8 AFib Myths That Keep Patients Scared — And What’s Actually True

What are the eight myths or misconceptions about atrial fibrillation? Number One: Atrial fibrillation is life threatening. The good news is that atrial fibrillation is not considered to be directly life threatening. Now does that mean that atrial fibrillation cannot hurt you? No. Does that mean that atrial fibrillation doesn't cause symptoms? No. What I mean when I say atrial fibrillation is not directly life-threatening is, if you consider abnormal heart rhythms, which atrial fibrillation is an abnormal heart rhythm, to be abnormal sources of electricity that form in the walls of your heart that can sleep and do nothing

or randomly wake up, generate their own electricity, and take over control of your heart away from the normal source of electricity. Because remember our heart runs on electricity. It's just a big dumb muscle. It only beats because it's actually receiving electricity telling it to beat, and that normal electrical source is actually in the roof of your heart. So all of us have a little spot at the roof of our heart that actually tells our heart to beat. It powers our heart. This is the intrinsic pacemaker of our heart. And our brain controls that little source.

It tells it what speed to go at based on what we're doing. Then you have these abnormal rhythm sources like atrial fibrillation that form in other walls of the heart and aren't supposed to be there. And then they could sleep and do nothing, or randomly wake up, generate electricity, override your normal rhythm source, take over control, and tell your heart to speed up. And then after a while they get tired of being awake. They go back to sleep. And then your normal rhythm takes back over control at a normal speed, but the abnormal rhythm can

wake up again in the future and still take over control of your heart and make it go fast. If you believe that atrial fibrillation is one of the many different abnormal rhythms that can do that, the good news is it will never make your heart speed up to a life-threatening speed. It certainly can make your heart speed up and cause symptoms like palpitations and other symptoms of rapid heart rates. And unfortunately it can cause a little risk of clots in your heart that could lead to strokes. But it will not ever make your heart go

fast enough for you to pass out and die. There are some dangerous rhythms that can do that, but it is not one of those. So when people are told, "Oh my God! You have atrial fibrillation! You have to go to the hospital!" And are basically told that if they don't go to the hospital they will die or implied that they will die, that is simply not true. Atrial fibrillation will speed your heart rate up as if you're exercising and definitely cause symptoms, but unless it happens to cause a clot in your heart that leads to

a stroke, you're not going to directly die just because you're in an atrial fibrillation. Number Two: Atrial fibrillation will lead to a heart attack. I'm here to tell people that atrial fibrillation will not directly lead to a heart attack. You need to think of the different systems in the heart as being for the most part separate systems. We all have a plumbing system, which is the blood vessels that supply blood to the heart to keep it alive. And when you block that up that's where you have chest pain, damage, and heart attacks. And we all

have a separate electrical system, which is the electricity inside our heart walls that tells our heart to beat at a certain speed. They really don't have directly anything to do with each other. So just because you're having atrial fibrillation and you come to me for treatment doesn't mean that if I don't treat it, oh my God, you're going to have a heart attack! Not everything about the heart has to do with the plumbing system. Just because we hear about that more than the electrical system, doesn't mean it's the only system. You will only have a

heart attack if you have a blocked heart artery cutting off blood supply to your heart that is going to cause chest pain and damage. If you do not have that, it doesn't matter if your heart's going faster in Afib. That will not directly lead to a heart attack. Electrical problems don't necessarily directly cause plumbing issues. Think of them as separate issues and separate systems. Number Three: Well my Afib just must be hereditary, right? My parents had atrial fibrillation. My brother has atrial fibrillation. So it must be something I was born with. No. Atrial fibrillation is

almost never hereditary. Atrial fibrillation forms primarily because we just get older and we live long enough to get it. As your heart walls age, these abnormal Afib cells tend to form in the walls of your heart. And then they can start to wake up and take over control of your heart and speed your heart rate up. So atrial fibrillation is one of the age related rhythm problems. This is why it's so common and prevalent because as we are all getting older, many more of us are getting atrial fibrillation. Every decade of life the number of

people with atrial fibrillation goes up. When you hit your 50's, 3% of people have Afib. When you hit your 60's, 5% have Afib. When your 70's, 12% have Afib. If you make it to your 80's, 15 to 20% have Afib. And if you actually make it to your 90's, up to 30% of people have atrial fibrillation. So it is mainly an age related rhythm problem. Somebody tells me that their parents and their siblings all had atrial fibrillation and they're all in their 70's and 80's, it just means they all lived long enough to get atrial

fibrillation. They all reached their 70's and 80's. If it was really something that was hereditary, then people would be getting atrial fibrillation as children or teenagers which doesn't really happen. Number Four: I have atrial fibrillation and therefore it's the only abnormal rhythm that I could possibly get. Unfortunately, this is incorrect. If we define abnormal heart rhythms as these abnormal sources that form in the walls of the heart and can wake up and take over control of the heart and speed it up, well there are actually 13 to 15 different abnormal heart rhythms that specialists like

myself see on a regular basis. Atrial fibrillation is just the most common abnormal heart rhythm that people can develop, so we see more of it than any of the other ones. But it is certainly not the only one. And just because you happened to develop atrial fibrillation doesn't mean that you can't develop other abnormal heart rhythms in your lifetime. Unfortunately you are not just allowed one abnormal rhythm in your lifetime. It doesn't really work that way. So when these abnormal rhythm sources wake up, they can override your normal source of electricity, take over control, and

speed your heart rate up. So if you had more than one abnormal heart rhythm problem, then it could be a matter of: One moment the atrial fibrillation is awake making your heart go fast and then eventually it may get tired of being awake and go back to sleep. And then your normal rhythm wakes back up and takes back over control and tells your heart to go to normal speed. And then a different abnormal rhythm may be able to wake up and take over control and speed your heart rate up. So it's just really a matter

of who's awake at that moment and who's the dominant rhythm and who's in control of your heart. But you are not just allowed one abnormal heart rhythm in your lifetime. There are some dangerous heart rhythms that we hope you never form that can wake up and make your heart go fast enough to kill you. And atrial fibrillation thankfully is not one of those. But you see there are many different abnormal heart rhythms that you can develop problems with. And so atrial fibrillation is just one of many, but it is certainly the most common one. And

thankfully it is not directly life-threatening. Number Five: My atrial fibrillation is preventable. So people will say, "Oh yeah. I had an episode of atrial fibrillation, and so I read on the internet somewhere that if I just don't do X, Y and Z, or I don't do this, or I don't drink this, or I don't engage in this activity or eat these kinds of foods, then I won't have atrial fibrillation. Or I noticed that it seemed to happen when I was in the bathtub or at work. So therefore I probably triggered it. Well it is true

that you can trigger atrial fibrillation with certain activities. You also have to understand these abnormal rhythm cells can wake up randomly once they're there in your heart, and you can go in and out of rhythm even if you didn't do anything specific. So it's not as simple as, "Oh just don't do that and you won't have that problem!" If that was the case then the treatment for Afib or any other abnormal rhythm problem would be, "Well just don't do that specific activity or eat that specific food, and you'll never have that rhythm!" And unfortunately, I

wish it was as simple as that, but it really isn't. No. Atrial fibrillation are these abnormal cells in your heart that actually can grow more and progress as you get older. So as you do age, they tend to wake up more and more and more. And they can wake up randomly irregardless of what you're doing. Yes. There are certain things you can do to trigger them, such as the most common ones being: Alcohol, stress, stimulants like caffeine and other types of stimulants. But while those things may wake up the Afib and cause you to have

more episodes, even without those triggers your Afib can wake up on its own. So no. Afib is not directly preventable, meaning you just stop doing certain things, you'll never have it again. Number Six: Atrial fibrillation is treated with a pacemaker. Unfortunately that is incorrect. Pacemakers actually treat the opposite problem. Pacemakers are little simple devices that specialists like myself perform to implant a little device underneath your skin, with little wires that go into your heart. And what they do is they actually sense your heart rhythm. And when your heart rhythm goes too slow, then they pace

your heart electronically, artificially, and tell your heart to beat at a normal speed. So pacemakers are actually given to treat slow heart rate problems. Whereas atrial fibrillation and other abnormal heart rhythms cause fast heart rate problems. So a pacemaker would not directly treat atrial fibrillation. There is this misconception out there that pacemakers are some kind of magical device that once you get a pacemaker, it just takes over control of your heart and tells your heart to beat at a normal speed. That is not correct. The way pacemakers work is: They sense the electricity controlling your

heart. And as we said, you have a normal source of electricity at the roof of your heart that's telling your heart to beat at a normal speed. If that normal source of electricity were to get old and diseased and start to go too slow where you started having symptoms from slow heart rates, or you were on medications for other medical problems that were making your normal rhythm too slow, then we could put in a little pacemaker. And whenever your normal rhythm got too slow the pacemaker would kick in, send out artificial signals to your heart,

override your normal source which is too slow, and take over control to tell your heart to beat at a normal speed. So the good news is, pacemakers treat slow heart rates. And then when your normal rhythm gets better, because it's it's not always slow. Sometimes it's slow and sometimes it's working at a normal speed. Your normal rhythm is telling your heart to beat at a normal speed, and the pacemaker doesn't pace. It only paces when it needs to when your heart rate is too slow. On the other hand when you're in an abnormal rhythm like

atrial fibrillation, it's making your heart go fast. So you're feeling rapid heart rates. The pacemaker cannot take over control from the Afib. The only way it would be able to take over control from the Afib would be if it paced your heart at a faster speed than the Afib to override it and take over control. Because remember, when you have two sources of electricity inside your heart the faster source always overrides the slower source and takes over control. So we wouldn't want a pacemaker to pace you at a faster speed than atrial fibrillation, because the

atrial fibrillation is already making your heart go at an abnormally fast speed and making you feel symptoms and palpitations. So why would we want to make that even worse? So no. A pacemaker does not directly treat atrial fibrillation. Now I believe this misconception came about because 10-20 years ago when we had a lot less treatment options for the symptoms of atrial fibrillation. When we had a lot less treatment options for the fast heart rates and symptoms of atrial fibrillation. Mostly we just had the ability to use medications to slow down your atrial fibrillation. So we

would say oh, you're going in and out of atrial fibrillation. Well we don't really have very many good drugs to keep that asleep. Or we don't have what we now have, the ablation procedure to try to get rid of the Afib cells from the inside so you don't keep going in and out of atrial fibrillation. Well back then we just had medicines that would slow your heart rate down; would still go in and out of atrial fibrillation at rapid speeds. But on these so-called rate controlling medications, your heart rates would be slower and you would

be able to maybe tolerate the atrial fibrillation better. And so that's why some older doctors right now just practice old medicine. And they just see somebody with Afib...they put them on a rate controlling medication. Slow it down a little bit. Say, "Well it's not going to kill you as long as you don't have a clot and a stroke. And just live with it. And just tolerate the symptoms." But they're not going to refer you for a specialist to talk about other treatment options like ablations or stronger drugs to suppress it, because they're kind of practicing

older medicine. But back then when that's pretty much what was done, sometimes we ran into situations where by slowing the atrial fibrillation down with these so-called rate controlling medications, when the Afib went back to sleep and the person's normal rhythm kicked back in and took back over control, sometimes those medicines would make the normal rhythm too slow. Because remember these rate controlling medications do not make the Afib go to sleep. Do not keep you in normal rhythm. They just slow your heart rate down no matter what rhythm you're in. So if you're in atrial fibrillation

with a super fast heart rate having palpitations, then those medicines will slow that speed down so you can tolerate that episode a little bit better. But when you're back in normal rhythm, it's going to slow that rhythm down and sometimes it can make it too slow. So back 10-20 years ago when that happened, then people would put in a simple pacemaker to treat the slow heart rate aspect of the treatment. So when they were in atrial fibrillation, the rate controlling medication would slow the rapid speeds of Afib down. But then when they were back in

normal rhythm if they sometimes went too slow on those rate controlling medications, then the pacemaker would kick in to keep them from going too slow and therefore create this floor below which the heart rate wouldn't go. And the medicines were treating the rapid speeds of Afib to try to slow down the faster speeds and keep the person in this middle range. So in those situations, was the pacemaker directly treating the atrial fibrillation? No. It was just treating the slow heart rates caused by the rate controlling medications. So by doing so it would allow the patient

to be safely treated with these rate controlling medications for their atrial fibrillation. Number Seven: Catheter ablation treatment for atrial fibrillation is "All or Nothing." That is certainly not true. You need to not think about treatment with the catheter ablation as being, "They either got all my Afib or they didn't!" It's it's not pass or fail. It's not all or nothing. Atrial fibrillation is a progressive rhythm problem. As you get older you are forming more and more Afib cells in the walls of your heart, and it is progressing. And the more walls you have Afib cells

on, the more Afib cells you have total, the more it wants to wake up. The longer it wants to stay awake. And the more episodes and more time you spend in Afib total. So the percent of time that you spend in Afib does actually go up the longer you've had atrial fibrillation. It is a progressive rhythm problem. It does get stronger as you get older. So like a forest fire. If the analogy was this is like a forest fire spreading in the walls of my heart and we're going on the inside to try to get

rid of the forest fire or get rid of those Afib cells, whether or not we use an energy source to freeze the Afib cells or cauterize the Afib cells or the newest technology source of pulse field ablation using electrical pulses to kill off these Afib cells, you're still trying to get rid of the forest fire little by little. And so therefore the bigger the forest fire, the harder it is to get rid of it completely. So one needs to think about the ablation as not being all or nothing. Pass or fail, They either got it

or they failed. It's really not like that. It's how much Afib cells do I have? What stage of Afib am I in? How progressed is my atrial fibrillation? Which will explain why I'm going into it the amount that I'm going into it. The longer I've had it. The more progressed it is. The more time I'm spending in atrial fibrillation. The less progressed I am. The earlier stage I'm at. The less episodes I'm having. The smaller the forest fire. So somebody with a much bigger forest fire, a much more progressed Afib, is going to need a

much more complex ablation to try to even get rid of the bulk of it let alone all of it. That's why every time somebody does an ablation they are getting rid of some of the Afib. But whether or not they're getting rid of enough so that you're mostly not in Afib or not in it completely. Whether or not they really get rid of the forest fire completely depends on what stage of Afib you are at and how big your forest fire is. Think of the ablation as turning the forest fire back to an earlier stage.

Like turning the clock back to an earlier stage. The bigger your forest fire, the harder it is to get all the way to zero. But you can make it smaller so that you may have less Afib cells on less walls, and it'll wake up less. It's like making it to an earlier stage. This this is why people who have much more progressed atrial fibrillation, if they choose to undergo an ablation, need to go to somebody who does more complex ablations. Easy is easy and hard is hard. To get rid of a 10% forest fire or

somebody in atrial fibrillation at a very early stage, isn't very hard. So it doesn't really matter which physician you go to to get that done. But if you've been in atrial fibrillation for 8 or 10 years, and you're in at 60 to 90% of the time, and you have many walls of your heart covered with atrial fibrillation cells, and your forest fire is very spread, then it does make more of a difference who you go to to do your ablation. Because not everybody does complex ablations. Some people do and some people don't. And even those

who do vary in terms of how complex a procedure they can do and how much Afib they can actually get rid of. Some people who've done ablation for over 20 years can ablate very complex Afib like persistent and long-standing persistent stages where the Afib is on four to six walls, and sometimes get rid of the bulk of it or sometimes even all of it in one sitting. Other people may be able to approach moderate complexity or moderate complex forest fires, but they may take three or four procedures to do it. And then there are some

electrophysiologists who just aren't able to do more than one or two walls or basically simple, early stage paroxysmal atrial fibrillation stages. So if you have an early stage of atrial fibrillation, it doesn't really matter who you go to. If you have a later stage atrial fibrillation, make sure that you go to somebody who does more complex ablations. Number Eight: Catheter ablation for atrial fibrillation is a cure. Unfortunately this is incorrect. Atrial fibrillation cannot be completely cured. The reason for this is because atrial fibrillation is a progressive rhythm problem. It progresses unfortunately as we age. As

you get older, once you've developed these Afib cells and they start to randomly wake up, every year you get older your walls keep forming more and more Afib cells almost like a blocked heart artery that keeps getting bigger and bigger and bigger the older you get. And the more walls you have these Afib cells on, the more often it wants to wake up and the less it goes to sleep. So you spend more and more time in atrial fibrillation. Well even if we do a successful catheter ablation procedure and turn the clock all the way

back down to zero so that you don't have any more Afib cells and it's not waking up at all, why would it be a complete cure? It's going to actually start forming from wherever we get it to. The analogy would be like a blocked heart artery. If you have a 10% blocked heart artery and has to be more than 75% blocked to cause chest pain, damage, and heart attacks, well you know 10% is not going to really hurt you. And in 5 years as it progresses it might be at 50%. And still that won't really

hurt you. But in 10 years when it finally gets to 80-90% blocked and you have a small heart attack, then one of our Interventional Cardiologists or plumbers is going to go in and try to open it up. Now if they happen to open it up back to 0 to 10%, are you going to celebrate and say, "Yay! My heart disease is cured! I'll never have another blocked heart artery!" No. Because we all understand that this is a progressive problem and that it's going to grow back from wherever they get it to. Which is why you

want them to open it up as much as possible back to zero or 10% or less. Because then it'll give you another hopefully 10 years before it blocks back up to 80 or 90% blockage. But if they only open it up from 80-90% blockage to 60% blocked, and now you don't really have chest pain because the blockage is under the 75% that will cause chest pain, damage ,and heart attacks, well you might feel good for a couple years. But because the coronary disease develops from wherever they open it up to, it's going to start growing

from that 60% blockage back up. And within a couple years you may have another heart attack. Same thing with atrial fibrillation. You have a very advanced stage of atrial fibrillation and you have say 70 to 80% of the walls covered with Afib cells and you're in it 70 to 80% of the time because there is a correlation between how many walls are covered with atrial fibrillation percent-wise and how often it's waking up and you're spending time in atrial fibrillation. If that's the case and somebody only goes in and does a little bit and does maybe

one wall, a very simple ablation, and only gets rid of 10 or 20% of it, well it's going to grow back very quickly back to where you were and you're not going to get very much out of that. But if somebody really actually has the skills to do a complex ablation and actually can get rid of all of it or almost all of it to 10% or less, then you might get many years before it develops back to the stage that you were at. So what you do in these more complex cases of atrial fibrillation

is very important, and who you go to is equally as important. Because not all electrophysiologists perform the ablation at the same skill level and not all electrophysiologists do complex procedures. And even those of us who do complex procedures, there's still a difference in terms of what is done and individual outcomes based on individual skill levels of the doctor. What are the eight myths or misconceptions about atrial fibrillation? Number One: Atrial fibrillation is life threatening. The good news is that atrial fibrillation is not considered to be directly life threatening. Now does that mean that atrial fibrillation

cannot hurt you? No. Does that mean that atrial fibrillation doesn't cause symptoms? No. What I mean when I say atrial fibrillation is not directly life-threatening is, if you consider abnormal heart rhythms, which atrial fibrillation is an abnormal heart rhythm, to be abnormal sources of electricity that form in the walls of your heart that can sleep and do nothing or randomly wake up, generate their own electricity, and take over control of your heart away from the normal source of electricity. Because remember our heart runs on electricity. It's just a big dumb muscle. It only beats because

it's actually receiving electricity telling it to beat, and that normal electrical source is actually in the roof of your heart. So all of us have a little spot at the roof of our heart that actually tells our heart to beat. It powers our heart. This is the intrinsic pacemaker of our heart. And our brain controls that little source. It tells it what speed to go at based on what we're doing. Then you have these abnormal rhythm sources like atrial fibrillation that form in other walls of the heart and aren't supposed to be there. And then

they could sleep and do nothing, or randomly wake up, generate electricity, override your normal rhythm source, take over control, and tell your heart to speed up. And then after a while they get tired of being awake. They go back to sleep. And then your normal rhythm takes back over control at a normal speed, but the abnormal rhythm can wake up again in the future and still take over control of your heart and make it go fast. If you believe that atrial fibrillation is one of the many different abnormal rhythms that can do that, the good

news is it will never make your heart speed up to a life-threatening speed. It certainly can make your heart speed up and cause symptoms like palpitations and other symptoms of rapid heart rates. And unfortunately it can cause a little risk of clots in your heart that could lead to strokes. But it will not ever make your heart go fast enough for you to pass out and die. There are some dangerous rhythms that can do that, but it is not one of those. So when people are told, "Oh my God! You have atrial fibrillation! You have

to go to the hospital!" And are basically told that if they don't go to the hospital they will die or implied that they will die, that is simply not true. Atrial fibrillation will speed your heart rate up as if you're exercising and definitely cause symptoms, but unless it happens to cause a clot in your heart that leads to a stroke, you're not going to directly die just because you're in an atrial fibrillation. Number Two: Atrial fibrillation will lead to a heart attack. I'm here to tell people that atrial fibrillation will not directly lead to a

heart attack. You need to think of the different systems in the heart as being for the most part separate systems. We all have a plumbing system, which is the blood vessels that supply blood to the heart to keep it alive. And when you block that up that's where you have chest pain, damage, and heart attacks. And we all have a separate electrical system, which is the electricity inside our heart walls that tells our heart to beat at a certain speed. They really don't have directly anything to do with each other. So just because you're having

atrial fibrillation and you come to me for treatment doesn't mean that if I don't treat it, oh my God, you're going to have a heart attack! Not everything about the heart has to do with the plumbing system. Just because we hear about that more than the electrical system, doesn't mean it's the only system. You will only have a heart attack if you have a blocked heart artery cutting off blood supply to your heart that is going to cause chest pain and damage. If you do not have that, it doesn't matter if your heart's going faster

in Afib. That will not directly lead to a heart attack. Electrical problems don't necessarily directly cause plumbing issues. Think of them as separate issues and separate systems. Number Three: Well my Afib just must be hereditary, right? My parents had atrial fibrillation. My brother has atrial fibrillation. So it must be something I was born with. No. Atrial fibrillation is almost never hereditary. Atrial fibrillation forms primarily because we just get older and we live long enough to get it. As your heart walls age, these abnormal Afib cells tend to form in the walls of your heart. And

then they can start to wake up and take over control of your heart and speed your heart rate up. So atrial fibrillation is one of the age related rhythm problems. This is why it's so common and prevalent because as we are all getting older, many more of us are getting atrial fibrillation. Every decade of life the number of people with atrial fibrillation goes up. When you hit your 50's, 3% of people have Afib. When you hit your 60's, 5% have Afib. When your 70's, 12% have Afib. If you make it to your 80's, 15 to

20% have Afib. And if you actually make it to your 90's, up to 30% of people have atrial fibrillation. So it is mainly an age related rhythm problem. Somebody tells me that their parents and their siblings all had atrial fibrillation and they're all in their 70's and 80's, it just means they all lived long enough to get atrial fibrillation. They all reached their 70's and 80's. If it was really something that was hereditary, then people would be getting atrial fibrillation as children or teenagers which doesn't really happen. Number Four: I have atrial fibrillation and therefore

it's the only abnormal rhythm that I could possibly get. Unfortunately, this is incorrect. If we define abnormal heart rhythms as these abnormal sources that form in the walls of the heart and can wake up and take over control of the heart and speed it up, well there are actually 13 to 15 different abnormal heart rhythms that specialists like myself see on a regular basis. Atrial fibrillation is just the most common abnormal heart rhythm that people can develop, so we see more of it than any of the other ones. But it is certainly not the only

one. And just because you happened to develop atrial fibrillation doesn't mean that you can't develop other abnormal heart rhythms in your lifetime. Unfortunately you are not just allowed one abnormal rhythm in your lifetime. It doesn't really work that way. So when these abnormal rhythm sources wake up, they can override your normal source of electricity, take over control, and speed your heart rate up. So if you had more than one abnormal heart rhythm problem, then it could be a matter of: One moment the atrial fibrillation is awake making your heart go fast and then eventually it

may get tired of being awake and go back to sleep. And then your normal rhythm wakes back up and takes back over control and tells your heart to go to normal speed. And then a different abnormal rhythm may be able to wake up and take over control and speed your heart rate up. So it's just really a matter of who's awake at that moment and who's the dominant rhythm and who's in control of your heart. But you are not just allowed one abnormal heart rhythm in your lifetime. There are some dangerous heart rhythms that we

hope you never form that can wake up and make your heart go fast enough to kill you. And atrial fibrillation thankfully is not one of those. But you see there are many different abnormal heart rhythms that you can develop problems with. And so atrial fibrillation is just one of many, but it is certainly the most common one. And thankfully it is not directly life-threatening. Number Five: My atrial fibrillation is preventable. So people will say, "Oh yeah. I had an episode of atrial fibrillation, and so I read on the internet somewhere that if I just don't

do X, Y and Z, or I don't do this, or I don't drink this, or I don't engage in this activity or eat these kinds of foods, then I won't have atrial fibrillation. Or I noticed that it seemed to happen when I was in the bathtub or at work. So therefore I probably triggered it. Well it is true that you can trigger atrial fibrillation with certain activities. You also have to understand these abnormal rhythm cells can wake up randomly once they're there in your heart, and you can go in and out of rhythm even if

you didn't do anything specific. So it's not as simple as, "Oh just don't do that and you won't have that problem!" If that was the case then the treatment for Afib or any other abnormal rhythm problem would be, "Well just don't do that specific activity or eat that specific food, and you'll never have that rhythm!" And unfortunately, I wish it was as simple as that, but it really isn't. No. Atrial fibrillation are these abnormal cells in your heart that actually can grow more and progress as you get older. So as you do age, they tend

to wake up more and more and more. And they can wake up randomly irregardless of what you're doing. Yes. There are certain things you can do to trigger them, such as the most common ones being: Alcohol, stress, stimulants like caffeine and other types of stimulants. But while those things may wake up the Afib and cause you to have more episodes, even without those triggers your Afib can wake up on its own. So no. Afib is not directly preventable, meaning you just stop doing certain things, you'll never have it again. Number Six: Atrial fibrillation is treated

with a pacemaker. Unfortunately that is incorrect. Pacemakers actually treat the opposite problem. Pacemakers are little simple devices that specialists like myself perform to implant a little device underneath your skin, with little wires that go into your heart. And what they do is they actually sense your heart rhythm. And when your heart rhythm goes too slow, then they pace your heart electronically, artificially, and tell your heart to beat at a normal speed. So pacemakers are actually given to treat slow heart rate problems. Whereas atrial fibrillation and other abnormal heart rhythms cause fast heart rate problems. So

a pacemaker would not directly treat atrial fibrillation. There is this misconception out there that pacemakers are some kind of magical device that once you get a pacemaker, it just takes over control of your heart and tells your heart to beat at a normal speed. That is not correct. The way pacemakers work is: They sense the electricity controlling your heart. And as we said, you have a normal source of electricity at the roof of your heart that's telling your heart to beat at a normal speed. If that normal source of electricity were to get old and

diseased and start to go too slow where you started having symptoms from slow heart rates, or you were on medications for other medical problems that were making your normal rhythm too slow, then we could put in a little pacemaker. And whenever your normal rhythm got too slow the pacemaker would kick in, send out artificial signals to your heart, override your normal source which is too slow, and take over control to tell your heart to beat at a normal speed. So the good news is, pacemakers treat slow heart rates. And then when your normal rhythm gets

better, because it's it's not always slow. Sometimes it's slow and sometimes it's working at a normal speed. Your normal rhythm is telling your heart to beat at a normal speed, and the pacemaker doesn't pace. It only paces when it needs to when your heart rate is too slow. On the other hand when you're in an abnormal rhythm like atrial fibrillation, it's making your heart go fast. So you're feeling rapid heart rates. The pacemaker cannot take over control from the Afib. The only way it would be able to take over control from the Afib would be

if it paced your heart at a faster speed than the Afib to override it and take over control. Because remember, when you have two sources of electricity inside your heart the faster source always overrides the slower source and takes over control. So we wouldn't want a pacemaker to pace you at a faster speed than atrial fibrillation, because the atrial fibrillation is already making your heart go at an abnormally fast speed and making you feel symptoms and palpitations. So why would we want to make that even worse? So no. A pacemaker does not directly treat atrial

fibrillation. Now I believe this misconception came about because 10-20 years ago when we had a lot less treatment options for the symptoms of atrial fibrillation. When we had a lot less treatment options for the fast heart rates and symptoms of atrial fibrillation. Mostly we just had the ability to use medications to slow down your atrial fibrillation. So we would say oh, you're going in and out of atrial fibrillation. Well we don't really have very many good drugs to keep that asleep. Or we don't have what we now have, the ablation procedure to try to get

rid of the Afib cells from the inside so you don't keep going in and out of atrial fibrillation. Well back then we just had medicines that would slow your heart rate down; would still go in and out of atrial fibrillation at rapid speeds. But on these so-called rate controlling medications, your heart rates would be slower and you would be able to maybe tolerate the atrial fibrillation better. And so that's why some older doctors right now just practice old medicine. And they just see somebody with Afib...they put them on a rate controlling medication. Slow it down

a little bit. Say, "Well it's not going to kill you as long as you don't have a clot and a stroke. And just live with it. And just tolerate the symptoms." But they're not going to refer you for a specialist to talk about other treatment options like ablations or stronger drugs to suppress it, because they're kind of practicing older medicine. But back then when that's pretty much what was done, sometimes we ran into situations where by slowing the atrial fibrillation down with these so-called rate controlling medications, when the Afib went back to sleep and the

person's normal rhythm kicked back in and took back over control, sometimes those medicines would make the normal rhythm too slow. Because remember these rate controlling medications do not make the Afib go to sleep. Do not keep you in normal rhythm. They just slow your heart rate down no matter what rhythm you're in. So if you're in atrial fibrillation with a super fast heart rate having palpitations, then those medicines will slow that speed down so you can tolerate that episode a little bit better. But when you're back in normal rhythm, it's going to slow that rhythm

down and sometimes it can make it too slow. So back 10-20 years ago when that happened, then people would put in a simple pacemaker to treat the slow heart rate aspect of the treatment. So when they were in atrial fibrillation, the rate controlling medication would slow the rapid speeds of Afib down. But then when they were back in normal rhythm if they sometimes went too slow on those rate controlling medications, then the pacemaker would kick in to keep them from going too slow and therefore create this floor below which the heart rate wouldn't go. And

the medicines were treating the rapid speeds of Afib to try to slow down the faster speeds and keep the person in this middle range. So in those situations, was the pacemaker directly treating the atrial fibrillation? No. It was just treating the slow heart rates caused by the rate controlling medications. So by doing so it would allow the patient to be safely treated with these rate controlling medications for their atrial fibrillation. Number Seven: Catheter ablation treatment for atrial fibrillation is "All or Nothing." That is certainly not true. You need to not think about treatment with the

catheter ablation as being, "They either got all my Afib or they didn't!" It's it's not pass or fail. It's not all or nothing. Atrial fibrillation is a progressive rhythm problem. As you get older you are forming more and more Afib cells in the walls of your heart, and it is progressing. And the more walls you have Afib cells on, the more Afib cells you have total, the more it wants to wake up. The longer it wants to stay awake. And the more episodes and more time you spend in Afib total. So the percent of time

that you spend in Afib does actually go up the longer you've had atrial fibrillation. It is a progressive rhythm problem. It does get stronger as you get older. So like a forest fire. If the analogy was this is like a forest fire spreading in the walls of my heart and we're going on the inside to try to get rid of the forest fire or get rid of those Afib cells, whether or not we use an energy source to freeze the Afib cells or cauterize the Afib cells or the newest technology source of pulse field ablation

using electrical pulses to kill off these Afib cells, you're still trying to get rid of the forest fire little by little. And so therefore the bigger the forest fire, the harder it is to get rid of it completely. So one needs to think about the ablation as not being all or nothing. Pass or fail, They either got it or they failed. It's really not like that. It's how much Afib cells do I have? What stage of Afib am I in? How progressed is my atrial fibrillation? Which will explain why I'm going into it the amount

that I'm going into it. The longer I've had it. The more progressed it is. The more time I'm spending in atrial fibrillation. The less progressed I am. The earlier stage I'm at. The less episodes I'm having. The smaller the forest fire. So somebody with a much bigger forest fire, a much more progressed Afib, is going to need a much more complex ablation to try to even get rid of the bulk of it let alone all of it. That's why every time somebody does an ablation they are getting rid of some of the Afib. But whether

or not they're getting rid of enough so that you're mostly not in Afib or not in it completely. Whether or not they really get rid of the forest fire completely depends on what stage of Afib you are at and how big your forest fire is. Think of the ablation as turning the forest fire back to an earlier stage. Like turning the clock back to an earlier stage. The bigger your forest fire, the harder it is to get all the way to zero. But you can make it smaller so that you may have less Afib cells

on less walls, and it'll wake up less. It's like making it to an earlier stage. This this is why people who have much more progressed atrial fibrillation, if they choose to undergo an ablation, need to go to somebody who does more complex ablations. Easy is easy and hard is hard. To get rid of a 10% forest fire or somebody in atrial fibrillation at a very early stage, isn't very hard. So it doesn't really matter which physician you go to to get that done. But if you've been in atrial fibrillation for 8 or 10 years, and

you're in at 60 to 90% of the time, and you have many walls of your heart covered with atrial fibrillation cells, and your forest fire is very spread, then it does make more of a difference who you go to to do your ablation. Because not everybody does complex ablations. Some people do and some people don't. And even those who do vary in terms of how complex a procedure they can do and how much Afib they can actually get rid of. Some people who've done ablation for over 20 years can ablate very complex Afib like persistent

and long-standing persistent stages where the Afib is on four to six walls, and sometimes get rid of the bulk of it or sometimes even all of it in one sitting. Other people may be able to approach moderate complexity or moderate complex forest fires, but they may take three or four procedures to do it. And then there are some electrophysiologists who just aren't able to do more than one or two walls or basically simple, early stage paroxysmal atrial fibrillation stages. So if you have an early stage of atrial fibrillation, it doesn't really matter who you go

to. If you have a later stage atrial fibrillation, make sure that you go to somebody who does more complex ablations. Number Eight: Catheter ablation for atrial fibrillation is a cure. Unfortunately this is incorrect. Atrial fibrillation cannot be completely cured. The reason for this is because atrial fibrillation is a progressive rhythm problem. It progresses unfortunately as we age. As you get older, once you've developed these Afib cells and they start to randomly wake up, every year you get older your walls keep forming more and more Afib cells almost like a blocked heart artery that keeps getting

bigger and bigger and bigger the older you get. And the more walls you have these Afib cells on, the more often it wants to wake up and the less it goes to sleep. So you spend more and more time in atrial fibrillation. Well even if we do a successful catheter ablation procedure and turn the clock all the way back down to zero so that you don't have any more Afib cells and it's not waking up at all, why would it be a complete cure? It's going to actually start forming from wherever we get it to.

The analogy would be like a blocked heart artery. If you have a 10% blocked heart artery and has to be more than 75% blocked to cause chest pain, damage, and heart attacks, well you know 10% is not going to really hurt you. And in 5 years as it progresses it might be at 50%. And still that won't really hurt you. But in 10 years when it finally gets to 80-90% blocked and you have a small heart attack, then one of our Interventional Cardiologists or plumbers is going to go in and try to open it up.

Now if they happen to open it up back to 0 to 10%, are you going to celebrate and say, "Yay! My heart disease is cured! I'll never have another blocked heart artery!" No. Because we all understand that this is a progressive problem and that it's going to grow back from wherever they get it to. Which is why you want them to open it up as much as possible back to zero or 10% or less. Because then it'll give you another hopefully 10 years before it blocks back up to 80 or 90% blockage. But if they

only open it up from 80-90% blockage to 60% blocked, and now you don't really have chest pain because the blockage is under the 75% that will cause chest pain, damage ,and heart attacks, well you might feel good for a couple years. But because the coronary disease develops from wherever they open it up to, it's going to start growing from that 60% blockage back up. And within a couple years you may have another heart attack. Same thing with atrial fibrillation. You have a very advanced stage of atrial fibrillation and you have say 70 to 80% of

the walls covered with Afib cells and you're in it 70 to 80% of the time because there is a correlation between how many walls are covered with atrial fibrillation percent-wise and how often it's waking up and you're spending time in atrial fibrillation. If that's the case and somebody only goes in and does a little bit and does maybe one wall, a very simple ablation, and only gets rid of 10 or 20% of it, well it's going to grow back very quickly back to where you were and you're not going to get very much out of

that. But if somebody really actually has the skills to do a complex ablation and actually can get rid of all of it or almost all of it to 10% or less, then you might get many years before it develops back to the stage that you were at. So what you do in these more complex cases of atrial fibrillation is very important, and who you go to is equally as important. Because not all electrophysiologists perform the ablation at the same skill level and not all electrophysiologists do complex procedures. And even those of us who do complex

procedures, there's still a difference in terms of what is done and individual outcomes based on individual skill levels of the doctor.