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



Symptoms

The Threat to Patients with “Silent A-Fib” How to Reach Them?

‘Silent A-Fib’ is a serious public health problem. Anywhere from 30%-50% of those with A-Fib aren’t aware they suffer from A-Fib and that their heart health is deteriorating.

In his A-Fib story, Kevin Sullivan, age 46, wrote about his diagnosis of Silent A-Fib.

“I was healthy, played basketball three times per week, and lifted weights. I started to notice on some days playing basketball, I was having some strange sensations in my chest. And sometimes, difficultly catching my breath. But the next day I would feel fine. I assumed this was just what it felt like to get old.”

He writes, that at the time, he happened to see a cardiologist about medication for high cholesterol:

“I went to see a cardiologist. They looked at my heart with ultrasound and asked if I could feel “that.” I asked them what they were talking about, and they told me that I was having atrial fibrillation. That was the first time I had ever heard of the phrase.”

‘Silent A-Fib’ vs. ‘Symptomatic A-Fib’

Silent (asymptomatic) A-Fib can have similar long-term effects as A-Fib with symptoms. Silent A-Fib may progress and get worse just like symptomatic A-Fib. Increased fibrosis may develop, the atrium may become stretched and dilated, the frequency and duration of the unnoticed A-Fib attacks may increase over time (electrical remodeling).

Silent A-Fib may progress and get worse just like symptomatic A-Fib.

Is “Silent A-Fib” Really Silent? Some people question whether “silent” A-Fib is really silent (from a clinical aspect). Even with Silent A-Fib, one loses 15%-30% of normal blood flow to the brain and other organs which certainly has an effect. (For Kevin Sullivan, he experienced occasional pain in his chest and shortness of breath while playing basketball.)

Those with Silent A-Fib may get used to their symptoms, or they write off the tiredness, dizziness or mental slowness like Kevin Sullivan did. Nonetheless, almost everyone in Silent A-Fib is affected and changed by their A-Fib to some extent.

‘Silent A-Fib’ More Dangerous: Increased Risk of A-Fib Stroke

When left untreated, A Fib patients have a 5X higher chance of stroke, and a greater risk of heart failure. Often, an A-Fib patient is hospitalized or dies from an A-Fib-related stroke without anyone ever knowing the patient had A-Fib.

And if the patient with A-Fib survives, they have about a 50% higher risk of remaining disabled or handicapped (compared to stoke patients without A Fib).

Tactics to Find Undiagnosed ‘Silent A-Fib’

Today, during a routine physical exam, general practitioners (GPs) will listen to your heart with a stethoscope and would notice if your heart beat was irregular. After a certain age, your exam may also include an ECG (EKG), and the tracing would show if you are in Atrial Fibrillation, even if your not aware of it. Cardiologists routinely perform an ECG and catch Silent A-Fib (like Kevin Sullivan’s cardiologist did).

But, to be detected, A-Fib must be present at the time of the ECG, and we know that A-Fib is often intermittent. If intermittent A-Fib is suspected, your EP has an array of A-Fib wearable event monitoring devices (like the band-aid-size ‘Zio patch’ monitor).

What if A-Fib isn’t even on the patient’s radar? What’s the remedy? More frequent and regular screenings! But how? First, by healthcare personnel teaching ‘at-risk age groups’ how to use pulse-taking palpation (which can be readily taught). See also the VIDEO: “Know Your Pulse” Awareness Campaign.)

Second, through community-sponsored health screening events when patients who are interacting with their healthcare provider for another reason, such as an annual flu vaccination.

Think of the lives and permanent disabilities that would be saved by inexpensive screening and easily administered monitoring for Silent A-Fib. 

The Future of Screening for Silent A-Fib: Heart-monitoring apps and devices are growing in popularity. Two FDA-approved devices are the iPhone app called Cardio Rhythm, and the AliveCor Kardia device that connects to a app-equipped smartphone.

In this emerging era of ‘wearable’ technology, the wearer, themselves, may be the first to detect an irregular heart beat.

These devices display an ECG tracing, and an irregular reading may direct the user to their doctors. In this emerging era of ‘wearable’ technology, the wearers, themselves, may be the first to detect an irregular heart beat.

What Patients Need to Know

If you have A-Fib, discuss it with your family and friends. Answer their questions. Because A-Fib runs in families, urge your immediate family members to discuss A-Fib with their doctors.

Encourage your friends over 60 years old to do the same. Support community-sponsored health screening events.

References for this Article

Eye Disease: The Atrial Fibrillation Link to Glaucoma

Glaucoma is a disease that damages your eye’s optic nerve and is a leading cause of blindness for people over 60 years old. While anyone can get glaucoma, those at higher risk include African Americans over age 40, everyone over age 60 especially Mexican Americans, and people with a family history of the disease. Blindness can often be prevented with early treatment.

Link with Atrial Fibrillation: Glaucoma may be related to ischemia (when your heart muscle doesn’t get enough oxygen) and has been linked with Atrial Fibrillation. Among A-Fib patients, glaucoma is found especially among those who are female, 60+ years old, take the medication Warfarin and have high blood pressure.

Risk May Be Dormant

Patients may be at risk of glaucoma for years but not develop any signs. Then something changes abruptly, such as developing atrial fibrillation, and the glaucoma-related damage begins to occur.

What Patients Need to Know

When you have Atrial Fibrillation, you should be tested for glaucoma regularly (most ophthalmologists will include a glaucoma test as part of your regular eye care).

if you fall into one of the high-risk groups for the disease, make sure to have your eyes examined through dilated pupils every one to two years by an eye care professional. Graphic of tooth A-fib.com

See the dentist too: Besides regular visits with your eye doctor, A-Fib patients should see their dentist regularly, too! See my article about the link between A-Fib, inflammation and gum disease: Brush & Floss! Is Oral Hygiene Linked to A-Fib

https://nei.nih.gov/glaucoma

References for this Article

How Drinking Too Little Can Trigger Your A-Fib

Drinking too little alcohol? Coffee? Juice? No, we’re talking about just plain ol’ water. Drinking too little water leads to dehydration which can trigger an Atrial Fibrillation episode, and raises the risk for blood clots (it makes the blood less viscous).

Hydration Affects the Function of Your Heart

Your body contains significant amounts of water. A change in fluid levels in your body can affect a number of bodily functions, including heart function. When you have atrial fibrillation, drinking enough water is important.

Electrolyte levels plummet when you’re dehydrated. This can lead to abnormal heart rhythm.

When you’re dehydrated, your body’s electrolytes (electrolytes in general, and sodium and potassium in particular) are crucial for heart health. Electrolyte levels plummet when you’re dehydrated. This can lead to abnormal heart rhythm.

Dehydration Risk Factors

Your risk of dehydration isn’t just from sweating during exercise or from the extreme heat of summer. Other risks include high altitudes, the desert, exhaustion and increased stress, missing meals or a change in eating patterns and vomiting or diarrhea.

Cold weather can also dehydrate you. When it’s cold, the body works to maintain its core temperature, and less to keep ideal fluid balance.

Do you travel by plane often? Flying dehydrates you because the humidity level on a plane is usually less than 10%. Alcohol and caffeinated drinks also dry you out.

Cold weather can also dehydrate you. When it’s cold, the body works to maintain its core temperature, and works less to keep ideal fluid balance. And since you don’t feel thirsty when it’s cold, you often don’t think about drinking extra water.

The Good News, The Bad News

The good news is that usually dehydration on its own won’t cause an A-Fib episode. The bad news, when combined with other well known triggers, it will.plane-facing-right

For example, you risk dehydration when traveling by air (low humidity) during the hectic holidays (tired and stressed), drinking too much coffee (diuretic effect), and vacationing in the desert (dry climate).

Preventing Dehydration

Under normal conditions, 64 to 80 ounces of water per day is considered enough. On a plane, a good rule of thumb is 6 to 12 ounces of water (or club soda) for every hour in the air.plastic-bottle-and-sports-bottle-no-box-330-x-400pix-at-96-res

Be aware of the not-so-obvious signs of dehydration: dry mouth, constipation, feeling tired and sleepy, low urine output, dry skin and dizziness or lightheadedness. Furthermore, your body may misinterpret the need for water as the need for food making you feel hungry, when what you really need is more water.

Drink more water when… the weather is too hot or too cold, when traveling by plane, when you’ve skipped meals, when exhausted or you’re sick. For each coffee or alcohol beverage, have a glass or two of water.

Check your hydration level. Each body has individual needs for water intake. If you’re drinking enough, look at the color of your urine when you go to the washroom. If your urine is clear or light yellow, you are well hydrated. If it’s darker, you need to drink more water.

Be Aware—Stay Hydrated

Sometimes it’s the lack of a dietary staple that causes the heart to misfire, and in many cases, that substance is water.

As fatigue or muscle ache turns into thirst, you’re already pretty far down that path to dehydration. Many people don’t realize how quickly and deeply dehydration can set in, especially since the early warning signs are subtle.

Dehydration is never a healthy state, but the mineral imbalance that results can be especially troublesome for A-Fib patients.

Infographic: A-Fib & Sleep Apnea—The Life-Threatening Risks


Sleep Apnea is common amount Atrial Fibrillation

At least 43% of patients with Atrial Fibrillation suffer from Obstructive Sleep Apnea (OSA) as well.

Sleep Apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

It is now established that there’s a correlation between Sleep Apnea and A-Fib.

 

Warning: Do you Acupuncture? Know it’s Not Without Risks

Some A-Fib patients report acupuncture has helped with their symptoms.

If you decide to try acupuncture, be aware that it is not without risks. There have been reports of lung and bladder punctures, broken needles, needles left in after treatment, and allergic reactions to needles containing substances other than surgical steel. There is always the possibility of infection from unsterilized needles.

Acupuncture needles at A-Fib.com

Acupuncture needles

The best guarantee of safety is to seek treatment from a properly trained and qualified practitioner who is licensed or certified. Always check their credentials. In the U.S., most states require a diploma from the National Certification Commission for Acupuncture and Oriental Medicine. Outside the U.S., check your national Accredited Registers for acupuncture practitioners.

To learn more about A-Fib and Acupuncture, see our articles:

• FAQs Natural Therapies Acupuncture: “What’s the research on acupuncture and Atrial Fibrillation? I’m willing to try it if it will help ease or reduce my A-Fib episodes

Acupuncture Helps A-Fib: Specific Acupuncture Sites Identified

References for this article

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.

 

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

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

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

From the Upside of Stress by Kelly McGonigal

From the Upside of Stress by Kelly McGonigal

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

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

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

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

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

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

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

Buy this book

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

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

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

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

Updated Answer to FAQ About Coping with PVCs & PACs

New Article icon - red-heart-negative 75 sq at 96 resWe’ve update our answer to the Frequently Asked Question: I have a lot of extra beats and palpitations (PVCs and/or PACs) which are very disturbing and frightful. They seem to proceed an A-Fib attack. What can or should I do about them?

We’ve added:

Sometimes PVCs Aren’t Always Benign

In patients with other heart problems like Coronary Artery Disease (CAD), frequent PVCs often aren’t “benign.” They can increase chances of a fatal heart attack or sudden death. PVCs have been implicated in the development of cardiomyopathy and LV (Left Ventricular) dysfunction.

But catheter ablation or antiarrhythmic pharmacological agents appears to reverse this cardiomyopathy and LV dysfunction. RF ablation for frequent PVCs in patients without structural heart disease has been shown to completely reverse cardiomyopathy in numerous studies.

To read the entire answer, go to: FAQs Coping with A-Fib: PVCs & PACs.

‘Silent A-Fib’ More Dangerous Than ‘Symptomatic A-Fib’

Dr. John Camm of St. George’s Hospital

Dr. John Camm of St. George’s Hospital

Dr. John Camm of St. George’s Hospital in London, England discussed how silent (asymptomatic) A-Fib can have similar long-term effects as A-Fib with symptoms. Silent A-Fib may progress and get worse just like symptomatic A-Fib. But all too often people with silent A-Fib have a stroke and only then find out they have A-Fib.

Doctors today have a wealth of new A-Fib monitoring devices to detect A-Fib, such as the Medtronic Reveal DX which is inserted just under the skin and can monitor the heart for over a year, or the Zio Patch which you wear like a Band Aid for 1-2 weeks, or phone apps like the

AliveCor Heart monitor for SmartPhones.

BUT—how can we get heart monitors to the people who need them the most—people with silent A-Fib? Read more of Steve’s summary of Dr. Camm’s presentation->

Sleep Apnea—New At-Home Testing Option

At least 49% of all patients with A-Fib suffer from Sleep Apnea as well. With untreated Sleep Apnea, you have a greater chance of a more severe form of A-Fib and increased risk of recurrence after a successful catheter ablation.   Everyone with A-Fib should be tested for sleep apnea which involves an overnight stay in the sleep lab. Now there’s an alternative—you can test at home with the WatchPAT™ device.

If you have untreated Sleep Apnea, your chances of having a more Read more.

Sleep Apnea: Home Testing with WatchPAT Device and the Philips Respironics

Photo: Itamar Medical patient brochure at A-Fib.com

Photo: Itamar Medical patient brochure

by Steve S. Ryan, PhD, Updated November 2016

At least 43% of patients with Atrial Fibrillation suffer from Obstructive Sleep Apnea (OSA) as well.

Sleep Apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

A-Fib anD Risks of Untreated Sleep Apnea

It is now established that there’s a correlation between Sleep Apnea and A-Fib.

If you have untreated Sleep Apnea, you are a greater risk of having a more severe form of A-Fib or of not benefiting from an A-Fib treatment .

See infographic for risks of sleep apnea at A-Fib.com

NEW! Click for infographic on risks of sleep apnea

For example, after a successful catheter ablation, patients with untreated sleep apnea have a greater chance for recurrence of their A-Fib.

The In-Lab Sleep Study

In the standard lab test for sleep apnea, you go to a hospital-like room, put on cumbersome sensors, then try to go to sleep in this unfamiliar environment. And this test isn’t cheap ($1100-$2,000).

It requires extensive monitoring to measure airflow, chest/abdominal movements, electromyography, electrocardiography, and oxygen saturation levels. The formal name for this test is polysomnography (PSG).

At Home Sleep Tests (HST)

A home sleep test (HST), also called ‘Unattended Sleep Study’, is a sleep study tool that is used for the diagnosis of obstructive sleep apnea. Most HST devices are portable —about the size of a telephone handset. A home sleep test is more affordable at $250-$300.

Itamar Medical’s WatchPAT™

WhyWPMed_desc2_6_2

Photo: Itamar Medical patient brochure

The WatchPAT is an FDA-approved wrist-worn sleep study device you can use in the comfort of your own bedroom to determine if you have sleep apnea. (PAT is short for Peripheral Arterial Tonometry [pressure measurement].)

It assesses respiratory disturbances and indirectly detects sleep apnea by measuring volume changes in the peripheral arteries along with pulse oximetry (oxygen desaturation) and respiratory arousals. (When you have sleep apnea, your breathing often stops till you have to gasp for breath. This is called “respiratory arousal.”)

Philips Respironics "Alice NightOne Sleep Apnea in-home test at A-Fib.com

Philips’ Alice NightOne

Philips‘ Alice™ NightOne

Another HST is the Philips Respironics Alice NightOne, an FDA-cleared Type III device. It features a belt that goes around your chest with a nasal cannula (short two-prong nose tube) which you place in your nostrils and a Pulse Oximeter which you wear on your finger. Read more about the Philips Respironic Alice NightOne at SingularSleep.com.

Other HSTs include Ares by Watermark and ResMed’s ApneaLink™ Plus.

How to Choose a Home Sleep Test Provider

According to Dr. Joseph Krainin, founder of SingularSleep.com, it’s important your interpreting physician review the entire record to make sure of the proper diagnosis.

Dr. Joseph Kranin

Dr. Joseph Kranin

Insist that your interpreting physician be a fellowship-trained, board certified sleep physician (who has one full year of training in sleep medicine and passed a rigorous national examination).

Before signing up with a HST provider, make sure to ask how long it will take to get results. And if your first encounters with a company’s customer service isn’t first-rate, steer clear of this provider.

Note: Dr. Joseph Krainin offers online sleep doctor telemedicine consultations.

What Patients need to know

Everyone with A-Fib should be tested for sleep apnea. It’s now available at a fraction of the cost of an in-lab sleep study ($250-$300 vs. $1100-$2,000). And it’s convenient (especially if being away from home overnight is problematic). Talk to your EP. With OSA home testing now available, there is no excuse for not doing a sleep study.

Learn more about Home Study Tests on the American Sleep Association website: What is a Home Sleep Test or HST.

Back to top

Return to Diagnostic Testing

Last updated: Wednesday, December 14, 2016

References for this Article

Catheter Ablation Reduces Stroke Risk even for Higher Risk Patients

Catheter Ablation Reduces Stroke Risk Even for Higher Risk Patients

by Steve S. Ryan, April 2015

In a study of nearly 38,000 people, patients with A-Fib who had a catheter ablation had about as many strokes as the people without A-Fib, while people on just medication had about twice as many strokes. (This isn’t a surprising finding. If you no longer have A-Fib, by definition you can’t have an A-Fib stroke.)

But what is surprising is that even patients at greater risk of stroke had a reduced stroke risk after catheter ablation. “Across all CHADS2 profiles and ages, A-Fib patients with ablation had a lower long-term risk of stroke compared to patients without ablation.” Even those at higher risks of stroke had a reduced risk of stroke.

Catheter Ablation Reduces Stroke Risk to That Of A Normal Person

And, more importantly, if someone had a catheter ablation, stroke risk decreased to that of a normal person. “A-Fib ablation patients had similar long-term risks of stroke across all CHADS2 profiles and ages compared to patients with no history of A-Fib.” “…freedom from A-Fib was the strongest predictor of stroke-free survival.”

Warfarin Not Needed After Successful Catheter Ablation

Some patients after a catheter ablation are still put on warfarin-for-life depending on their CHADS2 score. But research indicates that “A-Fib patients after ablation with moderate to high risk CHADS2 scores in which warfarin was discontinued do not show a higher risk of stroke compared to those in which warfarin is continued.”1

Editor’s Comments:
This study is medical breakthrough news, similar to another important study in which a successful catheter ablation reduced by 60% the expected rate of cardiovascular mortality. (See Live Longer—Have a Catheter Ablation.)
For anyone who has had a successful catheter ablation or who is thinking of having one, this study also is a game changer!
Even if you are at a theoretical high risk of stroke (high CHADS2), you don’t have to be on warfarin for the rest of your life after a successful catheter ablation. A successful catheter ablation reduces your stroke risk to that of a normal person (though obviously normal people do have strokes).
We already know that a catheter ablation significantly improves our well being. We certainly feel healthier in sinus rhythm. Few other medical procedures produce such a dramatic and nearly immediate improvement in our quality of life. This study confirms the long-term benefits of catheter ablation even for people who are sicker.
We don’t have to live a life on meds! A-Fib can be cured by a catheter ablation. And when you are made A-Fib free, not only do you feel better, but your risk of stroke is reduced to that of a normal person! This is terrific news for the A-Fib community.
References for this Article

Return to Reasearch and Innovations

Last updated: Tuesday, January 12, 2016

 

Footnote Citations    (↵ returns to text)

  1. Themistoclakis, S. et al. The risk of thromboembolism and need for oral anticoagulation after successful atrial fibrillation ablation. J Am Cardiol. 2010;55:735-743. http://content.onlinejacc.org/article.aspx?articleid=1140481 doi:10.1016/j.jacc.2009.11.039

FAQ: Natural Therapies & Holistic Treatment for A-Fib

Complementary & Natural Therapies

Complementary & Natural Therapies

FAQ: Natural Therapies & Holistic Treatment

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

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

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

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

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

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

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

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

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

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

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

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

If you find any errors on this page, email us. Y Last updated: Saturday, February 11, 2017
Return to Frequently Asked Questions

FAQs A-Fib Ablations: Feeling Better in Chronic A-Fib

 FAQs A-Fib Ablations: Better in Chronic? 

Catheter Ablation

Catheter Ablation

“I’m 80 and 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?”

With Chronic A-Fib of long duration, perhaps not. Although a few centers get very good results when treating Chronic A-Fib even of long duration (the French Bordeaux group achieves an acceptable success rate after 2 ablations), most centers have a success rate of only around 50% for Chronic A-Fib. And although catheter ablation is a low risk procedure, there are still risks.

Many centers won’t ablate patients who are over 80 years old or in Chronic A-Fib for over a year. There is a higher risk of complications in older people, and it is more difficult to ablate Chronic A-Fib. (In Chronic A-Fib there are often multiple spots in the heart producing A-Fib signals. It’s hard to identify and ablate [isolate] them all.)

The Positive Side of being in Chronic A-Fib: Sometimes people feel relieved to be in permanent A-Fib. There’s no longer the fear, uncertainty, and shock of an A-Fib attack. You can adjust your lifestyle to how your heart behaves, because it doesn’t change much. You may be short of breath, somewhat light headed, tired, and unable to work or exercise hard. But you get used to it. You may even feel better than when you had Paroxysmal A-Fib. In addition, an ablation may be only partially successful and have the unwanted consequence of putting you back into Paroxysmal A-Fib.

You still need to take blood thinners to prevent an A-Fib stroke. But if you get the Watchman or Lariat device installed (very low risk), it closes off your Left Atrial Appendage where 95% of A-Fib clots originate. It’s then possible to go off of Coumadin baring other risk factors for stroke.

The Negative Side of being in Chronic A-Fib: The down side of being in Chronic A-Fib is your heart forever and always will not pump properly. Blood flow to your brain and other organs is reduced by about 15%-30%. This can lead to conditions like dementia and Alzheimer’s. (If you are a superior athlete like a bicyclist or runner, your exercise may overcome this reduced blood flow.)

A-Fib is a progressive disease. It tends to get worse even in Chronic A-Fib. Your atria expand and stretch. Your ejection fraction diminishes. Chronic A-Fib produces fibrosis and collagen deposits which stiffen the heart and make it less flexible. All this leads to conditions such as Congestive Heart Failure and Cardiomyopathy

But please weigh the above statements carefully (the author is concerned that they may create unwarranted fear). How do you feel? If you don’t feel any symptoms and your doctor says your heart isn’t enlarging and/or developing poor ejection fraction, etc., then there’s no need to rush out to get a Pulmonary Vein Ablation which does involve real risk.

The Bottom Line: You can be cured of Chronic A-Fib, even at your age. But it will take at least 2 ablations. And it won’t be easy finding a doctor to do it. (There is a short list of doctors at Specialists In Persistent/Chronic A-Fib. You need someone with a proven track record in ablating Chronic A-Fib.) However, an ablation is more risky at your age.

On the other hand, you can live in Chronic A-Fib. Many people do. The key to living a satisfying life in Chronic A-Fib may be good rate control. For example, a resting heart rate of around 80 beats per minute with an exercise rate of 110 is very close to that of a normal person. People with good rate control of their Chronic A-Fib report a good quality of life and seem less prone to develop other heart or mental problems.

What this Means to You: Are you happy or content with your quality of life in Chronic A-Fib? If so, then the added hassles and risks of an ablation are probably not worth it for you. Only you (and your doctor) can decide if it’s better to spend your twilight years in a perhaps reduced but satisfactory quality of life.

References:
•  Haines, D. “Atrial Fibrillation: New Approaches in Management.” Un. of Virginia multi-media presentation, 1999, p.6.
•  The Link Between Infections in Heart Disease. Life Extension Vitamins. Last accessed Feb. 16, 2013. URL: http://www.lifeextensionvitamins.com/cadico6otco.html
•  Peykar, S. Atrial Fibrillation, Cardiac Arrhythmia Institute. Last accessed Feb 16, 2013. URL: http://caifl.com/arrhythmia-information/atrial-fibrillation/
•  Heartscape: The Heart’s Structure. Last accessed Feb. 16, 2013. URL: http://www.skillstat.com/tools/heart-scape.
•  Elias, MF, et al. Atrial Fibrillation Is Associated With Lower Cognitive Performance in the Framingham Offspring Men.  Journal of Stroke and Cerebrovascular Diseases, Vol. 15, No. 5 (September-October), 2006: pp. 214-222. http://www.ncbi.nlm.nih.gov/pubmed/17904078
•  Bunch, J. J., Weiss, P. P., & Crandall, B. G. et al. Atrial fibrillation is independently associated with senile, vascular, and alzheimer’s dementia. Heart rhythm, 2010:7 (4), 433-437. URL http://dx.doi.org/10.1016/j.hrthm.2009.12.004
•  Camm, “Clinical Relevance of Silent Atrial Fibrillation: Prevalence, Prognosis, Quality of Life, and Management.” Journal of Interventional Cardiac Electrophysiology 4, 369-382, 2000, p. 373-376. http://www.ncbi.nlm.nih.gov/pubmed/10936003
•  Un. of Utah Health Sciences, Atrial Fibrillation FAQ, What is Atrial Fibrillation, Risks. http://healthsciences.utah.edu/carma/forthepatient/faqs.html, heart weakness, heart attacks, etc.
• Benjamin EJ, et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998 Sep 8;98(10):946-52. Last accessed Nov 22, 2014. URL: http://circ.ahajournals.org/content/98/10/946.full.

Return to FAQ Catheter Ablations

FAQs A-Fib Ablations: Post-Procedure Symptoms and Success

 FAQs A-Fib Ablations: Post-Procedure Symptoms 

Catheter Ablation

Catheter Ablation

How long before you know a Pulmonary Vein Ablation procedure is a success? I just had a PVA. 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?”

After a Pulmonary Vein Ablation procedure, some people feel great and are in perfect sinus rhythm. But for most of us it usually takes two or three months (called a “blanking period”) for the ablation scars to heal and for our heart to learn to beat normally again.

Doctors sometimes help this process by prescribing antiarrhythmic meds for a month or longer. You may also have to continue to take Coumadin for a while.

Right after the PVA(I) you may experience the following:

•  Your groin will generally have two access site points, one on each side. After a Pulmonary Vein Ablation, some minor bruising is common at each site with minor soreness as if you had banged the area. Bruising may occasionally be seen to extend down the leg. This is normal, as is an occasional small quarter sized bump in the area. (If larger swelling or more significant pain occurs at the area, please contact the electrophysiologist who did the procedure.) One of the reasons for this bruising is the heavy dose of blood thinners you were administered during your ablation procedure to prevent a possible stroke.

•  After a Pulmonary Vein Ablation you may have some minor chest pain for the next week or so. The pain will often worsen with a deep breath or when leaning forward. This is pericardial chest pain from the ablation and is generally not of concern. It should resolve within a week, although it might increase for a day or so after the ablation. (This chest pain may be due to the heat from the catheter ablation burns which may temporarily irritate the Pericardium, the sac around the heart.)

•  Your heart may beat faster than before. Usually your heart rate will settle down after the two-to-three month blanking period. But some people report a slightly elevated heart rate even after three months, especially if they have previously been taking rate control or antiarrhythmic meds.

•  Low grade fevers of around 99 degrees are common in the first day or so post-ablation. (If you develop unexplained fevers exceeding 100 degrees anytime within the first 3 weeks post-ablation, you need to contact the electrophysiologist who performed your procedure.)

One or more of these symptoms is considered normal, but discuss any symptoms with your doctor during your post-procedure doctor visits.

Thanks to Marva Harp for this question.

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FAQs Understanding A-Fib: Flutter and A-Fib—Does one cause the other?

 FAQs Understanding A-Fib: Flutter

FAQs Understanding Your A-Fib A-Fib.com8. “A-Fib and Flutter—I have both. Does one cause the other?”

You can have A-Flutter without A-Fib. And of course, A-Fib without Flutter. But more often than not, they are linked.

If you have A-Flutter, A-Fib often lurks in the background or develops later.

But right now we can’t say for sure if one causes the other. We do know that A-Flutter usually comes from the right atrium, while A-Fib usually comes from the left atrium.

(When Electrophysiologists do a catheter ablation, the first stage of success is to convert A-Fib into A-Flutter, the second stage is to convert A-Flutter into tachycardia. When the tachycardia is stopped and can’t be re-induced, the ablation is considered finished. You can consider A-Flutter as a more organized form of A-Fib.)

Go back to FAQ Understanding A-Fib

FAQs Understanding A-Fib: Paroxysmal to Persistent A-Fib, What Causes the Progression?

 FAQs Understanding A-Fib: Paroxysmal to Chronic

FAQs Understanding Your A-Fib A-Fib.com6. What causes Paroxysmal (occasional) A-Fib to turn into Persistent (chronic) A-Fib?

Researchers are still working to find the answer(s) to this question. We do know that some patients remain paroxysmal (usually with anti-arrhythmic therapy), while a large proportion progress to persistent A-Fib. (In a study of 5,000+ A-Fib patients, 54% of those on rate control meds went into permanent A-Fib within one year.)

The main trigger seems to be increased pressures in the left atrium that cause the muscle fibers within the pulmonary vein openings to start beating on their own.

Uncontrolled blood pressure, untreated sleep apnea and diabetes, or a worsening cardiomyopathy seem to be key factors that make people progress from Paroxysmal to Persistent A-Fib. Research tells us that even after a successful ablation for Persistent A-Fib, “the long term success rates depend mostly on treatment of hypertension and obstructive sleep apnea.”

What does this mean to you? The longer you have Atrial Fibrillation, the harder it can be to cure it. Consider working aggressively to stop your A-Fib as with antiarrhythmic meds or with a minimally-invasive Pulmonary Vein Ablation or a Mini-maze surgery. You don’t want to be part of the 54% whose A-Fib becomes permanent.

Go back to FAQ Understanding A-Fib

FAQs Understanding A-Fib: Adrenergic and Vagal

 FAQs Understanding A-Fib: Adrenergic and Vagal

FAQs Understanding Your A-Fib A-Fib.com5. “What is the difference between “Adrenergic” and “Vagal” Atrial Fibrillation? How can I tell if I have one or the other? Does it really matter? Does Pulmonary Vein Ablation (Isolation) work for Adrenergic and/or Vagal A-Fib?”

If your A-Fib is normally triggered by exercise, stress, stimulants, exertion, etc., then you may have what doctors call ‘Adrenergically-Mediated’ A-Fib. People with structural heart disease seem more prone to Adrenergic A-Fib. The Adrenal (Adrenergic) Glands sit above the kidneys and produce the hormone epinephrine (adrenaline) in response to stress, which causes an increase in heart rate and blood pressure. This adrenaline stimulates what is called the ‘Sympathetic Nervous System’ to speed up the heart and constrict the blood vessels.

But if your A-Fib occurs at night, after a meal, when resting after exercising, or when you have digestive problems, then you may have ‘Vagally-Mediated’ A-Fib. The Vagus Nerve, in contrast, controls the abdomen and is part of the Parasympathetic Nervous System that tends to slow the heart and dilate blood vessels.

Adrenergic and Vagotonic forms of paroxysmal A-Fib are uncommon.

The majority of patients with paroxysmal A-Fib do not have a clear autonomic pattern. Those with Lone A-Fib (no other related medical condition) seem more prone to Vagal A-Fib. (Many people have a mix of both Adrenergic and Vagal A-Fib.) (Perhaps A-Fib begins as a nervous system problem, then becomes a heart problem after the arrhythmia is established.)

What does this mean to you? It might be helpful to determine if you have one or the other so that you can better identify what triggers your A-Fib, and because the treatments are often different for each.

For example, beta-blockers usually don’t work well with Vagal A-Fib or the antiarrhythmic 1C meds. Flecainide seems to work better for Vagal A-Fib than propafenone. (Though it’s difficult to generalize about A-Fib treatments, because each person reacts so individually.)

Pulmonary Vein Ablation: It seems that both Adrenergic and Vagal A-Fib are ‘focal’ in origin (come from specific points or spots in the heart), and are treatable with Pulmonary Vein Ablation (Isolation) procedures.

References for this Article

Go back to FAQ Understanding A-Fib

FAQs Understanding A-Fib: Aging into A-Fib

 FAQs Understanding A-Fib: Aging

FAQs Understanding Your A-Fib A-Fib.com3. “Why do older people get Atrial Fibrillation more than younger people?”

We know that those over 60 years old are in the higher risk group for developing A-Fib. This may be related to what is called “Interstitial Fibrosis” which is often part of the aging process.

The Pulmonary Vein openings (where most A-Fib signals originate) sometimes become fibrous as we age. The Pulmonary Vein openings are similar in structure and have similar smooth muscle tissue as the Sinus and AV Nodes which generate your normal heart beat signal. The Pulmonary Vein openings are electrically active in the heart like the Sinus and AV Nodes but usually beat in sync with them. When the Pulmonary Vein openings become fibrous, they tend to beat out of sync with the Sinus and AV Nodes which results in A-Fib.

Please be advised that the above statement is an observation, an attempt to explain, rather than a medical fact. Further research is necessary to confirm this observation.

Go back to FAQ Understanding A-Fib

FAQs from Newly Diagnosed Patient

You are not alone. A-Fib.comFrequently Asked Questions by Newly Diagnosed Patients

Newly diagnosed Atrial Fibrillation patients have many questions about living with A-Fib. These are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer)

1.  Cause: Did I cause my Atrial Fibrillation? Am I responsible for getting A-Fib?”

2.  Severity: My doctor says I had an attack of Atrial Fibrillation. How much trouble am I in?”

Related Question:Is Atrial Fibrillation a prelude to a heart attack?”

Related Question: “Can I die from my Atrial Fibrillation? Is it life threatening?”

3.  Anomaly?Could my Atrial Fibrillation go away on its own? I don’t want to take any medication. Can I just wait and see?”

Related Question: “Is it possible to have a single Atrial Fibrillation attack and not have any others? I had a single episode of A-Fib and was successfully converted in the ER with meds.”

Related Question:How can I tell when I’m in A-Fib or just having something like indigestion?”

4.  Sex/Exercise:Should I cool my sex life? Can I exercise if I have Atrial Fibrillation? Should I exercise?”

5.  Driving:Can I drive my car if I have Atrial Fibrillation?”

6.  Nutrition:Is drinking coffee (tea, colas, other products with caffeine) going to make my Atrial Fibrillation worse or trigger an A-Fib attack?”

Related Question: “Is there a diet I could follow which would cure my Atrial Fibrillation?”

7.  Medical ID:Should I carry a wallet card or a medical ID? I have A-Fib and take Coumadin (warfarin). In case of an A-Fib emergency, what information should I include?”

8.  Coping:I have a lot of stress at work. Does this stress cause or trigger my Atrial Fibrillation?”

Related Question:I live in fear of my Atrial Fibrillation. I never know when I’m going to get an A-Fib attack or how long it will last. How do I deal with the anxiety?”

Related Question: “Is there anything I can do to get out of an Atrial Fibrillation episode? How do others deal with their episodes?”

9.  Specialist?Should I see a cardiologist for my Atrial Fibrillation and not just my primary care doctor? (He wants to prescribe medication.) Should I also see an A-Fib specialist?”

10.  Cure?Is Atrial Fibrillation curable? Or can you only treat or control it? Should I seek a cure?”

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