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

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 unexpected 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

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

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

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.

Click to order at Spreadshirt.com

Click to order

Reference for this Article

In your 80s? Are You Doomed to a Life in A-Fib or Can You Still Have a Catheter Ablation?

If you’re in your 80s, you’re not automatically doomed to a life in A-Fib and on A-Fib drugs. You most likely can still have a catheter ablation. The research by Dr. Pasquale Santangeli is very hopeful and encouraging.

Study of Octogenarians Who Had a Catheter Ablation (PVI)

Dr. Pasquale Santangeli and his colleagues at the Texas Cardiac Arrhythmia Institute in Austin, TX examined data from 103 octogenarians who had an RF catheter ablation between 2008 and 2011. They compared this older group to younger patients who underwent the same procedure.

 If you’re in your 80s, you’re not automatically doomed to a life in A-Fib and on A-Fib drugs.

• There was no difference in the rate of success between the octogenarians and the younger group (69% vs. 71%).

• The rate of procedure-related complications was also not significantly different between the two groups, even when looking at different types of A-Fib such as paroxysmal and non-paroxysmal A-Fib.

• Octogenarians with paroxysmal A-Fib had more non-pulmonary vein trigger sites, and consequently required longer procedural time to effectively isolate such non-pulmonary vein areas. (Dr. Santangeli suggested a hypothesis that the underlying pathology of A-Fib in older patients might be different from younger patients.)

In practice, octogenarians have been largely excluded from clinical trials of catheter ablation. Current guidelines are also very conservative, because there has been a lack of adequate clinical studies in this area. Dr. Santangeli’s report is a step in the right direction.

When Old Isn’t Necessarily Old

In the real world old isn’t necessarily old. People in their 80s may indeed have ‘excellent functional and health status” which would make them good candidates for a catheter ablation. Most healthy 80-year-olds aren’t so frail that they can’t have a catheter ablation.

You can still have a catheter ablation but you need to find an EP Experienced in Non-PV Triggers.

After all, a catheter ablation is a non-invasive procedure. It isn’t like open heart surgery which is incredibly taxing and physically demanding. You don’t have to be a ‘Johnny Atlas’ muscleman to have a catheter ablation. Most healthy 80-year-olds aren’t so frail that they can’t have a catheter ablation.

In your 80s? Find an EP Experienced in Non-PV Triggers

If you’re in your 80s, you most likely can still have a catheter ablation. But, you need to find the right electrophysiologist (EP).

Make sure you select an EP with a proven track record of finding and isolating non-PV triggers. (Dr. Santangeli’s research found that octogenarians have more non-pulmonary vein trigger sites.) Some EPs can’t or won’t make the extra effort to map and ablate non-PV triggers.

(I’ve read O.R. reports where the patient was still in A-Fib after the EP had ablated their PVs. Instead of trying to map and ablate non-PV triggers, the EP simply electrocardioverted [shocked] the patient back into sinus rhythm. After a short time, the patient went back into A-Fib.)

Questions to Ask a Prospective EP

When interviewing a prospective EP, ask:

 “What do you do if I’m still in A-Fib after you’ve ablated my pulmonary veins?” (You want a reply such as “I use mapping to search for non-PV triggers in other areas of the heart”.)

We are indebted to Dr. Santangeli and his colleagues for showing that octogenarians can have a successful, safe ablation, and shouldn’t be excluded from a catheter ablation simply on the basis of their age.

To learn more: read my related article: FAQs A-Fib Ablations: Is 82 Too Old for a PVA?  

References for this article

Does a Successful Catheter Ablation Have Side Benefits? How About a Failed Ablation?

Are there additional dividends from a successful catheter ablation for A-Fib—beyond being back in normal sinus rhythm (NSR)? Research says, yes!

Additional Benefits of Successful Catheter Ablation

“The benefit of catheter ablation extends beyond improving quality of life…If successful, ablation improves life span,” says, lead author Dr. Hamid Ghanbari, an electrophysiologist at U.of Mich. Frankel Cardiovascular Center.

Illustration of RF ablation

His comments are based on a study that examined 10 years of follow-up medical data on over 3,000 adults who received RF catheter for paroxysmal or persistent atrial fibrillation. Researchers found that staying in normal sinus rhythm (NSR) was associated with a 60% reduction in the expected rate of cardiovascular mortality (risk of death from stroke and other cardiovascular events).

In another study (Anselmino), a meta-analysis of 26 studies involved 1,838 A-Fib patients who had undergone a catheter ablation. Post-ablation follow-up averaged 23 months. Examining the patient follow-up data, researchers found a significant 13% improvement in left ventricular ejection fraction (EF), i.e., the heart’s blood pumping efficiency.

In addition, there was a significant reduction in the number of patients who formerly had an ejection fraction of less than 35% (more patients improved their EF ratio out of the life-threatening range). Blood pressure levels were also improved.

Summary of Research Findings: These studies reveal some of the real benefits to patients after a successful catheter ablation that go beyond being in normal sinus rhythm (NSR):

• improved quality of life
• significantly lower risk of cardiac-related mortality
• better heart pumping efficiency for more patients (ejection fraction, EF)
• improved blood pressure levels

You may ask, do these side-benefits depend on the catheter ablation eliminating the patient’s A-Fib?

Ever Wonder If There Are Benefits from a Failed Ablation?

Catheter ablation from Cleveland Clinic

VIDEO: Catheter ablation, Cleveland Clinic

Researchers have studied the follow-up data of failed ablations and found a few ‘side’ benefits.

A clinical trial (Pokushalov) showed that, when ablation fails to eliminate paroxysmal atrial fibrillation, a second try is more successful in returning the patient to sinus rhythm than medication alone; it also slows the progression from paroxysmal A-Fib to persistent A-Fib.

In addition, some patients found their A-Fib symptoms were less intense or shorter in duration. (Might be attributed to an improvement in left ventricular ejection fraction.)

Other patients found they could take certain medications that prior to their ablation had been ineffective.

Summary of Research Findings: These studies reveal some of the real benefits to patients even if their catheter ablation doesn’t return them to normal sinus rhythm:

• second ablation is more successful than medication alone
• second ablation slows progression from paroxysmal to persistent A-Fib
• symptoms were shorter or less intense
• certain medications worked that didn’t work before

A catheter ablation can profoundly change one’s life, even if you need a 2nd ablation.

Conclusion

A catheter ablation can profoundly change one’s life, even if you need a 2nd ablation. 

So, either way, a catheter ablation offers benefits to Atrial Fibrillation patients. Even if you need a second ablation (or a third), know that you may still reap substantial benefits from the previous “failed” ablation.

For more about the benefits of ablation, see Live Longer―Have a Catheter Ablation!

References for this article

Increased Dementia Risk Caused by A-Fib: 20 Year Study Findings

Dementia risk is “strongly associated” with younger patients who develop Atrial Fibrillation. That’s the finding of a 20-year study among 6,196 people without established A-Fib.

Rotterdam Study of Cardiovascular Disease

In a 20-year observational study of participants in the long-term Rotterdam Study, researchers tracked 6,514 dementia-free people. Researchers were monitoring participants for dementia and Atrial Fibrillation. At the start of the study (baseline), 318 participants (4.9%) already had A-Fib. 

“The Rotterdam Study” is a long-term study started in 1990 in Rotterdam, The Netherlands. Cardiovascular disease is just one of several targeted diseases.

Results: A-Fib and Dementia

During the course of the study, among 6,196 people without established A-Fib: 11.7% developed A-Fib
and 15.0% developed incident dementia. Other findings:

• Development of A-Fib was associated with an increased risk of dementia in younger people (<67 years old)

• Dementia risk was strongly associated with younger people (<67 years old) who developed A-Fib

• Dementia risk was not strongly associated in the elder participants who developed A-Fib.

The Rotterdam researchers didn’t state explicitly that A-Fib “causes” dementia. Instead they concluded that A-Fib was “strongly associated” with dementia. Because there may be other factors at play, that’s as far as researchers can go (though they did use regression models to adjust for age, sex, and cardiovascular risk factors).

 The younger you are when you develop A-Fib, the more important it is to seek your A-Fib cure to reduce the associated risk of developing dementia.

A-Fib Leads to or Causes Dementia

As patients we have to conclude that, all things being equal, A-Fib leads to and/or causes Dementia. This makes intuitive sense, doesn’t it?

In A-Fib we lose 15%-30% of our heart’s ability to pump blood to our brain, and to the rest of our body. 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.

What Patients Need To Know

The bottom line, the younger you are when you develop A-Fib and/or the longer you have A-Fib, the greater your risk of developing dementia. Seek your A-Fib cure sooner rather than later.

To decrease your increased risk of dementia, your goal should be to get your A-Fib fixed and get your heart beating normally again. We can’t say it enough:

Do not settle for a lifetime on meds. Seek your A-Fib cure.

References for this article

A-Fib Recurrence Post Ablation: Should you Have a Second Ablation? or Anti-Arrhythmic Drug Therapy?

Evgeny Pokushalov, MD, PhD

E. Pokushalov, MD, PhD

It’s disappointing when your heart doesn’t return to normal sinus rhythm (NSR) after your catheter ablation. What’s your next step, your follow-up treatment?

In his study, researcher Evgeny Pokushalov asked several related questions:

“If A-Fib recurs after a patient’s initial catheter ablation procedure, which is the better follow-up treatment? A second catheter ablation or taking antiarrhythmic meds?”

The Three-Year Study

In this study, 154 paroxysmal A-Fib patients who had a failed ablation were divided into two randomized groups.

A catheter ablation can profoundly change one’s life. And, even if you need a second ablation one.

The first group had a second ablation, the other group was put on antiarrhythmic drug therapy (AADs). The two groups were monitored by an implantable loop recorder, followed for three years, then compared.

Study Results

After three years, researchers found A-Fib present in 5.6% of the re-ablation group. In the antiarrhythmic drug group, 18.8% had A-Fib.

A second significant finding was the rate of paroxysmal A-Fib progressing to ‘persistent A-Fib’.  The re-ablation group had a progression rate of 4%, while the progress to “permanent A-Fib’ was 23% in the drug therapy group.

Expected and Unexpected Findings

I had expected (and it was confirmed) that the group getting a second ablation would have better results than the group on antiarrhythmic drug (AAD) therapy.

…progress to permanent A-Fib was 23% in the drug therapy group.

Many studies have documented this when patients undergo their first ablations vs AAD therapy.

What I didn’t expect was the rate of progression to persistent A-Fib in the second group. Nearly one-fourth (23%) of patients taking antiarrhythmic drugs progressed to persistent A-Fib after a failed ablation!

The Message is Clear 

To reduce your risk of progressing to persistent A-Fib, if you have a failed ablation, you are best served getting a second ablation rather than relying on antiarrhythmic drugs.

Are there benefits from a catheter ablation even when the patient’s A-Fib has not been eliminated? Yes! To learn more, see: Are There Benefits from a Failed Ablation? Yes!

References for this article

Chocolate and Reduced Risk of Atrial Fibrillation: A 13-Year Study

In 2017, there’s more on the health benefits of chocolate! Accumulating evidence links chocolate to heart health and now, a lower risk of atrial fibrillation.

A 13-year Danish study published in 2017 tracked the health of 55,000 participants, aged 50–64 years. During the period, more than 3,300 cases of atrial fibrillation emerged. All of the participants had completed detailed questionnaires about their lifestyles, everything from exercise habits to what they ate and drank, including how much chocolate they consumed.

Study Results: Chocoholics Delight

“Our study adds to the accumulating evidence on the health benefits of moderate chocolate intake,” said lead author of the study Elizabeth Mostofsky of Harvard School of Public Health.

Compared to those who ate a 1-ounce serving of chocolate less often than once a month, the risk of atrial fibrillation was:

• 10 percent lower among those who ate one to three servings a month
• 17 percent lower among those who ate one serving a week
• 20 percent lower among those who ate two to six servings of chocolate a week

Benefits of All Types of Chocolate

In the 2015 study, all types of chocolate, including milk chocolate, seemed to have the same beneficial effect.
Most of the previous studies on the chocolate-heart connection found that only dark chocolate offered any cardiovascular protection. But in a 2015 study, “any type of chocolate, including milk chocolate, seemed to have the same beneficial effect” according to Howard LeWine, M.D., Chief Medical Editor, Harvard Health Publications.

Dr. LeWine added that while scientists aren’t sure why chocolate seems to boost heart health, it may be related to flavonoids, a type of antioxidant produced by plants.

Flavonoids are particularly abundant in cacao beans and have been shown to help lower blood pressure, improve blood flow to the brain and heart, prevent blood clots, and fight cell damage. They’ve also been shown to help thinking skills.

To Avoid A-Fib: How Much Chocolate?

The study results found “the rate of atrial fibrillation was 20 percent lower for people consuming two to six 1-ounce servings [of chocolate] per week”.

A-Fib risk was 20 percent lower among those who ate two to six (1 oz.) servings of chocolate a week.

While no recommended daily amounts have been set when it comes to chocolate (or cocoa flavonoids), the European Food Safety Authority suggests that 200 mg of cocoa flavonoids per day is a good target for the general population.

What Patients Need to Know

To reap the various health benefits of chocolate, the higher the cocoa content of the bar, the better. Look for chocolate bars with 70% cocoa or more. You may have to do some detective word, as the amount of cocoa used in chocolate varies a lot (and the amount of flavonoids in chocolate is not always listed.)

Your best bet is to stick with dark chocolate. As a general rule, dark chocolate has more cocoa and therefore more flavonoids than milk chocolate (and less sugar and saturated fat).

References for this Article

 

Eye Disease: The Atrial Fibrillation Link to Glaucoma

Glaucoma is a disease that damages your eye’s optic nerve and is a leading cause of blindness for people over 60 years old. While anyone can get glaucoma, those at higher risk include African Americans over age 40, everyone over age 60 especially Mexican Americans, and people with a family history of the disease. Blindness can often be prevented with early treatment.

Link with Atrial Fibrillation: Glaucoma may be related to ischemia (when your heart muscle doesn’t get enough oxygen) and has been linked with Atrial Fibrillation. Among A-Fib patients, glaucoma is found especially among those who are female, 60+ years old, take the medication Warfarin and have high blood pressure.

Risk May Be Dormant

Patients may be at risk of glaucoma for years but not develop any signs. Then something changes abruptly, such as developing atrial fibrillation, and the glaucoma-related damage begins to occur.

What Patients Need to Know

When you have Atrial Fibrillation, you should be tested for glaucoma regularly (most ophthalmologists will include a glaucoma test as part of your regular eye care).

if you fall into one of the high-risk groups for the disease, make sure to have your eyes examined through dilated pupils every one to two years by an eye care professional. Graphic of tooth A-fib.com

See the dentist too: Besides regular visits with your eye doctor, A-Fib patients should see their dentist regularly, too! See my article about the link between A-Fib, inflammation and gum disease: Brush & Floss! Is Oral Hygiene Linked to A-Fib

https://nei.nih.gov/glaucoma

References for this Article

When Tracking Your Heart: Is a Wrist-Worn Heart Rate Monitor Just as Good as a Chest Strap Monitor?

Wrist-worn heart rate fitness trackers like Fitbit and Apple Watch have become trendy wrist accessories, but are they accurate enough for Atrial Fibrillation patients? How do fitness trackers compare to chest strap heart rate monitors (HRMs)?

What’s Behind the Discrepancies? Different Technologies

Chest-band HRM transmitted to wristwatch

Chest strap style heart rate monitors are consumer products designed for athletes and runners, but used by A-Fib patients, too. They measure the electrical activity of the heart. They’re usually a belt-like elastic band that wraps snugly around your chest with a small electrode pad against your skin and a snap-on transmitter.

The pad needs moisture (water or sweat) to pick up any electrical signal. That information is sent to a microprocessor in the transmitter that records and analyzes heart rate and sends it to a wrist watch display or smartphone app.

Optical HRM with LEDs on inside

Wrist fitness trackers typically sit on your wrist and don’t measure what the heart does. Most glean heart-rate data through “photoplethysmography” (PPG) with small LEDs on their undersides that shine green light onto the skin on your wrist.

The different wavelengths of light interact differently with the blood flowing through your wrist, the data is captured and processed to produce understandable pulse readings on the band itself (or transmitted to another device or app).

HRMs Research Study

A 2016 single-center study was designed to find out whether wrist-worn heart rate monitors readings are accurate. Four brands of fitness trackers were compared against the Polar H7 chest strap heart monitor (HRM) and, as a baseline, with a standard electrocardiogram (ECG).

On a personal note, I used a Polar-brand chest-band monitor when I had A-Fib, and that’s what I recommend to other A-Fib patients.

Researchers at the Cleveland Clinic enrolled 50 healthy adults, mean age, 37 years. In addition to ECG leads and the Polar chest-band heart rate monitor, patients were randomly assigned to wear two different wrist-worn heart rate monitors (out of the four).

Participants completed a treadmill protocol, in which heart rate was assessed at rest and at different paces: between two and six miles per hour. Heart rate was assessed again after the treadmill exercise during recovery at 30 seconds, 60 seconds and 90 seconds.

In total, 1,773 heart rate values ranging from 49 bpm to 200 bpm were recorded during the study. Accuracy was not affected by age, BMI or sex. The four wrist-worn heart rate monitors assessed were the Apple Watch (Apple), Fitbit Charge HR (Fitbit), Mio Alpha (Mio Global) and Basis Peak (Basis).1

HRMs Study Results

Chest Strap Monitors: The chest strap monitor was the most accurate, with readings closely matching readings from the electrocardiogram (ECG).

The chest strap monitor was the most accurate, closely matching the ECG; The wrist-bands were best when the heart was at rest.
In general, the chest straps were more accurate because the sensor is placed closer to the heart (than a wristband), allowing it to capture a stronger heart-beat signal.

Wrist-Worn Monitors: Accuracy of wrist-worn monitors was best at rest and became less accurate with more vigorous exercise, which presumably is when you’d most want to know your heart rate.

None of the wrist-worn monitors achieved the accuracy of a chest strap-based monitor. According to the electrocardiograph, some wrist-worn devices over- or underestimated heart rate by 50 bpm or more.

What Patients Need to Know

Blue-tooth chest-band with smartphone app at A-Fib.com

Blue-tooth chest-band with smartphone app

Wrist-band optical heart-rate monitors may be more convenient or comfortable and have advanced over the years. But in this small study, researchers found that chest-strap monitors were always more accurate than their wrist counterparts and more reliable and consistent.

When monitoring your heart beat rate is important to you (while exercising or doing heavy work), you’ll want to stick with an electrode-containing monitor (chest band-style, shirts or sports bras with built-in electrode pads, etc.).

To help you choose a HRM, see Steve’s Top Picks: DIY Heart Rate Monitors for A-Fib Patients at Amazon.

Bottom line 
Leave the wrist-worn trackers for the casual fitness enthusiasts

References for this Article
Footnote Citations    (↵ returns to text)

  1. Safety Recall of Basic Peak Watch, Sept. 16, 2016: http://www.mybasis.com/safety/

Do we Need to Treat the Spouse as well as the A-Fib Patient?

I recall a heart-wrenching email I received late at night from the distressed wife of an Atrial Fibrillation patient. She described how the stress and anxiety of her husband’s A-Fib had reeked havoc with the entire family and placed the burden of their family-run business entirely on her shoulders. The impact of A-Fib had permeated their entire lives.

Her email ended on a positive note, though, as she told me she couldn’t wait for her husband to wake up so she could share the wealth of information and encouragement she had found on our website, A-Fib.com.

Quality of Life for Family and Spouse of A-Fib Patients

Research verifies that living with someone with Atrial Fibrillation may be about as stressful as actually having the condition. While A-Fib is known to lower ‘quality of life’ among patients, researchers wanted to find out how the families coped.

One-third of all A-Fib patients suffer from depression or anxiety.

In one study (Kopan, et al), researchers surveyed 260 patients and 94 spouses attending an educational symposium on living with Atrial Fibrillation.

Patients with atrial fibrillation reported a significant reduction in their quality of life, and their mates described the same, according to Dr. Bruce A. Koplan of Brigham and Women’s Hospital in Boston.

The overall quality of life effects reported by these two groups did not differ significantly. Perceived impacts were:

• Mild impact for 45.1% of patients and 43% of spouses
• Moderate impact for 28.6% of patients versus 25.8% of spouses
• Severe impact for 26.3% of patients and 31.2% of spouses

In a second study (Bohnen, et al) results were similar: 568 subjects completed the survey of which 411 were A-Fib patients and 129 were spouses/partners. The perceived effect of A-Fib on overall ‘quality of life’ was similar between patients and spouses. (Results did not change when adjusted for age and gender.)

Perceived impacts were: Mild for 42.0% of patients vs. spouses 44.1%; Moderate for 26.0% of patients vs. spouses 25.2%; and Severe for 32.0% of patients vs. spouses 31.7%.

Note: the adverse effect of A-Fib on patients’ sex life was the domain most frequently reported as being severely impaired.

Perhaps, A-Fib patients should also ask, “How can I help my family cope with the stress and anxiety of my A-Fib?”

Educate the Family Not Just the Patient

One simple solution might be to make sure the spouse comes to office visits, particularly during the early visits around the time of diagnosis, Dr. Koplan said. “Sometimes spouses come but stay in the waiting room,” he said. “But I don’t think that’s a good idea because they’re suffering too.”

According to Dr. Koplan, educational programs and other interventions aimed at improving patients’ quality of life should take spouses into account as well. Eliminating some of the unknowns may relieve the anxiety for both.

What Patients Need to Know

One of the most frequently asked questions at A-Fib.com is “What can I do for my spouse during an A-Fib attack?” Perhaps, A-Fib patients should also ask, “How can I help my family cope with the stress and anxiety of my atrial fibrillation?”

When I talk with an A-Fib patient, I always ask how their spouse or partner is doing―how they are coping. This often elicits a momentarily pause while the patient stops and ponders the impact of A-Fib on their family.

My best advice to patients is to get all your loved ones involved! Talk with them, answer their questions. Start with my report, “Top 10 Questions Families Ask about Atrial Fibrillation”, and then Why & How to Create Your ‘A-Fib Episode Action Plan’.

References for this Article

A-Fib and Dementia: My Top 5 Articles

There’s a growing body of evidence linking atrial fibrillation with early onset of dementia, one of the most feared diseases. (New cases of dementia are diagnosed every four seconds.)

When 65+ year olds were asked what disease or condition they were most afraid of getting, 56 percent cited memory-robbing dementia.

While both Atrial fibrillation and dementia have been linked to aging, neither is a normal part of growing older.

A-Fib Patients: Reducing Your Risk of Developing Dementia

You CAN impact developing or avoiding dementia. Review these articles to learn more about the link between Atrial Fibrillation and dementia:

1. FAQ: “I’m scared of getting dementia. Can the right minerals help? I’ve read about the link with A-Fib. What does research reveal about this risk?”
2. Leaving Patients in A-Fib Doubles Risk of Dementia—The Case for Catheter Ablation
3. Warfarin + Aspirin = Increased Risk of Dementia
4. FAQ: I’m concerned because Vitamin D deficiency has been tied to both A-Fib and Dementia. What is a normal level of Vitamin D?
5. Risks of Life-Long Anticoagulation Therapy: Patient on Anticoagulation Therapy for 10 years Develops Cerebral Microbleeds and Associated Early Dementia

Strategies for Preventing Dementia

What doesn’t work: current drugs, even statins, don’t work or have mixed results in preventing dementia.

What does work: Catheter ablation to eliminate your Atrial Fibrillation. Patients who get a catheter ablation have long-term rates of dementia similar to people without A-Fib. (This result holds regardless of their initial CHADS2 score.)

Don’t Settle. Seek your A-Fib cure: To decrease your increased risk of dementia, your goal should be to get your A-Fib fixed and get your heart beating normally again. We can’t say it enough:

Do not settle for a lifetime on meds. Seek your A-Fib cure.

Click image to enlarge "Seek your Cure" graphic at A-Fib.com

Click image to enlarge

Reference for this Article

In Persistent A-Fib? Time Matters: Ablate Sooner for Better Outcomes

Note: This research study is important if you have Persistent A-Fib or your Paroxysmal A-Fib has progressed to Persistent A-Fib.

The Cost of Waiting to Ablate

In patients with persistent atrial fibrillation undergoing ablation, the time interval between the first diagnosis of persistent A-Fib and the catheter ablation procedure had a strong association with the ablation outcomes.

Cleveland Clinic researchers found that shorter diagnosis-to-ablation time spans were associated with better outcomes. Longer diagnosis-to-ablation times was associated with a greater degree of atrial remodeling.

When A-Fib becomes persistent A-Fib, the ‘first diagnosis-to-ablation time span’ had a stronger impact on outcomes than the time spent in paroxysmal A-Fib.

According to electrophysiologist Dr. Oussama Wazni, “once the diagnosis of atrial fibrillation is made, it’s important not to spend too much time trying to keep a patient in normal rhythm with medical [drug] therapy” before referring for radio-frequency ablation.” Dr. Wazni is Co-Director of the Center for Atrial Fibrillation at the Cleveland Clinic.

His comments are based on the published analysis of two-year outcomes among 1,241 consecutive patients undergoing first-time ablation of persistent atrial fibrillation over an eight-year period at Cleveland Clinic. All patients had successful isolation of all 4 PVs (pulmonary veins), and the superior vena cava was isolated in 69.6%. In addition, Left Atrium ablations (including complex fractionated electrograms) were performed in 65.6% of patients.

First Diagnosis-to-Ablation Time Span: The Shorter the Better

Importantly, the first diagnosis-to-ablation time interval (of persistent A-Fib) had a stronger impact on outcomes than the time spent with a paroxysmal A-Fib diagnosis or the duration of continuous A-Fib before the ablation procedure.

These findings suggest that A-Fib is a disease with a continuous spectrum…
The findings suggest that A-Fib is a disease with a continuous spectrum, with patients at the extreme end of that spectrum having higher arrhythmia recurrence rates after catheter ablation, whereas patients with shorter diagnosis-to-ablation times having lower recurrence rates.

The analysis was published in the Jan. 2016 issue of Circulation: Arrhythmia and Electrophysiology. (Read online or download as a PDF.)

Reference for this Article

NOAC or Warfarin for Valvular A-Fib?

Patients with ‘Valvular Atrial Fibrillation’ are often restricted from most A-Fib clinical studies and research. In particular, for NOAC trials, people with Valvular A-Fib have generally been excluded because they may have a higher rate of forming clots (e.g.: left atrial clots). 

“Valvular Atrial Fibrillation” refers to those A-Fib patients with artificial heart valves or mitral stenosis.

Like most A-Fib patients, Valvular A-Fib patients with bioprosthetic or mechanical valves have to be on an anticoagulant which up to now was restricted to warfarin. So, are the new NOACs an option?

Bioprosthetic valves are non-synthetic (usually porcine) devices used to replace a defective heart valve. Compared to mechanical valves, bioprosthetic valves are less likely to cause clots, but are more prone to structural degeneration (35% fail within 15 years).

Warfarin vs Edoxaban (NOAC)

A 2017 study showed that the Novel Oral Anticoagulant (NOAC) edoxaban (brand name: Savaysa) was safer than warfarin in preventing an A-Fib stroke in people with bioprosthetic heart valves.

Edoxaban 30 and 60 mg (Savaysa)

Edoxaban works by inhibiting factor Xa in the coagulation process. The lower dose (30 mg) was associated with a reduced rate of major bleeding, but not the higher dose (60 mg).

Compared to warfarin, edoxaban was associated with lower annual stroke rates, systemic embolic events, major bleeds, and deaths annually.

“Our analysis suggests that edoxaban appears to be a reasonable alternative to warfarin in patients with Afib and remote bioprosthetic valve implantation,” according to Dr. Robert P. Giugliano of Brigham and Women’s Hospital in Boston, MA.

Edoxaban Works With Bioprosthetic Valves But Not Mechanical Ones

For the first time, research indicates that a NOAC (edoxaban) can be used for Valvular A-Fib to prevent an A-Fib stroke―but only in the case of bioprosthetic (porcine) valves.

The NOAC, Edoxaban (Savaysa), was safer than warfarin for A-Fib patients with bioprosthetic valves.

With regards to mechanical valves, the authors cited a study in which dabigatran (Pradaxa) fared poorly in mechanical valves.

What About Other Factor Xa NOACs?

What about the other ‘factor Xa inhibitors’ such as Xarelto and Eliquis? Can they be used like edoxaban? Currently there is little clinical data on this subject. But since all three are factor Xa inhibitors, most likely they will be proven to be effective in A-Fib patients with bioprosthetic valves.

What Patients Need to Know

Do you have Valvular A-Fib and a bioprosthetic valve? Are you on warfarin? If being on warfarin is difficult for you, you now have a choice of anticoagulant. Ask your doctor about switching to the NOAC, edoxaban.

Reference for this Article

Atrial Fibrillation and Atrial Flutter: Cause and Effect?

About Atrial Fibrillation and Atrial Flutter…are they linked? Does one precede the other? Can one procedure fix both? Can a typical catheter ablation fix both Atrial Fibrillation and Atrial Flutter at the same time? Can Maze surgery or Mini-maze surgery fix both?

Surgery vs. Ablation

In general, Atrial Flutter originates in the right atrium and Atrial Fibrillation in the left atrium.

Maze/Mini-maze surgical approaches typically don’t access the right atrium, and therefore can’t fix A-Flutter.

Maze/Mini-maze surgical approaches typically don’t access the right atrium, and therefore can’t fix A-Flutter. If you have both A-Fib and A-Flutter, a Maze procedure needs to be followed by a catheter ablation to fix the Atrial Flutter.

A catheter ablation procedure for A-Flutter is relatively easy and it’s highly successful (95%). It usually involves making a single line in the right atrium which blocks the A-Flutter (Caviotricuspid Isthmus line).

A Catheter Ablation Two-Fer? 

If you are having a catheter ablation, many doctors make this Caviotricuspid Isthmus ablation line while doing an A-Fib ablation (in the left atrium)—even if you don’t have A-Flutter at the time.

Catheter inserted into the heart and through septum wall into Left Atria

Catheter inserted into the heart and through septum wall into Left Atria

Catheters enter the heart through the right atrium. At the beginning of a catheter ablation for atrial fibrillation, doctors enter the heart through the right atrium. While there they may elect to make the right atrium ablation line at this point which takes 10-20 minutes.

They then go through the wall separating the right and left atria (transseptal wall) to do the ablation for A-Fib in the left atrium. (Some doctors chose to place the right atrium ablation line at the end of an ablation when they withdraw from the left atrium into the right atrium.)

Some say one should “do no harm” and not make this right atrium ablation line if there is no A-Flutter. Saying it can always be done later in another catheter ablation at little risk to the patient.

Research: Are A-Fib and A-Flutter Linked?

While you can have A-Flutter without A-Fib, more often than not, they are linked. When you have A-Flutter, A-Fib often lurks in the background or develops later.

Patients did much better if they had an ablation for both A-Fib and a A-Flutter at the same time even though they appeared to only have A-Flutter.

Some A-Flutter may originate in the left atrium, or the A-Flutter may mask A-Fib which may appear later after a successful A-Flutter ablation.

As many as half of all patients ablated for A-Flutter may later develop A-Fib.

In a small research study, patients did much better if they had an ablation for both A-Fib and a A-Flutter at the same time even though they appeared to only have A-Flutter.

What Patients Need to Know

But right now we can’t say for sure if one causes the other. We do know that A-Flutter usually comes from the right atrium, while A-Fib usually comes from the left atrium.

Resources for this article

New Research into Alcohol & A-Fib: How Many Drinks are Too Many?

“While moderate amounts of alcohol appear protective for the ‘plumbing,’ or blood supply to the heart muscle, the benefits of alcohol do not extend to the electrical parts of the heart, or heartbeat.”

Over time, drinking may actually change the electrical signals, triggering irregular heartbeat (arrhythmias).

“The benefits of alcohol do not extend to the electrical parts of the heart.”

Risk per Daily Alcohol Drink

A new study found the risk of atrial fibrillation grew by 8 percent for each daily alcoholic drink. The findings were similar for men and women. The authors looked at previous studies that tracked almost 900,000 people over 12 years.

Fibrosis: The study doesn’t establish a direct cause-and-effect relationship. Nevertheless, “cell damage from habitual drinking may lead to small amounts of fibrous tissue within the heart that causes the irregular, quivering heartbeat”, the study authors said.

Post-catheter ablation: The review found that people who continue to drink are more likely to have ongoing irregular heartbeats even after catheter ablation.

Weekly recommendation: “..No more than one alcoholic drink per day with two alcohol-free days a week.”

Weekly Alcohol Recommendation

Dr. Pater Kistler recommended that those with irregular heartbeat “should probably drink no more than one alcoholic drink per day with two alcohol-free days a week.”

He added they had no randomized data that tells what a ‘safe’ amount is to consume. The study authors called for more research to determine whether avoiding alcohol completely is required for patients who have irregular heartbeats.

Know Your Triggers

Some Atrial Fibrillation patients have sworn off alcohol altogether. Through trial and error, they’ve found that any amount of alcohol contributes to or triggers their A-Fib episodes.

Dr. Kistler’s research is helpful for the balance of A-Fib patients. It offers some research-based guidelines to minimize the impact of alcohol consumption on their A-Fib.

For additional reading, see my article:Holiday Heart”: Binging Alcohol, Marijuana & Rich Foods.

Resources for this article

New Research on NOACs: Which has More Bleeding Risk―Which is Safer?

Do you take the anticoagulant, Xarelto? Or one of the newer NOACs? Which is safest? Which has the least GI bleeding?

NOACs Research Study Results

The New NOACs - anticoagulants graphic at A-Fib.com

Which is safer?

A Mayo Clinic study indicated that the risk of gastrointestinal (GI) bleeding is higher for patients taking Xarelto than for other anticoagulants in its class.

The researchers compared the gastrointestinal (GI) safety profile of three rival oral anticoagulants: Xarelto (rivaroxaban), Pradaxa (dabigatran) and Eliquis (apixaban). All of the patients in the study had Atrial Fibrillation.

Bleeding occurrence: GI bleeding occurred more frequently in patients taking Xarelto compared to Pradaxa (approximately 20% increased risk), while Eliquis had the lowest GI bleeding risk.

Age factor: They also found that the risk of GI bleeds increased with age. In particular, patients over the age of 75 were at an increased risk.

Safety: Eliquis had the most favorable GI safety profile, even among very elderly patients, and Xarelto had the least favorable. … Continue reading this report…->

With A-Fib, Stroke is Not Your Only Risk

Xarelto advertisement

We hear it every day on TV, ads about ‘living with Atrial Fibrillation’. In today’s media, the message is about how to ‘manage’ your A-Fib. You’re advised to ‘just take our anticoagulant’ and you’ll live happily ever after.

But recent research (and common sense) indicates otherwise.

Mega Research Analysis of Your Additional Risks

Researchers at Oxford University, Oxford, UK and Massachusetts Institute of Technology (MIT), Cambridge, MA, USA, conducted a systematic review and analysis of 104 different studies involving nearly 10 million people, of which, over a half-million had A-Fib.

They found that Atrial Fibrillation is associated with not just stroke, but also with:

• Heart Disease
• Heart Failure
• Kidney Disease
• Sudden Death
• Death from All Causes

The term “associated with” is as strong as academic researchers can state their findings as other factors may be at play.

Heart failure: The strongest association was with heart failure, which was five times more likely in people with A-Fib. Because your heart isn’t pumping properly, it’s not surprising that A-Fib leads to heart disease, heart failure and sudden death.

Kidney disease: A surprising association is that A-Fib is tied to kidney disease and peripheral arterial disease, probably because of poor circulation due to A-Fib.

Death from all Causes: This isn’t such a surprising finding as A-Fib affects the whole body. A-Fib damages your heart, brain and other organs. It reduces the heart’s pumping capacity by about 15%-30% which may cause weakness, fatigue, dizziness, fainting spells, swelling of the legs, and shortness of breath.

Patients with A-Fib, even if they don’t have a stroke or heart failure, are more likely to die from other causes compared with people in normal sinus rhythm (NSR).

Note: this study didn’t examine the known link between dementia and A-Fib. See Leaving Patients in A-Fib Doubles Risk of Dementia—The Case for Catheter Ablation

Don’t be Misled by Pharmaceutical Ads

Xarelto drug ad at A-Fib.com

Xarelto drug ad with Brian Vickers, Arnold Palmer & Kevin Nealon

For patients with A-Fib, it isn’t enough to simply take an anticoagulant!

We need to worry not just about stroke, but also about the risks and potential damage of A-Fib to our overall health.

Contrary to today’s media, your goal shouldn’t be to just ‘manage your A-Fib’. It’s a Pollyanna fantasy to just ‘Take a pill (anticoagulant) and live happily ever after’.

That misconceoption is propagated by drug manufacturers who want you to stay an A-Fib patient and thus a customer for life.

Don’t Just Live with A-Fib

Don’t Settle. Seek your A-Fib cure. Your goal should be to get your heart beating once again in normal sinus rhythm (NSR). We can’t say it enough…

Do not settle for a lifetime on meds. Seek your A-Fib cure.

Resources for this article

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