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


Coping with Atrial Fibrillation

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

Click to open in new window

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

The REAL Cost of Living with Atrial Fibrillation 

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

Here are the highlights of our conversation:

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

Financial Costs

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

Quality of Life Costs

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

Resources mentioned in this episode

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


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

Transcript: The REAL Cost of Living with Atrial Fibrillation

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

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

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

Dr. Steve Ryan: Absolutely, yes.

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

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

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

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

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

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

Dr. Steve Ryan: Same here.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Travis Van Slooten: Yes.

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

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

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

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

Travis Van Slooten: Very toxic.

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

Travis Van Slooten: Wow!

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

Travis Van Slooten: That’s amazing.

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

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

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

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

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

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

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

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

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

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

Dr. Steve Ryan: No.

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

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

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

Dr. Steve Ryan: My pleasure.

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

Dr. Steve Ryan: Yes.

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

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

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

Dr. Steve Ryan: You’re welcome.

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

Big Payoff: An A-Fib Diary Helps You Cope

Pat Truesdale’s Atrial Fibrillation was very symptomatic and she could not tolerate any of the medications. In her personal A-Fib story, she shares how keeping an A-Fib Diary helped her cope. Through interpreting her log entries, she learned what triggered her A-Fib, what signs indicated an A-Fib attack was coming on, and some actions she could do that helped her during an A-Fib episode:

63. Personal Experience of Pat Truesdale

Pat Truesdale, now A-Fib free

“…I began to learn what activated my A-Fibs and what helped during my episodes. This was a real discovery about me! I learned that ice drinks, full meals, and caffeine all triggered my A-Fibs. I started a diary to record all my symptoms.

With Steve’s [Ryan] suggestion and my local cardiologist’s, I now know I have Vagal Lone A-Fib. This means certain conditions can trigger my A-Fib attacks. This is what I learned triggers my A-Fib:

• Iced Drinks
• 
Caffeine
• 
Heavy meals
• 
Quiet times relaxing
• 
Sleep time at night
• 
Medicines
• 
Blood pressure going up
• 
Low pulse

Here are some symptoms I discovered that are indications an A-Fib episode is coming!

• High blood pressure
• 
Belching
• 
Heartburn
• 
Frequent need to pee (also ISH symptom—Isolated Systolic Hypertension)
• 
Low pulse while exercising (A-Fibs never happened during exercise)
• 
Flutters or skipped heart beats
• 
Light headache (BP is higher)

Here are some things that help me during my A-Fibs:

• Knowing A-Fib would occur after exercising while I am resting.
• Take a tablespoon of Mylanta
• Yoga breathing
• lf ice water brings it on, ice water sometimes reverts it!
• Drink plenty of water all day
• Blowing into a straw lowers the pulse rate, but does not stop the A-Fib
• Don’t Panic – Have a “This Too Shall Pass” attitude
• Walk around, but don’t exercise since my pulse is too high already

• Take 200 mg of magnesium 3X a day 

• Take a B complex vitamin every day

Doing her detective work helped her make a treatment choice:

…I wanted to get this procedure over quickly. I wanted to start feeling like a normal human being again! So, I trusted my local cardiologist’s choice and had the [ablation] procedure.”

Pat’s diary of her A-Fib triggers is not unusual, especially for people with Vagal A-Fib (though not everyone will be affected by the same triggers).

But the symptoms she describes as predicting or forewarning her A-Fib attack are new and very insightful. (Thanks for sharing, Pat.) Her list of things that helped her get through A-Fib episodes may also be helpful to you.

Be a Sleuth: Keep an Episode Diary

Take your A-Fib binder to your appointments

Share your log with your doctors

You, too, may be able to predict when you’re going to have an A-Fib attack. Start by keeping a log or diary of your A-Fib episodes for three or six months. When an episode occurs, note the day & time, duration and what you were doing, eating or drinking.

As you collect data, scrutinize your log entries for patterns and specific triggers. This may lead you to lessen or eliminate certain foods or beverages or even activities that appear to trigger your A-Fib. You may want to share your log with your doctor.

Don’t be discouraged if you don’t find a pattern, not every log will be revealing. A-Fib seems to have a mind and schedule of its own that’s often hard to predict.

A-Fib Cured in Record Time

Pat probably has set a record for getting cured of A-Fib in the shortest time. Current guidelines recognize catheter ablation as a first line therapy for treating A-Fib (remember: she couldn’t tolerate the medications). After only eight weeks of being in A-Fib, she had a successful CryoBalloon Ablation. To read Pat’s personal A-Fib story, go to Active 64-Year-Old with Family History of A-Fib Gets a CryoBalloon Ablation Eight Weeks after First A-Fib Attack.

Cloud graphic - Michele Straube, A-Fib-free after 30 years - A=Fib.com

Michele Straube, A-Fib-free after 30 years.

Beat the A-Fib Mental Games: Try an Anxiety Thoughts Log

Up to 40% of patients say their ‘quality of life’ has suffered due to their Atrial Fibrillation. For many that manifests as stress, fear and anxiety. It’s my opinion, electrophysiologists (EPs) generally don’t focus on, or effectively help patients deal with the distress that A-Fib often creates.

In his personal A-Fib story, Anthony Bladon shared his techniques for dealing with the mental stress of his A-Fib. He wrote, “The constant lurking fear that A-Fib may spontaneously return, is insidious. I absolutely needed to develop coping mechanisms.”

Anthony’s Two Anxiety-Busting Techniques

Anthony Blandon photo

Anthony Blandon

First, he used a 17-minute audio relaxation exercise 1 on a daily basis (or more often) for months. He then went on to describe his second technique:

“In addition I developed an “anxiety thoughts log,” making myself write down word-for-word what the anxious thought was, as well as noting the physical event that seemed to trigger it.

By confronting my most extreme fears very explicitly (i.e., ‘Is this a TIA or A-Fib?’ ‘I’m afraid of a stroke, I might die or be disabled.’ I can’t contemplate a third ablation!’), it became easier to re-state and contextualize them in a more reasonable frame of mind, thereby reducing my anxiety.

And lastly, he offer this advise:

If fears of A-Fib prey on your mind, I encourage you to seek out the help of a professional psychologist, as I did. After a few sessions of consultation, and with the continued use of tools like these, I was fully able to cope.”

To read all of Anthony Bladon’s A-Fib story, go to: Two CryoAblations, Difficult Recovery Period, Dealing with the Fear that A-Fib May Return.

Coping with Fear and Anxiety; Overview of Atrial Fibrillation

Coping ideas

Beat the Mental Stress of A-Fib

Fight your fears! Ambush your anxiety! Seek your freedom from anxiety and improve the quality of your life.

You may also want to read my article, Seven Ways to Cope with the Fear and Anxiety of Atrial Fibrillation.

A-Fib may be in your heart—
But it doesn’t have to be in your head. 

Footnote Citations    (↵ returns to text)

  1. Still available: You can listen to the free 17 minute audio relaxation exercise on the Dr. Dean Given website (or download the free mp3) at http://drdeangiven.com/?page_id=76.

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
• Koplan BA, et al “Living with atrial fibrillation: Does the spouse suffer as much as the patient?” HRS meeting 2008; Abstract PO1-151.

• Phend, C.  HRS: Atrial Fibrillation Affects Family as Much as Patient. Heart Rhythm Society. Meeting coverage. MedPage Today, May 15, 2008. http://www.medpagetoday.com/meetingcoverage/hrs/9472

• Bohnen M, et al. Quality of life with atrial fibrillation: Do the spouses suffer as much as the patients? Pacing Clin Electrophysiol. 2011;34:804-809. DOI:10.1111/j.1540-8159.2011.03111.x. https://www.ncbi.nlm.nih.gov/pubmed/21535034

• Ekblad, H. et al. The Well-Being of Relatives of Patients with Atrial Fibrillation: A Critical Incident Technique Analysis.  The Open Nursing Journal, ISSN: 1874-4346 ― Volume 10, 2016. https://benthamopen.com/FULLTEXT/TONURSJ-8-48. DOI: 10.2174/1874434601408010048

FAQs Coping with A-Fib: Improving Circulation

 FAQs Coping with A-Fib: Circulation

FAQs A-Fib afib“Is there any way I can improve my circulation, without having to undergo a Catheter Ablation (poor success rate and risky at my age) or Surgery (even more risky)? I am in Chronic A-Fib. I feel tired and a little light-headed, probably because my atria aren’t pumping properly.”

In theory, yes. In Chronic A-Fib it’s not unusual to feel tired and light-headed. Your atria are fibrillating instead of pumping blood into the ventricles. Blood flow to your brain and other organs is reduced by about 15%-30%. But your ventricles still function by suctioning blood from the atria much like a turkey baster sucks up liquid.

To some extent, you can improve the strength and capacity of your ventricles by exercise, such as by walking on a treadmill or at the shopping mall.

You can also improve the oxygen saturation of your blood by using an Oxygen Concentrator ($500-$1,000). While on a treadmill, for example, you can breath in concentrated oxygen through a cannula (short tubes in your nostrils). You can measure how much oxygen is in your blood by using an pulse oximeter ($50). The desired range is 95-100% oxygen saturation. (Some athletes with good circulation use this technique to improve their athletic performance.)

Don’t dismiss the treatment options of catheter ablation or mini-maze surgery. Both have high success rates with low rates of complication.

Be cautious: While improved circulation is good for your overall health, don’t over do the exercising. It could be counterproductive. With Chronic A-Fib your heart is already working harder than a normal healthy heart. Adding even more demand can lead to more enlargement and remodeling.

The Bottom Line: the real question is whether these techniques will improve your A-Fib symptoms of feeling tired and light-headed. I’m unaware of any studies demonstrating the effectiveness of the above techniques for the symptoms of Chronic A-Fib.

Resources for this article
¤ The Link Between Infections and Inflammation in Heart Disease. Life Extension Vitamins. Last accessed November 5, 2012 http://www.lifeextensionvitamins.com/cadico6otco.html

¤ Atrial Flutter. Heart Rhythm Society website. Last accessed March 30, 2014. URL: http://www.hrsonline.org/Patient-Resources/Heart-Diseases-Disorders/Atrial-Flutter

¤ “Atrial Fibrillation Educational Material” University of Pennsylvania. 2002, p. 3.

If you find any errors on this page, email us. Y Last updated: Monday, February 13, 2017

Back to FAQs: Coping with Your A-Fib

FAQs Coping With Your Atrial Fibrillation: Day-to-Day Issues

FAQs A-Fib afibFAQs Coping With Your Atrial Fibrillation: Day-to-Day Issues

Coping with your Atrial Fibrillation means a patient and their family have many and varied questions. Here are answers to the most frequently asked questions about dealing with the day-to-day issues of having Atrial Fibrillation. (Click on the question to jump to the answer.)

1.  Specialist: “I like my cardiologist, but he has not talked about me seeing an Electrophysiologist [heart rhythm specialist]. Should I ask for a second opinion?”

2. Forewarning? Is there any way to predict when I’m going to have an A-Fib attack?”

3.  Exercise: Can I damage my heart if I exercise in A-Fib? Should I exercise when in A-Fib or skip it and rest?”

4.  Progression of A-Fib: How long do I have before my A-Fib goes into chronic or permanent A-Fib? I know it’s harder to cure. My A-Fib episodes seem to be getting longer and more frequent.”

5.  A-Flutter:They want to do an Atrial Flutter-only ablation, will that help if I possibly have A-Fib as well?”

6.  Medical Marijuana:Is smoking medical marijuana or using Marinol going to trigger or cause A-Fib? Will it help my A-Fib?

7.  Action Plan: During an A-Fib episode, when should I call paramedics (911 in the US) and/or take my husband to the hospital? I’m petrified. I need a plan.”

Related Question:When my husband has an Atrial Fibrillation episode, what can I do for him? How can I be supportive?”

Related Question: In case I have a stroke, what does my family need to know to help me? (I’m already on a blood thinner.)  What can I do to improve my odds of surviving it?”

8.  PVC/PACs:I have a lot of extra beats and palpitations (PVCs or PACs). They seem to proceed an A-Fib attack. What can or should I do about them?”

9.  DIY Monitors:What kind of monitors are available for atrial fibrillation? Is there any way to tell how often I get A-Fib or how long the episodes last?”

Related Question:My mom is 94 with A-Fib. Are there consumer heart rate monitors she can wear to alert me at work if her heart rate exceeds a certain number?”

10.  Heart Rate:Can I have A-Fib when my heart rate stays between 50-60 BPM? My doctor tells me I have A-Fib, but I don’t always have a rapid heart rate.”

Related Question:  “My doctor says I need a pacemaker because my heart rate is too slow. I’m an athlete with A-Fib and have a naturally slow heart rate.”

11.  Circulation:Can I improve my circulation, without having to undergo a Catheter Ablation or Surgery? I’m in Chronic A-Fib. ”

12.  Hereditary A-Fib: Both my uncles and my Dad have Atrial Fibrillation. I’m worried. How can I avoid developing A-Fib? Can dietary changes help? Or lifestyle changes?”

13.  Treatment choices: “How do I know which is the best A-Fib treatment option for me?”

Related Question:In one of your articles it said that having an ablation was better than living in A-Fib. If your article means all types of A-Fib [including Paroxysmal], then I will consider an ablation.”

If you find any errors on this page, email us. Y Last updated: Monday, February 13, 2017
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MAM 2016: My Challenge to Doctors of A-Fib Patients

Steve Ryan at the entrance to the MAM 2016 symposium - A-Fib.com

Steve at the entrance to the MAM 2016 symposium

In September, I was the only patient invited to present at MAM 2016 in Zurich, Switzerland. After dinner the first night, I spoke to over 200+ surgeons and electrophysiologists (EPs).

I tried to describe for the doctors what it’s like to live in Atrial Fibrillation. Here is what I told them.

You Never Forget Your First A- Fib Attack

“As most A-Fib patients will testify, you never forget your first A- Fib attack.
Mine was 19 years ago, but I can remember it like it was yesterday. All of a sudden my heart started going crazy! It felt like my heart was trying to jump out of my chest or like there was a live fish flopping around in there. I can still feel the sheer terror, fear, confusion, anxiety and worry it created.
I remember thinking, “Am I going to die?” “Is this a heart attack?” It was one of the most terrifying experiences of my life.
Most symptomatic A-Fib patients have a similar story.

Psychological and Emotional Effects of A-Fib

A-Fib doesn’t just affect you physically, it affects you emotionally as well.
A-Fib affects not just your heart—but also your head—and your quality of life.
It affects not just your heart—but also your head—and your quality of life.
By the way, I’ve never been to a medical conference where this aspect of A-Fib was studied.  (Today is a first, I guess.)
I wish there were some way to give you a one-minute episode of A-Fib. It would change your perception of A-Fib forever. The psychological and emotional aspects of A-Fib can be as bad as or even worse than the physical.

Living in Fear (and Anger)—A-Fib Wrecked My Life

In my case, I lived in fear of the next A-Fib attack. I went through all the emotional gamut—anxiety, fear, worry, confusion, uncertainty, frustration, depression, and finally anger at my own heart.
I went through all the emotional gamut—anxiety, fear, worry, confusion, uncertainty, frustration, depression, and finally anger at my own heart.
I’m a passionate runner. I used to run along Venice Beach. But my heart would go crazy and beat too fast. I’d have to stop and walk back to our apartment. Talk about frustration!
And A-Fib affected my work. I had a great job on the soap opera “Days Of Our Lives” as part of the technical crew. But I’d get dizzy and light headed and nearly lost my job. A-Fib wrecked my life!

Research—Then Going to Bordeaux for an Ablation

Steve Ryan before PVI, in Bordeaux, France, April 1998 at A-Fib.com

Steve Ryan before PVI, in Bordeaux, France, April 1998

To make a long story short, I locked myself in a medical library and read everything I could find about Atrial Fibrillation. During this time, I tried every drug known to man including the dreaded amiodarone which made me cough up blood. Nothing worked.
I found that doctors in Bordeaux, France, had discovered how to make people A-Fib free.
One of the doctors who treated me with catheter ablation is here today, Dr. Dipen Shah. Thanks to him, Dr. Haissaguerre and Dr. Jais I’ve been A-Fib free for 18 years. I was their first US patient.

My Challenge to Doctors treating A-Fib Patients

Today I want to challenge you. Just ask yourself:

What are you doing to help your patients deal with the Fear and Anxiety of A-Fib?

What are you doing to help them cope with the Psychological and Emotional effects of A-Fib?

Helping Your Patients Deal With Stress and Anxiety

Knowledge is Power and Control! Learning about A-Fib relieves worry and anxiety. Two ways to help your patients:
1. Reference books and websites. Give your patients a short list of web sites and books which you have read and recommend. If you do this, think of how much better informed your patients will be! 
Knowledge is Power and Control! Learning about A-Fib relieves worry and anxiety.
Hint: For distribution, list your recommendations on the back of a business card. If it comes from you, your patients will devour them.
2. Counseling and medication. You should have a list you can give out of several psychiatrists who understand A-Fib and how it affects patients.
You’ll know who needs this kind of help. Men, especially, may not admit to themselves that they need help.

Thanks for Making Us A-Fib Free

Steve S. Ryan - high jump at track meet

Steve, age 75; Making a high jump at track meet

Finally, I want to thank you on behalf of all the patients you’ve made A-Fib free. There are few medical procedures as transformative and life changing as going from A-Fib to Normal Sinus Rhythm.
There is simply no comparison between living in A-Fib and being A-Fib free! Normal Sinus Rhythm is wonderful!
There’s nothing like having a heart that beats normally again. No more tiredness, dizziness. being light headed. Your body feels alive. Your brain works. You can run and exercise again. [See the photo at right of me doing the high jump at age 75!]
Thank you for giving me my life back!”

After my talk I received enthusiastic complements and ‘fist bumps’.

I think I really made an impression. I don’t think anyone had ever talked to these doctors like that before.

My hope is that the effects of my talk will trickle down to helping others with Atrial Fibrillation.


Return to Reports of A-Fib Medical Symposiums & Conferences

If you find any errors on this page, email us. Last updated: Thursday, October 6, 2016

 

 

A-Fib Free? Celebrate Your Independence!

Seek your Cure at A-Fib.com

I’ve been A-Fib free since 1998. You can be too! Read my story and over 80 stories of others free from the burden of Atrial Fibrillation, go to: Personal A-Fib Stories of Hope and Courage.

P.S. This week in the U.S., we celebrate the founding of our country with the July 4, 1776 signing of our Declaration of Independence. (BTW: Patti found this photo and writes: “Our family’s Fourth of July picnic celebrations always include a cold slice of watermelon.”)

FAQs Coping with A-Fib Stroke: What Your Family Should Learn Now

 FAQs Coping with A-Fib: Stroke Action Plan

FAQs A-Fib afib“In case I have an A-Fib-related stroke, what does my family need to know to help me? (I’m already on a blood thinner.)  What can I do to improve my odds of surviving it?

Stroke is the most dreaded effect of having A-Fib. And an A-Fib-related stroke is usually worse because the clots tends to be larger. They often result in death or permanent disability.

Here are some basic facts and steps you and your family can take to prepare for and what to do if stroke strikes any member of your family.

Prepare Your Plan: The 4 Steps

For your own and your family’s peace of mind, you need to create a ‘Stroke Action Plan’.

Step 1: Learn the Signs of a Stroke

Make it a family affair. Discuss the most common signs of stroke: sudden weakness of the face, arm or leg, most often on one side of the body.  Stroke may be associated with a headache, or may be completely painless. Each person may have different stroke warning signs.

Step 2―Ask Your Doctor

Discuss with your doctor what actions to take in case of stroke. For example, some doctors recommend aspirin to help avoid a second ischemic stroke (A-Fib). If so, ask what dosage.

Step 3―Locate Your Nearest ‘Certified Stroke Center’

Why a Certified Stroke Center? If a stroke victim gets to a Certified Stroke Center within four hours, there is a good chance specialists can dissolve the clot without any lasting damage.

Only a fraction of the 5,800 acute-care hospitals in the U.S are certified as providing state-of-the-art stroke care.

A certified or ‘Advanced Comprehensive Stroke Center’ is typically the largest and best-equipped hospital in a given geographical area that can treat any kind of stroke or stroke complication.

A Certified Stroke Center will have drugs such as Tissue Plasminogen Activator (tPA) to dissolve the clot. Can use Clopidogrel or acetylsalicylic acid (ASA) to stop platelets from clumping together to form clots. Or use anticoagulants to keep existing blood clots from getting larger.

So do your homework. To find the nearest certified or ‘Advanced Comprehensive Stroke Center’ check these listings:

Find A Certified U.S. Stroke Center Near You/NPR News
Find a Certified Comprehensive Stroke Center

Step 4―Post Your ‘Stroke Action Plan’

Write up the three components of your plan (i.e., the signs of stroke, aspirin dosage and location of the nearest Certified Stroke Center).

What about your workplace? Locate the nearest Certified Stroke Center to your job, too, and post a copy.

Also, print handouts with the name and address of the nearest Certified Stroke Center (Advanced Comprehensive Stroke Center) for EMS responders. Keep a bottle of aspirin nearby.

Store your ‘Stroke Action Plan’ in a special binder or post so that family can easily find the information.

If a Stroke Strikes: Work the Plan

1. Immediately call your emergency medical services (EMS)―even if the person having the stroke doesn’t want you to. (e.g., 911 in US and Canada, 0000 in Australia, 999 in the UK.)

Note: DO NOT try to diagnose the problem by yourself, and DO NOT wait to see if the symptoms go away on their own.

2. While waiting for EMS, administer aspirin in the proper dosage (if advised by your doctor beforehand) to help avoid a second stroke.

Note: The emergency operator might connect you to a hospital that gives you instructions based on symptoms.

3. When EMS arrives, tell them to take the patient to your nearest Certified Stroke Center (give them a handout with the name and address).

Note: If necessary, be firm, insist they go to your choice of Certified Stroke Center. (Realize that some paramedics and ambulance services have side deals with hospitals to take patients to their hospitals, even if it’s not the right hospital for stroke victims.)

The Wrap Up

A ‘Stroke Action Plan’ with specific steps is reassuring during a medical emergency and helps everyone stay calm. Your family will be confident they’re supporting you in taking the right action at the right time.

The only guarantee of not having an A-Fib stroke is to no longer have A-Fib.

Know that quickly going to a certified or ‘Advanced Comprehensive Stroke Center’ may save you from the debilitating effects of an A-Fib stroke, or even death.

For additional reading, see Ablation Reduces Stroke Risk to that of a Normal Person.

References for this article
Chen ZM, et al. Indications for early aspirin use in acute ischemic stroke: A combined analysis of 40,000 randomized patients from the Chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collaborative groups. Stroke. 2000 Jun;31(6):1240-9

Why Choose Comprehensive Stroke Center Certification. The Joint Commission. June 20, 2014. http://tinyurl.com/JC-comprehensive-stroke-ctr

Emergency Telephone Numbers Around the World. ChartBin.com URL: http://chartsbin.com/view/1983

Find A Certified U.S. Stroke Center Near You. NPR News. Updated October 29, 2015. URL: http://tinyurl.com/certified-stroke-center

Find a Certified Comprehensive Stroke Center: Search by US state. The Internet Stroke Center.  URL: http://www.strokecenter.org/trials/centers/

Back to FAQs: Coping with Your A-Fib
Last updated: Monday, June 18, 2018

‘A-Fib’s Demise’, a Poem by Emmett Finch, The Malibu Poet

Photo - Emmett Finch, The Malibu Poet

Emmett Finch, The Malibu Poet

We met Emmett Finch, The Malibu Poet, when we researched his personal A-Fib story for our book, Beat Your A-Fib. (“40-Year Battle With A-Fib Includes AV Node Ablation With Pacemaker” on pp. 166-169.) Now in his 90s, Emmett’s story illustrates the evolution of A-Fib treatments from drug therapy to PVIs, and from AV Node ablation/Pacemaker to the Watchman device.

Emmett honored us with a special poem ‘A-Fib’s Demise’. It’s for people of faith who look for hope and help from the Divine but also see doctors, medicines, supplements, etc. as manifestations of the “creative power we call God.”

We hope ‘A-Fib’s Demise’ will inspire you to Seek Your Cure!

Note: Want a hard copy? Download and print the PDF.

Emmett's Poem - A-Fib_s Demise

 

Book Recommendation: “The Healing Kitchen” for Finding Foods that Promote Heart Health

The Healing Kitchen by Stephen Sinatra

The Healing Kitchen by Stephen Sinatra

Neville (from Australia) wants to share his experience with our A-Fib.com readers:

“I recently bought cardiologist Stephen Sinatra’s book, “The Healing Kitchen” from Amazon.com using your [A-Fib.com portal] link.
I recommend it to your readers as a big help in finding foods that promote heart health and avoiding those that are harmful. There is a wealth of useful advice in the book including information on clinical studies that back up his arguments.”

Thanks, Neville, for sharing your book recommendation. And thank you for using the A-Fib.com portal link to Amazon.com to make your purchase. Each sale generates a small commission which we apply to the monthly costs of publishing A-Fib.com. All at no extra cost to you.

Bookmark our Amazon.com portal link and use it every time you shop Amazon.A-Fib.com portal link to Amazon.com

Doing your Holiday shopping online?
Use our Amazon.com link: http://tinyurl.com/Shop-Amazon-for-A-Fib.
Support A-Fib.com at no extra cost to you.

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

Research on Atrial Fibrillation

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. Women suffer more from A-Fib related anxiety which in turn increases the risk of being misdiagnosed as panic disorders.

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 (an Electrophysiologist (EP)—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). (Women have a longer QT interval than men.) When treated with antiarrhythmic drugs, women are more likely to have life-threatening adverse events.

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
Patel, D. et al. Atrial Fibrillation Catheter Ablation in Females. Expert Rev Cardiovasc Ther. 2011;9(11):1391-1395. http://www.medscape.com/viewarticle/753555Forleo, G. et al. Gender-related differences in catheter ablation of atrial fibrillation. Europace 9, 613-620 (2007). Last accessed Aug 13, 2015. http://europace.oxfordjournals.org/content/9/8/613.short

Roten L, et al. Gender differences in patients referred for atrial fibrillation management to a tertiary center. PACE 32, 622–626 (2009). Specifically examines the proportion of males to females referred for ablation in a specialized outpatient clinic. Women were referred three-times less frequently than males to the clinic.

Friberg J, et al. Comparison of the impact of atrial fibrillation on the risk of stroke and cardiovascular death in women versus men (The Copenhagen City Heart Study). Am. J. Cardiol. 94, 889–894 (2004).

Patel D, et al. Outcomes and complications of catheter ablation for atrial fibrillation in females. Heart Rhythm 7, 167–172 (2010). The largest study to date that evaluates the safety and efficacy of catheter ablation in females.

Feinberg WM, et al. Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch. Intern. Med. 155, 469–473 (1995).

Humphries KH, et al. New-onset atrial fibrillation: sex differences in presentation, treatment, and outcome. Circulation 103, 2365–2370 (2001). Evaluated the effects of gender on atrial fibrillation presentation, management and outcomes.

Dagres N, et al. Gender-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Heart Survey on Atrial Fibrillation. J. Am. Coll. Cardiol. 49, 572–577 (2007).

Fang MC, et al. Gender differences in the risk of ischemic stroke and peripheral embolism in atrial fibrillation: the Anticoagulation and Risk Factors In Atrial fibrillation (ATRIA) study. Circulation 112, 1687–1691 (2005).

Dagres N, et al. Significant gender-related differences in radiofrequency catheter ablation therapy. J. Am. Coll. Cardiol. 42, 1103–1107 (2003). Evaluated gender-related differences in catheter ablation in patients with accessory pathways and/or atrioventricular nodal re-entrant tachycardia.

Fuster V, et al. ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 7, 257–354 (2006).

A-Fib Patients: Is Stress Really Bad For You?

Stanford University psychologist Kelly McGonigal, PhD, author of The Upside of Stress: Why Stress Is Good for You, and How to Get Good at It, has challenged the conventional view that stress is bad for you. I found a few insights from her book encouraging for A-Fib patients.

Researchers who followed 30,000 US Americans for eight years found that the risk for death from any cause rose by 43% among participants who had high levels of stress. But that number applied only to people who believed that the stress they were experiencing was bad for their health.

From the Upside of Stress by Kelly McGonigal

From the Upside of Stress by Kelly McGonigal

Study participants who reported similar levels of stress but who did not consider it to be bad for their health, had survival rates that were actually better than those of people with relatively stress-free lives.

Dr. McGonigal recommends telling yourself “I’m excited” rather than stressed. Try to look at stress as simply your body’s response when something you care about is at stake. The pounding heart or faster breathing is your body’s way of heightening your senses so that you are mentally focused and motivated to do well.

Look at stress as a challenge rather than a looming threat.

So What Does this Mean for A-Fib Patients? Stress, by itself, is not usually a trigger for an A-Fib attack. (You could be totally stress-free, lounging on a swing on a tropical isle and still have an A-Fib attack.)

But stress can play a role in the intensity and duration of your A-Fib attacks.

Beyond the physical, A-Fib has psychological and emotional effects as well. Recent research indicates that “psychological distress” worsens the severity of A-Fib symptoms.

Kelly G book cover - Upside of Stress 75 pix wide at 300 res

Buy this book

Give Dr. McGonigal’s Advice a Try. So, when feeling stressed, try mentally ‘reframing’ the stress as a ‘challenge’ rather than as a looming threat. Tell yourself “I’m excited” rather than stressed. It may help lessen your A-Fib symptoms. (Let me know if this works for you! Email me.)

Sounds like this approach could help in many areas of our lives.

For other ways to cope with your stress, see our A-Fib.com article, Coping With the Fear and Anxiety of Atrial Fibrillation.

For more about stress from Kelly McGonigal, read her The Washington Post interview, or her book, The Upside of Stress: Why Stress Is Good for You, and How to Get Good at It.

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

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

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

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

Controversial CHA2DS2-VASc Risk Data and Analyses?

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

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

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

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

Study Conclusion

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

Editor’s Comments:

Intuitively it doesn’t make sense that simply being a woman makes you more at risk of having an A-Fib stroke. This study seems to confirm what common sense would indicate.
Women in their child-bearing years are much less at risk of stroke because of the blood-thinning effect of losing blood each month. And even after menopause women have less risk of stroke. But eventually they do have more strokes. But not because of an innate inferiority, but because women live longer than men. Stroke and hypertension are age related. In this israeli study women who developed A-Fib were four years older than men.
Be advised that the original European guidelines were written by doctors with major conflicts of interest. These guidelines may be a not so very subtle form of gender bias. Also, just adding one point to a person’s stroke risk score translates into a huge increase in sales for pharmaceutical companies.
References for this article
Amson, Yoav et al. Are There Gender-Related Differences In Management, And Outcome Of Patients With Atrial Fibrillation? A Prospective National Study. Arrhythmias and Clinical EP. Acc.15. JACC. March 17, 2015, Volume 65, Issue 10S. doi: 10.1016/S0735-1097(15)60469-7 Last accessed March 23, 2016. URL:http://content.onlinejacc.org/article.aspx?articleid=2198096&resultClick=3

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Last updated: Monday, March 28, 2016

Warfarin vs. Pradaxa and the Other New Anticoagulants

by Steve S. Ryan, PhD, Last Updated June 2018
CT scan - Ischemic Stroke - NOAC and Warfarin at A-Fib.com

Most would agree that the worst thing that can happen to a patient with A-Fib is a life-altering stroke. A stroke often causes death or permanent disability. Thus the importance of anticoagulation therapy for A-Fib patients.

Low-Risk Patients: For patients at low or intermediate risk of stroke (including younger patients without any additional stroke risk factors), aspirin may be prescribed, or no anticoagulation therapy at all.

Stroke Prevention With warfarin

For many years, there was only one proven therapy for stroke prevention in A-Fib patients at high or intermediate risk for stroke: the anticoagulant warfarin (Coumadin). It’s readily available and inexpensive.

But maintaining correct warfarin levels is difficult especially over the long haul (studies indicate around 30% of people will stop taking warfarin).

But maintaining correct warfarin levels is difficult especially over the long haul (studies indicate around 30% of people will stop taking it).

Frequent blood tests are required to regulate the dose.

Higher Risk of Bleeding Gene? About a third of the people who take warfarin are at a higher risk of bleeding because their genes make them more sensitive to warfarin. If a family member experienced side effects, talk to your doctor about taking a genetic warfarin sensitivity test.

Drug Interactions: Warfarin also has many interactions with other drugs, herbs, and food sources. If taken incorrectly, warfarin can increase your risk of dangerous bleeding.

Warfarin: Notable Concerns

Taking warfarin over several years may lead to microbleeds in the brain and dementia.

Read about the post-ablation patient on anticoagulation therapy for 10 years who developed cerebral microbleeds and early dementia: The New CHA2DS2-VASc Guidelines and the Risks of Life-Long Anticoagulation Therapy 

“Oral anticoagulants…increase the risk of intracerebral hemorrhages (ICH), a less common but more deadly and disabling type of stroke. Over 50% of patients sustaining a  warfarin-related ICH die within the first three months.” (NOAC-related intracerebral hemorrhages outcomes are similar to warfarin.)

GI intestinal bleeding is another potential risk of Warfarin. “The risk of warfarin related GI bleeds can range from between 0.8% and 1.5% in patients on long term anti-coagulation.”

Stroke Prevention: NOACs

Novel Oral AntiCoagulants (NOACs) are alternatives for vitamin K antagonists (e.g., Warfarin) for stroke prevention.

For over 20 years there have been extensive efforts to replace warfarin with other drugs. In the US, we have four new anticoagulants to consider: Pradaxa (dabigatran), Xarelto (rivaroxaban), Eliquis (apixaban) and Savaysa (edoxaban)).

The data on the new anticoagulants comes from three randomized controlled trials involving more than 50,000 A-Fib patients:

RE-LY (dabigatran)
• ROCKET-AF (rivaroxaban)
• ARISTOTLE (apixaban)

Each study compared one drug against warfarin (not against each other). Taken together, these studies consistently revealed that A-Fib patients who took the non-warfarin blood thinners suffered fewer strokes, intracranial bleeds, and serious bleeds than those who took warfarin.

All of these drugs are at least as good as warfarin for preventing stroke and all are better than warfarin in reducing your risk of serious bleeding in the brain.

Questionable Trials Bias: Each of these NOAC trials had a questionable bias toward the new drug when compared against warfarin.

Warfarin users are notoriously non-compliant: Up to 50% are inconsistent in managing their diet, monitoring their INR levels and taking the correct dosage. Each of the three trials compared a group of compliant patients against a group of inconsistent warfarin patients. So results should be viewed with a critical eye.

For a more in-depth look at the clinical trials of the new NOACs, see 2013 BAFS: The New Anticoagulants (NOACs).

But NOACs are not like taking vitamins. They work by causing or increasing bleeding and are considered high risk meds. “For patients with atrial fibrillation, NOACs still pose a major bleeding risk,” according to Dr. Shang-Hung Chang and his colleagues at Chang Gung Memorial Hospital in Taiwan.

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NOACs: Three Notable Concerns

The new anticoagulants offer several advantages over warfarin. They are fast acting. And when stopped (i.e., for surgery), they just as quickly clear your body (a short “half-life). There’s a broad therapeutic window (wide range of safe use), and they have minimal drug or dietary interactions. They can be administered in fixed doses without monitoring, making them potentially more convenient to use than warfarin.

Remember: The goal of anticoagulation therapy is to reduce your risk of life-altering stroke.

Enthusiasm for the new anticoagulants (NOACs), however, must be tempered by three notable concerns in patients taking these drugs:

1. No readily available means for assessing the degree of anticoagulation
2. Life-threatening bleeding complications can occur after an injury
3. Stomach problems and gastrointestinal bleeding

According to Dr. Stephen Kimmel of the Un. of Pennsylvania: “If you have a history of stomach problems or gastrointestinal bleeding, you may want to avoid Pradaxa and Xarelto—both medications have the highest risk for those complications.”

NOACs: No Way to Measure Effectiveness

One of the problems with the newer anticoagulants (NOACs) is we don’t have a good way to measure how effective they are or how much of an anti-clotting effect there is at a given point in time. (For example, in treating trauma patients, ER doctors can only use the elapsed time from the last dose to estimate the clotting effect.)

With warfarin (Coumadin), on the other hand, we can measure how effective it is by its level in the blood stream measured in INR (International Normalized Ratio). A person not on anticoagulants will have an INR slightly above 1 (the author’s INR is 1.1). Someone with A-Fib on Warfarin should have an INR between 2.0 and 3.0. At this INR level a person will bleed more than someone with an INR of 1.0, but the blood will still clot.

With an INR below 2.0 you are more in danger of having an ischemic (clotting) stroke, the kind that most often occurs in A-Fib. With an INR of 4.0 and above, there is much more risk of blood not clotting and of developing a hemorrhagic stroke.

But the INR blood test doesn’t work with the new anticoagulants which affect only one particular stage in the anticoagulation process. Pradaxa, for example, is a direct thrombin inhibitor, whereas warfarin affects nearly every stage in the anticoagulation process. (Thrombin is an enzyme that converts soluble fibrinogen into insoluble fibrin. Fibrin is a fibrous protein involved in the clotting of blood. It forms a mesh or clot over a wound.)

The lack of a readily available method to determine the degree or current level of anticoagulation is a major challenge for ER physicians and staff treating trauma patients.

Medical ID: If you’re on any blood thinner, it’s a good idea to carry some kind of medical ID. If you have an accident involving bleeding, EMTs can call ahead to the ER and get the staff ready to help you. To print your own I.D. see: Print a free Medical Alert I.D. Wallet Card

Pradaxa: Too Effective?

Pradaxa, in particular seems to work almost too well.

Pradaxa won the FDA sweepstakes by being the first new anticoagulant to get FDA approval and thus captured a significant market share. 

In some patients there is excessive bleeding that is catastrophic (usually in older or weaker patients). Pradaxa has been associated with deaths in the ER before doctors had Praxbind, the Pradaxa reversal agent, to stop people from bleeding to death. (Warfarin on the other hand has several proven, time-tested reversal or antidote strategies.)

Pradaxa (dabigatran) won the FDA sweepstakes by being the first new anticoagulant to get FDA approval and consequently captured a significant share of the anticoagulant market.

Pradaxa comes in two doses in the United States, 150 mg twice daily or 75 mg twice daily. It’s large and harder to swallow, comes in a bottle with a 30-day shelf life once opened (or in blister packs which eliminates the shelf-life problem.) And it’s expensive.

Questionable Trials Bias: Each of these NOAC trials had a questionable bias toward the new drug when compared against warfarin.

In the RELY trial, Pradaxa was not only equal to warfarin, but it proved to be superior to it in preventing stroke. Bleeding rates in the head were lower than with Warfarin. However, bleeding from the stomach or bowels was higher. The most common side effect was stomach pain.

In addition to the bleeding deaths in the ER mentioned above, Pradaxa’s own fact sheet states common side effects of Pradaxa include:

• Indigestion, Upset Stomach, or Burning
• Stomach Pain

[These statements don’t capture the actual human toll—burning throat, roiling intestines, diarrhea, burning anus, lasting intestinal damage, etc. that Pradaxa can produce in some people.]

Xarelto and Eliquis

Xarelto (rivaroxaban) was the second drug available in the United States. Xarelto comes in two doses, 20 mg daily or 15 mg daily. In contrast to Pradaxa, it is a small pill taken once-a-day that doesn’t seem to cause a lot of intestinal problems. In the Rocket AF trial, Xarelto also significantly lowered the risk of bleeding in the brain and head compared to warfarin. Anecdotally we don’t seem to see a lot of deaths in the ER from Xarelto.

Eliquis (apixaban) was third to be approved, comes in two doses, 5 mg twice daily or 2.5 mg twice daily (the lower for A-Fib patients with kidney dysfunction). Similar to Xarelto, the risk of bleeding in the brain and head was lower versus warfarin.

However, this drug was unique in that bleeding from other sites including the stomach, bowels, and bladder was less. In the Aristotle trial, Eliquis was at least as good and tended to be better than warfarin at preventing stroke. Eliquis is the only drug that can claim that survival improved with its use compared to warfarin.

Xarelto and Eliquis, just like Pradaxa, are also very expensive.

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NOAC Reversal Agents and Bleeding Complications

As of May 2018, there are now FDA-approved NOAC reversal agents: Praxbind for Pradaxa (dabigatran) and Andexxa for the NOACs Xarelto (rivaroxaban) and Eliquis (apixaban). See FDA Approves Antidote for Xeralto and Eliquis).

The reported bleeding events tend to occur mainly in elderly patients (median age of 80) which raises a question regarding safe dosing and monitoring in older patients. Elderly patients often have mild to moderate renal impairment, which can cause plasma levels of the NOAC to increase to up to three times those with normal renal function.

“One-size-fits-all” dosage of these new anticoagulants may need to be re-examined for elderly patients. (The FDA rejected the lower 110-mg twice-daily dose of Pradaxa (dabigatran) tested in the RE-LY trial, instead approving a 75-mg twice-daily dose just for patients with severe renal impairment.)

 Eliquis Earns Best Safety Score

Through an analysis of data from the FDA Adverse Event Reporting System by AdverseEvents, Inc., Eliquis has received an “RxScore” safety score of 39.45 on a 100 point scale, with 100 representing the highest risk. In comparison, warfarin had a score of 67.57. Pradaxa (dabigatran) had a score of 67.15, Xarelto (rivaroxaban) 67.08.

The FDA’s database comprises all the reports made by doctors, patients and other healthcare providers, which means it’s not a “scientific” finding with the authority of a clinical trial. AdverseEvents applies logic, math and software to the database to sift out the important data.

For Eliquis, “the rate of suspect cases was lower in every type of adverse-event report, from hospitalization to death.” For example, among Eliquis patients reporting side effects, only 21% cited hospitalization, while Pradaxa had 39%, Xarelto 43% and warfarin 50%.

The results all point to the same general conclusion: Eliquis may be a safer choice among the new NOACs.

Choosing Your anticoagulant

If you’re conscientious and are pretty good at staying in the proper INR range, stick with warfarin (Coumadin) if you can. It may not be as convenient and easy to use as the newer anticoagulants, but we know warfarin works if you stay within the proper INR range. And there are proven reversal agents for warfarin. The cost of warfarin is significantly lower when compared to the new anticoagulants. (Your insurance provider may have a direct say about which drug you take.)

Note: There’s no guaranteed way to avoid a stroke altogether.

If you have trouble staying within the proper INR range, can’t juggle the diet restrictions or monthly monitoring, I suggest you talk with your doctor about switching from warfarin (Coumadin) to the NOAC Eliquis (apixaban). Eliquis doesn’t block Vitamin K like warfarin, has no interactions with food (not even spinach), and requires NO monitoring (no more finger stick checks).

Compared the other NOACs, Eliquis tested better and has the best RxScore safety score. Like all the NOACs, be aware of Eliquis’ much higher monthly price. (For those in the US and on Medicare with Part D coverage, the monthly cost may range from $30 to $50.) You will need to judge if the benefits outweigh the costs.

When choosing an anticoagulant, along with costs, you need to consider which is worse: the risk of uncontrolled bleeding or the risk of a debilitating stroke.

Resources for this article
• Gurol, M Edip. Brain MRI scans can inform the choice between OACs and LAA closure for non-valvular AF. Cardiac Rhythm News. March 18, 2018, Issue 40. p. 9

• Lakkireddy, Dhanunjaya. Octreotide enables left atrial appendage closure in AF patients with GI bleeding. Cardiac Rhythm News, May 31, 2018, Issue 40. P.1.

• Chang SH et al. Association Between Use of Non–Vitamin K Oral Anticoagulants With and Without Concurrent Medications and Risk of Major Bleeding in Nonvalvular Atrial Fibrillation. JAMA. 2017; doi:10.1001/jama.2017.13883.

• Piccini, JP. Interaction between newer anticoagulants, certain drugs increases major bleeding in AF. Perspective. Arrhythmia Disorders. Healio/Cardiology Today. Oct 2017. https://www.healio.com/cardiology/arrhythmia-disorders/news/online/%7B48813250-e3e1-4a0b-81bc-b2471691e666%7D/interaction-between-newer-anticoagulants-certain-drugs-increases-major-bleeding-in-af

• Connolly SJ, et al. RE-LY Steering Committee and Investigators.  Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139-51. Last accessed July 10, 2014 URL: http://www.ncbi.nlm.nih.gov/pubmed/19717844

• Patel MR, et al. ROCKET AF Investigators.  Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.  N Engl J Med. 2011;365(10):883-91. Last accessed July 10, 2014, http://www.ncbi.nlm.nih.gov/pubmed/2183095

• Granger CB, et al. ARISTOTLE Committees and Investigators.  Apixaban versus warfarin in patients with atrial fibrillation.  N Engl J Med. 2011; 365(11):981-92 Last accessed July 10, 2014

• Ansell J, et al. Descriptive analysis of the process and quality of oral anticoagulation management in real-life practice in patients with chronic non-valvular atrial fibrillation: the interactional study of anticoagulation management (ISAM) J Thromb Thrombolysis 2007; 23: 83—91. Last accessed July 10, 2014

• Kimmel, Stephen. The Truth About Blood Thinners, Bottom Line/Health, May 2015, p. 11

• Pradaxa: Highlights of Prescribing Information. Boehringer-Ingelheim website. Last accessed March 13, 2014 URL: http://tinyurl.com/PraxadaInfo

• Examining the Comparative Safety of Blood Thinners: An Analysis Utilizing AdverseEvents Explorer, February 2014, Special Report Download. http://info.adverseevents.com/special-report-blood-thinner Last accessed July 10, 2014

• Staton, Tracy. Eliquis earns best safety score in its class in analysis of FDA adverse event reports. FiercePharma, February 26, 2014. Last accessed July 10, 2014, http://www.fiercepharma.com/story/eliquis-earns-best-safety-score-its-class-analysis-fda-adverse-event-report/2014-02-26

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Last updated: Thursday, June 21, 2018

 

FAQ: Natural Therapies & Holistic Treatment for A-Fib

Complementary & Natural Therapies

Complementary & Natural Therapies

FAQ: Natural Therapies & Holistic Treatment

Many A-Fib patients have questions about treatment alternatives such as naturopathic doctors, complementary or integrated medicine as well as mind/body practices (such as chiropractic, acupuncture, yoga and meditation).

1. Holistic approach: How do I find a doctor with a more “holistic” approach? I want nutritional counseling and a more integrated approach to my A-Fib treatment plan?

2. Complementary Medicine: I’ve read that yoga and acupuncture are considered ‘Complementary Medicine‘. What is that? How does it relate to conventional medicine?

3.  Naturopathic Medicine: “A dietitian friend referred me to a Naturopathic doctor. What is naturopathic medicine? Are they ‘real’ physicians?”

Related question:Have any A-Fib.com readers reported success working with a Naturopathic doctor? Anyone controlling their A-Fib with supplements?”

4. Vagal: What is the ‘vagal maneuver’? I’ve heard it might help me during an A-Fib episode. What is it and how is it done? Is it safe?”

5. Diet: Is a whole food or organic diet helpful for patients with Atrial Fibrillation? Is there any research recommending one or the other?”

6. Chiropractic:  Do A-Fib patients find chiropractic adjustment useful? If so, what are their results? In the past, I’ve found it helpful for other ailments. Could it help with my A-Fib symptoms?”

7. Yoga: I do Yoga. It relaxes me and helps with my stress level. Is there any evidence on Yoga helping with other A-Fib symptoms?”

8. Acupuncture: What’s the research on acupuncture and Atrial Fibrillation? I’m willing to try it if it will help ease or reduce my A-Fib episodes.”

9. Natural blood thinners: “Have there been any tests comparing natural blood thinners to the new anticoagulants (NOACs) in terms of efficacy and speed of onset?”

“Most people use non-mainstream approaches along with conventional treatments. The boundaries between complementary and conventional medicine overlap and change with time.” ∼ US National Institutes of Health

If you find any errors on this page, email us. Y Last updated: Saturday, February 11, 2017
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FAQs: Mineral Deficiencies & Supplements for a Healthy Heart

FAQs: Mineral Deficiencies & Supplements for a Healthy Heart

A-Fib patients often look for non-drug approaches to ease or prevent the symptoms of their Atrial Fibrillation. Here we share answers to the most often asked questions about minerals deficiencies and the use of supplements.

1. Dementia: “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. Vitamin D: “How can I tell if I’m lacking in Vitamin D? I’m concerned because Vitamin D deficiency has been tied to both A-Fib and Dementia. What is a normal level of Vitamin D?

3. PVCs and PACs: “I have annoying PVCs and PACs with my A-Fib. Are there natural remedies to reduce these extra beats and palpitations? My doctor says to ignore them.”

4. Nutritional Info: I tried to talk with my doctor about magnesium and other nutritional supplements. His response was ‘There’s no proof that they work.’ Why are doctors so opposed to nutrition as a way of helping A-Fib.

Related Question:What’s the best way to take supplements—at the same time each day or spread throughout the day? In one lot or in divided doses?”

Related Question:Where can I find reliable, unbiased research and information on specific vitamins and supplements? (I want an independent resource, not some site trying to sell me their products.)”

5. BCAA+G: “The supplement BCAA+G helps builds muscle. Is it a natural remedy that could help my A-Fib? Are A-Fib patients BCAA-deficient?”

6. Iron levels: “I’m anemic. Is too little iron in the blood (anemia) a cause of Atrial Fibrillation? Any advice on how A-Fib patients can deal with iron deficiency?”

Related Question: Can excess iron in the blood (Iron Overload Disease, IOD) cause Atrial Fibrillation? How do I know if I have IOD? What can I do about it?

7. Chelate: “What does ‘chelate’ or ‘chelated formulas’ mean when talking about vitamin and minerals? Is it important?

8. Magnesium: “Regarding Magnesium, can supplementing and restoring Mg to healthy levels reverse my A-Fib? I’m about to schedule a catheter ablation. But if supplementing can cure my A-Fib, why do an ablation?

9. CoQ10  “Can I take the supplement CoQ10 while on Eliquis for Atrial Fibrillation? On your site it says CoQ10 could be helpful. But on my bottle of CoQ10, it says “do not take if you are on blood thinners.

10. Krill Oil: “I’m interested in the supplement, Krill Oil, that has natural blood thinning properties. I’m taking Eliquis for my risk of A-Fib stroke. Is It OK to take Krill Oil along with Eliquis?”

If you find any errors on this page, email us. Y Last updated: Tuesday, February 14, 2017
Return to Frequently Asked Questions

 

FAQs Understanding A-Fib: Stem Cells & Heart Tissue Research

 FAQs Understanding A-Fib: Stem Cells

FAQs Understanding Your A-Fib A-Fib.com“I’ve read about stem cells research to regenerate damaged heart tissue. Could this help cure A-Fib patients?”

Yes, this fascinating research, though not directed specifically to Atrial Fibrillation, may prove to be very important to A-Fib patients. These groundbreaking studies focus on using stem cells to regenerate damaged heart tissue.

Working with heart attack victims who had suffered major heart scarring, doctors infused into their damaged hearts, stem cells that had been harvested and grown from their own heart.

The results were astounding!

Scar tissue decreased—shrinking between 30% to 47%. New heart tissue was generated—the stem cell recipients grew the equivalent of 600 million new heart cells. Their ejection fraction increased from the low 30% range to almost normal. Patients who received these stem cells had significant improvements in heart function, physical capacity, and scored better on quality-of-life questionnaires. MRI and ultrasound imaging revealed that areas where stem cells were infused showed major improvement which continued for over a year.

Their heart damage was reversed without dangerous side effects.

What does this mean to A-Fib patients? For someone with Atrial Fibrillation, the research studies’ terms of ‘scar tissue’ and ‘heart damage’ translates to ‘fibrosis’, that is, tissue that becomes fibrous and inflexible. Fibrosis in A-Fib patients is linked to enlargement of the heart and the increased threat of stroke.

if injected stem cells can somehow signal the heart to repair itself, this may turn the A-Fib patient’s fibrosis and scarring back into normal heart muscle. The fibrosis and scarring associated with A-Fib would no longer be permanent and irreversible.

Maybe someday we could be cured of A-Fib through stem cell infusion rather than with ablation burns or surgery.

For more read my article: “Stem Cells Reverse Heart Damage—May Repair Fibrosis and Scarring in A-Fib”, and my reports: 2013 BAFS: A-Fib Produces Fibrosis—Experimental and Real-World Data, and BAFS 2014: High Fibrosis at Greater Risk of Stroke and Precludes Catheter Ablation: Lessons Learned from the DECAAF Trial.

Go back to FAQ Understanding A-Fib
Last updated: June 18, 2018

FAQs Understanding A-Fib: Supraventricular Tachycardia

 FAQs Understanding A-Fib: Supraventricular Tachcardia

FAQs Understanding Your A-Fib A-Fib.com“Is Atrial Fibrillation different from what doctors call Paroxysmal Supraventricular Tachycardia?”

‘Supraventricular’ refers to the upper part of the heart, the atria. “Tachycardia” means the upper part of your heart is beating faster than normal. “Paroxysmal” means occasional.

“Supraventricular Tachycardia” in clinical practice commonly refers to atrial tachycardia, atrioventricular nodal reentrant tachycardia (AVNRT), and atrioventricular reciprocating tachycardia (AVRT), an entity that includes Wolff-Parkinson-White syndrome. While Atrial Fibrillation is a distinct entity classified separately.

The term “Supraventricular Arrhythmia” most often is used to refer to Supraventricular Tachycardias and Atrial Flutter. In practice, “Supraventricular Tachycardia” is often used loosely to include all arrhythmias in the Atria, including A-Fib.

Thanks to Sol Yuyitung for this question.

Go back to FAQ Understanding A-Fib
Last updated: June 18, 2018

FAQs Understanding A-Fib: Genetic? Will my children get A-Fib too?

 FAQs Understanding A-Fib: Genetics

FAQs Understanding Your A-Fib A-Fib.com“Is my Atrial Fibrillation genetic? Will my children get A-Fib too?”

Genetic research in A-Fib, though in its preliminary stages, has the potential to be a game changer for patients with A-Fib. But right now we just don’t have a definitive answer to your question.

A-Fib does run in families. Do you have a parent or other family member with A-Fib? Research has found that, if you have any immediate family with A-Fib, you have a 40% increased risk of developing A-Fib yourself. And the younger that family member was when they got A-Fib, the more likely you are to develop A-Fib. Following the logic of this research, your children may be 40% more likely to develop A-Fib.

While the gene that increases the tendency for Familial A-Fib has been identified, there hasn’t been enough research on the genetics of A-Fib to say whether or not you will pass it on to your children.

To learn more about how A-Fib can run in families, read a few of our Personal A-Fib storiesJon Darsee (#68), Pat Truesdale (#63), Jan Claire (#39), Barry Gordon (#22), and James Adams (#13). You may want to read about Roger Meyer and Three Generations with AFib (see our book, Beat Your A-Fib, page 110).

Go back to FAQ Understanding A-Fib
Last updated: June 18, 2018

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