ABOUT 'BEAT YOUR A-FIB'...


"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"



ABOUT A-FIB.COM...


"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


Articles

Static page articles

Pinterest: My Best A-Fib.com Posts

A-Fib.com on Pinerest

A-Fib.com

I’m traveling for a few days, so this post has to be short, but not necessarily brief! Did you know I’ve listed my Best A-Fib News posts from 2015 on Pinterest? Each year Patti and I write about 150 posts, so we selected the best ‘evergreen’ posts for you.

To browse through our hand-picked selections, just click the Pinterest logo and click on a few picks.  You may find something you have missed or want to reread.

Ellen Degeneres on A-Fib.com

Ellen D.

Just For Fun

What do Mother Theresa, Ellen Degeneres and Vice President Dick Cheney have in common? If you guessed Atrial Fibrillation, you’re right! For fun, look at our board with 50 Celebs with A-Fib!

We’ve got it! Largest Glossary of Atrial Fibrillation Medical Terms

Atrial Fibrillation: Resources for Patients Glossary of Terms

Atrial Fibrillation: Resources for Patients Glossary of Terms

Check it out. Bookmark it! Refer to it often!

The A-Fib.com Glossary of Medical Terms and Phrases is the most complete online glossary devoted exclusively to Atrial Fibrillation and is the largest single source online. Each definition is written in everyday language—a great resource for patients and their families.

Bookmark this page and refer to it when reading and studying A-Fib research and literature. (if you have a medical dictionary, make a note of our web address for those terms you don’t find in your dictionary.)

If you don’t find the term you are looking for—email us and we’ll add it to the Glossary.

Print a free Medical Alert I.D. Wallet Card

Do you carry an emergency medical alert I.D. card? When you have A-Fib and you’re taking a blood thinner or other medications, you may want to carry your medical information.

Free Online Medical ID Wallet Card Generator

MedIDs.com offers a free online generator tool for a fully customized medical info wallet card. Go to Free Printable Medical ID Cards, type in your information and print. (Note: none of your personal information is stored on their website.) Trim the paper and fold to fit your wallet or purse. Add a label, “In Case of Emergency” (ICE). A Few More Tips:

• Laminate your wallet card to prolong its use (an office supply store can help you).
• Why not print a card for each member of your family?
• If you also wear a medic alert bracelet, inscribe it with the message “See wallet card”.

Money clip from Universal Medical Data

Money clip from Universal Medical Data

Additional Ways to Carry Your Emergency Medical Alert ID Information

There are many new styles of Medic Alert IDs bracelets and necklace pendants using different materials like waterproof foam, leather and stainless steel. Don’t carry a wallet? Consider a Money clip with compartment to slide in your emergency contact info.

USB bracelet from Medical Alert Drives

USB bracelet from Medical Alert Drives

Or, if you carry a paper-based day planner or calendar, add the same information to your address book.

For much more information about what and how to carry your emergency medical information, see our A-Fib.com article, Your Portable Medical Information Kit. 

Call for Guest Writers. How About You?

Are you a writer? Are you passionate about an A-Fib topic or issue? Why not share your insights with our A-Fib.com readers? We welcome guest writers!

For examples of guest articles, check out Lyn Haye’s Obesity in Young Women Doubles Chances of Developing A-Fib and Frances Koepnick’s “Patient Review: AliveCor Heart Monitor for SmartPhones“.

If you’re interested in being an A-Fib.com guest writer (or just have questions), send Steve an email. Do it NOW!

FREE Report: How & Why to Read An Operating Room Report

Special 12-page report by Steve S. Ryan, PhD

New FREE 12-page report by Steve S. Ryan

In our new FREE 12-page Report, How & Why to Read Your Operating Room Report, we examine the actual O.R. report of the catheter ablation of Travis Van Slooten, publisher of Living With Atrial Fibrillation performed by Dr. Andrea Natale, Austin, TX.

What is an O.R. Report?

An O.R. report is written by the electrophysiologist who performed the catheter ablation. It contains a detailed account of the findings, the procedure used, the preoperative and postoperative diagnoses, etc.

It’s a very technical document. Because of this, it’s usually given to a patient only when they ask for it.

New Report: How & Why to Read Your Operating Room Report

In our new FREE 12-page Report: How & Why to Read Your Operating Room Report, I make it easy (well, let’s say ‘easier’) to learn how to read an O.R. report.

Along with an introduction, I’ve annotated every technical phrase or concept so you will understand each entry. I then translate what each comment means and summarize Travis’ report.

Read more at: Special Report How & Why to Read Your Operating Room Report

Tip: If you’ve had an ablation, ask for your O.R. Report. If you or a loved one is planning a catheter ablation, make a note to yourself to ask for the O.R. report.

Anyone Hospital Bound at Major Risk for Thrombosis

To build awareness, this is World Thrombosis Day.

A thrombosis is a blood clot that forms within a blood vessel and can be carried by either a vein or an artery. If that clot breaks free, it can lodge in an artery, travel to the brain and result in a stroke.

Stroke - Blood vessel with clot

Stroke risk: blood vessel blocked by clot

At A-Fib.com we write often about stroke risk due to Atrial Fibrillation (and the role of blood thinners to address that risk). A blood clot that forms as a result of A-Fib is an example of ‘arterial thromboembolism’.

A-Fib-related stroke can be particularly dangerous. Patients are twice as likely to be bedridden and more likely to die compared to patients with non-A-Fib-related stroke.

Anyone in the hospital is at major risk factor for developing a blood clot. Patients with decreased mobility or who experience blood vessel trauma due to surgery are more likely to develop blood clots.

If your loved one is being admitted to the hospital, proactively discuss their risk of stroke (i.e. venous thromboembolism or VTE ) with the hospital’s medical staff. Ask them for a VTE risk assessment to determine if they have any risk factors and whether they are at an increased chance of developing blood clots while in the hospital – or in the days or weeks after a hospital visit. Visit the World Thrombosis Day site.

Patients with A-Fib can use the CHADS2 & CHA2DS-VASc Stroke-Risk Grading Systems to access their stroke risk.

Editorial: EP’s Million Dollar Club—Are Payments to Doctors Buying Influence?

By Steve S. Ryan, October, 2015

In 2014, the pharmaceutical and medical device industries paid out billions to doctors and teaching hospitals. What are they getting for their money? Are they paying for ‘influence’ at the expense of patients?

The EP’s Million Dollar Club

Drug and medical device makers reported payments to seventeen Cardiologists of at least $1 million each from August 2013 through 2014. The payments were for consulting, travel, royalties and other fees. The largest dollar recipients were those who developed a new interventional cardiology device and sold it to one of the big medical device companies.

Among the seventeen doctors are several Electrophysiologists (EPs):

 Dr. Sanjiv Narayan $10,990,510 Mostly from the sale of Topera to Abbott
 Dr. Eric Prystowsky  $2,829,957 Mostly from the sale of Topera to Abbott
 Dr. Benzy Padanilam   $1,018,500 Mostly from the sale of Topera to Abbott

$300 Million in Conflicts of Interest?

More routine activities can garner considerable medical industry payments for many thousands of additional cardiovascular healthcare professionals (who don’t invent a device or start a company). For example, Dr. Peter Kowey received $544,000.

Between August 2013 and December 2014, the medical industry paid $300 million to cardiologists and other related healthcare professionals for consulting, speaking and other various activities. Receiving a total of $299,050,686 were 31,379 doctors; 1,639 of those received over $50,000.

This doesn’t include larger sums paid to support healthcare research, or payments for ownership and investor interests.

And the Big Winner is…Anticoagulant Drugs

The new anticoagulants (NOACs) aimed at A-Fib patients for stroke prevention are among the top ten drugs promoted by the pharmaceutical industry. The number of payments to doctors linked to specific drugs are:

 Eliquis 145,000 payments
 Xarelto  124,000 payments
 Pradaxa  74,000 payments

As a healthcare consumer, do these payments related to a certain NOAC concern you? They do me!

Reporting Payments to Physicians Now Required by Law

Do the pharmaceutical and medical device industries ‘influence’ doctors through large dollar payments (or other “transfers of value”)? We can only speculate.

In the U.S. under the Sunshine Act [part of the 2010 Patient Protection and Affordable Care Act (PPACA)], we can now research if a doctor has received such payments.

The Center for Medicare and Medicaid Services (part of the U.S. Department of Health and Human Services) is responsible for Open Paymentsthe federally run program that collects the information about these financial relationships and makes it available to consumers. The second year of Open Payments data is now available.

The Open Payments online database along with the ProPublica Dollars for Docs project make it possible to look up payment history for individual physicians, teaching hospitals and companies.

Note: It’s currently hard to isolate data about EPs, specifically, and the Open Payments data doesn’t include all disbursements such as industry payments to sponsors of Continuing Medical Education (CME) courses. (Almost all CME courses are paid for by the medical industry.) But it’s a beginning.

What This Means to Patients

Industry Money a Form of Recognition? Most doctors and U.S. teaching hospitals are not ashamed or embarrassed to receive industry money. For most it is a badge of honor and a recognition of their importance in the industry.

A variety of doctors and U.S. teaching hospitals accept medical industry money, for example, for promotional talks, research, to speak at conferences, consult, etc. It’s reasonable they be reimbursed for their time and effort.

Or is it a Form of Influence? Like death and taxes, medical conflicts of interest are inevitable.

How much does ‘Conflicts of Interest’ factor in to the choices, recommendations and purchases made by these doctors?

For example, Dr. Philip Sager who received $350,000 from the medical industry, has served several times as a member and the chair of the FDA’s Cardiovascular and Renal Advisory Committee. Another frequent FDA panel member is Dr. Sanjay Kaul who earned $250,000 during this same period.

I know of only one medical center in the US that prohibit these types of medical conflicts of interest: The Mayo Clinic.

Legislation to Prevent Conflicts of Interest? Currently, it isn’t possible in the US to legislate away medical conflicts of interest.

Even if we could pass conflicts of interest laws, the medical industry is very creative. They would find other ways to influence doctors.

There is Hope: Transparency and Disclosure. At the last heart-related conference I attended, every presenter’s first slide described their conflicts of interest. The same information was also listed in a brochure given to all the conference attendees. Some doctors even included approximate dollar amount terms such as “significant.”

Takeaway

As healthcare consumers in the US, the most we can hope for right now is transparency and disclosure. The Sunshine Law goes a long way in telling us if our prescribing doctor or the influential speaker at a conference has conflicts of interest.

References for this article

Free Report: How & Why to Read An Operating Room Report

Special 12-page report by Steve S. Ryan, PhD

FREE 12-page Report by Steve S. Ryan, PhD

In our free Special Report, How and Why to Read Your OR Report – Special Report by Steve S. Ryan PhD – A-Fib.com, we examine the actual O.R. report of the catheter ablation of Travis Van Slooten, publisher of Living With Atrial Fibrillation performed by Dr. Andrea Natale, Austin, TX.

What is an O.R. Report?

An O.R. report is a document written by the electrophysiologist who performed the catheter ablation. It contains a detailed account of the findings, the procedure used, the preoperative and postoperative diagnoses, etc.

It’s a very technical document. Because of this, it’s usually given to a patient only when they ask for it. You need to call your doctor or his office to obtain it.

Why to Request and Read Your O.R. Report

The O.R. report is a historical record of how you became A-Fib free.
The O.R. report is a blow-by-blow account of your EP’s actions. It’s as close as you’ll get to understanding your own ablation without actually looking over the EP’s shoulder during the ablation. The O.R. report is a historical record of how you became A-Fib free. (File with your A-Fib medical records for future reference.)

If you’ve had an ablation that was less than successful, you want to know why! Your O.R. report would show what they found in your heart, what was done, and possibly why the ablation didn’t fulfill expectations.

Studying an O.R. report can be very revealing…you may decide to change EPs going forward!

Reading an O.R. report can be very revealing. Were there complications? Was your fibrosis more extensive than expected? Was there a problem with the EP’s ablation techniques? Or with the EP lab equipment? This information will help you and your healthcare team decide how next to proceed.

Also, depending on what you read in your O.R. report, you may decide to change EPs going forward!

O.R. Report with closeup

Close-up of O.R. Report with markups

FREE Report: How & Why to Read Your Operating Room Report

In our FREE Special Report: How and Why to Read Your OR Report – Special Report by Steve S. Ryan PhD – A-Fib.com, I make it easy (well, let’s say ‘easier’) to learn how to read an O.R. report.

Along with an introduction, I’ve annotated every technical phrase or concept (in purple text) so you will understand each entry. I then translate what each comment means and summarize Travis’ report.

Get your PDF copy TODAY. Download How and Why to Read Your OR Report – Special Report by Steve S. Ryan PhD – A-Fib.com our FREE 12-page Special Report (Remember: Save to PDF  to your hard drive.)

Tip: If you’ve had an ablation, ask for your O.R. Report. If you or a loved one is planning a catheter ablation, make a note to yourself to ask for the O.R. report.

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If you find any errors on this page, email us. Y Last updated: Monday, July 18, 2016

Intense Exercise: Lessons from Elite Athletes

Intense athletes have to face the fact that they’re more at risk of developing A-Fib and conditions like small heart injuries and fibrosis, and need to monitor their heart health more carefully.

That doesn’t mean you have to stop running or working out, but you have to be smart about it. Did you give yourself enough time to recover after the last race? What did the EP tell you about your overall heart health? Are you taking time to rest, sleep, and decrease other stressors in life?  Is your diet a healthy one, centered on whole foods?

‘Knowing your heart’ is the best tool in prevention. Understand your heart rate: your normal rate at rest, early in exercise, during peak exercise, and in recovery. For more, read my article, Intense Exercise and A-Fib: Lessons from Elite Athletes.

 

How to Find the Right Doctor: Steve’s Directory of Doctors & Medical Centers

Doctor acronyms wide 150 pix wide at 96 res

Article: Physician Credentials and What They Mean

Are you looking for a cardiologist who treats A-Fib patients? Or do you want to change doctors? We make it easier for you with our A-Fib.com Directory of Doctors and Medical Centers.

What makes our directory unique?

We list only those cardiologists and electrophysiologists who treat Atrial Fibrillation patients. It’s organized in two parts: by U.S. state and international. We include doctor’s names and contact information. (This evolving list is offered as a service and convenience to A-Fib patients.)


IMPORTANT: Be sure to refer to Finding the Right Doctor for You and Your A-Fib. It covers what you need to know to research and select the best doctor for you and your treatment goals. And read our article: Physician Credentials: Acronyms and What They Mean for Atrial Fibrillation Patients.
NOTICE: Unlike some other directories on the web, we offer no preferential listings to be in our Directory. We accept no fee, benefit or value of any kind for listing a specific doctor or medical center. A-Fib.com is not affiliated with any practice, medical center or physician.

Israeli Study Contradicts Recent CHA2DS2-Vasc Guidelines: Being Female Not a Risk Factor for Stroke

CHAD2DS2VAC Medium 100 pix at 96 resby Steve S. Ryan, May 2015

This is another powerful study contradicting the recent CHA2DS2-VASc guidelines which gives every women with A-Fib one point on the stroke risk scale because of her female gender, no matter how healthy she is otherwise.

An Israeli study tracked nearly 100,000 patients who developed A-Fib. They were followed for approximately four years between  2004 and 2011. The purpose of this observational study was to re-evaluate the risk of ischemic stroke, major bleeding and death in men and women with A-Fib.

Controversial CHA2DS2-VASc Risk Data and Analyses?

Previous controversial data and analyses showed an increased risk of stroke among women. The recent CHA2DS2-VASc risk score states that being a female is a risk factor for stroke.

“In light of our findings, we suggest to use a similar anticoagulant strategy in [both] men and women with atrial fibrillation over the age of 65.”

But in this Israeli study, “the risk of ischemic stroke was similar in men and women.” Women who developed A-Fib were older than men by four years (74 vs, 70) and had more hypertension, but lower prevalence of diabetes, congestive heart failure and ischemic heart disease. The rates of ischemic stroke were identical between male and female patients, 5.3% for both genders.

Factors associated with increased stroke risk were previous stroke, age older than 65, hypertension, congestive heart failure and diabetes. Adjusting for the age difference between the men and women who developed A-Fib in this study, death risk was associated with male gender, age over 65, previous stroke or heart attack, and diabetes.

Study Conclusion

The authors concluded, “In light of our findings, we suggest to use a similar anticoagulant strategy in men and women with atrial fibrillation over the age of 65.”

Editor’s Comments:

Intuitively it doesn’t make sense that simply being a woman makes you more at risk of having an A-Fib stroke. This study seems to confirm what common sense would indicate.
Women in their child-bearing years are much less at risk of stroke because of the blood-thinning effect of losing blood each month. And even after menopause women have less risk of stroke. But eventually they do have more strokes. But not because of an innate inferiority, but because women live longer than men. Stroke and hypertension are age related. In this israeli study women who developed A-Fib were four years older than men.
Be advised that the original European guidelines were written by doctors with major conflicts of interest. These guidelines may be a not so very subtle form of gender bias. Also, just adding one point to a person’s stroke risk score translates into a huge increase in sales for pharmaceutical companies.
References for this article

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Last updated: Monday, March 28, 2016

Who’s Performing Maze and Mini-Maze Operations?

If you aren’t a candidate for a catheter ablation, another option is the Maze/Mini-Maze surgeries. We’ve compiled a list of Medical Centers and doctors performing the Maze surgeries and organized it by US state.

Go to US Centers and Surgeons Performing Maze and Mini-Maze Operations.

We include doctor’s names and contact information. Be sure to refer to Finding the Right Doctor for You and Your A-Fib. It covers what you need to know to research and select the best doctor for you and your treatment goals.

NOTICE: Unlike some other directories on the web, we offer no preferential listings to be in our Directory. We accept no fee, benefit or value of any kind for listing a specific doctor or medical center. A-Fib.com is not affiliated with any practice, medical center or physician.

 

The largest Glossary of A-Fib related medical terms

Check it out. Bookmark it. Refer to it often.

The A-Fib.com Glossary of Medical Terms and Phrases is the most complete online glossary devoted exclusively to Atrial Fibrillation and is the largest single source online. Each definition is written in everyday language—a great resource for patients and their families. Bookmark this page and refer to it when reading and studying A-Fib research and literature.

If you don’t find the term you are looking for—email us and we’ll add it to the Glossary.

Choosing the Right Doctor: 7 Questions You’ve Got to Ask (And What the Answers Mean)

red-heart-negative 150 pix by 96 resThis list of 7 questions (8 if you are female) is designed to solicit information to help you select the best doctor for you and your type of A-Fib. After each question, we’ve included typical doctor responses and an analysis of what those responses may mean to you.

1. What treatments do you recommend for dealing with or curing my type of A-Fib?

If the doctor only talks about different medications, you should probably talk to other doctors on your list. Overall, Drug Therapies have poor success rates, and don’t address the progressive nature of Atrial Fibrillation. Today, the best A-Fib treatments are with Catheter Ablation.

2. Do you perform Catheter Ablation procedures for my type of A-Fib? What type of procedures do you use, or prefer?

Response #1:    “I only work or prefer to work in the right atrium.” Or, “I will eliminate the Atrial Flutter in your right atrium first.”

These responses indicate a doctor may not have the experience or be comfortable working in the left atrium. Though it’s more difficult to work in the left atrium, most A-Fib comes from the left atrium pulmonary veins. You may have Atrial Flutter in your right atrium along with your A-Fib, but it may well be triggered by the A-Fib coming from your left atrium.23 You should probably talk to other doctors on your list.

Response #2:    “We recommend catheter ablation of the AV node and implanting a permanent pacemaker.”

Though this used to be one of the most common treatments for A-Fib, you don’t want to be burdened with a permanent pacemaker for the rest of your life when there are better options available.

Also, this procedure leaves you in A-Fib and dependent on medication for the rest of your life. Unless you have a Sinus Node problem and need a pacemaker, you should probably talk to other doctors on your list.

Response #3:    “We use Circumferential Ablation to eliminate A-Fib.” Or “Segmental Ablation… .” Or “Anatomically-Based Circumferential Ablation….” Or “Pulmonary Vein Antrum Isolation… .”

Circumferential, Segmental, Anatomically-Based Circumferential (also referred to as Left Atrial Ablation or the Pappone technique) and Pulmonary Vein Antrum Isolation (PVAI) are refinements or different Pulmonary Vein Ablation procedure strategies. All offer you a good chance of being cured of your A-Fib.

Circumferential is the most used technique.

Response #4:    “We use a special catheter sensor to pinpoint ectopic beats coming from areas of the heart, mostly from the Pulmonary Veins in the left atrium. We then ablate these areas.”

(Ectopic beats come from any region of the heart that ordinarily should not produce heart beat signals, such as the pulmonary veins).

This response indicates the doctor and/or medical center is targeting (focusing on) specific spots generating the A-Fib signals. This technique is called Focal Catheter Ablation which was the first technique developed to ablate A-Fib.

However, most centers today use either Circumferential or Segmental techniques to ablate or isolate the entire area around the openings of all four Pulmonary Veins. If the A-Fib signals persist, they will proceed to target and abate the specific source of the ectopic beats.

Response #5:    “Besides RF catheters, we also use the CryoBalloon Catheter to isolate the Pulmonary Veins.”

The CryoBalloon Catheter for A-Fib Ablation (FDA-approved technology in December, 2010), it has proven effective, safer, and faster than the various types of RF ablation.

But it is a relatively new method of ablation without a long-term track record of extensive data validating its effectiveness. However, anyone using the CryoBalloon Catheter is probably innovative, knowledgeable, and experienced in A-Fib ablation.

3. What is your success rate for my type of A-Fib?

Major centers with a lot of experience have a success rate of around 70-85% for Paroxysmal (occasional) A-Fib, with a higher success rate if a second ablation is necessary. If their success rate is 50% or less, you should probably look elsewhere.

4. How long have you been performing catheter ablations for my type of A-Fib? How experienced are you with RF and/or Cryo? How many procedures do you perform a year?

It’s hard to quantify experience with specific numbers. When doctors say they have done a total of 20 Pulmonary Vein Ablations, they are probably still in their “training” stage or have just passed their certification. At a minimum, electrophysiologists should perform 100 procedures a year. Therefore, if a doctor only does a few PVAs a month, this may not be enough to maintain or develop ablation skills.

There are many electrophysiologists and several medical centers that have been doing Pulmonary Vein Ablations for years and have done hundreds (or thousands) of Pulmonary Vein Ablations.

5. What kind of complications have you had after ablations?

Every A-Fib doctor has had some complications when doing Pulmonary Vein Ablation procedures. A PVA is a low risk procedure, but it is not risk free. Possible complications include blood clots and stroke, PV Stenosis (post-op swelling of pulmonary vein openings which can restrict blood flow and lead to fatigue, flu-like symptoms, and pneumonia), Cardiac Tamponade (pooling of fluid around the heart that can cause a drop in blood pressure) and Phrenic Nerve Paralysis (related to the diaphragm, and usually temporary).

Doctors and their office staff are usually very open about the complications they have had and can usually give you statistics. If they are not, you may want to look elsewhere for your doctor.

6. Do you ever refer your patients for Maze or Mini-Maze surgery?

Some A-Fib patients might be better served by a Maze or Mini-Maze surgery. For example, someone who needs heart surgery for another problem might well combine that surgery with a Maze operation. Someone who can’t tolerate Coumadin or other blood thinners might be better served by a Mini-Maze surgery. Most Mini-Maze surgeries are the result of referrals by electrophysiologists.

If a doctor doesn’t normally refer patients for Maze surgeries, this isn’t necessarily a reason for rejection. They may be concerned about a loss of quality control if they send patients to someone who’s not a specialist in heart rhythm problems.

7. What techniques or technologies do you use to increase the safety and effectiveness of your procedures? For example, how do you protect the esophagus?

A doctor’s use of technology may improve their effectiveness compared to other doctors or medical centers. Examples: Using an imaging system that gives 3-D images of the inside of the heart, of the position of the esophagus, and of catheter placement and pressure; Using an energy source like the CryoBalloon catheter system to produce circular lesions around the pulmonary veins; Using magnetic or robotic arms that aid in more precise placements of lesions or ablations.

Damage to the esophagus during an ablation (called Atrial Esophageal Fistula) is a very rare complication (less than 1 in 1000+), but is often fatal. Heat from the RF catheter damages the esophagus which lies just behind the heart; over the next 2-3 weeks gastric acids can eat through the weakened area. Most doctors and medical centers take precautions to avoid this damage including prescribing Proton Pump Inhibitors to prevent gastric acid damage.

When you ask how the doctor protects the esophagus, you should hear answers like:

Response 1:     “We use low power at the back of the heart.”

Response 2:      “We use a temperature probe in the esophagus to make sure it doesn’t get too hot.”

Response 3:      “We use barium paste in the esophagus so that we can see where it is when we make ablations and don’t make ablations near the esophagus.”

Response 4:      “We give Proton Pump Inhibitors like Nexium for 2-3 weeks after an ablation to protect the esophagus.”

If you don’t get answers like these, especially about taking Proton Pump Inhibitors after an ablation, it might be wise to talk with other doctors.

8. (For female patients) What is the extent of your training specifically related to women’s heart health?

Women tend to have different symptoms of heart disease than men, in part because their bodies respond differently to risk factors such as high blood pressure. Cardiologists who specialize in women are more common than ever. Medical centers now have clinics devoted to women’s heart health. Women with A-Fib may want to seek out a specialist who is up-to-date in this field of research.

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Last updated: Wednesday, May 6, 2015

 

Steve’s List of EPs Installing the Watchman Device

If you are at high risk for stroke but can’t take anticoagulants, your doctor may suggest closing off the Left Atrial Appendage using an occluder such as the Watchman Device. Use of the Watchman is a relatively new treatment option (recently approved by the FDA for use in the US).

For Steve’s List of doctors who participated in the trial, go to US EPs Installing the Watchman Device – by US State.

We include doctor’s names and contact information. Be sure to refer to Finding the Right Doctor for You and Your A-Fib. It covers what you need to know to research and select the best doctor for you and your treatment goals.

NOTICE: Unlike some other directories on the web, we offer no preferential listings to be in our Directory. We accept no fee, benefit or value of any kind for listing a specific doctor or medical center. A-Fib.com is not affiliated with any practice, medical center or physician.

Research: Stimulating the Front Ear Flap Inhibits A-Fib

AF Symposium 2015

Dr Warren Jackman 200 x 200 pix at 300 res

Dr Warren Jackman

Stimulating the Front Ear Flap Inhibits A-Fib

by Steve S. Ryan, PhD

One of the most surprising presentations was by Dr. Warren Jackman of the Un. of Oklahoma. He cited research in dogs where they inserted an electrode which stimulated the tragus (the flap at the front of the ear). This ear stimulation shortened the episodes of A-Fib and lengthened the atrial cycle. Preliminary clinical data indicates that this works in humans as well.

It seems strange that simply stimulating the ear would help A-Fib attacks, but the vagus nerve has a branch in the tragus (the front flap in the ear). Increasing vagal tone is similar to what yoga or meditation does. Dr. Jackman and his colleagues found that this low level ear vagal stimulation in dogs paced into A-Fib inhibited the autonomic ganglionated plexi and prevented atrial remodeling.

Editor’s Comments:
This discovery that stimulating the tragus in the ear can inhibit A-Fib is an astounding and new finding with far-reaching implications. Imagine some day simply inserting an A-Fib earpiece to inhibit or stop a paroxysmal A-Fib attack!

Return to AF Symposium 2015: Brief Reports

Last updated: Thursday, April 23, 2015 

Silent A-Fib More Dangerous Than Symptomatic A-Fib

AF Symposium 2015

Dr John Camm 200 x 200 pix at 300 res

Dr. John Camm

Silent Undiagnosed A-Fib More Dangerous Than Symptomatic A-Fib

by Steve S. Ryan, PhD

Background: Back in 2004, Dr. John Camm of St. George’s Hospital in London, England was one of the first to identify the importance of “silent” or asymptomatic A-Fib. (See the first summary under Boston AF Symposium, January 16-17, 2004.)

In his 2015 presentation, Dr. Camm pointed out that silent (asymptomatic) A-Fib can have similar long-term effects as A-Fib with symptoms. Silent A-Fib may progress and get worse just like symptomatic A-Fib. Increased fibrosis may develop, the atrium may become stretched and dilated, the frequency and duration of the unnoticed A-Fib attacks may increase over time (electrical remodeling).

But what’s worse is that the risk of an A-Fib stroke may increase with the result that a patient is hospitalized or dies from an A-Fib stroke without knowing they had A-Fib. If someone with A-Fib has symptoms such as heart palpitations, shortness of breath, chest pains, tiredness, swelling of legs and a decline in mental ability due to reduced blood flow, etc., they and their doctors can usually determine that they have A-Fib. They can take precautions like taking anticoagulants to prevent an A-Fib stroke. But all too often people with silent A-Fib have a stroke and only then find out they have A-Fib.

Improved Device Monitors for A-Fib

Doctors today have a wealth of new A-Fib monitoring devices to detect A-Fib, such as the Medtronic Reveal DX which is inserted just under the skin and can monitor the heart for over a year, or the Zio Patch which you wear like a Band Aid for 1-2 weeks, or phone apps like the AliveCor Heart monitor for SmartPhones. But how can we get heart monitors to the people who need them the most—people with silent A-Fib? (I believe that everyone when they turn 50 or 60 years old should be given not only an EKG, but also some form of a long-term monitor to detect silent A-Fib. [In the US this could be a part of Obamacare.] That would save a lot of lives and permanent disabilities from A-Fib strokes. An EKG only works if one has A-Fib in the doctor’s office. But people with intermittent A-Fib often need a more long-term monitor to detect their A-Fib.)

Dr. Camm described studies such as REVEAL-AF and CHARISMA which are using monitoring devices to identify A-Fib as soon as possible in patients who are vulnerable to it.

In the new clinical study called ARTESiA, devices to detect A-Fib will be used to compare patients taking apixaban versus aspirin in reducing the risk of ischemic stroke and systemic embolism.

A-Fib May Not be the Only Factor in Ischemic Stroke

Dr. Camm made a thought-provoking statement about A-Fib and stroke. We know that people who get A-Fib are at a greater risk of having an ischemic stroke. But “there is not a clear relationship between the timing of the A-Fib and stroke.” Someone may develop A-Fib and have a stroke within a year, while others may go much longer without having a stroke or throwing a clot. Right now we can’t predict when someone in A-Fib will develop a clot and have a stroke. This suggests that “A-Fib itself may not be the only factor that is relevant, and that other underlying cardiovascular problems contribute to that ischemic stroke.”

Stroke Risk Low After an Ablation

What about the risk of silent A-Fib after a successful catheter ablation? (See also 2006 BAFS: Dr. Hans Kottkamp, The Frequency and Significance of Asymptomatic A-Fib After Catheter Ablation.)

Dr. Camm pointed out that a large number of studies have indicated that following ablation, “ischemic stroke rates are very low.” (See also my article: Catheter Ablation Reduces Stroke Risk even for Higher Risk Patients.)

Editor’s Comments:
Is “Silent A-Fib” Really Silent?
Some people question whether “silent” A-Fib is really silent from a clinical aspect. Even though someone isn’t experiencing the feeling that their heart is trying to jump out of their chest, in A-Fib one loses 15%-30% of normal blood flow to the brain and other organs which certainly has an effect. Even though people get used to it or their body adjusts or they write off the symptoms of tiredness, dizziness, mental slowness, etc. as old age, almost everyone in A-Fib is clinically affected and changed by A-Fib to some extent.
Silent A-Fib After an Ablation Less of a Danger
If you’ve had symptomatic A-Fib and been “cured” by a catheter ablation, it’s highly unlikely you wouldn’t notice if you went back into A-Fib. People with symptomatic A-Fib are usually very attuned to their heart and watchful. (One way to tell when someone has A-Fib is to watch them slyly check their pulse when no one is looking. I was particularly obsessive and used to wear a Polar Heart Rate monitor 24/7. Even after 17 years of being A-Fib free, I still check my pulse every night with a Pulse Oximeter.)
And EPs today are much more aware of silent A-Fib and its dangers. Plus they now have an awesome array of A-Fib monitoring devices. It’s highly unlikely that today’s EPs wouldn’t catch significant bouts of silent A-Fib, though they aren’t infallible. (When I had my yearly heart check-up, it included a stress test. Then my EP had me wear a Holter monitor for a day. [No A-Fib!] Several years ago he had me wear a Zio patch monitor for two weeks. [Again, no A-Fib!]) This is the kind of watchful observation most EPs employ on patients who have had catheter ablations.)
We Must Do Something About Silent A-Fib
Silent A-Fib is a serious public health problem. Up to 30%-50% of people with A-Fib aren’t aware they suffer from A-Fib and that their heart health is deteriorating.1 As a society we must develop the political will to identify everyone with silent A-Fib long before they die or are permanently disabled from an A-Fib stroke! And with the amazing new varieties of device monitors on the market, it should be easy to identify people with silent A-Fib.
I call upon the Heart Rhythm Society and the American Heart Association/American Stroke Association to develop protocols for identifying silent A-Fib. And heart doctors should not only be encouraged but required to use these protocols on everyone over a certain age. Think of the lives and permanent disabilities that would be saved by inexpensive, easily administered monitoring for silent A-Fib. 

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Return to 2015 AF Symposium: My In-depth Reports Written for Patients

Last updated: Monday, January 25, 2016

References    (↵ returns to text)
  1. Furberg CD et al. “Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study).” Am J Cardiol. 1994; 74: 236-241.PubMed PMID: 8037127. Last accessed April 3, 2014 URL: http://www.ncbi.nlm.nih.gov/pubmed/8037127

We Need Guest Writers, How About You?

Are you a writer with a passion for a specific A-Fib-related topic or issue? Would you like to write about it for A-Fib.com? We welcome guest writers! Why not share your insights with our A-Fib.com readers?

For examples of guest articles, see Frances Koepnick’s “Patient Review: AliveCor Heart Monitor for SmartPhones” and Lyn Haye’s Obesity in Young Women Doubles Chances of Developing A-Fib.

If you’re interested in being a guest writer for A-Fib.com (or just have questions) just send Steve an email. Do it Today!

Looking into the Hybrid Surgery/Ablation Procedure?

There are very few centers offering the Hybrid Surgery/Ablation approach because it’s extremely rare to have the tremendous expertise necessary in both catheter ablation and surgical A-Fib ablation at the same institution. If you are interested in this treatment option, see Steve’s Lists: US Centers performing the Hybrid Surgery/Ablation Procedure.

Similar ablation techniques are called ‘hybrid ablation technique’, ‘convergence process’, ‘Convergent Maze Procedure’ and ‘Convergent Ablation”’.

We include doctor’s names and contact information. Be sure to refer to Finding the Right Doctor for You and Your A-Fib. It covers what you need to know to research and select the best doctor for you and your treatment goals.

NOTICE: Unlike some other directories on the web, we offer no preferential listings to be in our Directory. We accept no fee, benefit or value of any kind for listing a specific doctor or medical center. A-Fib.com is not affiliated with any practice, medical center or physician.

 

DIY Heart Rate Monitors: How They Work For A-Fib Patients (Part II)

Polar Heart Rate Monitors

Go to: DIY Heart Rate Monitors

by Steve S. Ryan, PhD, Updated April 2015

A-Fib patients sometimes use consumer ‘DIY” Heart Rate Monitors (HRM) when exercising or performing physically demanding activities (For specific models and options, see our article, DIY Heart Rate Monitors & Handheld ECG Monitors Part I.)

How Do DIY Heart Rate Monitors Work?

Basic HRMs use a chest strap to pick up the electrical signals from the heart. However, due to the inherent design of the chest strap, the accuracy is somewhat limited and is no replacement for the signals recorded by a Holter or Event Monitor.

Heart-Rhythm-Monitors-EKG - 325 pix wide at 96 resA HRM keeps track of your heart’s R-R interval or the time between R peaks. Without getting too technical, the R peak on a generic ECG waveform (see the diagram) corresponds to the ventricle beat (depolarization) and has the largest amplitude (height) of the complete waveform.

When the amplitude (picked up as a voltage differential) exceeds a certain threshold, a “beat” is picked up by the chest strap and transmitted wirelessly to the HRM. It is the time between these R peak “beats” that is used by the HRM to determine instantaneous heart rate. It is only going to pick up episodes of arrhythmia as are manifested in ventricle beats (the R on the waveform).

Learn more about the EKG signal, see Steve’s article: Understanding the EKG (ECG) Signal.

So if your arrhythmia manifests itself in funky R activity (higher than normal rate) you will see a corresponding readout on the HRM. In this same light, an irregular or unevenly spaced R peaks will not be picked up by the HRM.

This is one of the fundamental differences in how data is recorded by HRMs (R-R interval) versus Holter/Event Monitors (actual waveform).

In fact, this is what Polar has to say:

Polar products are not designed to detect arrhythmia or irregular rhythms and will interpret them as noise or interference. The computer in the wrist unit will make error corrections, so that arrhythmia beats are not included in the averaged beats per minute. The blinking heart symbol in the face of the unit, however, will continue to show all heart beats received.

In most cases the Polar products will work fine for persons with arrhythmia.

Example PC interface capability of a Polar PC program.

Graphic example PC interface capability of a Polar PC program.

HRM Recording Capability

Most HRMs provide some internal storage recording capability. While lower cost HRMs simply record low, high and average heart rate, upper end models allow you to download heart rate data to your PC.

App-enabled smartphones are changing how this data is viewed, collected and saved for future review.

How To Setup and Use an HRM

On most of the HRMs, you can set a heart rate zone, and the watch monitor (or app-enabled smartphone) will record how long you stayed in that zone.

You could then program a high heart rate zone which you might only enter if you were in A-Fib. That way you could record how long you stayed in A-Fib and what your max heart rate was. This data could be reviewed on the watch monitor (or app-enabled smartphone) without having to download it to a PC.

On HRMs with PC interface capability, you can view data in a graphic form (on some watches/smartphones you can view the graphic data but with lower resolution.) This analyses could tell you when you were at a higher heart rate—A-Fib—and how long you stayed there. Of course these kinds of features require some PC skills, but typically the programs are pretty user friendly. (See the above graphic example of a Polar PC program).

For more, see our article, DIY Heart Rate Monitors & Handheld ECG Monitors.

Shop Amazon.com for Heart Rate Monitors & Handheld ECG monitors for A-Fib Patients. When you use this link, your purchases generate a small commission (at no extra cost to you) which we apply to the maintenance costs of A-Fib.com. Help A-Fib.com become Self-Supporting!

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Return to DIY Heart Rate Monitors & Handheld ECG Monitors

Return to Index of Articles: Diagnostic Testing

Last updated: Tuesday, April 14, 2015

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