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EP-EDGE Heart Talk is a patient-focused cardiology podcast created and hosted by Dr. Niraj Sharma, MD, FACC, FHRS—a board-certified cardiologist and cardiac electrophysiologist dedicated to helping patients and caregivers understand their heart rhythm conditions with clarity and confidence.
This podcast breaks down complex heart rhythm issues into simple, practical conversations you can trust. Each episode explores topics such as atrial fibrillation (AFib), palpitations, PVCs, SVT, ventricular arrhythmias, pacemakers, ICDs, heart failure, stroke prevention, and lifestyle factors that improve heart rhythm health. Whether you’re newly diagnosed, supporting a loved one, or trying to understand how heart rhythm disorders affect daily life, EP-EDGE Heart Talk gives you clear explanations, real-world guidance, and evidence-based insights directly from a heart-rhythm specialist.
With a warm, accessible style, Dr. Sharma walks listeners through the why, how, and what next of heart rhythm conditions—covering diagnosis, treatment options, medications, catheter ablation, wearable devices, and the latest advances in electrophysiology. Each episode empowers you to make informed decisions, ask better questions in clinic, and take charge of your heart health.
If you want a trustworthy, easy-to-follow resource on A-fib, arrhythmias, cardiac procedures, and day-to-day heart health, EP-EDGE Heart Talk is here to guide you—one heartbeat at a time.
Hello everyone and welcome back to EP EDGE Heart Talk, guiding patients and caregivers one heartbeat at a time. I am Doctor. Sharma, cardiologist and cardiac electrophysiologist. Whether you are listening during your morning routine, at home, at work, or winding down for the day, thank you for joining me. Today we continue our series on atrial fibrillation or AFib and focus on a major pillar of care: rhythm control.
Dr Niraj Sharma:Rhythm control means restoring the heart back to normal sinus rhythm and keeping it there. The approach depends on whether the AFib is paroxysmal, persistent, or long standing persistent. First paroxysmal Afib. Episodes come and go on their own. Rhythm control is still beneficial, especially for symptom relief.
Dr Niraj Sharma:But cardioversion is usually not required. Instead, rhythm control is achieved using antiarrhythmic medications and or a catheter ablation procedure. Now persistent and long standing persistent A fib. In these cases, the rhythm does not return to normal on its own. Symptoms may be present or may be subtle and unrecognized.
Dr Niraj Sharma:This is where cardioversion becomes essential. It allows us to determine whether a patient truly feels better in normal rhythm. This matters because rhythm control is recommended primarily for patients who have symptoms from AFib, and cardioversion helps reveal symptoms the patient may not have noticed. Many patients don't feel AFib at all. A trial of rhythm control in persistent AFib often shows improvements in energy, breathing, clarity, or sleep that the patient didn't realize were missing.
Dr Niraj Sharma:Let's talk about cardioversion. Cardioversion is performed in the hospital. You receive light sedation and you do not feel the shock. The procedure takes only minutes and patients usually go home the same day. Complications are rare.
Dr Niraj Sharma:The most common is mild superficial skin irritation, a small temporary sunburn like mark from the pads. Cardioversion remains one of the safest procedures we perform and one of the most informative. Next, let's review the major antiarrhythmic medications used for rhythm control: amiodarone. It is one of our most effective rhythm controlling medications and it can be used even in patients with a weakened heart, but it also has the most long term side effects. Because of these risks, amiodarone requires regular monitoring: blood work, thyroid and liver testing, chest x rays, and sometimes eye examinations.
Dr Niraj Sharma:It remains an excellent option when used carefully and with appropriate follow-up. Sotalol. Sotalol is part beta blocker, part antiarrhythmic. It is effective, but it requires close monitoring. Patients starting sotalol need: a baseline echocardiogram, regular QT interval checks on EKG, and ongoing kidney function testing.
Dr Niraj Sharma:These steps ensure safe dosing and reduce the risk of rhythm disturbances. Flecanide is highly effective, but only for patients with no heart disease. That means no prior heart attacks, no stents, no coronary artery bypass, no blocked arteries, and no scar tissue. Before starting flecainide, patients require a stress test, an echocardiogram, and basic blood work. This confirms that the heart is structurally normal and safe for this medication.
Dr Niraj Sharma:Propafenone is very similar to flecainide and the same safety requirements apply. It should only be used in patients with no blocked arteries, no stents, coronary artery bypass and no prior heart attacks. A stress test, an echocardiogram and basic labs are required before starting it. Dofetilide is very effective for persistent AFib and is safe in patients with heart failure. It must be started in the hospital so we can watch the QT interval and adjust the dose based on kidney function.
Dr Niraj Sharma:Now let's discuss AFib ablation. Ablation is often the most durable long term approach when medications fail or cause side effects and has become in many situations first line therapy for rhythm control. The procedure is performed under general anesthesia. We enter through one or both groins, guide catheters into the heart, and create a detailed three-dimensional electrical map to identify abnormal circuits. The procedure typically takes about two hours for paroxysmal AFib and longer for persistent AFib.
Dr Niraj Sharma:We use three main energy sources: radiofrequency, which uses heat cryoballoon, which uses freezing and the newest technology, pulse field ablation, which uses electrical fields to selectively target heart tissue while sparing nearby organs. Success rates vary depending on the type of paroxysmal seventy five-eighty five percent. Persistent A fib: fifty five-seventy percent. Long standing persistent A fib: lower, sometimes requiring staged procedures. AFib ablation is generally very safe, but all procedures carry risk.
Dr Niraj Sharma:These include bleeding, pericardial effusion, stroke, groin hematoma, and very rarely death. With the newer modality, pulsed field ablation or PFA, risks to the esophagus and phrenic nerve are dramatically reduced. After ablation, patients may notice palpitations, fatigue, or shortness of breath. These symptoms are normal during the six eight week blanking period. Long term monitoring includes EKGs, Holter monitors, event monitors, loop recorders, and increasingly smartwatches, which are becoming extremely useful for detecting AFib recurrence.
Dr Niraj Sharma:Rhythm control is a central part of managing AFib, especially in persistent and long standing persistent cases. Through cardioversion, medications, and ablation, many patients experience major improvements in energy, quality of life, and overall heart health. Thank you for joining me on EPH Heart Talk. Please share this episode with someone who may benefit. Until next time, take care, stay informed and remember we are guiding patients and caregivers one heartbeat at a time.
Dr Niraj Sharma:This is Doctor. Sharma. Bye for now.