Dr Singh performed one of the first Watchman Flx procedures, at Memorial Hospital yesterday! This is a new, exciting option for patients that want to get off blood thinners for AFib. To learn more about the WatchmanFlx, visit http://ow.ly/L4OX50Bi9lE To learn more about Dr Singh or any of our wonderful doctors, please visit http://ow.ly/a2sL50BhA2Z To make an appointment at any one of our 9 locations, please call: Duval: (904) 423-0010 Clay: (904) 375-8100 St. Johns: (904) 342-8300 Flagler and Putnam: (386) 446-9966 #FCHV #FirstCoastHeart #watchman #memorialhospital #DrSingh #TopDocs #jacksonvillecardiologist #cardiologist #cardiology #afib #AF #watchmanflx
Electrophysiologist, Dr. Dinesh Pubbi with First Coast Heart & Vascular Center discusses Atrial Fibrillation (AFib).
Is there a connection between AFib and Dementia?
One of the most comprehensive studies to date has revealed more evidence that people diagnosed with atrial fibrillation (AFib), a type of rapid or irregular heartbeat may be at greater risk for cognitive decline and dementia.
The new study doesn’t conclude if the association is more than a correlation, and there is no evidence showing atrial fibrillation is an actual cause of cognitive decline or dementia.
Dr. Lin Yee Chen, a cardiac electrophysiologist and associate professor at the University of Minnesota Medical School in Minneapolis who led the study stated that “the short answer is we don’t know. It is too early to say that atrial fibrillation directly causes cognitive decline.”
The new findings, published March 7, 2018 in the Journal of the American Heart Association, come from data gathered on 12,500 women and men from North Carolina, Maryland, Minnesota and Mississippi enrolled in the Atherosclerosis Risk in Communities study. Over half the participants were women and about a quarter were African-American.To read more about the study.
One of First Coast Heart & Vascular Center’s Electrophysiologists, Dr. Neil Sanghvi offers his viewpoint on this interesting study.
“The ARIC-NCS study highlights another risk associated with atrial fibrillation – the risk of worsening cognitive functioning and potential risk of future dementia.
“Asymptomatic” AF may not truly be asymptomatic since these future consequences of long-standing AF need to be considered. Talk to your physician about appropriate management including adequate anticoagulation.”
Dr. Pubbi talks AFib at Memorial Hospital.
Recently Dr. Dinesh Pubbi was invited to give a talk at Memorial Hospital here in Jacksonville about the effects of Atrial Fibrillation. Atrial Fibrillation is the most common type of arrhythmia. Dr. Pubbi discussed treatment options, including the Watchman implant device procedure that he performs at Memorial Hospital, to reduce the risk of stroke.
Heart Drug Warfin used to treat AFib tied to Dementia Risk
An interesting study was recently published showing that people with the heart rhythm disorder atrial fibrillation (AF) may be at a greater risk of developing dementia, and the quality of their drug treatment may play a role.
Researchers found that patients on the clot-preventing drug warfarin showed a higher dementia risk if their blood levels of the medication were frequently too high or too low.
This turned out to be true not only for people with AF, but also for those using warfarin for other reasons.
Dr. Neil Sanghvi commented on this study and article.
“I believe this study highlights the importance of monitoring warfarin levels closely and to consider alternate anticoagulation options if the warfarin levels are difficult to maintain. Patients should not become concerned if their warfarin level is in range > 75% of the time. This study also supports the importance of using anticoagulation in AF patients since patients with too low warfarin levels were also prone to dementia.”
SOURCES: T. Jared Bunch, M.D., Intermountain Medical Center Heart Institute, Murray, Utah; Gordon Tomaselli, M.D., chief, division of cardiology, Johns Hopkins University, Baltimore, and past president, American Heart Association; May 5, 2016, presentation, Heart Rhythm Society annual meeting, San Francisco
Please join us for a Healthy Hearts Support Group Meeting May 19, 2016
Thursday, May 19th @ 6PM
4670 Salisbury Rd. Jacksonville, FL 32256
Dr. Neil Sanghvi will talk about:
“What’s that fish flopping in my chest? Understanding Atrial Fibrillation”
Seating is limited please RSVP to jennifer.morrison@Firstcoastheart.com
Hors d’oeuvres & beverages will be provided.
A patient centered support group for discussing and understanding complete heart care. Attendees will find comfort and strength in education and self-awareness. Understand conditions of living with Cardiac Device Assistance, and connect with others to feel a sense of community. This forum is open to the public and free of charge. This group’s affiliation is not for profit.
Dr. Sanghvi was interviewed on First Coast Living and discussed the topics of Atrial Fibrillation, Pacemakers and Implantable Cardiac Devices. Dr. Sanghvi is an Electrophysiologist Cardiologist with First Coast Heart & Vascualr Center.
- What is a pacemaker and why would someone need one? Pacemakers are devices that are about the size of a silver dollar. They are placed under the skin usually below the collar bone. They typically have anywhere from 1-3 wires that enter the heart via a blood vessel under the collar bone. These devices are usually placed in patients who suffer from a slow heart beat which results in a number of symptoms including fatigue, shortness of breath, inability to exercise, lightheadedness, or fainting to name a few.
- What is a defibrillator, also known as an ICD, and why would someone need one of these devices? ICDs are implantable devices that are placed in similar fashion as a pacemaker. However, an ICD’s job is typically to treat fast and lethal irregular beats known as ventricular tachycardia (VT) or ventricular fibrillation (VF). Many people know that heart disease is the #1 killer in the US. What many do not know is that the reason most patients die is due to untreated VT or VF. Approximately 450,000 people die each year in the US from these arrhythmias. Patients at the highest risk include those who have had a prior heart attack, especially if this has resulted in a weakened heart muscle. Those with a weak heart muscle for other reasons are also at risk. Also, patients who may have had several episodes of passing out without an explanation should be evaluated since a small portion of these patients are likely suffering from VT and/or VF.
- If a patient needs to have a device implanted, what type of device should be used? This is a decision that is typically made by the implanting surgeon. There are several manufacturers of devices in the US. Many of the devices have similar features. However, there are some distinct differences.
- What happens if there is a problem with one of the wires or if one device type needs to be changed to another? Sometimes these devices may have a wire malfunction or one of the wires may be recalled due to a suspected risk of malfunction. Many surgeons often place a new wire in the heart and leave the old wire abandoned there since they are not capable of taking out the old wire. Unfortunately, this increases the risk of infections and for blood vessels to clot since there is more hardware in the body. Patients should seek out surgeons that specialize in lead extractions. Dr. Neil Sanghvi is able to utilize a laser to carefully and safely tease out the old lead that has scarred into the heart. The risk of a major complication is often less than 1-2% in many cases. The advantage is that it allows for less hardware to remain in the body which decreases the risks of infection and blood vessel clotting.
We are excited to announce that First Coast Heart and Vascular Center physician, Dr. Van Crisco is among the first physicians in Northeast Florida to implant the WATCHMAN device, a novel device for stroke risk reduction for patients with non-valvular atrial fibrillation who have problems taking blood thinners. This procedure is offered at Memorial Hospital in Jacksonville, Florida, thorough the Memorial Structural Heart Program where Dr. Crisco also implants transcatheter aortic valves for severe symptomatic aortic stenosis.
The WATCHMAN device is indicated for patients with non-valvular atrial fibrillation who are looking for an alternative to the long-term use of blood thinners, like Coumadin. The WATCHMAN device is an implantable acorn-shaped plug that closes off an area of the heart called the left atrial appendage where over 90% of clots develop that can lead to stroke. The device is implanted through catheter access from the groin, and prevents damaging blood clots from forming. By shutting off the left atrial appendix, the risk of stroke is diminished, and patients may be able to discontinue taking blood thinners like Coumadin. This procedure is FDA approved and typically requires an overnight stay in hospital.
“For patients with non-valvular atrial fibrillation, the WATCHMAN device gives patients a cutting-edge stroke-risk reduction option.” Dr. Crisco says, “The WATCHMAN device can potentially relieve patients from the complications and bleeding risk issues of long-term blood thinners.”
Atrial Fibrillation is a very common abnormal heart rhythm where the upper chambers of the heart beat with an irregular rhythm, predisposing patients to increased risk for stroke over time. Atrial fibrillation affects over 5 million Americans. Approximately 15-20% of all strokes occur in patients with atrial fibrillation, and strokes from atrial fibrillation are typically more severe then other causes. Currently, Coumadin and other newer anticoagulant blood thinners are the most common treatments to reduce stroke risk in patients with atrial fibrillation. Coumadin specifically, as well as some other blood thinners, is not well tolerated by many patients and carries a significant risk of bleeding complications in particular patients. Almost half of atrial fibrillation patients suitable for Coumadin are currently untreated due to tolerance and adherence issues. WATCHMAN gives these patients an innovative alternative to Coumadin for stroke risk reduction.
To learn more about atrial fibrillation and treatment options to reduce your risk of stroke and to learn about the WATCHMAN device, please call 904.423-0010 to make an appointment. Device specific information is also available at Watchman Implant Device.
What does your sex have to do with it? How to keep your heart ticking.
Join us for a FREE presentation, lunch, and discussion with heart expert Dr. Neil Sanghvi. The event will be held Wednesday, July 29 from Noon to 1pm at the WJCT Studios.
You will benefit from attending this event if you are interested in learning about the facts, symptoms, and treatments of irregular heart rhythms as well as understand the differences between women and men when it comes to heart care.
Surprising but true: Heart failure is more common in women than men, yet women receive treatment 2X less often than men. The focus of this community heart education talk is to discuss available therapies to treat irregular heartbeats and how women are treated differently than men.
Learn more about:
- How to decide if a cardiac device is right for uou and life after implant.
- The role of catheter ablation for the treatment of atrial fibrillation (Afib).
- Men are Mars and Women are from Venus. Does it matter?
Dr. Sanghvi is recognized as a leader in the field of clinical electrophysiology. His interests include atrial fibrillation, novel techniques for stroke prevention, and device therapy for heart failure and irregular rhythms.
Is This Just an Irregular Heart Beat or Can I Have a Stroke?
Is there a Cure? Maybe, with Ablation.
Atrial Fibrillation – also known as AFib or AF – is the most common arrhythmia. It affects more than 2.5 million American adults and 4.5 million people living in the European Union, and accounts for approximately one-third of hospitalizations for cardiac rhythm disturbances.
It is characterized by rapid and irregular heartbeat caused when the top chambers of the heart (the atria) quiver (fibrillate) erratically, sometimes faster than 20o times per minute.
AFib can also increase the risk of stroke fivefold. It is estimated to be responsible for 88,000 deaths and $16 Billion in additional costs to the U.S. Healthcare system. As the world population ages, the prevalence of AFib is projected to increase. In fact, in the next 30-40 years, the number of people diagnosed with AFib in the U.S. is expected to more than double.
Here’s how patients have described their experience:
“My heart flip-flops, skips beats, and feels like its banging against my chest wall, especially if I’m carrying stuff up my stairs or bending down.”
What happens during AF?
Atrial Fibrillation (AF) is the most common type of irregular heartbeat. Normally, you heart contracts and relaxes to a regular beat. In atrial fibrillation, the upper chambers of the heart (the atria) beat irregularly (quiver) instead of beating effectively to move blood into the ventricles. About 15-20 percent of people who have strokes have arrhythmia.
Additional common symptoms of atrial fibrillation
Sometimes people with AF have no symptoms and their condition is only detectable upon physical examination. Still, others may experience one or more of the following symptoms:
- Rapid and irregular heartbeat
- Fluttering or “thumping” in the chest
- Shortness of breath and anxiety
- Faintness or confusion
- Fatigue when exercising
- *Chest pain or pressure
*Chest pain or pressure is a medical emergency. You may be having a heart attack. Call 9-1-1 immediately.
Are there different types of AF? Do they have different symptoms?
The symptoms are generally the same; however the duration of the AF and underlying reasons for the condition help medical practitioners classify the types of AF problems.
- Paroxysmal fibrillation is when the heart returns to a normal rhythm on its own. People who have this type of AF may have episodes only a few times a year or their symptoms may occur every day. These symptoms are very unpredictable and often can turn into a permanent form of atrial fibrillation
- Persistent AF is defined as an irregular rhythm that lasts for longer than 7 days. This type of AF will not return to normal sinus rhythm on its own and will require some form of treatment.
- Permanent AF occurs when the condition lasts indefinitely and can no longer be controlled with medication.
Over a period of time, paroxysmal fibrillation may become more frequent and longer lasting, sometimes leading to permanent or chronic AF. All types of AF can increase your risk of stroke. Even if you have no symptoms at all, you are nearly 5 times more likely to have a stroke than someone that does not have atrial fibrillation.
Know your treatment goals
The treatment goals of atrial fibrillation (AF) start with a proper diagnosis through an in-depth examination from a physician. The exam usually includes questions about your history and often an EKG or ECG. Some patients may need a thorough electrophysiology study.
Prevention and Risk Reduction
After a patient is diagnosed with atrial fibrillation, the ideal goals may include:
- Restoring the heart to a normal rhythm
- Reducing an overly high heart rate
- Preventing blood clots
- Managing risk factors for stroke
- Preventing additional heart rhythm problems
- Preventing heart failure
1. How will I prevent stroke?
Depending on your risk, you will likely either need aspirin or warfarin or another type of anticoagulation medication.
2.Are there additional lifestyle modifications important for stroke prevention?
3.What is my C.H.A.D.S. risk? Congestive heart failure Hypertension Age (75 or greater) Diabetes Stroke (prior episode)
4. Are there options to control my heart rate and this irregular heart rhythm?
Based on your past medical history and risk for having a future stroke, there are several options for you and your health care provider to discuss in order to manage your AF.
Medications for Atrial Fibrillation (AF)
Medications are often prescribed to prevent and treat blood clot which can lead to a stroke. The longer you have untreated AF, the less likely it is that normal rhythm can be reestablished.
Medication options may include blood thinners, rate controllers, and rhythm controllers. Lists included here are not intended to be comprehensive, and we encourage you to contact our office to keep up with the newest in AF medication options.
Preventing Clots with Medication (antiplatelets and anticoagulants)
Drugs such as blood thinners are given to patients to prevent blood clot formation or to treat an existing blood clot. Examples include Aspirin, Warfarin and other FDA Approved anticoagulants.
Important Precautions when taking anti-clotting medications
- Call your healthcare provider right away if you have any unusual bleeding or bruising
- If you forget to take your daily anticoagulant dose, Don’t take an extra one to catch up! Follow your healthcare provider’s directions about what to do if you miss a dose.
- Always tell your doctor, dentist and pharmacist that you take one of these medicines.
- Many drugs change the effects of these agents on the body. Even vitamins (and some foods) could change this effect.
Heart Rate Controlling Medication
Beta blockers, Calcium blockers and Digoxin are drugs used to slow the heart rate. Most people can function and feel better if their heart rate is controlled. Some examples may include Carvedilol, Metoprolol, Atenolol, Dilitazem, and Verapamil.
Heart Rhythm Controlling Medications
Once your heart rate is under control, the next management consideration is usually treating the abnormal heart rhythm with medications to restore the heart rhythm to normal. Your healthcare provider will most likely want to monitor progress closely. Examples include Flecainide (Tambocor), Propafenone (Rhythmol), Amiodarone, Carodarone or Pacerone, Sotalol (Betapace), or Dronedarone (Multaq).
The decision to use electrical cardio version
Your provider may recommend a trans esophageal Echocardiogram (TEE) as a first step. The TEE procedure involves swallowing a small ultrasound device that allows the healthcare team to look inside your heart atria for blood clots.
Radiofrequency Ablation or Catheter Ablation
Catheter ablationis an atrial fibrillation treatment that is done by a specialized cardiologist, called an Electro physiologist (EP) who deals with irregular heartbeats (arrhythmias).
It is a minimally-invasive procedure that is generally less invasive than surgery. It is a commonly-used treatment for atrial fibrillation as well as other cardiac arrhythmia. Like other atrial fibrillation treatments, it is most successful in treating paroxysmal atrial fibrillation, but much progress has been made in treating persistent and long standing persistent as well.
Ablation is used for cardiac arrhythmias when long-term medications or electrical cardio version are either not preferred or were not effective. Or when the patient prefers no to take any medications. Before ablation surgery, electrical mapping of the heart is performed. An electrically sensitive catheter is used to map the heart muscle and the origins of the “extra” electrical activity throughout the heart. The map tells the physician which areas of the heart are creating problematic electric signals that interfere with the proper rhythm. After a single procedure, more than 60-70% of patients with an otherwise normal heart can enjoy freedom from arrhythmias according to studies that have followed patients typically for one year. With two or more procedures, the efficacy can be as high as 80-90% in other recent case studies.
Catheter ablation is the only cardiac procedure that can be correctly called curative (No, stents are not curative)
How is an ablation performed?
A catheter (thin, flexible tube) is inserted into the patient’s blood vessels and is gently guided to the heart. The physician carefully destroys malfunctioning tissue using the catheter to deliver energy (such as radiofrequency, laser or cryotherapy) to scar the problematic areas. The scarred areas will no longer send abnormal signals. If successful, the heart will return to a normal rhythm. This minimally invasive procedure usually has a short recovery period. Patients are generally placed on a short course of anti-arrhythmic drugs while the procedure takes full effect.
Common types of Ablation include:
- Pulmonary vein isolation ablation (PVI ablation or PVA) In some AF patients, fibrillation is triggered by extra electrical currents in the pulmonary veins. During this procedure, the catheter tip is used to destroy the tissue that is sending the extra currents and, in most cases, normal heart rhythm returns.
- AV node ablation with pacemakers. In other AF patients, the trigger for their AF occurs in the AV node (the place where the electrical signals pass from the atria to the ventricles). The catheter is placed near the AV nod and a small area of tissue is destroyed. A pacemaker is then implanted to restore and maintain the heart’s normal rhythm.
At First Coast Heart & Vascular Center, our group treats atrial fibrillation conservatively with medical treatment, however for select cases our board certified electrophysiologist, Dr. Dinesh Pubbi can perform Atrial Fibrillation ablations at the hospitals that have state of the art EP labs.