Transcription
deadly arrhythmia. The heart rate is 230. The heart is beating out of her chest at five times a normal. And she's blowing in a syringe and they're turning her upside down. What's going on here?
When she's blowing against a closed syringe and turning her upside down that increases the pressure in her chest tremendously and that activates the reflex via your vagus nerve to slow down the conduction in the heart. This is called modified Valsalva maneuver. But look at her heart rate slowing down. Amazing.
That lady was experiencing a condition known as supraventricular tachycardia. And I had to practice saying that five times. It can often stop that condition cold. But what about the chaotic rhythm of a racing heart with AFib? I sometimes see cardiologists recommending similar procedures you can try at home, kids. Stimulate your vagus nerve. Slow deep breathing. Bearing down like you're trying to have a bowel movement, tightening your abdominal muscles, inverting your body by raising your legs or standing on your head, coughing, taking a cold shower, whatever it seems to work for you to stimulate the vagus nerve may just do the trick for getting your heart back in rhythm.
What I love about YouTube videos about AFib is actual medical professionals who aren't spreading misinformation get the big views. For example, this cardiothoracic surgeon got three million views for a talk that didn't involve clickbait or science denial.
When I said AFib is a is a big deal and it affects a lot of people, here's what I mean. AFib affects in the US about 6.1 million patients today. We put this in perspective by understanding that all cancers combined aren't even this this big number. So AFib is affecting more patients than cancer does. In the next 25 years, we're expecting this number to double. And that's the thing about AFib. It is becoming epidemic like diabetes. But unlike diabetes, the attempts at science denial hardly get traction.
Do ketogenic diets cause atrial fibrillation? Well, some people mistakenly believe this to be true. After all, the American College of Cardiology says it's so. Right? But here's the problem. They're wrong. In diabetes, however, influencers who aren't medical professionals or nutrition scientists get the views and they cash in by selling supplements. I don't know why nutrition channels rarely talk about AFib and they talk about diabetes all the time when both of them are so influenced by nutrition.
The really exciting thing about AFib is how much we've learned recently about how to detect, treat, and prevent it. I think John Day is the most fascinating AFib doctor in the world as you're about to find out. So, we crashed his home for this interview.
All right. Well, thanks so much for having us in your home. Absolutely. Thanks for coming, Chris. Busy cardiologist. You introduced yourself as an electrician at the TEDx Expo. What does that mean?
Right. So, the heart has developed kind of additional sub-specialization. You've got your general cardiologist. There are the plumbers. The plumbers are the ones who keep the arteries open, stents and bypass surgeries and that sort of thing. Exactly. Then there are the electricians. The electricians, if you will, the cardiac electricians, our focus is to keep the heart beating. Right. We treat hearts that beat too fast, too slow, or too irregular. Interesting. And one of the irregularities is AFib. AFib is the most common arrhythmia. And that's your specialty, right?
That is really where my specialty is, my focus because it is so it afflicts so many people. And in fact, studies show that one in four Americans, that's crazy, will have at least one episode of atrial fibrillation over the course of their life. That's crazy. That's crazy. And you said this is the bestselling book of all time on AFib on Amazon? Yes. It continues to do remarkably well. The book came out several years ago. Uh, and it still always seems to be in the top 10, at least in the cardiac space on Amazon. That's amazing. And you're coming out with a new version? Yes, the updated edition. It's coming out in May of 2025. Uh, we're really excited about it. It's a fast-moving field. The science is changing. How we treat AFib is changing. And something that the patient support groups are asking for. And for many of the patient support groups, this is really becoming their bible. Wow. For navigating AFib.
We should we you should define what AFib is because it sounds like one of these strange things. Oh, I got AFib. I'm going to die. So, the official name is atrial fibrillation. Now, that's a mouthful for a lot of people. So, you'll often hear AFib or some people will just say AF. Mhm. Oh, I see. What is it?
So, the heart has four pumping chambers, Chris. And with atrial fibrillation, the two upper chambers are beating so fast. With atrial fibrillation, the upper chambers are beating maybe 300 to 600 beats a minute. Basically, so fast that they can't even move blood. It's just like they're quivering. And so with this, blood can stagnate in the heart and it's one of the leading causes of stroke. And so atrial fibrillation is often cited as increasing your stroke risk five times. Crazy. Also, it typically results in a very fast and chaotic rhythm. And particularly in patients with a very fast rhythm, atrial fibrillation can put them into heart failure. And so the risk of heart failure is more than doubled with atrial fibrillation. That erratic irregular pulse, the brain doesn't like it. And so it doubles your risk of dementia. The kidneys don't like it. The risks of kidney failure are also significantly increased with it. And overall it increases your risk of a premature death.
So is this uh like most chronic diseases it has multicauses like 10 different causes? It does. There are lots of different ways that people can get to atrial fibrillation. But how people get out of atrial fibrillation is often the same way. So how could you get into atrial fibrillation? Age is a huge factor. The older we get, the higher the risk of atrial fibrillation just because of tissue degeneration. Age-related fibrosis that's related to fibrosis fibrosis is scarring scar tissue scar tissue. It's related to the aging process. So for example in people who age more slowly they're less likely to get atrial fibrillation. So atrial fibrillation can be a marker of premature aging. So it's related to how fast you're aging. And so one of the goals, and I'm sure we're going to get into it, is how do we slow down that aging process? Genetics play a huge role, especially in the Caucasian population. And genetics may play a role in up to 30 to 40% of the cases. There are a lot of families where everyone in the family will have atrial fibrillation and as I mentioned this is particularly strong genetic trait within the Caucasian population less so with the other races. Other causes lifestyle can get you there and I think a lot of that is just that lifestyle that results in premature aging definitely can get you there. the same lifestyle that gets you diabetes and high blood pressure and and the list. Sleep apnea, obesity, and that list just goes on. Anything that stresses the heart, anything that exactly anything that stresses the heart.
So, not exercise? Well, with an exception. With exercise, it's actually quite interesting. There's a U-shaped curve. Who's at highest risk for AFib with regards to exercise? The couch potato and that ultra marathon runner, Tour de France cyclist, etc. There is a sweet spot. The heart loves regular daily physical activity. But if you push it too hard, and it seems to be related to how long you exercise, at what level of endurance, so it's a competitive athlete. We don't see it as much in someone who's just exercising vigorously for health. We tend to see it more in competitive racers, triathletes, marathon runners. And it's related to, for example, how many marathons you run and the faster your times. Tour de France riders have a five-fold increased risk of atrial fibrillation. And it's just that sustained high cardiac output over the years.
So I had a little incident. I had a minor stroke. I have an open PFO. So can you describe what a PFO is? So a PFO is called a patent foramen ovale. And it's a connection in the mother's womb. There is a connection between the two upper chambers of the heart, the right atrium and the left atrium. And for most people, it seals off with a membrane at birth. But in about a quarter of the population, it doesn't completely seal. And there can be different degrees of it. Fortunately, for more than 99% of the people, it's not an issue, but there are some, particularly in those with maybe a larger PFO that may be at risk for a stroke because it allows if you have a blood clot, it allows it to go directly to the brain. Exactly. Say you get a blood clot in the veins of your head. Say you go on a long plane ride, you develop a blood clot in your legs. Then if it breaks free, comes up to the heart because there is a connection there, it can cross from the venous side to the arterial side. I see. And that's where it is. For people that don't have this issue, if if that blood clot in the leg moves, it will typically lodge in the lungs causing a pulmonary embolism. Yeah. Yeah. So no blood clots. The other concern with PFOs is these patients often are at higher risk of migraine headaches. I don't have that.
So I had rheumatic fever as a child which scarred my left ventricle. And after I had this stroke, I went into the cardiologists and they said, "You're doing what? You're doing Iron Man triathlons. You're doing ultra runs. Never do that again. Don't ever. Not a guy like you at your age with scar tissue in your heart and open PFO. Just don't go there." And so they were concerned about AFib and they were just sure I must have AFib somehow. They had put a device on me for two weeks and when it came back negative they said well we must have missed it or let's give it another chance. So they put it on again and they said you know for you maybe we should plant a matchstick you know sized device in your chest an implantable loop recorder. Yeah because we're not seeing any signs of AFib but you are Caucasian an ultra athlete. You have these you're fitting the profile. Fitting the profile, you must have it. I don't know why you don't have it. And then I explained my lifestyle and diet and everything. And they said, "Well, maybe, but I haven't had that matchstick device placed, but and I know you can't give medical advice, but do you do that quite often for your patients?"
Yeah. So, particularly if there's a case, often times we do it for patients who have a stroke for unknown reasons. In the medical world, we call it a cryptogenic stroke. Basically meaning you had a stroke and we don't know why. Yeah. And by placing for example an implantable loop recorder a lot of times we can find atrial fibrillation as a cause of that because atrial fibrillation particularly in the early stages can come and go. It's something that can happen at home and then you go into the doctor's office and everything's perfect. Now there are also wearables and that's where a lot of most of my patients are going and we encourage all of our patients to get a wearable. For example, I've got an Apple Watch here. I've got all of my AFib alerts turned on in the background. You've got yours as well. And they're remarkably effective at screening for these. And so that's something we encourage all of our patients who either may be at risk of atrial fibrillation or have already had an episode is to wear a smartwatch. For those that may not have the funds, there are other sources like the KardiaMobile monitor and some of these others at a lower price point. But for those that can afford a smartwatch, if AFib is anywhere on your radar screen, they can be very helpful.
You the main thing you do in your hospital is ablations. Can you describe what those are? So, what is an ablation? An ablation is a minimally invasive procedure. It's in and out same day. Minimally invasive means you put a catheter here and there. And what it means is that we're not cutting. There's no cutting, no stitches. We have an IV in a large vein in the leg called the femoral vein. And through that, we thread the catheter. The patient is asleep. There's an anesthesiologist. Thread the catheter to the heart. We will trigger the AFib, map out where the AFib is coming from. Trigger it. How do you trigger it? Triggering AFib isn't too difficult. Often times we'll rev up the heart on adrenaline since adrenaline a lot of times can trigger atrial fibrillation. And then we may pace the heart fast or throw in premature beats to trigger atrial fibrillation. I see. And then we'll map it and zap it. Wow. And so zapping it used to require heat or cold or cryo. So because you kind of burn some, right? You're burning the misfiring tissue that's causing the AFib. Now it is completely changed. In a little over a year ago, pulse field ablation was approved in the United States. They've had it in Europe for a few years before us. The technology, what does it mean? What it is is it's delivering electrical energy. So, it neither heats nor cools the tissue. It's electrical energy. They often use it in the cancer space at a frequency that only targets electrically active heart cells. I see. So that's one of the big benefits of this is it's much safer. No longer are we putting the lung tissue at risk from an ablation, the esophagus, nerve tissue. It is very safe. It's a much faster procedure. And in our experience, we're seeing phenomenally better results than we were seeing with the old way of either burning or freezing these abnormally firing heart cells. And this is outpatient surgery. It's all outpatient. They're in and out same day. You come in in the morning and you're out by two in the afternoon or something. Yeah. Depending on what time your case is. Yeah. Interesting. And what's the success rate?
So, we are still in the early phases. We've been doing this now for a little bit over a year. We were the first center in the Mountain States area. I've been involved with the research on this for years before it ever made it to market. But we've now treated close to a thousand patients at St. Mark's Hospital. The remarkable thing, we don't have all the long-term data yet because we've only been doing this now for a little over a year, but what we're seeing so far in our repeat procedure rate. Right now, only 5% of the patients need to be retreated. Whereas before with either radiofrequency or cryo, we were seeing much higher rates than what we would see at this maybe double or triple that. Oh wow. So that is one big thing. And what we're finding is when we bring them back in that 5% of the patients that we've had to bring back for a repeat procedure thus far, what we're finding is everything we treated before is still durable. It's due to disease progression or they've developed a new arrhythmia like an atrial flutter that needs to be treated. Whereas before with for example radiofrequency or cryo when we would bring those patients back for a repeat procedure generally speaking it was one of the areas that we had treated before had electrically reconnected. And so we are expecting as we get our longer term data starts rolling in that we will see dramatically improved success rates with a markedly reduced need for a repeat procedure.
And you give talks about this around the world. I do. Including in Chinese. I do. In fact, I've got one next week coming up in Chinese. Where? Where? And so that's going to be at our Heart Rhythm Society annual scientific sessions which are going to be held in San Diego at the San Diego Convention Center. And so there will be many Chinese physicians from around the world that will be attending. And as the only Caucasian in my space that speaks fluent Chinese speaks fluent Chinese, I've been tasked to uh give a talk about our experience and early uh findings from our ablations on pulse field ablation for the treatment of patients with atrial fibrillation. I understand that talks in a foreign language are particularly difficult when they're scientific. They are. It's a whole different vocabulary. Yeah. Um, and so you have to learn a whole different vocabulary. Giving the talks isn't so hard. It's the Q&A because I don't know what I'm going to get. I don't know where they're from in China, what kind of dialect they may have, how well they annunciate their Mandarin as Mandarin may not be their native tongue in their home. That's where the challenge is.
[Music] There is a remote place in China which not long ago had the highest rate of centenarians in the world. John studied them and wrote a fascinating book about it. I asked John to give a TEDx talk about it. Michelle interviewed him about it. I know some people want to debunk the blue zones, but there are many other areas in the world like this one in China whose populations lived exceptionally long before the invasion of modern diets. Plus, there are dozens of rigorous centenarian studies all over the world and they all come to the same conclusions. Strong social ties, sense of purpose, optimism, sense of humor, happiness, plant dominant diets, and frequent movement to name a few.
When I listened to John's new book on AFib, my first thought was to say, "Wow, this intro took my breath away." And then I thought, "Whoops, we're talking about AFib here." And then I thought of all the times Michelle and Tony have threatened to buy me this t-shirt which says, "I failed sensitivity training." The first time you experience atrial fibrillation is likely to be the scariest moment of your life. Everything is fine. And then just like that, it's not. If you're standing, you sit down. If you're sitting, you lie down. You think you're dying. Chris and I have been married for 51 years. And I can honestly say that often in those 51 years, he has failed sensitivity training. Thankfully, I love him and I'm tolerant." Michelle shot back and said, "I'm surprised you didn't call the intro a heartstopper."
So, do you end up reading medical textbooks in in Mandarin or I have. So, for example, with the longevity plan, I had to review all of the medical literature in Chinese about this group of people that had these exceptionally long healthy lives. But outside of that, not so much because the prominent publications in our field are all published in English journals and that's within their own institutions in China. they get, if you will, higher academic credit by publishing in the top tier western journals. So, you not only have these respected books about AFib, but also about longevity, right?
And so, what does this mean when you see patients? You're doing like eight ablations a day or something like that. How do you tell these patients that lifestyle is a big factor with AFib? Well, I start off first of all, and that's something that is very important because with aggressive lifestyle intervention, what we're seeing is once people have their initial diagnosis of atrial fibrillation, with aggressive lifestyle intervention, studies show that up to half of them can put their atrial fibrillation into remission. Now the studies that have shown this were people who were overweight in someone who is already very health conscientious that becomes more challenging because we don't have as much to work with. For example, if I see the patient who's 50 pounds overweight, it's pretty simple. If we can get those 50 pounds off, not only will the AFib go away, but the diabetes, the high blood pressure, the sleep apnea, etc., etc. also all go away. But for the health conscientious patient that I see in my practice, we may not have as much to work with. Maybe they're in a toxic job and that stress may be contributing. Maybe they're an ultra athlete, one of these ultra marathoners or something like that. What I will say is for those patients, exercise is their way of life. It's their drug. It's their antidepressant. And so for those patients, the only thing that would help them would be to dial back their exercise and usually that's non-negotiable. So for the athlete, we usually move to ablation very quickly so that they can continue to run their tri, you know, run their marathons, do their triathlons.
Well, it's funny because my two cardiologists were they were adamant, you're going to stop. Don't do this anymore. And so it just they didn't give me the option. You can go run 10ks, fine. You know, run your six miles every couple of days, you know, whatever you want to do there, but don't do these 12-hour, you know, endurance fests overnight. You know, the 100 milers, you're running for 24 hours or something like that. It's crazy, right? And it is. And at least with regards to atrial fibrillation, you know, there are triggers. And some of the common triggers, of course, alcohol is a big trigger, but dehydration, an electrolyte, abnormalities is a huge trigger of atrial fibrillation. In fact, I would put that number two as far as, you know, the triggers behind alcohol. And so, yeah, if you're running through the night 12 hours, I could only imagine there's got to be significant degrees of dehydration. There's got to be and it's over 100 degrees and there's got to be huge massive electrolyte shifts. And yeah, you you are playing with fire. Yeah. Wow. That's fascinating.
What else do you want people to know about AFib? I think the main thing about atrial fibrillation is one I if you are at risk, if atrial fibrillation runs in your family, invest in a smartwatch. It may be one of the best health decisions you've ever made. If atrial fibrillation pops up, if you're diagnosed with atrial fibrillation, look at your lifestyle. We talked about weight as one of the biggest factors that you can reverse to help put atrial fibrillation into remission. But there are other aspects. It could be that your sleep is off. It could be that your diet is off. It could be that your stress levels are out of whack. And by addressing these, you may be able to get your AFib under better control. If you cannot quickly get it under control, of course there's the medication route, but as ablation technology gets better and better, particularly with pulse field ablation, generally speaking, if aggressive lifestyle intervention isn't moving the needle quickly, then moving toward or at least considering an ablation earlier rather than later improves your long-term success rates. We've published studies showing you basically we were able to map it out from the day of your diagnosis to the day of your ablation. How many days was it? And the shorter that interval, the more statistically likely that we were able to get rid of their atrial fibrillation with an ablation. Why is that? Every time you have an AFib episode, it leads to degenerative changes in the heart. And for the athletes, usually, as I mentioned with them, they've already optimized their lifestyle. The only thing that might be out of whack is they're exercising a little bit longer or maintaining these massive cardiac outputs for too long a period of time. For them, we may move to ablation very fast because for them it's their drug and they want to be able to continue to compete. And a lot of them, especially on race day, they just feel like they can eat whatever they want, just whatever that keeps them going. And that can be butterscotch frosting for the whole cans of it, you know, for the whole 100 miles, 24 hours. And I can tell you at the end of an Iron Man, we all feel the same way. When you get to 13th mile on the marathon part of the Iron Man, you're drinking Coke. I only the only time in my life I ever drank Coke is at the end of an Iron Man because it whatever for whatever reason, it keeps you running. And I don't know what that is, but it probably gives you a too. It's not good for AFib. Let's put it that way.
So, you weren't very specific about diet. What do you Is it a Mediterranean diet, whole plant food dominant diet? Right. There are some basic principles. I'm not one that necessarily believes that there's one right diet for everyone. Certainly, the ancestral diets are a huge step in the right direction from the modern diet. But many people interpret that to mean a very high meat diet, lots of red meat. Ancestral. Oh, didn't we evolve by eating killing big animals? No. There was a lot of foraging if you study the hunter-gatherers. Yes. And the meats that they may have eaten were wild meats that they had to chase down on the savannah or wherever. And a variety of meats. And the variety and wasn't just the right cuts. They were eating nose-to-tail eating. Right. Then not marbled muscle meat. Exactly. From highly bred cows fed. Exactly. But there are some general principles. A highly plant-based diet. For example, the Chimani people living in the Amazon rainforest that have been studied that have remarkable longevity. Their diet is primarily wild fruits and vegetables and some wild meats that they catch. They're autonomous too, don't they? They grow tubers and things. They also have some fat. But the remarkable thing is they don't get cardiovascular disease. Their rates of AFib are extremely low. And that's something we also cover in our book is some of these natural longevity communities, they don't see AFib. And our group from China that we've talked about, the rates of atrial fibrillation in that group are exceedingly low. Depending on which centenarian study you look at, it may just be a few percent out of all of them. Whereas if you look at a US centenarian population at any given time, if you were to randomly do an ECG, at least a quarter of them would be in AFib at any time just from those age-related changes to the heart. So yes, a more plant-based focused. Um if you eat meats, probably the wild meats are are better for you than than not. Um fast foods, processed foods, prepared foods, packaged foods, not good for AFib. Not good. Yeah.
For people who are wondering who the Chimani are and how well studied they are, Michael Gurven at UCSB and his team has studied them for what 25 years or something. It's remarkable. It's remarkable. Amazing. And it's a pretty big tribe, too. In a lot of locations, like 90,000 members. And it's the same thing with them. Once they leave the tribe and go to the cities, they lose that protective effect. So, it's not just like our people that we studied in China or the Chimani people, it's it's not their DNA, it's their way of living. It's interesting that he said uh they have the lowest documented heart disease rate of any known population in the world. Well studied. Absolutely. But it's still 10%. Yeah. So I guess there's no guarantees in life or there are there are still genetic factors and while lifestyle can help to if you will reprogram many of the bad genes through epigenetic factors there are still random events in this world and there are still some genetics that are you can't get around but for the vast majority of the people they can escape that.
A YouTuber went to visit the Hadza living like they have for 50,000 years. That's the way it's advertised. Wonderful people. But they walked into the village and bought uh grits or something. Um finely ground corn and they were pouring syrup on it and making little balls and they're squatting around the fire and eating that. Times have changed. Times have changed. Good morning guys. Oh, golli for breakfast. Thanks.
For more information on AFib, do you recommend? Yeah, you can start with our book. Is that is that consumer level book? It is. It is written for a patient. And really what I did is I wrote this for my patient. Everything I want to tell them, but I don't have time in a clinic visit to teach them. I see. It focuses on how you got AFib. Um, it focuses on what triggers AFib. I see. It talks about what's happening in the heart. It talks about how you can help to reverse this with lifestyle interventions. Once you're diagnosed with atrial fibrillation, your cardiologist is going to want to start you on medications. So, we have to cover the medications and a pathway to get off of those medications and a pathway to get out of AFib. That's the remarkable thing is everybody gets to AFib a different way. Interesting. But they all tend to get out of AFib the same way. Wow. Let's end on that note. That's fantastic. Thanks so much. All right. Thanks for having me.