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

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

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

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

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

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


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

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

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

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

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

Terry Traver, former A-Fib patient

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

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


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.


Wonder if You Have Sleep Apnea? At-Home Testing Option

WatchPat device product image

Photo: Itamar Medical patient brochure

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. Traditionally this has involved an overnight stay in the sleep lab.

But now there’s an alternative! You can test at home with the WatchPAT™ device.

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].)

Multiple studies have shown there is a high correlation of the WatchPAT with sleep indexes such as the respiratory disturbance index (RDI) and the apnea-hypopnea index (AHI), compared with the same indexes measured by the normal sleep test PSG.

If you think you may have untreated Sleep Apnea: read my full review.

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 Rspironics

Itamar Medical: Managing Sleep Apnea GFX

Photo: Itamar Medical patient brochure

by Steve S. Ryan, PhD

At least 43% of patients with A-Fib suffer from Sleep Apnea as well.1  (In Sleep Apnea your breathing stops while you’re sleeping). It is now established that Sleep Apnea and A-Fib are correlated.

If you have untreated Sleep Apnea, your chances of having a more severe form of A-Fib or of not benefiting from an A-Fib treatment are greater. After a successful catheter ablation, people with sleep apnea have a greater chance of A-Fib recurring.

In a normal test for sleep apnea, you to 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. 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).

The WatchPAT™ Device


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.”)

Multiple studies have shown there is a high correlation of the WatchPAT with sleep indexes such as the respiratory disturbance index (RDI) and the apnea-hypopnea index (AHI), compared with the same indexes measured by the normal sleep test PSG.


Philips Respironics Alice NightOne Sleep Apnea Test

Added 7/21/16: Singular Sleep.com features a different home use system for determining if you have sleep apnea. Developed by Dr. Joseph Krainin, MD, Singular Sleep offers home sleep testing in 24 states (new states are being added regularly), as well as online sleep doctor telemedicine consultations. They use the Philips Respironics “Alice NightOne Sleep Apnea Test” which features a belt that goes around your chest with a nasal cannula which you place in your nostrils and a Pulse Oximeter which you wear on your finger. This system can test both for obstructive sleep apnea and central sleep apnea. See https://singular sleep.com. Many people diagnosed with sleep apnea have trouble using or tolerating a typical CPAP breathing device. Dr. Krainin specializes in helping people adopt to or find the right machine or device to stop their sleep apnea. He is available for consultation in 24 states in the US.




Editor’s Comments:
Everyone with A-Fib should be tested for sleep apnea. Talk to your EP. With the WatchPAT device there is no excuse for not doing a sleep study. It’s easy. You just strap the WatchPAT on your wrist and put the sensors on your fingers, then go to sleep.
If your EP doesn’t have the WatchPAT device for you to use, contact Itamar Medical which produces the WatchPAT. They can usually connect you with an EP in your area who uses the WatchPAT. Website: www.itamar-medical.com; email: infousa@itamar-medical.com. Itamar’s North American number is 888-748-2627; their worldwide number is +972 4 6177000.

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Return to Diagnostic Testing

Last updated: Thursday, July 21, 2016

References for this Article
References    (↵ returns to text)
  1. Bitter, T. et al. Sleep-disordered Breathing in Patients With Atrial Fibrillation and Normal Systolic Left Ventricular Function. Dtsch Arztebl Int 2009; 106(10): 164-70  http://www.aerzteblatt.de/pdf/di/106/10/m164.pdf. DOI: 10.3238/arztebl.2009.0164

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


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

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

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

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

7. 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?

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

9. “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.”

10. “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

Last updated: Wednesday, May 18, 2016 

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

20. “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.

•  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

12. 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.

Return to FAQ Catheter Ablations

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. “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?

2. “With the recent improvements in Pulmonary Vein ablation techniques, should I wait for a better technique? I’m getting by with my Atrial Fibrillation.”

3. “Are there different types of “Pulmonary Vein Ablation”? Are they different from “Pulmonary Vein Isolation?

4. I’’ve heard of Cryo (freezing) catheters for PVA(I) ablations. Are they good or better than the RF (Radio Frequency) catheters for ablations?

5. “How dangerous is a Pulmonary Vein Ablation procedure? What are my risks?

6. “During the ablation procedure A-Fib doctors actually burn within the heart with RF energy. How does this burning and scarring affect how the heart functions? Should athletes, for example, be concerned that their heart won’t function as well after an ablation?

7. “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 can’t work or exercise, and live in fear of the next attack. Antiarrhythmic meds cause me bad side effects. But I’m worried about being exposed to radiation during the ablation.

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

9. “What is an enlarged heart? Does it cause A-Fib?. I was told I can’t have a Pulmonary Vein Ablation (Isolation) procedure because I have an enlarged heart. Why is that?”

10. “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?

11. “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?”

12. “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?”

13. I want to read exactly what was done during my Pulmonary Vein Ablation. Where can I get the specifics? What records are kept?

14. “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?

15. “After my successful Pulmonary Vein Ablation, do I still need to be on blood thinners like Coumadin or aspirin?

16. “I’ve had a successful ablation. For protection against potential stroke risk if my A-Fib re-occurs, which if better—81 mg baby aspirin or 325 mg?

17. 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?

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

19. I have Chronic Atrial Fibrillation (the heart remains in A-Fib all the time). 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?

20. “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?

21.“Will an ablation take care of both A-Fib and Flutter? Does one cause the other? Which comes first A-Fib or Flutter?

22. 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

23. “During an ablation, how much danger is there of developing a clot? What are the odds? How can these clots be prevented?

24. “I was told that I will have to take an anticoagulant for about 2-3 months after my ablation. After all, if fibrillation episodes are reduced or eliminated after an ablation, shouldn’t there be even less need for a prescription anticoagulant rather than more?

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

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

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

Last updated: Thursday, September 8, 2016

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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 in one year.)

The main trigger seems to be increased pressures in the left atrium that causes the muscle fibers around 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.  My doctor says I had an attack of A-Fib. How much trouble am I in?

2.  Did I cause my Atrial Fibrillation? Am I responsible for getting A-Fib?

3.  “Could my A-Fib go away on its own? I don’t want to take any medication. Can I just wait and see?”

4.  “Is Atrial Fibrillation a prelude to a heart attack?

5.  “Can I die from my Atrial Fibrillation? Is it life threatening?”

6.  “Is Atrial Fibrillation curable? Or can you only treat or control it? Should I seek a cure?

7.  “Is there a diet I could follow which would cure my A-Fib?

8.  “Should I cool my sex life? Can I exercise if I have Atrial Fibrillation? Should I exercise?

9.  “I have a lot of stress at work. Does this stress cause or trigger my A-Fib?”

10. “Can I drive my car if I have Atrial Fibrillation?

11. “Is drinking coffee (tea, colas, other products with caffeine) going to make my A-Fib worse or trigger an A-Fib attack?

12. “Is there anything I can do to get out of an A-Fib episode? How do others deal with their episodes?

13. “Should I carry a wallet card or a medical ID? I have A-Fib and take Coumadin. In case of an A-Fib emergency, what information should I include?

14. “I live in fear of my A-Fib. 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? 

15. “Should I see a cardiologist for my A-Fib and not just my primary care doctor? He wants to prescribe medication. Should I also see a specialist?”

Last updated: Monday, July 13, 2015

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FAQs Coping With Your A-Fib 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.  I like my cardiologist, but he has not talked about me seeing an Electrophysiologist. Should I ask for a second opinion from another cardiologist?”
2. Is there any way to predict when I’m going to have an A-Fib attack?”
3. Should I exercise when in A-Fib or skip it and rest? Can I damage my heart if I exercise in A-Fib?”
4. How long do I have before I go 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. They want to do an Atrial Flutter-only ablation, will that help if I possibly have A-Fib as well?”
6.  Is smoking medical marijuana or using Marinol going to trigger or cause A-Fib? Will it help my A-Fib?
7.  “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.”
8. 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.   “How do I know which is the best A-Fib treatment option for me?”
10. When my husband has an Atrial Fibrillation episode, what can I do for him? How can I be supportive?”
11. How can I tell when I’m in A-Fib or just having something like indigestion?”
12.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?”
13. I’m an athlete with A-Fib and have a naturally slow heart rate. My doctor says I need a pacemaker because my heart rate is too slow.”
14. Can excess iron in the blood cause Atrial Fibrillation? How do I know? If I have Iron Overload Deficiency (IOD), what can I do about it?”
15. Can too little iron in the blood (Anemia) cause Atrial Fibrillation? What can I do about iron deficiency?”
16.Is it possible to have a single A-Fib attack and not have any others? I had a single episode of A-Fib and was successfully converted in the ER with meds.”
17. “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?”
18. 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.”
19. I’m in Chronic A-Fib. Can I improve my circulation, without having to undergo a Catheter Ablation or Surgery?”

20. “In one of your articles it said that having an ablation was better than living in A-Fib. I’ve been taking 75 mg of propafenone 3X/day for seven years and have only had 5 A-Fib attacks in 7 years. If your article means all types of A-Fib [including Paroxysmal], then I will consider an ablation.

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

22. 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?”

Last updated: Sunday, March 27, 2016
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FAQs Newly Diagnosed with A-Fib: First Attack

 FAQs Newly Diagnosed: First Attack

1. “My doctor says I had an attack of Atrial Fibrillation. How much trouble am I in? (It was around 11:00 pm I was getting ready to go to sleep when my heart started going crazy, like it was trying to jump out of my chest. I panicked and drove to an Emergency room. But by the time I got there, my heart was normal again.)

A-Fib is probably the most frightening of heart problems. We take our heart for granted until it starts beating wildly out of control. Unlike other heart problems which often build up over time, A-Fib can come on like a ton of bricks, seemingly out of nowhere. A-Fib is a real shock not only to our body but also to our mind.

But as bad as A-Fib feels, it is probably the least immediately threatening heart problem. All things considered, you’re not likely to die from an A-Fib attack.

In A-Fib, the upper parts of your heart (the atria) start beating on their own out of sync with the rest of your heart; your heartbeat is irregular and rapid.

The biggest danger of A-Fib is the increased risk of stroke, because your heart isn’t pumping out properly. But that risk of stroke can be lowered by medications or by insertion of a Watchman device. Over time A-Fib can lead to more serious heart problems (because the heart is stretched and weakened).

Also, A-Fib may lead to mental deterioration because the heart isn’t pumping properly to the brain. As troubling as A-Fib is, many people have learned to control their A-Fib (usually with antiarrhythmic medications). Others seek a cure through a Pulmonary Vein Ablation (Isolation) procedure or surgery.

The bottom line: your A-Fib can be cured and/or controlled. But don’t delay. A-Fib is a progressive disease, and overtime becomes harder to cure.

Learn as much as you can about Atrial Fibrillation, knowledge dispels fear. Suggested reading: Overview of Atrial Fibrillation.

Last updated: Tuesday, July 14, 2015

Go back to FAQ for the Newly Diagnosed A-Fib Patient

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