Better Health
Atrial Fibrillation (AFib)
the most common type of arrhythmia in the United States
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Patients suffering from atrial fibrillation (AFib) whose doctors recommend ablation as part of their treatment now have another choice among the two types of ablations currently available.
By K eith J O ’C onnor Special To The Republican
Called pulsed field ablation (PFA), Boston Scientific’s FARAPULSE PFA System was approved by the U.S. Food and Drug Administration last year. The approval followed positive 12-month data from the pivotal ADVENT clinical trial – the first randomized clinical trial to directly compare the efficacy and safety of the system against standard-of-care ablation – which found that therapy with the device was as safe and effective as conventional thermal ablation.
Baystate Medical Center is one of the few facilities in Massachusetts to offer pulsed field ablation with their electrophysiologist team using the FARAPULSE™ Pulsed Field Ablation System.
Atrial fibrillation is the most common type of arrhythmia in the United States.
“AFib is due to changes in the electrical signaling that coordinate your heartbeat. During atrial fibrillation, the atria, which are the top chambers of the heart, begin contracting irregularly and fast which causes the heart to quiver or fibrillate,” said electrophysiologist Dr. Marshal Fox of the Baystate Health Heart and Vascular Program. As a result of the irregular heartbeat, the heart’s upper and lower chambers do not
work together as they are designed to, leading to the lower ventricular chambers not filling completely or pumping enough blood to your lungs and body.
“When a person is in AFib, they frequently become aware of their heart beating which very often can be quite fast, even while at rest. Other symptoms can include general fatigue, dizziness and lightheadedness, chest pain and shortness of breath. Some people may even have no symptoms,” Dr. Fox said.
“It is important to recognize the symptoms and to have regular check-ups with your provider because if left untreated, AFib can lead to stroke, heart failure, heart attack and dementia. If you have AFib, you are five times at greater risk for stroke because blood can pool inside the heart and form a clot which then travels to the brain,” he added.
For many, the most effective treatment for AFib is cardiac ablation. Offered in several forms - radiofrequency ablation, cryoablation and the new pulsed field ablation - ablation is a safe, minimally invasive, surgical procedure that alters targeted heart cells to the point of scarring. This helps disrupt the electrical signals causing the irregular heartbeat and works to maintain a normal rhythm.
During a traditional ablation procedure, a catheter is inserted into the femoral veins and guided to the interior of the heart and generates extreme temperatures – hot for radiofrequency ablation and cold for cryoablation – to destroy targeted areas associated with abnormal heart rhythms.
Different from traditional ablation procedures which
rely on thermal energy to create extreme temperatures, pulsed field ablation relies on tissue-selective, non-thermal electric fields to ablate heart tissue and return the heart to its normal rhythm.
Rather than heating or cooling tissue to create cell death, this form of energy utilizes high voltage, rapid electrical pulses, which function to
Because this novel form of energy delivery specifically targets cardiac tissue, the risk of damaging surrounding structures, particularly the esophagus, is dramatically reduced. While thermal based ablation is still incredibly safe, pulsed field ablation has taken already rare complications and further reduced the risk of occurrence adding
taken away what we worry about most as far as risks to our patients. When waking up after the procedure, patients tend to feel better, experiencing less side effects, such as chest discomfort, resulting from inflammation traditionally associated with thermal-based ablation,” he said.
One of the many features Boston Scientific identified as part of their promotion of the new procedure was the less time it takes to perform pulsed field ablation allowing doctors to perform more cases per day.
“Typical cases take about two hours, often quicker than thermal ablation. This means increased access for our patients to this highly effective procedure,” Dr. Gobeil said.
destabilize the cell membrane. This creates micropores within the cell membrane causing the cellular contents to leak from the cell, triggering cell death. The important distinction is that the amount of energy used is specific to cardiac cells.
“One of the greatest advantages to pulsed field ablation is the potential to lower the risk of complications.
additional safety to the procedure,” said Dr. Kyle Gobeil, one of three Baystate electrophysiologists trained in the procedure at Baystate.
In well over thousands of patients who have undergone pulsed field ablation in the country since its inception, there has not been a single reported case of damage to the esophagus, Dr. Gobeil noted. “So, this new procedure has
“While the goal is not to see how quickly the ablation can be performed, there is something to be said about the benefits of lesser time under general anesthesia for our patients, as well as lesser time being inside a patient’s heart.
So, with pulsed field ablation, a safer and quicker procedure can be performed resulting in a win-win for our patients,” he added, noting most patients go home the same day.
Some of the most common causes of AFib include weakening of the heart muscle or cardiomyopathy, coronary artery disease, hypertension and aging.
“AFib is primarily a disease that affects older people, one in ten of those above the age of 80,” Dr. Fox said, compared with 1 in 1000 of individuals less than age 55.
Recent studies have found that AFib is more common than previously thought. Today the Centers for Disease Control and Prevention (CDC) estimate that 6.1
million adults in the United States have AFib. This number is expected to increase to 12.1 million by 2030. Also, the CDC noted that because the number of AFib cases increases with age and women generally live longer than men, more women than men are experiencing AFib. Dr. Fox agrees that the number of patients seen by their doctor for AFib is growing. One reason is an aging population, but cardiologists are seeing younger patients as well due to unhealthy lifestyles leading to risk factors for AFib such as high blood pressure, diabetes, obesity and coronary artery disease. Yet another reason - the increasing use of wearable tech such as smart watches and mobile EKG monitors which alert the user to an irregular heartbeat.
While ablation is the most common treatment for AFib, your healthcare provider may recommend medications such as blood thinners and antiarrhythmic drugs, cardioversion, and in rare cases surgery which is used to fix structural problems that are causing the AFib in patients.
“Lifestyle changes such as exercising 30 minutes each day, eating a healthy diet and decreasing your alcohol intake are also important to reduce your risk of developing AFib. If you are obese, losing 10% of your body weight over time will reduce your risk. Obesity is also linked to sleep apnea which is another major risk,” Dr. Fox said.
For more information on AFib and its many treatments available, visit baystatehealth.org.
Foods that can compromise heart health
Certain foods have generated devoted followings among people from all
walks of life.
While flavorful foods can be hard to resist, some wildly popular items found in refrigerators and pantries far and wide could be compromising millions of people’s heart health.
The National Heart, Lung, and Blood Institute notes that food and heart health are inextricably linked. Individuals who prioritize including heart-healthy foods in their diets can lower their risk for various cardiovascular diseases, including heart attack and stroke. Those who succumb to the temptation of less heart-
healthy foods may pay a considerable price for such indulgences. The World Health Organization reports that cardiovascular disease is the leading cause of death across the globe, and poor dietary choices are among the handful of variables contributing to those high mortality rates. While the following popular foods might be delicious and tough to avoid, they also have a reputation for compromising heart health.
Bacon:
The sizzling sounds and enticing aromas of bacon, not to mention its flavor profile, make this a hard-toresist food. However, health care experts note that bacon is high in cholesterol and saturated fat. Saturated fat can be especially bad for heart health, which is one reason why the American Heart Association advises individuals aim for a dietary plan in which less than 6 percent of calories come from saturated fat. That makes
bacon a no-go for individuals interested in a heart-healthy diet, as a single slice of uncooked bacon typically contains 110 calories.
Red meat:
Red meat is another appetizing but heart-unhealthy food. Like bacon, red meat tends to be high in saturated fat, though that content varies depending on the cut and the type of meat chosen. For example, grass-fed beef contains less saturated fat than grain-fed beef. In addition, cuts that are not considered lean, which include beef short ribs, rib-eye steaks and T-bone steaks, also tend to be higher in saturated fat, and thus less heart-healthy, than leaner cuts like sirloin and extra-lean ground beef.
Baked goods:
Baked goods may be irresistible, but that status might change when people recognize that regular consumption of cookies, cakes and muffins has an adverse effect on heart health. WebMD notes that baked goods have been linked to elevated triglyceride levels. That’s significant, as the Cleveland Clinic reports that high triglyceride levels in the blood can lead to a condition known as hypertriglyceridemia, which can harm the heart and blood vessels.
Eating too many baked goods also can lead to weight gain and potentially overweight or obesity, each of which the AHA identifies as a significant risk factor for heart disease.
Processed meats:
Fans of deli meats may insist there’s no better midday meal than a sandwich, but their hearts might beg to differ. Processed meats, which include deli meat but also foods such as sausage and hot dogs, contain high amounts of salt and are often loaded with saturated fat. A study published in The American Journal of Clinical Nutrition found that eating a little more than five ounces of processed meat per week increases a person’s risk of cardiovascular disease by 46 percent. Five ounces equates to roughly five slices of deli meat cut 1/8-inch thick. Certain foods like bacon and red meat are hard to resist. However, those who want to preserve their heart health are advised to eschew these fan favorites and replace them with alternatives that help to lower their risk for cardiovascular disease.
The good, the bad and the confusing about
cholesterol
Cholesterol can be a complicated subject that many people might admit they do not fully understand
Most people have been taught that cholesterol is a bad thing. And for a while it was thought that dietary cholesterol, which is the cholesterol found in food, had a big impact on raising cholesterol in the blood. However, Healthline reports that more recent science indicates this is not the case for most people. Is it any wonder that cholesterol is still a mystery to so many?
What is cholesterol?
Cholesterol is a fat-like, waxy substance that occurs naturally in the body. Although widely believed to be harmful, cholesterol is actually necessary for the body to function. Healthline says the body needs it to make hormones and vitamin D, and cholesterol contributes to the membrane structure of every cell in the body.
What are lipoproteins?
When people talk about heart health and cholesterol, they’re really speaking about lipoproteins and not about cholesterol itself. Lipoproteins are structures that carry cholesterol through the blood. There are two main types of lipoproteins: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). HDL is typically called the ‘good’ cholesterol, because it moves extra cholesterol from the bloodstream to the liver where it is cleaned out, says the Cleveland Clinic. LDL is the ‘bad’ cholesterol because,
when amounts of it are excessive, that contributes to plaque buildup in the arteries. You need some LDL to carry cholesterol to the body’s cells, but having too much can be troublesome. HDL
Cholesterol can be a complicated subject that many people might admit they do not fully understand.
carries some LDL away from the arteries but other steps are needed to lower HDL. Another lipid in the blood includes triglyceride, which is a type of fat. High levels of triglycerides also can put a person at risk for heart issues, including atherosclerosis, which is a hardening of the blood vessels.
Dietary cholesterol vs. blood cholesterol
The amount of cholesterol in the blood and the amount in one’s diet are two different things. Typically, eating foods that contain cholesterol does not directly correspond to an elevated blood cholesterol level. Blood cholesterol is mainly determined by the amount of fats and carbohydrates in the diet, as well as genetics. Some people are
simply genetically prone to high cholesterol levels. Even for people whose blood cholesterol is affected by dietary cholesterol (hyperresponders), research shows dietary cholesterol only moderately increases LDL, and in these cases it does not seem to increase their risk of heart disease, offers Healthline. How to maintain good cholesterol health?
According to Piedmont Healthcare, there are ways to control cholesterol and lipoproteins so they are beneficial to the body.
▶ Choose foods lower in saturated fat and be mindful of foods that can impact blood sugar levels
▶ Quit smoking
▶ Reduce stress levels, which may help you avoid eating high-fat foods as a coping mechanism
▶ Exercise regularly
▶ Weight loss can both increase HDL and lower LDL
▶ Choose low-fat or nonfat dairy products and lean meats
▶ Incorporate more fiber into your diet, which will help remove excess LDL
There is much confusion about cholesterol among the general public. But learning the basics of cholesterol can help individuals make more informed decisions about their diet and overall health.
Ways to Eat Better
We consulted nutrition experts for their best advice on how to eat for improved health.
By A lice C allahan
The New York Times
Aimee Tritt, a dietitian in Minneapolis, said she sees the same pattern over and over: People want to become healthier, so they abruptly overhaul their diets, only to burn out a few weeks later. If this has happened to you, know that you’re not a failure, said Ms. Tritt, who also teaches dietetics at the University of Minnesota. “The goal was the problem; it was too aggressive.”
A better approach is to set small intentions that you implement gradually, she said. With that in mind, we asked about a dozen experts for the advice they would give for healthier eating. There’s something for everyone in their suggestions — consider trying one or two that resonate with you most.
Eat More Legumes
Legumes like lentils, peas and beans are packed with protein and a suite of other valuable nutrients, said Christopher Gardner, a nutrition scientist and professor of medicine at Stanford University. A cup of pinto beans, for example, provides about 16 grams of both protein and fiber, as well as plenty of iron and magnesium. And research suggests that replacing red and processed meats with plant proteins can reduce your risk of cardiovascular disease and earlier death. It also has the added benefit of being better for the environment.
Legumes are affordable and versatile, Dr. Gardner said. Toss white beans into a minestrone soup, steam
edamame for a quick snack or purée some chickpeas to make hummus.
Scale Back On Sweet Drinks
If you regularly consume sugary sodas, energy drinks, coffee drinks or cocktails, cutting back may be one of the best ways to improve your health, said Maya Vadiveloo, an associate professor of nutrition at the University of Rhode Island.
Sweet drinks account for more than a third of the added sugars people in the United States consume — and overdoing it can have serious consequences, including increased risks for Type 2 diabetes, cardiovascular and liver diseases and obesity. You don’t need to cut out sugar “cold turkey,” Dr. Vadiveloo said. Instead, find ways to scale back, like ordering a small soda instead of a large at lunch, or asking for fewer pumps of syrup in your morning Starbucks. Eventually, you might forego the sweet drinks completely.
Put Vegetables In Everything
Most adults in the United States don’t consume enough vegetables, so they are missing out on their antioxidants, anti-inflammatory compounds, fiber and essential nutrients.
To boost your vegetable consumption, look for ways to “add a little to a lot of different types of meals,” said Angela Odoms-Young, an associate professor of nutrition at Cornell University. Add sun-dried tomatoes to scrambled eggs; top a rice and bean bowl with arugula; saute onions, bell peppers and shredded carrots with ground meat for tacos; or toss frozen broccoli, collard greens or okra into soups.
Eat Fewer
Ultraprocessed Foods
Nearly 60 percent of the calories adults in the United
States consume come from ultraprocessed foods like hot dogs, lunch meats, sodas and certain snacks and baked goods. That’s concerning, said Marion Nestle, an emeritus professor of nutrition, food studies and public health at New York University, because researchers have linked ultraprocessed foods to various health issues, including Type 2 diabetes, cardiovascular disease and obesity.
One problem with ultraprocessed foods, research suggests, is that they can be
she wrote.
Dr. Laing likes to take a short walk after lunch, or whenever she can fit it into her day; it helps with digestion and blood sugar control, she said, and it improves her sleep, heart and muscle health, and immune function. It’s also one of her favorite parts of the day — it gives her a mood boost and a mental break — and that’s what has helped make it a regular habit. If you can’t make it outside for a walk, Dr. Laing said that you might climb up and
easy to overconsume. “These foods make you eat calories you don’t realize you’re eating,” Dr. Nestle said. You don’t have to banish ultraprocessed foods entirely, she added, but incorporating more minimally processed or whole foods into your diet may improve your health and help you lose weight without feeling hungry or deprived.
Take A Walk After Meals
Emma Laing, a professor and director of dietetics at the University of Georgia, said in an email that what you eat is just one aspect of your health. Physical activity goes “hand in hand” with good nutrition,
down some stairs, dance to your favorite music or do some gentle stretching. And consider trying new activities like Pilates, kickboxing, rock climbing, hiking or team sports.
Try Eating Three Square Meals Per Day
When Ms. Tritt’s nutrition clients tell her they have trouble with late-night snacking, she responds by asking if they’ve eaten enough throughout the day. The answer is often no, Ms. Tritt said. People may skip breakfast or jam through the workday without pausing for lunch or even a snack. After dinner, they may still be hun-
gry, she said, “feeling a little out of control” as they snack on less healthy options.
Ms. Tritt suggested starting the day with breakfast — toast with peanut butter, for example, or Greek yogurt with granola and berries — and incorporating a balanced lunch with plenty of protein, healthy fats and complex carbohydrates. Don’t be afraid to add nourishing snacks as needed, she said.
Make Big Batches Of Food When You Can
Preparing meals at home is one of the best things you can do for your health, said Emily Haller, a dietitian at Trinity Health Ann Arbor in Michigan. Home cooked meals are almost always better for you — usually less processed and lower in sodium and added sugars — than prepackaged or restaurant meals.
Ms. Haller suggested using your weekends or other free moments to prepare batches of staple ingredients.
Brown rice, quinoa, roasted vegetables, shredded chicken and sautéed tofu, for example, can be combined into various satisfying meals like burrito bowls, salads and wraps, she said.
Use Convenience Foods To Build Healthy Meals
Dr. Nate Wood, the director of culinary medicine at the Yale School of Medicine, loves to cook and has prepared plenty of elaborate meals from scratch.
But his best advice for healthier eating is to use simple, packaged foods like frozen vegetables, canned beans, tinned fish and precooked whole grains to more easily prepare balanced meals at home.
You can whip up a stir fry with frozen vegetables or a pasta puttanesca with tinned anchovies and canned tomatoes in just a few minutes, no chopping required, Dr. Wood said. Or add a generous heap
of warm, canned lentils to a bed of leafy greens, goat cheese and pumpkin seeds to elevate a salad from a side dish to a main. “That is not cheating,” he said.
Go Easy On Alcohol
The harms of even modest amounts of alcohol have become clearer in recent years, said Niyati Parekh, a professor of public health nutrition at New York University. Even moderate drinking — defined as one drink or less per day for women, or two drinks or less per day for men — can increase your risk of developing certain types of cancer and some forms of cardiovascular disease.
If you drink regularly, consider rethinking that habit, Dr. Parekh said. Instead of your nightly glass of wine with dinner, for example, try having a nonalcoholic cocktail or a seltzer a few nights per week.
If Your Relationship With Food Has Suffered, Work On Improving It
Food can be a wonderful source of joy. But if you have been hyper-focused on perfect nutrition or frustrated with cycles of dieting, weight loss and regain, you may associate it with restriction or shame, said Amanda Li, a dietitian at the University of Washington Medical Center. To repair your relationship with food, consider working with a dietitian, Ms. Li said, who can help you develop strategies to plan nourishing meals, try new cuisines, cook with family or friends, or slow down to eat more mindfully. This process can take time, but eventually it will foster a positive, relaxed attitude about eating, helping you to enjoy various foods and trust your body to tell you when it’s full — all of which are linked with better nutrition and health, Ms. Li said.