"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

"Your book [Beat Your A-Fib] is the quintessential most important guide not only for the individual experiencing atrial fibrillation and his family, but also for primary physicians, and cardiologists."

Jane-Alexandra Krehbiel, nurse, blogger and author "Rational Preparedness: A Primer to Preparedness"


"Steve Ryan's summaries of the Boston A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation."

Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

"I love your [A-fib.com] website, Patti and Steve! An excellent resource for anybody seeking credible science on atrial fibrillation plus compelling real-life stories from others living with A-Fib. Congratulations…"

Carolyn Thomas, blogger and heart attack survivor; MyHeartSisters.org

"Steve, your website was so helpful. Thank you! After two ablations I am now A-fib free. You are a great help to a lot of people, keep up the good work."

Terry Traver, former A-Fib patient

"If you want to do some research on AF go to A-Fib.com by Steve Ryan, this site was a big help to me, and helped me be free of AF."

Roy Salmon Patient, A-Fib Free; pacemakerclub.com, Sept. 2013


Focus on Stenosis

Inflammation and scarring or occlusion of the PV Opening after Ablation

by Steve S. Ryan, PhD

Dr. Douglas Packer from the Mayo Clinic, in a presentation on the Risks of A-Fib Ablation, discussed stenosis (a narrowing of blood vessels after A-Fib ablation)—a complication considered to be increasingly uncommon as ablation techniques have improved over the years.  But Mayo, as a nationally recognized A-Fib center, is often sent cases with “exotic” complications. Stenosis is seen more often than one would expect.

Dr. Packer stressed that A-Fib doctors need to be vigilant and should check ablated patients for stenosis after three months. (It usually takes six months for a severe case of stenosis to completely close a vein.) But only around 25% of A-Fib doctors really look for stenosis. If a patient has any significant pulmonary problems, from bronchitis to coughing up blood, complains of shortness of breath, develops pneumonia, etc., suspect stenosis unless proven otherwise. If caught early, angioplasty balloons and stents can often correct for stenosis. But these patients need to be re-checked probably for life, because re-stenosis can occur.

In good news for patients suffering from stenosis, Dr. Packer added that in Mayo’s experience, in many cases of complete stenosis or blockage, collaterals formed within two years. (Collaterals are new Pulmonary Veins that develop to replace the veins closed off by stenosis.) “The real issue is whether that is good enough to reduce symptoms. It depends largely on what the other vein on that side looks like. If it is also occluded, patients may remain very symptomatic.”

Among other complications, Mayo is also seeing:

      • Cases of stiff left atrium, presumably because of excessive scarring of the left atrium.
      • MRI studies have revealed Cerebral Micro Embolic events, but they don’t always cause symptoms and often disappear over time.  But they are certainly something everyone wants to avoid causing.
      • Phrenic Nerve injury during CryoBalloon ablation usually goes away over time and is less of a problem with experience.
      •  Dr. Packer also mentioned “late tamponade” (an accumulation of fluid in the pericardial sac around the heart) probably due to oozing from an ablation or catheter site that recurs when patients are started back on anticoagulants.


Last updated: Thursday, April 25, 2013

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