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

More FREE ‘Learn the Heart’ ECG Online Review Courses

Recently I posted about a FREE online course ‘ECG Basics‘ at Healio/LearnTheHeart.com designed to expand your understanding of Electrocardiograms (ECG or EKG) (see our description page).

More ‘Learn the Heart’ ECG Review Courses

This week I expanded the list of Healio ECG short courses that may be of interest to Atrial Fibrillation patients. Each includes examples of 12-lead ECGs and, where appropriate, specific criteria. Check out the following:

Illustration: Healio 'Atrial Fibrillation ECG Review‘

Illustration: Healio ‘Atrial Fibrillation ECG Review‘

Atrial Fibrillation ECG Review
Atrial Flutter ECG Review
Premature Atrial Contractions (PACs) ECG Review
Left Atrial Enlargement (LAE) ECG Review
Atrioventricular Nodal Reentrant Tachycardia (AVNRT) ECG Review

ECG Quizzes, Too

You can also challenge yourself with the Beginner ECG Quiz featuring detailed answers and links to pertinent explanation pages. Or test your overall knowledge of Atrial Fibrillation with a multiple choice Atrial Fibrillation Quiz.

Steve’s Brief Overview: The EKG Signal

If you want just a brief overview of the ECG waveform signal and how to “read” an ECG tracing, go to my report, Understanding the EKG Signal.

Learn to Read Your ECG: Free Online Self-Paced Courses at Healio.com

Start with the ‘ECG Basics’ course

For the reader wanting a more extensive understanding of the Electrocardiogram and A-Fib, we offer you a link to Healio Learn the Hearta FREE online cardiology resource for those seeking to increase their knowledge of ECG tracings interpretation and cardiovascular diseases.

‘Learn the Heart’: A Review or ECG Basics

I suggest you start with the ‘Atrial Fibrillation ECG Review‘ then move on to the ‘ECG Basics‘ to analyze each part of the ECG tracing. Included are detailed explanations and ECG images of the heart in Atrial Fibrillation.

The ‘ECG Basics‘ is concise and focused on only what you need to know, yet very thorough — from waves to segments to complexes. On the LearnTheHeart.com website:

⇒ Go to the Atrial Fibrillation ECG Review->
⇒ Go to the ECG Basics training module->

Reviews and Quizzes, Too

Healio ‘Atrial Fibrillation ECG Review‘ ECG graphic

You can even challenge yourself with the Beginner ECG Quiz featuring detailed answers and links to pertinent explanation pages. Or test your overall knowledge of Atrial Fibrillation with a multiple choice Atrial Fibrillation Quiz.

Other ‘Learn the Heart’ ECG Review Courses

Other ECG courses from Healio review all common ECG findings including normal and abnormal. Each review includes example 12-lead ECGs and, where appropriate, specific criteria. Of particular interest to Atrial Fibrillation patients may be:

Atrial Flutter ECG Review
Premature Atrial Contractions (PACs) ECG Review
Left Atrial Enlargement (LAE) ECG Review
Atrioventricular Nodal Reentrant Tachycardia (AVNRT) ECG Review

Steve’s Brief Overview: The EKG Signal

If you want just a brief overview of the ECG waveform signal and how to “read” an ECG tracing, go to my report, Understanding the EKG Signal.

VIDEO: RF Catheter Ablation for Atrial Fibrillation—From Start to Finish With Dr. Robert Fishel

Join Dr. Robert S. Fishel in the EP lab for a full RF catheter ablation procedure for Atrial Fibrillation. In a conversational manner, he talks the viewers through each step during an in-progress catheter ablation.

He discusses use of x-ray, protection of the esophagus, anticoagulation, and various catheters including circular mapping catheter with force touch. He describes pulmonary view potentials and the various video screens of a beating heart displaying 3-D mapping information. (1 hour)  Dr. Robert S. Fishel is Director of Cardiac Electrophysiology at JFK Medical Center Atlantis, FL. (Link updated 1-15-2018) 

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.

NOTE: In Jan. 2014, Steve joined Dr. Fishel in the EP Lab while in Florida for the 2014 BAFS. See A-Fib Alerts: January issue for photos of Steve in scrubs!

If you find any errors on this page, email us. Y Last updated: Thursday, January 18, 2018

Return to Instructional A-Fib Videos and Animations

My Top 5 Picks: Advanced-Level Atrial Fibrillation Videos

The A-Fib.com Video Library is for those readers who learn visually through motion graphics, audio, personal interviews and animations.

These are my top 5 picks of advanced-level videos. For the reader wanting a more in-depth look inside the EP lab and surgery, and at advanced topics relating to atrial fibrillation.

1. Step-by-Step: Cardioversion Demonstration by ER Staff

Step-by-Step: Cardioversion Demonstration by Alfred Sacchetti

Step-by-Step: Cardioversion

The goal of electrocardioversion is to convert the patient’s rhythm from atrial fibrillation back to normal sinus rhythm.

In this video, emergency room medical personnel demonstrate the equipment, pads placement and procedures of cardioversion. The video describes where pads are properly placed on the patient; how medication is chosen to produce deep sedation; and how after the shock is delivered, a successful cardioversion is confirmed by viewing a normal sinus rhythm on the cardiac monitor.

Close-up of the equipment is shown along with the monitor display. (2:10 min.) Uploaded by Alfred Sacchetti. Go to video->

2. Your Heart’s Ejection Fraction (EF): What You Need to Know

Ejection Fraction with Dr Robert Fishel

Ejection Fraction with Dr Robert Fishel

In the following three short videos, cardiac electrophysiologist, Dr. Robert Fishel, discusses the ejection fraction (EF) a measurement of the pumping efficiency of the heart and why cardiac patients should know their EF percentage.

Video 1: What is the ejection fraction? (:54 sec.) Cardiac Ejection Fraction (EF) is the percentage of blood pumped from the heart’s main chamber during each heartbeat, and why it’s important.

Video 2: Who should know their ejection fraction (EF)? (:34 sec.) Measurement of your Ejection Fraction (EF) is an important test and why A-Fib patients need to know their EF number.

Video 3: How is an ejection fraction measured? (:56 sec.) Ejection Fraction (EF) can be measured by various techniques including an echocardiogram.

Videos hosted by Share.com. Go to videos-> 

3. Mini-Maze Surgery In-Depth: Inside the O.R. with Dr. William Harris, Cardiovascular Surgeon 

Video still of Mini-Maze Surgery at A-Fib.com

In-Depth: Mini-Maze Surgery

Cardiovascular Surgeon, Dr. William Harris describes the Mini-Maze surgery for Atrial Fibrillation. In the Mini-Maze the heart is accessed through small incisions in the chest.

Of interest to A-Fib patients who can not tolerate blood thinners and thus do not qualify for a Catheter Ablation. The Mini-maze surgery is a highly effective with an 85%–95% success rate. (4:49 min.) Dr. Harris is with Baptist Medical Center, Jackson, Miss. Go to video->

4. Pulmonary Vein Isolation In-Depth: Step-by-Step Inside the EP Lab Using Mapping & CT Scan

PVI Step-by-Step Inside the EP Lab video at A-Fib.com

Pulmonary Vein Isolation Step-by-Step Inside the EP Lab

Cardiac Electrophysiologist Dr. James Ong begins with a brief tour of the EP lab and control room; Dr. Ong explains how pulmonary vein isolation is done with radiofrequency ablation to cure atrial fibrillation.

Included are: Mapping technology; the Virtual Geometrical shell of the heart displayed next to the CT scan; Placement of the catheter, real time tracking; the Complex Fractionated Electrogram (CFE) Map used to identify and eliminate the extra drivers (aside from the pulmonary veins). (6:01 min.) From a series of videos by Dr. Ong, Heart Rhythm Specialists of Southern California. Go to video->

5. Long-Standing Persistent A-Fib: A Live Case of Catheter Ablation Through 3D Mapping & ECG Images

Long-Standing Persistent A-Fib: Catheter Ablation Through 3D Mapping & ECG Images Video at A-Fib.com

Long-Standing Persistent A-Fib: Catheter Ablation Through 3D Mapping & ECG Images

Presented entirely through 3D mapping and ECG images, a live demo of ablation for long-standing, persistent A-Fib is followed from start to finish. Titles identify each step (no narration).

3D mapping and ECG images show the technique of transseptal access, 3D mapping, PV isolation, and ablating additional drivers of A-Fib. (8:03 min.) With Dr. James Ong, Heart Rhythm Specialist of Southern California. Go to video->

Note: These videos may require basic understanding of cardiac anatomy and A-Fib physiology.

Visit our A-Fib.com Video Library
for more Advanced-Level Videos

STEVE RYAN VIDEOS:
We’ve edited Steve’s most interesting radio and TV interviews to create several short (3-5 min.) videos. Check out Videos Featuring Steve S. Ryan, PhD, publisher of A-Fib.com.

Learn to Read Your ECG: My Brief Overview or a Healio.com Training Course

When I developed Atrial Fibrillation, one of my first courses of study was to learn how to read my own Electrocardiogram (ECG or EKG). If this interests you, too, consider my brief overview of the ECG waveform signal and how to “read” an ECG tracing. Go to my report, Understanding the EKG Signal.

FREE ECG Training Course

For the reader wanting a more extensive understanding of the Electrocardiogram and A-Fib, we offer you a link to LearnTheHeart.com – a FREE online cardiology resource for those seeking to increase their knowledge of ECG tracings.

Start with ECG Basics: I suggest you start with the ECG Basics to analyze each part of the ECG tracing; included are detailed explanations and ECG images of the heart in A-Fib. The tutorial is concise and focused on only what you need to know, yet very thorough — from waves to segments to complexes. Go to LearnTheHeart.com ECG Basics.

VIDEO: Graphic Display of Actual Heart in Atrial Fibrillation

Click to go to video

See an ECG waveform of an actual heart in Atrial Fibrillation–how it could look to your doctor. Your ECG may look different, but it will be fast and erratic. (You’ll see the changing heartbeat rate in the lower left.)

Go to video: ECG of Heart in Atrial Fibrillation on Monitor.

 

Use Every Tool Possible: Combine Ablation With Heart Healthy Nutrients and Life-Style Changes

The trap for those who work hard at improving nutrition and supplements is they feel like a failure if they can’t stop their A-Fib with natural means alone. They keep trying one thing after another for years while avoiding an expert’s opinion about an ablation procedure.

Of all the 90+ personal A-Fib stories we’ve published on A-Fib.com, we only have one who states she was cured by natural supplements. (She takes much more than just magnesium and started when she first developed A-Fib.)

But trying natural remedies for A-Fib shouldn’t be an ‘either/or’ decision.

We should use every tool possible to put the ‘A-Fib genie back in the bottle’.

We should use every tool possible to put the ‘A-Fib genie back in the bottle’. The best approach is to combine an expert ablation procedure with permanent dietary improvements (including heart healthy nutrients and supplements) while also addressing any appropriate life-style changes (i.e., for high-blood pressure, sleep apnea, diabetes and obesity).

For someone who has just developed A-Fib, try to get out of A-Fib ASAP. It goes without saying that it’s not healthy and feels terrible to have A-Fib attacks.

To learn more about combining ‘tools’: go to our Frequently Asked Questions: FAQ Mineral Deficiencies and Supplements and my two articles Natural’ Supplements for a Healthy Heart and Reader With A-Flutter Advises Two Lifestyle Changes.

New FAQ: Will EECP Heart Therapy Help my Circulation?

“I’ve heard about an out-patient heart therapy that improves circulation called EECP (Enhanced External Counterpulsation). Would it help me with my A-Fib?”

The goal of Enhanced External Counterpulsation (EECP) therapy is to improve the flow of healthy, oxygenated blood to the heart. It works by opening or forming small blood vessels called collaterals which create natural bypasses around blocked arteries.

It’s FDA cleared, non-invasive, requires no medication and has no recovery period. It improves circulation and decreases inflammation.

Ischemic means a restriction in blood supply to tissues caused by constriction or obstruction of the blood vessels.

Improve Blood Pressure and Circulation

EECP has been used with patients suffering from ischemic heart diseases (i.e. angina and heart failure).

In addition, if you have high blood pressure, EECP can decrease arterial stiffness and hardening of the arteries. It also pumps blood into bone marrow and pushes stem cells to secrete into the circulatory system.

My Experience with EECP

I recently had an EECP session at Global Cardio Care–West Los Angeles, CA. I can testify that EECP therapy is very powerful and invigorating.

During and after my session. I spoke with Sara Soulati, the CEO of Global Cardio Care, Inc. who is a pioneer in EECP since 1996. (She also helped with research for this article.)

In my case, they found that my arteries were very flexible, so I didn’t get as much benefit as someone with clogged arteries. I can testify from personal experience that EECP feels very effective. It seems like a naturally occurring bypass.

(Global Cardio Care, Inc. has two locations in Los Angeles and offers a free session, see their website).

What Happens During EECP Therapy

EECP therapy session: patient with compression cuffs on lower limbs at A-Fib.com

EECP therapy session: patient with compression cuffs on lower limbs

During an EECP therapy session, you lay on an EECP bed with a pulse-oximetry device on your finger and hooked up to a 12-lead ECG. Heavy-duty air compression pressure cuffs (similar to blood pressure cuffs) are wrapped around each calf, thigh, and the buttocks. The ECG signal synchronizes the sequential squeezing of the cuffs to the rhythm of the patient’s heartbeat.

When the heart is at rest, the blood pressure cuffs squeeze the blood from the lower legs and circulate it throughout the entire arterial system. When the heart pumps, the cuffs deflate rapidly.

EECP therapy increases the blood flow and oxygen back to the heart, reducing the work that the heart has to do. It also improves circulation and strengthens the cardiopulmonary system. A typical session lasts around 1 hour; one course of EECP is usually 35 hours.

EECP: How It Effects Your Body

Effect of EECP therapy at A-Fib.com

Effect of course of EECP therapy: new arteries for blood to flow through

This increased and powerful circulation to the arteries helps develop “collaterals”―new arteries for blood to flow through. Hormones and vasodilators (nerves that cause widening of blood vessels) are released.

Within the arteries, nitric oxide and Vascular Endothelial Growth Factor (VEGF stimulates the formation of blood vessels) are secreted which help the process of collateralization (forming a side branch of a blood vessel). This improves arterial stiffness, increases circulation, and decreases inflammation.

EECP and A-Fib Patients

When I interviewed Sara Soulati of Global Cardio Care, Inc. she shared her experiences with Atrial Fibrillation patients seeking EECP.  (Global Cardio is where I had my EECP session.)  She recalled how her first A-Fib client came from a referral from Dr. Julian Whitaker (Whitaker Wellness Institute in Newport Beach, CA). Her insights and advice come after conducting EECP on more than 60 A-Fib patients.

“About 20% of our clients have had their A-Fib converted back into normal sinus rhythm.” Sara Soulati of Global Cardio Care, Inc.

Criteria for Best Results: She learned that in order to conduct EECP on someone with A-Fib, one of the criteria for a successful outcome is to have controlled A-Fib as opposed to unstable A-Fib.

Uncontrolled A-Fib has a wider range of heart rates, for example 40 to 150 beats per minute which makes the heart rate very irregular. Whereas controlled A-Fib has a narrower range of heartbeat (50-70 beats/minute).

This allows EECP to work properly, since EECP is triggered by the resting phase of the heartbeat.

EECP Results for A-Fib Patients: Sara Soulati hypothesizes that EECP stimulates electrical conduction of the SA Node to start to conduct and to normalize electrical conduction.

Sara Soulati, Global Cardio Care, Inc

Sara Soulati

EECP works for those with A-Fib as though it were passive exercise. It lowers heart rate and blood pressure while increasing circulation. About results with A-Fib patients, she writes:

 “Since the earliest days when I started doing EECP, we have treated more than 60 A-Fib clients. Not every single person has returned to normal sinus rhythm. I have seen the conversion from A-Fib to normal sinus rhythm first-hand while watching the EKG heart monitor during EECP therapy. About 20% of our clients have had their A-Fib converted back into normal sinus rhythm.”

For those who don’t return to sinus, their heart rate often becomes more controlled and medications can be decreased.

Still frame from Renew Group Private Limited EECP video

Still frame from Renew Group Private Limited EECP video

More About EECP Therapy

Is EECP Therapy Safe?

EECP is FDA cleared for the following conditions: angina pectoris, congestive heart failure, cardiogenic shock, and acute myocardial infarction.

Medicare (and many private insurers) will reimburse for several courses of EECP if you meet the criteria.

Other diseases or conditions mentioned have been studied in clinical trials. Clinical research shows there is, in fact, improvement in these disease types with EECP treatment.

Medicare will reimburse for several courses of EECP if you meet the criteria. Most private insurance companies have coverage policies similar to Medicare.

We advise you to talk to your cardiologist or EP before proceeding.

Where can I Find Centers Offering EECP Therapy?

There are nearly 1,000 academic medical facilities, physician practices and stand-alone centers offering EECP throughout the world and in the U.S. See “Locate EECP®Therapy Centers” at the VasoMedical EECP Therapy website.

Read More About EECP Therapy

The Bottom Line for A-Fib Patients

A course of EECP therapy may offer a way to improve the flow of healthy, oxygenated blood to your heart. As Sara Soulati of Global Cardio Care, Inc. reports, with EECP therapy, about 20% of her A-Fib clients have converted back into normal sinus rhythm.

The criteria: if your A-Fib is controlled with a narrower range of heartbeat (50-70 beats/minute), or if you have paroxysmal (occasional) A-Fib, you may want to look into a course of EECP therapy. It can improve cardiac function and possibly decrease the need for A-Fib meds.

(If you do try EECP therapy, let me know about your experience! Email me.)

Resources for this Article

A-Fib Begets A-Fib: The Longer You Have A-Fib, the Greater the Risk


“My advice to other patients: Know that paroxysmal A-Fib becomes chronic. Drugs only work for so long. Get with a great EP or A-Fib clinic and find your cure.”

Joan Schneider, A-Fib free after Catheter Ablation


The Longer You Have A-Fib, the Greater the Risk

‘A-Fib begets A-Fib.’ The longer you have A-Fib, the greater the risk of your A-Fib episodes becoming more frequent and longer, often leading to continuous (Chronic) A-Fib. (However, some people never progress to more serious A-Fib stages.)

Don’t listen to doctors who want to just control your symptoms with drugs. Leaving patients in A-Fib overworks the heart, leads to fibrosis and increases the risk of stroke. The abnormal rhythm in your atria causes electrical changes and enlarges your atria (called remodeling) making it work harder and harder over time.

Don’t let your doctor leave you in A-Fib. Educate yourself. Any treatment plan for A-Fib must try to prevent or stop remodeling and fibrosis.

To learn more, read my editorial, Leaving the Patient in A-Fib—No! No! No!

Educate Yourself—and Always Aim for a Cure!

Be Courageous When Seeking Your A-Fib Cure


“When seeking your A-Fib cure: Be courageous! Be assertive! Get the care that you deserve. Do NOT go with the flow.”

From Beat Your A-Fib: The Essential Guide to Finding Your Cure


As you progress through your treatment plan, continue to educate yourself. Read, surf the internet, participate in online discussions. Become an equal partner with your doctors or healthcare team.

Personal Stories of Hope, Courage and Lessons Learned: For encouragement, browse our library of over 90 first-person stories by patients—many now A-Fib-free. Go to our Personal A-Fib Stories of Hope.

 

Don’t Let Your Doctor Leave You in A-Fib


Don’t live in A-Fib!

“Treating patients with drugs but leaving them in A-Fib, overworks the heart, leads to fibrosis and increases the risk of stroke and dementia. Seek your Cure.”


Leaving the Patient in A-Fib—No! No! No!
The goal of today’s A-Fib treatment guidelines is to get A-Fib patients back into normal sinus rhythm (NSR). Unless too feeble, there’s no good reason to just leave someone in A-Fib. Read more.

Don’t let your doctor leave you in A-Fib. Educate yourself. Learn your treatment options. And always aim for a Cure!

Learn more about all treatments for Atrial Fibrillation.

 

Don’t Just ‘Manage’ Your A-Fib. Learn All Your Treatment Options. Aim for a Cure.


“Get your A-Fib taken care of. It won’t go away. It may seem to get better, but it will return. Don’t think that the medication is long term solution.”

Danel Doane, A-Fib free after Mini-Maze surgery


Don’t Expect Miracles from Current Medications

Antiarrhythmic drugs are only effective for about 40% of patients. Many patients can’t tolerate the bad side effects. When drugs do work, over time, they become less effective or stop working. According to Drs. Savelieva and Camm:

“The plethora of antiarrhythmic drugs currently available for the treatment of A-Fib is a reflection that none is wholly satisfactory, each having limited efficacy combined with poor safety and tolerability.”

Drugs don’t cure A-Fib but merely keep it at bay.

Learn All Your Treatment Options

Educate yourself about all your treatment options, see: Treatments for Atrial Fibrillation and Which of the A-Fib Treatment Options is Best for Me? Finally, discuss these treatment options with your doctor. This should be a ‘team effort’, a decision you and your doctor will make together.

Don’t just ‘manage’ your A-Fib. Seek your Cure.

Increasing Your Quality of Life: Catheter Ablation versus A-Fib Drugs

When seeking your Atrial Fibrillation cure, you’re often faced with the choices of catheter ablation versus antiarrhythmic drugs therapy.

We know from previous research studies that it’s safer to have an ablation versus living a life on antiarrhythmic drug therapy (AAD). (See Ablation Safer Than Life on Antiarrhythmic Drugs.)

But how do the two treatments compare when it comes to improvement in general health and ‘quality of life’?

Measuring ‘Quality of Life’

To determine success after treatment, researchers traditionally measure if A-Fib recurs using periodic ECGs. But this is “hardly a measure of successful treatment”, says Dr. Carina Blomstrom-Lundqvist, principal CAPTAF investigator from Uppsala University in Sweden.

CAPTAF stands for ‘Catheter Ablation compared with Pharmacological Therapy for Atrial Fibrillation‘.

The CAPTAF clinical trial is one of the first studies in which improvement in ‘quality of life’ was the goal. The trial compared the Atrial Fibrillation treatment effects of ablation versus antiarrhythmic drugs.

One-year results were presented in August at the 2017 European Society of Cardiology (ESC) Congress.

The CAPTAF Clinical Study

The CAPTAF trial enrolled 155 symptomatic patients with paroxysmal or persistent A-Fib at four Swedish centers and at one center in Finland.

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

A-Fib Drug Therapies

All enrolled patients had to have failed one drug therapy (rate or rhythm control). The average age of the enrolled patients was 56 years. Nearly three-quarters had paroxysmal A-Fib. On average they had been diagnosed with A-Fib for about 5 years, and 70%-80% of the patients had severe or disabling symptoms.

Catheter ablation (RF)

Patients received a subcutaneously implantable cardiac monitor 2-m onths prior to the start of the study (to establish a baseline ‘burden’ of A-Fib, i.e. the proportion of time in A-Fib). Then participants were randomized to ablation with pulmonary vein isolation or antiarrhythmic drug therapy. (The study protocol required patients randomized to the ablation regimen to be completely off antiarrhythmic drugs by 6 months after their ablation procedure.)

The primary goal of the study was a change in general health-related quality of life.

CAPTAF Results: Overall Health & ‘Quality of Life’ Improved More after Ablation

Overall Health: After 12 months of follow-up, the ablation group showed a greater improvement in average overall health by 11.0 points versus 3.1 points improvement in the drug group (as measured by a standard survey instrument). The 8-point difference in gain between the two groups was statistically significant.

Quality of Life: The quality-of-life domains (general health, physical function, mental health, role-emotional, role-physical, and vitality) improved significantly more in the ablation group than in the drug group. No significant differences were shown in the remaining two domains (bodily pain and social functioning).

AF Burden: The AF burden of the ablation group was decreased by an average of 20% points versus 12% points among the group on antiarrhythmic drugs. The change from baseline did not reach statistical significance between treatment groups.

The complication rates were comparable between treatment groups.

Summarizing the Results

About the difference in quality of life, Dr. Carina Bloomstrom-Lindqvist, principal CAPTAF investigator, explained that continued treatment with an antiarrhythmic drug in the drug group of patients compared with no drug treatment in the ablated patients “is absolutely the explanation” for the observed difference in quality of life.

Regarding her findings, she said, “Using quality of life as the primary endpoint of a trial for the first time, we demonstrated that pulmonary vein isolation [PVI] is significantly more effective than antiarrhythmic drugs…even at an early stage of their disease.”

Want a Better Quality of Life? Get a Catheter Ablation

“Using quality of life as the primary endpoint…PVI is significantly more effective than antiarrhythmic drugs…”

The CAPTAF clinical study, though small, goes much further than previous studies and is a significant milestone for Atrial Fibrillation patients. This was one of the first studies to focus on quality of life after treatment.

The CAPTAF results prove scientifically that ablation works better for A-Fib patients than antiarrhythmic drugs (AADs).

If you have A-Fib and want to improve your quality of life―get a catheter ablation. It makes you feel better than a life on antiarrhythmic drugs.

Remember: Seek your Cure!
Anyone no longer in A-Fib can tell you how wonderful it is
to have a heart that beats normally again.

Resources for this Article

 

Atrial Fibrillation…Like a Thief in the Night


“‘Don’t let A-Fib rob you of your joy of living.
Don’t just take your meds and get used to it.’
Seek your cure.”

Robert Dell, patient quote from
Beat Your A-Fib: The Essential Guide to Finding Your Cure.


Now A-Fib-free, Robert Dell shares:

“I no longer live in the A-Fib shadow and no longer take the drugs. My life is back. I no longer have to be content with less. All is now quiet. The ablations have given me my life back. I no longer have to worry about what pills, foods, or attitudes I should have to avoid A-Fib. I no longer go to sleep at night wondering if I will wake up with A-Fib.”

To read Robert Dell’s A-Fib story, see: Daddy is always tired.” Daddy needed his life back.

We’ve Got Answers: Browse Our Q&As About Drug Therapies and Medicines

The various medications or drugs for treatment of Atrial Fibrillation can be overwhelming. What they are for, how they work and how they might affect you, can be confusing. After reading our page Treatment/Drug Therapies, you may still have unanswered questions (perhaps the same others have asked).

We may be able to address your concerns in our Q&A section, Drug Therapies and Medicines (under FAQ: Living with A-Fib). We provide answers to the most frequent inquiries by patients and their families.

Some of the questions we answer are:

Medicines & Drug Therapies at A-Fib.com

Q&A: Medicines & Drug Therapies

• “Is the “Pill-In-The-Pocket” treatment a cure for A-Fib? When should it be used?”

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

I’m worried about the toxic side effects of amiodarone. What should I do?

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

Go to Drug Therapies and Medicines to browse all our questions.

You’ll find more answers to questions about therapy, such as about warfarin and Coumadin, foods with Vitamin K, Electrical Cardioversion, aspirin and stroke prevention, and natural blood thinners.

We invite you to browse through all our categories of answered questions. Go to -> FAQs: Coping with Atrial Fibrillation.

 

FREE Download: Keep a List of Your Medications—The Easy Way

 Medication Inventory form complements of Alere at A-Fib.com

Medication Inventory form complements of Alere

Patti wanted to update her list of medications and vitamins, so I just downloaded and printed the Free Medication List form for her.

I thought I’d remind our A-Fib.com readers about the FREE Medication List (PDF) available on our Free Offers and Downloads page.

Keep up with changes to your meds.  Because your medications and dosages can change over time, store blanks with your A-Fib records binder or folder. Use one to collect changes (if desired you can later update your computer-based PDF document.)

List of over-the-counter drugs, too. Over-the-counter drugs, vitamins and mineral supplements can interfere with your medications, so you’ll want to list them, as well.

Download this FREE Medication List (PDF), complements of Alere, and remember to save to your hard drive.

You can open the PDF and type into the document and then print copies. Or, you can print blank forms and fill-in by hand. Give a completed copy to each of your doctors or other medical healthcare providers.

Keep Your Doctors Informed

It’s important to keep your doctor and other healthcare providers up-to-date on all the medications you are taking, the dosages, and for what purpose. Take a copy with you on your next appointment.

My doctor’s office has me verify all my medication on each office visit. My up-to-date printed medication list makes this a snap. – Patti

 

CASTLE AF Study: Live Longer―Have a Catheter Ablation!

Catheter ablation actually reduces death rates and hospital admissions. That’s the finding in the CASTLE AF trial, a key heart disease study, by Dr. Nassir Marrouche and his colleagues.

In a presentation at the 2017 European Cardiology Congress in Barcelona, Spain, Dr. Marrouche described CASTLE-AF study participants as having A-Fib, advanced heart failure (i.e., low ejection fraction) and an Implantable Cardioverter Defibrillator (ICD).

The multicenter CASTLE-AF trial focused on patients with A-Fib and systolic heart failure.

The CASTLE-AF trial enrolled 398 patients in 33 sites across Europe, Australia and the US between 2008 and 2016. Patients were randomized to receive either radiofrequency catheter ablation or conventional drug treatment.

The study set out to definitively test the ability of A-Fib ablation to improve hard outcomes in patients with symptomatic paroxysmal or persistent A-Fib and a left ventricular ejection fraction (LVEF) of ≤35 percent (dangerously low percent). Median follow-up period was 37.8 months.

Results: Ablation Improves Quantity Not Just the Quality of Life

After catheter ablation, the death rate of trial patients was lowered by an amazing 47%! This is a lot better result than research studies using ICDs with drug therapy to lower the death rate in similar patients.

Before this study, catheter ablation was known to improve quality of life, but unexpected it also improved life outcomes (the quantity of life, how long one lives).

In addition, there may be a “major impact” on reducing costs associated with hospitalizations.

Ablation Improves Ejection Fraction

Once we study the soon-to-be published CASTLE-AF results, we can document what we’ve often observed anecdotally, that catheter ablation improves lower-than-normal ejection fraction and consequently cures a major component of heart failure.

Dr. Marrouche recommends EPs treating heart failure patients with A-Fib to “ablate them early on, very soon in the disease stage.”

My Anecdotal Evidence: Just last month I advised a 73-year-old man in persistent A-Fib to have an ablation by Dr. Andrea Natale. After only one month in sinus, his ejection fraction improved from a low 35% to a normal 55% (normal range is 50 to 75 percent)!

The CASTLE-AF study could pave the way for wider adoption of catheter ablation for treatment of A-Fib.

Even though he’s only a month into his blanking period, he feels terrific.

Wider Adoption of Catheter Ablation?

The CASTLE-AF study results could be a game changer for Atrial Fibrillation patients! Results could pave the way for wider adoption of catheter ablation and may prompt changes in current guidelines for treatment.

CASTLE-AF stands for Catheter Ablation versus Standard conventional Treatment in patients with LEft ventricular dysfunction and Atrial Fibrillation

Resources for this Article

In Layman’s Terms: What is Post-Ablation ‘Recurrence’?

“Recurrence” or “Re-connection” is a general term electrophysiologists (EPs) use to describe when A-Fib returns after a successful catheter ablation.

Heart tissue is very tough and resilient. There is a tendency for ablated heart tissue to heal itself, regrow the ablated area, reconnect, and start producing A-Fib signals again.

Illustration: cyroballoon ablation

But if this happens, it usually occurs within approximately the first three to six months of the initial catheter ablation.

This type of recurrence may happen because the heart tissue was not originally ablated properly, the burn lesion may not have been deep enough (transmural).

In practice, there are four basic types of recurrence found primarily when using RF point-by-point ablation…continue reading more about recurrence…

A Primer: What is the Typical Progression of an Ablation for A-Fib?

In his AF Symposium presentation, Dr. Pierre Jais, of the French Bordeaux group made a reference to the ‘typical progression of a catheter ablation procedure.‘ Readers may ask, what does he mean? What is the typical progression of an ablation procedure?

The Goals of Catheter Ablation for A-Fib: Let’s start by looking at the two main goals of a catheter ablation for A-Fib:

Restore the heart to normal sinus rhythm
Eliminate the symptoms of A-Fib

Additional benefits: Achieving these goals also relieves the patient from the associated risks such as blood clot formation, stroke and increased risks of dementia and mortality.

The EP Lab: Typical Ablation for Persistent A-Fib

We know that Atrial Fibrillation is not a ‘one-size fits all’ type of disease. Every operating electrophysiologist (EP) caters each catheter ablation to the specific patient’s needs. In this simplified example we are looking at the progression of a typical ablation for Persistent A-Fib:

Dr Ali Sovari in EP lab, Oxnard, CA at A-Fib.com

Dr Ali Sovari in EP lab, Oxnard, CA

1. Mapping: First, the sources of the rogue A-Fib electrical signals are mapped using a computerized system.

2. Ablation/Isolation: The tip of the catheter is then maneuvered to the various sources of the A-Fib signals (usually starting with the openings to the pulmonary veins). Using RF energy (or Cryo) a tiny burn or lesion is made at each location to disrupt (or ablate) the electrical pathway.

3. Rogue signals terminate or transition: As the series of lesions progress, more and more of the A-Fib signals stop. Or, A-Fib signals may transition into Atrial Flutter which is a more stable and less erratic heart rhythm.

4. Re-Mapping/ablation: At this point it is not uncommon for some A-Fib signals to continue. So, one or more rounds of mapping and ablation may be required to stop any remaining sources of arrhythmic signals.

 5. NSR or Tachycardia: Finally, the heart typically transitions to either normal sinus rhythm (NSR) or a stable atrial tachycardia (a regular but fast heartbeat).

Outcomes After the Ablation

NSR: After their ablation, many patients will be in normal sinus rhythm (NSR). Hurray! Obviously, this is the best outcome.

Stable Atrial Tachycardia: A second good outcome is being in stable atrial tachycardia, i.e., a regular but fast heartbeat. It’s not NSR, but being in atrial tachycardia instead means the patient is NO LONGER in A-Fib.

Graphic: Cryoablation heat withdrawl at A-Fib.com

Graphic: Cryoablation heat withdrawl

Why is stable atrial tachycardia still a good outcome? Typically, your heart will heal itself over the following months—called the ‘blanking period’ and, on its own, return to normal sinus rhythm (NSR). (That’s why you should wait for the 3+ months blanking period before you decide if your ablation is a success.)

Benefits from Failed Ablation? When the patient doesn’t return to NSR (or tachycardia), researchers who studied the follow-up data, found a few ‘side’ benefits to a ‘failed’ ablation. Some patients found their A-Fib symptoms were less intense or shorter in duration. Some patients found they could take certain medications that prior to their ablation had been ineffective.

Conclusion: So, either way, a catheter ablation offers benefits. You may still reap some substantial benefits from the previous “failed” ablation even if you need a second (or third) ablation.

Atrial Fibrillation PVI: Can the Need for Multiple Ablations be Forecasted?

Could the necessity for multiple ablation procedures be predicted? According to a research study, the answer is YES!

In a study of patients who had catheter ablation of the Pulmonary Veins (PVs) for paroxysmal (occasional) A-Fib, 8% had to have more than two ablations to be A-Fib free.

The only independent predictor of the need for multiple procedures was the presence of non-PV triggers. According to this research, electrophysiologists (EPs) should check for non-PV triggers such as at the ligament of Marshall.

Illustration of RF ablation at A-Fib.com

Illustration of RF ablation

The lesson to be learned from this study: When having an ablation, make sure your Electrophysiologist (EP) is experienced at tracking down (mapping) and ablating (isolating) non-PV triggers.

For example, I reviewed the an O.R. (Operating Room) report of a patient who, after isolating the PVs, was still in A-Fib. Instead of looking for non-PV triggers, the EP just electrocardioverted the patient back into sinus rhythm. This does sometimes work. But not in this case. The ablation failed.

This is particularly important for EPs doing CryoBalloon ablations.

Graphic: Cryoablation heat withdrawl at A-Fib.com

Illustration: Cryoablation heat withdrawl

Find EPs Experienced at Ablating Non-PV Triggers

When getting a CryoBalloon ablation, you need to find an EP who is willing to do more than just isolate your PVs—someone who will put out the extra effort to find and ablate non-PV triggers such as at the ligament of Marshall.

To do this, your EP may have to replace the CryoBalloon catheter with an RF catheter to ablate these non-PV triggers. This may require mapping and ablation skills not all EPs have.

What to Ask Prospective EPs

To find the right EP for your CryoBalloon ablation ask:

What do you do if I’m still in A-Fib after you do the CryoBalloon ablation?

(You want to hear they’ll search for and ablate non-PV triggers.)

For more about Ablating Non-PV Triggers, see my article: CryoBalloon Ablation Study: 30% of Patients Required RF to Achieve Isolation

Note: This research study was conducted before the widespread use of Contact Force sensing catheters, whose use is another contributor to the reduction of recurrence and need for multiple ablation procedures.

References for this article

New Video: EKG of Actual Heart in Atrial Fibrillation

We’ve added a new video to our Library of Videos & Animations. A graphic display of actual heart in Atrial Fibrillation. How it could look to your doctor on an EKG/ECG monitor; (Your EKG may look different, but will be fast and erratic). Includes display of the changing heartbeat rate in the lower left.

For comparison, we’ve included a graphic comparing the tracing of a heart in normal sinus rhythm vs. a heart in A-Fib.

Share with you family and friends when you talk about your A-Fib. (:59 sec)  Go to video->

EKG tracing

How to Interpret an ECG Signal

A-Fib is fairly easy to diagnose using EKG. The ECG signal strip is a graphic tracing of the electrical activity of the heart.

An electrocardiogram, ECG (EKG), is a test used to measure the rate and regularity of heartbeats. To learn more, see our article, Understanding the EKG Signal.

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