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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 EPH Heart Talk where we guide patients and caregivers one heartbeat at a time. I'm Doctor. Sharma, cardiologist and cardiac electrophysiologist. Wherever you are listening from, your car, your kitchen or maybe on a quiet evening walk, I am grateful you are here. I hope you are taking good care of yourselves and each other.
Niraj Sharma:Today we are diving into a topic that affects millions of people worldwide: atrial fibrillation, or AFib. If you or someone you love has been diagnosed with AFib, this episode is for you. Let's begin with the basics. What is atrial fibrillation? AFib is an irregular heart rhythm that starts in the upper chambers of the heart, the atria.
Niraj Sharma:Instead of beating in a smooth, organized pattern, the electrical signals become chaotic. Think of it like a group of drummers suddenly playing out of sync. Fast, irregular, unpredictable. Because the atria aren't squeezing effectively, two major things happen. First, the heart rate can become fast or irregular.
Niraj Sharma:Second, blood may swirl or stagnate inside the atrium, increasing the risk of blood clots and stroke. AFib is the most common sustained heart rhythm disorder in the world. And while it's not usually life threatening in the moment, its consequences can be serious if not treated properly. Now let's talk about the different types of atrial fibrillation. Understanding your type helps guide treatment and predict success rates.
Niraj Sharma:Paroxysmal Afib. These are episodes that come and go. They may last minutes, hours or up to seven days but they stop on their own. Persistent Afib. This is AFib that lasts longer than seven days and usually requires treatment, such as cardioversion, to restore normal rhythm.
Niraj Sharma:Long standing persistent AFib. This means the rhythm has been present continuously for more than twelve months. By this point, the atria begin to remodel electrically and structurally, making treatment more challenging. And finally, permanent AFib. This is when the patient and physician decide not to pursue restoring normal rhythm anymore.
Niraj Sharma:The focus becomes symptom control and stroke prevention. So why does the type of AFib matter? Because AFib is progressive. The longer it's present, the harder it becomes to eliminate. Paroxysmal A fib has the highest success rate with treatments like ablation.
Niraj Sharma:Persistent A fib has moderate success. Long standing persistent A fib is more difficult and may require staged procedures. Early treatment often means better, longer lasting outcomes. That's why early evaluation with an electrophysiologist is so important. What does AFib feel like?
Niraj Sharma:Symptoms vary widely. Some people feel nothing at all. Others may experience palpitation, fatigue, shortness of breath, chest discomfort, lightheadedness, or reduced exercise tolerance. It's important to remember the intensity of symptoms does not reflect the severity of the condition. Even silent AFib increases stroke risk.
Niraj Sharma:Once AFib is diagnosed, we focus on three major goals: rate control, anticoagulation, and rhythm control. The second pillar is anticoagulation or stroke prevention. A fib increases stroke risk by four hundred to five hundred percent. To measure individual risk, we use the CHADS VASc score. This score considers factors such as age, high blood pressure, diabetes, prior stroke, heart failure, vascular disease, and female sex in specific cases.
Niraj Sharma:The higher the score, the higher the stroke risk. Fortunately, we have excellent anticoagulant medications. The first pillar is rate control, slowing the heart rate to protect the heart muscle. When the heart beats too fast for too long, the heart muscle can weaken. This is called tachycardia induced cardiomyopathy, and it is reversible with rate control.
Niraj Sharma:Our heart rate targets are usually around 100 beats per minute at rest for most patients, and closer to 80 beats per minute if heart function is reduced. These medications reduce stroke risk by sixty to seventy percent. Like all blood thinners, they carry some bleeding risk, typically around two-three percent per year for most direct oral anticoagulants, but for most patients the benefit of stroke reduction far outweighs the bleeding risk. For patients who cannot safely take blood thinners long term because of bleeding, falls, or other issues, we now have a non medication option called left atrial appendage occlusion. Devices such as the Watchman or Amulet seal off the left atrial appendage, the area where over 90% of AF related blood clots form.
Niraj Sharma:This can significantly lower stroke risk without the need for lifelong anticoagulation. The third pillar is rhythm control, trying to restore and maintain a normal heartbeat. There are two approaches: medications and catheter ablation. Antiarrhythmic medications like flecainide, propafenone, sotalol, dofetilide, and amiodarone can help maintain normal rhythm although they require monitoring. Catheter ablation is a minimally invasive procedure where we isolate the electrical triggers, usually around the pulmonary veins, that cause AFib.
Niraj Sharma:Success rates depend heavily on AFib type, about seventy-eighty five percent for paroxysmal AFib, fifty-seventy percent for persistent AFib, and lower for long standing persistent AFib, which may require staged procedures. AFib isn't just about the rhythm itself, It's connected to blood pressure, weight, sleep apnea, alcohol intake, fitness, and metabolic health. Treating AFib means treating the whole person. As we wrap up, remember the three pillars: rate control, anticoagulation, and rhythm control. Your AFib journey is unique and the best treatment plan depends on your symptoms, your risks, and your goals.
Niraj Sharma:In upcoming episodes of EPH Heart Talk, we will explore each of these areas in-depth, including medications, stroke prevention strategies, and catheter ablation. Thank you for listening. I appreciate each of you for taking the time to understand your heart better. Until next time, take care, stay informed, and remember we are guiding patients and caregivers one heartbeat at a time. This is Doctor.
Niraj Sharma:Sharma. Bye for now.