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

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

Do You ‘Like’ Your Doctor, Do You ‘Connect’?…How it Affects Your 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.

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

A-Fib doctor with stethoscope - A-Fib.com

You’re heatlthier if you like your doctor!

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.

Some doctors (particularly those from overseas) often communicate poorly, or talk in “medicalize” and are nearly incomprehensible. Other doctors come from a medical school with a tradition of aloofness and keeping a distance from patients (with women in particular).

Relationship-Based Strategies Improve Patients’ Health

This 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!

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

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

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

Don’t Be Afraid to Fire Your Doctor

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.”

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

Resources for this article
Top 10 List #2 Don't be afraid to fire your doctor at A-Fib.com

 

Don’t Delay—A-Fib is a Progressive Disease

Quote - Joan Schneider, Ann Arbor, MI, A-Fib free after PV Catheter Abaltion - A-Fib.com

Joan Schneider, Ann Arbor, MI, A-Fib free after PV Catheter Abaltion

The Longer You Have A-Fib, the Greater the Risk

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

Unless too feeble, there’s no good reason to just leave someone in A-Fib.
Don’t listen to doctors who want to just control your symptoms with drugs. Leaving patients in A-Fib overworks the heart, leads to fibrosis and increases the risk of stroke.

Fibrosis makes the heart stiff, less flexible and weak, reduces pumping efficiency and leads to other heart problems. The abnormal rhythm in your atria causes electrical changes and enlarges your atria (called remodeling) making it work harder and harder over time.

Don’t let your doctor leave you in A-Fib. Educate yourself. Any treatment plan for A-Fib must try to prevent or stop remodeling and fibrosis. And always aim for a Cure!

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

Educate Yourself—and Always Aim for a Cure!

 

My Top 5 Articles About Warfarin Therapy, Associated Risks and Alternatives

my-top-5-picks-stamp-warfarin-400-pix-sq-at-96-res

Any treatment plan for Atrial Fibrillation must address the increased risk of clots and stroke. By far the most commonly used medicine for stroke prevention is the anticoagulant warfarin (brand name Coumadin).

But warfarin is a tough drug to take long term with monthly blood tests and possible side effects. These are my top 5 articles to help you understand warfarin therapy, the associated risks and some of the alternatives.

Review these articles to learn more about Warfarin therapy:

1. Clinical Trials Results: Watchman Better Than a Lifetime on Warfarin;

2. Arterial Calcification From Warfarin: Vitamin K May Reverse it;

3. “Is there a way to get off blood thinners all together? I hate taking Coumadin. I know I’m at risk of an A-Fib stroke.”;

4. How to Avoid the Bleeding Risk of Anticoagulants;

5. If Sixty and Older: 99% Have Microbleeds—So Are Anticoagulants Risky?

Bonus: Video about Warfarin

A-Fib.com video libraryLiving with Warfarin: Patient Education
Excellent introduction to anticoagulant therapy with warfarin (Coumadin). Patients and medical professionals (clinical nurse, doctors, a pharmacist  and clinical dietician) discuss the practical issues associated with taking warfarin. (16:22) Uploaded on Mar 7, 2011. Produced by Johns Hopkins Medicine.

An Alternative to Blood Thinners

WATCHMAN device at A-Fib.com

The WATCHMAN device

Do you hate having to take Coumadin? Hate the monthly testing? Bothered by side effects? An alternative to taking blood thinners is closing off your Left Atrial Appendage (LAA) with the Watchman, an occlusion device. Learn more: The Watchman™ Device: The Alternative to Blood Thinners.

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.

NPR Interiew with Dr. Jerome E. Groopman.

NPR Interiew

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.)

Dr. Groopman Interview: Listen to an audio interview with The Anatomy of Hope author, Dr. Groopman on NPR’s Fresh Air program (recorded Sept. 2004; 20 min.)

Resources for this article

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

fantastic-voyage-ship-in-vein-400-x-300-pix-at-300-res

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.

(Added May 2017: Pharma companies signed onto a set of policies, the PhRMA Code of Conduct, regarding the way they would interact with physicians which is basically a code of conduct. Updated in 2009, here are some major points or changes in how sales reps should conduct themselves:
• No Personal Gifts
• No Entertainment of Recreational Events
• No Branded Products
• “Modest” Meals are OK – in context of education

Many academic centers now enforce stricter policies limiting access of pharmaceutical reps to physicians, and strict punishments or fines for rule violations. [Medpage Today, May 4, 2017])

U.S. patients can now 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 does them a favor, 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
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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

 

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