Atrial Fibrillation
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A-Fib News

SEPTEMBER 2, 2010
    A-Fib patients at risk of dementia
    In a study of 37,025 aging patients, 27% developed A-Fib, and 4.1% of these developed dementia during the five year follow-up. A-Fib was significantly associated with all types of dementia, particularly in the younger group (under 70 years of age). And dementia combined with A-Fib put patients at a high risk of death.
    (Author's Note: Treatment strategies to keep people in A-Fib while controlling the heart rate (rate control meds) may lead to dementia and early death.)
 
Bunch TJ, et al. "Atrial fibrillation is independently associated with senile, vascular, and Alzheimer's dementia." Heart Rhythm. 2010 Apr;7(4):433-7. Epub 2009 Dec 11.
http://www.ncbi.nlm.nih.gov/pubmed/20122875?dopt=Abstract

AUGUST 31, 2010
    Magnesium Importance for A-Fib

      In a letter to the editor of BMJ (British Medical Journal) Drs. Dietch, Wilson and Thomas point out that magnesium is important in regulating the electrical activity of the heart and can help cases of acute A-Fib. "Treatment with magnesium may correct rhythm disturbances in patients with both low and normal magnesium concentrations." Magnesium is "superior to amiodarone in treating atrial tachycardias in critically ill patients."

     "It is our impression that magnesium is underused; should we not use it more widely?"

     (Author's Note: Magnesium is a naturally occurring element that we should be getting from the food we eat. However, almost everyone today is magnesium deficient, due to the lack of magnesium and other trace elements in today's over-farmed soil (some magnesium can be obtained from fish). Because it is a naturally occurring element, magnesium is considered safe to take in normal doses. "Magnesium is a relatively safe drug." It is certainly safer than amiodarone or other antiarrhythmic meds.

     In addition to cases of acute A-Fib, all A-Fib patients may want to discuss with their doctor whether magnesium supplements might help their A-Fib.)

http://www.bmj.com/cgi/content/full/312/7038/1101/b

BMJ Letters "Magnesium is underused in acute atrial fibrillation." 1996;312:1101 (27 April)

AUGUST 29, 2010
    Effects of a successful catheter ablation
    In an analysis of 17 different studies enrolling 869 patients, a successful catheter ablation significantly decreased (improved) left atrial diameter and volume, but had no significant difference in ejection fraction and actual emptying fraction.
    (Author's Note: It's certainly reason for hope for A-Fib patients, that a successful A-Fib ablation will not only stop but reverse some of the remodeling effects of A-Fib. But these results seem counter-intuitive. If left atrial diameter and volume are decreased (improved), one would expect ejection fraction to improve as well.)

Jeevanantham, V et al. "Meta-analysis of the effect of radiofrequency catheter ablation on left atrial size, volumes and function in patients with atrial fibrillation." Am J Cardiol. 2010 May 1;105(9):1317-26.
http://www.ncbi.nlm.nih.gov/pubmed/20403486?dopt+Abstract
 
AUGUST 29, 2010
    Carotid Sinus Stimulus or Massage by manual pressure for A-Flutter/A-Fib
    Carotid Sinus Stimulation or Massage is a technique used by doctors to partially block or slow down the flow of blood through the carotid sinus. It is used to tell the difference between different types of arrhythmias, and "rarely, may also terminate the arrhythmias and reestablish sinus rhythm." It is used in patients "in whom a rapid decrease in heart rate is desirable."
    Dr. Nayab Ali describes why carotid sinus massage may work. "Vagal Stimulation, by altering the atrial refractory period, may break the circus movement, atrial reentry, and atrial response to ectopic focus, thus allowing the sinus node to take over control."²¹²
Nayab Ali, "Conversion of Atrial Flutter to sinus rhythm by carotid sinus pressure." Journal of the National Medical Association, Vol. 74, NO. 8, 1982.
   
    WARNING: Carotid Sinus Stimulus or Massage should be done only by doctors and not by individual patients on themselves.
   
AUGUST 28, 2010
    "Radioactivity in low doses is good for us."
    In 1983 180 apartment building were built in Taiwan. But somehow highly radioactive Cobalt-60 was mixed into the concrete. The 10,000 people who lived in these apartments for 9-20 years received an average of 74 millisieverts (mSv) of radiation a year (a typical catheter ablation using fluoroscopy produces around 15 mSv¹⁷⁶---non-x-ray imaging systems much less).
    But cancer rates of people living in these highly radioactive buildings were 3.6% of prevailing Taiwanese rates. This is a reduction in cancer rates of 96.4%. This phenomena is perhaps explained by the theory of hormesis which holds that intermediate levels of radioactivity actually stimulate life and improve health.
http://www.jpands.org/vol9no1/chen.pdf
http://www.ecolo.org/documents/documents_in_english/taiwan-cobalt-60-apartmt-04.htm
New Scientist, "Radiation thresholds." October 30, 2004
    (Author's Note: The nuclear theory that any level of radiation is cumulatively damaging may not be valid [the "Linear No Threshold [LNT}" theory.] The levels of radiation received during a typical catheter ablation may not be dangerous, but may even be healthful.)

AUGUST 28, 2010
    CryoBalloon & RF Ablation---the future of A-Fib treatment
    CryoBalloon ablation is safe and effective in Pulmonary Vein Isolation, but is limited in treating persistent A-Fib (because it only isolates the pulmonary veins and not other parts of the heart). Doctors at Mass General used a combined CryoBalloon and RF ablation to treat patients with persistent A-Fib.
    (The FDA has not yet approved the CryoBalloon catheter for general use. Though approved in Europe, some question whether the FDA will approve the CryoBalloon catheter, because of the over 13% of phrenic nerve injury (mostly reversible) during the clinical trials. {The cold from the catheter may have temporarily frozen the phrenic nerve in the pericardium, the sac around the heart.])
    First a PVI was done using the CryoBalloon catheter. It took approximately 10 minutes to isolate each vein (a considerable savings in time compared to a typical RF ablation). 6% of patients required additional RF ablations to completely isolate the pulmonary veins.
    Then an RF catheter was used to ablate complex fractionated electrograms (CFAEs). Finally linear ablations were performed with the RF catheter to terminate the persistent A-Fib.
    After a single procedure 86.4% of patients were A-Fib free without antiarrhythmic drugs (a high success rate for persistent A-Fib after only one procedure).
    (Author's Note: The above study only dealt with cases of persistent A-Fib. But this combination of CryoBalloon {or possibly Laser Balloon] and RF will probably become the standard treatment for all cases of A-Fib.
    Because the CryoBalloon is safe, effective, and fast, it will probably become the normal method of isolating the pulmonary vein openings. If A-Fib remains after the CryoBalloon ablation, then RF can be used to ablate other areas of the heart that produce A-Fib signals. This combination of CryoBalloon and RF ablation is a major medical breakthrough in the treatment of A-Fib.) 
Heart Rhythm. 2010 Apr;7(4):452-8. Epub 2009 Dec 24
http://www.ncbi.nlm.nih.gov/pubmed/20188229?dopt=Abstract
    
AUGUST 27, 2010
    Bypass Surgery and A-Fib
    It is estimated that one out of three bypass surgery patients will suffer at least one episode of A-Fib after surgery. 40% of these will have more than one A-Fib attack.
     Beta-blockers and ACE inhibitors, as well as potassium and non-steroidal anti-inflammatory drugs (NSAIDS) appear to reduce the risk of developing A-Fib after bypass surgery.
    The risk factors most associated with developing A-Fib after bypass surgery are:
        - Advancing age,
        - Past history of A-Fib,
        - Chronic obstructive pulmonary disease,
        - The discontinuation of beta-blockers and ACE inhibitors after bypass surgery.
(It was assumed that patients were too sick after surgery to continue to take beta-blockers or ACE inhibitors. But according to this study, "the discontinuation of beta-blockers and ACE inhibitors would be unwise, and their use appears to be protective.")

    (Author's Note: It wasn't clear whether this study included antiarrhythmic drugs. The author questions whether administering antiarrhythmic meds after bypass surgery [similar to what is often done after an A-Fib ablation] might prevent the development of A-Fib after bypass surgery.)
http://www.scienceblog.com/community/older/2004/3/20042692.shtml

   
       
AUGUST 26, 2010
    Fibrosis in A-Fib: Chicken or the Egg?
    In a study indirectly related to A-Fib, it was found that fibrosis leads to or is the cause of the development of cardiomyopathy, rather than being caused by or a result of the disease. (People with cardiomyopathy often have A-Fib as well.) According to Dr. Carolyn Y Ho of Brigham and Women's Hospital in Boston, MA, "...the development of fibrosis might play a role in actually driving the development of the disease, rather than being a reaction to the development of overt disease."
http://www.theheart.org/article/1109291.do
    (Author's Note: Since fibrosis also occurs in A-Fib, strategies to prevent fibrosis or to identify factors such as genetics, diet, life style, chemical/biological markers, etc. which influence the development of fibrosis may help prevent the future development of A-Fib. "...targeting fibrosis...may help to forestall the development of clinical disease."²⁰⁹)

AUGUST 18, 2010
    Dr. John Sirak of the Ohio State University has developed a type of Mini-Maze surgery for A-Fib---the "Five-Box Thorascopic Maze Surgery" or Total Thorascopic Maze (TTM) which, according to his web site, has a "cure rate in excess of 95%." (Author's Note: This Mini-Maze surgery may be an alternative to the full Cox (Radial) Maze surgery for A-Fib.)
http://www.ohioafib.com/maze-surgery/

AUGUST 9, 2010
    Chicago Cubs pitcher Carlos Silva had a catheter ablation procedure to correct a problem with his heart rate (paroxysmal supraventricular tachycardia). Dr. Bradley Knight performed the two-hour procedure at Northwestern Memorial Hospital. He is expected to begin light physical activity in a week, and start a throwing program early the next week.
    Silva had the same procedure as former Cubs player Mark DeRosa, now with the Giants. DeRosa had the heart work done during spring training 2008 and was able to play in 149 games that season. http://www.washingtonexaminer.com/breaking/cubs-silva-undergoes-heart-procedure-100310124.html

August 8, 2010
    In a study of 50 patients who underwent Mini-Maze surgery, 40% had recurrences of arrhythmias during the healing process, in a follow-up study of 12 months. PV reconnection accounted for most recurrences. Most patients' A-Fib was terminated by catheter ablation, often combined with antiarrhythmic and rate control meds.²⁰⁸ (Catheter Ablation procedures also have significant recurrence rates.)
    (Author's Note: This article may be very important to A-Fib doctors and researchers, because it identifies specific areas of the heart where re-growth/recurrence is likely to occur. "The relative thickness of human myocardium, particularly in areas with endocardial ridges, as well as the presence of blood flow, may explain the discrepant results between patient outcomes..."
    Catheter ablation does follow the contours and ridges of the heart. Can the catheter be programmed to produce deeper burns in areas of greater heart thickness like endocardial ridges? This might be a solution to a very troublesome problem for both A-Fib doctors and patients.)
    The author questions whether other energy sources like Cryo or Laser might help both surgery and catheter ablation overcome this problem of re-growth/re-connection after surgery and ablation for A-Fib.)
   

MAY 22, 2010 vernakalant successful in stopping A-Fib
    For A-Fib patients with underlying heart disease, the intravenous med Vernakalant converted 51.7% of A-Fib patients to sinus rhythm after only around 11 minutes. It was shown to be safe, well tolerated, and associated with greater improvements in quality of life (the AVRO trial). An FDA advisory panel voted in favor of vernakalant, but the FDA still has not approved it in the US.¹⁸³ http://www.theheart.org/article/1079027.do 
    (Vernakalant is a medical breakthrough for A-Fib patients with structural heart disease who cannot use other antiarrhythmic drugs, if the FDA approves it.)
   
MAY 21, 2010 Ablation of A-Fib reduces risk of Alzheimer's and dementia
    In a large population study (37,908) at the Intermountain Medical Center in Utah, some patients with A-Fib received catheter ablation treatment, while others received drug therapy. After three years of follow-up, the rate of Alzheimer's disease and all forms of dementia was significantly lower among patients who underwent catheter ablation. According to Dr. John Day, "In fact, the rates we saw were similar to those that you'd see in patients who never had A-Fib to begin with." Catheter ablation also reduced the risk of mortality and stroke at three years.^182*
    (Catheter ablation may reduce Alzheimer's and dementia:
    1. By improving and/or normalizing blood flow to the brain.
    2. By reducing inflammation. There may also be an inflammatory connection, "with both A-Fib and Alzheimer's disease associated with high levels of C-reactive protein."
    3. By reducing and eliminating TIAs and subclinical strokes caused by A-Fib. These mini-strokes produce amyloid plaque found in Alzheimer's disease patients.)
    Catheter ablation reduces the risk of mortality and stroke, and reduces the risk of Alzheimer's and dementia. Then why leave A-Fib patients on medications? As Dr. Day suggested, "...if you have A-Fib and medication isn't working, maybe we should move toward a potentially curative procedure earlier, rather than spinning our wheels for years with medication."¹⁸¹ http://www.theheart.org/article/1079365.do
     *The title of reference ¹⁸² is confusing. I have written the author for a clarification.  

   
MAY 17, 2010 High dose steroids may cause A-Fib.
    In a case-control study in the Netherlands involving 7,983 men and women, high-dose corticosteroid use significantly increased the risk of developing A-Fib. (Corticosteroids include meds such as prednisone, cortisone, hydrocortizone, budesonide, betamethasone, dexamethasone, Advair. High-dose refers to a daily dose greater than 7.5 mg of prednisone equivalents.)
    But it's dangerous to suddenly stop taking steroids. Sudden withdrawal can lead to serious side effects and, in some cases, be life threatening.¹⁸⁰ http://www.theheart.org/article/696423.do
 
May 15, 2010
    Dr. Andrea Natale has been named the Director of Interventional Electrophysiology at Scripps Clinic in La Jolla, CA (April 5, 2010). Here is his address info:
Scripps Clinic
10666 N. Torrey Pines Rd SW 206
La Jolla, CA 92037
(858) 554-5049
    Dr. Andrea Natale, Director of Interventional Electrophysiology
    Dr. Douglas N. Gibson (858) 554-8730
Dr. Natale is also available to help A-Fib patients in other areas of the US: see
    ---Austin, Texas Dr. Natale is the Executive Director of the Texas Cardiac Arrhythmia Institute
    ---Akron, Ohio Akron General Medical Center
    ---Cleveland, Ohio MetroHealth Medical Center
    ---San Francisco, CA Northern California Heart Center
 
APRIL 15, 2010
    Women with A-Fib had a higher stroke risk, more stroke-related disability, and were less often prescribed blood thinners, according to researchers analyzing past A-Fib studies comparing how A-Fib affects men and women. Doctors may be more reluctant to prescribe warfarin (Coumadin) to women, because some evidence shows that women have a significantly higher risk of bleeding from blood-thinning medication.¹⁷⁷
    (If you are a women with A-Fib, make sure you consult with your doctor about the risk-benefit of taking blood thinners. An A-Fib stroke is often a fate worse than death. See Anticoagulants.)

december 22, 2009
    The latest worldwide survey of A-Fib ablations includes data on 20,825 catheter ablation procedures performed on 16,309 patients over a four-year period from 2003 to 2006 (some patients had more than one ablation). This is almost twice the number of patients treated compared to the first survey from 1995 to 2002.
    The success rate was 70% (A-Fib symptom-free without having to take antiarrhythmic drugs), which was a major improvement over the 52% reported in the first survey. The "overall success rate"---defined as freedom from A-Fib with or without the use of antiarrhythmic drugs---was similar in both surveys, at 80%.
    More patients with persistent and long-lasting A-Fib were treated than in the previous survey. Of the 1,108 patients with long-standing A-Fib, the success rate was 63.1%, while the overall success rate was 72.3%.
    The overall complication rate was 4.5%, down slightly from the previous survey. But Transient Ischemic Attacks were cut in half, and Pulmonary Vein Stenosis was reduced by two thirds. (Pulmonary Vein Ablation is a relatively new procedure. More experience, improved techniques and equipment, and the sharing of knowledge have definitely improved the outlook for A-Fib patients.)
    There were 25 procedure-related deaths and 37 strokes, similar to the previous survey. Atypical Atrial Flutter doubled. Atrioesophageal Fistula, not reported previously, occurred in 0.04% of patients, of whom 71% died. (The author is not sure about these figures. 0.04% of 16,309 is only around 7 patients.) (Atrioesophageal Fistula is less of a problem today. Most centers now take precautions to prevent Atrioesophageaal Fistula.)
http://www.theheart.org/article/1035905.do

Author's Conclusions
    Limitations of the survey
        85 electrophysiology centers in North America, Europe, Asia, and Australia provided data for this survey. But in the US alone there are currently around 200 centers performing A-Fib ablations. The 85 centers providing data may be the most experienced, larger centers. Are the newer, smaller centers achieving similar success and complication rates? We simply don't know. (From the author's limited experience, the newer, smaller practices seem to be achieving similar success and complication rates, at least in the US.)
    Insufficient doctors and medical centers for A-Fib
       Though 16,000+ patients seems like a huge number, it's very small compared to the number of people developing A-Fib. Though there has been a tremendous growth in medical centers and doctors doing A-Fib ablations, they can not possibly handle all the cases of A-Fib which some are calling an epidemic. Nearly three million people in the U.S. have A-Fib. By the year 2050, the number will be 5.6 million.⁷¹ In the US people over 40 have a one in four chance of developing A-Fib.⁸² A-Fib needs to become a national and worldwide health issue.
    Remarkable progress in a short time
        A-Fib patients should be encouraged by the remarkable progress doctors have made in A-Fib catheter ablation within a relatively short period of time. The first Pulmonary Vein Ablation was done a little more than a decade ago. A worldwide improvement from 52% to 70% success rate is a notable achievement and a testament to the hard work of A-Fib doctors everywhere.)
   
december 19, 2009 Following a Pulmonary Vein Ablation procedure, patients should be given warfarin for at least 2 months regardless of their stroke risk factors (HRS/EHRA/ECAS AF Ablation Consensus Statement).¹²⁵ But a recent study found that "low-risk patients with a low CHADS2 (0-1) score... can safely be discharged on aspirin alone."¹⁷¹ (Thanks to William Pfeifer for calling our attention to this research.)
    (Author's Note: For safety's sake [and to avoid legal liability problems], your doctor will probably still want you to be on warfarin after an ablation.) 

december 7, 2009 Recent research indicates that A-Fib Fibrosis can be measured by an MRI.^{169, 170}

november 23, 2009 Medifocus provides a listing of the latest medical journal articles published in MEDLINE, with direct links to the specific article summaries (abstracts). To subscribe to the free Medifocus Digest Alert on Atrial Fibrillation, click on this link: http://www.medifocus.com/zcr004.php?assoc=afib

NOVEMBER 19, 2009
DABIGATRAN TO REPLACE WARFARIN (COUMADIN)
    The above title is presumptuous, because the FDA hasn't yet approved the oral anticoagulant dabigatran. But the recent RE-LY trial comparing dabigatran etexilate (by Boehringer Ingelheim) to warfarin at 951 centers in 44 countries with 18,113 A-Fib patients produced results that are hard to ignore. Low dose dabigatran was as good as warfarin, while the high dose was better at preventing stroke and systemic embolism.
    To paraphrase the lead investigator Dr. Wallentin, dabigatran does not need frequent blood-test monitoring for INR levels, isn't affected by possible food-drug or drug-drug interactions, can be used in many more patients than warfarin, has few side effects, and is more effective and safer than warfarin.
    (The author predicts that dabigatran will be approved by the FDA and will quickly replace warfarin as a treatment to prevent A-Fib stroke. [It is already approved in the European Union and Canada.]} This is a major medical breakthrough and most welcome news for A-Fib patients who will no longer have to cope with measuring INR levels, worrying about diet, vitamin K deficiency, side effects, etc. It's also welcome news for doctors who won't have to wrestle with keeping patients at the right INR levels. They will have an oral anticoagulant that is very effective, has fewer side effects, and can be administered to a broader range of patients.
http://www.theheart.org/article/1024935.do (Thanks to Ira David Levin for calling our attention to this article.)
   

NOVEMBER 17, 2009
RHYTHM (ANTIARRHYTHMIC) MEDS BETTER THAN RATE CONTROL
     In a study of 5604 patients with A-Fib who were treated with either antiarrhythmic or rate control meds, "81% of patients treated with rhythm control, compared with 33% of patients in the rate-control arm were in sinus rhythm, after one year... 13% progressed to permanent A-Fib in the rhythm-control arm, whereas 54% in the rate-control arm had permanent A-Fib after one year." This finding disagrees with the AFFIRM trial which indicated there was no advantage of rhythm control vs. rate control for the prevention of cardiovascular events.
    Author's Note: Though the study found no significant difference in clinical outcomes, from this patient's perspective it's certainly better to have a normally beating heart than to be in A-Fib---from a clinical as well as from a quality of life aspect. If the study were longer than one year, one would expect to see more heart problems develop in those still in A-Fib. And why isn't progressing to permanent A-Fib not considered a clinical outcome? Anyone who suffers from A-Fib dreads and fears going into permanent A-Fib.
    A disturbing point mentioned in passing in this study is the high percentage of patients (54%) in the rate-control arm who progressed to permanent A-Fib within one year! This should be a wake-up call to all A-Fib patients. If you don't aggressively try to stop your A-Fib (as with antiarrhythmic meds or a Pulmonary Vein Ablation. etc.), you can expect your A-Fib to become permanent within one year (54% chance).
    This RECORD AF Registry data was presented at the American Heart Association 2009 Scientific Sessions by Dr. John Camm. http://www.theheart.org/article/1023939.do (Thanks to Ira David Levin for calling our attention to this article.)

OCTOBER 1, 2009 dr. j. Marcus Wharton of the Medical Un. of South Carolina has a very informative 18 minute audio presentation on A-Fib Ablation http://www.muschealth.com/multimedia/Podcasts/displayPod.aspx?podid=252&autostart=true

August 14, 2009 We are very excited about starting a new way of helping people with A-Fib. Many people who've had A-Fib have generously committed to serve as A-Fib Support Volunteers, to help people cope with and be cured of A-Fib. They've listed their Email addresses and are there for anyone who needs advice, emotional support, and hope in getting through the A-Fib ordeal.

JULY 30, 2009 Dronedarone (brand name Multaq) is now available in pharmacies in the U.S. http://www.reuters.com/article/rbssHealthcareNews/idUSLS59493520090728

JULY 2, 2009 Dronedarone (brand name Multaq by Sanofi-Aventis) was approved by the FDA. This is a major medical breakthrough for many A-Fib patients. See Dronedarone. http://www.theheart.org/article/983519.do.
      But there is a caveat. "Dronedarone is not indicated in patients with severe heart failure or those with NYHA (New York Heart Association) class 2 or 3 heart failure with a recent decompensation requiring hospitalization." (Class 2 refers to patients with slight, mild limitation of activity, class 3 refers to patients with marked limitation of activity. "Decompensation" refers to rapid accumulation of fluid in the lungs due to heart problems.) "The ANDROMEDA trial showed that dronedarone increased the risk of mortality twofold among those treated by the drug." This is a major difference from amiodarone which dronedarone is similar to but with less toxic effects. Amiodarone is considered safer for patients with structural heart disease, while dronedarone is not indicated for patients with severe heart failure.

June 20, 2009 Dr. Richard Schilling of the London AF Center is doing preliminary research to help eliminate regrowth/reconnection of ablated areas in a Pulmonary Vein Ablation and the recurrence of A-Fib after ablation.
    He uses both RF (Radio Frequency burns) and Cryo (Freezing) ablation. He first performs a wide encirclement RF ablation of the left atrium pulmonary vein ostia. Then he supplements this with Cryo balloon ablation, which tends to freeze the veins a little bit closer to the origins of the veins. In effect he produces two parallel lines of electrical block, which reduces the chances of recovery of electrical connection between the pulmonary veins and the left atrium. This reduces the recurrence of A-Fib after ablation.
    Though this procedure has only been performed in 15 patients with reasonable follow-up, he has seen a dramatic improvement in the first time success rate for ablation of paroxysmal A-Fib. This technique is now being tested in a randomized control trial to see if the additional cost of using two technologies (RF and Cryo) is justified by a significant improvement in first time success rates.
    (Editor's Note: Dr. Shilling's innovative technique of using both RF and Cryo balloon may be a major medical breakthrough for A-Fib patients. Eliminating regrowth/reconnection and the recurrence of A-Fib after ablation may significantly reduce the need for a second ablation and improve the success rate of Pulmonary Vein Ablations.)

JUNE 9, 2009 Researchers have made a medical breakthrough connection showing a strong relationship between A-Fib and the development of Alzheimer's. This finding was presented at the May 15, 2009 Heart Rhythm Society Scientific Sessions.
    In the Intermountain Heart Collaborative Study in Murray, UT 37,025 people were followed for five years:
        1. Patients with A-Fib were 44 percent more likely to develop dementia than others.
        2. Younger patients with A-Fib were at a higher risk of developing all types of dementia, particularly Alzheimer's. A-Fib patients under age 70 were 130% more likely to develop Alzheimer's.
        3. Patients who had both A-Fib and dementia were 61 percent more likely to die during the study than dementia patients without A-Fib.
        4. Younger A-Fib patients with dementia may be at higher risk of death than older A-Fib patients with dementia.
    Alzheimer's is the most common form of dementia (a general term for life-altering loss of memory and other cognitive abilities), and accounts for 60-80 percent of all dementia cases today. Today Alzheimer's is the sixth leading cause of death in the US.
    "Previous studies have shown that patients with A-Fib are at higher risk for some types of dementia, including vascular dementia. But to our knowledge, this is the first large-population study to clearly show that having A-Fib puts patients at greater risk for developing Alzheimer's," according to Dr. T. Jared Bunch, the study's lead researcher.¹⁵⁴
    (Editor's Note: The study only states there is a strong connection or relationship between A-Fib and Alzheimer's, because there may be other factors influencing both the development of A-Fib and Alzheimer's. But as A-Fib patients we have to assume until proven otherwise, that A-Fib causes or leads to Alzheimer's and dementia. This conclusion makes intuitive sense. In A-Fib, blood is not being pumped properly to the brain and other organs.
    Another conclusion to be drawn from this study is: therapies which leave patients in A-Fib while controlling the ventricular rate should be avoided (rate control meds like Metoprolol or Digoxin), because they may lead to Alzheimer's and dementia.)
   
   
     May 22, 2009 Dr. Vivek Y. Reddy will join the Mount Sinai Medical Center July 1, 2009. He previously was affiliated with the Un. of Miami, Miller School of Medicine.¹⁵¹  Dr. Andre d'Avila and Dr. Srinivas R. Dukkipati will also transfer to Mount Sinai in December. (Thanks to contributor Ray for this info.)
    Their address will be:
Cardiac Electrophysiology Laboratories
1468 Madison Av. @ 100th. St.
New York, NY 10029
(212) 241-7911

MAY 11, 2009 Some research suggests that coffee and caffeine in moderate doses may be antiarrhythmic and may reduce propensity and inducibility of A-Fib both in normal hearts and in those with focal forms of A-Fib.¹⁴³

MAY 8, 2009 PREDICTING A-FIB  (For people with occasional or silent A-Fib, it is sometimes difficult to get an ECG or documentation of the A-Fib. By the time one gets to the Doctor's office or the ER, the A-Fib attack has stopped. It may now be possible to predict A-Fib simply by examining an ECG of the heart in sinus rhythm. Doctors can predict A-Fib by looking at the P wave which is formed when the atria contract. See EKG Signal.)
    The measures used to predict A-Fib are: "P-wave terminal force, P-wave duration, P-wave area, and PR duration."¹³⁹ For example, a P-wave duration of greater than 140 milliseconds is predictive of A-Fib.¹³⁸
     The study found that African Americans "seem to have more of these ECG predictors than whites, which might explain why they are at higher risk of ischemic stroke than whites, despite apparently having a lower prevalence of A-Fib." They may have intermittent or silent A-Fib which is not always detected.¹³⁹
    (Editor's Notes: The authors of the above study did not draw the following conclusions.
    Why not use the above A-Fib predictors to develop a nation-wide program to screen for A-Fib? For example, anyone over 50 could be screened by a Cardiologist looking at the patient's ECG. Anyone with A-Fib predictors, even though in sinus rhythm, could be given a Holter or other monitoring system to document if the patient has A-Fib. The A-Fib could then be treated, which would save many people from an A-Fib stroke or deteriorating heart health due to progressive A-Fib.)
   
    
    MAY 5, 2009 An FDA advisory panel on April 24, 2009 approved the Watchman device (Atritech, Plymouth, MN) with conditions: centers implanting the device must have surgical backup, and a physician certification program must be created. The panel also recommended the creation of a registry, and extended follow-up of current trials. The FDA usually follows its advisory panel's recommendations.
     Though the vote was split 7-5, "most panel members felt the sponsor showed the device to be effective." Some panel members were uncomfortable with the size of the 800-patient study, the duration of follow-up (two or three years) and the long-term safety of the device. Some felt a decision on effectiveness was difficult when there were so few strokes in either arm. (Six patients in the control Warfarin arm had a hemorrhagic stroke, four of whom died. No one died who received the Watchman device.)
    The PROTECT-AF study on which the FDA advisory panel based its approval was a prospective randomized trial comparing closure of the Left Atrial Appendage by the Watchman occluder with long-term warfarin therapy (90% of strokes come from the Left Atrial Appendage). This was a "noninferiority" study---"the Watchman device was associated with a reduction in hemorrhagic stroke risk vs. warfarin, and all-cause stroke and all-cause mortality outcomes were noninferior to warfarin."
    Of the patients receiving the Watchman device, 87% were able to stop taking warfarin after day 45. By 12 months, 93% were off warfarin permanently.
    There were problems such as pericardial effusion in the first implantings of the Watchman device. But these decreased with experience and improved devices, training, and procedural modifications. According to Dr. David R. Holmes, Jr., current effusion rates are now around 1% and "are going to be much more what we will see as the device rolls out." Dr. Gary Abrams added, "I think that once the early morbidity from this gets worked out as people get experience with it, I think it offers an option for people who need to stay on warfarin for many, many years." http://www.theheart.org/article/962955/print.do and http://www.theheart.org/article/951777.do
    Editors Comments: This approval of the Watchman device is a major medical breakthrough for A-Fib patients.
     It is estimated that only 50% of patients who need anticoagulation protection are receiving warfarin, because it's so hard to get the right dosage or because people can't tolerate it. But most A-Fib patients can receive the Watchman device. Dr. Holmes speculated that the Watchman device might be an option for up to 70% of patients with nonvalvular A-Fib.  
    Most of the panel were of the opinion that warfarin can have "devastating" effects over time. Dr. Jeffrey Brinker said, "the risk of Coumadin is high, especially in an older population who fall or who are more fragile," and who are more at risk of a hemorrhagic stroke. The Watchman device is a most welcome alternative to warfarin/Coumadin.
    Practical Consequences of the FDA Advisory Panel's Approval:
     Those of us who hate having to take Coumadin will be able to go in for a very low risk procedure that takes as little as 20 minutes, and never have to take Coumadin again! This is incredibly good news for many of us. 
    Even while we are waiting for or trying to decide on having a Pulmonary Vein Ablation, we can have the Watchman inserted and then not have to worry about an A-Fib stroke.
    The Watchman device may become part of most catheter ablation procedures. If the catheter ablation procedure were unsuccessful or in case of silent A-Fib attacks after ablation, we patients would still be protected from an A-Fib stroke by the closing off of the Left Atrial Appendage.

march 28, 2009 The AFIB REPORT by Hans Larson has the following caution about digoxin. "Recent research has clearly shown that digoxin should not be used on a continuous basis in patients with paroxysmal lone A-Fib, since it is likely to worsen their condition and result in it eventually becoming permanent.^{" No References Cited)} And, "Digoxin poisoning is a leading cause of hospital admissions with anywhere between 10 and 30% of patients on the drug being hospitalized for digoxin intoxication."^{(No References Cited)131}

March 21, 2009 Dronedarone (brand name Multaq) was recommended for approval by an FDA advisory committee (March 18, 2009). It isn't guaranteed that the FDA will approve dronedarone, but it usually doesn't disagree with its committee's recommendations.
    (This is a major medical breakthrough for A-Fib-ers, especially for older patients, for those who can't have a Pulmonary Vein Ablation or a Mini-Maze surgery, or for those who have failed these procedures/surgeries. Dronedarone may allow many of these A-Fib-ers to lead a relatively A-Fib free life.
    Dronedarone is similar to amiodarone which is considered the most effective anti-arrhythmic drug, but without its toxic side effects. In the ATHENA clinical trial, Multaq (by Sanofi-aventis) was the only anti-arrhythmic drug "to have shown a significant reduction in morbidity and mortality in patients with A-Fib/A-Flutter..." ) http://news.prnewswire.com/ViewContent.aspx?ACCT=109&STORY=/www/story/03-18-2009/0004991096&EDATE
     
March 4, 2009 WorldOne research is an independent market research organization based in London. We would like to invite patients with ATRIAL FIBRILLATION for a 15-20minutes research study. This can be completed via telephone or online.
    The Study aims at gaining an understanding of the following areas:

February 16, 2009 A-Fib.com complies with the HONcode standard of trustworthy health information on the internet. (The Health on the Net Foundation in Switzerland tries to guide lay users and medical professionals to reliable sources of health-care information online. This HONcode accreditation indicates that A-Fib.com has been deemed a reliable source of health information and meets standards, including those related to the qualification of the authorities cited, privacy of personal data submitted by a visitor to A-Fib.com, and financial disclosure of funding sources. It does not guarantee that all the health information on A-Fib.com is infallible.)

February 15, 2009 Preliminary tests results of Ablation Frontiers' multi electrode catheters is very positive, with an 83% success rate for Paroxysmal A-Fib patients. See http://download.journals.elsevierhealth.com/pdfs/journals/1547-5271/PIIS1547527108008679.pdf

February 14, 2009 Medtronic has developed an insertable cardiac monitor to detect A-Fib signals. The Reveal XT is placed just under the skin of the chest in a short outpatient procedure. It captures an electrogram (ECG) during an actual A-Fib episode. To store the ECG the patient places a hand-held, pager-sized assistant over the Reveal XT and presses a button. Later, a physician analyzes the stored information, transmitted via the Medtronic CareLink Network or during an in-office patient visit. For further info, go to http://www.medtronic.com.

February 10, 2009 The FDA approved the first ablation catheters for the treatment of A-Fib. The two radiofrequency catheters, the NaviStar ThermoCool and EZ Steer ThermoCool Nav (BioSense Webster), were approved February 6, 2009. http://www.theheart.org/article/939929.dohttp://www.theheart.org/
article/939929.do See also: http://www.fda.gov/bbs/topics/NEWS/2009/NEW01953.html

November 25, 2008 An FDA panel unanimously recommended approval of an A-Fib Ablation Catheter, the first to be so recommended. (Up to this point doctors had been using ablation catheters off-label.) http://www.theheart.org/viewArticle.do?primary Key=923617
     (As a consequence of this FDA panel decision, Pulmonary Vein Ablation (Isolation) procedures have officially entered mainstream medicine and can no longer be considered "experimental.")

August 11, 2008 A-Fib-ers in Southern California were sadden to learn of the death of Dr. Carolyn Kimme-Smith who hosted and supported the local A-Fib support Group in her Newport Beach home.
    Dr. Kimme-Smith was a breast cancer survivor who tirelessly devoted her time and energy to many issues, primarily focused on early detection of breast cancer. She had a distinguished career as a full Professor at UCLA's School of Medicine, Dept. of Radiological Sciences.
    Her husband Hal and her three children hosted a memorial celebration of her life August 9 which filled their home. We all learned a great deal about this wonderful woman who touched so many lives.

August 4, 2008 The osteoporosis drug alendronate (brand name Fosamax) is linked to A-Fib. Women who have used alendronate at any time in their lives have an 86% greater risk of developing A-Fib than women who have not used the drug.¹²⁸

July 17, 2008 The FDA recently approved the new beta blocker drug nebivolol (brand name Bystolic by Forest/Mylan, a selective beta-1-blocker).¹²⁶This is a minor medical breakthrough for A-Fib-ers taking traditional beta blockers like atenolol or metoprolol who may feel tired or fatigued due to slower blood flow. (Traditional beta blockers reduce the effect of excitement and physical exercise on heart rate and force of heart contraction.) Nebivolol is an effective beta blocker that also produces vasodilation (an expansion of the blood vessels) and reduces peripheral resistance by increasing nitric-oxide release. Instead of slowing blood flow, nebivolol maintains blood flow and lowers vascular resistance.
    Nebivolol is similar to the newer beta blocker carvedilol (Coreg), though they act differently. (Carvedilol is a non-cardioselective beta 1, beta 2 and alpha-receptor blocker, whereas nebivolol is highly cardioselective [blocking beta 1 receptors only] and produces vasodilation by nitric-oxide release.) 

June 30, 2008 The anitarrhythmic drug Procanbid will no longer be available for A-Fib patients. There doesn't seem to be any generic substitute. King Pharmaceuticals, Inc. which makes Procanbid issued this statement about its decision. It was "based upon many factors, including our understanding of current medical therapy and the general availability of alternative antiarrhythmics."

June 28, 2008 "Cryoablation (with the CryoCath Arctic Front cryoballoon): Safer than RF..." Dr. Burghard Schumacher of Germany described a study involving 346 patients with Paroxysmal (293) or Persistent (53) A-Fib. Following one Cryoballoon ablation, 74% of Paroxysmal patients were free of A-Fib and in permanent sinus rhythm. But this figure was much lower for those with persistent A-Fib---just 38%. There were no strokes, no pulmonary vein stenosis, no esophageal injury, and no coronary artery injury as sometimes occurs with RF ablation (RF ablations typically have a major complication rate of around 4%). The main complication reported was a temporary palsy of the phrenic nerve.
    According to Dr. Philippe Ritter, president of Cardiostim, "Cryoablation (with the Cryoballoon catheter) appears to have a lower complication rate than RF ablation and is easier to perform...but we need some more years to look at it and compare it with RF ablation." (See: http://www.theheart.org/article/877315.do)
    (Editor's Comments: A 74% cure rate for the CryoCath balloon catheter is similar to current cure rates for RF ablations for Paroxysmal A-Fib. The low 38% cure rate for Persistent A-Fib might be due to only having one ablation. Most RF ablation procedures for Persistent A-Fib now require two or more ablations. [See: 95% Success Rate in Curing Persistent A-Fib.] Also, in this study only the Pulmonary Vein openings were treated with the CryoCath balloon catheter. They did not attempt any other lines or lesions as is commonly done with current RF ablations for Persistent A-Fib. Persistent A-Fib is more complex and difficult to cure. As doctors get more experienced with Cryo, they may well be able to achieve similar success rates as RF for Persistent A-Fib.
    In the future we may see centers first use Cryoballoon catheters to isolate the Pulmonary Veins because it is safer, easier, and uses less fluoroscopic exposure; and secondly use RF or non-balloon Cryo catheters for linear lesions and to target other areas of the heart in more complex cases of Persistent A-Fib. Cryo will probably also be used to ablate near the esophagus to prevent Atrial-Esophageal Fistula [see Morady: Boston A-Fib Symposium 2008].
    Cryoballoon catheter ablation may also be the answer to the problem of re-do's. [See Dr. Marchlinski's presentation on Ablation re-do's.] All too often RF ablation patients have to return for a second ablation, because of re-growth and reconduction of the RF ablated areas, and because PV isolation with RF is difficult to achieve in a uniform fashion, even with experienced operators. Circumferential ablation with small-tipped catheters often results in gaps in the lesions lines and uneven scar formation. The Cryo balloon catheter ablation may solve the problem of  re-do's, because of its ability to easily and quickly produce uniform pulmonary vein isolation. [See: Dr. Kerwin's explanation of Cryo Ablation.])

June 27, 2008 "Dronedarone safety, efficacy standings bolstered in huge A-Fib trial." Dronedarone (brand name Multaq by Sanofi-Aventis) is a drug in clinical trials to replace amiodarone which often has serious toxic side effects. Both drugs have similar molecular structures and seem to work in a similar way. But dronedarone (a benzofuran analog of amiodarone) doesn't have the iodine component that is largely responsible for amiodarone' s toxic effects on the lungs, thyroid, eyes and other organs.
    In the randomized ATHENA trial over 4,500 A-Fib patients in 37 countries took either dronedarone or a placebo in "the largest antiarrhythmic drug trial ever conducted." Patients who took dronedarone experienced a 24% drop in risk of Cardiovascular (CV) hospitalizations or death over almost two years. Unlike other antiarrhythmic drugs, dronedarone seems to carry a low risk of adverse events. Secondary clinical end points also improved, such as less hospital admissions for A-Fib and acute coronary syndromes. According to Dr. Bramah N. Singh of UCLA, "...in terms of safety, it (dronedarone) is the best drug we have for atrial fibrillation." See http://www.theheart.org/article/867591.do.
    The trial did not compare the efficacy of dronedarone to amiodarone, which is the subject of another ongoing randomized clinical trial called DIONYSUS.
     

June 16, 2008 A new advancement in mapping techniques may significantly improve ablation treatments. A specialized multielectrode mapping catheter with a 20-pole penta-array produces rapid, high-density atrial mapping.  The whole atrium can be mapped in less than 8 minutes. It is used with an Ensite NavX mapping system.  See: http://circep.ahajournals.org/cgi/content/abstract/1/1/14 (Thanks to Dick Inglis for calling our attention to this article.)

June 12, 2008
    IRB approved notice: "Southeast Regional Research Group is looking for volunteers to participate in a medical research study. Patients must be taking Coumadin and have high blood pressure, congestive heart failure or diabetes. Call Southeast Regional Research Group at 888-SERRG-08, or tell your doctor you want to research your options with Southeast Regional Research Group. 1-888-737-7408. Qualified participants must be 18 years or older and will receive study related procedures and medication at no cost."
    For further information in the Columbus, GA area contact Kindal Klein, 888-737-4708, ex. 204; local tel: 706-321-0495. Address: 5210 Armour Road, Suite 400, Columbus, GA 31904. E-mail: KindalKlein(at)serrg.com (the "@" is written as "at" to prevent access by spam). Web site: http://www.serrg.com
    For further information in the Savannah, GA area contact Mike Schaben, (Toll-free) 888-737-7460 ext. 407; local telephone: 912-351-4571. Address: 6709 Waters Avenue, Savannah, GA 31406. Email: MichaelSchaben(at)serrg.com (the "@" is written as "at" to prevent access by spam). Web site: http://www.serrg.com.

June 8, 2008 Preliminary results very positive for Chronic A-Fib Clinical Trials. See: http://ablationfrontiers.com/webdocuments/
poster-heart-rhythm-society-2008.pdf

May 14, 2008 Dr. Andrea Natale has joined Texas Cardiac Arrhythmia in Austin, Texas. His web site is: http://tcaheart.com/physicians/andrea-natale-md He also still works in the Cleveland area on an as-needed basis.

April 9, 2008 (Good news for A-Fib patients with Chronic [constant] A-Fib.)  The first clinical trials focusing on ablation of Chronic A-Fib have begun in the US. The study, known as the Tailored Treatment of Permanent Atrial Fibrillation (TTOP AF) is sponsored by Ablation Frontiers (http://www.AblationFrontiers.com). It uses three innovative catheters with multiple electrodes to produce a variety of different ablations depending on the needs of the patient. Preliminary data show an 80% success rate after two ablations with relatively short ablation times. The purpose of this study is to make effective ablation for Chronic A-Fib available and feasible to all EPs in all clinics. 25 centers will be participating in these Chronic A-Fib trials. For a more detailed, technical description of this study, go to http://www.ablationfrontiers.com/webdocuments/acc-poster-march-20-2008.pdf.
    Patients will be randomly selected into two treatment groups: for every three patients who apply, two will receive ablation therapy, the third drug treatments. The trial allows patients in the control (drug treatment) arm to receive an ablation if they do not respond to drug therapy (a likely occurrence).
    (This may be a major medical breakthrough for patients with Chronic A-Fib. In the past, medical centers were often reluctant to ablate patients with Chronic A-Fib, because they were more difficult to cure. Some centers, for example, had rules excluding patients who had Chronic A-Fib for more than one year. But with the progress of these Chronic A-Fib clinical trials, most centers will be able to ablate Chronic A-Fib patients with a success rate similar to Paroxysmal (occasional) A-Fib patients.)
    If you wish to participate in this Chronic A-Fib clinical trial, a full listing of Medical Centers, Locations, Doctors, and Contact Information is available at TTOPAFTrialsContacts.

March 14, 2008 Dr. Andrea Natale, formerly at the Cleveland Clinic, will be joining the doctors at Texas Cardiac Arrhythmia, P.A. (Texas Cardiovascular) in Austin, TX. Currently he is also working at the Northern California Heart Center/California Pacific Medical Center

December 20, 2007 Vice-President Dick Cheney was diagnosed with A-Fib and successfully Electrical Cardioverted back to normal sinus rhythm at George Washington University Hospital November 27, 2007.¹¹³

December 11, 2007 Roche Diagnostics (maker of the Coumadin home monitor CoaguChek) would like to interview A-Fib patients about Coumadin self-testing, and will reimburse you $50 for your time.
    "Patients on Coumadin (warfarin) who self-monitor at home (or are interested in self-monitoring) are invited to participate in a 30-minute phone interview to discuss their experience with using a monitoring device at home. Questions will focus on patient needs, perceptions and reasons for choosing to self monitor. Please contact Julie Cousens at 619-261-4170 or juliec@davickassociates.com by December 31 if interested in participating. " Information on the CoaguChek is available at www.poc.roche.com.
 

November 11, 2007 Dr. Andrea Natale is now treating A-Fib patients in San Francisco. Here is his contact information:
Dr. Andrea Natale. Dr. Steven Hao, Dr. Richard Hongo
Northern California Heart Care/California Pacific Medical Center
2100 Webster St., Suite 516
San Francisco, CA 94115
    Appointments: Salwa Beheiry, (415) 925-7153, Fax: (415) 925-7792, E-mail: salwa.beheiryrn [at] gmail [dot] com
 

October 19, 2007 The A-Fib community is shocked to learn that the Cleveland Clinic did not renew Dr. Andrea Natale's contract. There is no word yet where Dr. Natale will work, or where A-Fib patients can be treated by him. For more information see http://www.cleveland.com/news/plaindealer/index.ssf?/base/news/119131405528890.xml&coll=2 . You can leave messages for Dr. Natale at his E-mail address andreanatalemd(at)gmail(dot) com.

 

September 1, 2007 Dr. Peng-Sheng Chen is moving from Cedars-Sinai in Los Angeles to become the new director of the Krannert Institute of Cardiology at Indiana University.

August 19, 2007 FDA APPROVES GENETIC TESTING LABELING FOR COUMADIN
    The FDA's new labeling for Coumadin will explain that people's genetic makeup may influence how they respond to the drug. In the Precautions section, "Periodic determination of PT/INR is essential. (See DOSAGE AND ADMINISTRATION: Laboratory control.) Numerous factors, alone or in combination including changes in diet, medications, botanicals, and genetic variations in the CYP2C9 and VKORC1 enzymes (see CLINICAL PHARMACOLOGY, Pharmacogenomics) may influence the response of the patient to warfarin."¹⁰⁵
    Genetic variants of the CYP2C9 and VKORC1 genes are individually responsible for anywhere from 35% to 50% of the variable dose response to warfarin, FDA officials say. But the agency stopped short of requiring physicians to use the test: there are no adequate clinical trials proving that genetic testing improves warfarin's safety profile; testing is also not universally available. The CYP2C9 gene is involved in drug metabolism such that certain variations permit the drug to remain active in the blood for longer. The VKORC1 gene represents the site of action of warfarin such that gene variants could affect patient sensitivity to the drug.
    The FDA estimates that 2 million persons start taking warfarin (the generic of Coumadin) in the U.S. every year to prevent blood clots, heart attacks and stroke. Warfarin is the second most common drug--after insulin--implicated in emergency room visits for adverse drug events.
    The FDA's "personalized medicine" initiative may further the study and application of pharmacogenomics---the science that predicts a response to drugs based upon a person's genetic makeup. Healthcare providers may use genetic tests to improve their estimate of what is a reasonable warfarin dose for individual patients. Warfarin is only the second drug in which specific pharmacogenetic details have been used in the label relating to drug dosing. However, this is the first time a widely used agent like warfarin has included these types of genetic details.
    (Author's Note: If your doctor puts you on warfarin (Coumadin) and does not test you for the above gene variations, you should probably get a second opinion. The tests cost between $125 and $500 and are fairly widely available. These tests could save you heart problems related to under- or over-dosing of warfarin.)
(See http://www.sciencedaily.com/releases/2007/
08/070817113120.htm) (Thanks to Larry Kushman for calling our attention to this article.)

June 9, 2008 CryoCath has currently enrolled 270 patients in its clinical trials of the CryoCath balloon catheter which was CryoCath's enrollment target.

 

July 18, 2007

    The French Bordeaux group now uses a five-step process to treat Chronic A-Fib.
    1. They start by isolating the Pulmonary Vein openings. They also eliminate potentials at the base of the Left Atrial Appendage, but do not isolate or electrically disconnect the whole of the LAA which could possibly lead to clots forming in the LAA and A-Fib stroke. (Ablating at the base of the LAA as part of the first step in treating A-Fib is a new approach and may become a very important first step in the ablation treatment of A-Fib.)

    2. Next they make a roof line linear ablation linking the Right Superior Pulmonary Vein with the Left Superior Pulmonary vein opening to create complete electrical block

3. They then work in the Inferior Left Atrium and the Coronary Sinus. They make an incomplete blocking line between the Right Inferior and Left Inferior PVs in order to slow down the rapid atrial electrical activity.

They treat the Coronary Sinus as though it were another heart structure or Left Atrium, rather than just another vein opening. They disconnect the CS from the Left Atrium and ablate potentials along the Mitral Annulus. They also slow down Coronary Sinus electrical activity by ablating both inside and outside the CS with a lower wattage power, usually 25 Watts. (Treating the Coronary Sinus as another Left Atrium is a new approach. Most current A-Fib ablation procedures tend to stay away from the Coronary Sinus because of the risk of Stenosis (swelling). The French Bordeaux group, by using a low wattage, irrigated tip catheter, ablates within the Coronary Sinus without damaging it.)

4. The fourth step is eliminating organized atrial activity in areas such as:

Anterior Left Atrium & Left Atrial Appendage

Septum

Posterior Left Atrium

Superior Vena Cava

Right Atrial Septum

5. The fifth step is to create a Mitral Isthmus blocking linear ablation line from the Mitral Annulus to the Left Inferior PV. The goal is to eliminate all potentials along this line.

In practice, even after these five steps, rapid atrial activity often remains. It has to be mapped, traced to its source and ablated. Often the top of the Left Atrial Appendage has to be ablated.

This whole procedure requires a great deal more time, effort, persistence, skill and experience than normal left ablation procedures. (Author’s note: Please be advised that this five-step process for treating Chronic A-Fib is relatively new and isn’t available today at most A-Fib medical centers.)

June 20, 2007 An interesting article from the Houston Independent Media Center suggests that President George Bush may have Chronic A-Fib http://houston.indymedia.org/news/2004/
12/35839_comment.php#45166.
 

June 1, 2007 Warfarin bests aspirin for stroke prevention in elderly A-Fib patients
    Results of the Birmingham Atrial Fibrillation Treatment of the Aged trial show that even among A-Fib patients older than 75 years, warfarin was superior to aspirin for primary stroke prevention without a significant increase in hemorrhage risk. (16th European Stroke Conference.) [31 May]
 

May 25, 2007 LOCAL A-FIB SUPPORT GROUPS FORMING.
    Are you interested in forming or participating in a local A-Fib support group? Our goals would be to share our experiences with A-Fib, get advice, learn about new developments, and form friendships with others who understand what A-Fib is like. Those who have been cured of A-Fib are also encouraged to join (and perhaps volunteer to mentor a new A-Fib-er). We'd meet for informal lunch or dinner, or an evening mixer with a speaker.
    We are trying to set up the first local A-Fib support group in the greater Los Angeles/ Southern California area. If you are interested in participating in this local A-Fib support group or in forming an A-Fib support group where you live, contact Joyce at jarintime(at)yahoo.com (the @ is written as "at" to prevent access by spam mailing lists).

May 25, 2007 A-FIB DECREASES MENTAL ABILITIES
    Men with A-Fib had lower levels of cognitive performance compared to men in normal sinus rhythm in the Framingham Offspring Study. This may be due to the reduced cardiac output and decreased blood flow to the brain in persons with A-Fib. Multiple cognitive abilities were tested over a wide age range (37-89 years).
     "...A-Fib may be one of a number of risk factors for conversion from mild cognitive deficit to dementia."⁹⁸ In a previous study persons with chronic A-Fib had a 3-fold risk of cognitive deficit compared with persons in normal sinus rhythm.⁹⁹
    There were too few women with A-Fib for analysis in this study. However, in a previous study women with A-Fib had a higher prevalence of dementia and cognitive impairment.¹⁰⁰ (Thanks to Darrel Seife for calling our attention to this study.)
    (Author's Note: This is an important study, especially for those in Chronic A-Fib. The option of simply staying in A-Fib while controlling the rate and taking blood thinners to prevent stroke may no longer be acceptable, because of the risk of mental impairment and dementia from A-Fib.)

May 13, 2007 Cox maze operation for patients with Chronic A-Fib. People with Chronic long-standing A-Fib and large left atria were generally thought not to benefit from a Maze operation. This Cox maze operation, which also utilizes supplemental RF ablation, cuts out sections of the atria to reduce atrial size and improve ejection fraction.⁹⁷

May 6, 2007 Dr. Shephal Doshi of St. John's Health Center in Santa Monica, CA performed what may be the first visually guided catheter ablation for A-Fib, using  the investigational "Visually Guided Endoscopic Ablation System." A steerable catheter with fiber optics and a transparent dome at the end works as a video camera using infrared signals to see through the blood in the heart  The system was developed by CardioFocus, Inc. of Marlborough, MA. For more info call (508) 658-7200 or visit http://www.cardiofocus.com.⁹⁶ For a list of the 20 medical centers participating in the clinical trials of this system, go to: http://www.cardiofocus.com/afib_trial_enable.htm

April 26, 2007 Additional centers participating in the CryoCath balloon catheter trials are: Bay Heart Group, Iowa Heart Center, Massachusetts General Hospital, Mayo Clinic, Virginia Commonwealth Medical Center Baylor Heart and Vascular Hospital, Arrhythmia Associates/Inova Research Center, Stanford Hospital, Quebec Heart Institute/Laval Hospital. See Cryo Cath balloon catheter trials.

April 16, 2007 The University of Chicago Hospitals announces new developments in their treatment of A-Fib. Joining their staff are: Drs. John F. Beshai, Martin Burke, Bradley P. Knight, and Al Lin.

March 21, 2007 A gentleman from India with A-Fib needs financial help in getting a Pulmonary Vein Ablation (Isolation) procedure. If you have the financial means to help him (or if you have any contacts in India), his E-mail address is: alexander_john123@yahoo.com. 

February 8, 2007 The A-Fib ablation doctors formerly associated with Riverside Methodist Hospital/MidOhio Cardiology have moved to the Ohio State University. Their new address is:
The Ohio State University
DHLRI, Suite 200
473 W. 12^th Avenue
Columbus, OH 43210-1252
(877) 478-2478
    Dr. Emile G. Daoud, Dr. Ralph S. Augostini, Dr. John D. Hummel, Dr. Steven J. Kalbfleisch, Dr. Raul Weiss

January 19, 2007 CRYO BALLOON CATHETER ABLATION TRIALS TO BEGIN
     Dr. Walter Kerwin of Cedars-Sinai Medical Center in Los Angeles and Dr. Christopher Cole of Colorado Springs Cardiologists will begin clinical randomized FDA trials of the Arctic Front-TM balloon CryoAblation catheter made by CryoCath Technologies Inc. Patients receiving Cryo (freezing) balloon ablation will be compared to patients taking antiarrhythmic drug therapy (Sotalol, Rhythmol or Flecainide).
    For every three patients, two will be randomly assigned to receive a CryoCath balloon ablation, while the third will take drug therapy (a 2:1 randomized ratio). After 90 days, patients in the drug therapy group who are still in A-Fib (a likely occurrence) can cross over and receive a CryoCath balloon ablation. Patients will be followed carefully during a one year follow-up.
    (To this author, Cryo ablation seems to be significantly safer for patients than standard RF ablation. However, Cryo ablations currently take more time to perform than RF ablations. The Cryo balloon catheter will likely allow a doctor to perform a Cryo ablation and isolation of the Pulmonary Vein openings more easily and much faster than current methods. The Cryo balloon catheter may become a major improvement in the treatment of A-Fib. It has already been approved in Europe, with close to 100% success rate in isolating the PVs, and 75-80% success in keeping patients free of A-Fib without anti-arrhythmic drugs.)
    The trial will be covered by most good insurance policies that provide for clinical research participation. Patients will not be paid or separately charged by the clinical trial for participation. If you're interested in participating in this Cryo balloon catheter ablation trial for A-Fib, here is the contact info:
Cedars-Sinai Medical Center
8631 W. 3rd. St., Suite 1017-E
Los Angeles, CA 90048
(310)-289-5901
    Dr. Walter Kerwin
Colorado Springs Cardiologists
2222 N. Nevada Ave., Ste 4007
Colorado Springs, CO 80907
(719) 634-6671
    Dr. Christopher Cole
   
The Ohio State University
DHLRI, Suite 200
473 W. 12^th Avenue
Columbus, OH 43210-1252
(877) 478-2478
    Dr. Emile G. Daoud, Dr. Ralph S. Augostini, Dr. John D. Hummel, Dr. Steven J. Kalbfleisch, Dr. Raul Weiss
    (There will be twenty different centers in the US participating in these cryo balloon ablation randomized trials. That info will be published here as it becomes available.)
    (Added April 26, 2007: Other centers participating in the CryoCath balloon trials are: Bay Heart Group, Iowa Heart Center, Massachusetts General Hospital, Mayo Clinic, Virginia Commonwealth Medical Center, Baylor Heart and Vascular Hospital, Arrhythmia Associates/Inova Research Center, Stanford Hospital, Quebec Heart Institute/Laval Hospital.)

November 1, 2006 Stereotaxis announces Initial U.S. Clinical Usages of Cardiac Ablation Catheter with Company's Niobe R) System. The Niobe system utilizes a computer-controlled magnetic field to remotely steer a magnetic ablation catheter that applies a consistent, "soft-touch" contact with the heart which may reduce the risk of perforation during ablation procedures.⁹⁴

October 21, 2006 A study comparing the Pappone Circumferential Anatomical PV Isolation procedure with an integrated approach using both the Pappone method followed by a Segmental ablation (with electrophysiological confirmation of PV disconnection) was found to be more effective than the Pappone method alone. "Electrophysiological confirmation of PV disconnection could be a useful marker of successful RF treatment of A-Fib."⁹³

October 14, 2006 In a major medical breakthrough the French Bordeaux group reported a 95% success rate in curing Persistent/Chronic A-Fib.⁹² See Jaïs Chronic A-Fib.

August 5, 2006 According to a Wall Street journal article by David Armstrong, four patients are known to have died after having the AtriCure (Wolf) Mini-Maze surgical operation to cure A-Fib.⁹¹

August 5, 2006 According to a Wall Street Journal article by David Armstrong, surgeons at the Cleveland Clinic may have or may have had extensive financial ties to manufacturers of medical equipment these surgeons use to treat A-Fib patients.⁹¹

June 11, 2006 Dr. Andrea Natale and the Cleveland Clinic now call their catheter ablation procedure to cure A-Fib "Pulmonary Vein Antrum Isolation (PVAI)." This procedure still involves making circumferential lesions around the outside of the PV openings.

June 11, 2006  Low-dose steroids have been reported to prevent recurrence of A-Fib, possibly because they suppress systemic inflammation.⁸⁵

June 10, 2006 "The Journal of Thoracic and Cardiovascular Surgery has admonished a Un. of Cincinnati surgeon (Dr. Randall K. Wolf who developed the Wolf Mini Maze operation for A-Fib) for failing to disclose financial ties to AtriCure, the West Chester, (Ohio) maker of heart-surgery equipment he and other researchers evaluated in a published study." Cincinnati Business Courier and The Wall Street Journal December 28, 2005. ⁸¹ "An AtriCure filing with the SEC in August, (2005) reports Dr. Wolf owns 18,402 shares of company stock (approximate current value $140,000) and has warrants or options to purchase 13,913 additional shares of stock. (ArtiCure's recent stock price was $7.60.) In November, AtriCure reported a four-year royalty agreement with Dr. Wolf that will pay him a minimum of $200,000 a year up to a total of $2 million over the entire length of the agreement."⁸¹

June 6, 2006 Flecainide or propafenone can be safely self-administered by outpatients for control of recurrent atrial fibrillation. This "pill-in-the-pocket" approach resulted in fewer emergency room visits. http://www.medscape.com/viewarticle/495111?rss, New England Journal of Medicine 2004;351:2384-2391.

May 27, 2006 Obesity (BMI over 30) and Smoking, but not Age, affect reoccurrence rates of A-Fib after ablation. Dr. Dimpi Patel of the Cleveland Clinic hypothesized that obese patients have larger left ventricles, often due to hypertension or diabetes, and left atrial dilation, resulting in an increased substrate (structure of the heart). These conditions may lead to reoccurrence of A-Fib after ablation.
    In a Mayo Clinic study by Dr. Jared Bunch reoccurrence rates were basically the same for patients under 50, between 50 and 65 years old, and over 65. (Studies presented at the Heart Rhythm Society 2006 Scientific Sessions in Boston, MA. http://www.theheart.org/article/706883.do

May 24, 2006 The long-term use of warfarin appears to increase the risk of bone fractures in men (not women). Warfarin prevents coagulation by blocking the vitamin K-dependent activation of certain clotting factors. Because vitamin K is also used to activate osteocalcin and other bone matrix proteins, "vitamin K antagonists might increase the risk of osteoporotic fractures." The study also found that taking beta-blockers decreased the risk of fractures, perhaps because they increase bone mass. (Archives of Internal Medicine, Jan. 23, 2006.) http://www.medscape.com/viewarticle/522264

April 23, 2006
    "Bottom Line Health," Vol. 20, number 5, May, 2006. "Aspirin vs. stroke. Because aspirin can cause bleeding, it is typically avoided by people who have had a hemorrhagic stroke, which occurs when a blood vessel bursts in the brain. New Finding: In a study of 207 hemorrhagic stroke survivors, those who took an antiplatelet drug, such as aspirin, were not at increased risk for another hemorrhage. Implication: Aspirin therapy may be appropriate for hemorrhagic stroke survivors who are at high risk for heart attack or ischemic stroke, in which a blood clot blocks blood flow to the brain.

April 15, 2006 The Cleveland Clinic has an E-Clinic Consult program that allows patients to receive a second opinion and start the registration process at the Cleveland Clinic. In cooperation with your cardiologist, all records pertaining to your A-Fib are sent to the C.C. for evaluation. An extensive medical questioner is also completed. Then all the data are evaluated by the C.C. cardiology staff. If deemed a candidate for ablation, the pre-registration process is then completed, and a procedure date is given for the ablation. The current fee is $565.

January 28, 2006 Dr. Christopher Cole of Colorado Springs Cardiologists will be starting CryoCath balloon trials in the spring of 2006.

December 1, 2005 Resolution Research wants to interview people who have had A-Fib for at least eight months and who have declined or discontinued the use of Coumadin. The interview will last from 45-60 minutes, and you will receive $50 as a thank you. The purpose of the interview is to develop info for a new anticoagulant drug.
    Contact Wendy Maynard at 800-800-0905 or by E-mail Wendy (at) re-search.com.

    November, 2005 A recent report from England suggests that the veterinary antibiotic "Lasalocid" found in eggs and poultry meat may cause or trigger A-Fib.
    Lasalocid is given as a feed supplement to certain farm animals particularly poultry as a preventative treatment against "coccidiosis"---an infectious disease caused by a parasite which damages the birds' intestines and causes illness and sometimes death. Outbreaks of coccidiosis are likely to occur when large numbers of animals are crowded together in warm and moist conditions. Lasalocid is considered a "highly toxic heart poison. ...It belongs to a group known as the ionophores, all of which are potent heart poisons many of which are in regular use in animal feed."⁶⁵ (Thanks to Richard Gee of the UK for providing this info.)

    June, 2005 Dr. Moussa Mansour of Massachusetts General Hospital reports that MGH now uses a mapping system called Carto-Merge to do PVIs. This  system incorporates an MRI (or a CT) of the pulmonary veins with real-time electroanatomical mapping. This image integration provides the operator with significantly better navigation of the left atrium and thus a safer and more effective procedure.

    January, 2004 Australia and New Zealand now has a doctor from the French Bordeaux group practicing in Australia. Here is his address:
AUSTRALIA
Royal Perth Hospital
Wellington St., Perth 6000
Perth, Australia
(+618) 9224 2388
Fax: (+618) 9389 5261
E-mail: ruk(at)ziplip.com (the @ is  written out as "at" to prevent it from being accessed by spam mailing lists)
    Dr. Rukshen Weerasooriya

We also have names but not complete addresses of doctors in England doing Pulmonary Vein Ablation (Isolation) procedures:

ENGLAND
King's College Hospital Cardiology Dept.
London SE5 9RS
E-mail: francis(at)sinusrhythm.com (the @ is  written out as "at" to prevent it from being accessed by spam mailing lists)
    Dr. Francis Murgatroyd (Starting May 1, 2004. Dr. Murgatroyd is currently at Papworth Hospital, Cambridge CB4  1BX till the end of April, 2004.)   
    (The author apologizes for not having more info on England. The author has heard of three other doctors in England but does not have their addresses. They are:
    Dr. D. Wyn Davies, St. Mary's Hospital, Imperial College of Science, Technology and Medicine, London
    Dr. Jaswinder S. Gill, St. Guy's and Thomas' Hospital, London (NHS patients) and London Bridge Hospital, London
    Dr. Steve Furniss, Newcastle Freeman Hospital)

April 25, 2003 Massachusetts General Hospital Tribute to Dr. Brian McGovern

Brian McGovern, MD: Remembering a physician, colleague and friend
 

Every seat in the O'Keeffe Auditorium was taken April 19. Two overflow rooms were filled beyond capacity. The aisles of the auditorium were crowded with people craning to see the podium and hear the words of remembrance for a beloved and world-renowned cardiologist, Brian McGovern, MD (right), who was killed April 8 in a senseless tragedy that stunned and saddened the hospital community. The memorial service, which was designed for McGovern's patients, also included colleagues, family, friends and MGH employees who came to hear eloquent words and heartfelt messages about the man who touched so many lives in his extraordinary 23-year career at the MGH.

"We can't put a good face on this terrible tragedy, but every time I think of Brian – which will be often – I will aspire in that moment to be a little more patient, a little nicer, a little more like the ideal that he personified," said David Torchiana, MD, chairman and CEO of the Massachusetts General Physicians Organization. "If that can happen a thousand times to all of us, maybe a million times over the years, I believe this world might be a better place."

With McGovern's widow, Anne Jennings, MD, and one of their daughters, Caitriona, in the audience, Torchiana introduced the service, which also included tributes from physicians, colleagues, patients, friends and family members of McGovern. While each shared personal anecdotes, tearful remembrances and even a few light-hearted memories, a common theme surfaced: McGovern was a brilliant physician who possessed the precious gift of genuine compassion and empathy for all he came into contact with – patients, friends and colleagues alike.

"When you met him, he made you feel like you were so important to him and that he was so happy to see you," said Guillermo Sosa-Suarez, MD, a colleague of McGovern's at St. Peter's Hospital in Albany, NY. "He drew people to him. They liked him because of his skills as a physician and because of his personal warmth."

During his tenure at the MGH, McGovern grew into a master clinician and was well known as a doctor's doctor – a physician who many colleagues confided in, consulted with and looked to for advice and wisdom. He built one of the largest referral practices in New England and was widely known as an expert in cardiac arrhythmia.

He was a sought-after lecturer, a highly respected teacher and, in addition to his commitment to patient care, he devoted much time to important clinical research. For many years, he served as medical director for the Ellison 10 Cardiac Step-Down Unit. Every Wednesday, McGovern traveled to Albany, NY, to see patients at the highly successful outreach arrhythmia program that he had founded and built. But beyond the impressive credentials and the lauded achievements, McGovern was what Torchiana described as a "good man" who was highly accomplished yet humble and self-effacing.

"Despite his incredible accomplishments, Brian never took himself too seriously, which is what we loved most deeply about him," said Jeremy Ruskin, MD, a colleague of McGovern's in MGH Cardiology and a close friend. "Everyone knew him for his sense of humor, which was kind-hearted and borne of intelligence and generosity. He was always funny, but his humor was never at anyone's expense. He was able to defuse countless difficult situations with his humor."
 

For Ruskin, this memorial tribute was a deeply personal one. Ruskin first met McGovern in 1981 when the young medical school graduate came to the MGH from Ireland to interview for a fellowship. During McGovern's training at the MGH and his subsequent career, Ruskin grew to rely on him for his insightful medical expertise and thoughtful advice. "Brian was my student, but he became my teacher," said Ruskin. "I'll always be grateful for his friendship, his loyalty and everything that he taught me. A piece of each of us is lost with Brian, but a part of him is alive in all of us. As we try to take care of each other – as he did so often for us – we must continue the extraordinary work he did with such grace, skill and generosity."

It is that extraordinary work of providing the highest quality patient care that was honored by McGovern's patients, who also spoke of his compassion, caring and commitment to the many people who walked into his exam room.

Bud Mueller, MD, was one of those patients. Mueller credited McGovern for saving his life and saving the lives of thousands of other cardiac patients. "His expertise and kindness gave and continue to give individuals and families the ultimate gift – the gift of time," he said. "His work improved beyond measure the quality of time for patients by decreasing the anxiety that is part of the condition that patients and their families must endure. Brian delved into his life's work in a way that showed compassion, caring, respect, empathy and love. We should try to do the same. If we can try to make the world a better place, we can honor Brian, his wife, his children, his MGH team, and then Brian can live on in an important way through each of us whose lives he enriched."

While McGovern touched the lives of many of his patients and his physician colleagues, the staff of the Arrhythmia Service, Electrophysiology Laboratory, the Ellison 10 Cardiac Step-Down Unit and the entire Cardiology Division also are particularly feeling the void left by the loss of a cherished colleague and friend.
Katie Lynch, RN, a nurse from Ellison 10, spoke of the profound impact McGovern had made on the step-down unit staff, both professionally and personally. "He cared for his patients with the utmost respect and compassion," she said. "He elevated our practice to do our very best work. Personally, he made us better because his happiness and love of life were evident and contagious. His presence in our lives was a gift from God, and we will try to honor his memory by caring for patients as he had taught us."
 

"The good physician knows his patients through and through, and his knowledge is bought dearly. Time, sympathy and understanding must be lavishly dispensed, but the reward is to be found in that personal bond, which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the caring of the patient is in the caring for the patient."
- Francis Weld Peabody, MD, (1881-1927) renowned physician and teacher at Harvard Medical School

"No one I've met in my professional
life embodied these words more than Brian did."
- Jeremy Ruskin, MD