the likelihood of freedom from clinical AFib five plus years, we would say is greater than 90%.”
However, he cautioned that waiting too long can reduce the success rate: “If you sit on it and you let AFib fester and get a root and a foothold, then that starts to come down.”
Your Questions Answered
Our listeners had some fantastic questions. Nancy, who survived a cardiac arrest while line dancing and now has a defibrillator, asked if she should limit her exercise.
Dr. Bumgarner encouraged her: “Go and live your life and do what you’re passionate about and do your best not to worry about the defibrillator. I tell patients that defibrillator is like an airbag in your car. Hopefully you never need it, but you wouldn’t drive a car without an airbag, right?”
Another listener, Marcia, asked about her Apple Watch detecting AFib while she slept. Dr. Bumgarner explained that these devices “are about as good as the generated computer reading that you get from an automatic 12 lead EKG,” though having a cardiologist confirm the readings is still important.
Simple Key Points About Atrial Fibrillation:
What is AFib?
- AFib is the most common cardiac arrhythmia worldwide
- Dr. Bumgarner describes the heart like a "two-story house" where the upper chambers (atria) normally send organized electrical signals to the lower chambers (ventricles)
- In AFib, the upper chambers quiver instead of beating regularly, causing erratic heart rhythm
- The pulmonary veins are often the source of the irregular electrical impulses that trigger AFib
Symptoms and Detection:
- Fatigue is the most common symptom of AFib, though many patients don't recognize it
- Some patients are asymptomatic but still benefit from treatment
- Modern technology like Apple Watch and Cardia Mobile devices can detect AFib with good accuracy
- Annual physical exams where doctors listen to heart rhythms remain important for detection
Risk Factors:
- Athletes and endurance exercisers have an increased risk of AFib
- High blood pressure, sleep apnea (mentioned twice for emphasis), obesity, and poor diet
- Aging is a significant factor (estimated 20% of people over 80 have AFib)
- Athletes may be susceptible due to both heart stress from intense exercise and very low resting heart rates that allow "windows" for irregular rhythms
Complications:
- Two main concerns: stroke risk and heart failure
- Blood clots can form in the left atrial appendage during AFib
- These clots can break loose and cause strokes (95%+ of AFib-related clots form in this appendage)
Treatment Options:
1. Stroke Prevention:
- Blood thinners/anticoagulants for patients with risk factors
- Watchman device for those who can't tolerate blood thinners
- The Watchman seals off the left atrial appendage where clots typically form
2. Rhythm Control:
- Cardioversion (electrical resetting of heart rhythm)
- Anti-arrhythmic medications
- Ablation procedure (90%+ success rate for early intervention)
Other Notable Points:
- Exercise is beneficial for heart health but extreme endurance exercise may contribute to AFib
- Olympic and professional athletes may develop heart issues from extreme training
- Heart rate monitoring during exercise should aim for 50-70% of maximum heart rate (calculated as 220 minus age)
Don’t Fight For Your Own Limitations
One thing I always emphasize to our PAD patients applies equally to those with AFib or any heart condition: “Don’t argue for your own limitations. Don’t make excuses.”
If you’re feeling unusually tired, experiencing heart palpitations, or noticing changes in your exercise tolerance, listen to your body. As Dr. Bumgarner put it, “When you exercise, you’re doing your own stress test every day. If something’s changing, that’s your way to pick up on it.”
Early detection and treatment of AFib can prevent serious complications like stroke and heart failure. With today’s advanced treatments and technologies, there’s no reason to let AFib limit your life or put you at risk.
I’m so grateful to Dr. Bumgarner for sharing his expertise with us and helping to raise awareness about this important heart condition. Remember, knowledge is power when it comes to your heart health!
What has your experience been with AFib? Have you used wearable technology to monitor your heart rhythm? I’d love to hear your stories in the comments below!
If you have questions about Peripheral Artery Disease, poor circulation in your legs, and/or experience leg cramps, leg pain, or neuropathy, call the Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS or go to PADhelp.org.
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