Edition #143 – est 3/2020

This week’s Bulletin discusses Atrial Fibrillation and Omicron as well as updates for
Atrial Fibrillation

Atrial fibrillation, often called AFib or AF, is the most common type of treated heart arrhythmia. An arrhythmia is when the heart beats too slowly, too fast, or in an irregular way. When a person has AFib, the normal beating in the upper chambers of the heart (the two atria) is irregular, and blood doesn’t flow as well as it should from the atria to the lower chambers of the heart (the two ventricles). AFib may happen in brief episodes, or it may be a permanent condition.
The timing of the heart’s contractions is directed by the heart’s electrical system. The electrical impulse begins in the sinoatrial (SA node), located in the right atrium. Normally, the SA node adjusts the rate of impulses, depending on the person’s activity. For example, the SA node increases the rate of impulses during exercise and decreases the rate of impulses during sleep. When the SA node is directing the electrical activity of the heart, the rhythm is called “normal sinus rhythm.” The normal heart beats in this type of regular rhythm, about 60 to 100 times per minute at rest.

In Atrial fibrillation, Instead of the SA node (sinus node) directing the electrical rhythm, many different impulses rapidly fire at once, causing a very fast, chaotic rhythm in the atria. Because the electrical impulses are so fast and chaotic, the atria cannot contract and/or squeeze blood effectively into the ventricle. The impulses that travel to the ventricles get through in a fast and disorganized manner. The ventricles then contract irregularly, leading to a rapid and irregular heartbeat.
Sometimes people with AFib have no symptoms and their condition is only detectable upon physical examination. Still, others may experience one or more of the following symptoms:

  • General fatigue
  • Rapid and irregular heartbeat
  • Fluttering or “thumping” in the chest
  • Dizziness
  • Shortness of breath and anxiety
  • Weakness
  • Faintness or confusion
  • Fatigue when exercising
  • Sweating
  • *Chest pain or pressure

There are two types of atrial fibrillation. Paroxysmal is intermittent, meaning it comes and goes and continuous is persistent. Untreated atrial fibrillation doubles the risk of heart-related deaths and is associated with a 5-fold increased risk for stroke – many patients are unaware that AFib is a serious condition.

These are the dangers with atrial fibrillation:

  1. Since the blood in the atria does not flow quickly through to the ventricle in AF, clots are likely to form. If a clot is pumped out of the heart, it can travel to the brain, resulting in a stroke, or to the lungs, causing a pulmonary embolism
  2. Atrial fibrillation can decrease the heart’s pumping ability. The irregularity can make the heart work less efficiently.
  3. Untreated atrial fibrillation that occurs over a long period of time can significantly weaken the heart and lead to heart failure and death

Some people who have atrial fibrillation have no known heart problems or heart damage. Possible causes of atrial fibrillation include:

  • Coronary artery disease
  • Heart attack
  • Heart defect that you’re born with (congenital heart defect)
  • Heart valve problems
  • High blood pressure
  • Lung diseases
  • Physical stress due to surgery, pneumonia or other illnesses
  • Previous heart surgery
  • Problem with the heart’s natural pacemaker (sick sinus syndrome)
  • Sleep apnea
  • Thyroid disease such as an overactive thyroid (hyperthyroidism) and other metabolic imbalances
  • Use of stimulants, including certain medications, caffeine, tobacco and alcohol
  • Viral infections

Things that can increase the risk of atrial fibrillation (A-fib) include:

  • Age. The older a person is, the greater the risk of developing atrial fibrillation.
  • Drinking alcohol. For some people, drinking alcohol can trigger an episode of atrial fibrillation. Binge drinking further increases the risk.
  • Obesity. People who have obesity are at higher risk of developing atrial fibrillation.
  • Family history. An increased risk of atrial fibrillation occurs in some families.

There is also a complex relationship between atrial fibrillation and anxiety and depression. At present, researchers don’t know whether people with anxiety or depression are more likely to develop atrial fibrillation or whether having atrial fibrillation increases the risk of anxiety and depression.Treatment for atrial fibrillation depends on how long you’ve had A-fib, your symptoms and the underlying cause of the heartbeat problem. The goals of treatment are to reset the heart rhythm, control the heart rate and prevent blood clots that can lead to a stroke.

You may be prescribed medications to control how fast your heart beats and to restore it to a normal pulse rate. Blood thinners are also prescribed to prevent blood clots, a dangerous complication of atrial fibrillation. Your doctor may attempt to reset the heart rhythm (sinus rhythm) using a procedure called cardioversion. Cardioversion is usually done in a hospital:

  • Electrical cardioversion. This method to reset the heart rhythm is done by sending electric shocks to the heart through paddles or patches (electrodes) placed on the chest.
  • Drug cardioversion. Medications given through an IV or by mouth are used to reset the heart rhythm.

Your doctor might recommend a procedure called cardiac ablation. Sometimes ablation is the first treatment for certain patients. Cardiac ablation uses heat (radiofrequency energy) or extreme cold (cryoablation) to create scars in your heart to block abnormal electrical signals and restore a normal heartbeat. A doctor inserts a flexible tube (catheter) through a blood vessel, usually in your groin, and into your heart.

With the worldwide aging of the population characterized by a large influx of “baby boomers” with or without risk factors, it is clear that AF is on the rise – a significant amount of health resources are invested in detecting and managing AF. It is estimated that 12.1 million people in the United States will have AFib by 2030.

The data is finally coming in
Will we be covered with our vaccines?
In order to assess vaccine “effectiveness,” the scientists counted the number of neutralizing antibodies that attached to Omicron. Neutralizing antibodies quickly recognize the virus and destroy it before entering cells so the virus can’t replicate. Because it can’t replicate, the person doesn’t get infected. The more neutralizing antibodies you have, the better off you will be.
  • The results so far show that people who got boosters and those who were previously infected plus got at least one vaccine, had significantly higher levels of neutralizing antibodies than people not fully vaccinated or without boosters.
Does Omicron increase hospitalizations and death?
Infection or “positive cases” is very different than severe disease or death. In South Africa’s epicenter you’ll see the headlines saying that the number of COVID-19 cases/infections are increasing exponentially…
  • But a report from one of these hospitals provided more context about individual hospitalizations over the weekend. Among a sample of 42 COVID patients in the hospital on Dec. 2, most were hospitalized “with COVID19”…not “because of COVID19.”
  • Also, among the 42 patients, 9 had a diagnosis of COVID19 pneumonia. All of the 9 pneumonia patients, were unvaccinated .
It’s still early to commit to whether Omicron will be less severe, but it is looking very much like this infection is quite mild with only some flu-like, upper respiratory symptoms. We don’t know anything about this variant causing long covid.

The Omicron variant is still using the same “door” to get into cells as before (the ACE2 receptors in our respiratory system). This is good news, because it means our tools (like vaccines, masking, better ventilation) are still useful. However, the virus is making a smarter key to that door which means we’re definitely going to see an increase in breakthrough cases especially if your antibody levels are dropping and you haven’t gotten your booster.There’s a good chance Omicron will outcompete Delta in the United States. This coupled with the high unvaccinated rate will result in a substantial Winter wave. The rate of breakthrough cases will be higher, but I’m hopeful that boosters will largely keep people out of the hospital and if they get sick, it’s mild disease

We’re all exhausted. Everyone. But the virus isn’t. And it won’t be until it can’t find good places to live and mutate. Go get your vaccines and/or boosters. We need to make this virus homeless so it goes away. It’s time to live our lives again so if you’re worried about a breakthrough infection, even though it’s likely mild, be more vigilant with your masking and get your booster. But also get out there and live your life. Just be smart.


  • 70.2% of Philadelphians over the age of 12 yo are fully vaccinated. 
  • 59.6% of Pennsylvanians are fully vaccinated
  • 60.4% of the US is fully vaccinated
  • Click HERE to see vaccination rates worldwide
  • Philadelphia officials are considering implementing a COVID-19 vaccine mandate at all indoor dining establishments, requiring both patrons and employees to show proof of vaccination. The proposed mandate would bring Philly closer in line with cities like New York and San Francisco that have required proof of vaccination since August for entry at restaurants and indoor events.
  • The University of Pennsylvania on Thursday banned indoor social gatherings for the rest of the semester due to a growing number of coronavirus cases on campus. Penn still has not documented any cases of classroom or workplace transmission of the virus, officials said. But they said the ban on indoor social gatherings was out of “an abundance of caution.” Friday marks the last day of classes, while the semester ends Dec. 22. Classes for the spring term begin Jan. 12.
  • Philadelphia School District policy shifted this week to now require all student athletes to be fully vaccinated even those told that they could opt out of a COVID-19 vaccination for religious or medical reasons. This could effectively bench hundreds of student athletes. Those who had submitted their exemption requests by Nov. 12 would be granted a grace period and get until Jan. 21 to be fully vaccinated.
  • Geisinger is running at 110% capacity across its nine hospitals in central and northeastern Pennsylvania — overrun with largely unvaccinated COVID-19 patients who represent a quarter to well over half of all admissions, said Dr. Jaewon Ryu, Geisinger’s president and chief executive officer. In addition to the rising virus patient count, hospitals are seeing more patients who had put off care.
  • Federal authorities are giving booster shots for 16- and 17-year-olds a strong endorsement. Hours after the Food and Drug Administration on Thursday authorized the extra doses of Pfizer-BioNTech’s COVID-19 vaccine for adolescents in that age group, the Centers for Disease Control and Prevention recommended that those teens get the added protection as soon as they’re six months past their initial shots.
  • The latest mutation of the coronavirus, omicron, is making headlines across the nation. But, it’s still delta that is responsible for the soaring number of infections and hospitalizations across the nation. 
  • Patients who are overweight or obese are more likely to develop severe Covid-19 and more likely to die. Now researchers have found that the coronavirus infects both fat cells and certain immune cells within body fat. Inflammation is the body’s response to an invader, and sometimes it can be so vigorous that it is more harmful than the infection that triggered it. The more fat mass (especially the fat mass around your internal organs), the worse your inflammatory response. For example, a man whose ideal weight is 170 pounds but who weighs 250 pounds is carrying a substantial amount of fat in which the virus may “hang out,” replicate and trigger a destructive immune system response. Infected body fat may even contribute to “long Covid”.
  •  All inbound international travelers are now required to test within one day of departure for the United States starting 12/6. This new testing time frame will apply to everyone, “regardless of nationality or vaccination status”. This only applies to air travel. Before the new rule went into effect, all vaccinated travelers were required to test within three days of their departure. Unvaccinated Americans and legal permanent residents are allowed to enter the country with a test taken within one day of departing for the United States. The new rule makes the testing time frame one day for everyone. Biden also announced that the federal mask mandate requiring travelers to wear masks in airports, on planes and on other modes of public transportation such as trains and buses has been extended through March 18.


  • Entering the 2021-22 NHL season, the vaccination rate among players against COVID-19 was close to 100%.  The pandemic has not wreaked havoc on the schedule, with no more than a handful of postponements and rearrangements.  But players continue to test positive for the coronavirus, as dozens across the league have landed on the NHL’s COVID-19 protocols list.  And with one player already opting out of the 2022 Winter Olympics over COVID-19 concerns, the pandemic’s effect on the sport isn’t going away anytime soon.
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Please stay safe and be smart,
Dr Bralow

Dr. Vicki Bralow
834 South Street
Philadelphia, Pa 19147