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

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

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

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

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

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


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

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

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

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

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

Terry Traver, former A-Fib patient

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

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


Can a Broken Heart Lead to Atrial Fibrillation? Yes!

by Patti J. Ryan, October 2016

Called ‘Broken Heart Syndrome’, a new study finds that the death of a partner is linked to a heightened risk of developing atrial fibrillation. The risk seems to be greatest among the under 60s and when the loss of the partner was least expected.

Risk of A-Fib with loss of partner

Risk of A-Fib with loss of partner

The researchers looked at a national registry in Denmark of 88,612 people who were diagnosed with atrial fibrillation and 886,120 healthy people matched for age and sex, and between 1995 and 2014. Other factors that might influence atrial fibrillation risk were included as well.

They found that people who had lost a partner were 41% more likely to develop atrial fibrillation in the first month after losing their partner. The risk seemed to be greatest 8 to 14 days following a death and gradually subsided during the following year.

More Evidence of Mind-Heart Link

Experts suspect acute stress may directly disrupt normal heart rhythms and prompt the production of chemicals involved in inflammation.

This study adds evidence to the growing knowledge that the mind-heart link is a powerful association.

What can be done about this risk? The answer requires more research but may focus on the way the body deals with stress.

Recommended Reading: The Anatomy of Hope: How People Prevail in the Face of Illness, by Jerome E. Groopman.

Written by an oncologist and citing actual patient cases (mostly cancer), Dr. Groopman explores the role of hope in fighting disease and healing. Top scientists are interviewed who study the biological link between emotion and biological responses; the most relevant studies are reviewed.

The author shows how hope, belief and expectations can alter the course of our lives, and even of our physical body. HOPE works! (For more read my review on Amazon.com.)

Resources for this article

MAM 2016: Fantastic 3-D Experience of the Heart or Why We Were Wearing 3-D glasses!


The movie won an Oscar for Best Special Visual Effects; Image: Foresight Institute

by Steve S. Ryan, PhD

In 1966, the wide-screen movie Fantastic Voyage took viewers inside the human body by injecting a miniaturized submarine, its crew and a surgical team into the carotid artery. Their mission was to break up a clot and save the VIP patient. Traveling through the heart to the brain, reveals a world of dazzling color, a floating wonderland with huge red corpuscles, whirling globules, platelets and particles.

I had that same amazing experience when Dr. Joris Ector presented his incredible 3-D vision of a real heart. Just like when watching the movie, there were involuntary gasps and shocks as you felt what it was like to move through the heart.

And yes, we had to wear 3-D glasses! That’s got to be a first at an A-Fib conference.

Joris Ector MD, with 3D glasses at MAM 2016 - A-Fib.com

Joris Ector MD, wearing 3D glasses; Inset: the exterior of the 3-D heart

Starting with the exterior of a beating heart, Dr. Ector, from the University of Leuven, Belgium, showed every possible 3-D angle.

Next, he peeled away the exterior to reveal the movement of the heart from the inside. Next, he whisked you inside the heart so fast that you almost got dizzy.

Particularly interesting was the trip through the left atrium into the Left Atrial Appendage (LAA) with its trabeculations (thick muscular tissue bands) which looked like columns in close-up.

In some ways, Dr. Ector’s presentation felt more real and comprehensive than watching footage of an actual heart beating. It was an astounding experience (just like watching Fantastic Voyage in 1966). (I wish I had an interior of the 3-D heart to share with you.)

Image credit: Fantastic Voyage movie still from Foresight Institute

Return to Reports of A-Fib Medical Symposiums & Conferences

If you find any errors on this page, email us. Last updated: Friday, October 7, 2016


Heart Team/MAM 2016: Moving A-Fib Care to a New Level

Multidisciplinary Arrhythmia Meeting 2016Totally historic! The MAM 2016 symposium set important goals for shaping the future of A-Fib care and showed how the emphasis on a ‘Heart Team’ is moving the field of patient A-Fib care to a new level.

This first Multidisciplinary Arrhythmia Meeting (MAM) was held in Zurich, Switzerland Sept 15-16, 2016 and advocated for a team approach―EPs, Surgeons, and other healthcare professionals working together to better help the A-Fib patient.

Leading cardiologists and surgeons explained why they favored the hybrid surgery/ablation referred to by several terms: “hybrid simultaneous,” or “hybrid staged,” or “multidisciplinary sequential approaches”.

MAM 2016 Hands-on demos at A-Fib.com

MAM 2016 Hands-on demos

Interactive Hands-On Workshops and Live Surgery

MAM 2016 featured interactive workshops with hands-on experiences in EP ablation, Surgical Ablation, and Mechanical Exclusion of the Left Atrial Appendage (LAA). Included were working examples of clinicians, electrophysiologists and surgeons teaming up to better help A-Fib patients.

MAM 2016 Live video feed of A-Fib surgery at A-Fib.com

Live video feed of A-Fib surgery by Dr. Stefano Benussi and staff

Observing via a live video feed, attendees watched Dr. Stefano Benussi and his colleagues perform a surgery of an A-Fib patient showing both the left side and right side approaches. (The patient had a huge amount of fat which first had to be cut away before the pericardium sac could be reached and cut into in order to access the heart and pulmonary veins.)

MAM 2016 Program and Faculty

Dr. Stefano Benussi and Steve Ryan in Zurich at A-Fib.com

Dr. Stefano Benussi and Steve Ryan, PhD

The  Multidisciplinary Arrhythmia Meeting was the brain child of the Course Director Dr. Stefano Benussi of the University Hospital Zurich, Switzerland. Course Co-Directors were Harry Crijins of Maastricht, the Netherlands and Firat Duru of Zurich, Switzerland.

The Program Committee and Scientific Faculty making presentations included 54 distinguished doctors from around the world including the famed inventor of the original Cox Maze operation, James L. Cox of Denver, USA. (The Cox Maze operation was the first treatment to make patients A-Fib free.)

A partial list of MAM 2016 participating doctors and countries:

Steve in front of MAM 2016 meeting site in Zurich - A-Fib.com

Steve in front of MAM 2016 meeting site in Zurich

Manuel Castella, Barcelona, Spain
Paolo Della Bella, Alberto Pozzoli, Claudio Tondo, Milan, Italy
Karl Heinz Kuck, Andreas Metzner, Hamburg, Germany
Bart van Putte, Utrecht, The Netherlands
Malcolm Dalrymple-Hay, Guy Haywood, Plymouth, UK
Joris Ector, Mark La Meir, Laurent Pison, Brussels, Belgium
Hans Kottkamp, Diana Reser and many more from Zurich, Switzerland
Gunther Laufer, Vienna, Austria
Randal Lee, Bing Liem, Steve S. Ryan, California, USA
Ju Mei, Shanghai, China
Peter Mueller, Dipen Shah, Geneva, Switzerland
Amiran Revishvili, Moscow, Russia
Timo Weimar, Stuttgart, Germany
Michael Zembata, Zabrze, Poland

Additional presenting doctors will be identified along with summaries of their individual presentations.

My presentation summaries will follow.

Return to Reports of A-Fib Medical Symposiums & Conferences

If you find any errors on this page, email us. Last updated: Monday, October 3, 2016


How A-Fib Damages Your Heart, Brain and Other Organs

A-Fib reduces the amount of blood flowing to the rest of your body by about 15%–30% and can have damaging effects.

That’s because the upper parts of your heart (the atria) aren’t pumping enough blood into the lower chambers of your heart (the ventricles). At the same time, your heart is working progressively harder and harder.

Here’s what can happen to your heart if you choose to just ‘live with Atrial Fibrillation”:

Don’t Just Live With Your A-Fib

Don’t listen to doctors who advise you to ‘live with A-Fib’ and who prescribe a lifetime on medication. Get a second opinion, or even a third! Educate yourself.

Seek your A-Fib cure!

Hybrid Surgery/Ablation Topic of the Multidisciplinary Arrhythmia Meeting (MAM)

Background: The Hybrid approach is an unusual team effort and is complementary in nature: the Surgeon works on the outside of the patient’s heart and the Electrophysiologist on the inside of the same patient’s heart.
Hybrid Surgery/Ablation is becoming an increasingly important and effective strategy for highly symptomatic patients with persistent atrial fibrillation or longstanding persistent atrial fibrillation who have failed one or two catheter ablations, and for the patient with a significantly enlarged left atrium. (Read more: Hybrid Surgery/Ablation.)

Multidisciplinary Arrhythmia Meeting (MAM)

Multidisciplinary Arrhythmia Meeting (MAM) GFXThe goal of MAM is to improve interaction between cardiologists and surgeons through multiple examples of cooperation in dealing with Atrial Fibrillation. [Note: In the past, it’s been a rare occurrence for a surgeon to work with a cardiac electrophysiologist.]

Zurich stamp GFX

Reporting for A-Fib.com

Cardiologists and surgeons from leading institutions in Europe, the US and Asia will discuss their experiences with hybrid simultaneous, hybrid stages, and multidisciplinary sequential approaches, and report their results.

Reporting from Zurich in September: I’ve been invited to attend this first Multidisciplinary Arrhythmia Meeting (MAM) by the organizers. I’ll be reporting on the key presentations and writing summary reports for our A-Fib.com readers.

Reduce Your Family’s Risk of Arrhythmia: Don’t Store Food in Plastic

The harmful chemical compound, BPA, may have been removed from many plastic bottles and food packaging, but “BPA-free” products may not be much safer.

The BPA chemical replacements, BPS and BPF, can also leach into food and beverages and may have the same impact on the human body (heart problems, as well as cancer, infertility and other health issues).

BPA Replacement Linked to Arrhythmias in Female Rats

Kinetic GoGreen Glasslock Elements food storage at A-Fib.com

Avoid BPS leaching: Use glass or ceramic containers to store or microwave food

A study published in the Journal Environmental Health Perspectives (Seltenrich) shows that the chemical compound BPS has nearly identical impacts on the cardiovascular system of rats as those previously reported for BPA. Researchers reported a link between BPS and irregular heartbeat. More research is needed.

What to Do: It Doesn’t Hurt To Be Cautious

Water bottle - Got A-Fib-Lets Talk at A-Fib.com

Aluminum water bottle at Spreadshirt.com

To reduce your risk of arrhythmia from BPS/BPF, decrease or eliminate your use of plastic storage containers for food or drink.

Drink from steel or glass containers, not plastic ones.

Don’t microwave your food in plastic containers. The heat from the microwave can separate BPA-like compounds from plastic containers, making them easier to ingest. If you must use plastic containers, avoid the microwave.

Ideally, just store food in ceramic, glass or stainless steel containers in the first place.

To read more, see the April 2015 TIME magazine article by Justin Worland, Why ‘BPA-Free’ May Be Meaningless.
References for this article

Conflicts of Interest—The Hidden Cost of Free Lunch for Doctors

by Steve S. Ryan, PhD, updated September 18, 2016

Few people in the U.S. today are shocked or scandalized that the Drug and Device Industry (DDI) basically bribes doctors and hospitals to prescribe their drugs or use their equipment. It’s so commonly done that we take it for granted.

In the U.S., in general, it isn’t considered unethical or immoral for doctors to accept payments or favors from the Drug and Device Industry (DDI). Nor is it illegal.

But soon U.S. patients will be able to simply type in our doctor’s name in the Open Payments Database and see how much they are being paid by the DDI and what conflicts of interest they have.

Open Payments DataThanks to the Sunshine Act (a provision of the U.S. 2010 Patient Protection and Affordable Care Act), the DDI must report when they make a payment to a doctor for meals, promotional speaking or other activities.

This data is available at https://projects.propublica.org/docdollars/ Just type in your doctor’s name. See also, OpenPaymentData.CMS.gov and the ProPublica Dollars for Docs project.

Influencing Doctors’ Prescriptions for the Price of a Meal

In a recent JAMA Internal Medicine report (DeJong, C., June 2016), the authors compared meal payments to doctors with the drugs they prescribed to Medicare patients.

Even doctors who accepted only one free meal were more likely to prescribe the brand name drug.

Not surprisingly, they found that physicians who accept free meals from a drug company are more likely to prescribe that company’s brand name drugs rather than cheaper (and usually more proven) generic drugs. This study only focused on physicians who received meals.

Even doctors who accepted only one free meal were more likely to prescribe the brand name drug. Doctors who accepted four or more meals were far more likely to prescribe brand name drugs than doctors who accepted no meals. Furthermore, doctors who accepted more expensive meals prescribed more brand name drugs.

In another related JAMA Internal Medicine report (Yeh, JS, June 2016), researchers found similar evidence that industry payments to physicians are associated with higher rates of prescribing brand-name statins.

Steer Clear of Conflicts of Interest

The publication, Bottom Line Personal, offered words of wisdom on this subject.

“Studies have found that when there is a conflict of interest, it is almost impossible for even well-meaning people to see things objectively.”

Dr. Dan Ariely of Duke University described how, if a doctor must choose between two procedures, they are likely to pick the one that has the better outcome for their bottom line.

“That doesn’t mean the doctor is unethical…it just means he is human. We truly seem to not realize how corrosive conflicts of interest are to honesty and objectivity.”

He advocates that we steer clear of people and organizations with conflicts of interest “because it does not appear to be possible to overcome conflicts of interest.”

Conflicts of Interest: Be Suspicious of Doctors

Doctors are only human. If a drug rep gets them great tickets to a sporting event, for example, of course they will be inclined to favor that rep’s drug.

Whenever you visit a health/heart website ask yourself: “Who owns this site?” and “What is their agenda?”

But be suspicious if your doctor tells you:

• to take an expensive new drug
• to just “live with your A-Fib”
• insists that catheter ablation is too dangerous or unproven
• that A-Fib can’t be cured
• that you have to take drugs for the rest of your life

If this happens to you, RUN and get a second opinion (and even a third opinion).

Conflicts of Interest: Be Suspicious of Health/Heart Websites

When I attend talks at most A-Fib conferences, the first slide a presenter shows is often a list of their Conflicts of Interest.

But this is not required of websites! Health/Heart websites are not required to be transparent and reveal their conflicts of interest.

Whenever you visit a health/heart website ask yourself: “Who owns this site?” and “What is their agenda?” (Hint: Check their list of “sponsors” and follow the money!)

Drug Industry Owns or Influences Most Heart/Health Web sites

The drug and device industry owns, operates or influences almost every health/heart related web site on the Internet!

The fact is most health/heart web sites are supported by drug companies who donate most of their funding.

For example, did you know that the drug company Ely Lilly partially owns and operates WebMD, the Heart.org, Medscape.com, eMedicine.com and many other health web sites?

The fact is that most health/heart web sites are supported by drug companies who donate most of their funding. Consider how that may affect the information they put on their web sites―they’re not going to bite the hand that feeds them.


About A-Fib.com: Read A-Fib.com disclosures on our website and check
A-Fib.com’s 990s at GuideStar.org.

Be Suspicious of A-Fib Info on the Internet

Steve Ryan video at A-Fib.com

Video: Buyer Beware of Misleading or Inaccurate A-Fib Information.

In our crazy world, you can’t afford to trust anything you read on the Internet.

At one time I tried to keep track of all the mis-information found on various A-Fib web sites. When we’d find something wrong, we would write the site. I don’t think we’ve ever received a reply. Finally, we gave up. (See my video: Buyer Beware of Misleading or Inaccurate A-Fib Information.)

Many web sites put out biased or mis-information. Be skeptical. You can tell if someone is trying to pull the wool over your eyes. Truth will out. If you feel uncomfortable or that something is wrong with a site, it probably is. When you find a good site, the truth will jump out at you.

In today’s world, you have to do your own due diligence. You know what makes sense and what doesn’t.

For more, see my article: EP’s Million Dollar Club—Are Payments to Doctors Buying Influence?

References for this article


Wearables in Healthcare: You can Help Develop A-Fib App

It’s early days for wearables in healthcare, but there’s a lot of potential.

In the near future, an Apple Watch or Android Wear could detect if the wearer is experiencing Atrial Fibrillation. A preliminary algorithm (app) to detect A-Fib has been developed by researchers at UCSF and engineers at Cardiogram, Inc.

Sample of A-Fib app on Smart Watch

Sample of A-Fib app on Smart Watch

The mRhythm Study: You Can Help Develop the Smart Watch App

The researchers need your help now. If you have an Apple Watch or Android Wear—regardless of whether you have A-Fib—you can contribute your data to help make the algorithm more accurate.

The mRhythm Study is being run with the UCSF Health eHeart Study, using Cardiogram to train a deep learning algorithm to detect atrial fibrillation.

To Participate in the Study: Visit the mRhythm Study website and scroll down the page and look for ‘We Need Your Help.’ At the bottom of the page, you can then read answers to ‘Frequently Asked Questions’.

See How the System Works: To see the graphic displays of how the system works, go to Cardiogram, Inc. or see the Apple Watch graphics in particular.

mrhythm graphic 400 x 175 pix at 300 res

What atrial fibrillation and normal heart rhythm look like when measured on a watch.

What This Means for Patients

Each year, more than 100,000 strokes are caused by A-Fib. But all too often, their A-Fib is “silent” with no obvious or noticeable symptoms. In these cases, their A-Fib is undiagnosed until they have a stroke. Only then do they find out they have A-Fib (…if they survive). About 50% will have a disabling stroke.

Apple Watch owners—regardless of whether you have A-Fib—you can contribute your data to help develop this app. 

If the Smart Watch algorithm app works as intended, anyone with an Apple Watch or Android Wear will be alerted if they are experiencing Atrial Fibrillation.

For the undiagnosed, their A-Fib will be ‘visible’ and no longer be “silent.” They will know if they are at risk of an A-Fib stroke and can get the proper preventive treatment.

Today patients rely on an ECG in a doctor’s office or the use of a Holter monitor to detect A-Fib. Instead, a Smart Watch with the A-Fib app can extend a patient’s monitoring period to a year (between doctor’s visits) or on an on-going basis.

Amazing! Think of all the lives saved and debilitating strokes avoided! The A-Fib Smart Watch app has the potential to revolutionize the field of A-Fib monitoring.

References for this article


New Report: Is Your Stroke A-Fib-Related or Something Else?

Third in my series from the Ninth Annual Western Atrial Fibrillation Symposium held February 26-27, 2016 in Park City, UT. Read my other reports here.

If you have A-Fib, it’s important to realize that not all strokes are ‘A-Fib related’. You may be perfectly anticoagulated or have a Watchman Device installed and still experience a stroke.

Realize: an A-Fib patient can have a stroke that isn’t caused by A-Fib.

Dr. Jennifer Majersik of the Stroke Center of the Un. of Utah described the case of a man with A-Fib who had an ischemic stroke even though his INR on warfarin was in the correct range.

An A-Fib patient can have a stroke that isn’t caused by A-Fib. There are multiple mechanisms which can cause a stroke. Of the 690,000 strokes in the US/year nearly 1/3 are cryptogenic (of unknown cause) and of those 30% is caused by asymptomatic or Silent A-Fib.

Read my full report in which Dr. Majersik described five subtypes of artery occlusion strokes (as opposed to hemorrhagic [bleeding or vessel rupture] strokes.) <…continue reading…>


65 and Older: 99% Have Microbleeds—So Are Anticoagulants Risky?

In a  recent study, 99% of subjects aged 65 or older had evidence of microbleeds; and closer examination of the cranial MRI images revealed an increased number of detectable microbleeds (i.e., the closer they looked, the more microbleeds they found).

Microbleeds in the brain are thought to be a precursor of hemorrhagic stroke.

Cerebral microbleeds (MBs) are small chronic brain hemorrhages of the small vessels of the brain.

If Microbleeds Cause Hemorrhagic Stroke, Should I be on a Blood Thinner?

The fact that almost everyone 65 or older has microbleeds is astonishing and worrisome, particularly if you have A-Fib and have to take anticoagulants. Anticoagulants cause bleeding. That’s how they work.

In plain language, this study indicates that cerebral microbleeds lead to or cause hemorrhagic stroke. It’s not surprising then that some doctors are reluctant to prescribe heavy-duty anticoagulants to older A-Fib patients.

Being older and already having microbleeds only makes taking anticoagulants all the more worrisome.

Risks of Taking Anticoagulants (Blood Thinners)

Taking most any prescription medication has trade-offs. Older A-Fib patients find themselves between a rock and a hard place.

In the case of anticoagulants, on one hand you get protection from having an A-Fib stroke (which often leads to death or severe disability), but on the other hand you have an increased risk of bleeding.

For those over 65 who already have microbleeds, … Continue reading this report…->

Brush & Floss! Is Oral Hygiene Linked to A-Fib?

Warren Welsh, from Australia, answers ‘Yes’ to that oral hygiene question. He wrote me about how he developed bleeding gums and felt it contributed to his Atrial Fibrillation diagnosis. (A 2010 catheter ablation made him A-Fib free. Read Warren’s story.)

Brush and floss regularly we were taught as kids, but who knew that oral hygiene is linked with A-Fib?

Dental Cleanings and New-Onset A-Fib

A study in Taiwan compared a group without A-Fib who received dental cleaning at least once a year to a similar group who didn’t. Both groups were followed for five years. The regular dental cleanings group had a lower occurrence rate of new-onset A-Fib.

More frequent dental visits (2-3 times a year) further reduced the risk.

Graphic of tooth A-fib.com

Good Oral Hygiene Reduces Inflammation

Studies have shown that inflammation is an independent risk factor both for the initiation of A-Fib and its continuation once you have it.

Good oral hygiene prevents A-Fib, probably by reducing the amount of inflammation of the gums and periodontitis (gum disease).

Take Away

Good oral hygiene reduces the risk of new-onset A-Fib and of sustaining it once you’ve got it.

For more about A-Fib and dental health, read my FAQ question about Local Anesthesia Used in Dentistry May Trigger Your A-Fib.

References for this article

Blizzard of 2016 Increases Risk of A-Fib Stroke

We’ve all heard of someone dropping dead from a heart attack while shoveling snow. But along with record snowfall and subfreezing temperatures comes a warning for those with Atrial Fibrillation. Winter increases stroke risk in people with A-Fib.

Winter and increased risk of stoke at A-Fib.com

Winter: increased stroke risk

Do You Live in a Cold Climate?

In a study from Taiwan, nearly 300,000 people with new-onset A-Fib were followed for eleven years. Almost 35,000 suffered an ischemic (A-Fib) stroke.

The risk for an ischemic stroke was nearly 20% higher in winter than in summer.

“When the average temperature was below 68⁰ F (20⁰C), the risk of ischemic stroke significantly increased compared to days with an average temperature of 86⁰F (30⁰C).”

Why More Ischemic Strokes During Winter?

Cold weather may make blood more prone to coagulate.

Cooler temperatures may produce greater plasm fibrinogen levels and factor VII clotting activity and may lead to “increased coagulability and plasma viscosity,” according to the author of this study, Dr. Tze-Fan Chao. 

Ischemic stroke was nearly 20% higher in winter than in summer.

What Patients Need To Know

The cold temperatures can put you more at risk for an A-Fib (Ischemic) stroke. So act accordingly. Bundle up during winter. Keep the thermostat set to keep you warm enough.
If you’re on a blood thinner, discuss this research with your doctor. You need to keep your anticoagulant levels up during winter.
References for this article

My 2015 Top Five List: Advancements in the Treatment of A-Fib

Looking back over 2015, I found five significant developments for those ‘living’ with A-Fib and those seeking their ‘cure’. My ‘Top Five List’ focuses on the Watchman device, a Pradaxa antidote and research findings about lifestyle choices, and reducing fibrosis.

1. FDA Approves the Watchman Device

The Watchman occlusion device

The Watchman is positioned via catheter

Anticoagulant Alternative: Because A-Fib patients are at high risk of stroke and clots, a blood thinner (anticoagulant) like warfarin is often prescribed. If you can’t or don’t want to be on blood thinners, you had few options.

That was until March 2015 when the US Food and Drug Administration (FDA) approved the Watchman device. There’s now an option to blood thinners! The Watchman device (Boston Scientific) is inserted to close off the Left Atrial Appendage (LAA), the origin of 90%-95% of A-Fib clots.

To read my complete Top Five List…go to My 2015 Top Five List: A Review of Advancements in the Treatment of A-Fib->.

My 2015 Top Five List: A Review of Advancements in the Treatment of A-Fib

2015 in Review at A-Fib.comWith the beginning of a new year, we often look back and measure how far we’ve come. In 2015, I found five significant advancements in the treatment of Atrial Fibrillation.

1. FDA Approves the Watchman Device

The Watchman occlusion device

The Watchman is positioned via catheter

Anticoagulant Alternative: Because A-Fib patients are at high risk of stroke and clots, a blood thinner (anticoagulant) like warfarin is often prescribed. If you can’t or don’t want to be on blood thinners, you had few options.

That was until March 2015 when the US Food and Drug Administration (FDA) approved the Watchman device. There’s now an option to blood thinners! The Watchman device (Boston Scientific) is inserted to close off the Left Atrial Appendage (LAA), the origin of 90%-95% of A-Fib clots.

It’s not an absolute guarantee you will never have a stroke―but neither is taking warfarin or the newer anticoagulants. For more, see Watchman Device: An Alternative to Blood Thinners.

2. Research: Watchman Better Than a Lifetime on Warfarin

Warfarin - Coumadin tablets various dosages

Warfarin (Coumadin)

The Watchman device isn’t simply an alternative to taking warfarin, clinical trials show it’s actually better. Patients with the Watchman had fewer hemorrhagic strokes and less bleeding compared to patients on warfarin. (Warfarin and other anticoagulants work by causing bleeding and are inherently dangerous.)

It’s too early to say the same about the newer anticoagulants like Pradaxa, Xarelto, Eliquis and Savaysa/Lixiana with their short history but one would expect the same general principles to apply. For more, see Watchman Better Than Warfarin.

3. Antidote for Pradaxa

Praxbind - antidote to Pradaxa

Praxbind: Pradaxa antidote

Up to now, patients on Pradaxa have been bleeding to death in the emergency room while doctors were powerless to stop their bleeding and could only stand by and watch them die. See Stop Prescribing or Taking Pradaxa.

In October 2015, the FDA granted “accelerated approval” to Praxbind, the reversal agent (antidote) to Pradaxa (Boehringer Ingelheim). Praxbind (idarucizumab) is given intravenously to patients and reverses the anticoagulant effect of Pradaxa within minutes.

Note: The reversal agent, Andexanet Alfa, is on FDA fast track and is expected to be approved by mid-2016 as an antidote for Xarelto and Eliquis (Factor Xa inhibitors).

4. Life Style Changes Can Make Some People A-Fib Free



Weight Loss: A weight loss program and counseling in Australia has worked so well that some patients have become A-Fib free.

In his Adelaide clinic, Dr. Prashanthan Sanders convinces his overweight A-Fib patients to buy into the program, lose weight, and keep it off.  This holistic approach to health has also been successfully applied to other A-Fib contributing factors such as diabetes, sleep apnea, hypertension, binge drinking and smoking. See Weight Loss Key to Reverse Atrial Fibrillation, Improve Ablation Success.



Exercise: But not everyone can lose weight and keep it off. And other risk factors like hypertension and diabetes are more difficult to permanently change.

The same Australian researchers found that exercise improves A-Fib (even obese A-Fib patients benefit from exercise). Supervised aerobic and strength exercises reduced A-Fib by 84%.

Combine for Best Results: Exercise and weight loss together produced the best results. An astounding 94% of obese patients who both lost weight and exercised regularly were A-Fib free after rhythm control therapy (i.e., antiarrhythmic drugs and/or catheter ablation).

Couch Potato Warning: If you don’t exercise regularly, you’re almost guaranteed to stay in A-Fib. Even with rhythm control (antiarrhythmic drugs and/or ablation), 83% of the low-fitness obese patients had A-Fib.

5. Research Studies: Preventing Fibrosis

Fibrotic cells - 2008 Boston A-Fib Symposium Kottkamp

Fibrotic cells

A-Fib produces fibrosis, and up to now, was considered permanent and irreversible. Fibrosis is fiber-like scar tissue that stiffens and weakens the heart muscle which reduces pumping efficiency and leads to other heart problems.  (See Fibrosis and A-Fib).

Dr. Jose Jalife’s experimental studies with sheep found that a Gal-3 inhibitor (GM-CT-01) actually reduced or prevented fibrosis. Better yet, instead of having to wait years for possible FDA approval, a natural supplement, Pecta-Sol C (Modified Citrus Pectin) works like a Galectin-3 inhibitor.

For A-Fib patients, this may provide the means to avoid fibrosis or repair fibrotic heart tissue. (See Galectin-3 Inhibitor Prevents A-Fib).

A Personal Prediction

WATCHMAN device at A-Fib.com


On a personal note, I’m excited about the great potential of the Watchman device to significantly reduce or eliminate the threat of strokes—especially in the elderly―even if they don’t have A-Fib.

Imagine a world where stroke risk could be eliminated by a simple 20-30 minute procedure. The Watchman device (and other occlusion devices) may change the way elderly medicine is practiced.

If you find any errors on this page, email us. Y Last updated: Thursday, January 21, 2016

Report: FIRM Mapping System—Should Ablation Patients Avoid It?

The FIRM mapping system was a hot topic at the last annual AF Symposium. In his presentation Dr. Ravi Mandapati compared data from his study of FIRM ablations performed at UCLA Medical Center to the CONFIRM clinical trial data published by Dr. Sanjiv Narayan, one of the inventors of the FIRM mapping system.

Topera-FIRMap catheter - three sizes

Topera-FIRMap catheter (three sizes)

Up to this point in time, everyone seemed to be jumping on the FIRM/Topera ‘bandwagon’ with very little critical analysis or understanding of how it worked.

As patients, we should now be skeptical of the FIRM system:

• It doesn’t map nearly ½ of the left atrium
• The FIRM mapping algorithms finds stable rotors that other research finds are not stable, and electrophysical characteristics that other research doesn’t confirm
• Results of ablating FIRM-identified rotor sites are relatively poor. (This is what should most concern us as patients.)

So, as an A-Fib patient, you may ask: “Should I now stay away from doctors or centers using the FIRM system?” Read my answer and my full 2015 AF Symposium report at Critical Analysis of the FIRM Mapping System.

For more background also see my 2014 AF Symposium report: ECGI vs. FIRM: Direct Comparison, Phase/Waveform Mapping.

Is Cryoballoon as Effective and Safe as RF Ablation? A Clinical Study

There have been few randomization trials directly comparing CryoBalloon ablation to RF ablation.

That’s why Dr. Armin Luik and his colleagues developed the FreezeAF clinical trial―to directly compare CryoBalloon ablation to RF ablation for treating patients with paroxysmal atrial fibrillation. Dr. Luik (U. of Freiburg, Karlsruhe, Germany) presented the study results at the May 2015 meeting of the Heart Rhythm Society.

CryoBalloon catheter

CryoBalloon catheter

FREEZEAF Trial: Patients and Method

In the FREEZEAF study, 315 paroxysmal A-Fib patients with a mean age of 60 years were randomized to either a CryoBalloon ablation (n=156) or a RF ablation (n=159) of the pulmonary veins. Clinical follow up was at three, six, nine and 12 months.

The FREEZEAF Study Results

The FreezeAF trial researchers noted that a number of CryoBalloon ablation studies have demonstrated its efficacy and safety for treatment of A-Fib, but few studies have compared the two techniques head-to-head.

How did Cryoballoon compare to RF Ablation? … Continue reading this report…->

The Risk of Dementia Caused by A-Fib―20 year Study Results

Atrial Fibrillation (A-Fib) has been suggested as a risk factor for dementia since A-Fib can lead to a decrease of blood supply to the brain independent of stroke.

Other long-term studies evaluating the link between A-Fib and dementia have shown inconsistent results.

Study Patients and Method

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 (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. Since 2008 it has 14,926 participants.

At the start of the study (baseline), 318 participants (4.9%) already had A-Fib.


During the course of the 20-year study, among 6,196 people without established A-Fib:

• 723 participants (11.7%) developed A-Fib, and
• 932 participants (15.0%) developed incident dementia.
• 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 but not strongly associated in the elder participants who developed A-Fib.

The authors concluded… Continue reading

FAQs A-Fib Drug Therapy: Hormone Replacement Therapy and A-Fib

 FAQs A-Fib Drug Therapy: HRT

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

22. Do you have information about Hormone Replacement Therapy (HRT) and if it might help or hinder my atrial fibrillation?”

Intuitively one would expect that, if properly administered, HRT would have good effects like decreasing menopause symptoms, improving bone density, improving cardiovascular health, etc. HRT might reduce the risk of A-Fib by improving a woman’s overall health. But research on this topic isn’t all that clear. I found two contradictory studies.

Danish Study 2012: I found one Danish observational research study that HRT was associated with a decreased risk on new-onset A-Fib in women who had had a heart attack. They looked at 32,925 women and followed them for a year after discharge from the hospital after a heart attack. New onset A-Fib was diagnosed in 1,381 women (4.2%). But A-Fib rates decreased significantly if the women were on HRT (37.4 incidence rate vs. 53.7 for no HRT use).

Womens Health Initiative Study: Another observational study found a “modest” link of HRT to Atrial Fibrillation. These results were somewhat unusual in that women [with a hysterectomy] taking estrogen alone had a higher rate of A-Fib. But women with an intact uterus taking estrogen plus medroxyprogesterone didn’t have a significantly higher rate of A-Fib.

The lead author, Dr. Marco V. Perez, described how anecdotally women say that at certain times-during a period, pregnancy, or menopause-their arrhythmias can flare up. Hormones may play a role in A-Fib in women. Dr. Perez said he would now add A-Fib to the list of risks associated with taking HRT.

Takeaway: These two studies obviously contradict each other. But the results in the Dr. Perez WHI research were so “modest” and even contradictory that, when making decisions about HRT, we should probably favor the Danish study. However, much more research needs to be done in this area. If properly administered HRT improves your overall health, that might decrease your risk of developing A-Fib.

(I am way out of my comfort zone discussing womens’ health and HRT and would welcome comments from women or from anyone with insights about this topic.)

References for this article

Last updated: Monday, September 28, 2015

Return to FAQ Drug Therapies

Women with A-Fib: Mother Nature and Gender Bias—Or—Get Thee to an EP ASAP

Research on Atrial FibrillationThe Facts About Women with A-Fib: Mother Nature and Gender Bias—Or—Get Thee to an EP ASAP

by Patti J. Ryan, August 2015

Several studies have established that the symptoms and consequences of A-Fib are more profoundly felt in women.

Mother Nature and A-Fib Symptoms in Women

Females tend to develop A-Fib at a later age than men. They are also more likely to seek medical attention, are usually more symptomatic, and have higher heart rates. A-Fib tends to affect their physical quality of life more severely.

While men as a group develop A-Fib twice as often as women, there are twice as many females as males in the age group with the highest percentage of A-Fib.

Cardiovascular mortality rates are 2.5-fold greater for women with A-Fib. Women have a 4.6-fold higher rate of stroke. A-Fib is the most frequent cause of disabling stroke in elderly females.

Remember: you don’t have to live with A-Fib! Seek your cure.

What can you do about it? As a female with A-Fib, you may have more symptoms, quality of life issues and are at greater risk of an A-Fib-related stroke. But you don’t have to live with A-Fib. As soon as practical, get a referral to a heart rhythm specialist (a cardiologist with a specialty in electrophysiology). Early diagnosis means less damage to your heart and more treatment options.

Drug Therapies for Women with A-Fib and Risk of Stroke

Women fail more antiarrhythmic drugs therapies than men. Women don’t do well on some antiarrhythmic drugs (estrogen may prolong the QT interval).

Antiarrhythmic drug therapy in women with hypertension is associated with more major cardiovascular events. (Some research indicates that women may have more hypertension than men, 55.2% vs 40%).

What this means to patients: Drugs don’t cure A-Fib but merely keep it at bay, says heart rhythm specialist, Dr. Dhiraj Gupta. Antiarrhythmic drugs only work for about 50% of patients, and often stop working after a period of time. Many can’t tolerate the side effects.
Don’t spend a year in A-Fib trying different medications or combinations of medications only to find none work for you. In addition, anticoagulants, like warfarin, for your increased stroke risk, have their own health risks. Don’t live a life on medication. Seek your cure.

Differences in Catheter Ablation for Females with A-Fib

Women, in general, have smaller cardiac chambers so that catheter manipulation is more of a challenge (40.6 mm on average for women vs 44.6 mm for men). (However, since research data shows there is a significant delay in referral for ablation in women, it is feasible that they may have larger left atrial sizes due to remodeling, making this a moot point.)

Run, don’t walk to the best heart rhythm specialist (an electrophysiologist) you can find. 

Females have more non-PV triggers and have lower ablation success rates.

Females tend to have more ablation complications like pericardial tamponade and vascular complications.

What can you do about it? Don’t delay. “Run, don’t walk” to the best heart rhythm specialist (an electrophysiologist) you can find, advises former A-Fib patient Sheri Weber. A-Fib is a progressive disease. Consult an EP after your diagnosis. Don’t wait for your A-Fib to get worse. (A-Fib rarely gets better.)

Gender Bias Also Plays a Role

Women are referred to A-Fib specialists three times less often than men. Men with A-Fib are managed more aggressively (such as more cardioversions) prior to seeking a catheter ablation.

Women often have developed a larger left atrium because of being referred to EPs later in their treatment plan than men (60 months for females vs 47 months for males).

Women are referred to A-Fib specialists three times less often than men.

Women are referred for catheter ablation less frequently and later into their treatment plan than men. When referred, they are older on average than men (61.6 years old vs 56.9 years old for men).

Consequently, they have more complex symptoms, and their procedure success rate is lower with more complications.

What can you do about it? When you go to your GP or cardiologist with your A-Fib symptoms or complaints, anticipate gender bias! Don’t let it deter you. A-Fib is a progressive disease. Don’t waste time. Don’t let your A-Fib worsen over time by remodeling or enlarging your heart. Request a referral to a heart rhythm specialist―an electrophysiologist (EP). Until you consult an EP, you may not be getting the best and most up-to-date A-Fib treatment advice. You deserve nothing less.

Don’t just take your meds and get used to being in A-Fib.

Why is there Gender Bias in the Treatment of Women with A-Fib?

In many cultures and societies, doctors are more conservative in their treatment of women with A-Fib. Some doctors, concerned with safety, may be reluctant to perform or recommend any invasive procedures in women.

Social and family pressures may delay medical consultation and treatment (“I can’t be sick. My family needs me.”) Access to health care may be limited for some women.

And, of course, there’s plain ol’ bias by male doctors against female patients. “Your symptoms are all in your mind.” or “Just take your meds and get used to being in A-Fib.” (These are actual quotes from A-Fib.com readers about their doctors’ advice.)

What can you do about it? Be prepared for your doctor appointment with a list of questions or concerns. Don’t leave until you have answers. Don’t be afraid to ‘fire’ your doctor. Get a second, or third opinion. Find a doctor who will partner with you to find your cure or best outcome. (For help, use the Finding the Right Doctor for You resources on A-Fib.com.)

Good News: EPs Less Likely to Have Gender Bias

Research indicates female gender bias tends to disappear when a woman sees an 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.

What this means to patients: It’s reassuring to be in the care of someone who regularly treats A-Fib patients. A-Fib is an electrical problem. Don’t waste you time. Don’t settle for just ‘managing’ your A-Fib. See a heart rhythm specialist, an electrophysiologist, a cardiologist who specializes in the electrical function of your heart. An EP will discuss all your treatment options. EPs want to free you from the burden of A-Fib.

Patti J Ryan, writer and editor, a-Fib.com

About the author: Patti J. Ryan is editor of A-Fib.com and regularly contributes her writing and graphics expertise.  She is also publisher of Beat Your A-Fib: The Essential Guide to Finding Your Cure by Steve S. Ryan, PhD (BeatYourA-Fib.com), an Amazon.com Top 100 Seller in two health-related categories.

References for this article

AFACART Clinical Trial: Preliminary Results of the CardioInsight—ECVUE System in Multiple Centers

AF Symposium 2015

Sébastien Knecht PMD PhD

AFACART Clinical Trial: Preliminary Results of the CardioInsight—ECVUE System in Multiple Centers

By Steve s. Ryan, PhD, July 2015

Pr. Sebastian Knecht from CHU Brugmann, Brussels, (now AZ Sint Jan, Brugge), Belgium gave a presentation entitled “AFACART Trial—Design and Preliminary Results.” (AFACART stands for “Non-Invasive Mapping of Atrial Fibrillation,” a new name for ECGI).


In preparation for their ablation the patient dons the ECGI vest-like device. The data generated creates an image of the heart and pinpoints sites (“drivers”) producing A-Fib signals. This 3-D computer model of the patient’s heart is used during the ablation procedure.

AFACART Clinical Trial Design and Participants

The AFACART trial is a European multicenter, feasibility, non-randomized study using “Panoramic Electrographic Non-Invasive Mapping”, specifically the CardioInsight—ECVUE System, for ablation of persistent A-Fib. 

AFACART stands for “Non-Invasive Mapping of Atrial Fibrillation,” a new name for ECGI

Ablation patients are to be followed for 12 months. The effectiveness of Panoramic Electrographic Non-Invasive Mapping is to be compared to conventional mapping and ablation procedures.

Eight European centers in France, Belgium and Germany are participating in this clinical trial. None of these centers had any practical experience with this system before this study.

Ablation Steps One to Three

In an important change to standard ablation procedures, the first step in the ECGI/ECVUE ablation process is ablation of A-Fib drivers (rotors and foci).  (This is in comparison to the step-wise approach that begins with ablation of the pulmonary vein openings.)

If A-Fib doesn’t terminate to sinus rhythm or stable atrial tachycardia isn’t achieved (> 5 min), then a standard PVI is performed.

This is followed by linear lesions. And finally by Electrocardioversion.

AFACART Trial Preliminary Results

• Step One (driver ablation only): 64% of the persistent A-Fib patients had their A-Fib terminated.
• Step Two (driver and PVI ablation): 66% termination
• Step Three (driver, PVI, and LA linear lesions) 73% termination

For our technical readers, Dr. Knecht defined ‘drivers’ as “local reentrant circuits (> 1.5 rotations) or focal breakthroughs (>2) that appear at the same spatial location per window.”

In 94% of patients, driver ablation had a significant impact on the A-Fib termination process. A-Fib cycle length was prolonged in all persistent patients except for 6%. Even patients who were not terminated (27%) had their A-Fib cycle length prolonged by driver ablation.

After 12 months, 72% of patients were A-Fib free and no longer taking antiarrhythmic meds (AADs). 31% had Atrial Tachycardia recurrence, but many had a second ablation.

Overall 83% were A-Fib free, 17% had Atrial Tachycardias and only 9% were still in A-Fib.

Ablation procedure time averaged only 44.7 minutes. As the number of driver regions increased, the ablation success rate decreased. 66% of drivers were in the Left Atrium, 34% in the right. 70% of termination sites were in the left atrium, 30% in the right.

Driver Sites and CFAEs

• In these persistent A-Fib patients, 50% of both atria had CFAEs.
• Most (but not all) driver sites contained CFAEs.
• Successful driver ablation only ablated 19% of both atria (this is a major improvement and resulted in much less ablation damage to the heart compared to trying to ablate all CFAE areas).

Dr. Knecht stated that “use of the ECVUE system seems to result in a more specific selection of CFAEs leading to a more targeted ablation strategy.”

Dr. Knecht’s Conclusions

Ablation of A-Fib drivers is associated with a high rate of A-Fib termination.

• Drivers are distributed in both atria (2/3 LA and 1/3 RA).
• Results are reproducible among centers without prior practical experience with the system.
• Preliminary chronic results are very promising.

Editor’s Comments:
Driver Ablation More Important Than PVI in Persistent A-Fib: ECGI is changing the way ablations are done and our understanding of A-Fib. In persistent A-Fib, the mapping and ablation of drivers is more important and is done before a PVI ablation. While driver ablation had a 64% success rate, doing a standard PVI after driver ablation only improved results by 2%.
ECGI/ECVUE Major Improvement in Ablation Success Rate: An 83% success rate after 12 months following ablations for tachycardias, is a major improvement and source of hope for persistent A-Fib patients. These results were even better when one considers that only 9% were still in A-Fib.
ECGI/ECVUE Results in Much Fewer Ablation Burns: Previous protocols for ablating persistent A-Fib usually involved mapping and ablating CFAEs. But CFAEs in persistent A-Fib patients can cover 50% of the atria surfaces which often necessitated a lot of burns and debulking.
Too many ablation burns could result in the development of fibrosis (dead heart tissue where the ablation catheter produced burns and scarring) and a stiffening of the atria with loss of pumping ability. ECGI/ECVUE only requires ablating 19% of the CFAE areas resulting in much less lasting damage to heart tissue.
Driver Ablation Prolongs A-Fib Cycle Length: Driver ablation had a major effect on the A-Fib termination process. A-Fib cycle length was prolonged in all but 6% of the persistent A-Fib patients. This is perhaps a first step in improving outcomes for persistent A-Fib patients.
Reproducibility: The most important finding of Dr. Knecht’s report is that ECGI/ECVUE works in other centers without doctors (operators) having to undergo extensive training.
These preliminary results from this multi-center clinical trial are quite impressive for the treatment of patients with persistent A-Fib. Hopefully it won’t be long before the ECGI/ECVUE system is available in more countries. (ECGI was invented at Washington Un. in St. Louis, MO and is available there on a limited basis.)

To learn more about ECGI, see Non-Invasive Electrocardiographic Imaging (ECGI): Presentation Summary and Comments from the 2013 AF Symposium. You may want to read this report in conjunction with Dr. Haissaguerre’s 2015 AF Symposium presentation The Changing Ablation World: Going Beyond PVI With ECGI Mapping and Ablation Techniques.

References for this article

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Last updated: Friday, January 1, 2016

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