DEAR MAYO CLINIC: I have a slow heart rate, and my cardiologist has recommended that I have a pacemaker implanted. Can you tell me what a pacemaker does and what I should consider when I make this decision? 

ANSWER: A heart rate slower than 50 beats per minute is called bradycardia. When the heart beats too slowly, it may not pump enough blood to meet the body's needs. People may experience fatigue, tiredness, shortness of breath, weakness and difficulty exercising.  

Some causes of bradycardia are reversible. These include: 

• Athletic training, which strengthens and conditions the heart. 
• Medications, such as beta blockers or calcium channel blockers.  
• Lyme disease, which can cause Lyme carditis and affect the heart. 
• Electrolyte imbalances. 

Once your heart team has identified and addressed any reversible causes, the most common irreversible cause is a problem with the heart's electrical system — specifically, its ability to properly conduct electrical signals between the chambers. When this happens, a pacemaker — a small, battery-operated device — can regulate the heart rate by delivering carefully timed electrical impulses to the heart.

Types of pacemakers

There are two types of permanent pacemakers: transvenous and leadless. Your heart team will determine which type is best for you based on your medical condition and lifestyle. 

Transvenous pacemaker. To implant a transvenous pacemaker, a cardiac electrophysiologist creates a small pocket just below the collarbone between the skin and chest muscle. Depending on your needs, up to three wires, called leads, are guided through a blood vessel into the heart. The leads are connected to the pacemaker, which is then placed into the pocket. Patients may go home the same day or the following day. 

The first four to six weeks after pacemaker implantation are especially important. You’ll need to avoid lifting anything heavier than five pounds and raising your left arm above your head to prevent the leads from getting dislodged. After this period, you can return to your usual activities without restrictions. 

It's a myth that pacemakers are affected by cellphones, microwave ovens, X-rays or airport scanners. Most modern pacemakers are MRI compatible, but your heart team may need to reprogram the device before the scan. 

However, strong magnetic fields, such as those found in certain industrial settings or during arc welding, can interfere with pacemakers. Talk with your healthcare professional if you're concerned about this type of exposure. 

Leadless pacemaker. This newer pacing technology allows the pacemaker to be implanted directly inside the heart. There is no surgical pocket or leads. The device is about the size of a large vitamin capsule or one-third the size of a standard AAA battery. 

A leadless pacemaker may be a good option for people on dialysis, who are at higher risk of infection, or those who rely heavily on their upper body for mobility, such as those who use a walker or wheelchair. 

To implant a leadless pacemaker, a small incision is made in the groin. The device is attached to the end of a delivery system, which is threaded through a vein in the leg and into the heart. 

Because there is no chest incision or leads to dislodge, recovery is often simpler. The main restriction is avoiding heavy lifting until the groin incision heals, typically within one to two weeks. 

Like transvenous pacemakers, leadless devices are safe around common household electronics, but they can be affected by strong magnetic fields. 

All pacemakers must be checked periodically to ensure they're functioning properly. After implantation, you'll be sent home with a monitor. Every three months, you will either transmit data remotely or visit your clinic for follow-up.  

The battery life of a pacemaker is typically 8 to 12 years, depending on the device and how often it's used. If you have a transvenous pacemaker, you'll receive a notice, usually about six months in advance, that it's time to replace the generator. Your electrophysiologist will remove the device from its pocket and replace it with a new one. A leadless pacemaker can be removed or left in the heart with a new one implanted alongside it. 

As patients with pacemakers approach the end of life, they may choose to have the device turned off or the settings adjusted so it doesn't prolong life. This is an important discussion to have with your family and heart care team, and it should be included in your advance healthcare directive. 

If you've been diagnosed with bradycardia, talk with your heart team about your options. If a pacemaker is recommended, ask which one best fits your health and lifestyle goals. 

Divya Korpu, M.B.B.S., Cardiology, Mayo Clinic Health System, Eau Claire, Wisconsin 

The post Mayo Clinic Q&A: What are the different types of pacemakers?  appeared first on Mayo Clinic News Network.

Amir Lerman, M.D., a cardiovascular physician-scientist, mentor, research leader and active Mayo Clinic staff member, passed away Feb. 23 at age 69. During his nearly 40 years at Mayo Clinic, he became one of the world’s foremost authorities on microvascular function and cardiovascular disease.

Dr. Lerman earned his doctor of science degree and M.D. in Israel before joining Mayo Clinic in 1987 as a resident. His research reshaped the understanding, diagnosis and treatment of vascular injury and ischemic heart disease. Focusing on early detection, he and his teams developed novel diagnostic tests, imaging and regenerative therapies to treat and cure patients with these conditions around the world.

Distinguished career of innovation

Dr. Lerman established essential cardiovascular infrastructure at Mayo, including the Mayo Clinic Cardiovascular Research Center and coronary physiology and imaging, among many others. Under his direction, the Mayo Clinic Cardiac Catheterization Laboratory pioneered in vivo testing protocols for endothelial and microvascular function that became best practices worldwide.

A Barbara Woodward Lips Professor of Medicine, Dr. Lerman authored nearly 1,000 peer-reviewed publications that have been cited more than 69,000 times, making him among the most influential cardiovascular investigators in the world. He served as vice chair for research in the Mayo Clinic Department of Cardiovascular Medicine from 2012 to 2024, held several patents and maintained continuous National Institutes of Health funding along with support from the American Heart Association and many other sources.

In 2023, Dr. Lerman was part of the Mayo AI-ECG team, which applies artificial intelligence to electrocardiogram workflows, that received the Mayo Clinic Research shield's Team Science Award for pioneering the use of deep neural networks to detect cardiovascular disease from standard electrocardiograms. In 2024, he was named a Distinguished Mayo Clinic Investigator — Mayo Clinic's highest honor for researchers, recognizing sustained scholarship, creative achievement and excellence in leadership and mentorship.

Mayo Clinic Board of Trustees and Board of Governors member Charanjit Rihal, M.D., a cardiovascular medicine consultant, nominated Dr. Lerman for the award. "It is remarkable that people from numerous countries flock to his laboratory; it takes a special individual to bridge potential geopolitical divides in the interest of our patients, science, mentees and Mayo Clinic," Dr. Rihal wrote in his 2024 nomination letter.

Dr. Rihal says Dr. Lerman's loss will be felt not only among his colleagues, patients and the Mayo Clinic community, but by the field of cardiovascular research and treatment.

"Dr. Lerman touched so many lives in so many ways," Dr. Rihal says. "He fostered innovation through internal grants, AI initiatives, faculty development programs and novel models of philanthropic and corporate partnership. He led his mentees to leadership positions around the world, particularly in his native Israel, encouraging them to keep their focus always on the patients whose lives they could improve."

Values and an enduring legacy

Paul Friedman, M.D., chair of the Mayo Clinic Department of Cardiology, says Dr. Lerman embodied Mayo Clinic’s values in his daily work and in his relationships with patients, trainees and peers.

"Dr. Lerman was an exceptional physician, scientist, leader, builder, innovator and creative thinker. The programs he built, the science he advanced and the leaders he inspired stand as a durable legacy," says Dr. Friedman. "Through those he mentored and the patients who benefit from his discoveries, Dr. Lerman’s influence on cardiovascular medicine will endure for generations."

The post Mayo Clinic remembers Dr. Amir Lerman, visionary cardiovascular researcher appeared first on Mayo Clinic News Network.

Jenny Gottfredsen and Shar Ballentine were accustomed to being on the other side of the hospital bed. 

Both nurses at Mayo Clinic Health System in Eau Claire, Wisconsin, spent their days teaching, supporting colleagues and advocating for patients. Within days of one another, however, both began navigating serious diagnoses of their own — experiences that strengthened their friendship and deepened their understanding of vulnerability, resilience and patient-centered care. 

Careers grounded in care 

Jenny's interest in healthcare began early in life. After earning a degree in cardiopulmonary rehabilitation, she went on to complete nursing school and build a career in cardiology. For more than a decade, she cared for patients with heart disease before joining Mayo Clinic seven years ago. Today, she works in Nursing Professional Development while continuing to support cardiology teams. 

Shar brings decades of experience in healthcare. After more than 20 years in academic medicine in Madison, Wisconsin, she relocated to the Eau Claire area in 2021 to be closer to family and begin a new chapter. As a seasoned nurse and team lead, she quickly became a mentor to colleagues — including Jenny, who leaned on Shar's experience as she transitioned into an educator role. 

What began as a professional collaboration grew into a close friendship built on trust, humor and shared values. 

A conversation and an unexpected turn 

That trust mattered the day Shar asked Jenny to meet privately. 

After a routine mammogram led to additional imaging and a biopsy, Shar learned she had breast cancer. Healthy and active with no family history of cancer, she struggled to reconcile the news. She chose to tell Jenny face-to-face. As Shar shared her diagnosis, she noticed Jenny glance at her smartwatch — checking her heart rate rather than a message. 

Moments later, Jenny began experiencing chest pain and arm discomfort. She initially attributed it to anxiety and hesitated to seek care. Shar listened carefully. She asked questions, reflected Jenny's words back to her and stayed present — a familiar Mayo Clinic approach rooted in listening first. 

That hesitation is something Dr. Fearghas O'Cochlain, a Mayo Clinic Health System interventional cardiologist involved in Jenny's care, says he sees far too often. 

"Unfortunately, it happens more often than we'd like. Especially in younger, otherwise healthy people, the first thought is usually, 'It's a pulled muscle,' or 'It's something else.' Heart disease isn't top of mind. Most people haven't experienced what cardiac pain feels like before — it's internal, unfamiliar and hard to describe — so they explain it away," Dr. O'Cochlain says. 

"We do see women, in particular, attributing symptoms to anxiety. Anxiety is real, but it typically doesn't come out of nowhere and feel completely different from anything you've experienced before," he adds. "New, persistent or escalating symptoms — especially chest tightness, arm pain or shortness of breath — shouldn't be ignored. We would much rather see someone in the emergency department and reassure them than ask later why they didn't come in sooner. Care begins with the call." 

Shar allowed Jenny time to process while gently encouraging her to get checked. Eventually, Jenny agreed to go to the emergency department — as long as Shar went with her. 

From educator to patient 

Once evaluated, Jenny's electrocardiogram was abnormal and lab work showed elevated troponins, a protein released into the bloodstream when the heart muscle is damaged. Cardiology teams moved quickly, and she was taken to the cardiac catheterization laboratory (“cath lab”) — a place she knew well, now from a very different perspective. 

She was diagnosed with spontaneous coronary artery dissection (SCAD), a rare cause of heart attack that more often affects younger, otherwise healthy women. Jenny required three stents, an intra-aortic balloon pump, intubation and several days in the coronary care unit. 

The diagnosis was unexpected. Jenny was active, health-conscious and well-versed in cardiology — yet she suddenly found herself on the other side of a condition she had rarely encountered in nursing. 

That surprise is common, Dr. O'Cochlain says, and underscores an important message about awareness — even for people who appear otherwise healthy. 

"Everyone needs to be aware of the signs and pay attention to their own body — especially what feels different," he says. "You're healthy until you're not. Even young, active women are not immune. It's not productive to live in constant fear of a diagnosis, but it is important to know what's normal for you. When symptoms come out of the blue or feel irregular, they deserve to be evaluated." 

Despite Jenny's background in cardiology, SCAD was new to her. The experience gave her a deeper understanding of what patients face when diagnoses are unexpected and frightening. For Shar, supporting Jenny during her hospitalization while beginning her own cancer treatment was challenging but also grounding.  

Both women leaned on humor and honesty as they adjusted to being seen not as nurses and caregivers, but as patients. 

Parallel paths, shared support 

As Jenny began cardiac rehabilitation, Shar showed up, standing nearby during workouts, offering encouragement and conversation. When Shar began chemotherapy, Jenny checked in before and after each treatment, understanding the mental weight of waiting for labs, results and side effects. 

Both were learning how to stay present in their own experiences while continuing to support one another. They made space for difficult days, talked openly and continued moving forward together. "This was chosen for us," Shar says. "So we choose how we're going to make it through." 

Living Mayo Clinic values together 

Throughout their care, Mayo Clinic's team-based approach was evident. Jenny benefited from close coordination between local cardiology teams and specialists at Mayo Clinic in Rochester, Minnesota.  

That collaboration is intentional, Dr. O'Cochlain says, and especially important in complex cardiac events like SCAD. 

"The Mayo Model of Care is what we strive for every day," he says. "We work as a group to care for the patient in front of us, and that means having world experts readily available to one another. It allows us to leverage the best knowledge at the best time in the best way for the patient. 

"In Jenny's case, once we addressed the acute issues in the cath lab, we were able to integrate expertise from Rochester's specialized SCAD team in the Women's Heart Clinic to guide her outpatient follow-up. We can work seamlessly across locations, even when we aren't in the same place." 

Shar's oncology care reflected careful attention to both treatment and quality of life. 

Equally meaningful was how colleagues lived Mayo Clinic values in everyday moments — listening, advocating and showing up as people first. 

Moving forward 

Today, Jenny is feeling well and continuing follow-up care locally. She continues to share her story to raise awareness about SCAD and the importance of listening to symptoms, even when they don't seem to fit expectations. 

Shar’s treatment continues, now transitioning to radiation and ongoing immune therapy, but so does her optimism and her friendship with Jenny. She encourages others to stay current on recommended screenings, especially mammograms. 

Their relationship, shaped by mentorship and strengthened through shared experience, reflects the power of connection in healing. 

They remain nurses and advocates, with a deeper understanding of what it means to be a patient and what it looks like when care begins with listening. 

The post When caregivers become patients: A story of heart, healing and friendship appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — A single 25 mg dose of a combination of amphetamine-dextroamphetamine salts (Adderall) can have measurable cardiovascular effects in healthy young adults, a Mayo Clinic study found. Researchers, whose findings are published in Mayo Clinic Proceedings, aimed to better understand how the stimulant affects those who use it without a medical prescription.

"The primary objective of our study was to investigate how a single dose of Adderall acutely affects cardiovascular hemodynamics — blood pressure and heart rate — and sympathetic activity in young adults who do not have a medical indication for the medication," says senior author Anna Svatikova, M.D., Ph.D., a Mayo Clinic cardiologist.

While Adderall is safe and effective when prescribed and monitored for ADHD, Dr. Svatikova says the risks of unsupervised use are often underestimated.

"We have seen an increase in nonmedical Adderall use, but many users are unaware that it can place acute stress on the cardiovascular system," Dr. Svatikova says.

"Adderall is sometimes used without a prescription outside of a medical setting, " she adds. "We found that even in individuals with no prior exposure, a 25 mg dose triggers significant increases in blood pressure, heart rate and activation of the body’s stress-response system."

Researchers also noted that even when people simply stood up after taking Adderall, their heart rates spiked much higher than usual.

"The average heart rate increase on standing was 19 beats per minute before Adderall. After taking Adderall, that response doubled to 38 beats per minute," says first author Kiran Somers, D.O., a resident family medicine physician at Mayo Clinic Health System in Northwest Wisconsin.

The findings highlight how stimulating effects can be in individuals who are not accustomed to the medication, the researchers say.

"These results demonstrate measurable, acute cardiovascular effects of Adderall used by those not regularly using Adderall prescribed for specific medical reasons," Dr. Somers says.

The researchers underscore that these findings apply to off-prescription use and do not reflect the long-term, supervised use of the medication for the treatment of ADHD. These findings should not be extrapolated to the long-term, supervised use of Adderall for the treatment of ADHD or other specific medical conditions, where the therapeutic benefits are well established and significant, Dr. Svatikova says.

### 

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Terri Malloy, Mayo Clinic Communications, newsbureau@mayo.edu

The post Study: 1 dose of non-prescribed Adderall raises blood pressure, heart rate in healthy young adults appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I've noticed that sometimes my heart races or skips a beat. What causes this? Is there treatment for it?

ANSWER: What you're experiencing may be an abnormal heart rhythm, also known as an arrhythmia. Arrhythmias fall into two categories: too fast or too slow. A racing heart or a skipped beat typically falls into the "too fast" category. When an abnormal heartbeat interrupts the normal rhythm, you may feel palpitations — sensations that your heart is racing, fluttering, skipping a beat — or a sense of panic. Often these symptoms are more noticeable at night or when lying down. 

In younger people, typically those in their 20s to 50s, the heart may suddenly speed up from a normal rate to 180-200 beats per minute. This rapid heartbeat can cause lightheadedness, dizziness, anxiety or, in some cases, fainting. 

Fast or skipped heartbeats can originate in either the upper or lower chambers of the heart. Those that begin in the top chamber are called premature atrial contractions (PACs), while those starting in the bottom chambers are premature ventricular contractions (PVCs). Although they can feel alarming, PACs and PVCs generally aren't dangerous or life-threatening. They don't cause heart attacks, strokes or increase the risk of death. 

These irregular heartbeats may be caused by:

• An abnormal electric circuit that people are born with.
• Thyroid disorders.
• Hormonal changes related to pregnancy or menopause.
• Excessive caffeine or alcohol consumption.

If symptoms are infrequent and don't interfere with daily activities, people often learn to live with them. However, if they become bothersome, medication may help suppress the extra heartbeats.

One way to slow a sudden racing heart is by performing a vagal maneuver, which can help interrupt the abnormal rhythm. Vagal maneuvers include bearing down like you are having a bowel movement, blowing into a straw with one end closed, clearing your ears as you might on an airplane, dipping your face in ice-cold water or taking a cold shower.

Evaluation

However, these are temporary fixes. If symptoms persist, patients may be referred for further evaluation, such as an electrophysiology study and possible catheter ablation. During this procedure, catheters are threaded through veins in the groin and guided to the heart. Doctors use specialized wires to find where the arrhythmia is coming from. Then energy is delivered via the catheter to eliminate the abnormal circuit.

Ablation is usually done under twilight sedation and typically is a same-day procedure. Patients need someone with them for 24 hours, should avoid driving for 24 hours and shouldn't lift anything heavy for a week to let the groin incisions heal. After that, they can resume their normal activities.

PACs and PVCs are most common in younger people. For older adults, the most common fast rhythm is atrial fibrillation (AFib) or atrial flutter. These are different types of heart rhythms which become increasingly common with age.

AFib can cause irregular heartbeat, palpitations, chest discomfort, lightheadedness, dizziness, fatigue and sometimes passing out. Some people have no symptoms, and the condition is discovered during routine care or procedures.

Common causes of AFib include untreated sleep apnea, excessive caffeine, binge drinking or overconsumption of alcohol, thyroid disorders, and hormonal changes. In a small group of patients, spicy foods may trigger AFib.

Treatment for AFib

Treatment options include:

• Medication to control fast heart rate.
• Medication to control heart rhythm.
• Catheter ablation.

Ablation for AFib is done under general anesthesia. It's a minimally invasive procedure in which doctors access the heart through the groin and target areas on the left side of the heart responsible for triggering or sustaining the abnormal rhythm. Traditionally, two types of energy — radiofrequency (heat) and cryoablation (cold) — have been used for ablation. 

Most recently, a new, nonthermal option — pulsed field ablation — has been introduced. This energy source selectively targets heart muscle cells. This reduces the risk of serious or life-threatening damage to the surrounding structures, such as the esophagus and the phrenic nerve, which controls the diaphragm and breathing.

Recovery after ablation is similar regardless of the energy source used, including about one week of limited activity.

During AFib, blood can pool in the heart, form clots and cause a stroke. Depending on individual risk factors, patients are often prescribed a blood thinner once they're diagnosed with atrial fibrillation or atrial flutter, even after undergoing ablation. If they're not able to tolerate blood thinners, a permanent device may be implanted in their heart to seal off the left atrial appendage, where most clots form, to reduce the risk of stroke.

If you're experiencing a racing heart, noticing skipped beats or symptoms of an irregular heart rhythm, consult with your healthcare professional or a cardiologist to determine whether further evaluation or treatment is needed.

Divya Korpu, M.B.B.S., Cardiovascular Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin

The post Mayo Clinic Q&A: Is my racing heart an arrhythmia? appeared first on Mayo Clinic News Network.

February is Heart Month

ROCHESTER, Minn. — As cancer therapies improve and increasingly achieve cures or recurring periods of remission, preventing and managing damage to organs from cancer treatment has become a top concern. That includes injury to the heart, says Joerg Herrmann, M.D., a cardiologist and the founder and director of the Cardio-Oncology Clinic at Mayo Clinic in Minnesota.

As physicians and researchers work to prevent, diagnose and treat heart damage from cancer therapies, they also have learned about connections between cancer and the heart that go beyond the cardiac effects of cancer treatments. Dr. Herrmann shares three things to know:

1. There is a "web of risk factors."

Cancer and heart disease have common risk factors, Dr. Herrmann says. Those include lifestyle habits.

"We call it the web of risk factors. Some of the very same lifestyle-related factors can set patients up for both cancer and cardiovascular disease," he explains. "Smoking is a prime example. It increases the risk of lung and other cancers and coronary artery disease, heart attacks and peripheral artery disease."

In addition to not smoking, you can reduce your risk of cancer and of heart disease by achieving a healthy weight; avoiding or moderating alcohol use; controlling cholesterol (some cancer treatments can worsen cholesterol levels); getting enough sleep; and adopting a healthy diet with fruit and vegetables, he adds.

Physical activity is another important factor. It has been shown to reduce heart damage risk during cancer treatment, help prevent cancer recurrence and improve cardiovascular outcomes, Dr. Herrmann says.

"The more elements of a healthy lifestyle you meet, the better your health projection is for the heart and cancer," he says. "You will reduce the risks of two of the leading killers and increase life expectancy."

Cancer and heart disease can actually be risk factors for each other.

"We've realized that the relationship between cancer and heart disease works in both directions," Dr. Herrmann says. "Cancer itself can impact the cardiovascular system apart from cancer therapies, and vice versa. Patients with heart failure or other cardiovascular diseases have a higher risk of cancer."

2. A variety of things may be done during cancer treatment to reduce risk to the heart.

Which treatments are given and how can affect the risk of heart damage, Dr. Herrmann says. For example, the medical team may:

• Use treatments that minimize harm to healthy tissue, such as targeted therapies or proton beam therapy.
• Stagger certain chemotherapy drugs to give the heart a chance to heal between treatments.
• Use medications that protect the heart during chemotherapy.
• Use techniques to shield healthy tissue during radiation therapy, such as body positioning and breath-holding to provide greater separation between the tumor and the heart. 

"These shielding efforts have come a long way for adults and children who have cancer," he says.

3. Artificial intelligence and wearables are promising innovations.

The goals of Dr. Herrmann's research including developing tools that predict – before treatment – who is at high risk of heart damage from certain cancer therapies. This would enable shared decision making among patients and their care teams about the approach to treatment.

He and his colleagues are also working on therapies to mend hearts broken by chemotherapy and to develop easier and more cost-effective surveillance strategies for cardiovascular side effects of cancer therapies. Early detection and intervention are likely to lead to the best outcomes, Dr. Herrmann says.

The use of wearables and artificial intelligence (AI) can help, he says. Research has found, for example, that applying AI to an electrocardiogram, a test that measures the heart's electrical activity, may help detect a decline in heart function.

"We're interested in going further with AI technologies and developing simulations to show how different therapies would affect a given patient," Dr. Herrmann says.

Some patients remain at risk of heart disease for a lifetime after cancer treatment, but it's impractical to do echocardiograms to look at the heart for the rest of their lives. Wearables to alert cancer survivors and their care teams to cardiac abnormalities are another promising area of research, he says.

"We've come a long way in cardio-oncology. We have a much better understanding of what we can do to manage heart risk from cancer therapies," Dr. Herrmann says. "Patients are in much better place now than they were even 10 years ago."

###

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu

The post 3 things to know about cancer and your heart: Mayo Clinic expert shares tips to reduce risk appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I have atrial fibrillation, and I've heard there's a new kind of ablation that could relieve my symptoms. Can you tell me about it?

ANSWER: If you have atrial fibrillation (AFib), you're not alone — it's the most common heart rhythm disorder, affecting millions around the world. AFib occurs when the heart's upper chambers beat in a fast, irregular way, which can cause symptoms such as palpitations, fatigue, shortness of breath, dizziness and/or reduced ability to exercise. 

For many people, medications can help control symptoms. But when drugs don't work well, cause side effects, or people opt out of that treatment, a procedure called catheter ablation may be another avenue for certain patients.

Catheter ablation is a minimally invasive procedure used to treat abnormal heart rhythms such as AFib. During the procedure, doctors guide thin, flexible tubes, called catheters, through blood vessels in the groin up to and into your heart.  

For AFib ablation, patients are put under anesthesia, and depending on the complexity of the rhythms, the procedure can take several hours. The treatment usually focuses on ablation of muscle tissue that can generate electrical signals and trigger AFib. 

This muscle tissue is found inside the pulmonary veins, which drain blood from the lungs into the left upper chamber of the heart, called the left atrium. By destroying these small areas of the heart, the main electrical impulses that set off AFib are isolated from the rest of the heart.  

Using advanced imaging tools such as X-ray, ultrasound and catheters, doctors can reconstruct a 3D rendering of the heart while it's beating in real time and locate areas of heart tissue that are triggering AFib. This provides a roadmap for pinpointing the areas that are causing AFib. Energy is then delivered through the catheter to disrupt those problem areas, helping the heart maintain a normal rhythm.

For the past 20 years, most AFib ablations have used thermal energy to destroy targeted tissue using:

• Heat (radiofrequency ablation). 
• Extreme cold (cryoablation). 

These approaches can be effective, but they carry risks because heat or cold can unintentionally cause serious and even life-threatening damage to nearby structures, including:

• Injury to the esophagus.
• Narrowing of the pulmonary veins. 
• Damage to the phrenic nerve, which controls the diaphragm and breathing. 

In recent years, a newer form of ablation — called pulsed field ablation (PFA) — has emerged and is generating excitement among heart rhythm specialists and patients.

PFA works in a completely different way. Instead of heat or cold, it uses very brief, high-voltage electrical pulses that last only microseconds. Because PFA is relatively nonthermal, the risks of thermal ablation appear to be dramatically reduced.

The electrical pulses delivered by the catheter create tiny openings in the membranes of heart muscle cells — a process called electroporation. These openings cause targeted cells to stop functioning, eventually die and become scar tissue. 

One of the biggest advantages of PFA is the ability to selectively disable cardiac cells. 

Another benefit is the efficiency of the procedure. PFA procedures are typically faster, meaning less time under general anesthesia, which may be especially important for older adults or people with other medical conditions.

So far, studies suggest that PFA is as effective as traditional ablation techniques. About 65% to 75% of patients remain free of AFib one year after a single procedure without antiarrhythmic medications. Success rates may improve with repeated procedures, continued medication use and other factors. 

Ablation isn't a cure for AFib, and sometimes more ablations aren't always better or the best option. Too much scar tissue in the heart can cause a different set of problems, which is why careful patient selection is essential when weighing the risks and benefits of ablation.

The goal is to relieve symptoms, reduce frequency and duration of episodes, and improve the patient's quality of life.

While promising, PFA is still relatively new. Rare complications include coronary artery spasm; small bubble formation, which can lead to a stroke; or kidney injury. These events aren't common, and their causes continue to be studied.

PFA may expand treatment options for many people with AFib, particularly those with certain conditions where prolonged anesthesia time poses more risk. Whether it's appropriate depends on your type of AFib, symptoms, overall health, prior treatments, modification of risk factors and the goal for AFib treatment.

Talk with a cardiologist or cardiac electrophysiologist to determine whether PFA fits into your personalized treatment plan.

Christopher DeSimone, M.D., Ph.D., Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota

The post Mayo Clinic Q&A: What is pulsed field ablation? appeared first on Mayo Clinic News Network.

With a failing heart and little hope of healing, Alan Lewis sunk into depression, gaining 330 pounds. After he came to Mayo, bariatric surgery enabled the transplant he'd sought for so many years.   

Alan Lewis was lying on the floor — the only position that eased his discomfort — watching a football game. When a Mayo Clinic commercial came on, the tagline seemed to leap off the screen.

"You know where to go."

With heart failure sapping his strength, Alan had begun to doubt there was an "other side" to his condition. At age 41, he'd already lived a decade with a poorly pumping heart, diagnosed during a hospital visit for a broken ankle. 

For years, Alan had relied on a left ventricular assist device, or LVAD, to help his heart circulate blood through his body. After the first one malfunctioned, he received a second device in 2018.

What Alan really needed was a new heart.

Even after bariatric surgery helped him lose weight, he still wasn't added to the transplant list. "When we'd ask about transplant, our care team would just say, 'Oh, he's doing fine. Just keep doing what you're doing,'" says his wife, Vida.

As months became years, Alan's hope of healing waned. His mental health spiraled.

"I was a nervous wreck," he recalls. "What if the LVAD malfunctioned? What if there was a power failure? I was scared to go places, worried about backup batteries. I was in my head 24/7. It was torture."

Deeply depressed, Alan gained 330 pounds during the pandemic, reversing his previous weight loss. Without a clear path forward, he resigned himself to dying.

Then, in 2022, Alan saw the Mayo commercial — and Vida saw an opportunity. She made the decision for them. They were going to Rochester.

A journey toward hope

After driving from Chicago, weak and rapidly declining, Alan sought help from Mayo Clinic.

There, Vida's long-simmering concern was confirmed —a tough-to-kill bacteria had infected the wiring that linked his LVAD to its external battery. The battery for his defibrillator was also dead, leaving him vulnerable to potentially deadly arrhythmias.

Right away, Alan received IV antibiotics, a new defibrillator and an introduction to the transplant team. "Day one, they spoke of transplant," says Vida. "I was shocked."

At his first follow-up visit, Sarah Schettle, a physician assistant on the LVAD team, could see the emotional strain of all that Alan and Vida had been through. "There was a lot of hesitancy — 'Will Mayo accept us?'" she recalls. "I also remember the hopefulness, the desire to know what was possible here."

Recognizing that Alan needed complex, multidisciplinary care, the team began formulating a plan.

Within two weeks, the couple relocated to Rochester — and just one year into marriage, Vida unflinchingly pivoted to her new role as caregiver.

"It was embedded in me to love as hard and as much as you can," she says.

Vida vowed to do that for Alan.

Preparing for tomorrow

The team said Alan needed to adopt a healthier lifestyle before a second bariatric surgery — a necessary step toward transplant. So Vida signed them up for a gym. She walked next to him on a treadmill, urging him on. She made healthy meals. She pored over the lengthy care plan, still shocked that they had one.    

"Back home, no one gave us clear answers. How long would he have the LVAD? Could he ever get a transplant?" she says. "At Mayo, we never experienced that. The focus was always on getting him well enough for a transplant, like he deserved to be transplanted."

Still, there was fear that the new heart wouldn’t happen. Sensing Alan's struggle, Adrian da Silva de Abreu, M.D., Ph.D., one of his cardiologists, spent an hour at his bedside, mostly listening.

"I'd never seen a doctor take that time," says Alan. "I put it all out there, and I could tell he was hearing me."

Peace replaced his once-crippling anxiety. At last, he knew his team wanted what was best for him. As Vida says, "They had a vision. They had a plan. It was healthcare like I've never seen before."

A risk with great reward

Alan's first bariatric surgery shrunk his stomach to the size of a banana.

To help him lose the weight he'd regained, Omar Ghanem, M.D., a bariatric surgeon, planned to reroute part of Alan's small intestine so food would bypass a long segment of his bowel. Known as a modified duodenal switch, this would reduce how many calories and nutrients he absorbed and alter the secretion of hunger-related hormones.

Dr. Ghanem knew the already complex surgery would be even more challenging in Alan's case.  

With his heart essentially outside his body, monitoring — and maintaining — his vitals would be difficult. Blood thinners to prevent clots in his LVAD would also elevate his risk of bleeding. Then there was the looming infection, suppressed but still active, only curable if the LVAD was removed.  

Seven Mayo Clinic teams — from Infectious Diseases to Anesthesiology — worked together to help Alan beat the odds.

"Where else do you have all this expertise in one place? I don't think anything like this can be done outside of a place like Mayo," says Dr. Ghanem. "Here we're able to safely push the limits."

Knowing this path was his best chance at healing, Alan and Vida agreed to go forward.

Despite its complexity, the revision was a success, and so was the recovery. Within months, Alan lost enough weight to qualify for a heart. He was finally on the transplant list.  

Moving forward at last

Six weeks later, a middle-of-the-night call brought Alan back to Mayo Clinic.

After years of heart failure, two LVADs, two bariatric surgeries, dozens of pounds lost and hundreds of tears shed, Alan was receiving another chance at life. He was receiving a new heart.

Less than five hours after opening his chest, Philip Spencer, M.D., a cardiovascular and transplant surgeon, brought Alan to the "other side" of heart failure — that place he'd once thought didn't exist.  

"We had an infection to deal with. And there was scarring within his chest," says Dr. Spencer. "But, once the LVAD was out, it went very well."  

IV steroids enabled his body to accept the organ, and with the LVAD out, his infection could finally clear. Even from his hospital bed, Alan felt his confidence returning.

"I'd had this yoke on me. I couldn't move without the LVAD. I couldn't bathe without it. I couldn't eat without it. It was always present," he says. "Mentally, I'd been down so long. Now I had freedom."

For the first time in years, there were no wires to wrestle with. There was no battery to worry about.

Alan could be himself again.

A new life for Alan

With Alan's heart fully functioning, the couple is now back in Chicago, enjoying a renewed zeal for life.

For Alan, that means showing his gratitude for everyone who supported him — his family, his close friends and, of course, Vida. Every day, he focuses on caring for her in every way possible.  

"When I wake up, I start catering to her," he says. "She had to cook and clean. She helped bathe me and put on my shoes and socks. It's a joy for me to be able to do things for her now."

During the night, Alan sometimes reaches across the mattress, making sure Vida is still there, even though he knows she always will be. She is his safe person, and Mayo Clinic is the safe place that showed him what healthcare should be.

Both their hearts remain in Minnesota, where hope first began to beat, strong and steady, in Alan's chest. The tagline from a football game ad — "You know where to go" — still feels like a summons.

"To have so many people involved in your care, and each one be a beautiful experience, is so rare," says Vida. "God has blessed him, and Mayo has been there for him. We want to move back because Rochester feels like home, you know?"

Related story:

• New year, new focus on health: Mayo Clinic expert highlights effective treatment options for obesity

The post Bariatric surgery paves way for heart transplant after end-stage heart failure  appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I found out during my pregnancy that I have mitral valve stenosis. How common is valve disease, and what should I know about it?

ANSWER: Valve disease affects how blood moves through the heart, and pregnancy is often a time when symptoms first appear or become more noticeable. Learning about a heart valve condition during pregnancy can be unexpected and overwhelming. Understanding why this happens and exploring treatment options can bring clarity and calm fears.

Pregnancy is often described as the body's ultimate cardiovascular stress test. The heart works significantly harder to support both the mother and the developing baby. Blood volume expands, vascular resistance drops and heart rate increases. These normal physiological changes begin early in pregnancy and peak in the late second to early third trimester.

These changes can unmask symptoms of previously silent valve disease or intensify those of known valve conditions because the heart is being asked to move more blood through a valve that isn't functioning normally. Known valve conditions include:

• Narrowed valves (stenosis)
• Leaky valves (regurgitation)
• Congenital valve abnormalities

Other valve conditions may result from infections, such as rheumatic fever, or changes in the valve's structure over time.

Symptoms

Even women who felt well before pregnancy may begin to notice symptoms around 28 to 30 weeks, when the cardiovascular system reaches its peak workload.

Many common pregnancy symptoms overlap with those of valve disease. Fatigue, shortness of breath, swelling and a faster heart rate can all occur in a healthy pregnancy. It's especially important to evaluate symptoms that begin suddenly or noticeably worsen.

Shortness of breath with activity or when lying flat, unusual fatigue that affects daily routines, swelling in the legs or feet, racing heartbeat, reduced exercise tolerance, or chest pressure should prompt a conversation with a clinician.

Because pregnancy symptoms can mask underlying cardiac issues, clear communication between patients and their care teams is essential. Many patients assume new symptoms are simply part of pregnancy, especially if previous pregnancies were uncomplicated. But when something feels off, listening to that instinct is important.

An assessment of symptoms may include:

• Physical exam.
• Echocardiogram to look at the heart's structure and function.
• Electrocardiogram (ECG) to check the heart's rhythm.
• Additional imaging or testing.

These evaluations help determine whether symptoms are pregnancy-related or caused by cardiac disease.

Treatment

Once valve disease is identified, coordinated care becomes especially important. Many patients benefit from a pregnancy heart team approach that includes specialists in cardiology and maternal-fetal medicine, with support from cardiac surgery or structural heart experts, if needed. Local obstetric teams may remain involved, particularly if delivery is expected to happen closer to home.

The pregnancy heart team approach helps align medical needs with a patient's goals for pregnancy and family planning. Shared decision-making plays a central role. Every situation is different, and treatment choices are shaped by personal values, risk considerations and long-term planning.

Treatment depends on the severity of the condition and how well a patient tolerates the physiologic demands of pregnancy.

Many women with mild or moderate valve disease can continue pregnancy safely with close monitoring. Medications may be used to help manage fluid retention, control heart rate or reduce symptoms.

When valve disease is more severe or symptoms significantly affect daily life, procedures may be done before or during pregnancy. These include:

• Catheter-based procedures to widen a narrow valve or improve function.
• Valve repair to preserve a person's own valve when possible.
• Valve replacement when the disease is advanced or symptoms can't be controlled.

For those who need valve replacement, care teams will discuss the choice between a mechanical or tissue valve, especially for women planning future pregnancies.

• Mechanical valves are durable but require lifelong anticoagulation, which can add complexity during pregnancy.
• Tissue valves typically avoid long-term blood thinners but have a shorter lifespan.

Treatment choices can shape both personal health and a family's future. Clear, collaborative discussions about risks and benefits support confident decision-making.

Expert teams across cardiology, maternal-fetal medicine, imaging and surgery help form a comprehensive plan tailored to each patient's needs.

Any expectant mother should reach out to a clinician if symptoms such as shortness of breath, difficulty breathing when lying flat, chest discomfort, palpitations, swelling that increases rapidly or new fatigue begin to interfere with daily life.

When something doesn't feel right, speaking up is one of the most important steps a patient can take. A strong care team is ready to help navigate each stage of pregnancy to safely support the health of both the patient and the baby.

Katie Young, M.D., Cardio-Obstetrics, Mayo Clinic, Rochester, Minnesota

The post Mayo Clinic Q&A: What to know about pregnancy and heart valve disease appeared first on Mayo Clinic News Network.

Editor's note: February is American Heart Month

Heart disease affects women differently than men, and understanding those differences can be lifesaving. Dr. Sharonne N. Hayes, a Mayo Clinic cardiologist and leading expert in the field of women’s heart health, says progress in research, treatment and prevention has accelerated but women still need better information.

Here are four things Dr. Hayes wants women to know, and do, when it comes to protecting their heart health.

Watch: Dr. Sharonne N. Hayes talks about heart disease in women

Journalists: Video sound bites are available in the downloads at the end of the post. Please courtesy: "Sharonne N. Hayes, M.D./Cardiovascular Medicine/Mayo Clinic" 

1. Women get heart disease, and symptoms can be missed.

Dr. Hayes says there are conditions that disproportionately affect women including heart failure with preserved ejection fraction, microvascular dysfunction and heart attacks due to spontaneous coronary artery dissection (SCAD). As a result, women with chest pain or shortness of breath were sometimes told their hearts were fine, only to learn later they did have heart disease.

Women were also historically excluded from clinical trials, meaning researchers are still closing evidence gaps today. Dr. Hayes says women should trust their symptoms and continue advocating for answers when something does not feel right.

2. Knowledge and advocacy can change outcomes.

One of the most encouraging changes Dr. Hayes has seen is the rise of patient advocacy and access to health information. Women are more engaged, more informed and more willing to ask questions.

That shift is especially visible through advocacy organizations such as WomenHeart: The National Coalition for Women with Heart Disease. Women may arrive at the point of care frightened and unsure how to describe their symptoms, or they may feel alone in dealing with their diagnosis. Education, training and peer support can give them tools to feel more confident and empowered.

Dr. Hayes describes the transformation as powerful, driven by knowledge and by the support women find in one another.

3. The future of heart care is promising

Advances in cardiology are moving quickly. Dr. Hayes says treatments that once required open-heart surgery may now be replaced by less invasive procedures, and emerging therapies offer hope that future outcomes may differ from those of past generations.

Study design is important. Representation in research, including artificial intelligence, can influence how findings apply. Dr. Hayes notes the role of patient data breadth in the development of new tools.

4. Prevention starts with habits and partnership.

Dr. Hayes emphasizes that it is never too early or too late to improve heart health. Healthy habits adopted in childhood reduce future risk, and starting an exercise program later in life still improves heart health.

She says prevention comes down to three things: behaviors, choices and knowledge. Staying physically active, avoiding tobacco, and eating a heart-healthy diet that includes fruits, vegetables, whole grains and fewer processed foods all matter. Knowing personal health numbers, such as blood pressure and cholesterol, and understanding family history are also critical.

Equally important is working closely with a healthcare team. Medications should never be stopped without consulting a healthcare professional. If a treatment causes side effects or is not working, there are often other options, says Dr. Hayes, emphasizing the importance of patience and care teams working together to find solutions.

To interview Dr. Sharonne N. Hayes, contact: 

• Terri Malloy, Mayo Clinic Communications, newsbureau@mayo.edu

The post (VIDEO) Heart disease in women: 4 things a Mayo Clinic cardiologist wants you to know appeared first on Mayo Clinic News Network.