Episode 194: Aging Well with AFib w/ Dr. Aseem Desai

In this episode of the Aging Well Podcast, Dr. Armstrong is joined by Dr. Aseem Desai, a accomplished cardiac electrophysiologist and the author of Restart Your Heart: The Playbook for Thriving with AFib. Dr. Desai shares his journey into cardiology, explains what AFib is, and discusses the inspiration behind his book. We discuss who is at risk for AFib, treatment options, common misconceptions, and the vital role of lifestyle changes in managing the condition. Dr. Desai also highlights the latest advancements in AFib treatment and addresses the psychological aspects of living with AFib. Tune in to learn practical tips for thriving with AFib and how to maintain a good quality of life despite the condition. Don’t miss this insightful conversation aimed at helping you… age well.

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Transcript

0:05

Our guest is Dr. Asim Desai, Stanford trained cardiac electrophysiologist, author, and speaker, specializing in heart rhythm disorders and advanced catheter ablation techniques. With over two decades of experience, he integrates heart health with mental well being. Focusing on the stress response and autonomic nervous system. As co director of Mission Heritage Heart Rhythm Specialists and former faculty at the University of Chicago, he advances patient care and advocates for physician mental health, teaching mindfulness to healthcare providers. Dr. Desai is the author of Restart Your Heart, the playbook for thriving with AFib, and writes the Mindful Beats column in Psychology Today, Exploring the Brain and the Mind. Heart Connection. He is also a contributing writer for Thrive Global and KevinMD.

jeff_1_09-14-2024_061604: 0:55

Dr. Desai welcome to the aging well podcast and we thank you for joining us today Let's have you start by telling us a little bit about yourself and how you became interested in the field of cardiology.

squadcaster-ef0f_1_09-14-2024_061653: 1:08

Thanks, Jeff. Thanks for having me today. And hello to all your listeners. So my story, I was about three and my dad actually had a heart attack in the middle of the night. And so I woke up in the neighbor's house, having no idea what was going on. And Learned only later. And so that was almost like an exposure at a very young age without being able to process much. And then as I got older, I saw my dad was an oncologist. I saw him kind of retreating from life. So he saw himself, I think is broken. And it was, it was sad because he was not. for participating in activities and wouldn't want to play out in the yard because he was afraid he was going to have another heart attack. And, you know, it was just sort of a sad thing to see. And I think that happens to a lot of patients with any kind of health condition, but in particular the heart. And so it was interesting. I wanted to follow in his footsteps, like many kids do with their parents. And so I wanted to be an oncologist. then as I started going through For even college a little bit in premed, but certainly in medical school, I started realizing that while oncology was really interesting. It wasn't quite pace for me. And I think I needed to see more of an immediate transformation for people. If I. Employed a therapy to see them, markedly improve. And so in the middle of medical school, unfortunately, he was traveling in India to visit a relative. And then I got a call in the night that he dropped dead. He had a cardiac arrest. I was at Northwestern in Chicago. so my brother and I had to drop everything and travel across the world to India. my mom was there with him. within a few days, I found myself cremating his body and spreading his ashes through India and Ganges river. And just like this surreal nightmare. And when I came back, I had to go right back into. medical school, there wasn't really much time to process. I didn't realize it at the time, but that sense of not having control over the situation and that sense of suddenly losing someone really did impact me, I think, at my brain's level. And it kind of gets into the next book I'm working on, but the whole idea of trauma. And post traumatic growth and how it initially spiraled me into a depression, but I think eventually as I process things, and especially when I was in my residency training at Stanford and in the coronary care unit in particular, we would see patients come in with cardiac arrest and we would resuscitate them and, you know, In some cases, we were not successful, but in many cases, we were and just being able to literally see someone come back to life and a team based approach. When you're in a code, there's this expression. When you arrive at a code, you should take your own pulse first. And this whole notion of working with the respiratory therapist and working with the pharmacist and working with the nurses and anesthesiologists, kind of in this unison of bringing someone back to life. with regards to heart attacks, many times it's due to a clot in an artery. we put in a stent or open up the vessel and so we would see a lot of that too. I think, I don't know about you, Jeff, but a lot of times people when they're deciding on an occupation, so much of it is influenced by mentorship and just these people that come along your path, whether it's a teacher or someone who took interest in you. one day I was reading EKGs and that was part of our job as interns. reading electrocardiograms, the tracings of the heart of all the patients in the hospital. That was one of our jobs. And I was in the office that was just outside of the cardiac electrophysiology division and cardiac electrophysiology is the sub branch of cardiology, where we specialize in the heart's electrical system. so we specialize in the rhythm. So if there's abnormal rhythms, irregular rhythms, including cardiac arrest, are a lot of different treatments that we can employ. And so this one of the electrophysiology attendings took an interest in me. We just kind of hit it off and the rest is history. I just found it It's probably the nerd in me. But with cardiology, you have the interventional cardiologists, the ones who come in the middle of the night to open up the artery, and we kind of call them the cowboys. We call them the the plumbers. There's lots of different expressions, but the electrophysiologists are sort of the nerds or the intellectuals, and we apply a lot of logical reasoning and deductive reasoning. And when we're making diagnoses it's. a good combination of patient connection, human connection in the office, but then also the procedural piece. we do pretty high risk procedures such as, managing people who are in cardiac arrest, or there's a condition called ablation, a procedure called ablation, where we can identify the short level circuits in the electrical system that can cause people to have rapid or have cardiac arrest, There's one condition in particular called atrial fibrillation, which I had written a book about, there we can actually cure people. In many cases, we can cauterize these spots or use different technologies. It's almost like repairing the insulation around a broken wire. that really, did it for me. I mean, we use robotics and all sorts of cool technologies, but it is interesting. I feel a little bit like the black sheep in my field because I was a philosophy major in college. I kind of take a little bit of that approach, this sort of right brain approach to the practice of medicine. I have this creative outlet of writing playing guitar and singing and things like that. And I found that music has been sort of this interesting connection with what I do for a living because the heart's rhythm is not unlike a musical rhythm you can have irregular Beats irregular notes, you can have chaotic symphonies, like flight of the bumblebee. in that particular case, it's kind of like an arrhythmia. our job is to restore the heart into a metronome, regular kind of rhythm. that's the story in a nutshell, in terms of the inspiration piece. You know, I think starting as a personal tragedy, and combining it with an intellectual interest. And then I think someone just typed. Taking an interest in me, to be honest, and, uh, kind of led me here. 20 years later.

jeff_1_09-14-2024_061604: 7:21

There are so many different directions I can go from your introduction and I got to rein myself in and stay with the path, we'll get back to the mental health piece of that. but it just kind of remind me, I'm an exercise physiologist. I have my PhD in that. when I got my master's degree, we had basically two options. This was almost 40 years ago. It's either cardiac rehabilitation or corporate fitness, and I wasn't as enthralled because the prescription for exercise for somebody post heart attack is really minimal. You have less freedom to be creative, and I'm much more like yourself. I want to. I'm kind of that more creative side of my field and kind of tying in the mental health, you know, I teach my students now that any kind of intervention, exercise medicine, whatever should be biomechanical, psychosocial, instead of just simply biological. So, as I'm listening to you, I'm thinking about I find that all fascinating. And it's only been recently that I've started, teaching a little bit more ECG. I was never that enthralled with ECG because it was almost like memorizing the rhythms. But when you get down to what's causing those rhythms, more of a cardiac electrophysiology, it's fascinating because it's telling you what's happening in that heart based on what point in that electrical rhythm is being disrupted. And in the fact that that can direct this into what do we have to do to go in and fix it is fascinating so let's just jump into what is a fib.

squadcaster-ef0f_1_09-14-2024_061653: 9:22

Absolutely. And to touch on what you were saying, we use a lot of the notions of exercise, physiology and cardiology. using something like oxygen consumption to determine people who are transplant candidates or heading down the route of transplant. the autonomic nervous system, which is heavily involved with. cardiac electrophysiology and connecting the brain and the heart, definitely has some of our understanding of it from the realm of exercise and the vagal nerve and sympathetic nervous system atrial fibrillation, I call it the electrical epidemic, or arthritis of the heart. the number one risk factor for this heart condition is age. when you're over the age of 40. one in four people at some point in your lifetime will get atrial fibrillation. So one in four people that are listening to the podcast, it's about estimated that six to 7 million Americans right now have atrial fibrillation, many of which don't realize they have atrial fibrillation. in about 2050, it's estimated to be about 16 million, probably even more. And again, our population is aging. People are living longer. And what happens just like many other areas of body, like. I mentioned arthritis is that you get scar tissue development. You have natural destruction of cells, apoptosis, and these areas of scar to healthy parts of the electrical system can create what we call a re entrant circuits, literally short circuits. And so with atrial fibrillation, people usually think of heart disease. They think of, Oh, I have chest pain. I'm having a heart attack. The electrical system is tricky. It's kind of like taking your car to the mechanic. With AFib, especially in the beginning, it's called paroxysmal, where you go in and out of it, and it can be random. You could have it in the middle of night, not even realize it. in fact, obstructive sleep apnea and other kinds of sleep apnea, it's a huge risk factor for atrial fibrillation. And, you know, we can touch on the different risk factors, but in essence, it's cardiac chaos. if we want to go back to the music analogy, it's, you know, It's basically your normal heartbeat originates in an area called the sinus node, which is in the upper right portion of the heart in the right atrium. it travels down the middle of the heart to an area called the AV node. And branches down into the lower portions of the heart, the two ventricles and what are called the bundle branches. So it's almost like this highway that splits with atrial fibrillation and originates from the left upper part of the heart called the left atrium. in an area called the pulmonary veins. these are the blood vessels that connect your lungs to your heart. when you get oxygenated blood and it's returning back to the left side of the heart to pump out to the body, it goes through these veins. interestingly, these veins, are not supposed to have electrical components to them, but these veins embryologically in some patients. with age, you can get tissue in the heart chamber, which is electrical. All of the heart inside of the heart is electrical. it can actually grow into the veins and, and create these muscular sleeves. the, nature of a fib is chaos. these four different veins have several cells or circuits in them, and they can all fire. At once. So you can get this chaotic rhythm. And what happens is when you have multiple things firing in a chamber, that chamber doesn't contract properly. You know, you're not having a uniform muscular contraction, because the heart's a muscle and it's got electrical system that drives it. It's an engine, you know, plumbing and electricity and valves. so when you don't have the proper contraction, the blood pools. you cut yourself and blood just sits there, it'll clot. And that's the same thing that happens in a chamber that's not moving properly. And then that clot, unfortunately, the heart's connected to all parts of the body and in particular, the brain. So a clot forms in the heart and it goes to the brain and causes a stroke. one of the most common presentations for atrial fibrillation is stroke, what we call cardio embolic stroke, that goes from the heart to the brain. many people don't realize they're having atrial fibrillation because the heart's electrical system, like I said, it can come and go. So when you show up to a doctor's office and have an electrocardiogram or someone listens to your heart, we're in an ER or urgent care or whatever. may have a normal rhythm. And then like two hours later, and me going to a fib, some people will feel a rapid heartbeat or a sense of rapid irregular rhythms. Some people just feel anxiety, when you have adrenaline and cortisol and all the stress hormone release, when your heart's going out of whack, it'll impact your amygdala, it'll impact different parts of your brain. So you get kind of hyped up and, you know, survival, flight or flight response. we've had patients get misdiagnosed as panic attacks. They'll show up to the ER and they'll be in a normal rhythm. at home, they were in rhythm atrial fibrillation. There's another one called SVT that can happen to younger patients, with AFib, the game changer, we traditionally have had these heart rhythm monitors that you can wear, these clunky Holter monitors that have multiple electrodes. only good for 24 hours. over time, we've developed more sophisticated medical grade monitors. There's one now almost like a patch, like a Band Aid that goes on the skin that's good for 14 days. And now there's one that we can implant in the office. the size of a matchstick called an insertable loop recorder. That has the ability to record the heart's rhythm for up to four and a half years and interfaces with your smartphone to send signals to us. It monitors your heart rhythm 24 seven. And so these cases with uterine fibrillation where people may not feel it, they may not have the palpitations. The only symptom people may have with AFib is fatigue. just not feeling good the heart's an engine if it's not pumping properly, which is what, when you have that chaotic rhythm, the heart's not having enough time to fill up with blood and there's an irregularity to the rhythm. in a sense, your pump performance drops. So when you go into AFib, you lose about 30 percent of the pump efficiency of your heart. So it would make sense that symptoms like fatigue would be a common symptom. If someone's reporting to you fatigue and you're listening to their heart in the office, you don't necessarily think right off the bat AFib. Apple and other companies have come out with devices that can monitor for AFib. So that's why you've seen this explosion in the wearable market about detecting AFib, starting with a device called Kardia, and then it transitioned over to these wearable devices. I have about an 80, 85 percent ability to detect AFib properly. there's limitations, but it has been a game changer. I've had people come into my office diagnosing their own AFib it is one of the most common heart rhythm disorders worldwide. one of the biggest risk factors is getting older, especially over the age of 65. it's a big cause of stroke. congestive heart failure, and reduced quality of life, there are many treatments available nowadays that even to this day, and nothing against my cardiology colleagues, but even cardiologists not necessarily aware of the most advanced techniques we have for atrial fibrillation. So A lot of people are told, especially if their AFib has progressed. it's kind of like cancer. If it's like cancer. when you're going in and out of it, the paroxysmal stage, it's like limited cancer. It's like breast cancer in situ or limited lung cancer, the heart's a muscle, you get muscle memory, just like any other muscle. So when you go into AFib. The electrical system literally changes at a cellular level. You have what we call changes in gap junctions, which are the connections between cells and the electrical system. as these change, you actually lower the threshold to go into atrial fibrillation and all it takes is a couple extra beats to set off the circuit. if you're predisposed to it, we can talk about the risk factors and genetics and other factors with AFib, As you have progression of that muscle membrane, the heart wants to stay in it longer and longer until eventually just stay in it. And that's called persistenafib, and that's where people really can't tell, and believe it or not, Jeff, we have people showing up to a colonoscopy or a pre op for gallbladder surgery, and they're in atrial fibrillation, and they have and that's when they get referred to us. you talk to the patient, they're like, I don't feel anything. But it's not until you restore the rhythm, until you restore that 30 percent pulp efficiency that they lost, But they actually feel substantially better. So it's like taking someone as a bad knee who adjusted their because they can't walk as far, they're parking closer to the supermarket or whatever. With AFib, it's the same thing. People don't realize it's a subtle, silent cancer. they just kind of adjust their lifestyle and think, Oh, it's just, this People think, I thought I was just getting older, you know? And then once you realize that. the heart's rhythm is the rhythm of life and so critical. And it makes sense why people feel fatigued. People can, in this gets into the thing you mentioned, Jeff, about mental health, people can feel depressed as a result of AFib because they're not getting blood flow to their brain or having a balanced, cognitive mental health picture. we've seen cases where when I've restored the rhythm, A person's depression actually lifted spouses and partners often notices, you know, the patient may say, don't feel anything, but you talk to the spouse and they're like, yeah, over the last six months, it's not been himself. The color isn't being as good. And that's usually when the AFib transition from going in and out to that continuous AFib. like cancer. You know, in the past, people who had metastatic cancer, you know, they're often told not much could be done. now we know with immunotherapy and all sorts of things, you can, you can manage these really advanced cancers. So similar with AFib, people who go into this continuous persistent AFib, are being told nothing can be done it's nothing against the people that are telling them that. It's just an issue of heart's electrical system is so complex. You've got people like me. electrophysiologists, that's all we do. We live and breathe things like a fib. we know what we're able to do now with technology. we've taken people who were told nothing could be done and restored their rhythm and their life has changed dramatically. that's actually what prompted me to write this book that I mentioned, restart your heart, because I had a guy who broke down crying at the checkout line at the clinic. And he was told by. two or three cardiologists, nothing could be done. You had to stay on drugs. And don't get me wrong, in some cases that's the case, but we were able to restore his rhythm through a combination of modalities, including pacemakers and other things, and this ablation procedure I mentioned. it's almost like having a multimodal treatment for metastatic cancer, like chemo and radiation, It's the same approach. when you get that heart into rhythm, it becomes a virtuous cycle. when you're out of rhythm, it's a vicious cycle, more and more AFib. AFib begets AFib is the term we use. But when you're in a normal rhythm called normal sinus rhythm, normal sinus rhythm begets normal sinus rhythm. So you can retrain heart muscles. So That's the shortened, not so short discussion on atrial fibrillation. I hope that comes across in a unified way. But I think of it as cardiac chaos. I think of it as, arthritis of the heart, to cancer of the heart. But I don't say those things to scare people. I say it to empower people to realize that. things can be done and I would advise people, you know, if there's one take home message is learn how to take your pulse, you know, learn how to take your pulse in your neck or your wrist, part of your daily routine to check, especially if you have risk factors like obesity, diabetes. sleep apnea, thyroid disease. There's a variety of other conditions that can contribute. And then the last piece I'll say is athletes are getting a lot of AFIB now, which is kind of a cool aspect of nature that we have high endurance athletes that have low resting heart rates because of the vagus nerve, because of that cardiac conditioning. And it turns out the vagus nerve in some patients can actually be a massive trigger for AFIB. A lot of people get. A fib in the middle of the night when the heart rate slows down and it's easier for these extra beats to trigger a fib. So the vagus nerve, you know, all of these parts of your autonomic and nervous system are there to protect you and help you survive. But anything out of balance, whether it's sympathetic or parasympathetic can be a problem. So in the setting of a fib, The vagus nerve has definitely been found in, in athletes in particular. And athletes, once they hit their forties and fifties, that's when the AFib comes out and a lot, a lot of people told, Oh, I had an irregular beat or skipping beats when I was younger. And oftentimes those are benign, But as people get older, that can turn into a fib, especially there's a lot of stuff on genetics and a fib. if you were to look at the people who have a fib people may recognize Larry Bird, Billy G King, Howie Mandel, Kevin Nealon, George H Bush. He had thyroid toxicosis. He had thyroid issues, which triggered a fib. And then in modern day, Kenley Janssen for the LA Dodgers, he had a fib. there's a lot of sort of more higher profile people now that have come out and become advocates for this, but it can affect anyone. Healthy or unhealthy. the biggest problem we're running into with AFib is obesity. I think of AFib as a body out of balance, if you go into AFib, something is off, like, stress or weight it's important not to just put a catheter in the heart and fix it, but you have to lose weight. You have to optimize your health. And, with this podcast aging well, I love the title by the

jeff_1_09-14-2024_061604: 22:21

Thanks.

squadcaster-ef0f_1_09-14-2024_061653: 22:23

the, know, the nature of a fib being so common in people as they get older, it's really important for people to, if everyone could wear an apple watch, great, I'm not endorsing apple, but if anyone could wear some kind of wearable now, my colleagues will probably curse me for that because one of the challenges is that our patients, especially our engineers and those people who really like data are often, anxious when they see changes in their heart rate and they don't know how to interpret it. So everything has to be taken into context, but I would just encourage people to get informed, you know, Google AFib, look it up. there's a lot of information on there and it's important to get informed about it.

jeff_1_09-14-2024_061604: 23:03

Today's an exercise physiologist. I want to really just geek out in this whole conversation because I'm hearing so much interest and so many questions and directions that I can go with this interview. I was trained as an exercise physiologist that hypertension is the silent killer. But as I'm listening to you, I'm hearing much more that a fib is probably much more of the silent killer because it's so connected to so many other things. you talked about depression, anxiety, and you mentioned Howie Mandel. I just recently saw a piece where they were talking about him being outed on the Howard Stern show for his depression and his mental health. But you know, he's got atrial fib. And then we've also had individuals on the podcast that have talked about the risk of sleep apnea for Alzheimer's disease. And I don't know, maybe you can elaborate on this a little bit if there's any literature out there that suggests that AFib is actually even an increased risk for, some of the multiple different forms of dementia that we see in the older population.

squadcaster-ef0f_1_09-14-2024_061653: 24:04

Yeah, actually, it's interesting. dementia has a couple of different mechanisms and several different mechanisms. One is Alzheimer's and, you know, other is multi infarct dementia, where you have tiny little strokes that go to different parts of the brain. AFib would be a big cause of multi infarct dementia because when those clots break off and go to the brain, they don't just go to one part of the circulation. They often shower the brain with tiny little clots and that's different than other mechanisms of stroke. So if you have a bleed in the brain, a subarachnoid hemorrhage, for example, that usually affects one area. If you have a big or plaque and you're carotid, That usually affects one area hypertension causes lacunar strokes in many cases. And so you can get this pattern on imaging where you have multiple areas, but there are specific patterns that you can see in the brain with regards to a fibs impact. And, you know, dementia, You know, in the end, with regards to the cognitive piece, of dementia, the AFib and the clots, don't spare the prefrontal cortex. So, you definitely can see that connection. there is a strong association between AFib and dementia is what I'm trying to say. But what's interesting is a catheter ablation of AFib, which we can talk about, that's actually been shown to potentially reduce the risk of developing Alzheimer's. And that's the part that's crazy because you're saying to yourself, if AFib is forming a clot that's going to the brain, I can understand multi infarct dementia, having an impact, but why Alzheimer's? what we're learning with AFib, just like many other things in the human body, is there's a big component of inflammation that's a trigger for AFib. So there are inflammatory markers that go up, just like with heart attacks, that there's data that, like, your diet and your gut health Can impact your risk of a fib. So, you know, I really kind of look at the body, in a holistic standpoint, and I'm not just talking from a standpoint of integrative medicine and some of the great things people are doing there. I'm talking about the standpoint of multi organ systems and in particular nervous systems, the enteric nervous system, the cardiac nervous system, the central nervous system, the autonomic nervous system. all of these things are interconnected. different hormones, neurotransmitters, circulation, like all it's interconnected. And I think you're raising a really important point because, it's not that necessarily fixing someone's AFib is going to, get rid of their dementia, but a lot of it's about reducing the progression. And I think that if you have patients that have dementia, I would definitely have strong considerations for doing some kind of monitoring to see if they may be going in and out of AFib. Because if that person with dementia shows up to an office and has a 12 lead EKG and they're in normal rhythm, just by virtue of having dementia being older, or maybe even having a younger onset of dementia, We also see connections with Parkinson's related dementia. do a heart rhythm monitor, even do like we have two week and four week kinds of simple monitors that, that can detect a fib. And I mentioned this, this implant we can put in the office. Like you have people that come into the hospital with a stroke, that they can't figure out the cause that's about 30 to 40 percent of patients that come into the hospital with a stroke. And we have no idea what caused it. Like the carotids are okay. There's nothing in the cerebral circulation, no big area that, had a bleed or had a plaque, there's no evidence. It wasn't a hypertensive stroke. And when you implant these devices, it's been shown that you can detect a fib up to a year out after a stroke event, like a year out. And that was the cause, but wouldn't have detected it any other way unless you had one of these implants. And pacemakers and implantable defibrillators, those devices have the same technology. They can also detect AFib. there is definitely a strong interest in the connection between AFib and dementia through multiple mechanisms. But what I find most fascinating, and I'm not pushing, you know, a procedure like catheter ablation necessarily, but this, this connection between reducing the risk of Alzheimer's. We haven't determined it's causal yet, but there's definitely enough. There's some investigators out of Intermountain Health in Utah and University of Utah that did a lot of work in this area, John Day and Jared Bunch. These are electrophysiologists. they had a very large database of patients who they have done atrial fibrillation ablation on and they followed these people and did analyses and found that Connection between development of dementia or reducing the risk of dementia and atrial fibrillation

jeff_1_09-14-2024_061604: 28:34

So one of the questions I wanted to ask you and I started to feel like you've answered it, but I'm also feeling like it really isn't easily answered is what are the risk factors for a fib? I mean, it seems like there's almost a plethora of them and you can't just narrow it down.

squadcaster-ef0f_1_09-14-2024_061653: 28:54

Believe me. And I need to be careful. I don't want to send a message to your listeners to be terrified of their heart. And they're like, everyone's going to have a film. Not at all. That's not what I'm trying to say. remember about 6 million Americans have it right now. So it's not like everyone has it and it's not like every athlete has to be terrified of being an endurance athlete. let's talk about the risk factor. So let's, let's go backwards maybe. So if a fib is a fire. risk factors of the wood. if the risk factors are out of control, the wood gets drier and you get kindling. all that's needed is the perfect storm of matches in the matches is what we call triggers. So if you imagine triggers like tripping an electrical circuit, you imagine the risk factors is the wood or like frayed insulation. And then you imagine the fire of a fib. So the risk factors I mentioned. age, scarring, anything that causes scarring. age is a big one. But if you look at obesity, there's a very strong association between obesity and atrial fib. Obesity leads to hypertension, leads to diabetes, leads to sleep apnea. And even independent of the obesity, sleep apnea is a big one. 50, it's estimated that 50 percent of people who have AFib actually have sleep apnea, either obstructive or central. And I think a lot of people, I mean, you know, know this probably from your other shows, but a lot of people don't realize you don't have to snore to have sleep apnea. I mean, that's I think something that a lot of people get hung up about. And we have slow homes. I order a lot of home sleep studies on our patients, even people who are thin, et cetera, because especially if their AFib is occurring in the middle of the night, it really makes you kind of think that sleep apnea may be a cause sleep apnea by dropping the oxygen levels, even transiently, that actually affects electrical system of the heart. So that drop, that hypoxia affects the electrical system and changes it from a cellular level. you have high blood pressure. That's a big one. That's a risk factor for AFib. That stress on the heart, that elevated pressure stretches out the left atrium, which is where the AFib originates and puts stress on those electrical circuits causing AFib. Congestive heart failure is a big one. congestive heart failure is an epidemic. There's multiple kinds of heart failure, but that is often a trigger for AFib and then with people who have a history of heart failure going to AFib, it puts them in the hospital. So there's this bi directional aspect of heart failure and AFib. mentioned diabetes thyroid disease. if your thyroid is out of whack, especially if it's overactive, like Graves disease or thyroid toxicosis, that can definitely be associated with atrial fibrillation and, the athleticism, the high endurance athleticism, I wouldn't necessarily consider a risk factor. It's more like a subset of. Patients, younger patients that we see who have a lot of frequent extra beats called premature atrial contractions under the right settings. Those patients can be at risk as they get older for getting atrial fibrillation, because those are like the matches, for that fire or these extra beats. if you imagine the woods, say you imagine someone who is obese and their weight is going up. then they start accumulating these other risk factors like diabetes and hypertension. That is a perfect setup, the metabolic syndrome, perfect setup for atrial fib, that wood is getting drier and drier. all it takes is the combination of triggers. the triggers would be like dehydration. Electrolyte imbalance, low potassium, low magnesium. Those are important for the electrical system. huge triggers for cardiac arrhythmias. Diet's a big one. there are things called the AFib diet, the Mediterranean diet. It's one of the best ways to help manage or prevent AFib besides modifying, your weight, anything that has high levels of potassium, magnesium. I will caution you that anyone who has kidney disease, you You need to definitely talk with your doctor because you have to be very careful about potassium, magnesium intake for the average person who has normal kidney function, etc. Potassium, magnesium are really, really good for, for the heart. and so, so those matches are things like dehydration and then the big one stress. with stress, mental, emotional, or physical, if you have increases in adrenaline increases in stress hormones, the heart's electrical system, the cells actually have receptors where the adrenaline interfaces with the heart's electrical system to trigger a fib. So when I'm doing an ablation procedure where I'm trying to treat a fib, I give IV in the procedure to trigger a fib. It's called isoproteinol. So with regards to. The piece of stress will have cases, for example, someone who is obese may have certain elements of stress at work and then not sleeping well. And we know the impact of insomnia on health and then they have a glass of alcohol. And alcohol is a huge trigger for AFib, know, all this thing about like alcohol being good for your heart, not dismissing it from the standpoint of perhaps cardiovascular related issues. The electrical system though, there's a study at University of California, San Francisco, where they were doing AFib ablations and they dripped a little bit of ethanol into the intravenous circulation, just small amounts. And they put a catheter in the heart and they saw that there were acute changes. And the electrical system to facilitate a fib. So we used to think this condition called holiday heart, which around the holidays, people drink a bunch of alcohol or binge drank, and then that put them into a fib. And we used to think it was because it just got massively dehydrated and their electrolytes were off. Well, it turns out. That little amounts of alcohol can be a trigger. So anyone who's had a fib, you know, I'm not very popular in that regard, but I tell people to stop drinking, it's not worth it. You know, would you rather have, would you rather be on the operating table or would you rather just not drink? And it's hard. I mean, I get it. You know, there's social pressure and everything else, but, It's in the setting of the heart's electrical system. It's just not good. And I don't have to tell you alcohol is one of the worst things for sleep. it revs up your cardiovascular system and autonomic nervous system. So I hope I answered your question. Those are kind of like the risk factors that fire the wood that matches.

jeff_1_09-14-2024_061604: 34:45

what are some of the common misconceptions about AFib that you frequently encounter and how do you address these with your patients?

squadcaster-ef0f_1_09-14-2024_061653: 34:54

I think, some of the misconceptions are, that if you get diagnosed with it, people may have told you, you just have to live with it. on if, if a doctor perceives whether you're having symptoms or not. So I think one of the most common misconceptions is I having symptoms from my AFib? And that's the part where you don't sometimes know if you're having symptoms from AFib. And I'm talking about people in continuous AFib. Until you restore the rhythm. And so I think that, that, that issue of symptoms is really tricky with AFib because they can be multiple types. You can have anything from fatigue to racing. I think a lot of people have this conception that a little bit of alcohol is okay. And when it comes to AFib, that's really bad. I've had to convince a lot of people, but they've been very thankful as a result. people really don't connect necessarily their other health conditions to a fib. So they don't realize that losing weight is probably just as effective as me performing a catheter ablation. one of the biggest challenges is expectations. People come into us and they think that if they come in and they have procedure done, it's going to fix it. And I believe me, I wish that were the case, but it's not. AFib is part of a systemic body out of balance. you have to manage the stress. I'm a big meditator and yoga is great for AFib, by the way. You have to manage the sleep. all of those things are really important. So I almost think of, of, you know, when people come in and the misconceptions they have, it's just that the AFib is somehow separate from the rest of their body. And I think. learning to see that everything fits together and trying to rebalance your life. that's kind of the theme of the book I'm working on the first book was restart your heart, which is literally what we do. We shock the heart back into rhythm. But the second is restart your mind. And the idea is finding balance in a world of chaos the brain is very similar to the heart, you know, anatomically, electrically, and the bidirectional aspect of, of influence to the autonomic nervous system. And, you know, we didn't talk on this, but things like heart rate variability, which you're very familiar with, you know, things like heart rate variability that measure the beat to beat variation and heart rate in a reflective of your state of physical, mental, or emotional resilience, a low heart rate variability, meaning that you're over, you're, you're, In a sense, overstressed, your vagus nerve is underactive, your sympathetic is overactive, and a high heart rate variability being a good thing, you know, that aspect is, something that can, can definitely, actually be something that people may find helpful in terms of their wearable devices too, and getting that information.

jeff_1_09-14-2024_061604: 37:30

So we've touched on this a little bit, but lifestyle changes play a crucial role in managing AFib. What are some practical tips? what are some practical tips, strategies that you would recommend for patients to thrive and maintain a good quality of life despite their condition?

squadcaster-ef0f_1_09-14-2024_061653: 37:50

Have hope, make sure that you have a strong support network, feel empowered, educate, be informed. There's lots of resources, before you go into your doctor's office for that consultation, make sure you have your top 3 questions that you want to have answered because of the limited time of office visits. be informed, be prepared, that'll help you be in control. the parting message is really that. You don't have to live a life, sort of afraid of this rhythm There are a lot of things that can be done and people are much more in control of things than they think they are I always tell people life doesn't have to stop with having atrial fibrillation and to really empower people reach out to a cardiac electrophysiologist or ask your doctor, if people remember, a couple of websites, there's an easy one, which is called get smart about a fib. That's an easy one to remember. I didn't touch on this, but there's lots of ways to prevent stroke blood thinners. There's a device out there called left atrial appendage closure, but there's ways to prevent stroke. So probably the biggest message for people is AFib is a big cause of stroke. So make sure that you get it checked out.

jeff_1_09-14-2024_061604: 38:56

And we've kind of touched on mental health and how that is very much intertwined with chronic conditions like AFib. so you mentioned you're working on another book. Is that The five life rhythms that I saw somewhere. Is that a different book?

squadcaster-ef0f_1_09-14-2024_061653: 39:12

Yeah, the five life rhythms is more of a concept with regards to managing life day to day in terms of emotional balance, mental health, spiritual health. So that's something that is kind of more of an approach, but the book that I'm working on, the working title, restart your mind, the playbook for finding balance in a sometimes chaotic world. it's for anyone who deals with stress on a day to day basis, and I'm trying to come at it from a somewhat unique standpoint, being an electrophysiologist, a philosophy major and into spirituality. So the idea is approaching the mind from 3 standpoints from a clinical scientific standpoint, a philosophical standpoint, and from a spiritual standpoint. And how people can have methods to prevent overwhelm in the setting of chaos in our world. And so daily prevention strategies, daily practices, and also ways to intervene. And so the idea is that it's a practical playbook, but it also starts, there's a lot of research in there. And the focus is on mental health, but drawing the connections with, with the heart, the heart, mind connection. that's sort of my brand is the heart, mind doc. the strong connection that if you help your heart, you can help your mind. If you help your mind, you can help your heart.

jeff_1_09-14-2024_061604: 40:28

Yeah. I have found over the years that the whole wellness concept is very important for my area in exercise physiology, that we look at the spiritual, the physical, the intellectual, the emotional and social, and that in how that is also intertwined. All of that leads to what we refer to here in the podcast as aging well. And so in your five life rhythms, those are, as I understand, harmony, emotional balance, activity, relationships, and tranquility. So that's your heart framework.

squadcaster-ef0f_1_09-14-2024_061653: 41:02

that's the heart framework. the biggest thing I found in my research and even in my own personal life, cause I've had my mental health struggle. So that, that's what, so the first book was born out of helping my patients. The second book is for helping me and the idea that it will hopefully help other people. I've struggled with depression and anxiety after my dad died and still to this day. with regards to that framework, I would say that the, the social connections piece, you know, the human connection, that's probably one of the, the most important aspects of wellbeing. And there's a lot of people that talk about this, but if you talk to people at their end of their life, you know, what they really remember are the relationships there's mutual healing that occurs. Between people, when you help another individual, that's probably one of the best antidepressants out there. the fact that we have such a disconnected planet right now, whether it's politics or whatever, we have a lot more shared humanity than we think that's a big message. I'm really trying to support out there along with many other people who are doing great work in that space. I'm just trying to come at it from the standpoint of the brain heart mind connection and realizing that we all have hearts and we all have brains and, you know, sometimes we don't use them very well. But I think that, just opening up the dialogue and realizing that it really is a win win I wrote an article, called, making compassion go viral. the idea is just that being compassionate to yourself, being compassionate for others, it's just a win win virtuous cycle. And believe me, it's hard. I have my days where, I'm stressed out, we have a crazy little guy at home that we love, but he's seven and a half He's amazing, but it's a lot of work and, you know, I mean, all of us, like we have our days, but I think that's one of the themes of my book giving yourself grace all these different wellness, modalities out there, whatever you read, you end up putting so much pressure on yourself. You're like, Oh my God, I'm not following the five heart rhythms or whatever framework. And I think the big thing is realizing that you're human and it's okay to eat that chocolate cake. As long as most of the time you're. Trying not to, but, yeah, I think that I think the big part, you know, that's why I appreciate podcasts like this podcast in general is the opportunity for people from different walks of life, like you and myself to connect and then realize how much overlap we actually have, I think that that's really a powerful thing.

jeff_1_09-14-2024_061604: 43:23

Yeah, that's one of the biggest things I've realized. We've been doing an increased rate of these interviews on the podcast. we didn't set out to necessarily do interviews, but they're just pouring in. And the more interviews that I do, we've had authors, we recently interviewed an author. I actually did two interviews with her. And then One was the second one we included her, her partner in it because they've traveled the world and they're, you know, just the whole story of their relationship. And we've had other doctors on in various capacities, the more I get these different dimensions of aging well, the more we start seeing commonalities between the medicine, the psychology, the sociology, the physiology, the philosophy of living. how do you approach the psychological aspects of living with AFib? And what advice do you have for patients who are struggling with the anxiety and depression that's related to the condition?

squadcaster-ef0f_1_09-14-2024_061653: 44:19

I think that's really where I do a lot of mindfulness education. even simple breath work, you have to give people tools so that at night, if they go into a fib, they're going to rush to the emergency room. we see all the time where people rush to the emergency room and then convert back to a normal rhythm because they know they're safe in a hospital. I mean, that really shows you the power of the heart mind connection, but even in the office, like the other day, there's this guy who, he's huge, like he's twice my size he was in my office and he has developed, like, Literally PTSD from his AFib. And now he's undergoing, recently underwent prostate surgery, and he's just developed a lot of chronic pain issues and has developed just profound anxiety. he was sitting in my office and I could tell, there was something about ready to explode. then he just broke down crying. I just sort of was like, you know, I have this full load of patients, blah, blah, blah, blah, blah, all this stuff that you go through is in your head. And I'm just like. Oh, my gosh, you know, and it just automatically I got up and I said, can I give you a hug and, know, I kind of joked with them. I'm like, just don't crush me, you know, because you're like twice my size and I got him to laugh and then we just breathe together. I was like, you know, just close your eyes. we did some of the asymmetric breathing to activate his parasympathetic nervous system. So I would say the big thing, you know, that, you know, sort of working with people on in terms of the psychological aspect, I give people routines. I say, you know, start small. I'm a big fan of the calm app. So I like download the calm app today. And then just do the daily calm, 10 minutes a day, you know, just do that. That's all you need to do. And then report back. Okay. Now let's do some journaling. Just do a brain dump before bedtime. A lot of our patients are, having a hard time sleeping because they're having all these thoughts in their head all night long, like many of us. Two minutes and just write out a bunch of stuff, stream of consciousness, whatever's in your mind, and that will help you sleep better, hydrate more. So these smaller things, but the key is not to overwhelm people. The key is for people to realize it's a lifestyle switch, small steps. And the key is to share some of our own personal journey. I found that to be very powerful. when I start to tell people, look, I get anxious or I struggle with this, that, and the other thing, you know, it's a hard thing to do as a doctor, because you have this perception that you have to be perfect or people need to see you as perfect, or people need to see you, they need to rely on you. So you feel like you can't be human, that's a misperception. It's something that, especially those of us who trained in my era, like it was sort of beaten down on you, you know, you were, you're really kind of, abused so it really does. I mean, it's such a difference when you're sitting in an office visit, if you start off the office visit by just letting someone talk, not running in there, typing in a computer and asking your list of questions, but letting someone talk, you will actually make it a more efficient office visit. a lot of times. we'll go through our little interchange in the office and then I'm walking out the door, the person, like their question that they came in with, that they had all along, they never got to ask. And so, you know, I found that these little things in the office visit, like doing the mindfulness, doing the breath work, you know, it felt very foreign and weird at first. I'm like, I'm an electrophysiologist. I do heart surgeries. Now I'm sitting in and you get this sort of feeling of like, I if my colleagues saw what I was doing, you know, this sort of weird peer pressure thing. But then I was kind of like, you know, what, would I want? I had a fib, you know, and that's like, so for me, I wrote the first book of if I had a fib, like, it's a playbook. It's like, what do you do from start to finish? You know, what do you do from start to finish of like, you get diagnosed and how do you get informed and how do you feel empowered? How do you form your team? with the current work I'm doing about mental health, what would I want? when I got diagnosed with depression and anxiety, especially in the medical field, I thought there was something wrong with me. I thought that, I wasn't as strong as my colleagues, and all of these cognitive distortions that you get. And I think when I started doing the work in the mental health area, I was like, you can reset, restart your mind. I just went through cognitive processing therapy, because I'm starting to discover that a lot of my depression, anxiety is actually PTSD originating from the death of my dad, that core trauma. And so I think as I am. together the toolbox for myself and walking the walk, naturally has an impact on people because they can see the sincerity coming across because I'm talking about things like, I'm terrified doing this procedure and I don't put it that way to people, but, you know, but am, I mean, that's the thing people don't realize when you're in, you may come across as overconfident or whatever, but deep down, speaking for myself and many, it wouldn't be a normal thing to go in there and not be worried that someone's heart isn't going to arrest or that you're not going to have a complication, but you have to find that balance. I go to the hospital chapel. I meditate for a few minutes before I do. Each of my procedures, I have that routine. when I share that with people, when I tell them I went to the chapel and I prayed and I meditated, it's like night and day. I didn't come out that way. I came out of training as a typical, my wife jokes with me. She's like, if you didn't have the depression and the anxiety, if you didn't have the mental health struggles. I think you would have been kind of a jerk cardiologist. You would have just been the guy who, thinks he can fix everything. and I kind of, you're right. It actually gives you some sense of humility and shared humanity with other people. And what I perceived as this weakness, the pandemic helped level the playing field. the pandemic. Put this big light on the importance of mental health. And we saw, with Lorna Greene who committed suicide, the ER doctor early on. And then that resulted in a law Congress passed to help fund, self care and that kind of thing for, for healthcare providers. I think, with me, I'm fascinated with the idea of post traumatic growth, you know, post traumatic stress and post traumatic, I really just fascinated with it. And like Oprah wrote a book with a neuroscientist, what happened to you versus what's wrong with you? You know, just this whole notion that why do some people who go through different traumas end up becoming, you know, incredibly, empowered and able to accomplish and help so many people. some people just spiral down because I've experienced both. I'm really kind of fascinated. And I think, I think one big piece of that is that social support network. if you have even one person in your corner, and this is the case, if you're severely depressed, is that like for people who are struggling with that. You know, first of all, resources are there, suicide prevention hotline. It's always important to mention that. if you are struggling, it's hard, but reaching out to one person, like literally can turn your day around. And that's not just people struggling with mental health. That's just people who've had a bad day, you know? I mean, it's, it's kind of a whole gamut.

jeff_1_09-14-2024_061604: 51:27

Yeah, the idea of purposeful social connections has become our sixth pillar

squadcaster-ef0f_1_09-14-2024_061653: 51:32

Yeah.

jeff_1_09-14-2024_061604: 51:32

health span and longevity, and I find it important to put that purposeful in front of it because a lot of times we think we're being social, but we're, we're going out and we're interacting with people that it's more of a transactional relationship rather than transformational, and it's not as deep as we really need for our well being. Yeah, you can go out and hang out with friends and you have a couple drinks and you're chatting and nobody's talking about how miserable their day was because you don't want to, share that with anybody God forbid anybody else might think you're having, depression when you realize that Probably all of you are depressed to a certain degree. we've talked about your mindfulness and I think we've talked a little bit of kind of diet, but what else are you doing personally to age? Well,

squadcaster-ef0f_1_09-14-2024_061653: 52:18

Yeah, that's a great question. if I could just touch on what you said, Jay Shetty wrote a book, Eight Rules of Love, and he talks about how initially this idea of love being transactional and then eventually spiritual and intentional, and I think you're totally right. I think besides. This notion of worrying in this culture of coming off as weak if you start talking about how bad your day was, how backwards is that line of thinking, Like just talking about your struggles as a human being, Why would that be a problem in a social setting? I think the other thing you're worried about, it's just like bringing everyone down, you know, and the reality is that the more vulnerable you are, like to me, vulnerabilities of superpower, if you're vulnerable, that is a sign of great strength and you don't have to do it in this, Charlie Brown kind of fashion. you can really engage with people and be intentional the more questions you ask. we had this tendency to just want to talk. I did that a lot on this podcast. Unfortunately, I didn't let you ask a lot of questions, but the more questions we ask, we learn about each other and realize what we have in common. in terms of what I do to age, well, daily routine, that's a big one. my daily routine involves getting up in the morning. First thing I do is meditate. Then I do some spiritual reading. I drink a tall glass of water. Um, I, thing I have fallen off. The wagon on the exercise piece, which I'll be the first to admit sometimes is challenging. And so that's something I'm trying to get back into because I used to go for a morning run, but I think people realizing that just any kind of daily movement is a good one. I wear an aura ring. That's part of me. I look at my sleep patterns and try to get some of that data to help determine what happened that day that impacted my sleep. I think sleep is critical. if you were to ask me the thing I'm working on the most right now. It's my sleep. My sleep has been very disrupted. A lot of it's due to stress. the nighttime journaling before bedtime, all of those things really matter. the diet piece is huge, in terms of anti inflammatories and superfoods I'll be the first to admit, we struggle with that at home. We have a young kid, we both work full time and we discovered, factor 75, which you may have heard about. it's a meal plan that, Patrick Mahomes, from the Kansas city chiefs, like he and his wife do it. I'm not a football person, so I hope I don't offend anyone. but, you know, it's, it's probably of all the meal plans that we've come across, one of the best tasting and, balance. And I think, granted these things cost money, but if you want to look at what helps you age well and helps prevent. It's not just about vitality it's really about emotional and mental resilience. I think the daily mindfulness practices, the interaction with people, daily movement, music and nature. are huge. I think that those really can help. we can learn a lot about how to live our lives by looking at how nature is so well balanced. I play guitar and sing and things like that. So I find that to really help me, stay grounded. And I think I think inspiration, like I have a patient who's 103

jeff_1_09-14-2024_061604: 55:27

Oh, wow.

squadcaster-ef0f_1_09-14-2024_061653: 55:28

pacemaker generator change on. I have a lady that's 94 that's still playing tennis and she's like 14 years older than her husband and can go faster than him. there's a colleague of mine, John Day, who's an electrophysiologist and he wrote a book. called the longevity plan. he and his wife, they're Mormon, but they speak Mandarin and Cantonese and they went out to the islands, in, Asia where people are living beyond a hundred they kind of distilled down, asking people what are the seven things that you are doing? they're trying to figure out. Um, and I think the commonality, I come from an Indian culture where we have multi generational households and things, and I think the commonality with a lot of this stuff is You, and that's kind of, I think the idea behind the book I'm working on is trying to live a balanced life as best as you can and not being as reactive, that's where the mindfulness piece comes in. everyone's going to define aging well in different ways. for me, aging well is being able to live a life day to day where you're moving through it. With a little more ease than perhaps you used to whether that's emotional ease mental ease or physical ease, yoga and stretching are really important too. But for me, I, one thing I've learned cause I've, I've dedicated my life to the heart is the importance of dedicating your life to your mental and emotional health.

jeff_1_09-14-2024_061604: 56:47

Well, we will have to have you back on when you finish and our. Introducing the second book, so promise me you'll come back. Let me know when that book is coming out. this has been an absolutely fascinating conversation and I encourage the listeners to check out the book. Again, that's Restart Your Heart. I believe it's available on Amazon and we will provide a link to that in the description notes. I assume it's in most of the bookstores. if our listeners want to learn more about you, and AFib, how can they connect with you? Is there a webpage? Is there social media?

squadcaster-ef0f_1_09-14-2024_061653: 57:20

I'm available on pretty much all the social media channels, at Dr. Asim Desai, D R A S E E M D E S A I. that's Instagram and, all of the major ones, Facebook. We have a Facebook group, the AFib Playbook group, and then also my website. My website features a lot of mental, emotional, cardiac health related issues. And so. It's a doctor, a seem to side. com. And that's where I talk about being the heart, mind doc. people can message me through there. There's a way to send messages They can also direct message me through things like Instagram

jeff_1_09-14-2024_061604: 57:54

Okay, we'll share all those links as well. anything we missed?

squadcaster-ef0f_1_09-14-2024_061653: 57:59

It's been a pleasure I appreciate you having me on the podcast and I'd love to spend more time. You know, learning from you rather than spending too much time on myself, talking to that. I think that. what you're doing here is great and I will definitely, be a fan. I did, listen a little bit to that last podcast you were talking about, about the author who traveled the world and it sounded really interesting.

jeff_1_09-14-2024_061604: 58:20

we definitely appreciate your time today. Thanks for joining us and thank you for the work you're doing. I think it's very important work and as always, keep aging well.

squadcaster-ef0f_1_09-14-2024_061653: 58:29

Thank you.

58:33

Thank you for listening. I hope you benefited from today's podcast. Until next time, keep aging well.