FLUTTERING HEARTS BODE ILL
But when it literally flutters for no apparent reason, it could signal trouble ahead.
According to Cardiac Vascular Sentral Kuala Lumpur (CVSKL) consultant cardiologist Datuk Dr Razali Omar, abnormal rhythms of the heart (arrhythmias) come in many forms, and one of the most common is called atrial fibrillation (AF).
'It's the oldest arrhythmia known to man.
'It was described in ancient Chinese texts some 5,000 years ago as a 'weak and irregular pulse',' observes Dr Razali.
Affecting millions worldwide, AF is linked to serious complications if left untreated.
'It used to be associated with advancing age, but we now see a new pattern emerging,' he says.
'AF now affects younger individuals as well.
'The incidence is increasing, not only in older population groups, but also younger ones.
'No one knows why the incidence is increasing, or why the ages of those affected are getting younger.
'Part of it may be due to lifestyle disorders such as obesity, diabetes, hypertension. It may be due to alcohol, as it was recently found that alcohol consumption increases risk as well.
'Obstructive sleep apnoea is also linked to AF.
'But more than that, no one knows for certain the exact cause,' adds Dr Razali.
All these have implications for treatment, requiring the need for AF to be treated holistically, which means addressing possible sources of the problem in addition to direct treatment targeted at the heart.
Dr Razali cautions that not only is incidence of AF increasing, but it now affects younger individuals as well. — ONG SOON HIN/The Star
Understanding AF
AF is an irregular and often rapid heart rhythm originating from the upper chambers of the heart known as the atria.
Normally, the heart's electrical system ensures the four chambers of the heart contract in a coordinated way.
But in AF, the electrical signals become chaotic, leading to a fast and irregular heartbeat.
The condition can be occasional (paroxysmal), persistent or long-standing persistent, with symptoms ranging from palpitations, fatigue and shortness of breath to dizziness and chest discomfort.
Some individuals might not experience symptoms at all (up to 50%, according to Dr Razali) and discover they have AF only through a routine medical exam, or when they are struck by the consequences of the condition.
AF can lead to serious complications like stroke, heart failure and cognitive decline if not properly managed.
'In a person with AF, the risk for stroke is increased by five to six times compared to someone who doesn't have it.
'And stroke from AF is worse than from other causes. AF- related strokes often lead to death, and among those who survive, a significant number are left with long-term disabilities,' stresses Dr Razali.
Diagnosis of AF typically begins with a physical examination and an electrocardiogram (ECG) to detect abnormal rhythms.
In some cases, wearable or implantable monitors may be used to track heart activity over longer periods, especially when symptoms are intermittent.
These are called Holter monitors and they are essentially ambulatory ECG devices that monitor the heart.
Such monitors can track between seven and 14 days, unlike the bulkier monitors of the past that usually track for a day only.
'These days, I also see patients who come to me after their smart watches alert them that they have heart rhythm disturbances.
'Of course, we have to confirm that it truly is AF, but there have been confirmed cases from these,' notes Dr Razali.
Traditional treatment options
According to Dr Razali, managing AF involves the primary goals of reducing the risk of stroke, preventing heart failure and restoring normal rhythm to the heart.
'After thorough assessment, treatment will be instituted based on our primary goals.
'Anti-coagulants are given to prevent blood clots that can cause stroke.
'Oral anti-arrhythmic medications are given to try and control heart rate and attempt to restore normal heart rhythm to prevent heart failure, although there haven't been any new discoveries for the past 30 to 40 years on this front,' he notes.
When medications aren't effective or suitable, catheter ablation – a procedure that targets and destroys the areas of heart tissue causing the erratic signals – is recommended.
Dr Razali observes that catheter ablation, traditionally using radiofrequency or cryotherapy, has been a game-changer for many patients, provided it is carried out in the early stages of AF.
'It's much more difficult to treat chronic AF,' he stresses.
According to Dr Razali, catheter ablation for heart arrhyth- mias have been available in Malaysia since 1992.
'AF ablation started in Malay-sia in December 1999, at the National Heart Insitute (IJN), Kuala Lumpur.
'Although it's the oldest known arrhythmia, it's the 'last' to be ablated since it was relatively late before the source of the arrhythmia was found – in the pulmonary veins.
'Radiofrequency and cryotherapy are thermal energy, and ablation with such energy is not without its challenges, including risk of collateral damage to nearby tissues of the heart, oesophagus, nerves, and even blood vessels.
'In expert hands, such risks are minimal, although the consequences could be catastrophic if it were to occur depending on the affected tissues,' warns Dr Razali.
A new frontier: pulse field ablation
In recent years, a new treatment – pulse field ablation (PFA) – has emerged.
PFA represents an exciting advancement in the treatment of AF because, unlike conventional ablation methods that rely on thermal energy (either heat or extreme cold), PFA uses high-voltage, short-duration electrical pulses to create tiny pores in heart cells – a process known as electroporation.
This approach selectively targets heart muscle cells without damaging surrounding structures like the oesophagus, nerves or blood vessels.
'This selectivity is one of the standout advantages of PFA as it significantly reduces the risk of collateral damage,' emphasises Dr Razali.
The procedure itself is typically done under general anaesthesia, with the patient anti-coagulated to prevent blood clots, which could lead to stroke.
A transoesophageal echocar- diogram (TOE) is carried out beforehand to assess the heart's anatomy and rule out any existing clots. Catheters are threaded through blood vessels to the heart, guided by imaging.
A 3D electroanatomical map is created, and once the catheters are in position, the PFA system delivers a series of controlled electrical pulses to isolate the areas triggering AF, usually around the pulmonary veins.
After ablation, the heart is challenged with isoprenaline to check for any remaining or additional AF triggers.
Once over, the patient is monitored – in the intensive care unit if required. But most patients can expect to go home the next day.
As with any medical procedure, risks still exist, though they are significantly lower with PFA.
The procedure represents a significant leap forward in the treatment of AF, offering patients a safer, quicker and potentially more effective solution.
As the technology continues to evolve and long-term data emerges, it could well become the new gold standard in arrhythmia management.
'I believe PFA is the way of the future. It's essentially the same technique as traditional ablations, it's just the energy source is different,' opines Dr Razali.
Access to PFA may also depend on availability, as the technology is still being adopted in many parts of the world, and even in many parts of Malaysia.
For patients currently living with AF, Dr Razali emphasises the importance of early detection, lifestyle modification and regular follow-up.
'Don't ignore the signs: palpitations, fatigue, or even mild breathlessness. Talk to your doctor.
'With the right treatment, including innovative options like PFA, you can regain control of your heart rhythm and your quality of life.'
KKLIU 2048 / Exp Dec 31, 2027
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
The Star
6 hours ago
- The Star
Actor Marcus Chin bleeds in mouth during live broadcast of charity show
Photo: Marcus Chin/Facebook Singaporean actor-host-DJ Marcus Chin (pic) shocked some viewers after he was seen bleeding in the mouth during a live charity show on June 29. The 71-year-old, who had a heart attack in October 2024, was the opening speaker of the Resilient Hearts: Singapore Heart Foundation 55th Anniversary Charity Show 2025. Blood was seen on his teeth and at the corners of his mouth while he was delivering his speech. Chin, who underwent two operations after the heart attack, said in an interview on June 30 that he had been taking two antiplatelet drugs since the heart surgery. He told Chinese-language newspaper Lianhe Zaobao that he believed the bleeding was a side effect of the drugs. 'After taking the medicine, my gums would bleed from time to time, sometimes once or twice a week, especially when I am under a lot of pressure,' he said. 'I was the first one to appear at the beginning of the live show and had to memorise the script, so I felt a little stressed.' He said he realised he had bled only after he was asked about it by his relatives, friends and colleagues. 'We had rehearsals for two days before the show and everything was fine, but it happened during the live broadcast, which really annoyed me,' he added. Chin praised the cameraman for reacting swiftly after blood was seen in his mouth. 'The camera was supposed to take a close-up of my face, but the lens was quickly pulled away after blood was seen,' he said. Chin said that his attending cardiologist has advised him to seek treatment from a dentist to alleviate the situation. In addition to bleeding gums, his teeth also feel sore from time to time after he takes the medicine. 'It is now very tough for me to sing,' he said. 'It is difficult to sing high notes, especially when my gums are sore.' Chin said he has always been very careful with his diet, but added that he has no time to exercise due to his work schedule. He is a co-host on Love 972's radio programme The Breakfast Quartet, which has been nominated for Best Radio Programme at the Star Awards 2025 on July 6. He is also a nominee for Top 10 Most Popular Male Artistes. 'Before I was hospitalised for the heart attack, I controlled my diet, such as by eating durians occasionally and char kway teow only once in a long while,' he said. 'I'm also the type of patient who takes his medication regularly.' Chin said he would focus on looking after his health while pursuing his career in the future. 'I just suffered a heart attack less than one year ago,' he said. 'Maybe I really need to slow down, relax and not be too busy.' – The Straits Times/Asia News Network
Sinar Daily
8 hours ago
- Sinar Daily
51-year-old man dies of heart attack after collapsing mid-badminton game in Kedah
What began as a regular badminton session turned tragic when the man suddenly lost consciousness and collapsed during a game at a court in Sungai Petani on the evening of June 30. According to a Chinese-language daily, the man had complained to a friend about feeling dizzy moments before the incident. - 123RF photo SHAH ALAM – A 51-year-old man tragically died after collapsing during a badminton match in Sungai Petani, Kedah, with an autopsy later confirming the cause of death as a heart attack. What began as a regular badminton session turned tragic when the man, who is a local, suddenly lost consciousness and collapsed during a game at a court in Sungai Petani on the evening of June 30. According to a Chinese-language daily, the man had complained to a friend about feeling dizzy moments before the incident. As he attempted to walk, he abruptly fell to the ground, prompting bystanders to rush to his aid. Cardiopulmonary resuscitation (CPR) was performed on the spot before he was sent to the hospital. Despite the swift action, medical personnel were unable to save him, and he was pronounced dead shortly after arriving at the hospital. Kuala Muda district police chief Assistant Commissioner Hanyan Ramlan confirmed the incident. 'The autopsy report revealed that a heart attack was the reason for the man's untimely demise,' he said.
The Star
a day ago
- The Star
Pioneering a greener healthcare centre
AS climate change becomes more apparent around the world—with melting icecaps, rising sea levels and severe, more frequent weather conditions—many industries have taken notice and are finding ways to reduce their carbon and GHG impact of their operations. Similarly, the post-Covid 19 pandemic demonstrated companies that embraced environment, social and governance (ESG) values tend to show more resilience, as mentioned in two separate reports on China (Gao, M., Geng, X.) and Nordic (Habeeb Yahya) companies. Straddled in a unique yet precarious situation is the healthcare industry, which National Heart Institute (IJN) chief executive officer Prof Datuk Seri Dr Mohamed Ezani Md Taib described the practices as 'a very complex environment.' He admitted in a recent interview that hospitals are traditionally one of the main culprits of carbon emitters due largely to the wide range of medical devices that they use. 'In the past, we used cloth masks so they were reusable. Due to worries of infection, there was a change to disposable masks and caps in the operating theatre.' He said this resulted in the increase in single-use medical devices that resulted in an increased number of waste products. 'Now with the concern for sustainability, environment and ESG, there's a relook at what we're doing now, if that is correct,' he added, referring to the use of plastic containers and bags for medication. 'To make that change will result in rising costs to repackage and redeliver these sustainably, and that is challenging. That's why it's not easy for the medical line to become fully ESG, but no doubt we are moving in that direction,' he explained. A greener approach Dr Mohamed Ezani: 'As a role model, we need to be responsible for our patients, and the environment as well'.— RAJA FAISAL HISHAN/The Star . Dr Mohamed Ezani explained that IJN is recognised as a premier health centre globally, thanks to its cutting-edge technology and services. As such, it has become an example for healthcare centres within the country to aspire to become. 'As a role model, we need to be responsible for our patients, and the environment as well,' he said. However he pointed out that the challenge arises in how to implement sustainability procedures without compromising the patient care or healthcare standards, basically: 'How to prevent infection from happening while using sustainable approaches.' He does so by targeting sustainability 'low-hanging fruits', such as using more energy efficient LED lights and harvesting rainwater to water plants in the landscaped areas of the centre. 'We have also installed solar panels on half or more of our rooftops, which means using less from the main grid. Electricity consumed from solar generation is approximately 32,000kWh per day on average which contributes to about 2.2% of IJN's total electricity consumption per day.' A significant challenge he identified was changing employees' mindset of using excessive resources such as electricity and papers. With his efforts, IJN has almost gone paperless for its clinical and financial operations for the environment. 'We benchmarked our performance against the highest standard possible, which is the American standard.' Waste issues Dr Mohamed Ezani said that IJN has been segregating its waste into either clinical or general. 'Clinical waste carries a lot of carbon footprint because it is either to burn, which has a high carbon footprint, or bury it in landfills. For this, we will ensure that the amount of waste given to our waste vendors is minimised,' he said. Another aspect involves recycling, of which he said the hospital's food services are currently using recyclable materials. 'We're trying to cut down the usage of single-use plastics, in the wards. Now we don't use plastic spoons, instead we have recyclable items. Food containers are also recyclable as opposed to using plastic or polystyrene in the past. About 30% of the hospital's surgical cases are already almost green,' he said. He also explained that the hospital has policies that minimise or eliminate redundancies in its operations, in order to be as green as possible. Social awareness Dr Mohamed Ezani pointed out that IJN has been taking the CSR road before ESG became important. 'We realised that in Malaysia, there's a lot of issues about non-communicable diseases and for the last 10 years, we have visited more than 160 rural areas, such as the islands off the East Coast, to conduct healthcare screening for more than 160,000 participants for free. He explained that the hospital conducted such screenings to identify those at risk, then referring them to the nearest hospital when needed, or even bringing them back to IJN for treatment if necessary. 'We have been doing this as a service to return what we have gained back to the people. Our way of giving back to the community.' He also mentioned that patients can expect the best care possible and that the accessibility to this standard is important. 'When you talk about being sustainable, it also means that any Malaysian should have access to IJN. Our target is that 75% of new patients should receive their first appointment within two weeks. We will also ensure IJN is free of risk of infections—these are the things that we monitor.' Matter of governance IJN has been diligent in ensuring it is accredited in its standing, from ISO 55001:2014 Asset Management System to MS ISO/IEC 27001:2013 in Information Security Management System and more. 'Way before anybody had been talking about this, we've been looking at topics like anti-bribery, net zero carbon charges, cybersecurity and of course digitalisation. We've been careful to ensure that SDG Goal 5 in upholding transparency is observed all the way up to the board of directors. 'We have to report to our audit risk and compliance committee to make sure these are performed.' In light that World Ocean Day is in July, he shared that IJN will embark on more rural community work, which will include cleaning out the beaches from plastics and other marine litter.
