Doctors & patients are saying about 'A-Fib.com'...


"A-Fib.com is a great web site for patients, that is unequaled by anything else out there."

Dr. Douglas L. Packer, MD, FHRS, Mayo Clinic, Rochester, MN

"Jill and I put you and your work in our prayers every night. What you do to help people through this [A-Fib] process is really incredible."

Jill and Steve Douglas, East Troy, WI 

“I really appreciate all the information on your website as it allows me to be a better informed patient and to know what questions to ask my EP. 

Faye Spencer, Boise, ID, April 2017

“I think your site has helped a lot of patients.”

Dr. Hugh G. Calkins, MD  Johns Hopkins,
Baltimore, MD


Doctors & patients are saying about 'Beat Your A-Fib'...


"If I had [your book] 10 years ago, it would have saved me 8 years of hell.”

Roy Salmon, Patient, A-Fib Free,
Adelaide, Australia

"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

"...masterful. You managed to combine an encyclopedic compilation of information with the simplicity of presentation that enhances the delivery of the information to the reader. This is not an easy thing to do, but you have been very, very successful at it."

Ira David Levin, heart patient, 
Rome, Italy

"Within the pages of Beat Your A-Fib, Dr. Steve Ryan, PhD, provides a comprehensive guide for persons seeking to find a cure for their Atrial Fibrillation."

Walter Kerwin, MD, Cedars-Sinai Medical Center, Los Angeles, CA


Research

The Impact of Race on Stroke Risk Among Atrial Fibrillation Patients

It’s well reported that African Americans have a lower risk of developing A-Fib as compared to Caucasians.

But it’s a different story regarding strokes. A new study has found that compared with whites, blacks are at increased risk of developing an ischemic stroke either before or after a diagnosis of atrial fibrillation (A-Fib).

A new University of Pennsylvania study found that such strokes may occur even before the patient is aware of having the heart-rhythm problem, and that this risk is higher for black patients. In many cases, the stroke was the red flag that led to the patient’s A-Fib diagnosis.

African Americans and Heart Disease

Heart disease tends to occur earlier in African American patients than in white counterparts.

The death rate from heart-related causes is higher, too, largely due to a higher rate of heart attacks, sudden cardiac arrest, heart failure, and stroke, according to the American Heart Association

The Penn Study: Looking Back and Monitoring Forward

Researchers used a centralized pool of patient data from across the University of Pennsylvania Health System, which was comprised of 56,835 patients without a history of atrial fibrillation or a remote history of stroke.

Of these patients, the authors identified 3,507 patients who developed A-Fib. Upon diagnosis, they checked each patient’s medical history for the prior six months to document any history of stroke.

Going forward, the authors monitored these A-Fib patients for strokes for a median of 3.6 years.

Unique Design: The study design was unique in that researchers had a time point that represented the initial diagnosis of atrial fibrillation.

This approach provided an opportunity to examine the risk of stroke during a six-month period prior to a formal, clinical diagnosis of atrial fibrillation. Until now, no prior study has examined stroke risk in this period prior to a diagnosis of atrial fibrillation.

Study Findings

Out of 538 strokes occurring in the study periods, nearly half, 254, occurred before diagnosis with atrial fibrillation.

The authors suspect that in many of those 254 cases, the patients already had A-Fib but were undiagnosed.

Blacks had an independently higher risk of stroke both before and after being diagnosed with A-Fib, as compared with whites.­

Prior Six Months Findings: For the strokes that occurred in the six months before A-Fib diagnosis, the rate in black patients was about one-third higher than the rate in white patients.

Findings after A-Fib Diagnosis: For the strokes that occurred in the years following an A-Fib diagnosis, the rate in black patients was two-thirds higher than in white patients — a 2.5 percent chance of stroke per year in black patients compared with a 1.5 percent chance for whites.

Blood-Thinning Medicines: The increased stroke risk for black patients (with A-Fib) was especially high among those who did not have prescriptions for blood-thinning medicines (i.e., warfarin or NOACs).

But even the black patients with prescriptions had a somewhat higher risk of stroke than their white counterparts. (Note: The study authors did not examine whether patients took the medicines, only if they had been given a prescription.)

Editor’s Comments

It’s well reported that African Americans have a lower risk of developing A-Fib as compared to Caucasians. But until now, there was little data on the additional risks that come with A-Fib for each race.

The new findings build on previous studies examining the impact of race on the risk of developing atrial fibrillation.

More Facts About Strokes in African Americans: On his website, Dr. Greg Hall, who specializes in urban health and the clinical care of African Americans shared these sobering facts about strokes in African Americans:

“Most strokes in African Americans occur due to high blood pressure, and a much higher number of African Americans have uncontrolled blood pressure.
quarter of all strokes occur in the presence of atrial fibrillation (a fib). And while representing 13 percent of the US population, African Americans experience almost twice that percentage of all strokes (26%).
Strokes are worse in Blacks. And when a stroke occurs, African Americans have them earlier in life and present with more severe and disabling conditions. “

To learn more, see Dr. Hall’s post: Atrial Fibrillation in African Americans

A-Fib Stroke Risk Greater for Blacks: This is obviously a very important study for black patients. If you’re African American, you have less chance of developing A-Fib. 

Blacks have almost twice the percentage of all strokes (26%) while making up only 13% of the U.S. population.

But if you do develop A-Fib, your stroke risk is much greater than for Caucasians. As Dr. Hall points out, African Americans experience almost twice the percentage of all strokes (26%) while making up only 13% of the U.S. population.

“Silent” A-Fib Stroke Risk Greater for Blacks: An even more disturbing fact is that in this study, half of the strokes occurred before an African American patient was diagnosed with A-Fib. Silent A-Fib is a danger for all A-Fib patients, but the stroke risk was nearly one-third higher in black patients.

Blacks Urgently Need Monitoring for Silent A-Fib: Most strokes in African Americans occur because of high blood pressure which is more prevalent in blacks. But from a public health aspect, it’s even more important to test black patients for silent A-Fib. Monitoring for silent A-Fib needs to become Standard Operating Procedure for blacks reaching middle age.

If you are African American, you should be monitored or get yourself a DIY A-Fib monitor to make sure you don’t have silent A-Fib.

(For recommended DIY heart monitors, see my article, Do-It-Yourself ECG: A Review of Consumer Handheld ECG Monitors.) 

Resources for this article
Patel PJ, et al. Race and stroke in an atrial fibrillation inception cohort: findings from the Penn Atrial Fibrillation Free study [published online February 19, 2018]. Heart Rhythm. doi:10.1016/j.hrthm.2017.11.025.

Avril, T. Black patients with a-fib at higher risk of stroke, Penn study finds, Health/The Inquirer, Daily News, Philly.com. Feb. 20, 2018. http://www.philly.com/philly/health/a-fib-stroke-penn-atrial-fibrillation-black-african-20180220.html

African Americans with Atrial Fibrillation at Significantly Higher Risk for Stroke Compared to Caucasians with the Disease.  Press Release. Newswise.com. Article ID: 689679, Released: 16-Feb-2018. https://www.newswise.com/articles/african-americans-with-atrial-fibrillation-at-significantly-higher-risk-for-stoke-compared-to-caucasians-with-the-disease

Ischemic Stroke Risk in Atrial Fibrillation Varies by Race. Cardiolog Advisor, February 28, 2018. https://www.thecardiologyadvisor.com/atrial-fibrillation/ischemic-stroke-risk-in-atrial-fibrillation-varies-by-race/article/745853/

Roger VL, Go AS, et al. Heart Disease and Stroke Statistics—2012 Update: A Report From the American Heart Association. Circulation. 2012;125(1):e2-e220. doi:10.1161/CIR.0b013e31823ac046. Strokes in African Americans.  October 22, 2017 by Dr Greg Hall. http://drgreghall.com/2017/10/22/strokes-african-americans/

 

Does Size Matter? What’s the Size of Your Left Atrium?

When in A-Fib, your left atrium has to work harder than normal and tends to stretch and dilate over time. Thus, an enlarged heart, specifically your left atrium, can be one symptom of living with Atrial Fibrillation.

Other contributors to an enlarged left atrium are obstructive sleep apnea (OSA) and high blood pressure. Also, people with a naturally large or tall body size often have an enlarged left atrium (ELA).

Consequences of an Enlarged Left Atrium

One study showed that Persistent A-Fib was associated with left atrium size (but not the number of years that a patient had A-Fib).

Left atrium size is a predictor of mortality due to cardiovascular issues.

Left atrium size has been found to be a predictor of mortality due to both cardiovascular issues as well as all-cause mortality (although other factors may contribute).

As a result, some medical centers won’t do a Pulmonary Vein Ablation (Isolation) procedure if the left atrium is enlarged (over 5.5 cm). However, with the newer ablation techniques, other centers will. Surgeons also are reluctant to operate on someone with an enlarged heart.

Normal left atrium: 2.0-4.0 cm

Left Atrium Size: Normal vs Enlarged

An enlarged left atrium can be diagnosed and measured using an echocardiogram (ECHO). A normal left atrium measures around 2.0-4.0 cm (20 mm–40 mm).

Ranges: Left atrial enlargement can be mild, moderate or severe depending on the extent of the underlying condition.

Note: Measurement of the volume is preferred over a single linear dimension since enlargement can be different for different directions.

Why You Need to Know Your Measurement

If you’ve had A-Fib for a while with significant symptoms, we often advise you to ask your doctor for this measurement to see if your left atrium is being enlarged.

To rank the size of your atrium, see TABLELeft Atrial Size
It will be described in either centimeters (i.e., 2.0 cm) or millimeters (i.e., 20 mm).

Store this info with your other A-Fib test results and other papers in your A-Fib Binder or folder. This will be your benchmark for future comparison.

To rank the size of your atrium, go to TABLE: Indexing the Left Atrial Size

Resources for this article
• Margolese, R G, et al. Cancer Medicine (e.5 ed.). Hamilton, Ontario: B.C. Decker. ISBN 1-55009-113-1. Retrieved 27 January 2011.

• Allen NE, et al. (March 2009). “Moderate alcohol intake and cancer incidence in women”. Journal of the National Cancer Institute. 101 (5): 296–305. doi:10.1093/jnci/djn514.

• Lang RM, et al. “Recommendations for chamber quantification”. European Journal of Echocardiography. (2006) 7 (2): 79–108.  PMID 16458610. doi:10.1016/j.euje.2005.12.014. Retrieved 2012-08-26.

• Left atrial enlargement. Wikipedia, the free encyclopedia. Last edited 20 March 2018, https://en.wikipedia.org/wiki/Left_atrial_enlargement

PODCAST: 15 Ways to Manage the Fear & Anxiety of Atrial Fibrillation

Open in a new window: How to Combat Fear and Anxiety from Atrial Fibrillation

Don't Let A-Fib in Your Head at A-Fib.com

Note: If you prefer to read instead of listen, click the transcript graphic bar below for the printed version.

A Podcast: Managing the Fear And Anxiety that Often Comes with Atrial Fibrillation

Atrial Fibrillation is often accompanied by Fear, Anxiety and Stress. That’s the topic of this podcast between Steve and our friend, Travis Van Slooten, publisher of LivingWithAtrialFibrillation.com. We discuss many ways that may help you with the emotional component of A-Fib. This is a longer episode (37 min.) as Travis and I had a lot to share and discuss!

Highlights from this Podcast

Note: Resources mentioned in this Podcast, plus others, are included below as hyperlinked text.

1.Knowledge is power. Knowledge is control.
2. Keep an Anxiety Thought log. (See Beat the A-Fib Mental Games: Try an Anxiety Thoughts Log)
3. Give yourself a daily “worry period” and then move on.
4. Keep a daily diary. Get your thoughts, anxiety, and worry on paper. (See Big Payoff: An A-Fib Diary Helps You Cope)
5. Consider yoga, meditation, and other relaxation techniques.
6. Engage in light-to-moderate exercise such as daily walks.
7. Natural remedies to try: lavender oil, pharma GABA, L Theanine, magnesium, Relora, chamomile, and Gotu Kola (Centella asiatica).
8. Prescription drugs such as Xanax and Ativan may help.
9. Professional counseling – especially Cognitive Behavioral Therapy (CBT) can help.
10. Reach out to A-Fib.com’s Support Volunteers.
11. Contact A-Fib.com’s Positive Thought/Prayer group.
12. Talk to your friends, family, and co-workers; explain how A-Fib makes you feel. (See our Free Report: Answers to the ‘Top 10 Questions Families Ask About Atrial Fibrillation)
13. Don’t become socially isolated because of your A-Fib. Stay connected with others!
14. Spiritual beliefs can help combat fear and anxiety. Pray. Go to your place of worship. Meditate.
15. Medical devices can help give you control over A-Fib and ease fear and anxiety. (See Guide to DIY Heart Rate Monitors [HRMs] & Handheld ECG Monitors)

Transcript: The Fear and Anxiety from Atrial Fibrillation
Travis Van Slooten: All right, for today’s episode of The A-Fib Podcast I invited Dr. Steve Ryan back again.

Steve is a former A-Fib patient who was cured of his A-Fib back in April 1998 via a catheter ablation. He’s the publisher of one of the most popular A-Fib websites, a-fib.com, and he’s the author of the bestselling book, Beat Your A-Fib: The Essential Guide to Finding Your Cure.

In this episode, Steve and I discover various things afibbers can try to do to help combat the mental and emotional challenges that come with having atrial fibrillation. So with that, let’s have a listen.

All right, Steve, what I want to talk about today is the mental and emotional challenges that afibbers face, because as you know A-Fib is a lot more than just the physical aspects of the condition. In fact, often times it’s the mental and emotional challenges that are harder to overcome than the physical aspects of A-Fib.

Steve Ryan: Yes indeed.

Travis Van Slooten: And I’m talking about those things like anxiety, fear, worry, confusion, frustration, depression, and of course, even anger. But as you noted, Steve, on your website so eloquently, A-Fib may be in your heart but it doesn’t need to be in your head. So with that Steve, I want you and I to give afibbers a variety of things that they could consider doing to combat some of these mental or emotional challenges. So with that, Steve, what are some of the things then that afibbers can do to overcome these things?

Steve Ryan: First, Travis, let me thank you for bringing up this subject; it’s perhaps one of the most important subjects that patients have to deal with. Let me start off by giving you a personal example. 20 years ago I had my first afib attack, and I can remember it like it was yesterday. I came home from work – I was working on the soap opera Days of Our Lives as part of the technical crew; best job I ever had besides what I’m doing now – and my wife wasn’t home. She was out of town. I walked in the door — five minutes later my heart started going crazy on me. It felt like my heart was trying to jump out of my chest. I had all this pounding and confusion and naturally you’re asking yourself: what’s going on? Am I dying? Am I having a heart attack? You know? You’re terrorized by this thing. Because what was, you know, I wasn’t thinking straight and just drove to the hospital, the ER, and by the time I got there the episode was over.

But anyway, one of the hardest things to deal with is the terror and confusion and anxiety, like all the things you mentioned; I went through all of them in one night. And especially anger; for me anger was the key. I was so angry. I’m in perfect shape. I’m running. I’m doing everything I should, and I didn’t talk to my heart but I mean, you know? I say why are you doing this to me? I’m taking good care of you, why are you behaving like this?

Travis Van Slooten: Yeah, I’ve been there.

Steve Ryan: So, unfortunately, when you have something like this and you go to the typical ER doctor you don’t expect much help. They’ve been trained to deal with the physical aspect of A-Fib, not the emotional and psychological. They don’t have that kind of training; they don’t have that kind of interest. So unfortunately we’re left to ourselves, and I wish I had a guaranteed way to help everybody but we’re doing the best we can. The first thing is knowledge is power, knowledge is control, and the more you learn about A-Fib…Let’s say for instance in my example; if someone had told me “Well, you’re not going to die from an A-Fib attack, that’s not what happened; it feels terrible but it isn’t going to kill you.” Well, if I had known I would have been much more relieved because I didn’t know that at the time.

And just to know that A-Fib is a heart condition, that as bad as it feels it’s not going to kill you immediately, that’s very stress relieving. And the more you read, the more you can get involved in websites — and good websites, not these fly-by-night things: Mayo Clinic, Cleveland Clinic, our sites, my book. Anything you can do to develop more knowledge about A-Fib will give you more control, will give you a sense that, hey, I don’t have to live with this disease, it’s not going to kill me. I know what to do now. I know what causes it, any kind of knowledge that you can get to help relieve this anxiety.

Also, I’d like to mention that on our site we have over a hundred stories of people who have had A-Fib and been cured. Not all of them have been cured. But read some of those. If you find out that other people have symptoms like you and have been cured, that’s a real relief, that helps anxiety and gets you over the hump, so to say.

Travis Van Slooten:  Oh absolutely. I just want to backup a second. I’m just curious, Steve, so when you were first diagnosed what did your doctor tell you about A-Fib, or did they not say anything?

Steve Ryan: Again, it’s been 20 years so I can’t tell you exactly, but what I remember is they just gave me drugs. I tried every conceivable medication known to man at that time and they all didn’t work, and that’s all they could do. I don’t remember exactly what they said but they considered it a serious disease. They didn’t blow me off and say, “Don’t worry about it. There’s nothing to worry about. Everybody gets things like that.” No, they didn’t do that, they considered it seriously and they were trying to do what they can to get me out of it, but 20 years ago they didn’t know very much about A-Fib.

Travis Van Slooten: So that was very different. My experience was actually just the opposite. I actually consider myself very fortunate because like you said I went to the ER my first time and the ER doc, as you mentioned, they’re not trained to give you any real education, they’re just there to help you out and get you out the door. And I had a great ER doc and she cardioverted me and when I was done my discharge paper she just said, “Okay, you had an A-Fib episode. It’s called atrial fibrillation, and you might want to follow up with a cardiologist,” and she didn’t freak me out at all. She didn’t make it sound like it was a big deal. It wasn’t like, “Oh, this is very serious, don’t delay.” I remember her specifically telling me you might want to go see a cardiologist sometime…

Steve Ryan: Wow, really?

Travis Van Slooten: Yeah, so I was like, “Okay, this can’t be a big deal,” but I, being the kind of person I am, type A person, I made the appointment the next day. And fortunately my cardiologist was an elderly cardiologist, and I didn’t know it at the time but he was nearing retirement. So he was in his upper 70s and he just was like, “Yeah, you have atrial fibrillation. It’s not a big deal. I’m going to put you on a Holter monitor. We just want to make sure that your heart is fine,” and so they sent me on my way for a 24-hour Holter monitor.

When I turned it back in he said everything looked fine. He said it’s no big deal. He said if these come back again—he said we have three options: we can cardiovert you again like you just went through, we can try some drugs as a lot of times that works, and if it doesn’t they have this thing called an ablation where we just go in and burn the spots, and you know, it’s not a big deal.

And so I was very fortunate because I had both the ER doc and the cardiologist telling me that it wasn’t really a big deal so I went for the first several years of my atrial fibrillation thinking it wasn’t a big deal. So it was, for me, I didn’t even really need to get knowledge because my doctors were telling me “Ah, it’s not a big deal.” I don’t know if that’s necessarily the right approach either. I think they’re somewhere in between, but for me, I didn’t really have too much anxiety or anything in the first few years of my A-Fib journey just because of the way they handled it. So I just find it interesting how different experiences we had.

Steve Ryan: Well, you know, again, I think they erred on the side of being too cavalier.

Travis Van Slooten: Yeah, exactly.

Steve Ryan: Let’s face it, you don’t want your heart to be in a disease condition if you can avoid it.

Travis Van Slooten: Yes.

Steve Ryan: And also let face it, one of the things I faced was I never knew when I was going to have another attack; they would come and go. For instance, I know some people keep a log and try to determine what they eat. I tried at that, it was no use at all. I have attacks—whenever A-Fib felt like coming it came. I had no control over it. And that kind of thing really put you on edge, you know, you just can’t relax, you never know when you’re going to have an attack.

That breathes anxiety and fear, and that’s something that we need to help patients cope with as much as we can. One thing that someone suggested to me that I thought seemed to work very well—I didn’t use it, but what he called it was an Anxiety Thought Log. This is from Anthony Bladen. And what he basically did was he recognized that in his subconscious all kinds of crazy things were going on. He was in fear, his subconscious was saying, without being explicit, “you’re going to die, you’re going to have another heart attack, you’re going to have a stroke, you are never going to get over this.” All these are things that are going around in his subconscious.

What he did was he tried to write each of these bad thoughts down specifically, make them specific and he called it an anxiety thought log; write down word for word what the anxious log was when and what was the trigger. Confront each fearful thought and try to restate it in a more reasonable frame of mind.

Another thing that people suggest is have a worry period, say, 20  Minutes a day; I’m just going to let all my thoughts go crazy, I’m going to worry about everything that I probably never should worry about and I’m going to let all these thoughts go and I’m going to do this for 20 minutes and then I’m going to go watch a movie or cooking show, whatever it takes to get into a different frame of mind and not try to worry about this any other time. These anxiety thought logs can be very helpful. And that’s one of the things we recommend for coping with the psychological and emotional effects of A-Fib.

Travis Van Slooten: Absolutely. And I’ll just piggyback on that too, I think just dairying in general— you did mentioned in an episode diary. I tried doing that as well, it didn’t really work for me, but I know some people have emailed me saying for them it’s— for some people actually kind of tracking when they have the episodes it gives them kind of a sense of control. So that might not necessarily work for all people, like you said for some it actually might create anxiety, but for some people it might give them some sense of control so that’s another type of diary that you could do as well.

Steve Ryan: Yes. Another thing that seems to help a lot is yoga relaxation technique, meditation. There is a real interesting study done by this doctor Lakkireddy at the University of Kansas. He had a bunch of his patients on monitors, and some of them were going to the same yoga class all together at the same time. And he noticed that, hey, these people, their A-Fib stops during this period of time, all of them. And he said, what’s going on here?

So he found out that they were going to a yoga class, and all of a sudden the light bulb went on and he said, “Maybe I better check this out,” and he started doing testing. And basically what he did was he took these people – again, it’s a short study so it wasn’t really comprehensive – he took them and the for three months he assessed their frequency of their A-Fib episode, how long they were, their anxiety, depression, their quality of life. Then months later he switched them to take in yoga classes for three. Specifically, this was iyengar yoga, which I don’t know about, but that’s what he particularly used.

I guess it uses breathing control exercises, yoga postures that you hold for 30 to 60 seconds and meditation relaxation techniques. And he found that doing these yoga exercises cut their episodes by 40 or 50%, and also improved their emotional well-being; their heartbeat and blood pressure dropped, their depression and anxiety eased. He didn’t know exactly why this happened but he speculates it. Here’s what he says—why he thinks yoga works to help relieve anxiety and depression and as well as A-Fib symptoms; “Yoga can be actually a very good intervention here because yoga reduces the number of episodes of A-Fib so that means it is decreasing the probability of you developing more systemic inflammation. It is also clearly established that doing yoga reduces the overall inflammatory burden on your body.”

Now a lot of people think that inflammation is one of the main causes of A-Fib and that may be one of the reasons why yoga works, but he added later “It’s not going to cure A-Fib; it’s going to help. It’s going to improve the burden. It’s going to help your anxiety and depression and things like that but it only makes A-Fib less burdensome, it isn’t a cure all.”

Travis Van Slooten: Yep. Now, I wonder what do you think; would you get the same benefits from doing light exercise like brisk walks and the like? I wonder if you get the same…

Steve Ryan: Oh yeah. Now, walking is very good. Walking at the same time of the day 20 minutes with the fresh air, and that is very relaxing and can be a great help to just relieving overall anxiety and depression, and improving blood pressure. Again, whenever you do anything like yoga, like we always recommend, always check with your doctor first before you do anything like this. It may seem that’s not going to cause any problem but you should always talk to your doctor about this to make sure everything is kosher.

Travis Van Slooten:  Well, especially if you’re in persistent A-Fib and you’re already having issues breathing or whatever because you’re in A-Fib — absolutely. Awesome. Other things you mentioned on your website Steve were natural remedies, lavender oil, aromatherapy. I never did that. Steve Ryan: Travis, I forgot one thing. Can I go back?

Travis Van Slooten: Oh yeah, absolutely.

Steve Ryan: I forgot to mention a meditation technique called mindfulness. This is advocated by Harvard Pilgrim nurse case manager Linda Bixby. And what it is — now this may sound counter-intuitive, but what it is, instead of rebelling and being frightened by an A-Fib attack is to sort of embrace it, look at it; what am I going through? How does this feel? Okay, I see, my heart is beating a little faster, I’m getting a little dizzy, whatever it takes.

It’s to observe rather than resist and worry. Let an A-Fib attack run its course. And like this one guy says; “What I do is just take it in and letting myself feel the physical A-Fib experience was actually relaxing.” Now, again, I’m not saying this will work for everyone but it’s a meditation technique that might help you. Okay, now let’s go back to what you mentioned about the natural remedies.

Travis Van Slooten: Yeah, you had mentioned on your site natural remedies like lavender oil, aromatherapy – again, I never got into that – Pharma GABA. I also want to add L Theanine. I like Suntheanine specifically. I found Pharma GABA and Suntheanine to help a little bit to kind of take the edge off anxiety. Also just throw some other ones here magnesium, Relora , I’ve never heard of that actually. Chamomile and other herbal teas, and you have this other thing called Gotu Kola. I’m not even sure what that is, but talk to me about some of the natural remedies.

Steve Ryan: Yeah, I can’t speak from experience on this because I’ve been cured of A-Fib for 20 years but I know I’ve tried lavender oil and it’s very soothing. It seems to smell really good and be relaxing. As far as the other one, Pharma GABA works on the same pathway as chemical things like Xanax and Valium but it doesn’t have all the negative side effects and it’s not addictive. It’s a bioidentical form of GABA which is gamma-aminobutyric acid. It’s a calming agent. It sort of calms your nerves.

Travis Van Slooten: And like I said, I’ve tried that. I actually was taking that up until recently just to kind of take the edge off. Supplements are so different than drugs. With supplements you don’t feel like an immediate hit like you do with a drug. I just want people listening to this, if you’re taking any of these supplements it’s not something that you’re going to pop and you’re going to feel right away, it’s usually kind of a gradual thing that you actually kind of have— it takes time actually for the effect the kick in, and by that I mean taking it kind of daily. But I don’t know if it ever really worked or not, I just took it. I seemed to be more calm than not, but I don’t know…Who knows, it could have been a placebo effect for all I know. But yeah, these are all things that people should have on their radar as potential ways to help them with their…

Steve Ryan: It’s worth a try.

Travis Van Slooten: Yeah, absolutely.

Steve Ryan: I mentioned Xanax; I should preface this by saying Xanax does have anti-arrhythmic properties but it’s addictive so you’ve got to be careful of it. There have been testimonials from people who take Xanax on a regular basis. I can’t recommend that again because it is addictive. Pharma GABA might be a better alternative for that.

The others I mentioned Relora  I have never tried it, I really have no idea. It’s supposed to reduce cortisol levels and promote feelings of relaxation. Chamomile tea, that’s been well known to reduce irritability and headaches and abdominal pain coming from anxiety. What you do is you substitute chamomile tea for caffeinated beverage or take 60 drops of chamomile tincture in two ounces of water four times a day before and after meals or add two drops of concentrated chamomile essential oil to a hot bath at night. Again, those are things that you can do that aren’t going to cause you any medical problems most likely, again, everybody is different.

And in terms of Gotu Kola, I really have not had any experience with that. It’s supposed to restore health to brain and nerve cells by promoting blood circulation to the brain which has a calming effect. And as you know, A-Fib reduces blood circulation to the brain, so anything that improves blood circulation to the brain should be a help.

Travis Van Slooten: Yeah, absolutely. And I’ll just say too with the magnesium, you could take that as an oral supplement or a spray. But another thing that I actually use even today – and I’m not suffering from A-Fib, knock on wood, thanks to my ablation – but I will do foot soaks with magnesium in the water, and I find that actually very relaxing.

Steve Ryan: Epsom salt baths.

Travis Van Slooten: Absolutely, very relaxing.

Steve Ryan: The one thing you need to be careful of is don’t go whole hog on magnesium right away because excess magnesium if your body isn’t ready for it can produce diarrhea which defeats the purpose of the magnesium.

Travis Van Slooten: Yeah, exactly.

Steve Ryan: So take it easy. If you use magnesium, start it gradually and work up to ideally 600 or 800 mg of magnesium a day.

Travis Van Slooten: Yeah absolutely. I want to segue here and get into the meds just a little bit because you’d mentioned it. Again, I’m not a big advocate of meds but there’s no doubt there is a time and place for them. You mentioned Xanax. One of the meds that I was prescribed and that I even take today from time to time is Ativan, but these are drugs as you’ve mentioned can be highly addictive so you’ve got to be really careful about them.

And typically when doctors prescribe these they’re very careful about how they prescribe it and they’re very careful to monitor how much you’re taking. But these are drugs at that, you know, like I said, I’m not a big fan of them but a lot of people — I know I get emails from a lot of people that say Xanax and Ativan helps them a great deal particularly during an episode. It just helps calm them and relax them. So I don’t want to discount meds. Again, it’s not something I recommend, but it is something certainly worth considering because they might in fact play a role for some people.

Steve Ryan: Again, this goes along with counseling. If A-Fib is really bothering you, especially if you’re a guy, don’t hesitate to get professional counseling and they will indicate to you maybe if you need meds to take or that kind of thing. But guys especially we tend to tough it out “I don’t have to put up with this.” Get professional counseling if it helps, just someone to talk to about what you’re going through with A-Fib and your anxieties and what you’re worried about and how it’s affecting your family and how to cope with it. That can be important, so don’t hesitate to get professional counseling. It can be very helpful.

Travis Van Slooten: Huge. And one of my readers had emailed me the other day actually. I had posted a question on Facebook and just asked hey, what do you guys do to combat anxiety? One woman contacted me and said she had tremendous success with Cognitive Behavioral Therapy or CBT. And so I kind of looked into that a little bit, and it turns out that CBT (Cognitive Behavioral Therapy) is one of the most effective natural ways to combat anxiety. So that’s definitely counseling and specifically cognitive behavioral therapy; these are things that definitely you want to have on your list.

Steve Ryan: Yes, yes indeed, good.

Travis Van Slooten: And you mentioned professional counseling, and on your site Steve you also have A-Fib support volunteers. Now, these aren’t professional counselors. Tell me a little bit about this program.

Steve Ryan: Well, professional counseling is one thing, but these people are sort of like friends who have had A-Fib. They’re not professional counselors, they’re just friends you can talk to and share experiences with. And we have about 60 or 70 people on our website from all around the world who volunteer their time to talk to people and to be – how shall I say it – A-Fib friends; someone they can talk to about what they’re going through because they’ve been through the same experience.

Not all of them have been cured; some are still in A-Fib. So you’re getting a wide spectrum of different people with different experiences. But that is very helpful. And we also have something that I don’t—well, let me talk about it and you’ll see what I mean.

We have a positive thought prayer group, an A-Fib positive thought prayer group. Now what that means, if people are so inclined, what I do for instance when I go to church on Sunday I will have the names of people who are coming up for an ablation and I will ask people at church to pray for them, and if someone, let’s say, is coming up for an ablation and they join the positive thought prayer group they will get emails and prayers and positive thoughts from people all around the world.

It’s very… well, I’ve experienced it myself. I recently had a colon surgery and I said to myself “Oh, gee wiz, why don’t I use this positive thought prayer group. You know, it’s not a fib but they can certainly be of help to me.” So I sent my information into them, and I was moved to tears by all the wonderful responses I got from people. Obviously, since I started the program I’m probably going to get more responses than the average person, but nevertheless, it was really heartwarming.

I mean it brings tears to my eyes right now thinking about all the wonderful people who emailed me and who prayed for me and who thought positive thoughts about me when I had my surgery. It’s really wonderful.

Travis Van Slooten: Yeah, and I’ll just attest to that because I’m actually on that list and so I get the emails that come through periodically. And you’re right though, I mean it’s very powerful. And you mentioned you might get more responses than someone else but I’ll just say that someone else actually they’ll get a lot of responses. It’s a very positive program, and I highly, highly recommend it. Now if they want to do the A-Fib support volunteer or this positive thought prayer group, they just go to your website, Steve? I assume there’s a link to these two different things.

Steve Ryan: Yes, they have a link there that they can sign up for. Right now we don’t have a coordinator for the support volunteers, but we do have a great coordinator for the positive thought prayer group. But they still are functioning very well and people can make use of those resources.

Travis Van Slooten: Absolutely. And the beauty of those types of resources—because the other thing I wanted to mention on our list here Steve, was list support from friends and family.

Steve Ryan: Yes indeed.

Travis Van Slooten: Well, that’s definitely important, but one of the things that I hear from a lot of people, and I’m one of them, friends and family, you know, they can only take you so far because if they can’t empathize what you’re going through. A-Fib is such a unique condition that so many people just have a real hard time kind of understanding. So sometimes even though you reach out to friends and family you can still feel so isolated because they don’t really know what to tell you or how to support you. And that’s the beauty of your support volunteer group and the positive thought prayer group; these are people that have been there, they know exactly what you’re going through.

Steve Ryan: It’s not like you’re bleeding or you have a broken leg; it’s hard for your family to identify with what you’re going through. You need to realize that A-Fib is going to affect you not only emotionally and mentally but socially as well. Maybe not necessarily your immediate family, but your friends, your co-workers; you need to sit down and talk to them and explain what atrial fibrillation is like and ask for understanding and try to communicate to them what you’re going through, because people go to work and all of a sudden they can’t do anything anymore because their brain is in a fog because if their A-Fib. It’s really scary when you have A-Fib, and you need to help your friends and support people understand what you’re going through. That’s very important.

Travis Van Slooten: Yeah, and it can be very easy to get into this rut where you get into a situation where you start to isolate yourself from your friends and family, particularly if you have persistent A-Fib where you’re constantly feeling like crap, you know, you got friends inviting you out to do things and go golfing with you or whatever and you can’t because you’re in A-Fib. You get in the situation where you’re “No, I can’t go.” And like you said, it’s not a good idea to keep things to yourself; communicate with your friends and family, let them know, “Hey, this is what’s going on. I’m not trying to be antisocial but I just kind of feel like crap right now.” Because if they understand more it’s just going to help you in these situations.

Steve Ryan: Yes.

Travis Van Slooten: Let’s see here; you mentioned again the positive thought prayer group, and with that, you know, just religion and prayer can help a lot of people. I’m a Christian, I go to church regularly, I read the Bible daily. I try to make a point to listen to inspiring sermons on a daily basis, and I make it a point to meditate on God’s words every day if I can. So I don’t want to discount—I know some people may not be religious, but for a lot of us religion and prayer can go a long way in relieving anxiety and fear.

Steve Ryan: Yeah, most of the people on the positive thought prayer a-fib websites are Christians but not all; many are of other religions, many have no religion. There have been studies that show that positive thoughts by itself can help other people, can help them improve their health. There have been studies on that. It’s not just a ‘we’re just making it up’ kind of thing; it’s really does have an effect on people.

Travis Van Slooten: Absolutely. And then the final thing, Steve, I think that can help relieve anxiety and fear and all these negative emotions and mental challenges is – and it’s going to sound kind of weird – but medical devices accessories can go a long way. And I’ll just give you some examples from my end, and Steve you may have some as well from your readers and followers of your website, but one of my readers sent me an email; she wears a medical ID bracelet that she pushes a button and it calls 911 and she says that just helps her – she’s an elderly lady with A-Fib – and she says that just gives her a sense of security and control that if something happens she can click on this thing and help will be on its way.

Others have had implantable heart monitors; and just knowing that your heart’s being monitored and so if anything weird goes on beyond A-Fib the doctor is going to be on the other line monitoring what’s going on with your heart.

And of course, I’m a huge fan of Alivecor’s Kardia heart monitor. That thing, I cannot tell you Steve how much that got me through my A-Fib episodes; just having that device there to kind of walk me through what was going on because as I was going through an episode I could grab my Kardia heart monitor and confirm I was in A-Fib—because I was on pill in the pocket therapy at that time so I would pop my flecainide, but before I would do that I wanted to make sure I was actually in A-Fib so I used this monitor, the Kardia monitor, and then after the flecainide kicked in and I cardioverted I would use the monitor again just to confirm that I was out of A-Fib so that device was a savior for me. So these medical devices can go a long way in giving you a sense of control over this condition.

Steve Ryan: Yes, and now they are developing a watch that you wear, and you just hit two buttons on that watch and it tells everything that’s going on. It’s perhaps one of the best things that has happened to patient care in maybe the last 10 years. Why? Almost everyone over 65 should have some kind of testing for atrial fibrillation, and instead of going through EKG and maybe there is nothing going on and having a 30-day monitor or something like that, you just put on this watch and it tells you all that information, and it tells the doctor everything. From a public health aspect, if we can get this going there may come a day when no one has a silent A-Fib anymore because everyone who turns 65 gets one of these watches and it can tell the doctors whether they’re in A-Fib or not. It’s really one of the most amazing breakthroughs in medical therapy for A-Fib that I’ve seen. We’re not there yet, but we’re close.

Travis Van Slooten: Oh, yeah.

Steve Ryan: We’re close.

Travis Van Slooten: And I would say we’re rapidly heading there though so that’s the good part of that. The medical devices are just—they’re awesome. Well, Steve is there any other summary thoughts here on this topic that you want to…

Steve Ryan: Well, I really want to mention something. A lady, Pat Truesdale, said she keeps a log of everything that seems to bring on her A-Fib. And she kept this log: ice, drinks, caffeine, every meals, going to sleep at night, and she also developed symptoms that are indications of A-Fib coming: high blood pressure, belching, heartburn where she can anticipate whether she’s going to develop an A-Fib attack. And I encourage anyone who might want to read her story on our website –they might be helped by this. Now, she also has a unique story in that she’s probably the one who has had the fastest catheter ablations in history. She develops A-Fib, eight weeks later she had an ablation and was A-Fib free. I’ve never heard of something happening that fast.

Travis Van Slooten: That is fast. So she’s A-Fib-free today then?

Steve Ryan: Yes.

Travis Van Slooten: Oh wow, that’s fantastic. Definitely I’ll link to her story because I know which one you’re talking about there so we’ll definitely link to that. Awesome. All right, well perfect. Steve I appreciate you joining me today and talking about this because it is a very, very important topic. I know when I threw this question out on Facebook it was the most responded to thing I’ve ever put on Facebook.

Steve Ryan: Really?

Travis Van Slooten: Yeah, there are a lot of people that struggle with the mental and emotional challenges with A-Fib. So I’m glad we’re having this discussion, and Steve….

Steve Ryan: They won’t get much help from their doctors. That’s one of the problems.

Travis Van Slooten: And even the good doctor’s like my local EP is a fantastic doctor, I absolutely love this guy, but he gives me zero information on this stuff. So even as good as he is they’re just not trained I don’t think to do that stuff. Is that the issue? Steve Ryan: Yes. That’s the issue, yeah. In other words, psychiatry, that’s another field for them.

Travis Van Slooten: Fantastic. Steve, as always, thanks for joining me today. Steve Ryan: You’re welcome.

Travis Van Slooten: All right, bye now.

MESA Preliminary Research―Depression Linked to A-Fib

Updated 12:30 pm About 20% of U.S. adults report depressive symptoms. A new study reports those adults may be at higher risk for developing atrial fibrillation. That’s according to a new observational study from the U.S. Multi-Ethnic Study of Atherosclerosis (MESA).

The MESA Study

P.K Garg, MD

Dr. Parveen Garg of the Keck School of Medicine, University of Southern California, described his preliminary research findings at a Scientific Session at the Epidemiology and Prevention/Lifestyle and Cardiometabolic Health in March 2018.

The analysis included 6,644 adults (mean age, 62; 53% women, 38% white, 28% black, 22% Hispanic, 12% Chinese-American) with no known heart disease at baseline who were followed for a median of 13 years as part of the MESA study.

Clinically depressed patients had a 34% higher risk of developing A-Fib during follow-up. Similarly, individuals taking anti-depressants had a 36% increased risk of developing A-Fib compared to those not taking those drugs.

What is the Link Between Depression & A-Fib?

G. Tomaselli MD

Dr. Gordon Tomaselli, a spokesman for the American Heart Association, said this study “affirms the association between depression and atrial fibrillation in a population that I think is important because it’s a mixed population and not just the standard Caucasian population.”

Speaking of a possible link, Dr. Tomaselli continued: “We don’t know whether treatment of depression will reduce the incidence of atrial fibrillation. There is some reason to think that it might, but there are other reasons to think that anti-depressant drugs actually have some effects on the heart, the ion channels that determine the rhythm of the heart.”

Dr. Garg could only speculate on the possible link between depression and A-Fib. But he stressed how important it might be to treat people with depression to reduce their risk of developing A-Fib.

The study, “Depressive Symptoms and Risk of Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis,” was presented at the American Heart Association’s Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions March 27, 2018.

What Patients Need to Know

Depression an Illness That Triggers A-Fib? Should depression be added to the list of causes, triggers, illnesses, or comorbidities which may lead to A-Fib? In addition to sleep apnea, obesity, diabetes, and hypertension, we should probably add depression, according to this study. Depressed people have a 34% higher risk of developing A-Fib.
Anti-depressant Drugs May Trigger A-Fib: But the drugs used to combat depression may be the reason people develop A-Fib in the first place. In this study, people taking antidepressants had a 36% increased risk of having A-Fib.
For people with depression, this study raises more questions than answers.
It’s obviously important to treat people with depression to reduce their risk of developing A-Fib. But at the same time, we have to be very careful with the drugs used to combat depression. Do anti-depressants bring on or trigger A-Fib? Much more research needs to be done to answer this question.
Resources for this article
Brooks, Megan. Depression Linked to Increased Risk of Developing Atrial Fibrillation. Managed Health Care. March 27, 2018. https://www.managedhealthcareconnect.com/content/depression-linked-increased-risk-developing-atrial-fibrillation

Gingerich, CP. Depression Increases Risk of Common Arrhythmia. MD Magazine, March 22, 2018. http://www.mdmag.com/medical-news/depression-increases-risk-of-common-arrhythmia

PODCAST 2: What Do You REALLY Pay to Continue Living with Atrial Fibrillation?

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Note: If you prefer to read instead of listening, click the transcript graphic bar below for the printed version.

The REAL Cost of Living with Atrial Fibrillation 

What does A-Fib REALLY cost you? To you physically? To your Quality of Life (QoL)? And to your pocketbook? That’s the topic of this podcast between Steve and our friend, Travis Van Slooten, publisher of LivingWithAtrialFibrillation.com. (About 28 min. in length.)

Here are the highlights of our conversation:

There are two costs of living with atrial fibrillation: financial and quality of life costs. Both are very high!

Financial Costs

 A-Fib costs the United States about 6 billion each year.
 Medical costs for people who have A-Fib are about $8,705 higher per year than for people who do not have A-Fib.
 There are 750,000 hospitalizations each year because of A-Fib.

Quality of Life Costs

 Atrial fibrillation is a progressive disease that tends to get worse over time.
 Frequent A-Fib episodes enlarge and weaken your heart and can lead to other heart problems, including heart failure and other cardiovascular problems.
 Ongoing A-Fib can remodel your heart (change how your heart works), produce fibrosis (fiber-like, immobile tissue) or permanently scar your heart.
 You’re losing 15% to 30% of your normal pumping ability of your heart when you’re in A-Fib.
 Frequent or prolonged episodes of atrial fibrillation tend to stretch and dilate your left atrium. In the extreme, you lose all contracting ability and function of your left atrium.
 If you leave someone in A-Fib, the A-Fib attacks tend to become longer and more frequent.
 One study showed that half the people who managed their A-Fib with rate control drugs went into long-standing persistent A-Fib within a year. (CB de Vos, 2010)
 A-Fib is strongly linked with developing dementia (because you’re not getting enough blood to your brain and to the rest of your body).
 The aim should be to stop an A-Fib episode NOT just control an episode (i.e. slow the heart rate while in A-Fib).
 Today’s anti-arrhythmic drugs only work about 40% of the time, have bad side-effects or don’t work at all. If they do work, they often lose their effectiveness over time.
 Patients with persistent or long-standing persistent A-Fib: If you have been told there is no treatment besides taking drugs to manage your A-Fib, DON’T BUY IT! You have options!
 The Castle AF Trial reveals ablations on heart failure patients with paroxysmal or persistent atrial fibrillation resulted in a 47% reduction in death rates. In the catheter ablation group, 60% improved their ejection fraction by more than 35%! And after 5 years, 60% of the ablation group were in normal sinus rhythm compared to 22% receiving normal drug therapy.
 The goal for every A-Fib patient should be to end their A-Fib and not just manage or tolerate it!

Resources mentioned in this episode

 Atrial Fibrillation Fact Sheet from the CDC
♥ Editorial: Leaving the Patient in A-Fib—No! No! No!
♥ de Vos CB, et all. Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis. (J Am Coll Cardiol. 2010)
♥ 2018 AF Symposium: Findings from the CASTLE-AF Clinical Trial
♥ Catheter Ablation for Atrial Fibrillation with Heart Failure (N Engl J Med 2018)


Travis Van Slooten was diagnosed with atrial fibrillation on Father’s Day in 2006. He would battle a-fib for nine years before having a successful catheter ablation in March 2015. He’s been a-fib-free since with no drugs! His blog covers his own journey and provides information, inspiration, and support for others with A-Fib. Visit his site.

Transcript: The REAL Cost of Living with Atrial Fibrillation

Travis Van Slooten: I invited Dr. Steve Ryan back again for today’s episode of the afib podcast. Steve is a former patient who was cured of his back in April 1998 via catheter ablation. He is the publisher of one of the most popular websites, A-Fib.com and he is the author of the best-selling book, Beat Your A-Fib: The Essential Guide to Finding Your Cure.

So in this episode Steve and I discussed a topic that we are both extremely passionate about. And that topic being “The Real Cost of Living with Atrial Fibrillation,” and why it’s imperative to seek a cure for your afib, rather than just living with your afib. The financial and quality of life cost of living with afib are absolutely staggering. And so in this episode we discussed those costs, and again we really emphasize why it’s so important to find a cure and not just settle with a life of afib. So with that, let’s roll the tape.

All right, Steve, our topic today is really near and dear to my heart – no pun intended – and I know it’s very near and dear to you as well. And I know when I’ve spoken with you in the past you and I are both very passionate about this topic, and it’s the topic of the real cost of living with atrial fibrillation. And of course, when we talked about the cost of living with afib — well, first of all, I should say when we say we’re living with afib, for most people that means they’re just tolerating it, they’re basically managing it as best as they can instead of trying to seek a cure. But the cost of doing that of just kind of tolerating your a favor rather than trying to see a cure, there are really two big cost there. There is the financial cost, but probably just as important, if not more important, is a health or quality of life cost.

Dr. Steve Ryan: Absolutely, yes.

Travis Van Slooten: Yeah, absolutely. So let’s talk about the financial costs, Steve. You found some interesting stats on the CDC website. Can you talk about these financial costs?

Dr. Steve Ryan: Yes, Travis. The CDC has some very interesting figures. Afib costs the United States about 6 billion each year. Medical costs for people who have afib are about $8,000 – and I’m reading from the CDC statement here – are about $8,705 higher per year than per people who do not have afib. Now who has $8,700 to throw around every year trying to cope with the…

Travis Van Slooten: Yeah, and unfortunately with the health care plans that are out there today a lot of people that won’t even meet their deductibles, so that usually probably out-of-pocket cost. Yeah, that’s on fortunate.

Dr. Steve Ryan: Yeah, it’s medication, it’s doctor visits, it’s ambulance, it’s trips to the ER it’s you know, all kinds of stuff goes into that that run up the bills cost. The CDC says there are 750,000 hospitalizations each year because of afib, and afib contributes to an estimated 130,000 deaths each year. The death rate from afib has a primary or a contributing cause of death as been rising for more than two decades. Now that’s because the more and more people are getting afib because it’s a condition of aging, but those are really staggering figures.

Travis Van Slooten: Yeah, tell me about it. And I can attest to those because until I seek my cure which was an ablation, those figures are actually pretty accurate. I mean I remember specifically one year I spent easily $8,000. My trip to the ER was $4,000 alone. Because it was my first episode and I was in an ambulance so the ambulance ride alone was like $1,500. I mean it was crazy, but the financial costs are unbelievable.

But what’s even scarier than the financial cost – and those are scary – is again the health and quality of life cost. And Steve this is where you and I really are passionate about this because I get — I cannot tell you Steve how many emails I get from people saying, “Well, my doctor says it’s no big deal, take these beta-blockers or take these rate control drugs, you know. It’s no big deal. We don’t need to fix it.” And a lot of times they’ll come to me and say, “Is that true?” Or I’ll get people that will say, “You know, my afib is really not that bad. When I have my episodes I’m a little winded but it’s no big deal, do I really need to think about having an ablation?” And I just want to cringe because it’s just like, ugh…

Dr. Steve Ryan: Same here.

Travis Van Slooten: You know it’s just like… So, Steve let’s talk about this. What are the health and quality of life issues that go into “living with afib“?

Dr. Steve Ryan: Well, it seems you and Travis, we both have had afib and we know how wonderful it feels to go from afib to normal sinus rhythm, and to feel wonderful, your body is alive again, you can do everything that you used to do. And leaving people in afib just makes no sense. Let’s say, I mean afib is a disease, it’s a progressive disease that tends to get worse over time and wreck your life and wreck your heart.

Let’s say someone had, God forbid, pancreatic cancer and the doctor told them, “Well, we’re just going to leave you in pancreatic cancer. We’re going to give you a few meds just to keep the pain away.” You look at that doctor and say, “You’re out of your mind.” Why leave someone’s heart in a disease state where you know they’re going to get worse and maybe eventually die from it? It makes no sense at all to me.

Travis Van Slooten: And I think part of the reason for this is with afib, you know, for some people when they have their episodes they don’t feel that bad, especially with people with silent or asymptomatic afib where they don’t really feel the episodes. But even if they have bad episodes, you know, for a lot of people they have an 8-hour, 10-hour episode that goes away and they’re good for another month, but I think what happens is they fail to realize the long-term picture here of what happens to your heart if it’s left in afib. So let’s talk about that. I think that’s the crux of the issue here is that people think “We’ll hey, it’s not that bad now,” but what they don’t realize is if you keep your heart in that states, as you talked about, down the road the end game is it could ultimately lead to heart failure. That’s the issue, right?

Dr. Steve Ryan: Yes, and many other things. Leaving people in afib is a death sentence. There’s all kinds of that document that. Here’s what afib does to you. Let’s say you give them the example of someone who has maybe a 10-hour episode once or twice a month. Having episodes like that enlarges and weakens your heart, and it leads to other heart problems and heart failure and cardiovascular problems. Afib, because it is a progressive disease it remodels your heart. I mean when we talk remodeling we’re saying your heart is changing permanently because of afib.

Now afib produces what is called fibrosis. Now fibrosis is if you look inside a heart you’d say smooth — in a normal heart you’d seem normal smooth heart tissue. It looks very healthy and red and everything is proper. When the heart becomes fibrotic, that smooth heart tissue turns into fibrous tissue. It turns it to basically dead tissue. There’s no transport function, there is no nerve going through, there’s no contraction. It’s dead. It’s like having dead tissue in your heart. And that’s what afib produces. And unfortunately, even though many of the remodeling effects of afib can be corrected by a catheter ablation, fibrosis is usually irreversible.

Now the other thing that afib does because when your heart is functioning normally, the atria, the upper part of your heart squeezes down, squeezes blood down into your ventricles and the ventricles and sends the blood to the lungs.

In afib instead of that squeezing down, that pumping down blood…if you look in your heart your heart is fibrillating, it’s vibrating it’s quivering, it’s not pumping properly. I mean, you’re losing 15 to 30% of your normal pumping ability of your heart. And this action tends to stretch and dilate your left atrium. If it goes too far you lose contractual ability of your left atrium to function at all.

And obviously if you leave someone in afib, the afib attacks tend to become longer and more frequent. There’s been a study where they followed people who developed afib for a year and they were just on rate control meds to control the heart from beating too fast, but leave them in afib, almost half within a year went into a chronic all-the-time afib (long standing persistent atrial fibrillation). Yeah, so the odds are really — I guess a lot of people don’t…I mean, how many people stay in paroxysmal occasional afib for years but the odds are against them.

Travis Van Slooten: I was one of those. I went 8 years, and then it was the 8th year where it spiraled out of control and became a weekly thing, and at that point I put the brakes on that and I had my ablation.

Dr. Steve Ryan: Yeah, good for you. And some of the other things that afib does is because you’re not getting enough blood to your brain to the rest of your body, people tend to develop dementia.

I’ve heard people describe being in afib like they’re in a brain fog. You know, they go to work and they can function. Things they used to do, no problem, all of a sudden they can’t even remember what they’re doing or how to do it. Or they used to speak a foreign language now they can’t anymore because they’re in afib.

One doctor gave at a conference gave an amazing example. His patient would be talking to him normally like a normal patient, he would go into afib and he could no longer talk. That’s the kind of thing that happens with afib. It just has really bad effects over time, and to leave people in afib like that is a death sentence – all too often.

Travis Van Slooten: And so what do you tell the person that again, they go to the doctor they have paroxysmal afib, which is just occasional episodes here and there that end on their own. They go to their doctor, they’re newly diagnosed — let’s say they’re, I don’t know, let’s say they’re 50 years old they’ve had one episode and so they go in the diagnosed “Yep, yep paroxysmal afib,” and the doctor typically in this scenario is going to say, “You’re fine for now. Here’s are some beta blockers,” or maybe “here’s a pill-in-the-pocket or whatever.” So that person will come to me or probably to you too Steve and I’m sure they’ll say, ‘Do I really need to be thinking about an ablation already at this point?” I mean, how do you handle that? What do you typically advise them to do?

Dr. Steve Ryan: Well the example you gave — in other words, if they’re taking flecainide as a pill-in-the-pocket they’re doing something, they’re trying to stop the afib, and they’re trying to stay in sinus with them. That’s good. I mean it may not be the best strategy but it may be something that will work for them for a while. But just the bad thing is to let people stay in afib and just give them a rate control beta blocker to keep their heart from beating too fast. That is what will kill somebody. But if they’re taking chemicals for drugs that will stop their afib, or if they have an attack will stop that attack, that’s good; it’s not the ideal but certainly they’re doing something to keep themselves out of afib, and that’s a good thing.

Travis Van Slooten: So the message here – and this is where I wanted to get to and I’m glad that we’re going there – is the message we’re sending here is — because I know it’s semantics, but if you were diagnosed with afib you have afib but then there are the actual episodes. To my mind they are two different things like I have afib but I’m not always in afib, I don’t always have episodes, at least for some people. So for the person that, okay, they’ve been diagnosed with afib but they’re not, they don’t have episodes all the time, in other words, they’re paroxysmal, the course of action may be fine to just stick with the drugs, but the key should be you’re taking those drugs, as you mention Steve, to get out of afib but not just stay in afib and make it tolerable.

Dr. Steve Ryan: Right, and of course we must say that anti-arrhythmic drugs are very imperfect, there’s no magic pill that anyone can take that will cure them of atrial fibrillation so they never have to worry about it again. The problem with today’s anti-arrhythmic drugs is that they don’t work or if they do work for a time they lose their effectiveness eventually, or they have bad side effects that they get impossible to take them. And they’ve done a number of studies where they have compared catheter ablation to taking anti-rhythmic drugs, and catheter ablation is much more healthy. It’s, you know, all the bad things that can come from staying like a lifetime on anti rhythmic drugs versus a catheter ablation where you’re cured of afib and you don’t have to worry about it anymore, there’s no comparison.

Travis Van Slooten: Yeah, absolutely. And then certainly for someone then that has persistent afib which means your episode is a week or longer or you have long-standing persistent afib, certainly those people should not accept the diagnosis that they should just live with their afib and here’s some drugs to make it more tolerable. Those are the people we especially are saying look, there is a cure or a potential cure out there for you and it’s probably going to be an ablation or a surgical procedure, but by all means you do not have to live with afib.

Dr. Steve Ryan: Right. Now in the example you gave we should tell patients that someone who has been in persistent afib for a while is not going to be as easy as someone who just developed afib. They may have to go to a master EP and they have to go through two ablations; one to get the main spot and second for a touch-up ablation, but it’s still a lot better than living with afib. And they should realize that if you have persistent afib you do not have to live in a fib. There is a cure out there. It may not be the easiest thing to do, or you may have to research and find the best EP doctor you can find, but there is light at the end of the afib tunnel. You don’t have to live for the rest of your life in afib.

Travis Van Slooten: And I think that’s such an important message because I get so many emails from people that are in persistent afib and they tell me you know my doctor says I’m not a candidate for an ablation because I’ve been in persistent afib for 2 years and they don’t want to touch me so they just keep me on drugs. Is that true? I mean that’s kind of the gist of a lot of the emails that I get, and I always tell them that’s absolutely not true. There is hope for you.

Dr. Steve Ryan: Yeah, and I can understand many of — first of all, not all electrophysiologists (EPs) are equal. Some are better than others, some are more experienced, some do not want to fool around with anyone who has been…in fact they will say in their statement on their websites, “We don’t take anyone who has been in persistent afib for over a year.” Why? Because it’s too difficult. But that’s not the case for some of the better people like you had your ablation by Dr. Natale, Andrea Natale, right?

Travis Van Slooten: Yes.

Dr. Steve Ryan: I mean people like him take those cases all the time.

Travis Van Slooten: Yeah, I mean 75% of his caseload is just that. But like you said, your path to a cure may not be necessarily easy but certainly do not give up and say, “Well this is my life and I just got to tolerate this for as long as I can with the drugs until my time is up.” That’s not the case. Good stuff.

Dr. Steve Ryan: I’ve got one other thing. At the last AF Symposium in January there was a presentation by a Dr. Marrouche that was perhaps the most important presentation in the last 10 or 20 years for patients. I mean it’s a groundbreaking study, and it relates to what we were talking about.

It’s called The Castle AF Clinical Trial. Now what they did was they took patients who had real bad heart problems, we’re talking ejection fraction of below 35%. These are people who probably without help would die within the next year. These are patients who had really sick hearts and they had ICDs or some kind of a monitoring device inside their heart that could tell the doctors whether they were in afib or not and what was going on in their heart. Dr. Marrouche started off by saying, he gave the example of a 50 year old patient of his who had an ejection fraction of 24%, I mean that’s really low. That guy is near death. So he had an ablation and he, by the way had moved from paroxysmal afib to persistent. He had taken anti-arrhythmic drugs that didn’t work; sotalol and Amiodarone, which Amiodarone is a killer.

Travis Van Slooten: Very toxic.

Dr. Steve Ryan: He had failed electrocardioversions. So he gave him an ablation and cured his afib and right away his ejection fraction improved from 24% to 44%.

Travis Van Slooten: Wow!

Dr. Steve Ryan: Now, what that means in practice is that this guy’s life was saved. He was no longer in danger of dying from congestive heart failure. And so he went on and described The Castle AF study with a bunch of patients like this and they found that after catheter ablation there was a 47% reduction in death rates. Now you’re saying, 47%, is that good? That’s fantastic! These patients were near death, and a 47% reduction in death rate for patients who had failing hearts, that’s incredible. In the catheter ablation group, 60% improved their ejection fraction by more than 35%. That is amazing.

Travis Van Slooten: That’s amazing.

Dr. Steve Ryan: That means that these patients who had a catheter ablation basically had their lives saved. They went from a heart that wasn’t functioning to a heart that was beating normally again. And after 5 years, 60% of the ablation group were in normal sinus rhythm compared to 22% receiving normal drug therapy. And that was you know, it could be rate control, it could be amiodarone, whatever people wanted to do. And there is a 38% reduction all across mortality. Heart failure emissions were radically improved. They didn’t go to the hospital anymore because they were cured, and obviously the quality of life was just amazingly better.

Now I want to read you something. I was at the conference and one of the interesting things about it was the question-and-answer afterwards. And I want to quote you something from Dr. Hugh Calkins at Johns Hopkins said, “This is such an unbelievably fantastic study. This is the first study to show that AF ablation improves mortality and heart failure; hats off to you for getting this done. All of us believed in this procedure but people kept asking us for hard endpoints, which you have provided.”

Here we have you and I both know how wonderful it feels to go from afib to sinus rhythm, but there were no studies up to this point that said it makes any difference. In other words, so what? So you’re in sinus rhythm, you still have the same mortality according to the AFFIRM study which is an old study that nobody follows anymore.

But now we have hard data that proves catheter ablation not only removes your symptoms, makes you afib free but lets you live longer. You live a better life and you live a longer life and the more healthy life. Now Dr. Douglas Parker from the Mayo Clinic added in the Q&A he said, I mean this is a little hyperbole, he’s exaggerating but he gets the point. “People everywhere were screaming with delight when they saw the results of your paper!” He’s right.

When you were there at that meeting it was like you were watching history unfold in a way. I mean historical finding that now everybody with afib knows that a catheter ablation will not only cure you and make you feel better but will let you live longer and more healthy life. That’s really important, probably the most important to study to come out for patients in the last 10 years.

Travis Van Slooten: Yeah, and that’s a published study so we can link to that and I can dig that up?

Dr. Steve Ryan: Yes, that’s a published study in January.

Travis Van Slooten: Perfect. And I think it’s important to, that study like you said these were people that were near death, so if they experienced that great transformation, imagine the guy that’s pretty much healthy and has paroxysmal afib, I mean the benefits for him are going to be… I mean, it’s amazing. Again, that’s why Steve and I are so passionate about this topic. There is no excuse to stay in afib.

Dr. Steve Ryan: Can you imagine, let’s say you’re someone with congestive heart failure; it feels like you’re suffocating, it feels like you’re going to die any minute. And 90% of people in this condition die within a year. And all of a sudden you have a catheter ablation and your heart is normal again, you’re having a normal ejection fraction. All of a sudden you’re out walking around, you’re talking to friends, you feel great. I mean you don’t feel perfect because it’s not…but your life you have your life back. Can you imagine what that means for these patients? It’s wonderful.

Travis Van Slooten: Yeah, and their families and friends. It’s just amazing. Thanks for sharing that study. Definitely I’ll be sure to link to that in the show notes so people can look at that. Awesome. Anything else that we need to discuss on this?

Dr. Steve Ryan: No.

Travis Van Slooten: So the message here Steve is clear. The goal for every afib patient should be to end their afib and not just manage it or tolerate it, correct?

Dr. Steve Ryan: Exactly. And we’re talking rate control where they just leave you in afib and don’t try to get you out of afib.

Travis Van Slooten: Yes, awesome. Well Steve it’s been a real pleasure talking to you and I just want to thank you for your time.

Dr. Steve Ryan: My pleasure.

Travis Van Slooten: And Steve you can be found at A-Fib.com, correct?

Dr. Steve Ryan: Yes.

Travis Van Slooten: Awesome. And just a quick plug too, Steve’s got a great book, Beat Your A-Fib, available on his website and on Amazon as well. And Steve, are you going to be rolling out an updated version of that book, because I remember at one point you had mentioned you were going to work on an update. What’s the status of that?

Dr. Steve Ryan: Well, we’re working on the second edition but it hasn’t been coming along very well. We’ll keep trying. There’s just been a lot of changes in the last 4 years that needed to be addressed. The book right now is very factual and timely and helpful, but it’s just, there’s a lot of new developments like this Castle AF study. Those are the things that need to be added to the book.

Travis Van Slooten: Yeah, and the beauty of the book is as the title implies, “Beat Your A-Fib,” not live with your Afib so that’s why I wanted to put a plug in there for that book. Steve again, thanks for your time and we’ll talk to you soon. Thanks Steve.

Dr. Steve Ryan: You’re welcome.

Outro: Thanks for listening to the podcast. Be sure to visit livingwithatrialfibrillation.com for more information, inspiration and support. Be well, and please join us next time.

Anticoagulants Increase Risk of Hemorrhagic-Type Strokes as Well

Background: Of late we’ve written a lot about A-Fib stroke and the risk of Ischemic stroke which occurs when a clot blocks an artery to the brain.
While it is by far the most common kind of stroke among A-Fib patients, there is another type of stroke threat, an Intracerebral Hemorrhagic stroke. An ICH stroke is caused by a leaked or ruptured blood vessel in the brain. Although less common in A-Fib patients, an ICH stroke can be just as devastating, even deadly.

Anticoagulants and Intracerebral Hemorrhage Stroke (ICH)

For A-Fib patients, anticoagulants are used for the prevention of clots and stroke. But according to Dr. M. Edip Gurol, anticoagulants may actually increase the risk of Intracerebral Hemorrhagic (ICH) stroke.

While Intracerebral Hemorrhagic (ICH) stroke is less common than Ischemic stroke, it is a more deadly and disabling type of stroke. Although accounting for only 15 percent of all strokes, hemorrhagic strokes are responsible for about 40 percent of all stroke deaths.

Dr, M. Edip Gurol

Dr. M. Edip Gurol’s comments are published in the March 18, 2018 issue Cardiac Rhythm News. A stroke neurologist specialist at Mass. General Hospital, he has a particular expertise in the care of patients at high risk for ischaemic (blockage type) strokes and haemorrhages.

According to Dr. Gurol, over 50% of patients sustaining a warfarin-related intracerebral hemorrhagic [ICH] stroke die within the first three months.

Are the outcomes any better for patients on the newer NOACs (New Oral Anticoagulants) who have an ICH? No, the outcomes are just as dismal, similar to patients having a warfarin-related ICH stroke.

The Link With Cerebral Microbleeds (CMBs)

Growing evidence suggests a link between cerebral microbleeds (small chronic brain hemorrhages of the small vessels of the brain) and increased risk of intracerebral hemorrhage stroke (ICH).

This has led to concerns about the safety of administering anticoaglulant drugs in patients with cerebral microbleeds (CMBs).

About cerebral microbleeds, Dr. Gurol warns:

“The presence of one or more CMBs [cerebral microbleeds] conferred a five to six times higher ICH (hemorrhagic stroke) risk,”
OACs [anticoagulants] are not benign medications in patients with CMBs even without a history of brain bleed.”

LEFT: Brain MRIs of two microbleeds in the same older adult with A-Fib taking an NOAC (red arrows point to tiny microbleed dots). RIGHT: Two years later, the patient had a hemorrhagic stroke and died. The right MRI shows the fatal hemorrhage.

How Common are Cerebral Microbleeds?

Long-term research studies using Magnetic Resonance Imaging (MRIs), show cerebral microbleeds are already present at middle age and their prevalence rises strongly with increasing age. Microbleeds rarely disappear.

One recent MRI study found evidence of microbleeds in 99% of subjects aged 65 or older, and that increasing the imaging strength increased the number of detectable microbleeds.

Anticoagulants are not benign medications in patients with CMBs [cerebral microbleeds] even without a history of brain bleed. Dr. M. Edip Gurol

Are You at Risk?

Should A-Fib patients over age 65 be taking anticoagulants for the rest of their lives? According to Dr. Gurol and his research, probably not.

In the decades-long population-based Rotterdam Study, the risk of intracerebral hemorrhage stroke was found to increase as the number of microbleeds increased.

Since almost everyone over age 65 has microbleeds, it’s all too easy for long-term anticoagulants to expand those microbleeds into full blown Intracerebral hemorrhagic strokes (ICHs).

Are There Alternatives to a Lifetime on Anticoagulants?

Yes, there are alternatives to having to take anticoagulants for the rest of your life. Read my articles: Watchman Better Than Warfarin and Are Anticoagulants Risky if Over Age 65?

Or…get your A-Fib cured so you don’t need to take an anticoagulant at all.

Resources for this Article
Gurol, M Edip. Brain MRI scans can inform the choice between OACs and LAA closure for non-valvular AF. Cardiac Rhythm News. March 18, 2018, Issue 40. p. 9. https://cardiacrhythmnews.com/brain-mri-scans-can-inform-the-choice-between-oacs-and-laa-closure-for-non-valvular-af/

Janaway BM, et al. Brain haemosiderin in older people: pathological evidence for an ischaemic origin of magnetic resonance imaging (MRI) microbleeds. Neuropathol Appl Neurobiol. 2014 Apr;40(3):258-69.

Akoudad, S., et al Cerebral Microbleeds are Associated With an Increased Risk of Stroke: The Rotterdam Study. Circulation. 2015;CIRCULATIONAHA.115.016261. https://doi.org/10.1161/CIRCULATIONAHA.115.016261.

Poels MM, et al.Prevalence and risk factors of cerebral microbleeds: an update of the Rotterdam scan study. Stroke. 2010 Oct;41(10 Suppl):S103-6. doi: 10.1161/STROKEAHA.110.595181. PubMed PMID: 20876479.

Wang, Z., et al. Cerebral Microbleeds: Is Antithrombotic Therapy Safe to Administer? Stroke. 2014;45:2811-2817, originally published July 15, 2014.  https://doi.org/10.1161/STROKEAHA.114.004286

Intracranial Hemorrhage, Cerebral Hemorrhage and Hemorrhagic Stroke, Cleveland Clinic. Health Library / Disease & Conditions.  https://my.clevelandclinic.org/health/diseases/14480-intracranial-hemorrhage-cerebral-hemorrhage-and-hemorrhagic-stroke

PODCAST: Marijuana—Good, Bad or Ugly for Patients with Atrial Fibrillation?

Click to open in new window

Note: If you prefer to read instead of listening to the audio, click below on the transcript graphic bar to roll down the printed version.

Podcast Introduction 

Our friend, Travis Van Slooten is publisher of LivingWithAtrialFibrillation.com. With marijuana legal in a growing number of U.S. states, he invited Steve to join him on his podcast and share the latest about marijuana use by A-Fib patients. (About 18 min. in length.)

Here are the highlights of this podcast:

We do not have a lot of clinical data on marijuana and atrial fibrillation simply because it’s so new. What we know is often anecdotal at this point.
Some A-Fib patients say it helps them. Others say it puts them into A-Fib.
There has been some research saying that smoking marijuana might lead to the development of A-Fib and it may affect the cardiovascular system, but this is general data without a whole lot of really hard studies confirming that.
If there is any benefit of marijuana for A-Fib, the best form is probably CBD in edible form (but we really don’t know for sure).
An unpublished study followed 6 million heart failure patients. Those in the group that were non-dependent on marijuana were 18% less likely to develop A-Fib. Dependent marijuana users were 31% less likely to experience A-Fib.

Resources mentioned in this episode

States Where Marijuana is Legal
FAQs Coping with A-Fib: Marijuana


Travis Van Slooten was diagnosed with atrial fibrillation on Father’s Day in 2006. He would battle a-fib for nine years before having a successful catheter ablation in March 2015. He’s been a-fib-free since with no drugs! His blog covers his own journey and provides information, inspiration, and support for others with A-Fib. Visit his site.

Transcript: Marijuana and Atrial Fibrillation

Marijuana and Atrial Fibrillation

Into: The host of this podcast is not a medical doctor. The information provided is not intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician prior to starting any new treatment or with any questions you have regarding a medical condition. Now on to the show. Welcome to the Afib podcast, where we provide information, inspiration, and support for afibbers. And now your host, Travis Van Slooten.

Travis Van Slooten: I have a special guest for this episode of the afib podcast. His name is Dr. Steve Ryan. Steve is a former afib patient who was cured of his afib back in April 1998 via catheter ablation. He’s a publisher of one of the most popular afib websites, a-fib.com and he’s the author of the best-selling book Beat Your A-Fib: The Essential Guide to Finding Your Cure.

In this episode Steve and I discussed the topic of marijuana use and atrial fibrillation. We discuss recreational pot smoking versus medical marijuana and how many marijuana may or may not be beneficial for people with afib. So without further ado, let’s roll the tape.

All right, Steve, so I want to talk to you about something that it was a very interesting topic that I honestly had not thought about before. I got an email from one of my readers who wanted to know if it was safe to smoke marijuana while they had afib. First I thought this has got to be some kind of a joke because I honestly had never thought about this before, but it makes sense, you know, recreational marijuana is definitely becoming a morbid thing, it’s currently legal in nine states, and medical marijuana use is legal in 29 States.

Recent poll shows that 64% of Americans support the legalization of marijuana. So this is going to be become – if it hasn’t already – become a more kind of important topic. And then ironically, a week later I got another email from someone that had the same question, so I’m like, “Wow, this is really kind of a big deal.”

So I found an article on your site, Steve, that you just recently wrote about this very topic, marijuana use and afib. And in that article you had discussed a little bit about the differences of recreational marijuana and the prescription form of marijuana which is called marinol, and you kind of discussed that there was some key differences between these two. So what are the differences between the two? .

Steve Ryan: Travis, I apologize that we do not have a lot of clinical data on this subject simply because it’s so new and the answers I give aren’t going to be definitive, but we’re doing the best we can with the information that we have. The marinol is the prescription form of cannabis, and the makers of it have a blanket disclaimer saying “Don’t use this with any kind of heart problem…” you know, it’s kind of legal thing. They haven’t done any clinical studies on this subject to say that but they’re just protecting themselves. There have been some research saying that smoking marijuana might lead to the development of afib and it may affect the cardiovascular system, but this is general data without a whole lot of really hard studies indicating that.

Now, what I’ve done on our website is – since I don’t know enough about it to really give a definitive answer –  I have asked people to tell me their experiences and they vary all across the board. Some say that this is the best thing I’ve ever taken, some people say as soon as I start smoking marijuana I get afib. Now, the reason for that might be the different in the pot they’re smoking or the edibles they’re taking. THC is a component found in the marijuana plant stavia. That’s what makes you feel high.There is a CBD is a component found in the marijuana plant indica. That works better to reduce pain and anxiety and induce sleep. Now the problem is the manufacturers of pot – every state has their own little companies, and some produce CBD and a tincture and an oil, in edibles; but some just mix it all together and it’s really hard depending on the state to find something that is just CBD that you can use to get rid of anxiety and get to sleep, that kind of thing.

Now what is the best product for afib patients? Probably CBD in edible form. Smoking marijuana unfortunately produces a lot of problem just like smoking does because there are a lot of bad things in the cigarette smoke as there is in the marijuana smoke. So people tend to want to use marijuana for medical purposes, they’re probably better off using an edible form with more CBD and THC. Does that make any sense?

Travis Van Slooten: Yeah, absolutely. I mean looking at again that article you wrote and I’ll link to it here to in the show notes so people can reference it. If they have experience smoking marijuana or taking it medically, they can surely reach out to you and share their experience with it. But as I look at your article you do have some anecdotal stories there, and it doesn’t seem that the few that are there that I’ve had that experiences with it were people smoking it. And one of the gentleman that wrote, a guy named Jim, said that it was like a life savior for him, but again, he was taking the medical prescription form of it, so that seems to back up kind of what we’re talking here.

Steve Ryan: Yeah. He has a great statement. He’s the guy who is very under a lot of stress, he has his own business. He comes home at night and his brain was throbbing on a mile a minute and he couldn’t get to sleep. So he use marijuana edibles and the stress goes right away and he seems to sleep very well at night. Just to be honest with you, I’m also some kind of like him. I’m very wound, very tight.

Travis Van Slooten: You’re a Type A?

Steve Ryan: I tend to think of all of the things about afib. I’m thinking about, you know… And to tell you the truth, I take edible marijuana and it gets me really relaxed and I go right to sleep.

Travis Van Slooten: Let’s talk about— for people that aren’t familiar with medical marijuana, I am one of those, by the way, I know nothing about this stuff which is why I find it so fascinating, but when we talk edibles, like, what is it? Is it literally like a brownie, a piece of cake? Is it like a gum? I mean what is it? When you say edible, what is it?

Steve Ryan: There are a lot of different products, and unfortunately every state has their own different companies. We don’t have companies that are nation-wide to put out a standard product, but a lot of them are like a brownie that comes in a package like a cookie. It comes in like 100 mg and you cut it into 10 mg slices. To me that’s a pain, but a lot of people use that. Another way is they have product like this one product is blueberry based. They make the marijuana in with blueberries and you just take one, and one is 5 mg and I usually take two at night. Other forms, let see, brownies.

Travis Van Slooten: Now you mentioned and oil-based, a tincture base…

Steve Ryan: What?

Travis Van Slooten: You mentioned a tincture based. That isn’t edible but that’s a different form.

Steve Ryan: Yeah, the way they do with that is they develop a tincture with CBD in an oil, and you put it on your body and let it absorb into your body, and that’s another… I’ve never tried that. I have no idea how well that works or how good it is.

Travis Van Slooten: And that tincture that isn’t something you… You don’t put it in your mouth; you put it on your skin.

Steve Ryan: Yeah, you put it on your skin. But again, I am not an expert in this field and we’re just doing the best we can with little knowledge that we have, and I beg all the listeners to be aware that this is not something that is definitive and written in stone and this is the way to go. Everything I say may completely change when we get more information on medical marijuana.

Travis Van Slooten: Yeah, absolutely. Like you said, I think it’s just starting to explode right now. Do you know, are there any studies underway right now? Do you know of any?

Steve Ryan: Well, there was a really interesting study that just came out where they studied patients with heart failure. And what they found was that– first of all, patients with heart failure are really in deep doo-doo, we’re talking like an ejection fraction of like low or below 35% normally is 50 to 75. These patients, if they have really serious heart failure it’s like they’re suffocating to death. It’s a terrible way to go if you’re ill and you have congestive heart failure, you just feel terrible from what I understand. I’ve never had it. So what they did was they followed 6 million in US hospitals with heart failure. About 1200 used and depended on marijuana. About 2300 used marijuana, but were not depended on it. So the non-dependent marijuana users were 18% less likely to develop afib. And the dependent users were 31% less likely to experience afib.

Now what that means is that marijuana prevented these patients who had heart failure from developing afib. Now, why is that important? Basically a combination of heart failure and afib is a killer. One is bad, two together like that is much worse. These people are much more apt to die, and marijuana basically prevented these people from developing afib even though they had heart failure. This is really big news because sure, now we’re applying it to heart failure, but what about normal people, would marijuana prevent them from developing afib? We don’t know. But the study indicate that. In study would say definitely that anyone who has heart failure should consider marijuana use in some form because it does seem to prevent them from going into a atrial fibrillation. Now can we go further and say everybody should smoke marijuana to prevent them from developing afib? No, we can’t say that.

Travis Van Slooten: Yeah, absolutely. And the other thing is I suppose we don’t have the details of the study either like what form they were taking, how much they were taking every day. We don’t have that information, do we, from that study? I mean you might not have it on hand, but…

Steve Ryan: I don’t have it on hand but there would probably be some indication of that, and I’d have to look that up and maybe get back to you. Those are some good questions. But you know, in general they usually do these things it’s usually 10 mg a day. That’s a general rule of thumb. But again, I don’t really know the specifics. But people who are dependent, those are probably smokers, and they were probably doing much more smoking of pot than the other group. That worked for them and prevented them from developing afib more so than the other people.

Travis Van Slooten: Now, did that study say they were pot smokers or they were taking the medical prescription form of marijuana? Because we talked earlier that smoking was probably not the good form or as the medicals…

Steve Ryan: Since this is done between 2007 and 2014 we can assume they were smokers.

Travis Van Slooten: And that to me is kind of promising because it’s saying — of course, that leads to more questions, right? Because what’s more effective, the recreational smoking pot or the medical form of it, you know, like the edibles? I mean all these things are still — we have no idea here.

Steve Ryan: We just don’t know yet, we just don’t know. Another part of this study that was interesting was people using marijuana were 46% less likely, and dependent users 58% less likely to die in the hospital. Now that’s good news because one of the main problems with afib is you’re in the hospital so often, and that’s really good news and something that is worth looking into. By the way, this study that I’m talking about hasn’t been published yet.

Travis Van Slooten: Oh, it hasn’t, okay.

Steve Ryan: So that’s why we don’t have the information on all the details of the study. As soon as the study get published we’ll get that information.

Travis Van Slooten: That’s good to know in case someone is listening this and they’re trying to Google this they’re not going to find it right now.

. Steve Ryan: Yeah, right, I don’t think so.

Travis Van Slooten: So the bottom line with this topic then is what’s your bottom line message to someone that would pose that question that was posed to me which is, “Hey, I have afib and I smoke pot, is this good or bad?” Mypersonal response to them Steve is kind of what you said Steve “We don’t know much of anything on this topic right now because it’s kind of so new.” And the other thing is I just told them I would approach it kind of like smoking or drinking; that it’s probably not best to do it heavily on a regular basis. And more importantly, if you smoke pot and you have an episode that’s probably an indication that’s a trigger so you should probably avoid it. But likewise if you are a moderate smoker and it seems to keep your afib episode at bay, then it might be okay to continue to smoke. That was kind of the way I handled it. Is that kind of the way you handle that answer or that question is well?

Steve Ryan: Yes. Some of the people like John wrote to me and said “99% of these afib attacks occurred when I’m under the influence of marijuana.”

Travis Van Slooten: Okay, the obvious trigger.

Steve Ryan: Yeah, and Jonathan writes “I tried a tiny bit of brownie for the first time since being diagnosed with afib. It was okay until about two hours later. I went into afib and a bit later came the closest I ever have to blacking out. I don’t think it’s for me anymore.” On the other hand, Jim writes that he uses it every night and it work for him fine.

Travis Van Slooten: Yeah, so it kind of gets back to the whole what’s trigger, what’s not. And so yeah, I think it’s all fascinating. Definitely I think this is going to become more and more of an issue as I said in the opening here with the marijuana legalization kind of sweeping across the country here. This is going to become a very hot topic, I think.

Steve Ryan: Yes, definitely.

Travis Van Slooten: Well, Steve, I just want to thank you for your time to discuss this topic, and I look forward to talking to you in the next week’s episode. We’re going to be talking about the real cost of living with afib. So Steve, thanks again for your time.

Steve Ryan: You’re welcome.

Outro: Thanks for listening to the podcast.Be sure to visit livingwithatrialfibrillation.com for more information, inspiration and support. Be well, and please join us next time.

A-Fib Produces More Ischemic Strokes, Despite Improvements in Stroke Prevention

A good friend of ours with A-Fib recently had a crippling ischemic stroke, even though her INR on Coumadin was 2.5, right in the middle of the desired range. Her left side is paralyzed. It’s heartbreaking to eat dinner with her and watch food dribble from the side of her mouth.  She’s getting good care and physical therapy, but she will probably never recover fully.

A-Fib Ischemic Stroke All Too Common

A recent retrospective study of more than 930,000 stroke patients found that 20% of acute ischemic stroke patients had A-Fib in 2014, up from 16% in 2003.

CT brain with Ischemic stroke at A-Fib.com

CT brain with Ischemic stroke

And despite recent improvements in stroke treatment outcomes (and stroke prevention), the negative effect of A-Fib was pretty much the same over the 12-year period of the study. Nearly 10% of A-Fib stroke patients died (“mortality”), compared to about 6% for patients without A-Fib.

According to co-author Dr. Mohamad Alkhouli of West Virginia University in Morgantown,

…the prevalence of A-Fib among patients admitted with acute ischemic stroke is rising, especially among white and elderly patients.

A-Fib stroke patients in this study were older (82 versus 70 years), more likely to be female (59.3% versus 51.8%, and Caucasian (80.6% versus 67.3%). (Females on average live about 5 years longer than males. Increased stroke probably relates to the fact that females live longer than males rather than female gender. See Being a Woman Not a Risk Factor for Stroke)

A-Fib Ischemic Stroke Worse Than “Normal” Stroke

The authors found that A-Fib patients were more likely to receive thrombolytic therapy. But even so, they showed worse outcomes, with 9.9% dying versus 6.1% of the non-A-Fib patients. And the A-Fib group had a higher rate of acute kidney injury, bleeding, infectious complications, and severe disability. They had longer hospital stays, higher costs of care, and more non-home discharges.

Danger of Hemorrhagic Stroke

This study didn’t investigate hemorrhagic stroke which is more likely to happen with increased age. 99% of people over age 65 have microbleeds in the brain. Taking anticoagulants to decrease the risk of an ischemic stroke can turn these microbleeds into full hemorrhagic strokes. Older A-Fib patients are between a rock and a hard place. See Anticoagulants Risky over Age 65.

Don’t Just Live With Your A-Fib

Living with A-Fib, especially as you get older, is often a death sentence. Don’t settle for a life on meds. Seek your cure!

Resources for this Article
Alkhouli M, et al “Burden of atrial fibrillation associated ischemic stroke in the United States” JACC Clin Electrophys 2018; DOI: 10.1016/j.jacep.2018.02.021.

George, Judy. Afib Found in Growing Proportion of Strokes―And despite improved stroke care, worse outcomes persist in Afib. Medpage Today. May 2, 2018. https://www.medpagetoday.com/neurology/strokes/72659

Anticoagulants, Dementia and Atrial Fibrillation

The prevalence of dementia and atrial fibrillation (A-Fib) are both on the rise with the aging population and increasing burden of vascular risk factors.

The association between A-Fib and dementia is well documented. To describe that relationship, researchers use the term “strongly associated” rather than explicitly state that A-Fib causes or leads to dementia. That’s as far as they can go, because there might be other factors at play.

Patients with A-Fib lose 15%-30% of their heart’s ability to pump blood to their brain, and to the rest of their body.

A-Fib Linked with Dementia

As patients, we use more direct language. All things being equal, we say A-Fib leads to and/or causes dementia. It makes intuitive sense, doesn’t it? Patients with A-Fib lose 15%-30% of their heart’s ability to pump blood to their brain, and to the rest of their body. (See: Increased Dementia Risk Caused by A-Fib: 20 Year Study Findings)

Research confirms that older adults with dementia had significantly reduced blood flow into the brain compared with older adults with normal brain function or young adults.

Research Reveals: Anticoagulants Reduce Risk of Dementia

Swedish study investigated the effect of anticoagulation on the development of dementia among A-Fib patients. Research data was collected on patients diagnosed with and treated for A-Fib in Sweden between 2006-2014. This included 444,106 patients, and over 1.5 million patient-years.

The retrospective registry study compared the incidence of dementia developed in A-Fib patients with and without ongoing anticoagulation with warfarin or direct oral anticoagulation (DOAC) (i.e., dabigatran, rivaroxaban, apixaban and edoxaban).

This study of A-Fib patients found that anticoagulant treatment was associated with a 29% reduced risk of dementia. There was no difference in dementia risk between patients treated with warfarin and those treated with direct oral anticoagulants. 

It’s encouraging to know that, if you have A-Fib and must take anticoagulants, they may reduce dementia to a limited degree.

The authors concluded that the risk of dementia is higher among A-Fib patients not treated with anticoagulation.

In fact, absence of anticoagulation treatment was among the strongest predictors for dementia along with age, Parkinson’s Disease, and alcohol abuse.

Anticoagulants May Reduce Micro-Clots

This study did not tell us how anticoagulation achieves this effect.

Some speculate that anticoagulants, while preventing macro-clots (strokes), also prevent or reduce micro-clots and smaller ischemic events which damage the brain over time.

Another Reason to Not Live with A-Fib

This study also raises another reason not to live in A-Fib if at all possible. Unlike macro-clots which cause strokes and which can kill or severely disable, A-Fib tends to produce micro-clots (smaller ischemic events or silent mini-strokes). The effect of micro-clots may not even be noticeable but, nonetheless, damages our brains over time.

Resources for this Article
• Risk of dementia higher without oral anticoagulants for AF. Cardiac Rhythm News. 15th December 2017.  https://cardiacrhythmnews.com/leif-friberg-oac-dementia-af/

• Friberg l, Rosenqvist M. Summary by Geoffrey Barnes. Less Dementia With Oral Anticoagulation in Atrial Fibrillation. American College of Cardiology, Oct. 26, 2017. http://www.acc.org/latest-in-cardiology/journal-scans/2017/10/26/15/38/less-dementia-with-oral-anticoagulation-in-atrial-fibrillation.

• Gallagher, C et al. Reducing Risk of Dementia in AF–Is Oral Anticoagulation the Key? Mayo Clinic Proceedings, February 2018, Volume 93, Issue 2, Pages 127-129. http://www.mayoclinicproceedings.org/article/S0025-6196(17)30920-5/fulltext. DOI: https://doi.org/10.1016/j.mayocp.2017.12.017

 

Left Atrial Appendage (LAA): An Under-Recognized Trigger Site of Atrial Fibrillation

Recurrence of A-Fib after an ablation is very disappointing and frustrating both for patients and for EPs performing the ablation.

A link to the source of A-Fib recurrence may have been found. A study by Dr. Di Biase and his colleagues established that the LAA is responsible for a great deal of A-Fib recurrence.

Research: LAA Responsible for 27% of Recurrences

The multi-center study enrolled patients at leading medical centers in Austin, Texas, San Francisco and Palo Alto, Calif, Rome and Venice, Italy, Cleveland and Akron, Ohio.

In the study of 987 patients undergoing redo catheter ablations, 266 (27%) showed a prevalence of A-Fib triggers firing from the LAA.

In 32+% of these 266 patients, the LAA was the only source of arrhythmia signals.

Trial Design of LAA for Recurrences

The 266 patients were divided into three groups with different treatments. Each group was followed for 12+ months with these results:

  • Group 1. The LAA was not ablated (isolated); 74% of this group had recurrences of A-Fib.
  • Group 2. The LAA was ablated with focal lesions. 68% of this group had recurrences of A-Fib.
  • Group 3. The LAA was ablated by a circular catheter at the ostium of the LAA. 15% of this group had recurrences of A-Fib.

Trial Findings: LAA Responsible for Much A-FibLeft Atrial Appendage heart illustration

While this study was limited, as it only looked at redo ablations and recurrences, it’s significant. The patients (Group 3) who were ablated by a circular catheter at the ostium of the LAA, had a recurrence rate of only 15%!

Compared to 68% and 74%, this is a major, significant reduction in recurrences. This is great news for A-Fib patients undergoing a catheter ablation.

Trial results indicate that the LAA is responsible for a great deal of arrhythmia signals, probably more than any other area of the heart.

A-Fib Ablations: Check LAA for Non-PV Signals

Many EPs today aren’t aware of the importance of the LAA as a source of A-Fib signals and never even look at the LAA when doing an ablation. In the words of the study’s authors, “the LAA is an underestimated site of initiation of atrial fibrillation.

It’s good news that an increasing number of EPs after performing a PVI, then as their second step, map and ablate the LAA. This is especially in cases of persistent A-Fib and those with non-PV triggers. After the PVs are isolated, the LAA should be the next place to look. (Make sure your EP is one those who check the LAA!)

What This Means to Ablation Patients

This research is important not just for patients undergoing a redo catheter ablation but for any A-Fib patient seeking a catheter ablation.

Important when selecting your EP: When having a catheter ablation, no matter what kind of A-Fib you have, make sure your EP knows how, is experienced at, and routinely maps and ablates the LAA.

This may produce a more successful ablation and save you from a recurrence of A-Fib.

To learn more about the Left Atrial Appendage, see my article, The Role of the Left Atrial Appendage (LAA) & Removal Issues.

Resources for this Article
Di Biase et al. Left Atrial Appendage: An Underrecognized Trigger Site of Atrial Fibrillation. Circulation. 2010;122:109-118. http://circ.ahajournals.org/content/122/2/109. https://doi.org/10.1161/circulationaha.109.928903

Is Warfarin a Protective Factor for Cancer Among A-Fib Patients? Research Finds a Possible Link

A 7-year retrospective study of patients older than 50 years drawn from the Norwegian National Registry and other databases (1,256,725 persons), found a possible link between warfarin use and cancer prevention. Particularly for A-Fib patients.

Study Participants and Design

Warfarin (brand: Coumadin) tablets

Of the over one million patients in the combined databases, 48.3% were male, 51.7% were female, 7.4% were classified as warfarin users, and 92.6% were classified as nonusers. The participants were divided into 2 groups—warfarin users and nonusers.

Warfarin users had to be taking warfarin for at least 6 months and at least 2 years from first prescription to any cancer diagnosis.

A subgroup were persons taking warfarin for atrial fibrillation or atrial flutter.

Study Findings: Warfarin Users vs. Nonusers

During the 7-year follow-up period, 10.6% (132,687) individuals developed cancer. There were 9.4% cancer diagnoses among the warfarin users and 10.6% among the nonusers.

Warfarin Users vs. Nonusers: Among warfarin users as compared with nonusers, there was a significantly lower incidence of cancer in all organ-specific sites (lung, prostate, and breast, except colon cancer).

A-Fib/A-Flutter group: The effect of warfarin use was more pronounced in the subgroup of patients with atrial fibrillation or atrial flutter for all cancers (lung, prostate, and breast). These patients also had a significant reduction in colon cancer associated with warfarin use.

Interpreting the Study Results

Warfarin use may have broad anti-cancer potential (in patients older than 50).

“An unintended consequence of this switch to new oral anticoagulants (NOACs) may be an increased incidence of cancer.”

The study authors believe that warfarin’s vitamin K antagonism is the property that may prevent or hinder the progression of cancer.

They noted that new oral anticoagulants that require less monitoring are being used more often. “An unintended consequence of this switch to new oral anticoagulants may be an increased incidence of cancer, which is an important consideration for public health,” they cautioned.

James Lorens (University of Bergen) and co-investigators say their findings “could have important implications for the selection of medications for patients needing anticoagulation.”

What This Means to Patients

This begs the question, on the basis of this Norwegian study, Should A-Fib patients stop taking the new anticoagulants (NOACs) and switch back to warfarin?”  Probably not.

Warfarin blocks vitamin K and has bad side effects: The bad side effects of warfarin use include increased bleeding, hemorrhagic stroke, and microbleeds in the brain.

In addition, warfarin blocks vitamin K absorption, thereby depositing calcium in our arteries and progressively turns them into stone (hardening of the arteries). Vitamin K is essential for heart and bone health. For more, see my article, Stop Taking Warfarin―Produces Arterial Calcification.

Some comfort: If warfarin is your anticoagulant of choice, it’s good to know that it may have anti-cancer properties.

Resources for this Article
• Haaland, GS et al. Association of Warfarin Use With Lower Overall Cancer Incidence Among Patients Older Than 50 Years. JAMA Intern Med. 2017;177(12):1774-1780. doi:10.1001/jamainternmed.2017.5512 PubMed PMID: 29114736. URL: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2661703?redirect=true.

• Cowen, L. Warfarin shows broad anti-cancer potential. medwireNews and Medicine Matters/ Epidemiology, 08-11-2017.  URL: https://oncology.medicinematters.com/epidemiology/lung-cancer/warfarin-shows-broad-anti-cancer-potential-/15200674

VIDEO: A-Fib Best Treated by Changes to Diet and Lifestyle Says Dr. John Mandrola 

Atrial Fibrillation videos at A-Fib.com

Dr. John Mandrola, MD, cardiac electrophysiologist, Louisville, KY, on the impact of lifestyle factors on patients with atrial fibrillation; how A-Fib can be a sign of metabolic risk factors like obesity, poor diet, sleep apnea, alcohol intake, and lack of exercise; and how managing these risk factors can reduce the risk of stroke, and make a significant impact on the patient’s heart rhythm and overall health. (5:29)

Posted by Dr. John McDougall; Interview from McDougall Advanced Study Weekend in Santa Rosa CA, 2016.

YouTube video playback controls: When watching this video, you have several playback options. The following controls are located in the lower right portion of the frame: Turn on closed captions, Settings (speed/quality), Watch on YouTube website, and Enlarge video to full frame. Click an icon to select.

If you find any errors on this page, email us. Y Last updated: Wednesday, July 18, 2018
Return to Instructional A-Fib Videos and Animations

The Costs and Consequences of Living with Atrial Fibrillation

Our mission at A-Fib.com is, in part, “to empower patients to find their A-Fib cure or best outcome.” We often advise:

Don’t listen to doctors who want to just control your symptoms with drugs. Leaving patients in A-Fib overworks the heart, leads to fibrosis and increases the risk of stroke. The abnormal rhythm in your atria causes electrical changes and enlarges your atria (called remodeling) making it work harder and harder over time. Seek your Cure.

A Few CDC Facts About A-Fib

I was recently reminded of the other costs of living with Atrial Fibrillation when I re-read the  A-Fib Fact sheet from the U.S. Centers for Disease Control and Prevention.

In part it reads: “More than 750,000 hospitalizations [in the U.S.] occur each year because of Atrial Fibrillation (A-Fib). The death rate from A-Fib as the primary or a contributing cause of death has been rising for more than two decades.”

The A-Fib stat that jumped out at me was:

“Medical costs [in the U.S.] for people who have A-Fib are about $8,705 higher per year than for people who do not have A-Fib.”

How disconcerting! A-Fib costs you in many ways. Beyond the physical toll, staying in A-Fib with medication is costly to your wallet. Besides the annual costs of your medications, the odds of your being hospitalized increases. Just in terms of dollars and cents, A-Fib on average costs you an additional $8,700 a year.

To learn more, read my editorial, Leaving the Patient in A-Fib—No! No! No!

How Much Will You Pay to Stay in A-Fib?

Remember: ‘A-Fib begets A-Fib.’ The longer you have A-Fib, the greater the risk of your A-Fib episodes becoming more frequent and longer, often leading to continuous (Chronic) A-Fib. (However, some people never progress to more serious A-Fib stages.)

When you add up all the costs (physical, emotional and monetary) of living in A-Fib, doesn’t it make sense to ‘Seek you Cure’?

Don’t let your doctor leave you in A-Fib. Educate yourself. Learn all your treatment options.

Resources for this Article

• Agency for Healthcare Research and Quality. Weighted national estimates. HCUP National Inpatient Sample [online]. 2012. [cited 2015 Feb 9]. Available from: http://hcupnet.ahrq.gov/HCUPnet.jsp.

• Centers for Disease Control and Prevention. About multiple cause of death 1999–2011. CDC WONDER Online Database. 2014. [cited 2014 Oct 2]. Available from: http://wonder.cdc.gov/mcd-icd10.html.

• January CT, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Journal of the American College of Cardiology. 2014;64(21):2246–80.

• Mozaffarian D, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131:e29–e322

• Atrial Fibrillation Fact Sheet. Last reviewed August 2017. National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_atrial_fibrillation.htm

Choosing Your Doctor: Good Rapport & Trust are Vital for Your Health

An A-Fib.com reader, now A-Fib-free after two ablations, wrote me about an experience with one EP she had consulted:

“I checked your website’s listing of EPs and was surprised to find (name withheld) listed under (affiliation withheld).

This is the EP who told me I was definitely not a candidate for ablation and I needed to just accept the fact that I needed to stay on basic medications (atenolol and Eliquis).  

This guy is a smooth talker and tells you how he “treats his patients just like they were his family members”.  

However, when I pressed him with questions, he told me that ‘he was the one who went to medical school’. I would never recommend this EP to anyone.”

Studies of Doctor-Patient Relationships

At A-Fib.com, we stress the importance of a good doctor-patient relationship and finding the right doctor for you and your treatment goals. Don’t just go to a doctor because their office is nearby.

Indeed, recent research proves that patients do better when they have a good rapport with their doctor. Researchers at Massachusetts General Hospital analyzed the results of 13 high-quality studies of doctor-patient relationships.

“Patients who trust their doctors are more likely to follow their advice, ask questions and discuss how treatments are working”, according to Dr. Gerald B. Hickson of Vanderbilt University School of Medicine.

Doctors, in turn, may be more engaged.

Finding the Right Doctor for You

Caduceus at A-Fib.com

Which doctor?

If the first doctor you interview doesn’t meet your needs, move on the second (or third) doctor on your list, etc. Yes, I know it takes time and energy, but a good doctor-patient relationship is important. You’ll do better when you have a positive rapport with your doctor.

Read more at How to Find the Right Doctor for You and Your Treatment Goals.

References for this Article
• Finding the Right Doctor for You. A-Fib.com. “Your consultation Appointments: ‘Questions for Doctors’ and Worksheet”; http://a-fib.com/doctors-for-a-fib/finding-right-doctor-for-you-and-your-afib/#Questions
• Shannonhouse, Rebecca. From the Editor: When a Good Doctor is Bad. Bottom Line Health, Volume 28, Number 12, December 2014.
• Shannonhouse, R. “Is Your Doctor a Bully?” Bottom Line Health, September 2013, p. 2.
• Kelley, J. M, et al. The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS ONE 9(6): April 9, 2014. DOI: 10.1371/journal.pone.0094207 Last accessed February 22 2015, URL: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0101191

Increasing Your Quality of Life: Catheter Ablation versus A-Fib Drugs

When seeking your Atrial Fibrillation cure, you’re often faced with the choices of catheter ablation versus antiarrhythmic drugs therapy.

We know from previous research studies that it’s safer to have an ablation versus living a life on antiarrhythmic drug therapy (AAD). (See Ablation Safer Than Life on Antiarrhythmic Drugs.)

But how do the two treatments compare when it comes to improvement in general health and ‘quality of life’?

Measuring ‘Quality of Life’

To determine success after treatment, researchers traditionally measure if A-Fib recurs using periodic ECGs. But this is “hardly a measure of successful treatment”, says Dr. Carina Blomstrom-Lundqvist, principal CAPTAF investigator from Uppsala University in Sweden.

CAPTAF stands for ‘Catheter Ablation compared with Pharmacological Therapy for Atrial Fibrillation‘.

The CAPTAF clinical trial is one of the first studies in which improvement in ‘quality of life’ was the goal. The trial compared the Atrial Fibrillation treatment effects of ablation versus antiarrhythmic drugs.

One-year results were presented in August at the 2017 European Society of Cardiology (ESC) Congress.

The CAPTAF Clinical Study

The CAPTAF trial enrolled 155 symptomatic patients with paroxysmal or persistent A-Fib at four Swedish centers and at one center in Finland.

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

A-Fib Drug Therapies

All enrolled patients had to have failed one drug therapy (rate or rhythm control). The average age of the enrolled patients was 56 years. Nearly three-quarters had paroxysmal A-Fib. On average they had been diagnosed with A-Fib for about 5 years, and 70%-80% of the patients had severe or disabling symptoms.

Catheter ablation (RF)

Patients received a subcutaneously implantable cardiac monitor 2-m onths prior to the start of the study (to establish a baseline ‘burden’ of A-Fib, i.e. the proportion of time in A-Fib). Then participants were randomized to ablation with pulmonary vein isolation or antiarrhythmic drug therapy. (The study protocol required patients randomized to the ablation regimen to be completely off antiarrhythmic drugs by 6 months after their ablation procedure.)

The primary goal of the study was a change in general health-related quality of life.

CAPTAF Results: Overall Health & ‘Quality of Life’ Improved More after Ablation

Overall Health: After 12 months of follow-up, the ablation group showed a greater improvement in average overall health by 11.0 points versus 3.1 points improvement in the drug group (as measured by a standard survey instrument). The 8-point difference in gain between the two groups was statistically significant.

Quality of Life: The quality-of-life domains (general health, physical function, mental health, role-emotional, role-physical, and vitality) improved significantly more in the ablation group than in the drug group. No significant differences were shown in the remaining two domains (bodily pain and social functioning).

AF Burden: The AF burden of the ablation group was decreased by an average of 20% points versus 12% points among the group on antiarrhythmic drugs. The change from baseline did not reach statistical significance between treatment groups.

The complication rates were comparable between treatment groups.

Summarizing the Results

About the difference in quality of life, Dr. Carina Bloomstrom-Lindqvist, principal CAPTAF investigator, explained that continued treatment with an antiarrhythmic drug in the drug group of patients compared with no drug treatment in the ablated patients “is absolutely the explanation” for the observed difference in quality of life.

Regarding her findings, she said, “Using quality of life as the primary endpoint of a trial for the first time, we demonstrated that pulmonary vein isolation [PVI] is significantly more effective than antiarrhythmic drugs…even at an early stage of their disease.”

Want a Better Quality of Life? Get a Catheter Ablation

“Using quality of life as the primary endpoint…PVI is significantly more effective than antiarrhythmic drugs…”

The CAPTAF clinical study, though small, goes much further than previous studies and is a significant milestone for Atrial Fibrillation patients. This was one of the first studies to focus on quality of life after treatment.

The CAPTAF results prove scientifically that ablation works better for A-Fib patients than antiarrhythmic drugs (AADs).

If you have A-Fib and want to improve your quality of life―get a catheter ablation. It makes you feel better than a life on antiarrhythmic drugs.

Remember: Seek your Cure!
Anyone no longer in A-Fib can tell you how wonderful it is
to have a heart that beats normally again.

Resources for this Article
Blomstrom-Lundqvist, Carina. Ablation of Atrial Fibrillation Improves Quality of Life More Than Drugs (CAPTAF). Presentation. ESC Congress, August 2017.

Zoler, M.  A Fib ablation surpasses drugs for improving quality of life. Cardiology News, Aug 30, 2017 URL: http://www.mdedge.com/ecardiologynews/article/145764/arrhythmias-ep/fib-ablation-surpasses-drugs-improving-quality-life

Ablation of atrial fibrillation improves quality of life more than drugs (CAPTAF). Press release. European Society of Cardiologists. Aug 29, 2017. URL: https://www.escardio.org/The-ESC/Press-Office/Press-releases/ablation-of-atrial-fibrillation-improves-quality-of-life-more-than-drugs-captaf

ESC 2017: Ablation of Atrial Fibrillation Improves Quality of Life More than Drugs – CAPTAF Trial Sept 4, 2017. URL: http://www.practiceupdate.com/content/esc-2017-ablation-of-atrial-fibrillation-improves-quality-of-life-more-than-drugs-captaf-trial/57590

 

CASTLE AF Study: Live Longer―Have a Catheter Ablation!

Catheter ablation actually reduces death rates and hospital admissions. That’s the finding in the CASTLE AF trial, a key heart disease study, by Dr. Nassir Marrouche and his colleagues.

In a presentation at the 2017 European Cardiology Congress in Barcelona, Spain, Dr. Marrouche described CASTLE-AF study participants as having A-Fib, advanced heart failure (i.e., low ejection fraction) and an Implantable Cardioverter Defibrillator (ICD).

The multicenter CASTLE-AF trial focused on patients with A-Fib and systolic heart failure.

The CASTLE-AF trial enrolled 398 patients in 33 sites across Europe, Australia and the US between 2008 and 2016. Patients were randomized to receive either radiofrequency catheter ablation or conventional drug treatment.

The study set out to definitively test the ability of A-Fib ablation to improve hard outcomes in patients with symptomatic paroxysmal or persistent A-Fib and a left ventricular ejection fraction (LVEF) of ≤35 percent (dangerously low percent). Median follow-up period was 37.8 months.

Results: Ablation Improves Quantity Not Just the Quality of Life

After catheter ablation, the death rate of trial patients was lowered by an amazing 47%! This is a lot better result than research studies using ICDs with drug therapy to lower the death rate in similar patients.

Before this study, catheter ablation was known to improve quality of life, but in this study it also improved life outcomes (the quantity of life, how long one lives).

In addition, there may be a “major impact” on reducing costs associated with hospitalizations.

Ablation Improves Ejection Fraction

Once we study the soon-to-be published CASTLE-AF results, we can document what we’ve often observed anecdotally, that catheter ablation improves lower-than-normal ejection fraction and consequently cures a major component of heart failure.

Dr. Marrouche recommends EPs treating heart failure patients with A-Fib to “ablate them early on, very soon in the disease stage.”

My Anecdotal Evidence: Just last month I advised a 73-year-old man in persistent A-Fib to have an ablation by Dr. Andrea Natale. After only one month in sinus, his ejection fraction improved from a low 35% to a normal 55% (normal range is 50 to 75 percent)!

The CASTLE-AF study could pave the way for wider adoption of catheter ablation for treatment of A-Fib.

Even though he’s only a month into his blanking period, he feels terrific.

Wider Adoption of Catheter Ablation?

The CASTLE-AF study results could be a game changer for Atrial Fibrillation patients! Results could pave the way for wider adoption of catheter ablation and may prompt changes in current guidelines for treatment.

CASTLE-AF stands for Catheter Ablation versus Standard conventional Treatment in patients with LEft ventricular dysfunction and Atrial Fibrillation

Resources for this Article
Marrouche, Nassir. Castle AF: Catheter Ablation vs. Conventional Therapy for Patients with A-Fib and LV Dysfunction. Presentation at the 2017 European Society of Cardiology (ESC) Congress. August 27, 2017.

CASTLE-AF: Catheter Ablation vs. Conventional Therapy for Patients with AFib and LV Dysfunction. American College of Cardiology (acc.org). Aug 27, 2017. URL: http://www.acc.org/latest-in-cardiology/articles/2017/08/16/13/24/sun11am-castle-af-catheter-ablation-conventional-therapy-patients-afib-lv-dysfunction-esc-2017

CASTLE-AF Study Results Indicate Catheter Ablation of Atrial Fibrillation as First-Line Treatment for Heart Failure Patients. Biotronik Pulsar Press Release. Distributed by Pressebox.com. Aug 28, 2017. URL: https://www.pressebox.com/pressrelease/biotronik-se-co-kg/CASTLE-AF-Study-Results-Indicate-Catheter-Ablation-of-Atrial-Fibrillation-as-First-Line-Treatment-for-Heart-Failure-Patients/boxid/868578

Research Supports It: ‘If You Don’t Like Your Doctor, Look For a New One!’

If you like, trust and respect your doctor(s), you’re more likely to accept and follow their advice. It’s intuitive, isn’t it? But now a review of studies backs it up. Developing a good relationship helps you feel comfortable asking questions and getting feedback in a give-and-take environment.

Relationship-Based Strategies Improve Patients’ Health

The more people like their doctors, the healthier they tend to be. This is what researchers at Massachusetts General Hospital found in a review study where they examined 13 research reports on this subject.

If you like, trust and respect your doctor(s), you’re more likely to accept and follow their advice.

A mega-study review looked at doctors who were trained in “relationship-based strategies” such as making eye contact, listening well, and helping patients set goals.

The results: these strategies significantly improved their patients’ health compared to control groups. Their patients achieved lower blood pressure, increased their weight loss, reduced pain and improved glucose management.

If You Don’t Like Your Doctor, Look For a New One!

If you don’t have a good rapport with your current doctors―even if they are “the best” in their field―it’s worth looking elsewhere for a new doctor.

Stethoscope and EKG tracing at A-Fib.com

Know When it’s Time to Fire Your Doctor

In the article, Know When it’s Time to Fire your Doctor, CNN.com Senior Medical Correspondent Elizabeth Cohen discusses five ways to know when it’s time to think about leaving your doctor, and the best way to do it. The highlights are:

1. When your doctor doesn’t like it when you ask questions
2. When your doctor doesn’t listen to you
3. If your doctor can’t explain your illness to you in terms you understand
4. If you feel bad when you leave your doctor’s office
5. If you feel your doctor just doesn’t like you — or if you don’t like him or her

Being the “Best in the Field” Isn’t Enough

Even if a doctor(s) is the best in their field and an expert in your condition, that may not help you if you don’t communicate well with them and don’t relate to them. If we don’t like our doctors, we’re less likely to listen to them.

Don’t Be Afraid to Fire Your Doctor

Doctor shopping? Caduceus at A-Fib.com

Doctor shopping?

Changing doctors can be scary. According to Robin DiMatteo, a researcher at the University of California at Riverside who’s studied doctor-patient communication. “”I really think it’s a fear of the unknown. But if the doctor isn’t supporting your healing or health, you should go.”

Finding a new doctor: To learn how, read our page: How to find the right doctor for you and your treatment goals.

Resources for this article
Shallenberger, Frank. When You Should Fire Your Doctor…Even if He’s “the Best in his Field”, Second Opinion Newsletter, Vol. XXVI, No. 11, November 2016. pp 3-4.

Cohen, E. Know When It’s Time to Fire Your Doctor. CNN.com. October 7, 2016. URL: http://www.cnn.com/2016/10/07/health/fire-your-doctor/

Your Life-Threatening Risk of A-Fib with Untreated Sleep Apnea

At least 43% of patients with Atrial Fibrillation suffer from Obstructive Sleep Apnea (OSA) as well. In his A-Fib story, Kevin Sullivan, age 46, wrote about his discovering his Sleep Apnea on his own and the effect on his A-Fib. He wrote:

“My A-Fib seemed to start at night while I was sleeping. One night when I woke up, my heart was racing and I felt sweaty. I started reading about things which contribute to A-Fib and learned that high thyroid levels and sleep apnea contribute to the condition. My brother had sleep apnea, so that made me think I might as well.

When I asked my doctor about it, he told me that it was unlikely because I was not overweight and I did not feel tired during the day.

I went to a sleep lab anyway, and it turned out that I did have sleep apnea. My A-Fib was being triggered by apnea episodes during the night. I got an CPAP machine to address the sleep apnea and hoped that was the end of my A-Fib….

To read the rest of Kevin Sullivan’s A-Fib story, go to: A-Fib Patient Story: Overcoming Silent A-Fib—Ablation by Dr. Patrawala.

Sleep Apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

Risk of A-Fib with Untreated Sleep Apnea

It is now established that there’s a connection between Sleep Apnea and A-Fib.

If you have untreated Sleep Apnea, you are at greater risk of having a more severe form of A-Fib or of not benefiting from an A-Fib treatment. To learn more about sleep studies, see my article: Sleep Apnea: Home Testing with WatchPAT Device and the Philips Respironics

More EPs are Sending Patients for Sleep Studies

So many A-Fib patients also suffer from sleep apnea that many Electrophysiologists (EPs) routinely send their patients for a sleep apnea study. Some A-Fib centers have their own sleep study program. (The patient just walks down the hall to an A-Fib sleep study area.)

For some lucky patients, normal sinus rhythm (NSR) can be restored just by controlling their sleep apnea and getting a good night’s sleep.

For some lucky patients, normal sinus rhythm (NSR) can be restored just by controlling their sleep apnea.

Take Action: Sleep Apnea Can be Lethal

Sleep apnea isn’t a minor health problem, and it’s a condition you can do something about. If your bed partner tells you that you have pauses in breathing or shallow breaths while you sleep, or that you snore, do something about it! (Not everyone with sleep apnea snores, but snoring may indicate sleep apnea.)

Talk with your doctors about testing for sleep apnea. You may need an in-lab or home sleep test).

Atrial Fibrillation PVI: Can the Need for Multiple Ablations be Forecasted?

Could the necessity for multiple ablation procedures be predicted? According to a research study, the answer is YES!

In a study of patients who had catheter ablation of the Pulmonary Veins (PVs) for paroxysmal (occasional) A-Fib, 8% had to have more than two ablations to be A-Fib free.

The only independent predictor of the need for multiple procedures was the presence of non-PV triggers. According to this research, electrophysiologists (EPs) should check for non-PV triggers such as at the ligament of Marshall.

Illustration of RF ablation at A-Fib.com

Illustration of RF ablation

The lesson to be learned from this study: When having an ablation, make sure your Electrophysiologist (EP) is experienced at tracking down (mapping) and ablating (isolating) non-PV triggers.

For example, I reviewed the an O.R. (Operating Room) report of a patient who, after isolating the PVs, was still in A-Fib. Instead of looking for non-PV triggers, the EP just electrocardioverted the patient back into sinus rhythm. This does sometimes work. But not in this case. The ablation failed.

This is particularly important for EPs doing CryoBalloon ablations.

Graphic: Cryoablation heat withdrawl at A-Fib.com

Illustration: Cryoablation heat withdrawl

Find EPs Experienced at Ablating Non-PV Triggers

When getting a CryoBalloon ablation, you need to find an EP who is willing to do more than just isolate your PVs—someone who will put out the extra effort to find and ablate non-PV triggers such as at the ligament of Marshall.

To do this, your EP may have to replace the CryoBalloon catheter with an RF catheter to ablate these non-PV triggers. This may require mapping and ablation skills not all EPs have.

What to Ask Prospective EPs

To find the right EP for your CryoBalloon ablation ask:

What do you do if I’m still in A-Fib after you do the CryoBalloon ablation?

(You want to hear they’ll search for and ablate non-PV triggers.)

For more about Ablating Non-PV Triggers, see my article: CryoBalloon Ablation Study: 30% of Patients Required RF to Achieve Isolation

Note: This research study was conducted before the widespread use of Contact Force sensing catheters, whose use is another contributor to the reduction of recurrence and need for multiple ablation procedures.

References for this article
LO, LW et al. Predictors and Characteristics of multiple (More than Two) Catheter Ablation Procedures for Atrial Fibrillation. J Cardiovasc Electrophsiol. 2015 Jul 14. http://www.ncbi.nlm.nih.gov/pubmed/26178628 doi: 10.1111/jce.12748.

Top My 5 Articles: Atrial Fibrillation and Women’s Health

There are important gender differences in the electrical activity of the heart, e.g., women have higher resting heart rates compared to men. Women with atrial fibrillation are at a higher risk of stroke, and they are less likely to receive anti-coagulation and ablation procedures compared to men in the U.S.

Learn more about the health concerns for women with Atrial Fibrillation:

  1. Women with A-Fib: Mother Nature and Gender Bias
  2. Under-Diagnosed & Under-Treated Women & A-Fib
  3. Women, Anticoagulants, CHA2DS2-VASc and Risk of Bleeding
  4. Doubles Chance of A-Fib: Obesity in Young Women
  5. Hormone Replacement Therapy (HRT): Will it Help or Hinder my Atrial Fibrillation

Good News: EPs Less Likely to Have Gender Bias

Research indicates female gender bias tends to disappear when a woman sees an cardiac electrophysiologist (EP), particularly concerning catheter ablation. This suggests that treatment bias may be more at the primary care level, i.e., your GP or general cardiologist.

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Reference for this Article
Curtis, A.B., Narasimha, D., ‘Arrhythmias in Women’ Clinical Cardiology, 2012 Mar; 36(3)   www.ncbi.nlm.nih.gov/pubmed/22389121

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