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An unexpected alert from his Apple Watch let Josh Smith know he had an irregular heartbeat and prompted his health journey to diagnose and treat his atrial fibrillation. He shares his journey from diagnosis to treatment.
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Atrial fibrillation, also called AFib, affects more than 12 million people in the United States, according to the Centers for Disease Control and Prevention. If left untreated, the condition may cause stroke, heart failure or sudden cardiac arrest.
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The Providence Swedish AFib Clinic offers comprehensive, collaborative care that focuses on personalized, patient-centered care to address heart rhythm issues and reduce their impact.
Heart rhythm problems were the last thing Josh Smith, 58, expected to find when his Apple Watch alerted him to an irregular heartbeat in November 2020. But then his naturopath noticed “something odd” during a routine checkup and suggested he see a doctor, just to be safe.
"That kicked off what became a long journey," says Smith, a scientist at the University of Washington.
After extensive testing at another facility, Smith was diagnosed with atrial fibrillation, or AFib – a type of heart rhythm issue called arrhythmia. The diagnosis took Smith by surprise.
“At first, I had paroxysmal AFib, meaning I would bounce between a normal sinus rhythm and AFib. I didn’t really feel bad. I was still biking 25 miles a day,” says Smith. “I kept thinking, ‘How can I have a heart issue and not know it?’ I didn’t have any of the typical risk factors. I wasn’t overweight. I had no major family history of heart problems. I’m super athletic. But I guess sometimes you’re just an outlier.”
What is atrial fibrillation?
Atrial fibrillation (AFib) is the most common form of heart arrhythmia or rhythm disorder, affecting more than 12 million people, according to the Centers for Disease Control and Prevention (CDC). It occurs when the upper and lower chambers of your heart don’t beat with a coordinated rhythm, causing your heart to beat too quickly, too slowly or irregularly.
AFib has several causes, says David Lam, M.D., co-medical director of the Providence Swedish Comprehensive AFib Network (SCAN), also called the Providence Swedish AFib Clinic. “Sometimes it’s random. Other times, it's secondary to something else, such as infections, or stress from undergoing surgery or medical procedures. It can also be related to alcohol use, being overweight or just aging. We always try to find a reason when we can, but sometimes there’s no clear answer.”
AFib symptoms
Some people don’t experience symptoms of AFib and may be unaware they have a problem. Others may experience symptoms occasionally or have symptoms that worsen over time.
According to the National Heart, Lung and Blood Institute (NHLBI), the warning signs of atrial fibrillation include:
- Excessive fatigue
- Heart palpitations that feel like your heart is skipping a beat, pounding too hard or too fast or fluttering
- Difficulty breathing
- Chest pain
- Dizziness or fainting
- Low blood pressure
“The most common sign people should watch for are irregular heartbeats or palpitations,” says Dr. Lam. “Normally, you don’t really feel your heartbeat unless you’re doing something strenuous, like exercise. But if you’re just sitting in a chair and your heart suddenly starts pounding, and it’s an irregular beat, that’s not normal.”
“Irregular heartbeats don’t always mean AFib; they could mean a lot of things,” continues Dr. Lam. “They’re a clue, however, that something’s going on, and it’s worth getting checked out.”
If left untreated, AFib can cause serious health problems, according to the NHLBI, including:
- Stroke
- Heart failure
- Blood clots
- Sudden cardiac arrest
- Cognitive impairment and dementia
AFib treatment
After his diagnosis, Smith began treatment but “wasn’t thrilled” with the care he received. A friend recommended he move his care to Dr. Lam at Providence Swedish.
The Providence Swedish AFib Clinic was created with patients’ needs in mind, specifically focusing on newly diagnosed patients. It uses a team-based collaborative approach to help people with atrial fibrillation manage their condition and lessen its impact on their lives.
For Smith, the switch to Providence Swedish was the first step in successfully treating his AFib.
“It was a completely different experience from the start,” says Smith. “Dr. Lam was thoughtful, collaborative, really smart – just incredible. He walked me through all the options and was very honest about what we knew, what we didn’t and what we could try.”
Treatment for AFib depends on the type and severity of the issue. It may include lifestyle changes, medication, procedures such as an ablation, or devices such as pacemakers to control the heart rhythm. “There's no one-size-fits-all solution,” explains Dr. Lam. “Some people don’t need much care, and others may need multiple procedures. Our goal is to take a comprehensive, personalized approach.
“The first thing we do is address lifestyle factors,” says Dr. Lam. “We look at blood pressure and if it’s high we treat it. If someone has diabetes, we work at getting their blood sugar under control. If they’re overweight, we talk about weight loss. We screen for sleep apnea and counsel people about cutting back or eliminating alcohol.”
Smith tried medication to regulate his heartbeat, but it didn’t work, so Dr. Lam referred him to Darryl Wells, M.D., director of electrophysiology at Providence Swedish, for an ablation.
“An ablation is a procedure where the patient is put to sleep,” explains Dr. Lam. “An electrophysiologist threads a catheter through the leg and up into the heart to specific areas where we know the AFib is coming from. We either burn or cool those areas to break the faulty circuits. It’s a same-day procedure. You go home the same day.”
Smith resisted an ablation because he thought it sounded scary. “I worried about everything that could go wrong. It took me a couple of years to come around. We kept trying medications, but eventually, it became clear ablation was the next step,” he says.
Smith first underwent cryoablation, a procedure that uses extreme cold to freeze heart cells and redirect the heart’s electrical pathways. However, cryoablation didn’t solve the issue, so he recently had a second procedure called radiofrequency ablation. This time, the results were what he hoped for.
“I’m four months post-procedure and feeling fantastic. I’m back in sinus rhythm, biking every day and just feeling super healthy,” Smith explains. “It’s like night and day. I have so much more energy now that my heart is functioning properly again.”
“If anyone out there is hesitant because it sounds big and scary, it’s really not,” says Smith. “The risks are low, and the benefits are huge. I just wish I had done it sooner.”
Learn more and find a physician or advanced practice clinician (APC)
If you have atrial fibrillation, it can be difficult to get an accurate diagnosis and personalized treatment plan. The Providence Swedish Comprehensive AFib Network and Clinic features the expertise of a multidisciplinary team and care options including weight loss programs, sleep apnea screening and medication management.
Whether you require an in-person visit or want to consult a doctor virtually, you have options. Contact Swedish Primary Care to schedule an appointment with a primary care provider. You can also connect virtually with your provider to review your symptoms, provide instruction and follow up as needed. And with Swedish ExpressCare Virtual, you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections and more. You can use our provider directory to find a specialist or primary care physician near you.
Information for patients and visitors
Additional resources
At Providence Swedish, comprehensive care for atrial fibrillation
Understanding atrial fibrillation, or AFib
Wearable and personal heart monitors are increasingly popular
The Providence Swedish Heart & Vascular Institute is transforming cardiovascular care in the Pacific
This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.
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