Treatments

Don’t Delay—A-Fib is a Progressive Disease

Quote - Joan Schneider, Ann Arbor, MI, A-Fib free after PV Catheter Abaltion - A-Fib.com

Joan Schneider, Ann Arbor, MI, A-Fib free after PV Catheter Abaltion

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.)

[su_pullquote align=”right”]Unless too feeble, there’s no good reason to just leave someone in A-Fib.[/su_pullquote]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.

Fibrosis makes the heart stiff, less flexible and weak, reduces pumping efficiency and leads to other heart problems. 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. And always aim for a Cure!

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

Educate Yourself—and Always Aim for a Cure!

 

Book Review: Bad Pharma—How Drug Companies Mislead Doctors & Harm Patients

Bad Pharma by Ben GoldacreThe author of Bad Pharma does an excellent job of shining a light on the truths that the drug industry wants to stay hidden.

Those truths include how they mislead doctors and the medical industry through sales techniques, and manipulate consumers into becoming life-long drug customers. (For doctors that industry influence begins in medical school and continues throughout their practice.)

We also learn truths about the internal workings of the medical academia, the U.S. FDA, and medical journals publishing. Here are a few highlights from Bad Pharma.

Manipulating Clinical Drug Trials

As consumers, how do we really know which drugs are best? The U.S. FDA protects us, right? Well sort of. Read how trials for drugs and their perceived usefulness can be manipulated, poor trials go unpublished or outright suppressed, and underperforming trials are stopped early or the trial period extended.

One way to manipulate clinical trials starts at the beginning―the design of the trial. Often, few comparison studies are done. Far more common are new drug studies going against placebo pills (that everyone knows don’t work). This helps inflate findings, makes new drugs look more effective than older drugs―because they were never compared against each other.

Bad Pharma & the Cost of Doing Business

Learn how pharmaceutical companies legitimately funnel $10 million to $20 million a year to major medical journals including the New England Journal of Medicine and the Journal of the American Medical Association. So, are we surprised then that studies funded by the pharmaceutical industry are much more likely to get published by these influential journals?

Direct to Consumer Drug Sales

Did you know drug companies spend twice as much on marketing and advertising as on researching and developing new drugs? (I was shocked.)[su_pullquote align=”right”]To learn how medication advertisements on TV can be misleading to consumers, see my review of “Know Your Chances: Understanding Health Statistics” by Steven Woloshin.[/su_pullquote]

Of special interest to me is the ‘Direct to Consumer’ drug sales which has significantly increased drug sales in the U.S. ‘Direct to Consumer’ drug sales is so misleading that it is banned in all countries except two: the U.S. and New Zealand. (No wonder that 70% of drug companies’ profit comes from the U.S.)

To be specific, I hate those misleading TV commercials that target A-Fib patients. What these ads for anticoagulants don’t tell you is:

• You are on their meds for life! (they want lifelong customers!)
• These meds do nothing to treat your A-Fib (only your risk of stroke)
• A-Fib can be cured (you don’t have to be on meds for the rest of your life)

These ads for anticoagulant medications imply if you just take their pill once day, you’ve taken care of your A-Fib. Wrong!

Well Written, Easy to Understand

Bad Pharma, is written in an easy-to-understand manner (you don’t need a medical or science degree). If you wish, you can skim through the book to get an overview, then stop and read a topic of interest. Or you can dig in for a full read, including the authors’s research and other references (documented in footnotes with citations.)

Check on Your Doctor

After reading how big Pharma may be influencing your doctor, you can now find out. In the U.S., with the passing of the Sunshine Act (part of the 2010 Patient Protection and Affordable Care Act), we can now research if a doctor has received pharma money to prescribe their products. Just go to the Open Payments or Dollars for Doctors website.

One of our tenets at A-Fib.com, is ‘Educate Yourself’! If you want to be a more savy consumer of health care services, I highly recommend Bad Pharma. I also recommend Ben Goldacre’s other book, Bad Science.

Bonus Idea: If you pair this book with “Know Your Chances: Understanding Health Statistics” by Steven Woloshin, you’ll have a complete course on how the drug industry skillfully markets their products.

 

A ‘Magic Pill’ to Improve Your Chances of a Long, Healthy Life

It’s not a pill, nor a medication. Magnesium is the ‘magic’ pill that improves by 34% your chances of living a long, healthy life—a mineral naturally present in many foods. Magnesium is important for anyone with a high cardiovascular risk (including patients with Atrial Fibrillation).

Insights come from researchers in Spain who carefully monitored the diets of 7,216 men and women between the ages of 55-80 (an age range more likely to develop A-Fib). Mg 200 pix sq at 96 resThe people in the highest third of magnesium intake (442 mg/day) were 34% less likely to have died from any cause over a five-year period. And they had a 59% reduced risk of cardiovascular mortality, plus a 37% reduction in cancer mortality.

Why was the risk of cardiovascular disease (CVD) lowered by ingesting more magnesium? …Continue reading…

Sleep Apnea: When Snoring Can Be Lethal

Obstructive Sleep Apnea (OSA) is so common that at least 43% of patients with Atrial Fibrillation also suffer with it. For that reason alone, you should be tested for sleep apnea.

Aside from causing or triggering A-Fib, untreated sleep apnea can cause many other serious health threats.

Got Sleep Apnea? Your Life-Threatening Risks

Researchers at the U. of Wisconsin examined 22-years of mortality data on the study’s participants and found the following:

infographic-sleep-apnea-stats-section-only-500-v-425-pix

The Wisconsin Sleep Cohort Study

Beginning in 1989, the U. of Wisconsin study used a random sample of 1,522 Wisconsin state employees. The participants underwent overnight sleep apnea studies and many other tests at four-year intervals. They were not selected because they had known sleep problems. (After the testing, researchers contacted participants with severe sleep apnea and explained the health risks.)

The study reveals the numerous life-altering and life-threatening health issues associated with sleep apnea.

Sleep Apnea: a condition in which one or more pauses in breathing occur while sleeping, pauses can last a few seconds to minutes and can occur 30 times or more an hour.

More EPs are Sending Patients for Sleep Studies

So many A-Fib patients also suffer from sleep apnea that many Electrophysiologists (EPs) routinely send their patients for a sleep apnea study. Some A-Fib centers have their own sleep study program. (The patient just walks down the hall to an A-Fib sleep study area.)

For some lucky patients, normal sinus rhythm (NSR) can be restored just by controlling their sleep apnea and getting a good night’s sleep.

Take Action: Sleep Apnea Can be Lethal

The Wisconsin Sleep Study findings demonstrate just how lethal sleep apnea can be. Sleep apnea isn’t a minor health problem, and it’s a condition you can do something about. (Just like A-Fib, you don’t have to just live with it).

If your significant other tells you that you pause breathing when you sleep or that you snore, do something about it! (Not everyone with sleep apnea snores, but snoring may indicate sleep apnea.)

Talk with your doctors about testing for sleep apnea. You may need an in-lab sleep study (or the newer option of a home sleep test).

Learn More About Sleep Studies

Read about in-lab and in-home sleep studies in our article, Sleep Apnea: Home Testing with WatchPAT Device and the Philips Respironics

On a Personal Note: My wife has sleep apnea (but not A-Fib). While sleeping, she would actually stop breathing for what seemed like a long time, then suddenly gasp for air. It was very scary! But now she uses a CPAP machine, sleeps soundly and wakes up rested.

Sleep apnea may run in families. Her brother has sleep apnea also.

[su_spoiler title=”Resources for this article” style=”simple”]Dudley, David. World War ZZZ. AARP the Magazine, August/September 2016, p.51.

Young, Terry. New Wisconsin Study Documents Severity of Sleep Apnea Risk. UW Health 2008 Annual Report. http://www.uwhealth.org/about-uwhealth/annual-report/new-wisconsin-study-documents-severity-of-sleep-apnea-risk/15018

Nieto, Javier. Sleep Apnea Associated with Higher Mortality from Cancer. University of Wisconsin School of Medicine and Public Health. News and Events, Med.Wisc.edu, 05/21/2012. http://www.med.wisc.edu/news-events/sleep-apnea-associated-with-higher-mortality-from-cancer/37687[/su_spoiler]

The Watchman Device: My Top 5 Articles

You’re on a blood thinner for your increased stroke risk from A-Fib. But you hate it.

Is the monthly testing or diet restrictions a hassle? Is the increased risk of bleeding stressful?  Have you developed side effects, i.e., gastrointestinal problems or poor kidney function? Maybe you just don’t want a lifetime on meds.

Or, perhaps you’re unable to take a blood thinner for other medical reasons. What do you do?

WATCHMAN™ Occlusion Device: The Alternative to Blood Thinners

There is an alternative to taking blood thinners―closing off your Left Atrial Appendage (LAA) with the Watchman™, an occlusion device. The LAA, a small sack located at the top of your left atrium, is where 90-95% of A-Fib strokes originate.

Inserting the Watchman is a very low risk procedure that takes as little as 20 minutes to install. Afterward, you usually don’t need to be on a blood thinner.

Review these articles to learn more about the Watchman:

1. The Watchman™ Device: The Alternative to Blood Thinners

2. Clinical Trials Results: Watchman Better Than a Lifetime on Warfarin

3. A Watchman and Ablation Combo? Everything You Never Thought to Ask

4. Technology & Innovations: The Watchman Device 

5. Steve’s List of EPs Installing the Watchman Device

Bonus: Video about the Watchman

Video - Closure of the Left Atrial Appendage Technique

Click image for video.

Closure of the Left Atrial Appendage: The Watchman Device

Animation shows how the Watchman is inserted and positioned in the left atrial appendage (LAA) using a catheter; then how heart tissue grows over the Watchman, closing off the opening of the LAA trapping any blood clots. (1:04)

Taking Supplements? How to Time Your Daily Doses

Updated November, 10, 2016

If you take several supplements (like I do), you may wonder:

Should I take them at the same time each day? Or should I spread doses throughout the day? Should I take with meals? Or on an empty stomach?”

The best answer may depend on whether you are taking medication, on the specific supplement and/or on your personal life style.

Medication Inventory form

Medication Inventory form

Start with the ‘Suggested Use’

Read the supplement label. Some are fairly specific, i.e., “with or without food”, or “with food” or “on an empty stomach”; or specific time (morning or bedtime) or in divided dosages. Make notes for each supplement. Download and use this FREE form to help you keep track of everything.

Do you Have Other Medical Conditions?

If you have diabetes, hypertension or heart disease, first talk to your doctor or pharmacist. Combining supplements with prescription medications, can produce unexpected or life-threatening results.

They may offer advice specific to the combinations of your meds and supplements.

Do Some Reading, Take Some Notes

The best time to take a specific vitamin or supplement may depend on the specific supplement. Do some reading on each at the library or at a reputable website or two. Make notes of the information you find. A few examples:

• Taking a single dose multi-vitamin? It’s best to take it in the morning when nutrients are depleted and with or near breakfast so it’s broken down, then digested with the food.
• Vitamin D is best absorbed after your biggest meal, usually dinner, averaging 56 percent greater boost than those who take it without food.
• Calcium supplement, don’t take along with a multivitamin containing iron. The calcium may interfere with the iron’s absorption.
• Magnesium may be best taken in the evening, since Magnesium may support sound sleep.

Healthy Directions, Dr. David Williams

On the website Healthy Directions, Dr. David Williams offers advice about the best times to take vitamins. He lists specific vitamins and supplements and organized them into three groups, those that should be taken before meals, with meals, or in-between meals. See his article for specifics, The Best Times to Take Your Vitamins

[Healthy Directions offers advanced nutritional supplements and guidance from highly respected integrative and alternative health doctors including Julian Whitaker, MDDr. David WilliamsDr. Stephen Sinatra, MD and others.]

My favorite independent research sites

For reliable, unbiased research and information on specific vitamins and supplements, we recommend these three sites (in order or preference). None of the three sell supplements (or anything else). They just offer information on vitamins, herbs, natural products and supplements.

memorial-sloan-kettering-cancer-center-logo1. Memorial Sloan Kettering Cancer Institute/Integrative Medicine: “About Herbs, Botanicals & Other Products
2. Drugs.com: ‘MedFacts Natural Products Professional database
3. The ‘Dietary Supplement Label Database’ at the U.S. National Institutes of Health.

Adjust for Your Life Style

You may need to adjust your supplement taking to accommodate work or school demands, family schedules, etc. For example, if you work the swing shift, your “morning” dose may need to be 1 pm, and your ‘evening’ doze may need to be at 2 am.

Or, if you often skip meals during your work day, taking equally divided doses may become erratic. So, it may be better taking your doses before you go to work.

EZY Dose-4-times a day organizer - A-Fib.com

EZY Dose-4-times a day organizer

Bottom Line: Try to be Consistent

For optimum benefit, it may take some effort to work up your supplement schedule. But you don’t have to obsess about it. Since these are ‘natural’ substances (vs. prescription drugs), you usually don’t have to be overly careful about when you take them. What’s important is do try to be consistent from day to day.

After you work out your schedule, consider using a vitamin/supplement organizer. Check out My Search for the Best 7-Day Medicine/Vitamin Organizer.

For more answers to your questions about mineral deficiencies, see our: FAQ Minerals & Supplements

For more on where to research specific vitamins and supplements see, FAQ Minerals Deficiencies: Reliable Research.

New A-Fib Story: Frustrated, Crosses Canadian Border for Treatment

Rani and Moni Minhas

Rani and Moni Minhas

Our newest personal A-Fib story is told by a Canadian about his wife, Rani, who’s first symptom was feeling dizzy when checking in for a flight from Barbados. Over the next many months, she developed palpitations and A-Fib.

“Rani had fatigue and didn’t feel right. Before this, she was always healthy. She continued to exercise, as much as she could. But A-Fib really bothered her and made her feel both sick and anxious. Our whole family was worried about her.
Under the Canadian nationalized health care system, it took a lot of proactive action and aggressive approach to get proper help (which in the end wasn’t the proper treatment).
Almost every time we went to a doctor or a specialist, none of them had properly reviewed her file before they walked in to talk to her. It was pathetic. And we went to 4 cardiologists and 2 doctors.”

Frustrated for his wife, Moni turned to his friend, Google, and searched the web for information about Atrial Fibrillation. Read what Moni discovered and learn why they decided to cross the Canadian border to seek treatment in the U.S. …Continue reading…

My Top 5 Articles About Warfarin Therapy, Associated Risks and Alternatives

my-top-5-picks-stamp-warfarin-400-pix-sq-at-96-res

Any treatment plan for Atrial Fibrillation must address the increased risk of clots and stroke. By far the most commonly used medicine for stroke prevention is the anticoagulant warfarin (brand name Coumadin).

But warfarin is a tough drug to take long term with monthly blood tests and possible side effects. These are my top 5 articles to help you understand warfarin therapy, the associated risks and some of the alternatives.

Review these articles to learn more about Warfarin therapy:

1. Clinical Trials Results: Watchman Better Than a Lifetime on Warfarin;

2. Arterial Calcification From Warfarin: Vitamin K May Reverse it;

3. “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.”;

4. How to Avoid the Bleeding Risk of Anticoagulants;

5. If Sixty and Older: 99% Have Microbleeds—So Are Anticoagulants Risky?

Bonus: Video about Warfarin

A-Fib.com video libraryLiving with Warfarin: Patient Education
Excellent introduction to anticoagulant therapy with warfarin (Coumadin). Patients and medical professionals (clinical nurse, doctors, a pharmacist  and clinical dietician) discuss the practical issues associated with taking warfarin. (16:22) Uploaded on Mar 7, 2011. Produced by Johns Hopkins Medicine.

An Alternative to Blood Thinners

WATCHMAN device at A-Fib.com

The WATCHMAN device

Do you hate having to take Coumadin? Hate the monthly testing? Bothered by side effects? An alternative to taking blood thinners is closing off your Left Atrial Appendage (LAA) with the Watchman, an occlusion device. Learn more: The Watchman™ Device: The Alternative to Blood Thinners.

Don’t Just Manage Your A-Fib with Meds. Seek your Cure!

Daniel Doane, A-Fib free after Mini-Maze surgery, from Sonora, California. - A-Fib.com

Daniel Doane, Sonora, CA, 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, the 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

To start, educate yourself about Atrial Fibrillation and review all your treatment options on our page: Treatments for Atrial Fibrillation.

Next, move on to the guidelines we’ve posted: Which of the A-Fib Treatment Options is Best for Me? Then, 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.

[su_spoiler title=”Reference for this article” style=”simple”]Savelieva I, Camm J. Update on atrial fibrillation: part II. Clin Cardiol. 2008 Mar;31(3):102-8. Review. PubMed PMID: 18383050. URL Retrieved Nov 17, 2011. http://www.ncbi.nlm.nih.gov/pubmed?term=PMID%3A%2018383050[/su_spoiler]

Can You Suppress Your PVCs and PACs?

Are you one of the many A-Fib patients who also have PACs and PVCs? Are your PACs more than just annoying? Do your PACs become more frequent and trigger an A-Fib attack?

Perhaps you’re thinking if you reduce these extra beats and palpitations, you may be able to reduce your A-Fib episodes. So, what can you do?

[pullquote]PAC and PVC stands for Premature Ventricle Contractions and Premature Atrial Contractions.[/pullquote]

Catheter Ablation Option

In extreme cases where the extra beats are very disturbing and damage one’s quality of life, Electrophysiologists (EPs) can perform an ablation for them similar to an ablation for A-Fib. But this is a specialized procedure that not all EPs perform or are willing to perform.

Suppress PACs and PVCs with the “Awesome Foursome” Cocktail

Dr. Stephen T. Sinatra in his book, The Sinatra Solution—Metabolic Cardiology, recommends the following natural “cocktail” for suppressing PACs and PVCs, what he calls the “awesome foursome”:

L-carnitine: A derivative of the amino acid lysine which helps to turn fat into energy. It promotes energy metabolism and enhances cardiac function. Some consider it the single most important nutrient in cardiac health. It reduces PVCs.

Dosage: Daily: 750-2000 mg of L-Carnitine Fumerate (250 to 500 mg three to four times a day).

Coenzyme Q10 (Ubiquinone): A naturally occurring enzyme, part of the quinone chemical group, that is found in every cell in the body. It produces energy in the mitochondria and energizes the heart. 95% of the body’s energy is generated by CoQ10, which generates energy in the form of ATP. It prolongs the action potential and helps maintain sinus rhythm. It improves heart rhythm problems.

Dosage: 100-300 mg daily in divided doses with meals.

D-ribose: A five-carbon sugar that is a regulator in the production of ATP. The only compound used by the body to replenish depleted energy stores. Ribose increases tolerance to cardiac stress, improves exercise tolerance and physical function, provides cardiac energy needed to maintain normal heart function, increases cardiac efficiency, lowers stress during exercise, and maintains healthy energy levels in heart and muscle.

Dosage: Daily: 7-10 grams of Ribose powder. Take in divided doses with meals or just before and after exercise.

Magnesium: A vital mineral used by the enzymes that make energy synthesis and recycling possible. Adequate intracellular magnesium is essential to normal tissue and organ function. Low magnesium is associated with cardiac abnormalities, fibrillation, and vascular and muscle spasms, and is seen in cardiac failure.

Dosage: A recommended goal is a minimum 600 mg/day, preferably 800 mg. (For example, 200mg three times a day and 200 mg at bedtime.)

To Learn More About PACs and PVCs

Read the research in my article, Premature Atrial Contractions (PACs) Predict A-Fib.
Read John’s personal A-Fib story, PVC-Free After Successful Ablation at Mayo Clinic.

The Sinatra Solution: Metabolic Cardiology by Stephen Sinatra, MD

Get yours at Amazon.com

Dr. Sinatra’s Book on Amazon.com

Use our A-Fib.com portal link to Amazon.com to get your copy of Dr. Stephen T. Sinatra book, The Sinatra Solution—Metabolic Cardiology.

When you use the A-Fib.com Amazon.com link, we receive a small commission on each sale, at no extra cost to you. We apply it toward the monthly publishing costs of this website. Bookmark this link and use every time you go to Amazon.com.

Clinical Study Findings: CryoBalloon Better Than RF Ablation?

We can now say that CryoBalloon ablation is better than RF, at least according to a secondary analysis of a recent clinical study.

In the FIRE AND ICE clinical trial by Dr. Karl-Heinz Kuck and his colleagues, 762 patients with symptomatic paroxysmal A-Fib were randomized into two groups, either RF catheter ablation or CryoBalloon ablation.

Results: Many findings were comparable. Both groups had similar results in terms of primary efficacy and safety endpoints. Furthermore, both groups had improvement in quality of life over 30 months of follow-up.

Where Results Diverged: Re-Hospitalization and Recurrence

While many of the outcomes were similar between the two groups, there were some significant differences. The CryoBalloon group had lower rates of re-hospitalization (32% with CryoBalloon versus 41.5% with RF catheter ablation). In addition, the CryoBalloon patients had fewer:

• Cardiovascular re-hospitalizations (23.8% vs 35.9%)
• Repeat ablations (11.8% vs 17.6%)
• Direct current cardioversions (3.2% vs 6.4%)

Karl-Heinz Kuck, MD portrait at A-Fib.com

KH Kuck, MD

According to lead researcher, Dr. Kuck:

“The secondary analysis (of the FIRE AND ICE study) favors CryoBalloon over (RF ablation), with important implications [for EPs] on daily clinical practice.”

Dr. Wilber Su of Banner-University Medical Center in Phoenix, who was not part of this FIRE AND ICE study, concluded:

Dr Wilber Su at A-Fib.com

Dr Wilber Su

“…for most operators, CryoBalloon may be a safer and more efficient approach… . In my practice, CryoBalloon has already become the preferred approach both from personal experience as well as patient demand.”

What Patients Need to Know

Which ablation procedure is better—RF or CryoBalloon? According to the FIRE AND ICE clinical trial, we can now say that CryoBalloon is better in terms of less re-hospitalizations, repeat ablations and recurrences within a 30 month period.[pullquote]More important than the energy source used to perform the ablation, is the skill and experience of the operator (EP).[/pullquote]

Don’t Avoid RF: In practical terms, the differences weren’t so great that you should avoid EPs who prefer to use RF.

Dr. Su points out that many electrophysiologists (EPs) may continue with RF ablation because being comfortable with their choice of technology is a critical factor.

Look for Skill and Experience: More important than the energy source used to perform the ablation, is the skill and experience of the operator (EP).

The Bottom Line: When researching an EP to do your ablation, look for the best, most experienced high volume operator you can find and afford, even if you have to travel.

Caveat About CryoBalloon Ablation

CryoBalloon catheter

CryoBalloon catheter

CryoBalloon ablation is much easier and faster to do than RF point-by-point ablation. Consequently, some operators are entering the field with little RF ablation experience on which to build or complement their Cryo skills.

Others are doing only “anatomical ablation”—only ablating the pulmonary vein openings and not looking for and ablating non-PV triggers. (Happily in many cases, this is often all that is needed, particularly in cases of recent onset or Paroxysmal A-Fib.)

For more critical information about choosing your EP for a Cryoballoon Ablation, read my posts:

• Huge Growth in Number of EPs Doing Catheter Ablations
• CryoBalloon Ablation: Alarming O.R. Reports (Part I)
• CryoBalloon Ablation: All EPS Are Not Equal (Part II)

[su_spoiler title=”Resources for this article” style=”simple”]Lou, Nikole. Afib Ablation: Fewer Returns After ‘Ice’ Than ‘Fire’ MedPage Today/CRTonline.org June 14, 2016. http://www.medpagetoday.com/cardiology/pci/58529

Kuck K “The FIRE AND ICE trial secondary analyses: reintervention, rehospitalization, and quality-of-life outcomes” Cardiostim 2016. http://www.cardiostim.com/

Kuck KH, et al. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med. 2016; 374(23): 2235-45.

Kuck KH, et al. Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation: reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trial. Eur Heart J (2016) First published online: 5 July 2016

[/su_spoiler]

 

Considering a Mini-Maze? Don’t Destroy the Ganglionic Plexus

Many surgeons performing Mini-Maze or other Maze operations for A-Fib routinely ablate/destroy the Ganglionic Plexus (GP) areas on the outside of the heart which contain clusters of nerve cells.

But recent studies show this strategy is not only ineffective but causes a lot of complications.[pullquote]AFACT stands for Atrial Fibrillation and Autonomic modulation via Thoracoscopic surgery[/pullquote]

The AFACT Trial: Mini-Maze Surgeries for Paroxysmal or Persistent A-Fib

The 2016 randomized clinical trial from Amsterdam in The Netherlands included 240 participants who underwent mini-maze surgeries: totally thoracoscopic pulmonary vein isolation for paroxysmal A-Fib or isolation plus Dallas lesion set for persistent A-Fib.

Approximately half also received ganglionic plexus ablation in which four major ganglionic plexus were ablated as well as the ligament of Marshall in the ganglionic plexus group. Patients were followed for one year.

Results: Ablating GPs—No Clinical Benefit, More Complications

ganglionic-plexus-areas-420-x-400-pix-at-96-res

Areas outside of the heart with clusters of nerve cells.

The researchers found no clinical benefits associated with ganglion plexus ablation added to a thoracoscopic ablation strategy, and significantly more complications.

There were significantly more recurrences in the ganglionated plexus group (78.1%) than in the control group (51.4%). And what is worse, more than double the number of major adverse events occurred in the ganglionic plexus group such as major bleeding and sinus node dysfunction which required pacemaker implantation.

Presenting at 2016 Heart Rhythm Society scientific session, researcher Dr. Joris R de Groot stated that “ganglionic plexus ablation is associated with significantly more periprocedural major bleeding, sinus node dysfunction and pacemaker outcome, but not with improved rhythm outcome.”

He concluded that routine ganglionated plexus ablation offers “no clinical benefit” in this patient category, and “should not be performed.”

The 2016 AFACT trial may finally have determined that ablating GPs doesn’t work.

What Patients Need to Know

Surgery Not Recommended as First Choice Treatment for A-Fib: Current guidelines do not recommend surgery as a first choice or option for A-Fib. Surgery is generally more invasive, traumatic and risky than a simple catheter ablation procedure.[pullquote]Routine ganglionated plexus ablation offers “no clinical benefit” and causes major permanent complications.[/pullquote]

Most current surgical strategies have built in limitations. For example, if you have A-Flutter coming from the right atrium, current surgical techniques don’t access the right atrium or some other non-PV trigger sites. See Cox-Maze, Mini-Maze and Hybrid Surgeries. In such cases, one often needs a catheter ablation after the surgery.

Make Sure Your Surgeon Doesn’t Ablate Ganglionic Plexus Areas: If you have to have surgery for A-Fib, make sure your surgeon does not ablate the ganglionic plexus areas as part of his A-Fib surgery. Ablating the ganglionic plexus areas doesn’t improve ablation results and causes more major permanent complications. As Dr. de Groot unequivocally states, ganglionic plexus ablation “should not be performed.”

The Bottom Line if Having Mini-Maze Surgery

If you have to have surgery for A-Fib (versus a catheter ablation by an EP), make sure you ask the surgeon if they ablate the ganglionic plexus areas as part of your A-Fib surgery. (Don’t expect a surgeon to volunteer this info. You have to ask!)

If they say yes, hand them a copy of this post. Then find another surgeon.

[su_spoiler title=”Resources for this article” style=”simple”]Routine ganglionic plexus ablation “should not be performed” in advanced atrial fibrillation patients. Cardiac Rhythm News, Issue 33, June 2016, p. 2. http://tinyurl.com/afib-ganglionic-plexus

Driessen AH, et al. Ganglion Plexus Ablation in Advanced Atrial Fibrillation: The AFACT Study. J Am Coll Cardiol. 2016;68(11):1155-1165. doi:10.1016/j.jacc.2016.06.036

Ganglionated Plexus Illustration: Heng, C. Atrial Fibrillation Mechanism and autonomic nervous ganglion ablation. http://www.365heart.com/show/83937.shtml[/su_spoiler]

Helping Doctors Understand A-Fib from the Patients’ Point-of-View

ssr-lake-zurich-400-x-300-pix-at-96-res

Steve Ryan in Zurich, Switzerland

Have you ever wished you could give your doctors an episode of Atrial Fibrillation, just so they would understand what you are going through? That’s what I did in Zurich last week (well, sort of).

I’m back from Zurich, Switzerland, where I was the only patient speaking at the 2-day 2016 Multidisciplinary Arrhythmia Meeting (MAM), a gathering of cardiologists and surgeons from leading institutions in Europe, the US and Asia who treat Atrial Fibrillation.

The Patient’s Point of View

After dinner on the first night, I spoke to a room of 200+ cardiac electrophysiologists (EPs) and surgeons. I was there to help them better understand A-Fib from the patient’s point of view. I focused on the psychological and emotional impact of A-Fib on patients―how the anxiety, fear and stress of the disease can be as bad (or worse) as the physical symptoms.

My Wish: Let Doctors Experience A-Fib for 60-Seconds

I shared my own journey with A-Fib and described my own stress, fear and frustration; then how I did extensive research and found my cure in Bordeaux by a catheter ablation (one of my Bordeaux doctors, Dr. Dipen Shah, was in the audience).

With Dr. Stefano Benussi, my host in Zurich

With Dr. Stefano Benussi, my host in Zurich

I next shared my wish that each of them could experience an episode of A-Fib for just 60-seconds―it would change their perspective of A-Fib forever. They wouldn’t soon forget the fear (am I going to die?) and anxiety (God, please stop this!).

My Challenge: Be a Resource for Your Patients

Then, I challenged them to go beyond the physical symptoms and help patients deal with their anxiety and fear. Knowledge is empowering so I recommended they personally check out and be ready to recommend at least two books and 2 websites about Atrial Fibrillation. In addition, I suggested they vet at least three psychiatrists who understand A-Fib and who could help patients in need of counseling and medication to address their anxiety.

Being Back in Normal Sinus Rhythm: Life Changing

And finally, I thanked them, on behalf of all the patients they have made A-Fib-free. There are few medical procedures as transformative and life changing as going from A-Fib to Normal Sinus Rhythm. For me, it was getting my life back.

I think I really made an impression. I don’t think anyone had ever talked to these doctors like that before. I hope my efforts will trickle down to helping others with A-Fib.

MAM 2016 300 x 100 pix at 96 resMultidisciplinary Arrhythmia Meeting 2016

The goal of MAM was to improve interaction between cardiac electrophysiologists (EPs) and surgeons who treat difficult A-Fib cases through a new Hybrid approach. Both a surgeon and an EP work together, one from inside the heart, the other from outside the heart. (Note: In the past, it’s been a rare occurrence for a surgeon to work with a cardiac electrophysiologist.) To learn more about the hybrid approach, see THE HYBRID SURGERY/ABLATION.

I want to thank my host, Dr. Stefano Benussi, University Hospital, Zurich, Switzerland, for his personal invitation to attend and speak at MAM 2016.

Look For My Reports

I’ll soon be writing reports on the key presentations. Just look for 2016 MAM.

New FAQ: Does Ablation Reduce Heart’s Pumping Volume?

Our new Frequently Asked Questions & Answers (FAQs) is about the heart’s blood pumping capacity after an ablation.

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

As a fellow runner, I understand your concern on how an ablation might affect your ability to resume your athletic activities.

Lesions at PVs openings

Seek Your Cure: Keep in mind, with Atrial Fibrillation you lose 15% to 30% of your heart’s normal pumping volume along with lower oxygen levels. Your body and brain aren’t getting the blood and nourishment they need. An catheter ablation is an important way to improve or restore your heart’s pumping volume.

PVAI - Ccommon lesion set at A-Fib.com

More extensive lesions pattern

Ablate as Little Tissue as Possible: A common ablation technique for paroxysmal A-Fib (using RF or Cryo), ablates only around the opening of each Pulmonary Vein (PV) and isn’t likely to affect the heart’s output.

On the other hand, more extensive lesion patterns affecting more tissue may affect the heart’s output. For example, during a PV Wide Area Antrum Ablation, instead of just ablating around each of the PV openings, large, oval lesions are made in the left atrium encircling both the upper and lower vein openings.

My Best Advice to Runners with Atrial Fibrillation

For a runner, a more extensive ablation of the left atrium may affect heart output more than circular lesions of each vein opening. …Continue reading my answer…

September is A-Fib Awareness Month: Share our Infographic

Infographic - September is Atrial Fibrillation Month at A-Fib.com

Click image to see full Infographic.

This is the month we focus on reaching those who may have Atrial Fibrillation and don’t know it.

An estimated 30%−50% of those affected with Atrial Fibrillation are unaware they have it—often only learning about their A-Fib during a routine medical exam.

Of untreated patients, 35% will suffer a stroke. Half of all A-Fib-related strokes are major and disabling.

To spread the word about Atrial Fibrillation, A-Fib.com offers a new infographic to educate and inform the public about this healthcare issue.

See the full infographic here. (Then Share it, Pin it, Download it.)

In A-Fib for 15 Years, Eventually Unable to Work

Terry Traver' s story at A-Fib.com

Terry Traver’ s story

We’ve posted a new personal experience story. Terry Traver of Thousand Oaks, CA, shares his 15-year battle with A-Fib.

“For over 15 years I suffered with A-Fib. It was not so bad [at first]. I stopped using caffeine and chocolate and cut back on my [alcohol] drinking.

Every three months or so I would have an episode that would last about 15 hours and then I would be fine. Meds never really helped in my case.

A-Fib Progresses to Severe and Incapacitates

In 2011, my A-Fib became severe to the point where I was almost completely incapacitated [Persistent Atrial Fibrillation]. I was not even able to work. …Continue reading Terry’s story…

Top 10 List #1 Find the best EP your can afford - A-Fib.com

My Top 7 Picks: Natural Supplements for a Healthy Heart

By Steve S. Ryan, PhD

While not considered “A-Fib specific” like your medications, these minerals and supplements may improve overall heart health and thereby help your Atrial Fibrillation.

Recommendations for Heart Health

For a detailed discussion of these minerals and supplements along with recommended dosages, see our article, ‘Natural’ Supplements for a Healthy Heart. Our seven recommendations are: [pullquote]For a detailed discussion of these seven nutritional supplements, see our article ‘Natural’ Supplements for a Healthy Heart.[/pullquote]

• Taurine
• Coenzyme Q10
• L-Carnitine
• Omega-3 Fish Oils
• Ribose (D-Ribose)
• Hawthorne Berry
• BCAA+G

Many Sources and My Amazon.com List

These minerals and supplements are available from many reputable retail and online sources. To make shopping easy for you, see my ‘Wish List’ on Amazon.com. (Note: Use any of these Amazon portal links, and your purchases help support A-Fib.com.)  

To get you started choosing brands, tablet size and forms of each supplement, we offer you 2 brands that meets our requirements.

1.  41A5986BbLL._SL500_SL135_Taurine, 1000 Mg

Taurine, along with Magnesium and Potassium, have been described as “the essential trio” for treating nutritional deficiencies relating to A-Fib. Taurine protects potassium levels inside the heart, regulates cellular calcium, and improves heart muscle contraction. Suggested products:

Now Foods Taurine 1000Mg, 100-Capsules; Source Naturals Taurine 1000mg, 240 Capsules

2. Ubiquinol CoQ10 (coenzyme) 100 Mg

Coenzyme’s ability to energize the heart is perhaps its chief attribute; improves heart functions and heart rhythm problems. Coenzyme is a naturally occurring enzyme and plays a key role in producing energy in the mitochondria. “Ubiquinol” is a more readily absorbed form.

Source Naturals Ubiquinol CoQ10 100mg, 90 Softgels; Jarrow Formulas Ubiquinol QH-Absorb, High Absorption/Enhanced Stability, 100 mg, 120 Softgels

3. GPL-Carnitine dosage: 500 -1000 Mg41pGdDbehjL._SL500_SL135_

L-Carnitine is a vitamin-like nutrient; a derivative of the amino acid lysine which helps to turn fat into energy. Considered by some to be the single most important nutrient in cardiac health. It reduces the incidence of cardiac arrhythmias and premature ventricular contractions (PVCs).

Swanson Glycine Propionyl-L-Carnitine Hcl Gplc 840 mg 60 CapsVitacost GPLC Glycine Propionyl L-Carnitine HCl-GlycoCarn 1000 mg PLC per serving – 60 Capsules

4. Omega 3 Fish Oil 1000 Mg 41XsPG8LBGL._SL500_SL135_

Essential fatty acids like EPA and DHA are considered by some to be natural defibrillators, lessening the incidence of cardiac arrhythmias and A-Fib. Krill Fish Oil 1000 Mg; Essential Fatty Acids (EPA and DHA) make blood platelets less sticky, less likely to form clots (cause of strokes). Some prefer Krill oil to fish oil as it’s exacted from organisms living in pristine deep-water seas.

Source Naturals Omega EPA Fish Oil, 1000mg, 100 SoftgelsMegaRed Extra Strength Omega 3 Krill Oil 500mg Supplement, 60 Count

5. Ribose/D-Ribose Powder 51d1BMLf-LL._SL500_SL135_41ZcLixRg3L._SL500_SL135_

Ribose increases tolerance to cardiac stress, lowers stress during exercise, and maintains healthy energy levels in heart and muscle. The heart’s ability to maintain energy is limited by one thing—-the availability of Ribose.

Now Foods D-Ribose Powder, 8-OunceDoctor’s Best Best D-Ribose Featuring Bioenergy Ribose, 250-Gram

6. Hawthorne Extract 41vl3oo6+7L._SL500_SL135_41VLGf88IyL._SL500_SL135_

Hawthorne Berry reduces tachycardias and palpitations and prevents premature ventricular contractions (PVCs). Hawthorne Berry can energize the heart without prompting arrhythmias. It has a normalizing effect upon the heartbeat. Dosage 300 to 510 Mg

Now Foods Hawthorn Extractract 300mg, Veg-capsules, 90-CountNature’s Way Hawthorn Berries , 510 mg., 180 Veg-capsules

7. 512+5YkmiCL._SL500_SL135_BCAA with L-Glutamine, 1000 Mg

‘Branched Chain Amino Acids’ (BCAA) are critical to the repair and maintenance of strong heart muscle and function. Be sure to get BCCA in combination with L-Glutamine (though challenging to find). We like the powder form. Suggested products:

MRM BCAA+G, Lemonade, 35.2-Ounce (1000g) Plastic JarBodyTech BCAA and Glutamine (13.8 Oz Powder)

Note: Mineral supplements may interfere or interact with your prescription medications, so always consult your doctor before adding any supplements to your treatment plan.

Many Physicians are Not Well Versed in Nutritional Support

Always discuss with your doctor before adding supplements - A-Fib.com

Always discuss with your doctor

Don’t expect a lot of support from your doctor. Unfortunately, a great number of doctors are not well versed in recommending or supervising nutritional support. Quite often, they may dismiss your inquiries about nutritional supplements. 

You may need to work with (or educate) your doctor to determine the benefit of supplements for your A-Fib health.

Learn about Mineral Deficiencies and Atrial Fibrillation

For an extensive discussion about mineral deficiencies, see our Treatments page: Minerals Deficiencies.

AliveCor Kardia May be Big Winner in Britain’s NHS Plan

AliveCor, maker of the Kardia ECG smartphone attachment to detect Atrial Fibrillation, may be a big winner in a plan by the British National Health Service (NHS).

AliveCor sensor with screen and smartphone 400 x 270 pix at 300 res

AliveCor Kardia attached to a smartphone

Dr. David Albert, AliveCor founder, said the British plan opens the door to the NHS buying AliveCor devices for all 2 million atrial fibrillation patients in England.

The NHS has announced plans to give millions of patients free health apps & connected health devices in a bid to promote self-management of chronic diseases.

The plan is expected to “save money and lives by preventing strokes.” About 20 percent of British A-Fib patients have strokes. The program will start in April 2017.

The AliveCor Kardia, cleared for use in the US by the FDA, attaches to Android and Apple Devices and by pressing the sensors with your fingers (or thumbs), capture single-lead, medical-grade EKGs in just 30-seconds. Instantly you know if your heart rhythm is normal or if atrial fibrillation (A-Fib) is detected in your EKG. Data can be captured and sent to your doctor. 

Request to Our Readers

Is anyone using the latest AliveCor® version, ‘Kardia™ Mobile’? (Model 1141, out since Feb. 2016) I want to update our Feb. 2015 review.

How do you typically use it? Are you satisfied with the performance? Do you transfer the data to your doctor?

Will you share your product experiences with me? Just shoot me an Email with your impressions.

[su_spoiler title=”Resource for this article” style=”simple”]

Versel, N. Britain’s NHS to fast-track AliveCor smartphone ECG for AFib patients. MedCityNews.com. Jun 20, 2016. http://medcitynews.com/2016/06/nhs-alivecor/

[/su_spoiler]

Don’t Take Any Medication Without Asking These 10 Questions

Before taking any prescription drug to treat your Atrial Fibrillation, you should educate yourself about the drug. We’ve prepared the top 10 questions you should ask your doctor. As a service to our readers, we offer the questions as a free PDF worksheet you can Download. It has convenient spaces to write down your doctor’s replies for later review.

Print as many as you need and take a copy to every doctor appointment (you never know when you’ll need one). Download our worksheet (and don’t forget to save to your hard drive).

Before Starting a Prescription Drug, Ask These Questions

Use our worksheet as a guide as you ask these questions of your doctor or healthcare professional, and note their responses:

Download our Free Worksheet

1. Why am I being prescribed this medication?
2. What are the side effects of this drug?
3. Are there any precautions or special dietary instructions I should follow?
4. Can it interfere with my other medications?
5. What should I do if I forget a dose?
6. How long before I know if this drug is working?
7. How will I be monitored on this drug? How often?
8. What happens if this drug doesn’t work?
9. What if my A-Fib symptoms become worse?
10. If I don’t respond to medications, will you consider non-pharmaceutical treatments (such as a Pulmonary Vein Isolation procedure)?

Keep your medical records in a binder or folder. at A-Fib.com

Keep your medical records in a binder or folder.

Your A-Fib Binder or Folder

When completed, file the worksheet in your A-Fib binder or file folder to use for future reference and follow-up.

Your A-Fib binder is where you should file and organize all your A-Fib-related treatment information: printouts of information from the internet and your local public library or medical center library, notes from phone calls with doctors’ offices, and answers to “interview” questions during doctor consultations.

Research Any Prescription Drug 

To determine if the prescription is the right one for you, do your research. An excellent prescription database is the U.S. National Library of Medicine Drug Information Portal. (For an example, see the page on Warfarin [Coumadin].)

Also see the free worksheet: Keep an Inventory List of Your Medications


Worksheet from Chapter 6 of Beat Your A-Fib: The Essential Guide to Finding Your Cure, by Steve S. Ryan, PhD

How A-Fib Damages Your Heart, Brain and Other Organs

A-Fib reduces the amount of blood flowing to the rest of your body by about 15%–30% and can have damaging effects.

That’s because the upper parts of your heart (the atria) aren’t pumping enough blood into the lower chambers of your heart (the ventricles). At the same time, your heart is working progressively harder and harder.

Here’s what can happen to your heart if you choose to just ‘live with Atrial Fibrillation”:

Don’t Just Live With Your A-Fib

Don’t listen to doctors who advise you to ‘live with A-Fib’ and who prescribe a lifetime on medication. Get a second opinion, or even a third! Educate yourself.

Seek your A-Fib cure!

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