Atrial Fibrillation
 RESOURCES FOR PATIENTS

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WHAT'S NEW ON THIS SITE   

    If you've visited A-Fib.com before, this section will list any changes or additions to A-Fib.com by date, the most recent topic first.

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 (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
    (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.)
    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 13, 2010 New question answered in the FAQs section:
    "I am having a Pulmonary Vein Ablation next week for my A-Fib. Because i love to exercise, I am very curious as to what and how much physical activity I can participate in after the procedure. Everything i read says 'You can resume normal activity in a few days.' But i know that what is "normal" is not normal for me. Is there a range of BPM (beats per minute) to keep my heart within? Light walking? Exercising/light weights in the gym? Is there a common road to recovery for those of us who are very physically active?" (Thanks to Monique Van Zeebroeck for this question.)
    Caution would say to start off slow, then work your way up. You could get a Polar (or other) heart rate monitor to keep track of your heart rate. Your heart is considered healed from the scarring of the ablation after three months (possibly sooner).
    Often you feel so good being in sinus rhythm after an ablation, that you can't wait to exercise, to do something physical. But even though you feel great, it's better to be prudent and rein yourself in for a short while.
    (A special thanks to Ed Webb, a very active exerciser, who shares his following experiences and insights.)

It seems the prevailing opinions seem to lean toward resuming normal activities a week to two weeks after the procedure.  In fact that's what my EP had recommended for me (the first time around).  I started light walking and cycling, but unrelated to these activities I also was doing some outside work on my boat (during the fall here in Florida where it can be putrid).  On two separate occasions--I happened to be wearing a heart rate monitor--my heart was a comfortable 85 BPM and then WHAM back into A-Fib!  As I am one of those persistent A-Fibbers, I had to be cardioverted both times.  This all happened within a span of 3 weeks after the procedure.  Needless to say, I was somewhat discouraged thinking the ablation had been a failure.  My EP wasn't too concerned and just advised me to hang in there.  After the second cardioversion, I finally got the hint and took it really easy for the next month, after which I started a walking regimen where I allowed my heart rate to increase from 80BPM on the first day up to 100BPM at an increase of 1 beat per day.  Once I hit the magic 100, I got back on the bike and picked it up from there and was fine after that (until 2 years later when I had another onset!).  The bottom line is I think this all had to do with not allowing enough time for the scar tissue to heal.

 My second time around (which was 2 years ago) I pretty much stuck to the same routine.  First two weeks, absolutely nothing.  Then easy walks allowing my heart rate to increase a little each day.  I walked for a month (starting at 80 and finishing at 105).  After 6 weeks or so, I was back on the bike and doing maximum efforts by the end of 3 months.  I have been in sinus rhythm ever since (that sound you hear is me knocking on my desk!) 

Anyway, I hope this gives you at least one perspective for your recovery.  All the best for your procedure. 

August 9, 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..."
    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.
    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.)

august 8, 2010 In a major revision of A-Fib.com, the "Natural" Remedies section has been revised and placed first under Treatments.

"NATURAL" REMEDIES

    When you have A-Fib, a sensible starting point may be to check for chemical imbalances or deficiencies. A deficiency in minerals like magnesium or potassium can force the heart into fatal arrhythmias.¹³³
    Warning: consult with your doctor before adding any minerals or supplements to your treatment plan. They may interfere or interact with the medications you are taking. In addition, you may need closer medical supervision while taking minerals and/or supplements.
    Unfortunately a great number of physicians are not well versed in recommending or supervising nutritional support and quite often, will dismiss your inquiries about nutritional supplements.²⁰⁰ You may need to work with your doctor to determine the benefit of  supplements for your A-Fib health.
    Specific health supplements and how to obtain them are mentioned only as a convenience for readers. A-Fib.com has no financial ties to supplement distributors.

 MAGNESIUM

    "Anyone in A-Fib is almost certainly magnesium deficient."¹⁸⁸ While Magnesium (Mg) is one of the main components of heart cell functioning, it seems to be chronically lacking in most diets. "Magnesium deficiencies range from 65% to 80% in general populations in the US and globally.^"187 Most US adults ingest only about 270 mg of magnesium a day, well below the modest magnesium RDAs of 420 mg for adult males and 320 mg for adult females. This creates a substantial cumulative deficiency over months and years.¹⁹⁰
    One method of determining your magnesium levels is the diagnostic tool "EXAtest" (http://www.exatest.com) which tests for intracellular rather than serum (in the blood) magnesium concentration. A normal lower limit is 33.9 mEq/IU¹⁹¹. (Serum Magnesium levels aren't good indicators of how much Magnesium is actually present and working within cells. Serum levels of magnesium remain relatively stable [about 1%], even though working intracellular magnesium levels may be low.) Unfortunately few doctors provide this test. But if you have A-Fib, you can take for granted that you need more Magnesium.
    A more common test is the Red Blood Cell (RBC) Magnesium analysis, though it may not be as accurate as the EXAtest.

WHAT KIND OF MAGNESIUM?
    Two forms of easily absorbed magnesium are:
    * Magnesium Glycinate: a chelated amino acid. Look for the label "Albion Minerals." This is a patented process designed to limit bowel sensitivity. One source is "Doctor's Best High Absorption 100% Chelated Magnesium" available from iherb.com.
    * Angstrom Magnesium: such as "New Beginnings Liquid Magnesium - Ionic Liquid Concentrate," available from evitalhealth.com

 DOSAGE
    A recommended goal is a minimum 600 mg/day, preferably 800 mg. (For example, 200mg three times a day and 200 mg at bedtime.)
    It's prudent to start off with very low doses of oral magnesium such as 100 mg. (Excess magnesium or magnesium sensitivity can cause loose stools and diarrhea which is counterproductive, because of the loss of electrolytes.) Increase the dosage of magnesium every 4-5 days.  It may take as long as six months to replenish your intracellular magnesium levels.¹⁹²

ORAL MAGNESIUM ALTERNATIVES   
    If oral magnesium causes bowel sensitivity, an alternative (or an additional source of magnesium) is Magnesium Oil which is applied to the skin and over the heart. An example is "Ancient Minerals Ultra Pure Magnesium" which is odorless. Available from AliveAndAware.net
    Another alternative treatment is Epsom Salts Baths. See Personal Experiences section Epsom Salts Cure.

WARNING: DANGER OF TOO MUCH CALCIUM !
    Too much calcium (Ca) can excite the heart cells and induce A-Fib, especially when magnesium is deficient.¹⁹² According to Dr. Andrea Natale, calcium overload is the primary factor in A-Fib remodeling.¹⁹⁶ A-Fib patients may need to stop or lower significantly their calcium supplements and increase magnesium.¹⁹⁵

POTASSIUM

    Potassium (K+) is often the second key nutrient A-Fibers may be deficient in. In fact, magnesium depletion can lead to potassium depletion.¹⁹³ Potassium helps prevent A-Fib by prolonging the refractory period---the time when the heart is resting between beats. (During this rest period the heart can't be stimulated to contract, thus leaving the heart in normal sinus rhythm.) When potassium levels are too low, heart cells become unusually excitable, often leading to premature contractions and/or A-Fib.¹⁹⁴
   
DOSAGE
    The recommended dosage is 1600-2400 mg/day. While potassium is available in tablets, the 99 mg maximum dosage makes them impracticable (requiring 16+ tablets a day). Instead the powder form---Potassium Gluconate powder is recommended. Available from iherb.com. Take a total of 3-4 teaspoons a day with meals (approximately 540 mg per teaspoon).
    But as with magnesium, start off low, one teaspoon/day, and increase the dosage every 4-5 days. The goal is to keep the serum blood potassium level at 4.5 but under 5.0.¹⁹²
    A word of caution---adding too much potassium too soon will make A-Fib worse, not better.¹⁹² Too much potassium in blood plasma makes the cardiac cells depolarized and unexcitable, leading to spontaneous activity in other areas of the heart such as the Pulmonary Vein openings.¹⁹⁴

WARNING
    Please be advised that, before taking magnesium and/or potassium, you should check with your doctor and be tested to determine your current levels.

_{RECOMMENDED SUPPLEMENTS FOR HEART RHYTHM PROBLEMS:}¹³⁵
    _{TAURINE
    COENZYME Q10}
    L-CARNITINE
    FISH OIL
    RIBOSE (D-RIBOSE)¹⁹⁷
    HAWTHORNE BERRY
    Because the above supplements occur naturally, they can not be patented by drug companies and are not pharmaceuticals. Natural remedies are often not submitted to rigorous double-blind studies with large populations such as the FDA requires for medications. That doesn't mean these remedies aren't effective for A-Fib, but only that the level of proof of their effectiveness is different.
    Consult with your doctor before adding any supplements to your treatment plan. They may interfere or interact with the medications you are taking.

TAURINE

    Taurine along with magnesium and potassium have been described as "the essential trio" for treating nutritional deficiencies relating to A-Fib.²⁰²
    Taurine is a sulfur-containing amino acid and is the most important and abundant amino acid in the heart. It regulates membrane excitability, scavenges free radicals, protects potassium levels inside the heart, and dampens activity in the sympathetic nervous system.¹³⁵ Taurine regulates cellular calcium, improves heart muscle contraction, and also prevents the heart from becoming overly irritable, which can lead to heart rhythm problems."²⁰¹
    CAUTION: Food additives such as monosodium glutamate (MSG) and the artificial sweetener aspartame lower the body's concentration of taurine.²⁰¹

DOSAGE
    3,000 mg per day in divided doses with meals.¹⁹² (No brand preference.)

COENZYME Q10 (UBIQUINONE)

    Coenzyme Q-10 is a naturally occurring enzyme, part of the quinone chemical group, that is found in every cell in the body. It plays a key role in producing energy in the mitochondria. CoQ10's  ability to energize the heart is perhaps its chief attribute. 95% of the body's energy is generated by CoQ10, which generates energy in the form of ATP.¹⁹⁹ CoQ10 improves heart functions and heart rhythm problems.¹⁸⁵
    Dr. Sinatra calls Coenzyme Q10 "the spark of life." In heart cells CoQ10 provides the spark that initiates the energy process.²⁰³ It prolongs the action potential and helps maintain sinus rhythm. It's also a powerful antioxidant.
    CAUTION: Be advised that taking statin drugs reduces CoQ10 levels. A CoQ10 deficiency is associated with illness and death in animals.¹³³

DOSAGE
    100-300 mg daily in divided doses with meals.¹⁸⁵ (No brand preference, but the CoQ10 should have "Ubiquinol" on the label. This is a more readily absorbed form of CoQ10.)

L-CARNITINE

    L-Carnitine is a vitamin-like nutrient. It's a derivative of the amino acid lysine which helps to turn fat into energy. It is considered by some to be the single most important nutrient in cardiac health. It reduces the incidence of cardiac arrhythmias and premature ventricular contractions (PVCs).¹³³ Dr. Sinatra says Coenzyme Q10 and Carnitine work together, and calls them the "twin pillars of heart health."²⁰⁴ While CoQ10 ignites the spark that generates ATP, L-Carnitine is the energy shuttle that transports long-chain fatty acids to the heart cells (mitochondria) where they are burned as fuel.

DOSAGE
    750-2000 mg of L-Carnitine Fumerate daily (250 to 500 mg three to four times a day). (No brand preferences.) A newer form "propionyl-L-carnitine (PLC)" targets heart tissue specifically.²⁰⁶

FISH OIL

    Fish Oil/Essential Fatty Acids (EPA and DHA are essential nutrients obtained primarily from eating fish or from supplements.) DHA plays a crucial role in brain function, as well as in normal growth and development. Essential fatty acids like EPA and DHA are considered by some to be natural defibrillators, lessening the incidence of cardiac arrhythmias and A-Fib.¹³⁶ "DHA in particular helps stabilize the heart’s electrical activity, reducing risk of fatal arrhythmias and sudden cardiac death. (In one experiment, Harvard researchers added different toxins to heart cell cultures that caused them to beat erratically. However, when they added omega-3 fatty acids at the same time, arrhythmias were prevented.)^"185
    Try to find a Fish Oil that includes the supplement Gamma E (d-Alpha Tocopherol) to prevent oxidation of the oil once it reaches the tissue.²⁰⁶

DOSAGE
    2,000-8,000 mg daily, liquid or tablets, in divided doses.¹⁸⁵ The two products below have a desired high ratio of DHA compared to EPA. 
    * Source Naturals' "Arctic Pure DHA" liquid, available from iherb.com, tablets iherb.com
    * Nutricology "DHA Fish Oil Concentrate" available from SupplementWarehouse.com

ribose (D-RIBOSE)

    Ribose (D-Ribose) is a five-carbon sugar that is a regulator in the production of ATP. It's a carbohydrate that is the backbone of genetic materials, and it's needed in the production of many metabolic compounds. "The heart's ability to maintain energy is limited by one thing---the availability of ribose."
    Ribose increases tolerance to cardiac stress, improves exercise tolerance and physical function, provides cardiac energy needed to maintain normal heart function, increases cardiac efficiency, lowers stress during exercise, and maintains healthy energy levels in heart and muscle.²⁰⁵

DOSAGE
    7-10 grams of Ribose powder daily. Take in divided doses with meals or just before and after exercise. (No brand preferences.) ¹⁹⁷
    When first starting Ribose, start with small doses at first, then increase gradually.

HAWTHORNE BERRY

    Hawthorne Berry Extract is made from the tiny red berries of the Hawthorne Shrub, and has been used in traditional medicine since ancient times. It reduces tachycardias and palpitations and prevents premature ventricular contractions (PVCs). Hawthorne Berry can energize the heart without prompting arrhythmias. It has a normalizing effect upon the heartbeat.¹³⁷

DOSAGE
    4,500 mg daily in divided doses (three 510 mg capsules three times a day¹⁹⁸), by MSS/Pro available from  HealthRemedies.com.

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 21, 2010
    New question answered in the FAQs section: "I just had an Electrical Cardioversion. My doctor wants me to stay on Coumadin for at least one month. Why is that required?
    They mentioned something about a "stunned atrium." What is that?" (Thanks to David Mobley for this question.)
    A "stunned atrium" is medically defined as a "state of temporary mechanical atrial dysfunction with preserved bioelectrical function"¹⁷⁸---in non-medical terms your heart doesn't contract properly even though is it getting the right electrical and chemical signals to contract. This can happen after an Electrical Cardioversion and is why the left atrium and, in particular, the Left Atrial Appendage tend to develop clots after an Electrical Cardioversion.
    The Left Atrium, and especially the Left Atrial Appendage, is "stunned" after the electrical shock and may not immediately contract and pump out properly. Clots can develop and be released when the LAA starts to contract again.¹⁷⁹ That's why you need to be on a blood thinner like Coumadin for a month after your Electrical Cardioversion. 

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.)

February 14, 2010
    New question answered in the FAQs section: "Where can I get more information on what was done to my heart during my Pulmonary Vein Ablation?"
    Ask your doctor or his office for your O.R. (Operating Room) report. This is a technical, detailed, step-by-step account of what the doctors found in your heart and what was done. Because it is technical and hard to understand, it isn't normally given to patients unless they ask for it. (If you need help understanding it, email or send me a copy [Feedback]. Together we can probably figure it out.)

February 13, 2010
    New question answered in  the FAQs section:
    "I just had a Pulmonary Vein Ablation. But my A-Fib feels worse and is more frequent than before the ablation, though I do seem to be improving each week. My doctor said I shouldn't worry, that this is normal. But I feel terrible. Is my ablation a failure?"
    You won't know if your ablation is a success for about three months. It takes that long for your heart to heal.
    There is a period of time (which varies from patient to patient) when the A-Fib may seem to get worse. This happens in some people because of the inflammation and trauma to the heart and body tissues caused by the catheter ablation burns and the poking around in your heart during the procedure. These can seem to exacerbate your A-Fib. (An ablation procedure doesn't create new A-Fib producing areas in your heart, though it may stir up existing A-Fib areas temporarily.)
    Another reason you may still have A-Fib is because of gaps in the ablation lines. In the most common A-Fib ablation procedures used today, doctors try to create ablation lines around your pulmonary vein openings to isolate them from the rest of your heart. (A-Fib producing areas are usually found inside your pulmonary vein openings.) But it's difficult making continuous, perfect ablation lines. Sometimes there are gaps in those lines which let A-Fib signals through. But as your heart heals, these gaps usually fill in with scar tissue.

    Remember, also, that it isn't the end of the world if your ablation isn't a total success. Some 15-20% of ablations are not successful. These patients have to go back for a second ablation (including myself). This touch-up ablation is usually much easier than the first. Often all the doctor has to do is ablate any gaps that haven't filled in or ablate where there has been re-growth/re-connection. See Second Ablations.
 
    If you want more specific information about your ablation procedure, ask your doctor or his office for your O.R. (Operating Room) report. (It's very technical. You can email or send me a copy if you want help reading it [Feedback]. See the Operating Room Report question.)
(Thanks to A-Fib Support Volunteer Jerry for helping write this answer.)
   
February 10, 2010
    New question answered in the FAQs section: "I know I'm at risk of an A-Fib stroke, but I hate taking Coumadin. Aren't there any natural remedies or supplements I could take?"
    There are "natural" remedies that thin the blood. But there isn't much research on their effectiveness in preventing an A-Fib stroke.
    Realize also that your doctor isn't likely to tell you to stop taking prescription blood thinners like Coumadin (warfarin) and Plavix. That would be legal suicide. Even people on Coumadin with the proper INR levels get strokes. Coumadin reduces the annual risk of an A-Fib stroke by two-thirds,⁴⁵ but it doesn't eliminate it entirely. However, if your doctor took you off of Coumadin and you had a stroke, he/she could be sued.
    The same is true for this web site which is not recommending or suggesting you quit taking prescription blood thinners.
    Here are two "natural" remedies that are thought to thin the blood. Again, how effective these "natural" blood thinning regimens are to prevent A-Fib stroke has not been scientifically established.

1. Gingko 120 mg once or twice daily
2. Essential Daily Defense (Garry Gordon's Product) 3-4 3 times daily (Contains Niacin, Vitamin B-6, Garlic Powder, Calcium Disodium EDTA, MSM, Malic Acid, Betaine HCL, Papain, Silica, Red Yeast, di-Methionine, Beta Sistosterol, Crataegus 6x (Hawthorne Berry), Carrageenan (Red Yeast)
3. Nattokinase or Lumbrokinase 2-6/day depending on circumstances
4. Unique E 1200 IU daily
5. Omega 3/6 2 twice/day

Another similar regimen is the following:

    Nattokinase 1 2-3 times a day
    Fish Oil 2 capsules twice daily
    Gingko capsules 2-4 times a day
    Garlic (Kyolic) capsules 2-4 times a day
    Delta Tocotrienols 100 mg daily

January 19, 2010
    Overview-Highlights of the 2010 Boston A-Fib Symposium:
 

15th BOSTON A-FIB SYMPOSIUM, January 14-16, 2010 "Atrial Fibrillation: Mechanisms and New Directions in Therapy"

    The annual international Boston A-Fib Symposium is one of the most important conferences on A-Fib in the world. It brings together researchers and doctors who share the latest information.  However, if you haven't read and understood most of A-Fib.com, it may be difficult reading.

OVERVIEW-HIGHLIGHTS

    The overall mood of the 15th annual Boston A-Fib Symposium seemed to be a sense or feeling of certainty in making progress and moving forward.
    One might describe this Symposium's signature or most prominent topic of interest as "New Achievements in A-Fib Imaging/Mapping."

4D & 5D IMAGING/MAPPING IN A-FIB
    In a thought provoking and somewhat controversial presentation, Dr. Douglas Packer described new developments in A-Fib Imaging/Mapping as "4D and 5D Imaging."
    Over the last few years, A-Fib doctors and medical companies have developed very sophisticated Imaging/Mapping systems for doing A-Fib ablations. For example, in the Satellite Case Transmission presented by Massachusetts General, Dr. Moussa Mansour watched on a monitor a 3D rotating, detailed color cartoon image of the patient's heart. He then pushed a button to open up the end of the heart and look inside.
    Rotational Angiography produces even more astounding images. Instead of cartoon recreations, it shows the patient's actual heart in a 3D, real time rotation. One can see the heart in every detail and can watch where the ablation catheter is in the heart. (Seeing this for the first time takes one's breath away.) 
    (The author is negotiating with different Imaging/Mapping companies to make their images of the heart available on A-Fib.com.)
    Time is the 4th A-Fib Dimension, according to Dr. Packer. An example is the CardioFocus Endoscopic laser balloon Ablation System. The doctor operating the CardioFocus catheter can directly see in color 3D real time where the CardioFocus laser balloon is positioned in the heart. The operator also sees tissue change imaging (A-Fib 4D), how the heart tissue is affected over time as the Near Red Laser Light ablates in overlapping arcs around the Pulmonary Vein opening. (This system is not yet approved by the FDA for use in the US.)   
    The 5th A-Fib dimension would include other parameters such as integrated temperature sensing imaging probes (and contact force imaging---how much pressure an ablation catheter applies when ablating heart tissue).

ATHLETES AND A-FIB
    Athletes and endurance training was the subject of two sessions and a great deal of discussion. Dr. Stanley Nattel presented studies indicating that high level physical training doubled the risk of developing A-Fib. In Dr. Nattel's animal lab experiments, high level exercise training (30+ miles/week) developed A-Fib by two mechanisms:
    1. increasing Vagal tone,
    2. producing structural remodeling of the heart---atrial overload leads to atrial enlargement, increases atrial fibrosis and ventricular hypertrophy.
    Dr. Riccardo Cappato described how A-Fib hurts athletes' performance and their ability to exercise. It also makes them ineligible for competitions because they fail pre-qualifying tests (other professions and avocations such as pilots have this same problem).
    Because athletes often can not tolerate antiarrhythmic drugs and/or refuse to take them, Dr. Cappato and other doctors in a panel discussion say they recommend Pulmonary Vein Ablation as first line treatment for athletes. A successful PV ablation restores athletes to full competition intensity and makes them re-eligible to compete.
    Current guidelines state "catheter ablation of A-Fib in general should not be considered as first line therapy." At least one antiarrhythmic med should be tried first. But the guidelines also state, "in rare clinical situations, it may be appropriate to perform catheter ablation of AF as first line therapy." Dr. Eric Prystowsky, who was instrumental in writing the current A-Fib guidelines, stated that he uses PV Ablation as first line therapy for athletes because of the above reasons.

ABLATION NOT A PERMANENT "CURE" FOR A-FIB
    When counseling patients with A-Fib, a successful A-Fib ablation is considered the only current hope of a permanent "cure" for A-Fib (as compared to, for example, Rhythm or Rate control drugs which tend to lose their effectiveness over time). But a study by Dr. Francis Marchlinski cast doubt on this hypothesis.
    He persuaded patients who had experienced successful PV ablations and who were A-Fib symptom free, to be re-examined in the EP lab. He found that some had Regrowth/Reconnection in their ablated vein openings even though they were A-Fib symptom free. He also examined patients who had Regrowth/Reconnection and reoccurrence of A-Fib after a successful PV ablation.
    He estimated that there is a 5-6% chance of Regrowth/Reconnection each year, out to five years. He doesn't have data for beyond five years.
    (The author has been A-Fib symptom free for 12 years. Doctors he spoke to didn't think there was much chance of A-Fib reoccurrence after 12 years.
     However, the author will eliminate the work "cure" from all A-Fib.com postings and instead use the term "A-Fib symptom free.")

CONTACT FORCE SENSING
    A Mini-Symposium was devoted to the subject of Contact Force Sensing.
    When performing an ablation, doctors monitor power, duration, and temperature; but not how hard the ablation catheter presses on heart tissue. Insufficient ablation catheter contact can produce lesions that don't work or that do not penetrate heart tissue, while too much contact or pressure can cause perforation or damage to adjacent structures like the esophagus.
    Dr. Karl-Heinz Kuck described a study using the TactiCath contact force sensing system which found a high variability of force applied both between different operators (which one would expect), and during an ablation by one operator. 12% of ablation burns had a low force contact of under five grams. (Perhaps this is one of the causes of re-occurrence of A-Fib after ablation.) 82% of patients had a force of over 100 grams applied at least once during their ablation. This could potentially cause steam pop, puncture, and clotting. Dr. Hiroshi Nakagawa explained how Contact Force Sensing catheters would eliminate the above problems.
    Dr. Dipen Shah presented studies which showed that Contact Force Sensing:
        1. Improves lesion effectiveness
        2. Reduces ineffective applications (by indicating insufficient contact force)
        3. Reduces collateral damage
        4. Improves safety
        5. Predicts sites of conduction recovery

STROKE PREVENTION
    A Mini Symposium was held on Stroke Prevention in A-Fib.
    Dr. David Singer described why A-Fib is a major risk factor for stroke. Because in A-FIb the left atrium doesn't contract to push blood into the ventricle, clots can easily form especially in the Left Atrial Appendage.
    Warfarin (Coumadin) reduces the risk of stroke by 68% and is safe at the proper levels. Warfarin's risk of producing an hemorrhagic stroke is only 0.3%/year compared to a normal risk of 0.1%/year. But warfarin is underused. 40% of people who should be on warfarin don't take it, perhaps because of its side effects, bleeding risk, and the difficulty in maintaining proper INR levels.
    Aspirin is much less effective, only reducing the risk of stroke by approximately 21%. Clopidogrel, when taken with aspirin, reduces the risk of stroke by approximately 28%. But it significantly increases the risk of major hemorrhage, mostly gastrointestinal.
    The good news, both for patients and doctors, is stroke rates in A-Fib are declining.

DABIGATRON TO REPLACE WARFARIN?
    The RE-LY study found that dabigatron reduces the risk of stroke by 30% while also reducing the risk of intracranial bleeding by 30% (dabigatron dose 150 mg). It also reduces vascular death. Unlike warfarin which needs four days loading to be effective, dabigatron works right away. It doesn't have to be monitored for INR levels. (Both doctors and patients are impatiently waiting for FDA approval for dabigatron, which hopefully will come soon.)

THE WATCHMAN DEVICE TO PREVENT STROKE
    The Watchman Device works by closing off the Left Atrial Appendage where 90% of clots/strokes come from. (See The Watchman Device.)
    Dr. Zoltan Turi showed a slide of a man who had a Watchman Device installed, but died nine months later from other causes. His family graciously allowed doctors to do an autopsy to examine how the Watchman device had worked. The Watchman Device was covered over by smooth heart muscle tissue which looked like any other part of the heart. (The Editor is negotiating to get a copy of this slide for A-Fib.com.)
    Data from the Watchman Device study showed that it is safe, effective and easily installed (one doctor said he installed them in 20 minutes). A surgeon speaking at the Symposium said he had to remove Watchman Devices (implying that this is a major problem with the Watchman Device). Acknowledging there was a short learning curve when first installing the Watchman Device, Dr. Turi said that to date only four have had to be removed.
    An FDA preliminary panel has approved the Watchman Device. But the vote was close---7-5. All agreed that the Watchman Device worked, but some wanted to see more than 800 cases. Clinical trials of the Watchman Device have been extended.

FDA AT THE BOSTON A-FIB SYMPOSIUM
    Dr. Randall Brockman and Dr. Jun Dong from the FDA both expressed the FDA's willingness to help and encourage the development of effective therapies for A-Fib. Dr. Brockman pointed out that A-Fib is a major public health issue (some have called it an epidemic). He also expressed the FDA's interest in developing an A-Fib Registry (SAFARI). (He was asked why new devices or drugs seem to be always started in Europe.)
    Dr. Dong explained the FDA's Investigational Device Exemption (IDE) and how it could be used by both industry and physicians. He welcomed physician-initiated trials and gave the audience his email address and office phone number. 

MEASURING QUALITY OF LIFE IN A-FIB
    Having A-Fib can be devastating. A-Fib can affect General and Mental Health, as well as Physical and Social Function.
    Some A-Fib symptoms can be described and objectively quantified by degree and severity: Palpitations, Dyspnea (difficulty breathing), Chest Pressure and Pain, Dizziness, Presyncope, Syncope (fainting), Exercise Intolerance and Fatigue. Other symptoms are more subjective: such as Anxiety and Depression.
    "Quality of Life" is a subjective phenomenon based on each person's perception, experience, beliefs, and expectations. What may be intolerable for one person may not be all that bad for another. Dr. Jeremy Ruskin is proposing an A-Fib Symptom Classification System that also includes Quality of Life. Such a system or universally accepted shorthand would facilitate communication between doctors and patients, and between health care providers.
    CLASS    SYMPTOM SEVERITY
    I.         Asymptomatic
    II.        Mild---having a mild affect on a patient's qualify of life, mild awareness
                of symptoms in Persistent/Permanent A-Fib, rare episodes (less than a
                few a year) in Paroxysmal A-Fib
    III.        Moderate---having a moderate affect on quality of life, moderate
                awareness of symptoms on most days in Persistent/Permanent A-Fib,
                more common episodes (more than every few months) and/or more
                severe symptoms in Paroxysmal A-Fib.
    IV.        Severe---having a severe effect on quality of life, very unpleasant
                symptoms in Persistent/Permanent A-Fib, frequent and highly
                symptomatic episodes in Paroxysmal A-Fib
                Syncope (fainting)
                Congestive Heart Failure because of A-Fib

DR. JEREMY RUSKIN HONORED
    Dr. Jeremy Ruskin from Massachusetts General Hospital was honored for his 15 years of organizing the Boston A-Fib Symposium. He was given a Chelsea clock from Boston and was enthusiastically applauded for his years of service to the A-Fib community.

(More to follow)
   

JANUARY 2, 2010
    New question added to the FAQs section:
    "I know I need a Pulmonary Vein Ablation (Isolation) procedure to stop my A-Fib. A-Fib destroys my life. I can't work or exercise, and live in fear of the next attack. Antiarrhythmic meds cause me bad side effects. But I'm worried about being exposed to radiation during the ablation. How dangerous is the fluoroscopy radiation during an ablation?" (Thanks to Stephanie Fagan for this question.)
    Exposure to radioactivity during an ablation used to be a legitimate concern.  (Doctors and nurses wore lead aprons during an ablation.) Back in 2003, a typical A-Fib ablation resulted in around 50 minutes of fluoroscopy time.¹⁷² One hour of fluoroscopy imaging is associated with a lifetime three-in-ten thousand chance (0.03%) of developing a fatal malignancy, and a risk of passing on a genetic defect of 20 per 1 million births.¹⁷⁵ These risks were considered relatively small compared to the risks of being in A-Fib, antiarrhythmic drug therapy, and surgery.¹⁷⁴
    Doctors follow directives which limit the amount of radiation you can be exposed to during an ablation. If you get close to exceeding these limits, they will stop the ablation (though this rarely happens).
    But many centers today use much less or no fluoroscopy at all. Instead many use 3D non-fluoroscopy (no radiation) imaging techniques such as Intracardiac Echocardiography (ICE), and Magnetic Resonant Imaging (MRI). You need to check with your A-Fib center as to how much radiation their typical A-Fib ablation patient is exposed to. The radiation dose for a typical A-Fib ablation is estimated to be 18.4 mSv.¹⁷⁵ However, the radiation amount at your A-Fib center will vary depending on what type of imaging equipment they use.
    Once you learn what amount of ablation radiation you might be exposed to at your A-Fib center, then you can compare it to the following to determine if you should be concerned:
    • Average Background Radiation/year                    2.4 mSv
    • Chest X-Ray Radiation                                        0.02-0.2 mSv
    • Heart CT Scan Radiation (100-600 Chest X-rays)    12 mSv
    • Typical A-Fib Ablation                                        18.4 mSv
But bear in mind that, even a one hour-long exposure to fluoroscopy, is a relatively small risk compared to the risks of being in A-Fib, antiarrhythmic meds, and surgery.
    (The author did a very unscientific survey of the A-Fib medical centers in his area. The average seemed to be 10-20 minutes of fluoroscopy time [for those who used fluoroscopy] for an A-Fib ablation, but more complicated cases could expose patients to 60(+) minutes of fluoroscopy time.)

Protecting Yourself From Radiation Damage
    You can take measures before and after your ablation to help protect yourself from radiation damage. Since much of the cancer-causing damage from ionizing radiation is from hydroxyl free radicals, it's recommended to take antioxidant supplements to neutralize them. A typical plan is to take the following natural supplements every six hours for at least 24 hours before and after your radiation exposure. These are available without a prescription from health food stores. But check with your doctor before taking any supplements.
    1. Vitamin C 1000 mg
    2. Lipoic Acid 400 mg
    3. N-Acetyl Cysteine 200 mg
    4. Melatonin 3 mg
   

added December 31, 2009 to the FAQs question about Cryo
    The FDA hasn't yet approved the Cryo Cath balloon catheter. We don't know when or if the FDA will approve it. It is currently not available in the US even in clinical trials which have terminated (it is available in Europe). it may be available in special circumstances of "compassionate use." But this "compassionate use" exception is often difficult to obtain.
    You can get an ablation using just a Cryo catheter, but it currently takes too long to do a good Pulmonary Vein Isolation ablation. And, probably because it takes so long, it  doesn't seem to work as well as an RF ablation.
    Doctors have been doing RF ablations for years. They work. The Cryo Balloon and RF catheter ablations are pretty much equally effective. The Cryo Balloon is safer, but not that much safer than RF which is a low risk procedure.
    If we had a choice between the Cryo Balloon and RF, we'd probably choose the Cryo Balloon. But right now we don't have that choice. An RF ablation remains a good option with a high success rate and low complication rate. (Thanks to Jean Kirkland for suggesting this update.)

december 24, 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 worldwide 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 there are currently around 200 centers performing A-Fib ablations in the US alone. 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 20, 2009
    New section added to the Overview, Causes sections of A-Fib.com:
    Some research has identified a Familial A-Fib where A-Fib is passed on genetically²⁸ but it is relatively rare. (Author's theory: Some consider all A-Fib genetic in that we are born with A-Fib triggers---usually the Pulmonary Vein Openings in the Left Atrium. They seem to be genetically related to and similar in structure to the AV Node, the natural pacemaker of the heart. They usually beat in sync with the AV Node. But when impaired, they start beating on their own producing A-Fib signals. [Be advised that this is only a theory and not established medical fact.]) 

december 20, 2009 New question answered in the FAQs section:
"I'm worried about having to take the blood thinner warfarin (brand name Coumadin). If I cut myself, do I risk bleeding to death?"
    In general, no. On a normal dosage of warfarin (Coumadin) you will bleed longer if you cut yourself (not a serious wound). But your blood will still clot. You will also bruise more easily.
    You should stay away from contact sports like hockey, football, rugby, etc. or activities where you could easily injure yourself like mountain climbing, competitive biking, etc. Professional athletes should not be on warfarin (Coumadin).
    But you can do normal daily activities on warfarin. However, in case of an emergency, you may want to get a Medical ID Alert to warn paramedics and doctors that you are taking a blood thinner.

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 30, 2009
    New question answered in the FAQs section: "I am in Chronic (all-the-time) A-Fib. I feel tired and a little light-headed, probably because my atria aren't pumping properly. Is there any way I can improve my circulation, without having to undergo a Catheter Ablation (poor success rate and risky at my age) or Surgery (even more risky)?"

november 28,2009
    New question answered in the FAQs section:
"The A-Fib.com web site claims that an A-Fib stroke is often worse than other causes of stroke. Why is that? If a clot causes a stroke, what difference does it make if it comes from A-Fib or other causes? Isn't the damage the same?"

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 21, 2009 New story for the PersonalExperiences section of A-Fib.com:

Cured after 30 years in A-Fib

november 20, 2009 New question answered in the FAQs section of A-Fib.com:

    "I'm eighty years old and have been in Chronic (persistent/permanent) A-Fib for 3 years. I actually feel somewhat better now then when I had occasional (Paroxysmal) A-Fib. Is it worth trying to get an ablation to cure my Chronic A-Fib?"
    With Chronic A-Fib of long duration, perhaps not. Although a few centers get very good results when treating Chronic A-Fib even of long duration (the French Bordeaux group achieves an acceptable success rate after 2 ablations), most centers have a success rate of only around 50% for Chronic A-Fib. And although catheter ablation is a low risk procedure, there are still risks.
    Many centers won't ablate patients who are over 80 years old or in Chronic A-Fib for over a year. There is a higher risk of complications in older people, and it is more difficult to ablate Chronic A-Fib. (In Chronic A-Fib there are often multiple spots in the heart producing A-Fib signals. It's hard to identify and ablate [isolate] them all.)

The Positive Side of being in Chronic A-Fib
    Sometimes people feel relieved to be in permanent A-Fib. There's no longer the fear, uncertainty, and shock of an A-Fib attack. You can adjust your lifestyle to how your heart behaves, because it doesn't change much. You may be short of breath, somewhat light headed, tired, and unable to work or exercise hard. But you get used to it. You may even feel better than when you had Paroxysmal A-Fib. In addition, an ablation may be only partially successful and have the unwanted consequence of putting you back into Paroxysmal A-Fib.
    You still need to take blood thinners to prevent an A-Fib stroke. But if you get the Watchman device installed (very low risk), it closes off your Left Atrial Appendage where 95% of A-Fib clots originate. You can then go off of Coumadin.

The Negative Side of being in Chronic A-Fib
    The down side of being in Chronic A-Fib is your heart forever and always will not pump properly. Blood flow to your brain and other organs is reduced by about 15%-30%.^{164, 165} This can lead to conditions like dementia and Alzheimer's.98^{, 163, 76} (If you are a superior athlete like a bicyclist or runner, your exercise may overcome this reduced blood flow.)
    A-Fib is a progressive disease. It tends to get worse even in Chronic A-Fib. Your atria expand and stretch. Your ejection fraction diminishes. Chronic A-Fib produces fibrosis and collagen deposits which stiffen the heart and make it less flexible. All this leads to conditions such as Congestive Heart Failure, Cardiomyopathy¹⁶¹, heart weakness, heart attacks, etc.^{77, 61, 167}
    But please weigh the above statements carefully (the author is concerned that they may create unwarranted fear). How do you feel? If you don't feel any symptoms and your doctor says your heart isn't enlarging and/or developing poor ejection fraction, etc., then there's no need to rush out to get a Pulmonary Vein Ablation which does involve real risk.

The Bottom Line
    You can be cured of Chronic A-Fib, even at your age. But it will take at least 2 ablations. And it won't be easy finding a doctor to do it. (There is a short list of doctors at specialists in persistent/chronic a-fIB. You need someone with a proven track record in ablating Chronic A-Fib.) However, an ablation is more risky at your age.
    On the other hand, you can live in Chronic A-Fib. Many people do. The key to living a satisfying life in Chronic A-Fib may be good rate control. For example, a resting heart rate of around 80 beats per minute with an exercise rate of 110 is very close to that of a normal person. People with good rate control of their Chronic A-Fib report a good quality of life and seem less prone to develop other heart or mental problems.
    Are you happy or content with your quality of life in Chronic A-Fib? If so, then the added hassles and risks of an ablation are probably not worth it for you. Only you (and your doctor) can decide if it's better to spend your twilight years in a perhaps reduced but satisfactory quality of life.

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 18, 2009
    New question answered in the FAQs section: "I've had Paroxysmal (occasional) A-Fib for a couple of months, but the A-Fib episodes seem to be getting longer and more frequent. I'm worried about going into permanent (Chronic) A-Fib which I know is harder to cure. How long do i have before I go into permanent A-Fib?"
    Worst case scenario, about one year. In a study of 5,000+ A-Fib patients, 54% of those on rate control meds went into permanent A-Fib in one year.¹⁶⁴
    There are people who've had Paroxysmal A-Fib for years and never progress to permanent A-Fib. But the odds are against you. 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).¹⁶⁴

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.)

NOVEMBER 15, 2009
    Under "Natural" Remedies, Harold Bosworth writes that Branched Chain Amino Acids (BCAAs) coupled with L-Glutamine got him out of Chronic (continuous) A-Fib after taking it for 2 days. He had been in Chronic A-Fib for 3 years. (MRM BCAA+G with Vitamin B6 2 mg, L-Leucine 2,500 mg, L-Valine 1,500 mg, L-Isoleucine 1,000 mg, L-Glutamine 1,000 mg. 2 teaspoons in the morning and evening.) "Don't know if this will work for everyone, but it sure worked for me."
Email: capthb(at)sbcglobal.net (When typing this email address, substitute an "@" for the "(at)"---this substitution is necessary to prevent automatic search engines from sending spam to this email address.)

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

September 2, 2009
    A new topic was added to the Overview of the 2009 Boston A-Fib Symposium:
_{Genetics may play a very significant role in the development of A-Fib
    Dr. Dan Roden of Vanderbilt University described how genetic research may become very important to A-Fib patients. He predicted that within five years research may identify what genes predispose a patient to A-Fib. Then personalized therapy can be developed based on the patient's genes. "Lone A-Fib" (A-Fib without a known cause) may actually be caused by genetics.
    The full report of Dr. Roden's presentation is also available:}
The Role of Genetics in the Development of A-Fib.

august 17, 2009
    New question answered in the FAQs section: "I've been on amiodarone for over a year. It works for me and keeps me out of A-Fib. But I'm worried about the toxic side effects. What should I do?"

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 11, 2009 New question answered in the FAQs section:

"I am on Coumadin (warfarin) to thin my blood and prevent A-Fib blood clots. Do I now need to avoid foods with Vitamin K which would interfere with the blood thinning effects of Coumadin?" (Thanks to Ruth McKee for the suggestion of this question.)
    No. Vitamin K is an important nutrient, especially for bone health.¹⁵⁵ You should instead try to maintain a consistent intake of vitamin K through food and/or supplements. You should maintain at least the U.S. recommended amounts of Vitamin K (120 mcg/day for men, 90 mcg/day for women¹⁵⁵).
    Your liver uses vitamin K to make blood clotting proteins. Coumadin lowers your risk of forming a blood clot by reducing the liver's ability to use vitamin K to produce these blood clotting proteins. But you still need vitamin K for your overall good health. A lack of vitamin K, for example, can lead to osteoporosis.¹⁵⁵
    Let's say you have low levels of vitamin K. If you then eat a spinach salad or liver which are high in vitamin K, this will cause a huge increase in vitamin K intake and consequently a significant drop in your INR (the amount of thinning of your blood). But if you consistently have normal (or preferably higher) levels of vitamin K, a spinach salad or liver will not cause a huge increase in vitamin K.
    When starting Coumadin, you should talk over with your doctor how to maintain a consistent diet and/or supplement level of vitamin K. This is especially important if you change your diet. Ideally you should consult your doctor before making any major changes in your diet and vitamin K intake.
 

JULY 7, 2009
    New material added to the FAQs question about how one feels after a Pulmonary Vein Ablation:
Right after the PVA(I) you may experience the following:
    1. Your groin will generally have two access site points, one on each side. After a Pulmonary Vein Ablation, some minor bruising is common at each site with minor soreness as if you had banged the area.  Bruising may occasionally be seen to extend down the leg. This is normal, as is an occasional small quarter sized bump in the area.  (If larger swelling or more significant pain occurs at the area, please contact the electrophysiologist who did the procedure.)
    2. After an Pulmonary Vein Ablation you may have some minor chest pain for the next week or so. The pain will often worsen with a deep breath or when leaning forward.  This is pericardial chest pain from the ablation and is generally not of concern.  It should resolve within a week, although it might increase for a day or so after the ablation.
    3. Low grade fevers of around 99 degrees are common in the first day or so post-ablation. (If you develop unexplained fevers exceeding 100 degrees anytime within the first 3 weeks post-ablation, you need to contact the electrophysiologist who performed your procedure.) 

JULY 2, 2009
    New story in the Personal Experiences section of A-Fib.com: Not Necessary To Go To Top-Name A-Fib Centers To Have Excellent Care and Good Results

JULY 2, 2009
    Dronedarone (brand name Multaq) 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 20, 2009 New comments added to the Robotic vs. Magnetic Navigation/Ablation debate at the 2009 Boston A-Fib Symposium.
    (A correspondent who wishes to remain anonymous pointed out that the Hansen robotic system does require extensive manual skill, whereas the Stereotaxis magnetic system is automated. (To this author, this is a major difference between the two systems. Even with skilled, experienced operators it is still possible with a robotic system to have misplaced ablation burns or accidents such as perforations. Whereas the magnetic system using a mouse to make the ablations seems safer, ultimately more efficient, and more capable of being used by new operators.
    The Stereotaxis system now uses an irrigated-tip catheter which is less prone to charring.)
    (Before each presentation, doctors disclose any potential conflict of interest. Dr. Natale disclosed he is a partner with Dr. Burckhardt, the CMO of Stereotaxis.)

June 19, 2009 New question answered in the FAQs section:
    "I had a single episode of A-Fib 17 months ago and was successfully converted with medication (Cardizem drip). That day I had only four hours of sleep, had eaten no breakfast, but did have an extra large coffee. I also had watery diarrhea and was somewhat dehydrated. Is it possible that my electrolytes were out of whack and led to the A-Fib episode? Other than an occasional PAC of PVC, I haven't felt any A-Fib symptoms since. I'm wondering if it's possible to have a single A-Fib attack and not have any others." (Thanks to Joan for this question.)
    Once a spot in your heart starts producing A-Fib pulses, it's usually hard to turn it off again. But whatever you did seems to have worked for you.
    Have your doctor keep track of your blood chemistry to make sure you don't get into chemical imbalances that might trigger A-Fib again. (When you went to the hospital for that single episode of A-Fib, what kind of imbalances did they find?) You may want to look into taking supplements or foods that help keep your heart chemistry in balance. (See Natural Remedies.)
    PACs and PVCs are considered benign---people with normal hearts have them. But in A-Fib they often seem to be precursors of an A-Fib attack.
    For your own peace of mind, ask your doctor for a Holter or other type of monitor which you would wear for one or three days. This would tell if you have any "silent" A-Fib which you may not be aware of, but which can be dangerous.
   

JUNE 13, 2009 New comments added about pacemakers:
    (The author admits to not knowing much about pacemakers. Happily one of A-Fib correspondents installs pacemakers and offers the following observations.)
    "I like to tell patients who receive pacemakers that, after a couple of months, they can have a VERY active, normal lifestyle.  All of the current pacers have a "rate responsive" mode, meaning they are designed specifically for activity. The more active you are, the faster the pacer goes. Three triathlon runners, and two NFL players have pacers. Most people forget they have a pacemaker.
    A recent trend is to implant the ventricular lead on the septum vs. the right ventricular apex, which gives better cardiac output and a more 'normal' heartbeat. You might want to ask your doctor about this possibility. Even if your doctor does not prefer this technique, he/she will be impressed that you did your homework.
    In addition, you always want a dual chamber pacer which will give better cardiac output. It will also attempt to synchronize between the atria and ventricles, unless the patient is in Chronic A-Fib. If the A-Fib is intermittent, the pacer will temporarily switch modes to VVIR during the A-Fib, and then back to normal DDDR pacing when the A-Fib terminates. This is all done by the device memory/logic program.
    ("DDD" signifies a dual chamber pacer, capable of sensing and pacing in both the atrium and the ventricle)
    ("VVI" is ventricle only)
    ("AAI" is atrium only)
    ("R" signifies Rate Response, a programmable on/off feature which increases the pacing during activity)
    So, during A-Fib, the DDDR pacer will switch to VVIR and pace only the ventricle during the A-Fib."

JUNE 13, 2009 New comments added about Defibrillators:
IMPLANTABLE DEFIBRILLATOR
    Having a defibrillator implanted in your heart is, from the point of view of most patients, not a probable option. A defibrillator shock is painful, like being "kicked in the chest." Most people would rather have A-Fib than be shocked throughout the day and night. Also, it does not address the underlying problem or condition of your heart that causes your A-Fib.
    Our A-Fib pacemaker correspondent writes:
    "Defibrillators are far more complicated (than pacemakers). When people report getting a big shock (500-700 volts) from the unit, that was probably for V (ventricular) Fib, not A-Fib, if the unit is programmed properly. One good thing about the V-Fib is that it is usually (not always) proceeded by Ventricular Tachycardia, a much slower, organized rhythm that often responds to painless anti-tachycardia pacing. We will attempt anti-tachycardia overdrive pacing for several different patterns before we finally give up and go to the full output shock."

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 out 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 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 that 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.)

    JUNE 7, 2009 The author apologizes to anyone trying to email me recently. He believes the email problems are now fixed. Please send your emails again.

MAY 27, 2009 Under Natural Remedies the author included a new section on Homeopathic Remedies.
    Homeopathic remedies. Diane Willis writes that she took Unda #8¹⁵² and #248¹⁵³ 5 drops 5X a day. Her A-Fib stopped within 24 hours after homeopathic treatment.
    Diane adds, "Homeopathic doctors never prescribe on a "one size fits all" basis. They muscle-test to arrive at the right medications and dosages."
    Diane also is being treated by a Chiropractor, is on a "raw" diet, and is involved in the spiritual healing community. She isn't sure the Unda remedies were the one thing that stopped her A-Fib. "Although I personally feel that Unda was a leading contributor."
     Email: Diane Willis docflute (at) gerf.org (the "@" is written as "at" to prevent access from spam mailers).
    (The author knows very little about homeopathic remedies and welcomes input and explanations about how homeopathy works. The ingredients of Unda #8 and #248 are listed on the footnote reference pages.)

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 6, 2009 Under "Natural" Remedies the following comments about Magnesium, Potassium, and Calcium were added:
    A deficiency in minerals like calcium, magnesium, or potassium can force the heart into fatal arrhythmias¹³³ and may possibly trigger or cause A-Fib. A suggested dosage to treat arrhythmias is: 400 mg of magnesium, 500--1000 mg of calcium, and 500-1000 mg of potassium.¹³⁵ (Please be advise that, before taking the above dosages, you should check with your doctor and get yourself tested to determine what are your current levels of the above minerals. Though rare, it is possible to overdose on the above minerals.)


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 A-Fib stroke by the closing off of the Left Atrial Appendage.

MAY 5, 2009 New info on vitamins and minerals for A-Fib.  Vitamins and supplements that seem particularly helpful to heart arrhythmias are: Coenzyme Q-10, L-Carnitine, Fish Oil, Taurine, and Hawthorne Berry.
    Coenzyme Q-10's ability to energize the heart is perhaps its chief attribute. It improves arrhythmia and heart functions. Be advised that current statin drugs reduce CoQ10 levels. A CoQ10 deficiency is associated with illness and death in animals.¹³³
    L-Carnitine is considered by some to be the single most important nutrient in cardiac health. It reduces the incidence of cardiac arrhythmias and premature ventricular contractions (PVCs).¹³³
    Fish Oil Fatty Acids (EPA, DHA, GLA) are considered by some to be natural defibrillators, lessening the incidence of cardiac arrhythmias and A-Fib.¹³⁶
    Taurine is the most important and abundant amino acid in the heart. It regulates membrane excitability, scavenges free radicals, protects potassium levels inside the heart, and dampens activity in the sympathetic nervous system.¹³⁵
    Hawthorne Berry reduces tachycardias and palpitations and prevents premature ventricular contractions (PVCs). Hawthorne can energize the heart without prompting arrhythmias. It has a normalizing effect upon the heartbeat.¹³⁷
 
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

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 16, 2009 New question answered in the FAQs section:
"I've had A-fib for several years and have read that it may produce fibrosis and collagen deposits in the atrium (See: A-Fib Induces Fibrosis). How can I determine or measure how much fibrosis I have? Can something non-invasive like a CT scan measure fibrosis?" (Thanks to Stewart Stafford for this question.)
    To the best of my current knowledge, a CT scan does not measure Fibrosis. EPs currently can measure fibrosis by going inside the heart and mapping fibrosis with a voltage monitoring catheter.

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.

February 14, 2009 Cautionary Author's Note added to the Boston A-Fib Symposium 2009 presentation on GPs (Ganglionated Plexi).
(Author's Note: Dr. Prystowsky raised a serious question for A-Fib patients. Does ablating the GPs risk damaging the nerve electrical system which affects the ventricles, and which may even lead to future sudden cardiac death? Until more research establishes how these GP nerves actually affect the ventricles, we should be cautious about having our GPs ablated.)  To read the full article, see Merits of GP (Ganglionated Plexi) Ablation. 

February 12, 2009 New question answered in the FAQs section: "Can too little iron in the blood (Anemia) cause Atrial Fibrillation? What can I do about it?"

February 10, 2009 The FDA approved the first ablation catheters for A-Fib.

January 25, 2009 Overview/Highlights of 2009 Boston A-Fib Symposium.

November 30, 2008 New question answered in the FAQs section: "I have an enlarged heart due to years of A-Fib. I was told I can't have a Pulmonary Vein Ablation (Isolation) procedure. Why is that?"

July 17, 2008 The FDA recently approved the new beta blocker drug nebivolol (brand name Bystolic by Forest/Mylan, a selective beta-1-blocker)).¹²⁶ This 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.) 

July 9, 2008 EPs & Surgeons' Consensus Statement on A-Fib  and Catheter Ablation Approved as First Line Treatment for A-Fib. Summary of Dr. Calkins presentation at the 2008 Boston A-Fib Symposium.

July 5, 2008 Catheter Ablation Far Superior to Current Antiarrhythmic Drugs. Summary of Dr. Hans Kottkamp's presentation at the 2008 Boston A-Fib Symposium: "Is Catheter Ablation of Atrial Fibrillation Superior to Antiarrhythmic Drug Treatment for Rhythm Control?"

June 30, 2008 Procanbid will no longer be available for A-Fib patients.

June 28, 2008 "Cryoablation (with the CryoCath Arctic Front cryoballoon): Safer than RF..."

June 27, 2008 New story in the PersonalExperiences section of A-Fib.com: ABLATION FOR V-TACH (VENTRICULAR TACHYCARDIA) AT MASS. GENERAL BY DR. VIVEK REDDY---COPING WITH ICD SHOCK

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

June 16, 2008 Drs. Vivek Reddy and Andre d'Avila of Massachusetts General are moving to the Un. of Miami Hospital at the end of June, 2008.

June 15, 2008 Summary of Dr. Fred Morady's presentation at 2008 Boston A-Fib Symposium: "Lessons Learned: Providing Guidance for the Next (and Current) Generation of Ablationists"  Topics discussed: Evaluating Current Strategies to Prevent Atrial-Esophageal Fistula, Current "Tailored" Approach Used at the Un. of Michigan

June 13, 2008 New question answered in the FAQs section: I have a heart condition. What medications work best for me?"

June 12, 2009  Southeast Regional Research Group, Columbus and Savannah, GA is looking for volunteers to participate in a medical research study comparing Coumadin with a new anticoagulant. Patients must be taking Coumadin and have high blood pressure, congestive heart failure or diabetes.  Qualified participants must be 18 years or older and will receive study related procedures and medication at no cost, and receive stipends that help with transportation to and from appointments.

June 11, 2008 Summary of Dr. Carlo Pappone's presentation at the 2008 Boston A-Fib Symposium and a comparison of Drs. Pappone's, Haïssaguerre's and Reddy's different stepwise approaches to treating Chronic A-Fib: Biatrial Catheter Ablation for Chronic Atrial Fibrillation

May 19, 2008 New stories in the PersonalExperiences section of A-Fib.com: TWO DIFFERENT "PILL-IN-THE-POCKET" APPROACHES---BOTH TURN TO CATHETER ABLATION FOR A CURE

May 15, 2008 New story in the PersonalExperiences section of A-Fib.com: IT TAKES THREE ABLATIONS---DEALING WITH THE "PARALYSIS OF ANALYSIS" THAT A-FIB PATIENTS OFTEN FACE

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 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.

April 5, 2008 New story in the PersonalExperiences section of A-Fib.com: WHAT IT FEELS LIKE TO HAVE A PVI AT THE UN. OF PENNSYLVANIA

March 11, 2008 New story in the PersonalExperiences section of A-Fib.com: SUCCESSFUL PVA(I) BUT STILL ON MEDS

February 27, 2008 Summary of Dr. Vivek Reddy's presentation at the 2008 Boston A-Fib Symposium: Novel Catheter Approaches to Thrombo-Prophylaxis

February 27, 2008 Summary of Dr. Albert Waldo's presentation at the 2008 Boston A-Fib Symposium: Novel Approaches to Thrombo-Prophylaxis

February 27, 2008 Summary of Dr. John Camm's presentation at the 2008 Boston A-Fib Symposium: Oral Anticoagulation: A Review of the Data

February 26, 2008 Additional Overview-Highlights of the 2008 Boston A-Fib Symposium. Danger of "Silent" A-Fib Strokes and Aspirin may not be Effective in Preventing A-Fib Stroke

February 13, 2008 Overview-Highlights of the 2008 Boston A-Fib Symposium

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.

December 2, 2007 New question answered in the FAQs section: "Is the "Pill-In-The-Pocket" treatment a cure for A-Fib? When should it be used?"

November 27, 2007 New question answered in the FAQs section: "I take atenolol, a beta-blocker. Will it stop my A-Fib."

November 20, 2007 The Pill-In-The-Pocket treatment. How some people use high doses of an antiarrhythmic med to shorten the duration of an A-Fib attack.

October 31, 2007 New story in the PersonalExperiences section: FROM NEPAL TO BORDEAUX---TREATMENT OF CHRONIC A-FIB

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 2, 2007 Report on Dr. Warren Jackman's presentation on how areas of Autonomic Ganglionated Plexi may affect A-Fib "The Facilitation of A-Fib by Communication Between Autonomic Ganglionated Plexi."

August 19, 2007FDA APPROVES GENETIC TESTING LABELING FOR COUMADIN

August 18, 2007 New story in the PersonalExperiences section: ABLATION AT NEW DELHI, INDIA FOR $5,200.

August 14, 2007 A somewhat controversial study gives actual odds for getting an A-Fib stroke depending on overall heart health and whether one is taking aspirin or warfarin.

August 2, 2007 New story in the PersonalExperiences section: CRYO BALLOON CATHETER ABLATION AT MASS. GENERAL

July 31, 2007 New question answered in the FAQs section: "I've had a successful Pulmonary Vein Ablation (Isolation) procedure a year ago. I'm in normal sinus rhythm and have been A-Fib symptom free. Will my A-Fib eventually return over time, or am I permanently cured?"

July 27, 2007 Bordeaux 5-Step Ablation Treatment for Chronic A-Fib

July 20, 2007 Report on Dr. Morady's presentation at the 2007 Boston A-Fib Symposium, "The Interpretation of the ECG Morphology During PACs, Atrial Tachycardia & Atrial Flutter."

July 18, 2007 A WORD OF CAUTION REGARDING WEB SITES WITH A-FIB INFORMATION:
    Some web sites for A-Fib patients may be biased toward a particular technique or approach, often because of financial, political, or other ties to medical devices manufacturers, pharmaceutical companies, hospitals, doctors, or other organizations. The author recommends, when searching the Internet for info on A-Fib, you ask yourself, "Who is paying for this web site, and what is their agenda?"
    (The author of A-Fib.com strives to offer unbiased info on all A-Fib treatments, but admits to enthusiasm for the catheter ablation procedure (PVA[I]). He was cured of his A-Fib in 1998 by at PVA(I) procedure in Bordeaux, France. However, he has no financial ties, receives no remuneration or grants, and has no affiliation with anyone or any organization.)

July 15, 2007 Report on Dr. Damiano's presentation at the 2007 Boston A-Fib Symposium: "Future Directions in A-Fib Surgery: Can We Make the Atria Fibrillation-Proof?"

June 30, 2007 Report on Dr. Kress' presentation at the 2007 Boston A-Fib Symposium: Surgical Therapy for A-Fib: Selected Cases and Techniques

June 22, 2007 A new question answered in the FAQs section: "I’ve heard of ablation catheters that use Cryo (freezing). Are they any good or better than the RF (Radio Frequency) catheters in use today for PVA(I) ablations?"

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 16, 2007 New question answered in the FAQs section: "I have a lot of extra beats and palpitations (PVCs and/or PACs) which are very disturbing and frightful. They seem to proceed an A-Fib attack. What can or should I do about them?"

June 16, 2007 Report on Dr. Marchlinski's talk at the 2007 Boston A-Fib Symposium "Third and Fourth PV Isolation/Ablation Procedures: Outcomes and Insights."

June 8, 2007 In the Cures section, the various types or conditions of A-Fib are listed with possible options for a cure "Which the best A-Fib treatment option for me?"

June 1, 2007 Warfarin bests aspirin for stroke prevention in elderly A-Fib patients

May 25, 2007 LOCAL A-FIB SUPPORT GROUPS FORMING
    For further info 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
    In a research study men with A-Fib had lower levels of cognitive performance compared with men in normal sinus rhythm.

May 24, 2007 New question answered in the FAQs section: "I have chronic A-Fib. In case of an emergency, should I carry a wallet card or a medical bracelet? What information should I put on it?"

May 14, 2007 New story in the PersonalExperiences section CYCLIST/TRIATHELETE WITH PERSISTENT A-FIB

May 13, 2007  Cox maze operation for patients with Chronic A-Fib.

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."

April 22, 2007 New story in the Personal Experiences section WIFE AND HUSBAND BOTH WITH CHRONIC A-FIB---THE SECOND ABLATION WORKS

April 13, 2007 New story in the Personal Experiences section 25 YEARS IN A-FIB.

March 13, 2007 Under the Cures section a new heading for "NATURAL" REMEDIES.

March 5, 2007 New question answered in the FAQs section: "Around 11:00 pm I was getting ready to go to sleep when my heart started going crazy, like it was trying to jump out of my chest. I panicked and drove to an Emergency room. But by the time I got there, my heart was normal again. What happened to me? My doctor says I may have had an episode of Atrial Fibrillation. How much trouble am I in?"

March 3, 2007 New question answered in the FAQs section: "I have a lot of stress at work. Does this stress cause or trigger my A-Fib?"

March 3, 2007 New story for the PersonalExperiences section of A-Fib.com: THE SALTMAN MICROWAVE MINIMAZE OPERATION FOR A-FIB

February 3, 2007 Update/summary of the 2006 Boston A-Fib Symposium by Drs. David Keane, Vivek Reddy and Jeremy Ruskin. (This update is written by doctors for doctors and may be somewhat difficult for patients to read. However, it is an excellent summary not only of the main points of the 2006 Symposium but of all the issues of concern to A-Fib patients today.)

January 27, 2007 Overview #4 of the 2007 Boston A-Fib Symposium. Doctors discuss their most difficult and/or least successful cases, and two ablation cases were presented live via satellite.

January 26, 2007 Overview #3 of the 2007 Boston A-Fib Symposium. Insurance not adequately compensating for complicated A-Fib ablations, and the new atrial-selective medication Ranolazine.

January 25, 2007 Overview #2 of the 2007 Boston A-Fib Symposium. New Research and Medical Developments in A-Fib: The Possible Importance of Ganglionated Plexi Sites in A-Fib, Randomized Clinical Trials of the CryoAblation Balloon Catheter, The Importance of the 95% Success Rate of Curing Persistent A-Fib reported by the French Bordeaux Group.

January 23, 2007 Overview of the 2007 Boston A-Fib Symposium. The overall mood was one of confidence in a maturing field. Steps currently being taken to prevent Atrio-Esophageal Fistula. Silent A-Fib episodes after successful catheter ablations and their importance.

January 19, 2007 Cryo Balloon Catheter Ablation Trials to begin.

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 (Thanks to Dick Inglis for this info.)

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. (Thanks to Dick Inglis for this info.)

October 10, 2006 New questions answered in the FAQs section: "Is there anything I can do to get out of an A-Fib episode? Is there any way to predict when I'm going to have an A-Fib attack?"

September 18, 2006 New history for the PersonalExperiences section of A-Fib.com International Traveler/Scuba Diver Dizzy and Fainting from A-Fib

August 5, 2006 New link added: http://patients.uptodate.com/topic.asp?file=hrt_dis/4882 Review of over 350 journals to update new research findings on A-Fib. Very comprehensive and up-to-date.
 
August 5, 2006 New link added: http://www.af-ideas.com/Choosing treatment for atrial fibrillation.htm Good analysis of the surgical options to cure A-Fib, and what doctors and/or centers perform them.

August 5, 2006 According to a Wall Street journal article by David Armstrong, four patients are known to have died after having the ArtiCure (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

August 4, 2006 Sleep apnea may be a trigger or cause of A-Fib, and may be cured in some patients by treating the sleep apnea.⁹⁰

June 29, 2006 A new Personal Experiences story Cured at the Cleveland Clinic.

June 11, 2006 How We Approach Catheter Ablation for A-Fib Today. Summary of panel discussion at the 2006 Boston A-Fib Symposium.

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."⁸¹

June 6, 2006Patients having an A-Fib attack can use a pill-in-the-pocket approach to self administer the antiarrhythmic drugs flecainide or propafenone to stop the attack.

June 5, 2006 Debate---Should Catheter Ablation Be First Line Therapy in Selected Patients with A-Fib? Summary of a  debate between Drs. Andrea Natale and Eric N. Prystowsky at the 2006 Boston A-Fib Symposium.

June 1, 2006 A detailed explanation of the French Bordeaux group's catheter ablation procedures, risks, costs, etc.

May 31, 2006 2006 ACC/AHA/ESC Guidelines for the Treatment of A-Fib - Update and Critique: Impact of A-Fib Guidelines on Clinical Practice. Summary of Dr. Waldo's presentation at the 2006 Boston A-Fib Symposium.

May 28, 2006 Advances in the Genetics of A-Fib. Summary of Dr. Patrick Ellinor's presentation at the 2006 Boston A-Fib Symposium.

May 27, 2006 Obesity (BMI over 30) and Smoking, but not Age, affect reoccurrence rates of A-Fib after ablation.

May 27, 2006 The Relationship Between High-Frequency Fractionated Electrograms and Reentrant A-Fib Drivers in the Posterior Left Atrium. Summary of Dr. Jose Jalife's presentation at the 2006 Boston A-Fib Symposium.

May 25, 2006 Pacing to Prevent A-Fib and CHF---the Role of Lead Position and Pacing Algorithms. Summary of Dr. Michael R. Gold's presentation at the 2006 Boston A-Fib Symposium.

May 24, 2006 The long-term use of warfarin appears to increase the risk of bone fractures in men (not women).

May 22, 2006 Atypical Atrial Flutter During and After A-Fib Ablation: Incidence, Physiology, and Management. Summary of Dr. Marcus Wharton's presentation at the 2006 Boston A-Fib Symposium.

May 21, 2006  Three Dimensional Left Atrial Anatomy: Implications for Catheter Ablation. Summary of Dr. Moussa Mansour's presentation at the 2006 Boston A-Fib Symposium.

May 20, 2006 The Use of Remote Robotic Navigation in Catheter Ablation for A-Fib. Summary of Dr. Vivek Reddy's presentation at the 2006 Boston A-Fib Symposium.

May 12, 2006  The Use of Remote Magnetic Navigation in Catheter Ablation for A-Fib. Summary of Dr. Carlo Pappone's presentation at the 2006 Boston A-Fib Symposium.

May 10, 2006  Surgical & Catheter-Based Strategies for Stroke Prevention in A-Fib. Summary of Dr. Douglas Packer's presentation at the 2006 Boston A-Fib Symposium.

May 8, 2006  Left Atrial Function & Remodeling Before and After Catheter Ablation or Surgery for A-Fib. Summary of Dr. David Wilber's presentation at the 2006 Boston A-Fib Symposium.

May 6, 2006 Non-PV Triggers for A-Fib: Provocation, Recognition, Location, and Relationship to Chronicity of A-Fib. Summary of Dr. Francis Marchlinski's presentation at the 2006 Boston A-Fib Symposium.

May 5, 2006  Relationship Between Locations of Autonomic Ganglionated Plexi and Sites of Complex Fractionated Atrial Electrograms and/or High Frequency Electrograms During A-Fib. Summary of Dr. Warren Jackman's presentation at the 2006 Boston A-Fib Symposium.

May 2, 2006  Detection of Complex Fractionated Atrial Electrograms (CFAEs). Summary of Dr. Koonlawee Nademanee's presentation at the 2006 Boston A-Fib Symposium.

April 26, 2006 A moving story about a father's death Toxic Effects of Amiodarone? in the Personal Experiences section.

April 25, 2006  Advances in Surgical Therapy for A-Fib. Summary of Dr. David Kress's presentation at the 2006 Boston A-Fib Symposium.

April 22, 2006  An Individualized Approach to Catheter Ablation for Atrial Fibrillation. Summary of Dr. Fred Morady's presentation at the 2006 Boston A-Fib Symposium.

April 19, 2006  The Role of Esophageal Monitoring During A-Fib Ablation. Summary of Dr. Andre d'Avila's presentation at the 2006 Boston A-Fib Symposium.

April 16, 2006  Future Directions in Antiarrhythmic Drug Therapy for A-Fib. Summary of Dr. Peter Kowey's presentation at the 2006 Boston A-Fib Symposium.

April 15, 2006    
 The Cleveland Clinic E-Clinic Consult program.

February 20, 2006 New link added: http://health.groups.yahoo.com/group/A-fibcures/ Forum on the Maze and Mini-Maze operations.

January 28, 2006 Defining Successful A-Fib Ablation. Summary of Dr. Hugh Calkins' presentation at the 2006 Boston A-Fib Symposium.

January 23, 2006 Silent A-Fib After Catheter Ablation. Summary of Dr. Hans Kottkamp's presentation at the 2006 Boston A-Fib Symposium.

January 17, 2006 Ablation of Long-Lasting A-Fib. Summary of Dr. Pierre Jaïs' presentation at the 2006 Boston A-Fib Symposium.
   
January 16, 2006 Overview of the 2006 Boston A-Fib Symposium.
   
January 2, 2005 New question answered in the FAQs section:
"I have a defective Mitral Valve? Is it causing my A-Fib? Should I have my Mitral Valve fixed first before I have a PVA?"
  
December 31, 2005 New question answered in the FAQs section:
"How can I tell when I'm in A-Fib or just having something like indigestion?"
   
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 30, 2005 New question answered in the FAQs section: My husband's A-Fib is getting worse. When should I call Emergency and/or take him to the hospital? I'm petrified with fear for him. Our doctors say don't worry unless he shows signs of a heart attack or stroke.

November 16, 2005. Maintaining proper warfarin levels.

November 8, 2005. In a report from England Eggs and Poultry Meat may be a cause or trigger of A-Fib.

November 3, 2005. Explanation of Tedy Bruschi's stroke.

November 1, 2005.  Deaths Reported Due to PVA Procedures Causing Holes in the Esophagus.

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