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



FAQ

Frequently-Asked-Questions

Most Asked Q&As About Coping with the Day-to-Day Issues

Here at A-Fib.com, we have answered thousands of questions from A-Fib patients—many of the same questions you may have. Under Coping with Your A-Fib: Day-to-Day Issues, here are a few of the questions we answered:

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?”

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

Coping with the Day-to-Day Issues at A-Fib.com

Coping with the Day-to-Day Issues

Other questions under Coping with the Day-to-Day Issues address A-FlutterMedical Marijuana, PVC/PACsDIY heart monitors, Hereditary A-Fib and more.

Go to Coping With Your Atrial Fibrillation: Day-to-Day Issues to review all our posted questions, Browse the list and ‘click’ on any question to jump to the answer.

More Categories of Question & Answers

For all our Q & A lists, go to our page Frequently Asked Questions (FAQs) by Patients with Atrial Fibrillation.

New FAQ About A-Fib Drug Therapy: Any Guarantee Against Stroke?

The following FAQ is very timely as a close friend of mine just suffered a major stroke, even though she was on Coumadin and her INR was in the correct range. I can’t tell you how discouraging this is, not just for her but for me, too. I worked with her to get the best treatment possible and by one of the best EPs in our area. But she still had a stroke.

Q: “I’ve heard of people with A-Fib on anticoagulants who still had a stroke. What can I do to make sure I never have a stroke?”

A: There is currently no way to absolutely guarantee you will never experience a stroke. “Even when A-Fib patients are effectively anti-coagulated, 14% are still found with clots,” stated Dr. John Camm of St. George’s Medical School, London, England, at the 2008 Boston AF Symposium.

Read more of my answer: how anticoagulants can significantly lower your overall stroke risk by as much as 70%, how closing off your Left Atrial Appendage (LAA) can stop 90%–95% of A-Fib clots which usually originate in the LAA, and whether you should consider combining the Watchman with anti-coagulation… Continue reading… .

FAQ: With A-Fib, Can I Make Sure I Never Have a Stroke?

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

FAQs A-Fib Drug Therapy: Guarantee Against Stroke?

“I’ve heard of people with A-Fib on anticoagulants who still had a stroke. What can I do to make sure I never have a stroke?”

This question is very timely as a close friend of mine just suffered a major stroke, even though she was on Coumadin and her INR was in the correct range. I can’t tell you how discouraging this is, not just for her but for me, too. I worked with her to get the best treatment possible and by one of the best EPs in our area. But she still had a stroke.

There’s No Absolute Guarantee

There is currently no way to absolutely guarantee you will never experience a stroke. “Even when A-Fib patients are effectively anticoagulated, 14% are still found with clots,” stated Dr. John Camm of St. George’s Medical School, London, England, at the 2008 Boston AF Symposium.

Anticoagulants Reduces A-Fib Stroke Risk

Anticoagulants can significantly lower your overall stroke risk. When warfarin was first approved (in 1954 with brand names: Coumadin and Jantoven), it was considered a ‘wonder drug’. It reduced the risk of an A-Fib stroke by as much as 70%―a huge reduction. For the first time, doctors (and patients) had something that would work to significantly lower the risk of an A-Fib stroke.

Caution: Anticoagulants are High Risk Drugs

Be aware that anticoagulants in general are considered high risk medications. They work by causing or increasing bleeding. They aren’t like taking vitamins.

As Thomas J. Moore of the Institute for Safe Medical Practices points out, “Anticoagulant treatment for people with A-Fib ranks as one of the highest risk treatments in older Americans…more than 15% of older patients treated with blood thinners for 1 year have bleeding.”

Nevertheless, for most people, even though anticoagulants are considered high risk meds, they are a welcome trade-off to having an A-Fib stroke.

An Medication Alternative: The Watchman Occlusion Device

The Left Atrial appendage (LAA) is where 90%–95% of A-Fib clots originate. Closing off the LAA is an alternative strategy for people who can’t or don’t want to take anticoagulants. The Watchman Device (Boston Scientific), an occlusion device, is an ingenious method of closing off the LAA. (Other occlusion devices include the Lariat II and AtriClip surgical device.)

Inserting the Watchman is a very low risk procedure which takes as little as 20 minutes. Usually afterwards, the patient doesn’t need to be on an anticoagulant.

Combine the Watchman with an Anticoagulant?

One may wonder: Could combining a Watchman Device with an anticoagulant (to prevent strokes from other parts of your heart) come close to guaranteeing you will never have a stroke?

This treatment strategy is very speculative. I don’t know of any clinical studies on this subject.

However, if you have a Watchman Device installed, you could discuss with your doctor continuing on an anticoagulant as added protection.

Reference for this Article

Return to FAQ Drug Therapies
Last updated: Tuesday, May 16, 2017

 

FAQ: After Ablation—What’s my Chance of Staying A-Fib Free?

There is a tendency for ablated heart tissue to heal itself, regrow the ablated tissue, reconnect, and start producing A-Fib signals again. But if this happens, it usually occurs within the first three to six months of the initial PVA(I).

An A-Fib.com reader sent me this question about recurrence of his A-Fib after a successful ablation:

Illustration of catheter ablation

Illustration of catheter ablation of pulmonary vein

“Since my PVI, I have been A-Fib free with no symptoms for 32 months. What do you think my chances of staying A-Fib free are?”

Regrowth/Reconnection of Ablated Heart Tissue

I think your chances of staying A-Fib free are pretty good.

If your Pulmonary Veins (PV) are well isolated and stay that way, you can’t get A-Fib there again. When the PVs are isolated and disconnected and haven’t reconnected, it seems to be permanent. But it’s too early in the history of PVA(I)s to say this definitively. …read the rest of my answer.

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

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
Return to Frequently Asked Questions

FAQs A-Fib Treatments: Medicines and Drug Therapies

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

Drug Therapies for Atrial Fibrillation

Atrial Fibrillation patients often search for unbiased information and guidance about medicines and drug therapy treatments. These are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer.)

1. “ I have a heart condition. Which medications are best to control my Atrial Fibrillation?” What medications work best for me?“

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

3. Rate Control Drug: “I take atenolol, a beta-blocker. Will it stop my A-Fib.”

Antiarrhythmic Drugs

1. “Is the “Pill-In-The-Pocket” treatment a cure for A-Fib? When should it be used?” (“Pill-In-The-Pocket” makes use of an antiarrhythmic drug such as flecainide)

2. I’ve been on amiodarone for over a year. It works for me and keeps me out of A-Fib. But I’m worried about the toxic side effects. What should I do?”

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

4. “My doctor told me about the Tikosyn drug option that I want to consider in getting rid of my 5-month-old persistent A-Fib. That seems like something that should be discussed on your web site.”

Blood Thinners/Anticoagulants

Note: August 2015 Update: Aspirin is no longer recommended as first-line therapy to prevent A-Fib stroke.

1. “Are anticoagulants and blood thinners the same thing? How do they thin the blood?

2. Should everyone who has A-Fib be on a blood thinner like warfarin (brand name: Coumadin)?”

3. Which is the better to prevent stroke—warfarin (Coumadin), an NOAC or aspirin?

4. “I am on Coumadin (warfarin). Do I now need to avoid foods with Vitamin K which would interfere with its blood thinning effects?”

5. Are natural blood thinners for blood clot treatment as good as prescription blood thinners like warfarin?”

6. “I’m worried about having to take the blood thinner warfarin. If I cut myself, do I risk bleeding to death?

Related question: My new cardiologist wants me to switch from Pradaxa to Eliquis. if bleeding occurs, is Eliquis easier to deal with?

Related question: My heart doctor wants me to take Xarelto. I am concerned about the side effects which can involve death. What else can I do?”

7. “I”ve read about a new anticoagulant, edoxaban (brand names: Lixiana, Savaysa) as an alternative to warfarin (Coumadin). For A-Fib patients, how does it compare to warfarin? Should I consider edoxaban instead of the other NOACs?”

Post-Procedure

1. I’ve had a successful catheter ablation and am no longer in A-Fib. But my doctor says I need to be on a blood thinner. I’ve been told that, even after a successful catheter ablation, I could still have “silent” A-Fib—A-Fib episodes that I’m not aware of. Is there anything I can do to get off of blood thinners?“

2. “I just had an Electrical Cardioversion. My doctor wants me to stay on Coumadin for at least one month. Why is that required? They mentioned something about a “stunned atrium.” What is that?“

A-Fib Stroke Risk

1. “What are my chances of getting an A-Fib stroke?

2. “The A-Fib.com web site claims that an A-Fib stroke is often worse than other causes of stroke. Why is that? If a clot causes a stroke, what difference does it make if it comes from A-Fib or other causes? Isn’t the damage the same?“

3. “How long do I have to be in A-Fib before I develop a clot and have a stroke?

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

5. “I’ve heard of people with A-Fib on anticoagulants who still had a stroke. What can I do to make sure I never have a stroke?

If you find any errors on this page, email us. Y Last updated: Monday, May 8, 2017
Return to Frequently Asked Questions

FAQs A-Fib Treatments: Catheter Ablation Procedures

Catheter ablation illustration at A-Fib.com

Catheter ablation

Atrial Fibrillation patients seeking a cure and relief from their symptoms often have many questions about catheter ablation procedures. Here are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer)

1. Heart Function: “Does this burning and scarring during the ablation procedure affect how the heart functions? Should athletes, for example, be concerned that their heart won’t function as well after an ablation?”

Related question: “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.”

2. Radiation: “How dangerous is the fluoroscopy radiation during an ablation? I know I need a Pulmonary Vein Ablation (Isolation) procedure to stop my A-Fib—A-Fib destroys my life. I’m worried about radiation exposure.”

3. Condition of Heart: “What is an enlarged heart? Does it cause A-Fib? I was told I can’t have a catheter ablation because I have an enlarged heart. Why is that?”

Related question: I have serious heart problems and chronic heart disease along with Atrial Fibrillation. Would a Pulmonary Vein Ablation help me? Should I get one?”

Related question:  I have a defective Mitral Valve. Is it causing my A-Fib? Should I have my Mitral Valve fixed first before I have a PVA?”

4. Age: “I am 82 years old. Am I too old to have a successful Pulmonary Vein Ablation? What doctors or medical centers perform PVAs on patients my age?”

Related question:I’m 80 and have been in Chronic (persistent/permanent) A-Fib for 3 years. I actually feel somewhat better now than when I had occasional (Paroxysmal) A-Fib. Is it worth trying to get an ablation?

5. Blanking Period: “How long before you know a Pulmonary Vein Ablation procedure is a success? I just had a PVA(I). I’ve got bruising on my leg, my chest hurts, and I have a fever at night. I still don’t feel quite right. Is this normal?”

Related question: Since my ablation, my A-Fib feels worse and is more frequent than before, though I do seem to be improving each week. My doctor said I shouldn’t worry, that this is normal. Is my ablation a failure?”

6. O.R. Report: I want to read exactly what was done during my Pulmonary Vein Ablation. Where can I get the specifics? What records are kept?”

7. Procedure Length: “What is the typical length of a catheter ablation today versus when you had your catheter ablation in 1998 in Bordeaux, France? What makes it possible?”

8. Clots/Blood Thinners: “After my successful Pulmonary Vein Ablation, do I still need to be on blood thinners like Coumadin, an NOAC or aspirin?”

Related question:I was told that I will have to take an anticoagulant for about 2-3 months after my ablation. Afterwards shouldn’t there be even less need for a prescription anticoagulant rather than more?”

Related question: During an ablation, how much danger is there of developing a clot? What are the odds? How can these clots be prevented?”

9. Exercise: “I’m having a PVA and I love to exercise. Everything I read says ‘You can resume normal activity in a few days.’ Can I return to what’s ‘normal’ exercise for me?”

10. Non-PV Triggers: “Are there other areas besides the pulmonary veins with the potential to turn into A-Fib hot spots? I had a successful catheter ablation and feel great. Could they eventually be turned on and put me back into A-Fib?

11. 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.”

12. 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?”

13. Cure? “I have Chronic Atrial Fibrillation. Am I a candidate for a Pulmonary Vein Ablation? Will it cure me? What are my chances of being cured compared to someone with Paroxysmal (occasional) A-Fib?”

Related question: I’ve read that an ablation only treats A-Fib symptoms, that it isn’t a ‘cure’. If I take meds like flecainide which stop all A-Fib symptoms and have no significant side effects, isn’t that a ‘cure?’”

14. Tech Advances: “I’m getting by with my Atrial Fibrillation. With the recent improvements in Pulmonary Vein ablation techniques, should I wait until a better technique is developed?”

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

FAQs: Does Ablation Treat Symptoms or “Cure” Atrial Fibrillation?

Catheter Ablation

FAQs A-Fib Ablations: Is it a Cure?

“I’ve read that an ablation only treats A-Fib symptoms, that it isn’t a “cure.” If I take meds like flecainide which stop all A-Fib symptoms and have no significant side effects, isn’t that a ‘cure?’”

A successful catheter ablation doesn’t just treat A-Fib symptoms, it physically changes your heart.

Isolates PVs: An ablation closes off the openings around your pulmonary veins (PVs) so A-Fib signals from the Pulmonary Veins (PVs) can no longer get into your heart. It electrically ‘isolates’ your PVs. If successful and permanent, you should be protected from developing A-Fib that originates from your PVs (where most A-Fib originates).

Recurrence Rates: Older research showed that recurrence of A-Fib after an ablation occurred at a 7% rate out to five years. But this was before the use of the newer techniques of Contact Force Sensing catheters and CryoBalloon ablation which make more permanent lesion lines around your Pulmonary Veins.

Also, people with comorbidities, like sleep apnea, obesity, diabetes, hypertension, tend to have more recurrences. Sleep apnea can cause A-Fib to develop in other parts of the heart besides the Pulmonary Veins.

Worst case scenario: But let’s discuss a worst case scenario after a successful catheter ablation. Let’s say that five years later, your A-Fib reoccurs. Usually, all that’s necessary is for a touch-up ablation to fix some gaps in the isolation burns around the openings to the PVs or other spots. It’s usually a much easier, faster procedure than your original ablation. Often, that’s all that’s necessary to keep you A-Fib free.

No Magic Pill for A-Fib: In more than 40% of cases, antiarrhythmic drugs don’t work, cause bad side effects, or lose their effectiveness over time. We don’t currently have a magic pill you can take which will guarantee to forever cure you of A-Fib.

I’m glad that flecainide works for you, but it’s not generally considered a permanent cure for A-Fib.

Catheter Ablation Only Hope of a “Cure”: The bottom line is that catheter ablation (and some surgeries) currently offers the only hope of a permanent cure of A-Fib. That doesn’t mean that all A-Fib ablations are 100% successful. Catheter ablation is a relatively new field where there is still a lot to learn. But catheter ablation is a low-risk procedure with a high rate of success. Right now, it’s the best that medical science has to offer to fix Atrial Fibrillation.

Return to FAQ Catheter Ablations

New FAQ about Asymptomatic Long-Standing Persistent A-Fib

We’ve posted a new FAQ and answer based on an email I received from a fellow with a very challenging case of Long-standing Persistent Atrial Fibrillation:

“I am 69 years old, in permanent A-Fib for 15 years, but non-symptomatic. My left atrium is over 55mm and several cardioversions have failed. My EP won’t even try a catheter ablation. I exercise regularly and have met some self-imposed extreme goals. What more can I do?

My answer: As you may know, being in permanent (long-standing persistent) Atrial Fibrillation can cause other long term problems like fibrosis, increased risks of heart failure and dementia. So you are wise to be concerned.

I’m not surprised your electrophysiologist (EP) is reluctant about performing a catheter ablation. Being asymptomatic with 15 years of long-standing persistent A-Fib and a Left Atrium diameter of 55mm, most EPs wouldn’t recommend or perform a catheter ablation on you.

Tikosyn: generic name dofetilide at A-Fib.com

Tikosyn: (dofetilide)

Drug Therapy Option: Tikosyn

Have you tried the newer antiarrhythmic drug Tikosyn (generic name dofetilide)?

Tikosyn was designed for cases like yours. It’s a Class 1A drug that works by blocking the activity of certain electrical signals in the heart that can cause an irregular heartbeat. Read more of my answer…

FAQs Understanding A-Fib: Options for Asymptomatic Longstanding Persistent A-Fib

 FAQs Understanding A-Fib: Asymptomatic Longstanding Persistent A-Fib

FAQs Understanding Your A-Fib A-Fib.com16. “I am 69 years old, in permanent A-Fib for 15 years, but non-symptomatic. My left atrium is over 55mm, and several cardioversions have failed. My EP won’t even try a catheter ablation. I exercise regularly and have met some self-imposed extreme goals. What more can I do?

As you already know, being in permanent (long-standing persistent) Atrial Fibrillation can cause other long term problems like fibrosis, increased risks of heart failure and dementia. So you are wise to be concerned.

I’m not surprised your electrophysiologist (EP) is reluctant about a catheter ablation. Being asymptomatic with 15 years of long-standing persistent A-Fib and a Left Atrium diameter of 55mm, most EPs wouldn’t recommend or perform a catheter ablation on you.

Drug Therapy Option: Tikosyn

Tikosyn (dofetilide) for long-standing persistent atrial fibrillation at A-Fib.com

Tikosyn (dofetilide)

Have you tried the newer antiarrhythmic drug Tikosyn (generic name dofetilide)?

Tikosyn was designed for cases like yours. It’s a Class 1A drug that works by blocking the activity of certain electrical signals in the heart that can cause an irregular heartbeat.

The only inconvenience of Tikosyn drug therapy is you have to be in a hospital for 3 days for observation and to get the dosage right.

Benefits of Activity and Exercise on Your A-Fib

You are truly blessed to be so active and without noticeable symptoms in spite of being in A-Fib. While exercise will not reduce the size of your LA, your activity level may compensate for the lack of pumping of your left atrium. In fact, your ventricles may be acting kind of like a turkey baster sucking blood down from your non-functioning LA before pushing blood out to the rest of your body.

Catheter Ablation and Surgical Options

Catheter ablation: Studies of non-paroxysmal A-Fib have shown that a successful catheter ablation can significantly reduce atrial dilation and improve ejection fraction. But, with your A-Fib being persistent long-standing, this may not apply.

Surgery: A Cox Maze IV surgery may reduce the volume and size of your left atrium while hopefully making you A-Fib free, but surgeons may be reluctant to tackle your case since the success rate is under 80%. A Cox Radial Maze is open heart surgery which is very traumatic and risky. It may be hard to justify open heart surgery if you’re asymptomatic.

My Recommendations

1. If you haven’t tried it yet, ask your EP about taking the newer antiarrhythmic drug Tikosyn.

2. If you’ve tried Tikosyn and it doesn’t help you, I recommend you consult an EP who specializes in longstanding persistent A-Fib. See Steve’s Lists. You may need to travel, but it may be worth it to you for your peace of mind. Also, ask the EP if surgery may be a helpful option.

3. Based on the results of the EP consult, I’d seek the opinion of a cardiac surgeon who performs the Cox Maze IV surgery. (See Steve’s Lists of surgeons who treat A-Fib patients.)

Making an Informed Choice

Armed with the above information you will be able to determine how you want to proceed. This is a decision only you can make.

With no A-Fib symptoms and a fulfilled life with plenty of body and soul enriching exercise, you may decide you are content with your present A-Fib status.

Resources for this article

If you find any errors on this page, email us. Last updated: Monday, February 13, 2017‘
Back to top

Go back to FAQ Understanding A-Fib

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

“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: Thursday, February 9, 2017

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 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 currently 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: Monday, February 13, 2017

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”

“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: Thursday, February 9, 2017

Return to FAQ Catheter Ablation and Maze Surgeries

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.

Depending on how a pacemaker is installed, it may make a catheter ablation more difficult. You may have to go to a more experienced EP for your ablation.

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: Monday, February 13, 2017

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…>

Follow Us
facebook - A-Fib.comtwitter - A-Fib.comlinkedin  - A-Fib.compinterest  - A-Fib.comYouTube: A-Fib Can be Cured!  - A-Fib.com


A-Fib.com is a
501(c)(3) Nonprofit



Your support is needed. Every donation helps, even just $1.00.



A-Fib.com top rated by Healthline.com for fourth year 2014  2015  2016  2017

A-Fib.com Mission Statement
We Need You

Mug - Seek your cure - Beat Your A-Fib 200 pix wide at 300 resEncourage others
with A-Fib
click to order

Home | The A-Fib Coach | Help Support A-Fib.com | A-Fib News Archive | Tell Us What You think | Media Room | GuideStar Seal | HON certification | Disclosures | Terms of Use | Privacy Policy