ABOUT 'BEAT YOUR A-FIB'...


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

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

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

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

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

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



ABOUT A-FIB.COM...


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

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

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

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

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

Terry Traver, former A-Fib patient

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

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


FAQ

Frequently-Asked-Questions

New FAQ: Does Ablation Reduce Heart’s Pumping Volume?

Our new Frequently Asked Questions & Answers (FAQs) is about the heart’s blood pumping capacity after an ablation.

“I’m a life-long runner. I recently got intermittent A-Fib. Does ablation (whether RF or Cryo) affect the heart’s blood pumping output potential because of the destruction of cardiac tissue? And if so, how much? One doc said it does.”

As a fellow runner, I understand your concern on how an ablation might affect your ability to resume your athletic activities.

Lesions at PVs openings

Seek Your Cure: Keep in mind, with Atrial Fibrillation you lose 15% to 30% of your heart’s normal pumping volume along with lower oxygen levels. Your body and brain aren’t getting the blood and nourishment they need. An catheter ablation is an important way to improve or restore your heart’s pumping volume.

PVAI - Ccommon lesion set at A-Fib.com

More extensive lesions pattern

Ablate as Little Tissue as Possible: A common ablation technique for paroxysmal A-Fib (using RF or Cryo), ablates only around the opening of each Pulmonary Vein (PV) and isn’t likely to affect the heart’s output.

On the other hand, more extensive lesion patterns affecting more tissue may affect the heart’s output. For example, during a PV Wide Area Antrum Ablation, instead of just ablating around each of the PV openings, large, oval lesions are made in the left atrium encircling both the upper and lower vein openings.

My Best Advice to Runners with Atrial Fibrillation

For a runner, a more extensive ablation of the left atrium may affect heart output more than circular lesions of each vein opening. …Continue reading my answer…

FAQs A-Fib Ablations: A Runner’s Heart After Ablation

 FAQs A-Fib Ablations: A Runner’s Heart 

Catheter ablation illustration at A-Fib.com

Catheter ablation

27. “I’m a life-long runner. I recently got intermittent A-Fib. Does ablation (whether RF or Cryo) affect the heart’s blood pumping output potential because of the destruction of cardiac tissue? And if so, how much? One doc said it does.”

As a fellow runner, I understand your concern on how an ablation might affect your ability to resume your athletic activities.

Seek Your Cure: Keep in mind, with Atrial Fibrillation you lose 15% to 30% of your heart’s normal pumping volume along with lower oxygen levels. Your body and brain aren’t getting the blood and nourishment they need. An catheter ablation is an important way to improve or restore your heart’s pumping volume.

Catheter Ablation Lesions around PV openings at A-Fib.com

Lesions around PV openings

Ablate as Little Tissue as Possible: A common ablation technique for paroxysmal A-Fib (using RF or Cryo), ablates only around the opening of each Pulmonary Vein (PV) and isn’t likely to affect the heart’s output.

On the other hand, more extensive lesion patterns affecting more tissue may affect the heart’s output. For example, during a PV Wide Area Antrum Ablation, instead of just ablating around each of the PV openings, large, oval lesions are made in the left atrium encircling both the upper and lower vein openings.

PVAI - Ccommon lesion set at A-Fib.com

More extensive lesion pattern

(This is intuitive on my part; we don’t have clinical studies confirming any effect or difference between the two approaches in terms of heart output and atrium function.)

For a runner, the more extensive ablation of the left atrium may affect heart output. Less active patients may not notice the difference, but a runner like you may.

My Best Advice to Runners with Atrial Fibrillation

Seek out the Best EPs: Select the most experienced Electrophysiologists (EPs) you can afford (and travel if you need to). Discuss catheter ablation and your concerns about decreased heart output after ablation. A good EP will make as few lesions during your ablation as possible.

Paroxysmal A-Fib Easiest to Ablate: At the moment you have “paroxysmal A-Fib of recent onset” and it’s usually the easiest to fix. It’s likely you will not need an extensive ablation. (Though one never knows till the actual ablation; Read what Travis Van Slooten wrote about how his “easy case” turned into a complex, extensive ablation.)

Ablate ASAP: Get your ablation as reasonably soon as possible, before your A-Fib has a chance to get worse and requires a more extensive ablation.

Keep your medical records in a binder or folder. at A-Fib.com

Keep A-Fib records in a binder or folder.

Monitor Progress of your A-Fib: A-Fib is a progressive disease. You should track if your heart’s measurements are getting better or worse, and by how much. Ask your doctor for the measurements of heart dimensions and its functions including the diameter and volume of the left atrium, your Ejection Fraction (EF) and any other test results.

Store all your test results and measurements in your A-Fib three-ring binder or file folder.

What Patients’ Need to Know: A progressively enlarging heart and a falling EF percentage (below 35%) means your A-Fib is worsening. To preserve your heart’s best functions, seek an ablation before your A-Fib worsens.

As a runner, even if your heart is somewhat enlarged and your EF has decreased, a successful catheter ablation may not only end your A-Fib and improve your Ejection Fraction but over time may even reduce your enlarged left atrium.

Thanks to Joe O’Flaherty for this question.

If you find any errors on this page, email us. Last updated: Friday, September 9, 2016

Return to FAQ Catheter Ablation and Maze Surgeries

New FAQ Answered: Which Procedure Has the Best Success Rate?

We’ve answered a new FAQ under the category: Understanding Atrial Fibrillation. Thanks to Thomas Scheben for this question:

I have paroxysmal A-Fib and would like to know your opinion on which procedure has the best cure rate.

The best cure rate isn’t the only criteria you should consider when seeking your Atrial Fibrillation cure. Let me first review your top three procedure options: cardioversion, catheter ablation, and surgical Maze/Mini-Maze. 

Atrial Fibrillation is not a one-size fits all type of disease.

Electrocardioversion: When first diagnosed with Atrial Fibrillation, doctors often recommend an Electrocardioversion to get you back into normal sinus rhythm. But for most patients, their A-Fib returns within a week to a month. (However, you might be lucky like the A-Fib patient who wrote us that he was A-Fib free for 7 years after a successful cardioversion.)

Catheter Ablations: Radio-frequency and CryoBalloon catheter ablations have similar success rates 70%-85% for the first ablation, around 90% is you need a second ablation.

How to achieve these high success rates? It’s crucial you choose the right electrophysiologist (EP)…Continue to read my full answer.

FAQs Understanding A-Fib: Which Procedure Has the Best Cure Rates

 FAQs Understanding A-Fib: Best Cure Rate

FAQs Understanding Your A-Fib A-Fib.com15. “I have paroxysmal A-Fib and would like to know your opinion on which procedure has the best cure rate.”

The best cure rate isn’t the only criteria you should consider when seeking your Atrial Fibrillation cure.

Let me first review your top three procedure options: cardioversion, catheter ablation, and surgical Maze/Mini-Maze.

Electrocardioversion: When first diagnosed with Atrial Fibrillation, doctors often recommend an Electrocardioversion to get you back into normal sinus rhythm. But for most patients, their A-Fib returns within a week to a month. (However, you might be lucky like the A-Fib patient who wrote us that he was A-Fib free for 7 years after a successful cardioversion.)

Catheter Ablations: Radio-frequency and CryoBalloon catheter ablations have similar success rates 70%-85% for the first ablation, around 90% is you need a second ablation. Currently, CryoBalloon ablation has a slightly better cure rate with the least recurrence.

It’s crucial you choose the right electrophysiologist (EP), one with a high success rate and the best you can afford.

How to achieve these high success rates? It’s crucial you choose the right electrophysiologist (EP), one with a high success rate and the best you can afford (considering cost and any travel expense). What counts is the EP’s skill and experience.

You want an EP who not only ablates your pulmonary veins, but will also look for, map and ablate non-pulmonary vein (PV) triggers. That may require advanced techniques like withdrawing the CryoBalloon catheter and replacing it with an RF catheter to ablate the non-PV triggers. (See our Choosing the Right Doctor: 7 Questions You’ve Got to Ask [And What the Answers Mean].) 

Cox Maze and Mini-Maze surgeries: Success rates are similar to catheter ablation, 75%–90%. But surgery isn’t recommended as a first choice or option by current A-Fib treatment guidelines. Compared to catheter ablations, the maze surgeries are more invasive, traumatic, risky and with longer (in hospital) recovery times

When should you consider the Maze/Mini-Maze? The primary reasons to consider a Maze surgery is because you can’t have a catheter ablation (ex: can’t take blood thinners), you’ve had several failed ablations, or if you are morbidly obese.

Atrial Fibrillation is not a one-size fits all type of disease.

You should also consider that Mini-Maze surgeries have built in limitations. For example, unlike catheter ablations, mini-maze surgery can’t reach the right atrium, or other areas of the heart where A-Fib signals may originate (non-PV locations). The more extensive surgeries create a great deal of lesions burns on the heart which may impact heart function.

So How Do You Choose the Best Treatment For You?

Atrial Fibrillation is not a one-size fits all type of disease.

Your first step is to see a heart rhythm specialist, a cardiac electrophysiologist (EP), who specializes in the electrical function of the heart.

An EP will work with you to consider the best treatment options for you. If your best treatment option is surgical, your EP will refer you to a surgeon and continue to manage your care after your surgery.

To help you find the right EP for you, see Finding the Right Doctor for You and Your A-Fib.

Comment

If you find any errors on this page, email us. Last updated: Wednesday, August 24, 2016

Go back to FAQ Understanding A-Fib

Updated FAQ about ‘The Bordeaux Group’ & Dr. Häissaguerre

We’ve updated the contact information in the FAQ asking about Dr. Michel Häissaguerre and the University Hospital of Bordeaux (Hôpital Cardiologique du Haut Lévêque-de Bordeaux) often referred to as ‘The Bordeaux Group’.

“I’ve heard good things about the French Bordeaux group. Didn’t Prof. Michel Häissaguerre invent catheter ablation for A-Fib? Where can I get more info about them? How much does it cost to go there?”

Prof. Häissaguerre and his colleagues invented catheter ablation for A-Fib (Pulmonary Vein Isolation) in the late 1990s. (They cured my A-Fib back in 1998. I was their first U.S. patient. Read my story.) The Cardiologic Hospital of Haut-Lévêque is still considered one of the top A-Fib centers in the world.

How to Contact The Bordeaux Group

Online links to the University Hospital of Bordeaux, Cardiology and Electrophysiology services (Hôpital Cardiologique du Haut Lévêque-de Bordeaux):

• Cardiology and Electrophysiology and Pacing ServicesHead of department: Pr Jean-Michel Haïssaguerre
• Electrophysiology and Ablation, Head of Unit: Prof. Pierre Jais
• Patient Care: Services and Appointment Request – online form

Continue… to read my full answer.

Note: While the website is written in French, my search engine/browser (Google/Google Chrome) offered to translate to English and did a great job! (Learn more at: https://translate.google.com)

FAQs A-Fib Ablations: The Bordeaux Group

FAQs A-Fib Ablations: The Bordeaux Group 

CHU Hopitaux de Bordeaux logo

“The French Bordeaux Group”

26. “I’ve heard good things about the French Bordeaux group. Didn’t Prof. Michel Häissaguerre invent catheter ablation for A-Fib? Where can I get more info about them? How much does it cost to go there?”

Prof. Häissaguerre and his colleagues invented catheter ablation for A-Fib (Pulmonary Vein Isolation). The Bordeaux group at the Cardiologic Hospital of Haut-Lévêque is still considered one of the top A-Fib centers in the world. (They cured my A-Fib back in 1998. I was their first U.S. patient. Read my story.)

In particular, they are doing cutting edge research using ECGI (CardioInsight) to map and ablate persistent A-Fib. ECGI will probably revolutionize how ablations are mapped and performed.

For the 2016 costs, see my post about David Neth.

How to Contact the Hôpital Cardiologique du Haut Lévêque-(CHU) de Bordeaux 

Online links to University Hospital of Bordeaux, Cardiology and Electrophysiology services (June 2016):

 

Cardiology and Electrophysiology and Pacing ServicesHead of department: Pr Jean-Michel Haïssaguerre
• Electrophysiology and Ablation, Head of Unit: Prof. Pierre Jais
• Patient Care: Services and Appointment Request – online form (in English)

2010 Article by The Bordeaux Group

Here is something they published in 2010 which explains their methodology and the costs of being treated at Bordeaux. Published as: Are you a good candidate? http://Are you a good candidate?

CATHETER ABLATION OF ATRIAL FIBRILLATION

Currently the only treatments that cure atrial fibrillation (AF) are:

a) Surgery (such as the Cox Maze operation and its variations)
b) Catheter Ablation

The main goals of catheter ablation of AF are to:

1) restore the heart to normal sinus rhythm, thereby eliminating the symptoms of AF.
2) relieve the patient from the associated risks of AF, such as blood clot formation, stroke, cardiac failure, and increased mortality. (It has not been proven that a successful Catheter Ablation will achieve these goals in all A-Fib patients.)

In the catheter ablation procedure a catheter, a soft, thin, flexible tube with an electrode at the tip, is inserted through a large vein in the groin and moved into the heart. This catheter delivers Radiofrequency (RF) energy to cauterize and eliminate the sources or spots in the heart (ectopic foci or wavelet circuits) that are triggering or maintaining the episodes of AF. These sources or spots in the heart are usually found in the pulmonary vein openings. The catheter also makes linear lines or lesions to segment the atrial tissue, thereby interrupting the errant electrical waves responsible for maintaining AF.

This isolation of the pulmonary veins cures the intermittent (paroxysmal) form of AF in 80% of patients (without having to take any medications). An additional 10% of patients are improved—an antiarrhythmic drug keeps them is sinus rhythm without the need for blood thinners.

For patients with permanent or persistent AF (lasting more than 48 hours or who have had Electrocardioversion), isolation of the pulmonary veins is less effective and should be combined with linear lines or lesions. This is because the longer one has episodes of AF, the more the sources or spots in the heart which produce AF signals tend to spread outside the pulmonary veins.

Ablated heart tissue has a tendency to heal itself and recover. For this reason and to increase the success rate to 90%, more than one procedure is required after 1-3 months of follow-up.

PRE-ABLATION MANAGEMENT

For safety reasons (to avoid clot formation during the catheter ablation procedure) the patient should take oral anticoagulation (coumadin, not aspirin) at an optimal therapeutic range (INR 2-3) for at least 1-2 months before the procedure. In addition, a transesophageal echocardiogram should be performed a few days before hospitalization to make sure there are no clots in the heart, particularly in the left atrial appendage. If clots are found, the procedure must be postponed a few days until these clots can be dissolved by blood thinners.

Anticoagulants should be interrupted 48 hours before the day of the procedure. If the patient is taking antiarrhythmic drugs, they should be stopped on admission.

CATHETER APPROACHES

General anesthesia is rarely performed on adult patients, in order to minimize the associated risks of anesthetic drugs. The patient is slightly sedated and a local anesthetic is applied to the groin area. Usually three catheters for mapping and ablation are inserted through one or two femoral veins in the groin and moved up into the heart.

The mapping catheters have multiple electrodes mounted in a longitudinal or circumferential shaft. (Other configurations including investigational designs may be used for individual situations.) The ablation catheter has an irrigated tip to prevent local clot formation and to allow greater energy delivery if needed (at thick parts of the cardiac tissue). To insert these catheters into the left atrium, it is usually required to make a puncture of the transseptal wall between the two upper chambers (atria) at what is called the foramen ovale. After the ablation procedure, this foramen ovale closes back up and heals over. (In 20% of patients this foramen ovale hole never closes up completely and remains open, creating a pathway between the two atria chambers.)

Two or three physicians usually perform the catheter ablation procedure. They are involved in positioning the catheter, and in the collection, analysis and interpretation of heart signals obtained during conventional or computerized mapping.

RF ablation is performed around the openings of the pulmonary veins, one by one or two by two, using a limited level of energy to avoid swelling of the pulmonary vein openings or atrial perforation. Isolation of the pulmonary vein openings is successfully performed in 100% of cases.

In paroxysmal (occasional) AF, PV isolation cures AF in 60-70% of cases. Ablation of the appropriate site in the right atrium (Cavotricuspid Isthmus) is also performed to prevent right atrial flutter. Linear block here is successfully achieved in 99% of cases.

In persistent AF (lasting more than 48 hours or with a history of electrical cardioversion), PV isolation is rarely sufficient. Additional RF applications are required to eliminate spots of AF activity outside the pulmonary veins. In the most resistant cases (usually long lasting AF), linear ablation similar to surgical incision is performed in the left atrium between the two superior PV and/or from the vein to the mitral annulus (mitral “isthmus”). This achieves linear block in 90% of cases. The success depends on achieving continuous and coalescent cauterizing lesions to create a complete barrier. Any gap in the lesion line, even of a millimeter size, allows AF signals to cross thereby keeping the heart in AF. A gap in the lesion line is due either to a too thick atrial wall or recovery of atrial tissue during the 1-4 week healing process following ablation.

Pain and discomfort associated with ablation are controlled by Midazolam and Morphine. Because there are no nerve endings in the smooth tissue of the heart and veins, the pain and discomfort are minimal and usually well tolerated.

DURATION OF OPERATION AND HOSPITAL STAY

The duration of the procedure varies from one to five hours depending on individual conditions:

• the number of ectopic sources in the atrial tissue (outside the pulmonary veins) may require more mapping time.
• successful lineal ablation lines depend on the thickness of the heart wall which varies from one patient to another and can not be precisely determined by pre-ablation imaging.

The end point or goal of the procedure is the achievement of local block in all targeted structures (veins and isthmuses) so that no AF signals travel through the heart. In addition, after the ablation multiple pacing maneuvers are used to try to induce sustained AF. In paroxysmal AF, multiple pacing maneuvers do not induce AF in 90% of cases.

A second procedure may be needed within 3-5 days in 25% of AF patients due to partial recovery of ablated tissue and/or secondary AF sources not ablated in the original procedure. In difficult cases of multiple or unmapable ectopic foci (heart tissue generating AF signals), a second linear ablation may be required in the left atrium.

Patients are hospitalized 4 to 6 days depending on the number of procedures required. Typically they return to the normal care

unit after ablation and are ambulatory 12 to 24 hours later. They are monitored by telemetry during the next 3 days when any recurrence of arrhythmia is most likely to occur. The likelihood of recurrence decreases over the next month.

Patients are usually admitted on Monday and can leave the hospital for the week-end, if there are no complications. They must stay in the region during the week-end and must return the following Monday for outpatient evaluation, which could result in re-hospitalization if needed.

The occurrence of complications may increase the duration of the hospitalization and therefore the cost. In our experience, this happens to 2.5% of patients.

If AF symptoms do not reoccur, patients can return home and resume normal activities. Anticoagulants are recommended for at least 1-3 months after ablation, and can then be stopped if there is no AF or other risk factors. In persistent AF, antiarrhythmic medications are recommended for 1-3 months after ablation to enable the atria to return to normal (this process is called “remodeling.”)

POPULATION OF PATIENTS

Catheter ablation of AF has been performed since 1994 in Bordeaux. As of October 2009, over 6,000 patients have been treated. At least 15 cases of atrial fibrillation or flutter are treated every week. The clinical characteristics of patients cover a wide spectrum of age (15-84 years old, average 52 years old). 78% of patients are male, while 22% are female. 80% have paroxysmal (occasional) AF, 20% have persistent AF. All patients were resistant to or intolerant of an average of 4 antiarrhythmic drugs and experienced at least weekly episodes of AF at their referral.

Some patients had documented pauses in their sinus heart beat after an attack of AF. They were cured by AF ablation, and thus avoided pacemaker implantation. 12% reported a previous embolic event (stroke), most in the circulation of the brain.

In patients with heart failure and permanent AF, the restoration of sinus rhythm (normal heart beat) is associated with a significant improvement of ventricular function in 80% of the patients.

RISKS ASSOCIATED WITH AF CATHETER ABLATION

Currently no one has died of a catheter ablation procedure in our department. Compared to other catheter procedures a 0.1% risk of death is a reasonable estimation.

The other risks of catheter ablation of AF are:

• bleeding in the pericardial sac surrounding the heart and requiring drainage (0.5-1%)
• embolic event (stroke) (0.2%)
• groin access hematoma (bruising) (4%)

There is no risk of sinus node or AV node damage by ablation which would require implanting a pacemaker.
World-wide there have been deaths reported by the use of high wattage catheters (50 watts or higher) creating a fistula (burn through) to the esophagus, usually 2 days after the procedure. We have not observed this complication.
Pulmonary vein narrowing (stenosis), if it did occur, would not usually cause symptoms. Out of 6,000 patients treated in our institution, 7 developed symptoms due to PV narrowing (>70% of lumen [opening] diameter) and required angioplasty and stenting.

The above risks compare very favorably with the risks involved in living with untreated AF. The risks of catheter ablation also compare very favorably with the risks involved in taking antiarrhythmic drugs and anticoagulants.

PROCEDURE COSTS (2010)

This cost is fixed by the public health administration.  The cost for a private service (operators: Drs. M. Haissaguerre/P. Jais/ M. Hocini) is 5000 euros (around $6,000) (hospital and physician charges). The total cost of AF catheter ablation depends on the duration of one’s stay in the hospital, which depends on the difficulty of individual ablation cases.

The typical hospital stay of 5 days with an ablation including pulmonary vein isolation and ablation of the right and left atria would cost about 10,328 euros (around $12,600). One day more or less would be 2044 Euros (around $2,500).

The total costs of a 5 day stay and ablation would be 17,600 euros (around $21,500).
For patients accompanied by a family member and without local accommodations, a meal, bed and breakfast is provided in the same room 27,10 euros/day (around $33.00).

The current waiting time for a procedure is 2 months.

Patients should come with personal clothes, since it is possible to walk outside. Patients are generally expected to wear their own clothes, including pajamas. Since the hospital only provides small towels, you may wish to bring your own towels.

INFORMATION ABOUT THE HOSPITAL

Cardiologic Hospital of Haut-Lévêque is a 300 bed hospital entirely dedicated to medical and surgical cardiology. It is located in Pessac and is a 20 minute drive from the airport, and a 20-30 minute drive from the center of Bordeaux and the TGV station.

Languages spoken: English and Spanish

The web site is: http://www.chu-bordeaux.fr/LES-HOPITAUX-ET-SITES-DU-CHU/Groupe-hospitalier-Sud/Hôpital-Haut-Lévêque/.

If you find any errors on this page, email us. Y Last updated: Saturday, October 1, 2016

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With 3-4 Second Pauses, Do I Need a Pacemaker?

We’ve answered a new FAQ about understanding A-Fib with long pauses and if a pacemaker is appropriate.

“I have paroxysmal A-Fib with “pauses” at the end of an event. I can’t tell how many of these I have experienced. Will they stop if my A-Fib is cured?
My cardiologist recommends a pacemaker to prevent blackouts during a pause as well as other serious heart problems. I am willing, but want to learn more about these pauses first.”

I had the same problem. I’d get pauses as long as 6 seconds and get dizzy, I felt like I was about to faint, etc. It was very frightening. But the pauses completely disappeared when my A-Fib was cured by a catheter ablation back in 1998.

Pauses are “Normal” in A-Fib

Pauses of up to 4 seconds duration in atrial fibrillation are considered as ‘normal’. Just because you have pauses doesn’t mean there is something wrong with your Sinus or AV Node and doesn’t mean that you need a pacemaker. When you are returned to normal sinus rhythm (NSR), these pauses usually disappear.

Unfortunately, many cardiologists don’t know this and will try to rush you into having a pacemaker implant…Read the rest of my answer… .

 

FAQs Understanding A-Fib: With A-Fib Pauses—Do I Need a Pacemaker?

 FAQs Understanding A-Fib: Pacemaker for Pauses?

FAQs Understanding Your A-Fib A-Fib.com14. “I have paroxysmal A-Fib with “pauses” at the end of an event. I can’t tell how many of these I have experienced. Will they stop if my A-Fib is cured?

My cardiologist recommends a pacemaker to prevent blackouts during a pause as well as other serious heart problems. I am willing, but want to learn more about these pauses first.”

I had the same problem. I’d get pauses as long as 6 seconds and get dizzy, I felt like I was about to faint, etc. It was very frightening. But the pauses completely disappeared when my A-Fib was cured by a catheter ablation back in 1998.

Pauses are “Normal” in A-Fib

Pauses of up to 4 seconds duration in atrial fibrillation are considered as ‘normal’. Just because you have pauses doesn’t mean there is something wrong with your Sinus or AV Node and doesn’t mean that you need a pacemaker. When you are returned to normal sinus rhythm (NSR), these pauses usually disappear.

Unfortunately, many cardiologists don’t know this and will try to rush you into having a pacemaker implant.

Monitoring Your Symptoms

Are you symptomatic? Do you fall or faint from these pauses? (This is different from occasionally feeling lightheaded or dizzy.)

If your cardiologist hasn’t yet suggested it, you may need to wear a holter or similar monitor for a few days (or up to a month or longer).

Monitoring will tell your doctor exactly how long your pauses are and how often you have them.

Avoid Getting a Pacemaker, if You Can

I can understand your cardiologist’s concern, but try to avoid getting a pacemaker, if you can.

If you do have to get a pacemaker, make sure the cardiologist guarantees that it can and will be easily removed once you are restored to normal sinus rhythm (NSR). You don’t want to be saddled with a pacemaker for life when you don’t need it.

Be assertive. You may have to be very assertive about this. Most cardiologists will insist that you keep the pacemaker forever. (But it isn’t so.)

Cure Your A-Fib=No More Pauses

Ask your doctor about antiarrhythmic drugs. They generally don’t “cure” A-Fib but may reduce your pauses.

If your pauses cause you problems, consider a catheter ablation to cure your A-Fib.

Once you no longer have A-Fib, those pauses should stop and your heart should beat again in normal sinus rhythm.

To read a first-hand story about pacemakers see Personal A-Fib Story #50: Pacemaker & A-Fib Ablation—You Can Have an A-Fib Ablation if You Have a Pacemaker

References for this article

Last updated: Wednesday, June 8, 2016

Go back to FAQ Understanding A-Fib

New FAQ: Risks of Xarelto and 3 Alternatives to Anticoagulants

We’ve posted a new FAQ and answer about the risks of anticoagulants and three alternatives to taking them.

“I have A-Fib, and my heart doctor wants me to take Xarelto 15 mg. I am concerned about the side effects which can involve death. What else can I do?”

You are right to be concerned about the side effects of Xarelto, one of the new Novel Oral Anticoagulants (NOACs). Uncontrolled bleeding is the primary risk (patients have bled to death in the ER.)

Be advised: No anticoagulant will absolutely guarantee you will never have a stroke.

All anticoagulants are inherently dangerous. You bruise easily, cuts take a long time to stop bleeding, you can’t participate in any contact sports; there is an increased risk of developing a hemorrhagic stroke and gastrointestinal bleeding. (Most EPs are well aware of the risks of life-long anticoagulation.)

Anticoagulants cause or increase bleeding. That’s how they work. To decrease your risk of blood clots and stroke, they hinder the clotting ability of your blood. But, they also increase your risk of bleeding. But in spite of the possible negative effects of anticoagulants, if you have A-Fib and a real risk of stroke, anticoagulants do work.

What Else Can You Do? Remove the Reason for an Anticoagulant—Three Options

The best way to deal with the increased risk of stroke and side effects of anticoagulants is to no longer need them. Here are three options…<…continue… to read my full answer…>

FAQs A-Fib Drug Therapy: Safety of Multaq [dronedarone] vs amiodarone

 FAQs A-Fib Drug Therapy: Safety dronedarone vs amiodarone

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

Safety of dronedarone

25. “Is the antiarrhythmic drug Multaq [dronedarone] safer than taking amiodarone? How does it compare to other antiarrhythmic drugs?”

Multaq is probably safer than amiodarone, but it isn’t just “amiodarone-lite.”

Higher Death Rates with Dronedarone

Some studies indicate Multaq by Sanofi-Aventis (generic name: dronedarone) has its own set of problems.

In a study of dronedarone in high-risk patients with permanent A-Fib (PALLAS-3,236 patients), patients taking dronedarone were dying at more than twice the rate of those on a placebo. The ratio of stroke and hospitalization for heart failure was also more than twice as high.

The EMA recommends dronedarone not be used in patients still in A-Fib.

Dronedarone Shouldn’t Be Used in Patients in A-Fib

The European Medicines Agency (EMA) has recommended that the antiarrhythmic drug dronedarone not be used in patients still in A-Fib, that it should be discontinued if A-Fib reoccurs, that it shouldn’t be used in patients who have previous liver or lung injury following treatment with amiodarone, and that patients using it should have their liver and lung functions regularly monitored.

Who Should be Taking Dronedarone (If Anyone)?

The Committee for Medicinal Products for Human Use (CHMP) of the EMA said that dronedarone may be a useful option in patients who are in sinus rhythm after a successful cardioversion. But even in this case, dronedarone should only be prescribed after alternate treatment options have been considered.

…Dronedarone should only be prescribed after alternate treatment options have been considered.

About dronedarone, noted A-Fib blogger, Dr. John Mandrola wrote, “I’m surprised that the drug has persisted. I don’t know any of my colleagues who would start a patient out on Multaq [dronedarone]. It just doesn’t work.”

Editor’s Comments
According to these studies and news reports, no one with any type of A-Fib should be taking dronedarone (Multaq).
This is a major change in treatment options for patients with A-Fib.
Dronedarone may be associated with increased strokes, hospitalizations, heart failure, liver damage, lung damage and death. And it may not be very effective anyway.
No antiarrhythmic drug is 100% safe and effective for all A-Fib patients. But until we get more favorable research on dronedarone, all patients with A-Fib should consider not taking it and try alternative options.

References:

Connolly SJ. Dronedarone in High-Risk Permanent Atrial Fibrillation. PALLAS Clinical trial (Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of Standard Therapy). New England Journal of Medicine, 2011; 365: 2268-76. http://www.nejm.org/doi/full/10.1056/NEJMoa1109867 DOI: 10.1056/NEJMoa1109867

O’Riordan, Michael. “EMA recommends restricting use of dronedarone” HeartWire, Sept. 22, 2011. http://www.medscape.com/viewarticle/750196

Burton, Thomas M., FDA Reviews Heart-Rhythm Drug. The Wall Street Journal, September 22, 2011. http://www.wsj.com/articles/SB10001424053111904563904576585091471862916

The European Medicines Agency (EMA): a decentralised agency of the European Union (EU) is responsible for the scientific evaluation, supervision and safety monitoring of medicines developed by pharmaceutical companies for use in the EU. http://www.ema.europa.eu/ema/; See: Multaq/dronedarone

Last updated: Wednesday, May 25, 2016 Return to FAQ Drug Therapies

Are Anticoagulants and blood thinners the same thing? How do they thin the blood?

We’ve posted a new FAQ and answer under Drug Therapies and Medicines in our section:

Are Anticoagulants and blood thinners the same thing? How do they thin the blood?

Blood clots are usually good, such as when you get a scrape or cut.

Since A-Fib increases your risk of clots and stroke, blood thinners are prescribed to prevent or break up blood clots in your heart and blood vessels and thereby reduce your chance of an A-Fib-related stroke.

Although referred to as “blood thinners”, they don’t actually affect the “thickness” of your blood.

Anticoagulant Warfarin chemical diagram

Anticoagulant Warfarin

There are two main types: anticoagulants and antiplatelet agents.  They work differently to accomplish the same end effect.

Anticoagulants work chemically to lengthen the time it takes to form a blood clot.

Common anticoagulants include warfarin (Coumadin), Heparin and the NOACs such as apixaban (Eliquis).

Antiplatelet Aspirin

Antiplatelets prevent blood cells (platelets) from clumping together to form a clot.

Common antiplatelet medications include aspirin, ticlopidine (Ticlid) and clopidogrel (Plavix) .

Final answer: Yes, an anticoagulant is a blood thinner, but not all blood thinners are anticoagulants.

Note: To read about ‘clot buster’ drugs or treatments that could save you from a debilitating stroke, see my article: Your Nearest ‘Certified Stroke Center’ Could Save Your Life.

New FAQ: In Case of Stroke, How Your Family Should Plan Now!

A new FAQ answers what your family should plan NOW, and what do in case you have an A-Fib-related stroke.

“In case I have a A-Fib 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.

CT brain with Ischemic stroke at A-Fib.com

Brain CT showing ischemic (clotting) stroke

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.

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... Continue reading the answer—>..

New FAQ: Post-Ablation and Increased Heart Rate

I’ve answered a new question from a patient who’s post-ablation with a higher than previous heart rate:

“I’m six months post CryoBalloon ablation and very pleased. But my resting heart rate remains higher in the low 80s. Why? I’ve been told it’s not a problem. I’m 64 and exercise okay, but I’ve had to drop interval training.”

It’s common after an ablation for one’s heart rate to increase somewhat, but usually returns to normal as the heart heals. That’s probably because the heart’s nerve endings have been irritated by the ablation. Although I’ve heard of some patients whose heart rate remains higher than it was before ablation. This is an area that hasn’t been well investigated.

If your higher heart rate affects you, there are steps you can take to lower it. Continue reading

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

 FAQs Coping with A-Fib: Stroke Action Plan

FAQs A-Fib afib22. “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 before hand) 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

If you find any errors on this page, email us. Y Last updated: Wednesday, April 27, 2016

Back to FAQs: Coping with Your A-Fib

FAQs A-Fib Ablations: Increased Heart Rate after Ablation

 FAQs A-Fib Ablations: Elevated Heart Rate 

Catheter Ablation

Catheter Ablation

25. “I’m six months post CryoBalloon ablation and very pleased. But my resting heart rate remains higher in the low 80s. Why? I’ve been told it’s not a problem. I’m 64 and exercise okay, but I’ve had to drop interval training.”

It’s common after an ablation for one’s heart rate to increase somewhat, but it usually returns to normal as the heart heals. That’s probably because the heart’s nerve endings have been irritated by the ablation. Although I’ve heard of some patients whose heart rate remains higher than it was before ablation. This is an area that hasn’t been well investigated.

We may have to list “increased heart rate” as a possible consequence of an ablation. But, as you have already experienced, it sure beats living in A-Fib.

Exercise to Lower Heart Rate: If your higher heart rate affects you, there are steps you can take to lower it. As you are already doing, long-term exercising at a moderate/high level helps lower heart rate. (I am a fairly fit 75-year-old sprinter. My heart rate over the years has dropped down to the 50s.)

Beta Blockers to Lower Heart Rate: Discuss your increased heart rate with your EP and how it affects you. Ask if short-term use of medication such as beta blockers may help you.

Warning: But only take beta blockers (or medications like them) for a short time, certainly not for life.  These type of drugs have bad side effect over the long term. (Bob writes that metoprolol hasn’t lowered his heart rate after ablation.)

Resources Needed: If anyone his run across more research or has insights into this question of higher heart rate after an ablation, please let us know. Thanks to Bob for this question.

If you find any errors on this page, email us. Y Last updated: Wednesday, May 18, 2016

Return to FAQ Catheter Ablation and Maze Surgeries

Can I Prevent Familial A-Fib with Diet? Supplements?

I’ve posted a new Frequently Asked Question and Answer about A-Fib that runs in families:

“Both my uncles and my Dad have Atrial Fibrillation. I’m 50 years old and so far I don’t have A-Fib (yet), but I’m worried. How can I avoid developing A-Fib? Can dietary changes help? Or lifestyle changes?”

A-Fib does run in families and is called Familial A-Fib. Research says you have a 40% increased risk of developing A-Fib yourself. And the younger your uncles and dad were when they got A-Fib, the more likely you are to develop A-Fib. So, you are correct to be concerned about getting A-Fib.

My answer covers:

• What can someone with A-Fib in the family do to avoid getting A-Fib?
• Is there a diet to prevent A-Fib? The Mediterranean diet? A whole-food organic diet?
• What are the causes of A-Fib that can be controlled?
• Do mineral deficiencies cause A-FIb?
• What are the vitamins and supplements known to improve your overall heart health?  (I take these myself to help stay A-Fib free after my 1998 catheter ablation which isolated only one of my pulmonary vein, common at the time.)

Read my full answer at FAQs: Can I Prevent Familial A-Fib with Diet? Supplements?

FAQs: Can I Prevent Familial A-Fib with Diet? Supplements?

“Both my uncles and my Dad have Atrial Fibrillation. I’m 50 years old and so far I don’t have A-Fib (yet), but I’m worried. How can I avoid developing A-Fib? Can dietary changes help? Or lifestyle changes?”

A-Fib does run in families and is called Familial A-Fib. Research says 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. So, you are correct to be concerned about getting A-Fib. 

Note: Most heart health eating plans aim to improve the ‘plumbing’ of the heart, whereas A-Fib is primarily an ‘electrical’ problem.

A Heart Healthy Diet and Lifestyle

While there’s no “Atrial Fibrillation diet” proven to prevent, stop or cure A-Fib, anything that improves your overall heart health might indirectly affect developing A-Fib.

Start with a ‘heart healthy’ diet and healthy lifestyle. There are lots of on-line resources and books about eating healthy for your heart.

• The U.S. National Heart, Lung and Blood Institute recommends the “DASH” eating plan which reduces the risk of developing cardiovascular disease;
• A Mediterranean diet may reduce the risk of atrial fibrillation, according to a article by Case Adams, a board-certified Naturopath;
• A whole-food organic diet is “preferred” for A-Fib patients, states Naturopathic doctor (ND) Dan Carter. But he doesn’t claim that this diet will prevent or cure A-Fib.

For more about a whole food or organic diet, read my FAQ answer.

A-Fib Causes: Some are Under Your Control

The four main causes or co-morbidities of A-Fib are sleep apnea, obesity, hypertension and diabetes. If you have any of these conditions, it’s important to get them under control.

Binge drinking has been known to start one’s A-Fib, as well as smoking and excessive stress or anxiety. Avoid these as much as you can. (Also, many patients develop A-Fib post-surgery due to sudden low levels of magnesium.)

Dehydration can contribute to A-Fib. Too much alcohol or caffeine and too little water can alter the fluid levels in your body. Consume an adequate amount of water especially on hot days and when exercising.

Minerals Quad- flat 200 pixVitamins, Supplements and Herbs

Several vitamins, supplements and herbs have been shown to reduce or eliminate A-Fib symptoms. Magnesium and Potassium deficiencies are prevalent among A-Fib patients, as well as Calcium overload. Read more on our Mineral Deficiencies page.

For a list of 7 other vitamins and supplements known to improve your overall heart health, see my article: ‘Natural’ Supplements for a Healthy Heart’. (I take these myself to help stay A-Fib free after my 1998 catheter ablation which isolated only one of my pulmonary vein, common at the time.)

What This Means to Families of A-Fib Patients

With A-Fib running in your family, you have a 40% increased risk of developing A-Fib yourself. And the younger your uncles and dad were when they got A-Fib, the more likely you are to develop A-Fib.

The younger your uncles and dad were when they got A-Fib, the more likely you are to develop A-Fib.

While there’s no diet to prevent A-Fib, you can get control of co-morbidities such as obesity, sleep apnea, diabetes and high blood pressure. And you can avoid lifestyle choices like binge drinking, smoking, excessive stress and anxiety that increase your odds of A-Fib. (If you have surgery, ask your doctor about Magnesium IV post-op).

Above all, choose a healthy heart lifestyle, exercise, don’t overindulge and eat well.

References for this article

Return to: FAQs Coping With Your A-Fib Day-to-Day Issues

If you find any errors on this page, email us. Y Last updated: Wednesday, March 16, 2016

Newly Diagnosed Patients: Answers to Frequently Asked Questions

Photo collage of patients who have shared their story on A-Fib.com

A few of the patients who have submitted questions to A-Fib.com.

For over a decade of publishing A-Fib.com, we have answered thousands of patient’s questions—many times the same questions. Perhaps the same questions you may have right now. In our section FAQ about Living with A-Fib, the first group of answers is For the Newly Diagnosed A-Fib Patient

Here we share answers to the most often asked questions by the new A-Fib patient and their family. Questions such as, “Did I cause my Atrial Fibrillation? Am I responsible for getting A-Fib?”, “Is Atrial Fibrillation a prelude to a heart attack?”, and “Can I die from my Atrial Fibrillation? Is it life threatening?”

We also answer questions about driving your car, your sex life, and dealing with the fear and anxiety.

We invite you to browse through the lists of questions. Then, just ‘click’ to read the answer. Go to -> Frequently Asked Questions by Newly Diagnosed Patients.

 

New FAQs About Hormone Replacement Therapy and A-Fib

Drug Therapies for Atrial Fibrillation, A-Fib, AfibThanks to Mary LaPorte for this question: “Do you have information about Hormone Replacement Therapy (HRT) and if it might help or hinder my atrial fibrillation?”

One would expect that, if properly administered, HRT would have good effects like decreasing menopause symptoms, improving bone density, improving cardiovascular health, etc. HRT might reduce the risk of A-Fib by improving a woman’s overall health.

But research on this topic isn’t all that clear. I found two contradictory studies…Read the rest of Steve’s answer here.

NOTE: I am way out of my comfort zone discussing womens’ health and HRT and would welcome comments from anyone with insights about this topic. Email me.

FAQs A-Fib Ablations: Recurrence or Reconnection Explained

 FAQs A-Fib Ablations: Recurrence 

Catheter Ablation

Recurrence after Catheter Ablation

26. “What is ‘recurrence’ or ‘reconnection’? Could you explain it in layman’s terms? (I worry after my ablation, my A-Fib will return.)”

“Recurrence” or “Reconnection” is a general term EPs use to describe any A-Fib that re-occurs after a catheter ablation. In practice, there are four basic types of recurrence or reconnection found primarily when using RF point-by-point ablation:

1. Self-Healing Recurrence/Reconnection. Heart tissue is very tough and resilient. There is a tendency for ablated heart tissue to heal itself, regrow the ablated area, reconnect, and start producing A-Fib signals again. But if this happens, it usually occurs within approximately the first three to six months of the initial PVA(I).

This type of recurrence may happen because the heart tissue was not originally ablated properly, the burn lesion may not have been deep enough (transmural). The EP may not have applied sufficient contact catheter pressure to achieve transmurality and permanent blocking. But with the new Contact Force Sensing catheters, top tier EPs tell me “the use of contact force has definitely reduced the reconnection rates.  It is very unusual to see reconnection these days.”

2. Gap Reconnection. RF point-by-point ablation is not easy to do. It requires manual dexterity, feel and intense concentration to make sure there are no gaps between the RF point-by-point ablations in order to, for example, make a circular lesion line around the opening of a Pulmonary Vein. If a significant gap is left, this can result in recurrence. The A-Fib signal escapes from the Pulmonary Vein through this gap into the rest of the left atrium, thereby producing A-Fib again.

EPs have strategies to find any gaps during and after an ablating an area of tissue. They use a drug like adenosine to try to stimulate A-Fib. They may instead or in addition wait 30 minutes or an hour after the ablation is complete to see if there is any reconnection.

It’s also possible that, after the blanking period when the swelling from point-by-point RF ablations goes down, gaps may appear which were hidden by the swelling of the RF burns—though this is increasingly rare with the use of Contact Force sensing catheters and proper ablation techniques. In this case you will probably need a short touch-up ablation to fix this gap.

(CryoBalloon ablation usually doesn’t produce these types of gaps, because it produces a continuous freezing ablation line around a PV.)

3. Recurrences/Reconnections Due to Pre-Existing Conditions. There are health conditions which tend to cause A-Fib to recur, such as hypertension, obesity, sleep apnea, diabetes, smoking and binge drinking. Controlling these conditions will reduce the risk of recurrence.

For example, let’s say patient “Joe” has A-Fib and sleep apnea, then has a successful A-Fib ablation and is A-Fib free. Because of his sleep apnea, Joe’s A-Fib is more likely to recur than someone without sleep apnea. So much so, that Electrophysiologists (EPs) today are insisting that A-Fib patients with sleep apnea be treated and use devices like a CPAP breathing machine before they can get a catheter ablation. In one study sleep apnea was an independent predictor for catheter ablation failure after a single procedure.

Also, those with long-standing persistent A-Fib, or those with vascular heart disease, or cardiomyopathy are more likely to have a recurrence.

4. “Lone” Recurrence. Around 50% of A-Fib patients have no apparent cause for their A-Fib—called “lone A-Fib” because there’s no other contributing health condition. After a successful catheter ablation, those with lone A-Fib are less likely to have a recurrence. But some lone A-Fib patients do have recurrences.

Your EP may not use the word ‘cure’, but the dictionary defines ‘cure’ as “restoration of health; recovery from disease.

What This Means to Patients

Catheter ablation today is the best hope of a “cure” for A-Fib (Your doctors may not use the word ‘cure’, but the dictionary defines ‘cure’ as “restoration of health; recovery from disease.”) That should be your goal!

Let’s take a worst case scenario after your ablation:

You’re in good health and have no pre-existing medical conditions. Seven years after your ablation you have a “recurrence” of A-Fib.

Think about that for a moment.

You’ve had seven years of a normal heart beat and a normal life! (Only those of us who’ve had symptomatic A-Fib know how wonderful it is to be A-Fib free―even if it’s just for three, five or whatever length of time.)

So what if you have a recurrence. You know what to do. Your EP does a touch-up ablation (which is much easier and faster than your original ablation). That reassuring, isn’t it!

Don’t waste your life worrying about recurrence/reconnection. Live your life as though you are cured for the long term. You probably are.

Last updated: Sunday, October 4, 2015

Return to FAQ Catheter Ablation Catheter Ablation, Pulmonary Vein Isolation/Ablation, CyroBalloon Ablation

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