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


Treatments

VIDEO: What Should I Expect After the Atrial Fibrillation Ablation Procedure?

Atrial Fibrillation videos at A-Fib.comCardiac electrophysiologist Dr. Darryl Wells talks about judging success of your ablation, why it’s difficult to predict which patients will be completely cured after one ablation procedure and why some require two procedures, safety and the appropriate age range for patients to receive the ablation procedure. (3:17)

Published by Swedish Heart and Vascular Institute.

YouTube video playback controls: When watching this video, you have several playback options. The following controls are located in the lower right portion of the frame: Turn on closed captions, Settings (speed/quality), Watch on YouTube website, and Enlarge video to full frame. Click an icon to select.

If you find any errors on this page, email us. Y Last updated: Wednesday, July 18, 2018
Return to Instructional A-Fib Videos and Animations

VIDEO: The Hybrid Maze/Ablation for Atrial Fibrillation for Persistent A-Fib

For persistent or long-standing persistent atrial fibrillation, the Hybrid Maze/Ablation (also called the Hybrid Convergent Procedure) combines the complementary efforts of both the cardiothoracic surgeon and the cardiac electrophysiologist. The surgeon works on the outside the heart and the EP on the inside of the heart to eliminate the Atrial Fibrillation signals.

In this video, two cardiac EPs and a cardiothoracic surgeon describe the advantages, safety and effectiveness of the Hybrid approach and who is a good candidate. Includes animation and on-camera interviews.

Published by Tenet Heart & Vascular Network. Length 4:30. 

YouTube video playback controls: When watching this video, you have several playback options. The following controls are located in the lower right portion of the frame: Turn on closed captions, Settings (speed/quality), Watch on YouTube website, and Enlarge video to full frame. Click an icon to select.

If you find any errors on this page, email us. Y Last updated: Tuesday, July 17, 2018

Return to Instructional A-Fib Videos and Animations

Which Comes First: Sleep Apnea or Atrial Fibrillation?

Obstructive Sleep Apnea (OSA) affects about 100 million people worldwide with 85% of cases going undiagnosed.

Of Atrial Fibrillation patients, about 43% additionally suffer with Obstructive Sleep Apnea.

Could undiagnosed sleep apnea be linked to development of Atrial Fibrillation?

OSA Link to A-Fib

OSA is characterized by repetitive episodes of shallow or paused breathing during sleep that lead to a drop in blood oxygen level and disrupted sleep.

85% of Sleep Apnea cases go undiagnosed.

New research has found that patients with Sleep Apnea may be at greater risk of developing Atrial Fibrillation. Abnormal oxygen saturation level during sleep may be responsible.

Patients with OSA are more likely to have high blood pressure, or hypertension, which is a major risk factor for heart disease and other cardiovascular conditions.

Risk of New Onset A-Fib: The Clinical Cohort Study

Lead author Dr. Tetyana Kendzerska, Ph.D., of the University of Ottawa in Canada, and colleagues reviewed the records of 8,256 adults (average age 47) with suspected OSA. Individuals with any diagnosis of arrhythmias were excluded. Participants were followed for an average of 10 years. During that time, 173 developed A-Fib resulting in hospitalization.

Study Results

The reviewers found that the amount of sleep time spent with lower than normal oxygen saturation (below 90 percent) was a significant predictor of developing Atrial Fibrillation.

By contrast, the number of breathing pauses during each hour of sleep did not appear to affect A-Fib risk.

Study participants who developed A-Fib during the follow-up period were more likely to be older, current or former smokers, and have a high level of comorbidities (i.e., high blood pressure, or hypertension).

“The association between oxygen desaturation and A-Fib remains significant, suggesting that OSA can directly cause A-Fib.”

What This Means to Patients

In light of this study, a diagnosis of Atrial Fibrillation raises the question, ”Could my A-Fib have been brought on by undiagnosed Sleep Apnea?”

Sandy from Boston

Sandy from Boston and her doctor say ‘yes”. Updating her personal A-Fib story, she wrote:

“After my [successful] CryoBalloon ablation at BWH in 2014, I underwent a sleep study that revealed during REM sleep I stopped breathing an average of 32 times every hour. My physician suspected that my traumatic brain injury in 1995 caused my undiagnosed sleep apnea, which in turn caused Paroxysmal A-Fib. I have been using a CPAP ever since.”

Take Action: Sleep Apnea Can be Lethal: If you have untreated Sleep Apnea, you are at greater risk of having a more severe form of A-Fib or of not benefiting from an A-Fib treatment.

So many A-Fib patients also suffer from sleep apnea that many Electrophysiologists (EPs) routinely send their patients for a sleep apnea study.

Sleep apnea isn’t a minor health problem, and it’s a condition you can do something about. To learn more, see Sleep Apnea: When Snoring Can Be Lethal.

Resources for this article
Atrial Fibrillation and Sleep Apnea. Heart Rhythm Society. http://resources.hrsonline.org/pdf/patient/HRS_AF_SleepApnea_R3.pdf

What You Need to Know: Sleep apnea may increase atrial fibrillation risk. Brighsurf.com, May 22, 2017. https://www.brightsurf.com/news/article/052217429745/sleep-apnea-may-increase-atrial-fibrillation-risk.html

Kendzerska, T, et al. Sleep Apnea Increases the Risk of New Onset Atrial Fibrillation: A Clinical Cohort Study. American Thoracic Society. Public Release: 22-May-2017. https://www.eurekalert.org/pub_releases/2017-05/ats-sam051517.php

Whiteman, H. Obstructive sleep apnea might lead to irregular heartbeat. Medical News Today. May 23, 2017. https://www.medicalnewstoday.com/articles/317577.php

Wondering if you Should Consider a Cox Maze or Mini-Maze for your A-Fib?

What are your options when drugs aren’t working or you can’t tolerate them? When your symptoms are impacting your quality of life? And you want to cure your A-Fib not just manage it? Treatment options to consider include Catheter Ablation or Maze or Mini-Maze surgeries.

We’ve published a new FAQ question and answer about the Maze or Mini-Maze surgeries:

Surgical Maze pattern of series of lesions; used with permission Nature Publishing Group

Surgical Maze pattern of series of lesions

“When should A-Fib patients consider a full Cox Maze or a Mini-Maze surgery instead of a Catheter Ablation?”

In general, candidates for Maze or Mini-Maze surgeries are patients with significant, frequent A-Fib symptoms that do not respond to medication or catheter ablation. Patients who are unaware of their A-Fib symptoms are probably not candidates. However, each case is unique, so it’s best to discuss your options with your cardiologist.

There are several specific circumstances in which you might consider a Maze surgery…continue reading our answer…

Daniel Shares About A-Fib: “I Have Gotten a Lot of Bad Advice From Various GPs”

Advice from a patient now free from the burden of Atrial Fibrillation: Educate yourself on all treatment options before making decisions.

Daniel Doane, Sonora, California, talks about all the false info he got from doctors.

“Don’t believe your GP. I have gotten a lot of bad advice from various GPs.

Daniel D.

• ‘Just take a little digoxin and you will be fine.’
• ‘You are probably missing some micro-nutrient. If you buy this product I sell, it may well provide that and stop your A-Fib.’
• ‘I think that all of these tests your EP is requesting are just a waste of money.’
• (From a cardiologist) ‘Don’t worry about a little A-Fib. It won’t kill you.’ “

“If you have Atrial Fibrillation, see an electrophysiologist. If you aren’t comfortable with what they are saying, see another one.” 

Daniel did his research and is now A-Fib-free after a Totally Thoracoscopic (TT) Mini-Maze operation.

If you want to read more of Daniel Doane’s story, you’ll find it on pp. 152-162 in Beat Your A-Fib: The Essential Guide to Finding Your Cure by Steve S. Ryan, PhD. Learn more about my book.

Don’t Believe Everything You’re Told About A-Fib

In Daniel’s story you read how important it was for him to educate himself. You, too, can learn about all your treatment options. Check our Treatments section covering diagnostic tests, common mineral deficiencies, drug therapies, cardioversion, catheter ablations, surgery and more.

Next, read answers at FAQ: About A-Fib Treatments Options including natural therapies and holistic treatments.

In addition, you may want to browse our A-Fib Video Library and check our list of Online Discussion Groups.

Finally, ask yourself, ‘What are my treatment goals?”, then read our Q&A section: Decision About Treatment Options.

Remember: Always Aim for a Cure.

A Tale of Two Ablations and Why All EPs Are Not Equal

I just received an email and O.R. (Operating Room) reports from Louis who in 2014 had a successful catheter ablation by Dr. David Wilber at Loyola in Chicago. Dr. Wilber is nationally known for both his ablation skills and experience, as well as for his research.

First Ablation with Dr. David Wilber

Dr. Wilbur’s ablation of Louis was textbook. Louis’ A-Fib terminated during his ablation procedure, which is considered the ideal outcome.

But Dr. Wilber didn’t stop there.

Dr. Wilber didn’t stop there; he found A-Fib signals coming from the Superior Vena Cava (SVC).

He used isoproterenol (IV medication) to try to induce non-PV triggers and found A-Fib signals coming from the Superior Vena Cava (SVC). He isolated the SVC and could no longer induce any arrhythmias in Louis. (Some EPs would not work that hard, and would have trouble finding and ablating non-PV triggers.)

Relocation, Then Second Ablation―Failure!

But later Louis did develop A-Fib/Flutter again. He had relocated to a distant state so he selected a second EP and had a second ablation there. This ablation was a failure.

After touching up the right pulmonary veins (PVs), the second EP used adenosine and pacing to try to induce arrhythmia signals. He induced Flutter and isolated the right atrium by making a cavo-tricuspid isthmus line. He documented bidirectional block in the right atrium, but Louis still had Flutter.

The second EP didn’t map and track down the flutter.

Rather than map and track down the source of the Flutter, the EP simply Electrocardioverted Louis and stopped the ablation at that point. Then he put Louis on the dreaded antiarrhythmic drug amiodarone.

Still in Flutter―Amiodarone Side Effects

But after the second ablation, Louis still had A-Fib/Flutter.

On amiodarone, Louis developed the symptoms of loss of weight, thinning hair, extreme dry mouth, increased hand tremors, etc. Louis was taken off of amiodarone and is doing better. But he is still bothered by Flutter. See Amiodarone Effective but Toxic.

I’m working with Louis to get him to a “master” EP, a highly skilled EP with a high success rate with difficult A-Fib cases.

What Went Wrong with Louis’ Second Ablation?

From what can be deduced from Louis’ O.R. (Operating Room) report, there seems to be no mention of checking for entrance and exit block after ablating Louis’ pulmonary veins.

As a “crutch”, he put Louis on amiodarone, the most effective but also the most toxic of the antiarrhythmic drugs.

The second EP did use adenosine and pacing and induced a Flutter circuit. He ablated the right atrium and made a cavo-tricuspid isthmus line to make sure no Flutter came from the right atrium. But Louis still had Flutter.

Instead of using any of today’s advanced mapping and isolation strategies, Louis’ EP simply Electrocardioverted him to restore him to sinus. Then he stopped the ablation.

As a “crutch”, he put Louis on amiodarone, the most effective but also the most toxic of the antiarrhythmic drugs.

All EPs are Not Equal―It May Take Work to Find the Right EP

I’m sorry to say, the second EP Louis went to is indeed listed in our directory of EPs. He has all the proper credentials and is a member of the Heart Rhythm Society. But all EPs are obviously not equal. (See my editorial, Huge Growth in Number of EPs Doing Catheter Ablations, But All EPs Are Not Equal.)

Don’t just go to the EP whose office is near you. Go to the best, most experienced EP you can reasonably find. I know it’s a lot of effort. But you have to work at finding the right EP for you.

Do your due diligence. Seek recommendations from your General Practitioner (GP) and from other A-Fib patients (see our Resources/Bulletin Boards for a list of online discussion groups).

If you know nurses or support staff who work in the cardiology field or in Electrophysiology (EP) labs, they can be great resources.

Don’t rely on a single online source when researching and selecting doctors. Be cautious of all doctor informational listings you find on web sites (yes, including this one).

Be prepared to travel if that’s what it takes.

Learn How to Select Your EP

On our page Finding the Right Doctor for You and your A-Fib, we take you step-by-step to finding the right EP for you and your treatment goals.

FAQ Update: For stroke prevention—warfarin (Coumadin), an NOAC or aspirin?

We’ve updated our answer to the Frequently-Asked-Question (FAQ):

“For A-Fib patients, which is the better to A-Fib-related stroke—warfarin (Coumadin), an NOAC or aspirin?”

For decades, people more at risk for A-Fib-related stroke have been on warfarin (Coumadin). In the last few years, many of these patients have switched to the newer NOACs. A-Fib patients with low or no risk factors for stroke are often put on aspirin, or nothing at all.

Differences with the Same Goal

Aspirin is an antiplatelet drug that decreases the stickiness of circulating platelets (small blood cells that start the normal clotting process), so that they adhere to each other less and are less likely to form blood clots. (Cost: dirt cheap.)

Warfarin (brand name Coumadin) is an anticoagulant that works by slowing the production of blood clotting proteins made in the liver. Warfarin is highly effective, reducing the annual risk of stroke by approximately two thirds, but does require periodic lab tests to maintain the proper therapeutic level. (Cost: dirt cheap + lab tests.)

NOACs stands for Novel Oral AntiCoagulants. NOACs are alternatives for vitamin K antagonists (e.g., Warfarin). NOACs don’t require periodic blood testing as with warfarin. The clinical trials indicate NOACs work as well as warfarin. (Cost: Extremely expensive.)

 —Continue reading—for the rest of our answer along with a few takeawys.

FAQ: When to Consider the Maze/Mini-Maze Surgery for Atrial Fibrillation

FAQ: Maze Surgeries

“When should A-Fib patients consider a full Cox Maze or a Mini-Maze surgery instead of a Catheter Ablation?” 

Surgical Maze pattern of series of lesions; used with permission Nature Publishing Group

Surgical Maze pattern of series of lesions

There are several specific circumstances in which you might consider a Maze surgery:

• You are having other heart-related surgery. If you have to undergo open heart surgery for another heart problem, such as a Mitral Valve replacement, the Cox Maze operation can be performed concurrently with your other heart surgery.

• You don’t qualify for a catheter ablation. If you can’t take blood thinners, for example, you can’t have an ablation.

• You’ve already had a stroke. Or you are in danger of having a stroke during a catheter ablation.

• You’re morbidly obese. It’s more difficult to see a clear image of the heart with current imaging systems during a catheter ablation if someone is significantly overweight.

A word of caution—the Maze/Mini-Maze are surgical operations with the potential risks and complications of surgery.
Maze incisions

Typical Mini-Maze incisions for surgical ablation of A-Fib

Current Guidelines for the Management of Patients with A-Fib

Surgery isn’t recommended as a first choice by current A-Fib treatment guidelines. The Maze surgeries are more invasive, traumatic, risky and with longer (in hospital) recovery times.

In general, candidates for Maze or Mini-Maze surgeries, are patients with significant, frequent A-Fib symptoms that do not respond to medication or catheter ablation. Patients who are unaware of their A-Fib symptoms are probably not candidates.

However, each case is unique, so it’s best to discuss your options with your cardiologist.

Find the Right Doctor

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

Resource for this article
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology, Volume 64, Issue 21, December 2014. DOI: 10.1016/j.jacc.2014.03.021. http://www.onlinejacc.org/content/64/21/2246.

FAQ: I am considering closure of the LAA. What do I need to know?”

FAQ: Closure of the LAA

“I don’t want to be on a blood thinner for years and years. My doctor is talking about closure of the Left Atrial Appendage. What is an occlusion device?”

An occlusion device, like the FDA approved Watchman., is used to close off the Left Atrial Appendage (LAA), the source of most clots (90%-95%) and A-Fib-related strokes.

The Watchman is inserted in a very low risk procedure that takes as little as 20 minutes. Afterward, you would usually not need to be on a blood thinner (anticoagulant).

Closure of the LAA is often included in a Maze/Mini-Maze surgery and sometimes as part of a catheter ablation.

Side Effects: Closure of the LAA may compromise the ability of the Left Atrium to function fully. Serious athletes would probably miss the reduced blood flow from the left atrium. But most A-Fib patients would hardly notice.

Catheter positioning the Watchman occlusion device at the mouth of the Left Atrial Appendage

Catheter placing Watchman in LAA

Long-Term Effects: What are the long-term effects of leaving a mechanical device like the Watchman inside the heart? We know that, after a few months, heart tissue grows over the Watchman device so that the LAA is permanently closed off from the rest of the heart.

It seems unlikely that complications would develop after a long period of time (compared to long-term use of the blood thinner, warfarin). But we can’t say that for sure until enough time has passed. The first clinical trials installation of the Watchman device in the US was in 2009 and in Europe in 2004. So far, no long-term complications have developed.

Other Occlusion Devices: Besides the Watchman from Boston Scientific, other occlusion devices include the Amplatz Amulet from St. Jude Medical and the LAmbre from LifeTech Scientific.

EPs Installing the Watchman Device: To find EPs installing the Watchman or other occlusion devices, I highly recommend selecting an electrophysiologist (EP) who is certified in “Clinical Cardiac Electrophysiology”. For a list of EPs meeting this criteria, see Steve’s Lists of A-Fib Doctors by Specialty: Doctors Installing the Watchman.

Reference Articles: To learn more about the removal of the LAA, and the Watchman, see my articles, The Role of the Left Atrial Appendage (LAA) & Removal Issues and The Watchman™ Device: The Alternative to Blood Thinners.

Resource for this article
Holmes, Jr. DR et al. Left Atrial Appendage Closure as an Alternative to Warfarin for Stroke Prevention in Atrial Fibrillation. J Am Coll Cardiol. 2015;65(24):2614-2623. http://content.onlinejacc.org/article.aspx?articleid=2323039 doi: 10.1016/j.jacc.2015.04.025

FAQs A-Fib Drug Therapy: Natural Blood Thinners

 FAQs A-Fib Drug Therapy: Natural Blood Thinners

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

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

There are a number of foods and supplements that are known to thin the blood. These include foods with high amounts of aspirin-like substances called salicylates, omega-3 fatty acids, vitamin E supplements, and foods with natural antibiotic properties.

Healthy adults can greatly reduce the risk of blood clots and cardiovascular disease by modifying their lifestyle and adding nutritional supplements proven to support cardiovascular health. But this site is not recommending or advising that people switch from prescription anticoagulants to natural blood thinners.

No Studies that ‘Natural’ is as Effective as Warfarin

As of yet, there aren’t any double blind studies which demonstrate any natural alternative (or combination) is as effective against stroke as warfarin (Coumadin) or the new NOACs.

Certain foods and supplements may be “natural” and thin the blood, but there’s little research on their effectiveness to prevent clots in those at high-risk for stroke, such as A-Fib patients.

What’s more, there isn’t a way to track their effectiveness in the same way doctors can monitor the action of warfarin through routine blood tests.

If considering a switch to natural blood thinners, do not stop taking your anticoagulation medication. Talk to your doctor first.

Patients with Lone Atrial Fibrillation

Natural blood thinners may be considered for patients with “lone” Atrial Fibrillation, that is, patients who have had A-Fib occur only once or twice, are young, and have an otherwise healthy heart (normal size, no enlarged chambers or leaky valves, not otherwise prone to blood clots or other heart risk factors like diabetes, etc.). These low-risk patients may be candidates for natural alternatives to warfarin (Coumadin). (Historically, these patients may have been put on aspirin.)

If considering a switch to natural blood thinners, do not stop taking your anticoagulation medication. Talk to your doctor first. (But realize that your doctor isn’t likely to tell you to stop taking your warfarin or NOAC prescription.)

Seek Holistic-Minded Practitioners

Instead, you may want to seek out doctors who are holistically-minded and have knowledge of natural medicines; for example, a doctor who practices complementary or integrative medicine or a naturopathic physician. They can partner with you to pursue natural alternatives to prescription medicines. For a listing of such doctors in your area, go to http://www.ACAM.org.

For example, on his website, the Integrative Cardiologist and anti-aging specialist Dr. Stephen Sinatra discusses combating blood clots with this regimen of natural blood thinners:

•  Fish oil (2–3 grams daily)
•  Garlic (1–2 grams daily in capsule form)
•  Nattokinase (100 mg daily)
•  Vitamin E as mixed tocopherols (200–300 IU daily)
•  Bromelain, an enzyme derived from pineapple (600 mg daily)

For additional advice on natural ways to prevent blood clots, visit www.drsinatra.com.

Talk to Your Doctor: Supplements Can Interfere with Coagulation

Always talk to your doctor before adding any supplements to your treatment plan. Some ‘natural’ supplements may interact with your prescription meds (when taken alone or in combination) or interfere with coagulation and increase your bleeding risk.

References for this article
Sinatra, S. The Most Common Blood Thinners. DrSinatra.com website. Last accessed Nov 28, 2014. URL: http://www.drsinatra.com/the-most-common-blood-thinners

Stanger MJ, et al. Anticoagulant activity of select dietary supplements. Nutr Rev. 2012 Feb;70(2):107-17. doi: 10.1111/j.1753-4887.2011.00444.x. http://www.ncbi.nlm.nih.gov/pubmed/22300597

Return to FAQ Drug Therapies
Last updated: Monday, June 18, 2018

Does Size Matter? What’s the Size of Your Left Atrium?

When in A-Fib, your left atrium has to work harder than normal and tends to stretch and dilate over time. Thus, an enlarged heart, specifically your left atrium, can be one symptom of living with Atrial Fibrillation.

Other contributors to an enlarged left atrium are obstructive sleep apnea (OSA) and high blood pressure. Also, people with a naturally large or tall body size often have an enlarged left atrium (ELA).

Consequences of an Enlarged Left Atrium

One study showed that Persistent A-Fib was associated with left atrium size (but not the number of years that a patient had A-Fib).

Left atrium size is a predictor of mortality due to cardiovascular issues.

Left atrium size has been found to be a predictor of mortality due to both cardiovascular issues as well as all-cause mortality (although other factors may contribute).

As a result, some medical centers won’t do a Pulmonary Vein Ablation (Isolation) procedure if the left atrium is enlarged (over 5.5 cm). However, with the newer ablation techniques, other centers will. Surgeons also are reluctant to operate on someone with an enlarged heart.

Normal left atrium: 2.0-4.0 cm

Left Atrium Size: Normal vs Enlarged

An enlarged left atrium can be diagnosed and measured using an echocardiogram (ECHO). A normal left atrium measures around 2.0-4.0 cm (20 mm–40 mm).

Ranges: Left atrial enlargement can be mild, moderate or severe depending on the extent of the underlying condition.

Note: Measurement of the volume is preferred over a single linear dimension since enlargement can be different for different directions.

Why You Need to Know Your Measurement

If you’ve had A-Fib for a while with significant symptoms, we often advise you to ask your doctor for this measurement to see if your left atrium is being enlarged.

To rank the size of your atrium, see TABLELeft Atrial Size
It will be described in either centimeters (i.e., 2.0 cm) or millimeters (i.e., 20 mm).

Store this info with your other A-Fib test results and other papers in your A-Fib Binder or folder. This will be your benchmark for future comparison.

To rank the size of your atrium, go to TABLE: Indexing the Left Atrial Size

Resources for this article
• Margolese, R G, et al. Cancer Medicine (e.5 ed.). Hamilton, Ontario: B.C. Decker. ISBN 1-55009-113-1. Retrieved 27 January 2011.

• Allen NE, et al. (March 2009). “Moderate alcohol intake and cancer incidence in women”. Journal of the National Cancer Institute. 101 (5): 296–305. doi:10.1093/jnci/djn514.

• Lang RM, et al. “Recommendations for chamber quantification”. European Journal of Echocardiography. (2006) 7 (2): 79–108.  PMID 16458610. doi:10.1016/j.euje.2005.12.014. Retrieved 2012-08-26.

• Left atrial enlargement. Wikipedia, the free encyclopedia. Last edited 20 March 2018, https://en.wikipedia.org/wiki/Left_atrial_enlargement

FAQ: “Which is the better to prevent A-Fib-related stroke—warfarin (Coumadin), a NOAC or aspirin?

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

FAQs A-Fib Drug Therapy: Stroke Prevention

“For A-Fib patients, which is the better to prevent A-Fib-related stroke—warfarin (Coumadin), a NOAC or aspirin?”

Updated: June 2018. For decades, patients more at risk for A-Fib-related stroke have been on warfarin (Coumadin). In the last few years, many of these patients have switched to the newer NOACs. A-Fib patients with low or no risk factors for stroke are often put on aspirin, or nothing at all.

Differences with the Same Goal

Aspirin is an antiplatelet drug that decreases the stickiness of circulating platelets (small blood cells that start the normal clotting process), so that they adhere to each other less and are less likely to form blood clots. (Cost: dirt cheap.)

Warfarin (brand name Coumadin) is an anticoagulant that works by slowing the production of blood clotting proteins made in the liver. Warfarin is highly effective, reducing the annual risk of stroke by approximately two thirds, but does require periodic lab tests to maintain the proper therapeutic level. (Cost: dirt cheap + lab tests.)

NOACs stands for Novel Oral AntiCoagulants. NOACs are alternatives for vitamin K antagonists (e.g., Warfarin). NOACs don’t require periodic blood testing as with warfarin. The clinical trials indicate NOACs work as well as warfarin. (Cost: Very expensive.)

Takeaways

The FDA approved the NOACs without any recognized method of determining their clot preventing effectiveness (as with warfarin, i.e. INR).

Warfarin has been successfully used for stroke prevention in A-Fib patients at high or intermediate risk for stroke. It’s readily available and inexpensive.

Aspirin is no longer recommended as first-line therapy for Atrial Fibrillation patients according to the 2014 AHA/ACC/HRS Treatment Guidelines for Atrial Fibrillation. And has been downgraded to a class 2B drug.

Microbleeds: We obviously don’t have any data on the long-term effects of taking NOACs for years. Some people on long-term warfarin have been known to develop micro bleeds and dementia. Will this happen with the NOACs? We simply don’t know. But intuitively one would expect the same thing to happen, though probably not to the extent of warfarin.

Weighing the various risk/benefit ratios is a decision for you and your doctor. And should be re-evaluated as you grow older.

Return to FAQ Drug Therapies
Last updated: Monday, June 18, 2018

FAQ: Are Anticoagulants and Blood Thinners the Same Thing? How do they Work?

Drug Therapies for Atrial Fibrillation, A-Fib, AfibFAQs A-Fib Drug Therapy: Warfarin 

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

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

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

Anticoagulant Warfarin chemical diagram

Anticoagulant Warfarin

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

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

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

Antiplatelet Aspirin

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

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

Final answer: An anticoagulant doesn’t really thin the blood or make it less viscous, but it does help prevent a stroke like blood thinners do.

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

Return to FAQ Drug Therapies
Last updated: Tuesday, June 19, 2018

FAQs: Normal or Enlarged Left Atrium—What does it Mean?

FAQs Understanding Your A-Fib A-Fib.comFAQs Understanding A-Fib: Enlarged Left Atrium

“How do I know if I have an enlarged left atrium and what does it mean, if it is? What is the size of a normal left atrium? 

When in A-Fib, your left atrium has to work harder than normal and tends to stretch and dilate over time. Obstructive sleep apnea (OSA) and high blood pressure can also contribute to an enlarged left atrium.

Consequences of an Enlarged Left Atrium: One study showed that Persistent A-Fib was associated with left atrium size (but not the number of years that a patient had A-Fib).

Left atrium size has been found to be a predictor of mortality due to both cardiovascular issues as well as all-cause mortality (although other factors may contribute).

As a result, some medical centers won’t do a Pulmonary Vein Ablation (Isolation) procedure if the left atrium is enlarged (over 5.5 cm). However, with the newer ablation techniques, other centers will. Surgeons also are reluctant to operate on someone with an enlarged heart.

Why You Need to Know Your Measurement: If you’ve had A-Fib for a while with significant symptoms, we often advise you to ask your doctor for this measurement to see if your left atrium is enlarged. This will be your benchmark for future comparison. It will be described in either centimeters (i.e., 2.0 cm) or millimeters (i.e., 20 mm).

Store this info with your other A-Fib test results and other papers in your A-Fib Binder or folder. Use the table below to rank the size of your atrium. (Reference note: 1 cm = 10 mm) Indexing the Left Atrial Size:

Women
Left Atrium Normal Enlarged
 mild  moderate severe
Diameter  (mm) 27–38 39–42 43–46 ≥ 47
Volume  (ml) 22–52 53–62 63–72 ≥73
Volume/BSA*  16–28 29–33 34–39 ≥ 40
Men
Left Atrium Normal Enlarged
 mild   moderate severe
Diameter  (mm) 30–40 41–46 47–52 ≥52
Volume  (ml) 18–58 59–68 69–78 ≥79
Volume/BSA* 16–28 29–33 34–39 ≥40

Note: Indexing the left atrial volume to body surface area* (BSA) is recommended by the American Society of Echocardiography and the European Association of Echocardiography. * BSA=body surface area.

Resources for this article
• Margolese, R G, et al. Cancer Medicine (e.5 ed.). Hamilton, Ontario: B.C. Decker. ISBN 1-55009-113-1. Retrieved 27 January 2011.

• Allen NE, et al. (March 2009). “Moderate alcohol intake and cancer incidence in women”. Journal of the National Cancer Institute. 101 (5): 296–305. doi:10.1093/jnci/djn514.

• Lang RM, et al. “Recommendations for chamber quantification”. European Journal of Echocardiography. (2006) 7 (2): 79–108.  PMID 16458610. doi:10.1016/j.euje.2005.12.014. Retrieved 2012-08-26.

• Left atrial enlargement. Wikipedia, the free encyclopedia. Last edited 20 March 2018, https://en.wikipedia.org/wiki/Left_atrial_enlargement

Back to FAQs: Understanding A-Fib 
Last updated: June 18, 2018

Catheter Ablation vs Surgery For A-Fib: Finally an Apples-to-Apples Comparison

Update July 27, 2018 Which is better from a patient’s perspective―Catheter Ablation or Surgery (Mini-Maze)? A new study compares the two head-to-head.

An article in Cardiac Rhythm News (no author), describes the SCALAF trial (Surgical vs. Catheter Ablation of paroxysmal and early persistent Atrial Fibrillation).

SCALAF Trial Design

The SCALAF study is the first randomized control trial of patients with symptomatic A-Fib. In a 1:1 ratio, 52 patients received either a catheter ablation or surgery as their first invasive procedure. Follow-up data in all patients was collected for 2 years using implantable loop recorders (Medtronic Reveal XT).

The measurement of success was freedom from A-Fib (atrial tachyarrhythmia) and off antiarrhythmic drugs with safety measured by procedure-related complications.

PV Isolation Direct Comparison: The catheter ablation arm only isolated the PVs without additional lesion sets. The surgical arm (Mini-Maze) only isolated the PVs (and removed the left atrial appendage).

Trial Results

Efficacy: Catheter ablation vs. surgical patients (60% vs. 27%) were free from A-Fib without drugs.

Efficacy: After 2 years, a significantly greater number of catheter ablation patients (60%) were free from A-Fib without having to take A-Fib drugs compared to a much smaller number of surgical patients (27%).

Safety: Surgery patients had a higher procedure-related complication rate (34.8% vs. 11.1%) and a higher rate of major complications (22% vs. 0.0%) compared to catheter ablation patients. That’s about 1-in-4 surgical patients who had significant complications.

Safety: Surgery patients had a higher procedure-related complication rate (34.8% vs. 11.1%).

Hospital Stay: Hospitalization was longer for surgical patients with an average hospital stay of nine (6–10) days compared to three (2–3) days for catheter ablation.

Trial Conclusions

The investigators concluded that catheter ablation of the PVs in the treatment of paroxysmal and early persistent A-Fib is safer and results in higher long-term arrhythmia free survival compared to surgical (Mini-Maze) PV isolation. Follow-up with continuous monitoring using implantable loop recorders was important for true and accurate outcomes.

What Patients Need to Know

Don’t Make Surgery Your First Choice: Following the 2014 Guidelines for the Management of Patients with Atrial Fibrillation, your first treatment option should not be surgery (Mini-Maze).

Catheter Ablation Higher Success and Safer: Though this was a small study, this trial showed that catheter ablation is safer with better long-term freedom from A-Fib (and without medication) when compared head-to-head with surgical Mini-Maze. Follow-up monitoring of each patient with an implantable loop recorder (for 24/7, 365 days for two years) produced unbiased, non-disputable results.

The 2011 FAST Trial: The SCALAF trial results might be compared to the 2011 FAST Trial sponsored by AtriCure, Inc. The FAST trial compared AtriCure’s own system for Mini-Maze surgery to catheter ablation. The results favoring surgery don’t hold up under close scrutiny. More important was the high complication rate of the surgical approach. For more, see Surgical Versus Catheter Ablation―Flawed Study.

SCALAF: Catheter ablation is safer with better long-term freedom from A-Fib (and without medication) when compared head-to-head with surgical Mini-Maze.
 The Bottom Line: We now have an unbiased clinical trial comparing catheter ablation with surgery.

According to the SCAFAL trial, catheter ablation has higher success for long-term freedom from A-Fib than the surgery approach. Just as important, data from both FAST and SCAFAL demonstrate that catheter ablation is much safer than surgery.

Update July 27, 2018: In response to this post about the SCAFAL trial, we received this statement from surgeon Dr. John H. Sirak who performs the “5 box surgery” for A-Fib. Especially relevant is his statement that surgical PVI alone tends to produce Flutter. (The FAST study did compare more complex surgeries to catheter ablation.)

“I must be direct and say this study is next to worthless. First, it isn’t clear how the cohorts compare in terms of AF chronicity. Surgical PVI should at least be no worse than percutaneous. PVI is the most foolproof step of a surgical maze. If the randomization were truly accurate, why was the surgical arm so much smaller? My suspicion is that the surgical arm had a significantly higher number of non-paroxysmal patients. And who were the orangutans operating with a 35% complication rate? Along the same lines, since surgical PVI alone is now widely known to be fluttergenic and thus contraindicated, no reputable surgeon would offer a patient such an outdated operation! This study is not only pathetically executed, but also has no relevance to current standard-of-care practice.” 
Resources for this article
• Surgical treatment of atrial fibrillation results in higher complication rates when compared to catheter ablation. Cardiac Rhythm News (no author). May 18, 2018, Issue 41, p. 9.

• Surgical or Catheter Ablation of Lone Atrial Fibrillation (AF) Patients (SCALAF). ClinicalTrials.gov Identifier: NCT00703157. Sponsor: Medtronic Bakken Research Center Note: Principal Investigators are NOT employed by the organization sponsoring the study. https://clinicaltrials.gov/ct2/show/results/NCT00703157.

• AHA/ACC/HRS 2014 Guideline for the Management of Patients With Atrial Fibrillation. Circulation. published online March 28, 2014, 4.2.1. Antiplatelet Agents, p 29.doi: 10.1161/CIR.0000000000000041 Last accessed Nov 23, 2014.URL: From http://content.onlinejacc.org/article.aspx?articleid=1854230

For Your A-Fib—Try Magnesium Oil to Raise Your Level

A deficiency in the mineral Magnesium is central to creating conditions in the heart that cause Atrial Fibrillation. Therefore, anyone in A-Fib is almost certainly Magnesium deficient. (See our recent post, Got A-Fib? You’re Almost Certainly Magnesium Deficient.)

Tips for Increasing Absorption of Magnesium

One of the easiest ways to increase your level of Magnesium is by applying topical Magnesium Oil. One benefit is it doesn’t cause loose bowels or diarrhea like oral tablets can. And it’s handy. It comes in a spray bottle.

We ran across this advice on the website of LL’s Magnetic Clay, the company that makes Ancient Minerals Magnesium Oil ($18). To increase absorption of magnesium oil through the skin:

• Increase the area of application
• Increase the amount of time the application is left on the skin (at least 20 min.)
• Increase the frequency of application
• Varying the location of application, with areas such as the scalp and armpits exhibiting higher rates of absorption
• Increasing temperature of the area of application
• Applying to well-hydrated skin

Practical Use of Magnesium Oil

This advice comes from Patti, who prefers Magnesium Oil to oral tablets. She uses it for muscle twitching. When that happens, she starts her nightly application routine. She uses four sprays of Life-Flo Pure Magnesium Oil ($10) on each lower leg and massages it in. This ensures a large area for absorption.

A total of eight sprays is equal to about 100 mg of topical magnesium. You can wipe off in 20 minutes, but she just showers it off in the morning. (She continues this for 6 weeks or more to rebuild her magnesium levels). A 8 oz. bottle lasts 3–6 months.

To read more about the importance of Magnesium to A-Fib patients, go to our pages:

  Mineral Deficiencies
  ‘Natural’ Supplements for a Healthy Heart.
  My Top 5 Picks: When You’re Deficient in Magnesium & Potassium

MESA Preliminary Research―Depression Linked to A-Fib

Updated 12:30 pm About 20% of U.S. adults report depressive symptoms. A new study reports those adults may be at higher risk for developing atrial fibrillation. That’s according to a new observational study from the U.S. Multi-Ethnic Study of Atherosclerosis (MESA).

The MESA Study

P.K Garg, MD

Dr. Parveen Garg of the Keck School of Medicine, University of Southern California, described his preliminary research findings at a Scientific Session at the Epidemiology and Prevention/Lifestyle and Cardiometabolic Health in March 2018.

The analysis included 6,644 adults (mean age, 62; 53% women, 38% white, 28% black, 22% Hispanic, 12% Chinese-American) with no known heart disease at baseline who were followed for a median of 13 years as part of the MESA study.

Clinically depressed patients had a 34% higher risk of developing A-Fib during follow-up. Similarly, individuals taking anti-depressants had a 36% increased risk of developing A-Fib compared to those not taking those drugs.

What is the Link Between Depression & A-Fib?

G. Tomaselli MD

Dr. Gordon Tomaselli, a spokesman for the American Heart Association, said this study “affirms the association between depression and atrial fibrillation in a population that I think is important because it’s a mixed population and not just the standard Caucasian population.”

Speaking of a possible link, Dr. Tomaselli continued: “We don’t know whether treatment of depression will reduce the incidence of atrial fibrillation. There is some reason to think that it might, but there are other reasons to think that anti-depressant drugs actually have some effects on the heart, the ion channels that determine the rhythm of the heart.”

Dr. Garg could only speculate on the possible link between depression and A-Fib. But he stressed how important it might be to treat people with depression to reduce their risk of developing A-Fib.

The study, “Depressive Symptoms and Risk of Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis,” was presented at the American Heart Association’s Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions March 27, 2018.

What Patients Need to Know

Depression an Illness That Triggers A-Fib? Should depression be added to the list of causes, triggers, illnesses, or comorbidities which may lead to A-Fib? In addition to sleep apnea, obesity, diabetes, and hypertension, we should probably add depression, according to this study. Depressed people have a 34% higher risk of developing A-Fib.
Anti-depressant Drugs May Trigger A-Fib: But the drugs used to combat depression may be the reason people develop A-Fib in the first place. In this study, people taking antidepressants had a 36% increased risk of having A-Fib.
For people with depression, this study raises more questions than answers.
It’s obviously important to treat people with depression to reduce their risk of developing A-Fib. But at the same time, we have to be very careful with the drugs used to combat depression. Do anti-depressants bring on or trigger A-Fib? Much more research needs to be done to answer this question.
Resources for this article
Brooks, Megan. Depression Linked to Increased Risk of Developing Atrial Fibrillation. Managed Health Care. March 27, 2018. https://www.managedhealthcareconnect.com/content/depression-linked-increased-risk-developing-atrial-fibrillation

Gingerich, CP. Depression Increases Risk of Common Arrhythmia. MD Magazine, March 22, 2018. http://www.mdmag.com/medical-news/depression-increases-risk-of-common-arrhythmia

Good News for A-Fib Patients!―FDA Approves Reversal Agent for the NOACs Xarelto and Eliquis

Background: One of the problems for Atrial Fibrillation patients taking anticoagulants is the risk of life threatening or uncontrolled bleeding, particularly if one is injured. Since the introduction of the NOAC anticoagulants, there’s been an increase of hospital admissions and deaths related to bleeding, one of the major complications of anticoagulation.
In the U.S. alone in 2016, there were about 117,000 hospital admissions attributed to factor Xa inhibitor-related bleeding and nearly 2,000 bleeding-related deaths per month. An estimated 4 million people are taking factor Xa inhibitors.

Anticoagulant Reversal Agents

Up to now, only the anticoagulants Pradaxa (dabigatran) and Coumadin (warfarin) had a reversal agent or antidote.

As an example, if you were taking Pradaxa and were injured in an auto accident, doctors in the ER could administer ‘Praxbind’ (idarucizumab), the Pradaxa reversal agent, to stop any uncontrolled bleeding and (probably) save your life.

Many patients with Atrial Fibrillation were put on Pradaxa rather than Xarelto and Eliquis because Pradaxa has had a reversal agent since 2015.

Andexxa: Antidote for Xarelto and Eliquis

Now both Xarelto (rivaroxaban) and Eliquis (apixaban) have the FDA-approved reversal agent Andexxa (Portola Pharmaceuticals) as of May 7, 2018. It probably won’t be available till early June.

Andexxa rapidly and significantly reverses ‘anti-factor Xa’ activity which is the anticoagulant mechanism of both Xarelto and Eliquis.

Should you Switch From Pradaxa?

If you are taking Pradaxa, you may want to discuss with your doctor whether you should switch to another NOAC. (Note: Eliquis tested the best and is the safest of the new anticoagulants. See my article: Pradaxa and the Other New Anticoagulants.)

Are you tolerating Pradaxa well ? Nearly two out of five people (35%) couldn’t― that’s a high rate of adverse reactions. A large number of patients on the 150mg dose of Pradaxa had an increased incidence of gastrointestinal adverse reactions (35%/yr) compared to warfarin (24%/yr). For more see my article: The New Anticoagulants.

Pradaxa’s own fact sheet states common side effects of Pradaxa include:

• Indigestion, Upset Stomach, or Burning
• Stomach Pain

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

Even if you seem to tolerate Pradaxa well, it may cause permanent GI damage over time.

Anticoagulants are Still Considered High Risk Drugs

FAQs A-Fib afibEven though Xarelto and Eliquis join Pradaxa with an antidote reversal agent, they are all still considered high-risk drugs.

Taking an anticoagulant is not like taking a multi-vitamin.

Anticoagulants work by causing or increasing bleeding. Though they are certainly better than having an A-Fib stroke, they carry their own risks. Read more: Bleeding Risk of Anticoagulants.

Resource for this article
Wending, P. FDA Approves First Factor Xa Inhibitor Antidote, Andexxa. Medscape Medical Nrews, May 4, 2018. https://www.medscape.com/viewarticle/896182

PODCAST: Marijuana—Good, Bad or Ugly for Patients with Atrial Fibrillation?

Click to open in new window

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

Podcast Introduction 

Our friend, Travis Van Slooten is publisher of LivingWithAtrialFibrillation.com. With marijuana legal in a growing number of U.S. states, he invited Steve to join him on his podcast and share the latest about marijuana use by A-Fib patients. (About 18 min. in length.)

Here are the highlights of this podcast:

We do not have a lot of clinical data on marijuana and atrial fibrillation simply because it’s so new. What we know is often anecdotal at this point.
Some A-Fib patients say it helps them. Others say it puts them into A-Fib.
There has been some research saying that smoking marijuana might lead to the development of A-Fib and it may affect the cardiovascular system, but this is general data without a whole lot of really hard studies confirming that.
If there is any benefit of marijuana for A-Fib, the best form is probably CBD in edible form (but we really don’t know for sure).
An unpublished study followed 6 million heart failure patients. Those in the group that were non-dependent on marijuana were 18% less likely to develop A-Fib. Dependent marijuana users were 31% less likely to experience A-Fib.

Resources mentioned in this episode

States Where Marijuana is Legal
FAQs Coping with A-Fib: Marijuana


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

Transcript: Marijuana and Atrial Fibrillation

Marijuana and Atrial Fibrillation

Into: The host of this podcast is not a medical doctor. The information provided is not intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician prior to starting any new treatment or with any questions you have regarding a medical condition. Now on to the show. Welcome to the Afib podcast, where we provide information, inspiration, and support for afibbers. And now your host, Travis Van Slooten.

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

In this episode Steve and I discussed the topic of marijuana use and atrial fibrillation. We discuss recreational pot smoking versus medical marijuana and how many marijuana may or may not be beneficial for people with afib. So without further ado, let’s roll the tape.

All right, Steve, so I want to talk to you about something that it was a very interesting topic that I honestly had not thought about before. I got an email from one of my readers who wanted to know if it was safe to smoke marijuana while they had afib. First I thought this has got to be some kind of a joke because I honestly had never thought about this before, but it makes sense, you know, recreational marijuana is definitely becoming a morbid thing, it’s currently legal in nine states, and medical marijuana use is legal in 29 States.

Recent poll shows that 64% of Americans support the legalization of marijuana. So this is going to be become – if it hasn’t already – become a more kind of important topic. And then ironically, a week later I got another email from someone that had the same question, so I’m like, “Wow, this is really kind of a big deal.”

So I found an article on your site, Steve, that you just recently wrote about this very topic, marijuana use and afib. And in that article you had discussed a little bit about the differences of recreational marijuana and the prescription form of marijuana which is called marinol, and you kind of discussed that there was some key differences between these two. So what are the differences between the two? .

Steve Ryan: Travis, I apologize that we do not have a lot of clinical data on this subject simply because it’s so new and the answers I give aren’t going to be definitive, but we’re doing the best we can with the information that we have. The marinol is the prescription form of cannabis, and the makers of it have a blanket disclaimer saying “Don’t use this with any kind of heart problem…” you know, it’s kind of legal thing. They haven’t done any clinical studies on this subject to say that but they’re just protecting themselves. There have been some research saying that smoking marijuana might lead to the development of afib and it may affect the cardiovascular system, but this is general data without a whole lot of really hard studies indicating that.

Now, what I’ve done on our website is – since I don’t know enough about it to really give a definitive answer –  I have asked people to tell me their experiences and they vary all across the board. Some say that this is the best thing I’ve ever taken, some people say as soon as I start smoking marijuana I get afib. Now, the reason for that might be the different in the pot they’re smoking or the edibles they’re taking. THC is a component found in the marijuana plant stavia. That’s what makes you feel high.There is a CBD is a component found in the marijuana plant indica. That works better to reduce pain and anxiety and induce sleep. Now the problem is the manufacturers of pot – every state has their own little companies, and some produce CBD and a tincture and an oil, in edibles; but some just mix it all together and it’s really hard depending on the state to find something that is just CBD that you can use to get rid of anxiety and get to sleep, that kind of thing.

Now what is the best product for afib patients? Probably CBD in edible form. Smoking marijuana unfortunately produces a lot of problem just like smoking does because there are a lot of bad things in the cigarette smoke as there is in the marijuana smoke. So people tend to want to use marijuana for medical purposes, they’re probably better off using an edible form with more CBD and THC. Does that make any sense?

Travis Van Slooten: Yeah, absolutely. I mean looking at again that article you wrote and I’ll link to it here to in the show notes so people can reference it. If they have experience smoking marijuana or taking it medically, they can surely reach out to you and share their experience with it. But as I look at your article you do have some anecdotal stories there, and it doesn’t seem that the few that are there that I’ve had that experiences with it were people smoking it. And one of the gentleman that wrote, a guy named Jim, said that it was like a life savior for him, but again, he was taking the medical prescription form of it, so that seems to back up kind of what we’re talking here.

Steve Ryan: Yeah. He has a great statement. He’s the guy who is very under a lot of stress, he has his own business. He comes home at night and his brain was throbbing on a mile a minute and he couldn’t get to sleep. So he use marijuana edibles and the stress goes right away and he seems to sleep very well at night. Just to be honest with you, I’m also some kind of like him. I’m very wound, very tight.

Travis Van Slooten: You’re a Type A?

Steve Ryan: I tend to think of all of the things about afib. I’m thinking about, you know… And to tell you the truth, I take edible marijuana and it gets me really relaxed and I go right to sleep.

Travis Van Slooten: Let’s talk about— for people that aren’t familiar with medical marijuana, I am one of those, by the way, I know nothing about this stuff which is why I find it so fascinating, but when we talk edibles, like, what is it? Is it literally like a brownie, a piece of cake? Is it like a gum? I mean what is it? When you say edible, what is it?

Steve Ryan: There are a lot of different products, and unfortunately every state has their own different companies. We don’t have companies that are nation-wide to put out a standard product, but a lot of them are like a brownie that comes in a package like a cookie. It comes in like 100 mg and you cut it into 10 mg slices. To me that’s a pain, but a lot of people use that. Another way is they have product like this one product is blueberry based. They make the marijuana in with blueberries and you just take one, and one is 5 mg and I usually take two at night. Other forms, let see, brownies.

Travis Van Slooten: Now you mentioned and oil-based, a tincture base…

Steve Ryan: What?

Travis Van Slooten: You mentioned a tincture based. That isn’t edible but that’s a different form.

Steve Ryan: Yeah, the way they do with that is they develop a tincture with CBD in an oil, and you put it on your body and let it absorb into your body, and that’s another… I’ve never tried that. I have no idea how well that works or how good it is.

Travis Van Slooten: And that tincture that isn’t something you… You don’t put it in your mouth; you put it on your skin.

Steve Ryan: Yeah, you put it on your skin. But again, I am not an expert in this field and we’re just doing the best we can with little knowledge that we have, and I beg all the listeners to be aware that this is not something that is definitive and written in stone and this is the way to go. Everything I say may completely change when we get more information on medical marijuana.

Travis Van Slooten: Yeah, absolutely. Like you said, I think it’s just starting to explode right now. Do you know, are there any studies underway right now? Do you know of any?

Steve Ryan: Well, there was a really interesting study that just came out where they studied patients with heart failure. And what they found was that– first of all, patients with heart failure are really in deep doo-doo, we’re talking like an ejection fraction of like low or below 35% normally is 50 to 75. These patients, if they have really serious heart failure it’s like they’re suffocating to death. It’s a terrible way to go if you’re ill and you have congestive heart failure, you just feel terrible from what I understand. I’ve never had it. So what they did was they followed 6 million in US hospitals with heart failure. About 1200 used and depended on marijuana. About 2300 used marijuana, but were not depended on it. So the non-dependent marijuana users were 18% less likely to develop afib. And the dependent users were 31% less likely to experience afib.

Now what that means is that marijuana prevented these patients who had heart failure from developing afib. Now, why is that important? Basically a combination of heart failure and afib is a killer. One is bad, two together like that is much worse. These people are much more apt to die, and marijuana basically prevented these people from developing afib even though they had heart failure. This is really big news because sure, now we’re applying it to heart failure, but what about normal people, would marijuana prevent them from developing afib? We don’t know. But the study indicate that. In study would say definitely that anyone who has heart failure should consider marijuana use in some form because it does seem to prevent them from going into a atrial fibrillation. Now can we go further and say everybody should smoke marijuana to prevent them from developing afib? No, we can’t say that.

Travis Van Slooten: Yeah, absolutely. And the other thing is I suppose we don’t have the details of the study either like what form they were taking, how much they were taking every day. We don’t have that information, do we, from that study? I mean you might not have it on hand, but…

Steve Ryan: I don’t have it on hand but there would probably be some indication of that, and I’d have to look that up and maybe get back to you. Those are some good questions. But you know, in general they usually do these things it’s usually 10 mg a day. That’s a general rule of thumb. But again, I don’t really know the specifics. But people who are dependent, those are probably smokers, and they were probably doing much more smoking of pot than the other group. That worked for them and prevented them from developing afib more so than the other people.

Travis Van Slooten: Now, did that study say they were pot smokers or they were taking the medical prescription form of marijuana? Because we talked earlier that smoking was probably not the good form or as the medicals…

Steve Ryan: Since this is done between 2007 and 2014 we can assume they were smokers.

Travis Van Slooten: And that to me is kind of promising because it’s saying — of course, that leads to more questions, right? Because what’s more effective, the recreational smoking pot or the medical form of it, you know, like the edibles? I mean all these things are still — we have no idea here.

Steve Ryan: We just don’t know yet, we just don’t know. Another part of this study that was interesting was people using marijuana were 46% less likely, and dependent users 58% less likely to die in the hospital. Now that’s good news because one of the main problems with afib is you’re in the hospital so often, and that’s really good news and something that is worth looking into. By the way, this study that I’m talking about hasn’t been published yet.

Travis Van Slooten: Oh, it hasn’t, okay.

Steve Ryan: So that’s why we don’t have the information on all the details of the study. As soon as the study get published we’ll get that information.

Travis Van Slooten: That’s good to know in case someone is listening this and they’re trying to Google this they’re not going to find it right now.

. Steve Ryan: Yeah, right, I don’t think so.

Travis Van Slooten: So the bottom line with this topic then is what’s your bottom line message to someone that would pose that question that was posed to me which is, “Hey, I have afib and I smoke pot, is this good or bad?” Mypersonal response to them Steve is kind of what you said Steve “We don’t know much of anything on this topic right now because it’s kind of so new.” And the other thing is I just told them I would approach it kind of like smoking or drinking; that it’s probably not best to do it heavily on a regular basis. And more importantly, if you smoke pot and you have an episode that’s probably an indication that’s a trigger so you should probably avoid it. But likewise if you are a moderate smoker and it seems to keep your afib episode at bay, then it might be okay to continue to smoke. That was kind of the way I handled it. Is that kind of the way you handle that answer or that question is well?

Steve Ryan: Yes. Some of the people like John wrote to me and said “99% of these afib attacks occurred when I’m under the influence of marijuana.”

Travis Van Slooten: Okay, the obvious trigger.

Steve Ryan: Yeah, and Jonathan writes “I tried a tiny bit of brownie for the first time since being diagnosed with afib. It was okay until about two hours later. I went into afib and a bit later came the closest I ever have to blacking out. I don’t think it’s for me anymore.” On the other hand, Jim writes that he uses it every night and it work for him fine.

Travis Van Slooten: Yeah, so it kind of gets back to the whole what’s trigger, what’s not. And so yeah, I think it’s all fascinating. Definitely I think this is going to become more and more of an issue as I said in the opening here with the marijuana legalization kind of sweeping across the country here. This is going to become a very hot topic, I think.

Steve Ryan: Yes, definitely.

Travis Van Slooten: Well, Steve, I just want to thank you for your time to discuss this topic, and I look forward to talking to you in the next week’s episode. We’re going to be talking about the real cost of living with afib. So Steve, thanks again for your time.

Steve Ryan: You’re welcome.

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

Got A-Fib? You’re Almost Certainly Magnesium Deficient

Magnesium deficiency is central to creating conditions in the heart that cause Atrial Fibrillation. Therefore, anyone in A-Fib is almost certainly magnesium deficient.

Why? It’s now almost impossible to get adequate amounts of magnesium from our diets.

Magnesium used to be plentiful in fruits, vegetable and grains, but decades of industrial-scale farming have stripped the soil of minerals like magnesium. One study found that the nutrient content of crops has declined by as much as 40% since the 1950s.

How to Increase your Magnesium Level

To learn how to supplement your Magnesium go to our pages:

Mineral Deficiencies
Natural’ Supplements for a Healthy Heart.

For recommended products and brands  see Steve’s Shopping Guide for a Healthy Heart (and all of Steve’s Shopping Guides on our sister site, BeatYourA-Fib.com)

References for this Article
Goodman, Dennis. This Mineral Prevents Headaches, Heart Disease, More. Bottom Line Personal. Volume 35, Number 2, January 15, 2014.

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