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

The Warfarin Myth: A Quiz About Foods and Vitamin K

Taking warfarin to manage your increased risk of clots and A-Fib stroke? Have you been told to avoid foods with vitamin K to prevent excess clotting? To separate the facts from the myths about warfarin and vitamin K, take our 5 question quiz.

A 5 Question Quiz about Warfarin and Vitamin K

1. True or False: Warfarin and vitamin K actually work against each other in your body.
True. Vitamin K helps your blood clot. Warfarin makes your blood clot more slowly. Your INR level is monitored to keep them in balance.

2. True or False: When taking warfarin, you should limit foods with high levels of vitamin K like dark, leafy greens.
False. You don’t need to avoid foods with vitamin K. The key is to consistently maintain your daily level of vitamin K.

Don’t confuse vitamin K with the K on the periodic table for potassium. One’s a vitamin, the other is a mineral.

3. True or False: Vitamin K information is not included on most packaged food nutritional labels.
True. So it’s often hard to determine the amount of vitamin K in your food.

4. True or False: To be safe, it’s better to maintain a low level of vitamin K in your diet.
False. Don’t avoid vitamin K foods. Vitamin K is an important nutrient especially for bone strength, brain function and cardiovascular health.

5. True or False: A vitamin K supplement may actually help stabilize your INR levels.
True. Some experts suggest that a low-dose vitamin K supplement (50-150 mcg/day) may help stabilize fluctuations in INR.

The Facts About Warfarin and Vitamin K

Vitamin K Finder - veggies with border at A-Fib.com

Vitamin K Finder at ptinr.com

Well, how’d you do on the quiz? Did you learn something? So, if you’re on warfarin, you now know the facts from the myths:

• You can eat dark, leafy greens rich with vitamin K
• You need to maintain a consistent intake of vitamin K
• Most nutritional labels won’t help when checking for the amount of vitamin K
• Vitamin K is important for bone strength, brain function and cardiovascular health
• A low-dose vitamin K supplement may help stabilize your INR

Misinformation Surrounding Warfarin

Prolific A-Fib blogger Dr John Mandrola (Dr. John M.), posted about misinformation surrounding warfarin patients and vitamin K. He wrote:

“I am so utterly tired of correcting this mistake….Patients on warfarin can indeed eat green vegetables; they should just eat them consistently. I have vegetarians who do beautifully on warfarin. The problem comes when people vary the weekly dose of vegetables.”

Reclaim the Benefits of Vitamin K

Safety first. When on warfarin, don’t make any changes to your vitamin K intake without first talking to your doctor.

If you and your doctor decide that you can increase your vitamin K intake, the key is to be consistent on a daily schedule. If consumption of vitamin K does affect your INR, your doctor can always adjust the warfarin dosage.

For a practical reference about foods with vitamin K, check out the online ‘Vitamin K Finder’ at the ptinr.com website.

References for this article

Considering a CryoBalloon Ablation? Seek an EP also Skilled in RF Ablation Techniques

Recently a patient, still in A-Fib after a CryoBalloon ablation, sent me their Operating Room (O.R.) report which is a blow-by-blow account of the EP’s actions during the procedure.

In my review of their report, after cryoablation of the Pulmonary Veins (PV), the patient was still in A-Fib. It appears the EP did not to make any attempt to map and isolate non-PV triggers. Instead the EP simply electrocardioverted the patient to return him to normal sinus rhythm (NSR). This may work in some cases, but for this patient the ablation was a failure. 

Your O.R. report is a historical record of the EP’s actions during your ablation.

When Considering a CryoBalloon Ablation

When selecting your electrophysiologist (EP), be cautious. For the best results, you want an EP who is not only experienced with CryoBalloon, but also, when needed, can use RF to map and isolate non-PV triggers.

Stay away from EPs who only do CryoBalloon ablation. Some EPs with little or no expertise with RF catheter ablations are now doing CryoBalloon ablations because they’re easier (i.e. less demanding) and faster to perform (more lucrative).

Seek an EP with Both Sets of Skills

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

Dr Ali Sovari and nurse, EP Lab, Oxnard, CA (procedure observed and photographed by Steve Ryan)

A dual skill-set approach is supported by a study of about 75 paroxysmal A-Fib patients undergoing their first CryoBalloon ablation. Researchers found about 30% of patients required the additional use of RF focal lesions to achieve isolation (to restore normal sinus rhythm).

Most RF-experienced EPs who are now doing CryoBalloon ablations, have the ability and skill to use focal point RF techniques, as needed, to make you A-Fib free during your CryoBalloon ablation.

What Patients Need to Know

In the patient’s case above, an EP experienced in mapping and making RF lesions, could have used these additional skills and tools to locate and ablate non-PV sources of A-Fib signals, and hopefully return the patient to normal sinus rhythm (NSR) at the conclusion to the ablation.

To find the right electrophysiologist (EP) for your CryoBalloon ablation, seek out RF-experienced EPs by asking these probing questions:

 “What do you do if I’m still in A-Fib after you do the CryoBalloon ablation? Will you use RF focal lesions to achieve isolation?”

To learn more about these research findings see By Combining RF and CryoBalloon Ablation Techniques, Do Success Rates Increase?

References for this article

My Top 7 Articles about Catheter Ablation for Atrial Fibrillation

Catheter Ablation techniques are achieving success rates of 70%-85% in making patients A-Fib-free and up to 90% successful when a second ablation procedure is required.

Side Benefits: A successful catheter ablation also reduces development of early onset dementia and returns your risk of stroke to that of a person without A-Fib. Catheter ablation is currently the best technique available for “curing” A-Fib.

You don’t have to live the rest of your life on medication. To seek your A-Fib cure, review these articles to learn more about catheter ablation:

1. A-Fib Research: Live Longer―Have a Catheter Ablation
2. Weight Loss Key to Reverse Atrial Fibrillation, Improve Ablation Success
3. Considering a Catheter Ablation? When Choosing Your Doctor—Know  EP’s Complication Rates
4. Chances of A-Fib Recurrence After Successful Catheter Ablation
5. What are the Risks Associated with a Pulmonary Vein Ablation Procedure?
6. A-Fib Ablations: Recurrence (Re-connection) Explained
7. The Evolving Terminology of Catheter Ablation

VIDEO: Catheter Ablation For A-Fib: What it is, How it’s Done and What Results Can Be Expected. Cardiologists from the Cleveland Clinic describe the catheter ablation procedure for the treatment of atrial fibrillation, what it is, how it’s done and what results can be expected from this surgery.

Excellent animations: showing A-Fib’s chaotic signals, and the pattern of ablation scars around the openings to the pulmonary veins. By the Cleveland Clinic (4:00 min.) Go to Catheter Ablation video.

A-Fib Symptoms: Patients’ Anecdotal Tips and Alternative Remedies

Updated article: I’ve added to this article several times over the years. A-Fib.com patients continue to send me first-hand reports of alternative remedies that have given them some relief from their Atrial Fibrillation symptoms. They may work for you too.

Topics include acupuncture, chiropractic adjustment and homeopathic remedies. (For more about natural treatments, see FAQs: Natural Therapies & Holistic Treatments.)

There’s also a long list of anecdotal suggestions. To be clear, these anecdotal tips may provide temporary relief from A-Fib attacks or they may not work at all for your A-Fib. So, try them at your discretion.

I hope one or more of these patient suggestions will give you some relief, too. Go to: Alternative Remedies and Patients Tips for A-Fib Symptoms.

Share Your Own TipsShare your tip at A-Fib.com

We invite you to pass on advice to help others with A-Fib. Has something worked to lessen your A-Fib symptoms, or reduce your frequency or duration of your episodes?

Why not share it with others? Just take a few minutes and send me an email about it. Short or long, your tip can help others.

Silent Persistent A-Fib: A Proactive Patient’s 3-Year Journey to Burden Relief

By Frances E. Koepnick, Athens, GA, June, 2017

Frances, now A-Fib free after 3 yrs.

 “I was diagnosed with atrial fibrillation (A-Fib) in April 2014, at age 69, while undergoing a pre-operative physical examination prior to hip replacement surgery. This was a surprising development since my A-Fib was completely “silent” with no symptoms.

My A-Fib was diagnosed as being ‘persistent’ rather than ‘paroxysmal’. These two forms of A-Fib are quite different. However, both types of A-Fib are usually treated initially with prescription drugs. I was given the beta blocker atenolol to reduce my heart rate and the anti-coagulant Eliquis to prevent the formation of blood clots.

Family History of Atrial Fibrillation

Unlike many other stories on A-Fib.com, I was familiar with Atrial Fibrillation. I am the third person in my family with A-Fib after my mother and older sister. However, they both had paroxysmal A-Fib while I was diagnosed with persistent A-Fib.

On-going studies indicate that there may be a genetic link to A-Fib.  Consequently, if someone in your immediate family has been diagnosed with A-Fib, then your risk of developing it in the future may be increased.”

Six Cardioversions: Not a Long-Term Solution

Eventually, I underwent a total of six cardioversions in an attempt to return my heart to normal sinus rhythm. Three of these procedures were electrical cardioversions and three were by means of intravenous drugs. I soon learned that cardioversion is rarely effective for maintaining normal sinus rhythm over a significant period of time.

Consequently, I did not consider it to be a long-term solution for my A-Fib.

The First Two Cardiologists Advised: ‘Just Take Your Medications and Live with A-Fib’―No! No! No!

I eventually consulted a total of five cardiologists―three in the state of Georgia, one in Manhattan and one in Bordeaux, France. I have a background in anatomy/physiology as well as microbiology, so I asked a lot of questions and managed to irritate several physicians.

“I eventually consulted a total of five cardiologists. I asked a lot of questions and managed to irritate several physicians.”

The advice of the first two cardiologists was to “just take my medications and live with A-Fib”.

If your cardiologist recommends this treatment regimen, I urge you to get a second, third or even fourth opinion.

More Interviews: Three Electrophysiologists & Lots of Questions

After my first electrical cardioversion in March 2015, my heart remained in normal sinus rhythm for only 12 hours. At that time, I had been in persistent A-Fib for one year, and was re-classified as long-term persistent A-Fib. That motivated me to pursue a catheter ablation.

I ultimately discussed an ablation procedure with three different electrophysiologists and consequently learned to ask lots of questions such as:

  • What is the percentage rate of successful ablations performed by this cardiologist/electrophysiologist?
  • What is the risk of serious complications?
  • How many ablations does this cardiologist/electrophysiologist perform at his/her facility annually? (My opinion is: “the more, the better”.)
  • What type of instrumentation is used for electrical cardiac imaging? (My opinion is the CardioInsight or ECGI/ECVUE imaging system; FDA-approved for the USA in February 2017.)

I finally located a cardiologist/electrophysiologist (EP) at a regional medical center who performed ablations for long-term persistent A-Fib.

Look for the Best EP―and Ablate Sooner Rather Than Later

At this point, I had been in long term persistent A-Fib for 17 months. I delayed ablation until September 2015 due to need for second hip replacement. That was a mistake as I should have pursued ablation first. 

“…This delay of treatment reduced my chance of a successful first ablation to approximately 65%. I anticipated I might need a 2nd ablation because of this.”

That time delay was due to recommendations from two different EPs and consequently, reduced my chance of a successful first ablation to approximately 65%. (I anticipated I might need a 2nd ablation because of this.)

Ablation for Persistent A-Fib is More Difficult

There are many competent electrophysiologists in the USA who have been successful with ablations for paroxysmal A-Fib. However, ablations for persistent and long-term persistent A-Fib are more difficult, require a higher level of expertise, and are performed less frequently in the USA.

CHU Hopitaux de Bordeaux logoBordeaux, France: Consequently, in September, 2015 I decided to have my ablation for long-term persistent A-Fib performed in Bordeaux, France. I chose this location because it’s internationally known for its cardiologists/electrophysiologists as well as for its use of the computerized CardioInsight or ECGI imaging system. [They cured Steve Ryan’s A-Fib back in 1998.]

This arrhythmia group is headed by Dr. Michel Haissaguerre and Dr. Pierre Jais, and they perform ablations for paroxysmal, persistent and long-term persistent A-Fib. Of course, French citizens are first priority for admission, but out-of-country patients can be wait-listed.

Pierre Jais MD

Fran’s EP: Pierre Jais MD

Not Covered by My Insurance: I do need to mention that the decision to travel to Bordeaux, France, was financially significant. My medical treatment was not covered by insurance.

The Hopital Haut Leveque-Cardiologique in Bordeaux is not an impressive building. It was most likely built in the 1970s, the patient rooms are not air conditioned, and the parking lot is gravel rather than pavement. However, the French government obviously invests their health care funds in medical research, excellent physicians, quality hospital staffing, and state-of-the-art medical equipment.

“The hospital staff speak English, but I did purchase an English/French app with medical terminology for my smartphone.”

The physicians and most of the hospital staff speak English, so there really isn’t a significant language barrier problem. I did purchase an English/French app with medical terminology for my smartphone, and it was helpful on occasion. [In Bordeaux they have broken ground on the new LIRYC Institute which is intended to become one of the premier research institutions in Europe.]

Difficult Six-Hour Ablation at Bordeaux, then Electrical Cardioversions

My first ablation by Dr. Pierre Jais was a difficult procedure requiring six hours for completion. [Not only were her Pulmonary Vein openings isolated, but in addition, non-PV triggers were identified, mapped, and isolated using the CardioInsight ECGI mapping system.]

Fran wearing the mapping vest.

During the three-week time period following this ablation, two electrical cardioversions were also required. This was later explained to me by Dr. Jais as the interior of the atria needed to heal sufficiently so that scar tissue would successfully block abnormal electrical signals.

After this ablation, I continued to take the anticoagulant Eliquis and was also put on the anti-arrhythmic drug amiodarone for six months.

Normal Sinus Rhythm for 11 Months, then Atypical Flutter

I knew at the time of my first ablation that I most likely would require a second ablation due to my predicted one-year success rate of 65%.

My heart actually stayed in normal sinus rhythm (NSR) for a total of 11 months. Then I experienced three episodes of atypical atrial flutter over a two-week period, and each of these episodes resulted in an admission to the emergency room. After three intravenous drug cardioversions, I was placed back on amiodarone to maintain a normal sinus rhythm.

Suspected Sleep Apnea

After my third ER admission, I suspected that these episodes might have been triggered by obstructive sleep apnea (OSA). I was waking up during the night with an extremely uncomfortable dry mouth even though my head was elevated while sleeping.

I consulted my dentist, and he referred me to a cardiologist/sleep specialist who ordered a sleep study. This study confirmed that my OAS was “severe” during periods of rapid eye movement sleep (REM).

Sleep Apnea and A-Fib: I would like to emphasize that OSA is a significant “trigger” for A-Fib. A recent study found that 43% of individuals with A-Fib also had a diagnosis of OSA.

“I suspected that these episodes might have been triggered by obstructive sleep apnea (OSA), a significant “trigger” for A-Fib. Of all A-Fib patients 43% are also diagnosed with OSA.”

This means that all individuals diagnosed with A-Fib need to be screened with a sleep study. If OSA is confirmed, it needs to be addressed immediately so that any future treatment for A-Fib is not compromised.

OSA can be controlled by continuous positive airway pressure (CPAP) machines whereby you wear a face mask at night when sleeping. I decided instead to have a custom oral appliance (FDA-approved TAP3) made by a sleep dentist. This oral appliance prevents my lower jaw from moving out of position when sleeping and thereby ensures that my airway remains open.

Second Ablation by Dr. Vivek Reddy Using CardioInsight ECGI

Dr. Vivek Reddy, Mt Siani Hospital

Dr Vivek Reddy, Mt Sinai Hospital

My second ablation was performed by Dr. Vivek Reddy at Mount Sinai Hospital in Manhattan, New York in March 2017.

I had been referred to Dr. Reddy by my doctors in Bordeaux. It was fortuitous that Mount Sinai Hospital had just obtained the FDA-approved CardioInsight (ECGI) imaging system which was previously only available in Europe.

The physicians, staff and facilities at Mount Sinai Hospital are absolutely excellent. The arrhythmia group there is headed by Dr. Reddy, and I found him to be professional, personable and comfortable answering my questions.

My second ablation was another difficult, six-hour procedure, but ultimately successful. [If interested in Dr. Reddy’s O.R. Report on Frances’ ablation, see my comments below.]

I recommend that you go online to the Mount Sinai Hospital website and then watch short informative videos on A-Fib which are presented by Dr. Reddy himself. See What Do I Need to Know About Atrial Fibrillation? (21:29).

Success & Lessons Learned

My 3-year journey with A-Fib has included numerous cardioversions, two ablations and a belated diagnosis of underlying obstructive sleep apnea (OSA).

It’s now about three months since my second ablation, and I am doing well. I no longer am taking the anti-arrhythmic drug amiodarone, but continue on the anticoagulant Eliquis.

My recommendations:  Look locally, regionally, nationally and perhaps internationally in order to identify the best option for a successful ablation. (Yes, consider traveling to find the best EP for you.)

It is also important to seek an ablation sooner rather than later as a delay may decrease your chance of a successful procedure.

 Yes, consider traveling to find the best EP for you…seek an ablation sooner rather than later, a delay may decrease your chance of a successful procedure. 

Seek up-to-date information : I highly recommend the website, www.A-Fib.com for up-to-date information on A-Fib. This website is run by Steve Ryan, Ph.D. and―although he is not a medical doctor― he is an A-Fib expert who explains A-Fib in terms readily understood by the average person.

Steve also attends the AF International Symposium held annually in the USA, and his synopses of conference presentations contain the latest in A-Fib research. Steve was and continues to be my A-Fib coach.

Smartphone app: Finally, I recommend the AliveCor Kardia device ($99) and app for smartphones. This app determines your heart rate in beats per minute (BPM) and also records a 30-second electrocardiogram (ECG) using two electrodes attached to the back of your phone. Kardia’s software interprets your ECG as “normal” or as “possible A-Fib”, and you can email a copy of an ECG directly to your cardiologist. [Also see our 2016 Update: AliveCor Kardia Review by Travis Van Slooten]

I welcome your email,
Frances Koepnick
fek67@hotmail.com

Editor’s Comments:
We’re most grateful to Frances for her story. She’s a great example of a proactive patient. When told to ‘just take her meds and live with A-Fib’, she said NO! Even though she was relatively symptom-free, she knew how destructive A-Fib can be over time.
Don’t Just Live in A-Fib: Leaving patients in A-Fib overworks the heart and leads to remodeling and fibrosis which increase the risk of stroke, and also doubles the risk of developing dementia. For more read: ‘Drug Therapies’: Rate Control and A-Fib Doubles Risk of Dementia. If you hear someone tell you to just live with A-Fib, get a second opinion (or third, or fourth!).
Educate Yourself About A-Fib―Be Proactive: Frances knew she would be a more difficult case to fix. She researched who were the best EPs for her case. She asked all the right questions of the EPs she interviewed. (See Selecting a New Doctor? 10 Questions You’ve Got to Ask.) She even went to Bordeaux, France, on her own dime.
Find the Best EP You Can: All Electrophysiologists are not equal. Like Frances, don’t just settle for the nearest EP. Consider traveling to the best, most experienced EP you can afford, particularly if you have progressed to persistent A-Fib which is harder to fix. (See Finding the Right Doctor for You and Your A-Fib.)
Silent A-Fib: If You’re 65 or Older, Get Yourself Tested: Frances is lucky. She could have easily been one of the 25% of stroke victims who only discover their silent A-Fib after having a stroke. Everyone 65-years-old or older, should be tested for silent A-Fib.
Sleep Apnea: Most EPs today will insist you get tested for sleep apnea before performing a catheter ablation. Why? Patients with untreated sleep apnea have a greater risk of their A-Fib reoccurring even after a successful ablation. Also, for a lucky few, just getting rid of sleep apnea restores them to normal sinus rhythm (NSR). To learn more, see Sleep Apnea: When Snoring Can Be Lethal
CardioInsight ECGI/ECVUE System: The CardioInsight ECGI/ECVUE mapping system is probably the most significant, game changing improvement in mapping A-Fib, particularly for people with persistent A-Fib. To learn more, see Bordeaux New ECGI Ablation Protocol—Re-Mapping During Ablation.
Special 12-page report by Steve S. Ryan, PhD

FREE 12-page Report

Frances’ O.R. Report: Using the CardioInsight system, Dr. Reddy found 5 A-Fib drivers in Frances’ atria. (In typical persistent cases, 4 driver regions are usually identified. 7 drivers is the maximum found in more difficult cases.) (For you technical types, the 5 A-Fib drivers were found: at the base of the Left Atrial Appendage (LAA), the Ostium of the Coronary Sinus (CS), the posterior Left Atrium (LA), the Right Atrial Appendage (RAA) and the lateral Right Atrium (RA).)
When Dr. Reddy ablated at the base of the LAA, Frances’ A-Fib terminated. (That’s the ideal result when A-Fib terminates during the ablation.) But then Dr. Reddy checked to see if there were any other regions in her heart producing A-Fib/Flutter signals. By pacing her heart, he was able to induce Atrial Flutter (CL 380msec). Using activation mapping, he found the re-entry atrial flutter circuit was coming from the anterior inferior RA. Ablating this area terminated her Flutter.

For more about O.R. reports, see my free report: How to Read Your Operating Room Report.

Return to top of page

Return to: Personal A-Fib Stories

If you find any errors on this page, email us. Y Last updated: Friday, June 23, 2017

 

Now A-Fib Free: A Personal A-Fib Story 23 Years in the Making

It’s been a 23-year ordeal for Charn Deol who’s from Richmond, British Columbia, Canada. He was 43 in August of 1993 when he was aware of a few skipped heartbeats. He had just returned to Canada after working for years in Southeast Asia. A week later, the irregular heart beating got worse in duration.

Personal A-Fib story by Charn Deol, BC, Canada at A-Fib.com

Charn Deol, BC, Canada

At the same time, Charn’s story is complicated by two other medical problems. First, simultaneous with the start of his A-Fib, a dull aching pain started in the left chest region the size of a 50-cent piece. Second, he was discovered to have very high levels of mercury in his blood.

Mercury Cleared, Atrial Fibrillation Stops!

By 2000, through chelation therapy treatments, the mercury was finally out of his system. And surprise! His atrial fibrillation stopped too. (It is known mercury can concentrate in nerve tissue.) While it’s only a correlative relationship―mercury out of system―his atrial fibrillation did stop.

For 10 years He had No Atrial Fibrillation

In 2010, while starting a hike, the atrial fibrillation began again. The A-Fib would last 6-8 hours and occur an average of 2 times per week. He was immediately tested for heavy metals again…continue reading Charn’s A-Fib story…

No Magic A-Fib Pill: Learn All Your Treatment Options


“To date, the magic pill that will permanently cure your A-Fib probably doesn’t exist.

‘Drugs don’t cure A-Fib. But merely keep it at bay.’ Dr. Dhiraj Gupta, Heart rhythm specialist, UK”


Don’t let your doctor leave you in A-Fib.

Educate yourself about Atrial Fibrillation. Learn about all treatments for Atrial Fibrillation. Review all your options on our page, Decisions About Treatment Options.

And always aim for a Cure!

 

 

 

Now A-Fib Free: A 23-Year Atrial Fibrillation Ordeal, Trial, Tribulations and Recovery

By Charn Deol, Richmond, British Columbia, Canada, May 2017
Personal A-Fib story by Charn Deol, BC, Canada at A-Fib.com

Charn Deol, B.C., Canada

My medical issues with atrial fibrillation started when I was 43 in August of 1993 when I was aware of having a few skipped heartbeats. I had just returned to Canada having been working extensively for the last few years in Southeast Asia. About a week later, the irregular heart beating got worse in duration.

At the same time, a dull aching pain started in the left chest region the size of a 50-cent piece.

A-Fib Drugs Don’t Work, Chest Pain Condition Worse

Upon being sent to a heart specialist in September 1993, numerous drugs were prescribed to keep my heart in rhythm (digoxin, flecainide, sotalol). They did not work, some had serious side effects, and every few days I would go into atrial fibrillation.

The atrial fibrillation happened once or twice per week and lasted from a few hours to 24 hours. Then it would stop on its own, and the heart would go into normal sinus rhythm.

Second medical condition: At the same time, the very centered pain in the upper left chest area kept getting worse and added to the debilitation of daily life. These medical conditions started my long journey to find relief (cure) from two medical conditions that were not being controlled or cured by conventional medical treatments.

Alternative Healthcare Practitioners―India & China, Too

In my search for a cure(s), I met a family practitioner and other medical and alternative specialists who used treatment protocols that could be labeled ‘experimental’ or ‘out of the box’, as they say.

I was all mixed up as to what was going on in my body. This can be psychologically very distressing if you do not have a strong family/friend support network.

While discovering alternative medical treatments in 1994, I also went to India for Ayurvedic treatment [one of the world’s oldest holistic healing systems] and even to China for treatment. Most alternative (non-allopathic) medical practitioners look at the body as an interconnected processing unit and believed in my case that the pain in the left chest and the atrial fibrillation were connected. This was not the thinking of the allopathic doctors, so I was all mixed up as to what was going on in my body. This can be psychologically very distressing if you do not have a strong family/friend support network.

Having been to a multitude of healthcare practitioners, numerous chiropractors, massage therapists and other more esoteric healthcare practitioners (100s over the 23 years), there was no resolution to my medical condition.

Encainide Drug Therapy: Up and Out

The heart specialist that gave me sotalol [an antiarrhythmic drug] in 1995 gave me a dose that dropped the heartbeat to 30 beats per minute putting me into the emergency room, but the drug had no effect on my atrial fibrillation.

In 1996 seeing my third cardiologist, I was put on a drug called encainide [also an antiarrhythmic drug], to be used on an as needed basis [pill-in-the-pocket].  It worked and would stop my atrial fibrillation in approximately 20 minutes.

But it had no effect on the chest pain which was getting worse now with a pain spot in the left shoulder blade area also the size of a 50-cent piece having started out of nowhere.

Encainide is a class Ic antiarrhythmic agent. It is no longer used because of its frequent proarrhythmic side effects.

About 6 months after starting on the encainide, one of my friend’s son with a heart condition since childhood passed away. And I was told he had just been started on a new drug for him called “encainide” along with “sotalol”. The same cardiologist had been providing this drug free of charge to me, so I was pleased that it worked for me and cost me nothing.

The problem I found out was that it was illegal for the cardiologist to prescribe this drug because it had killed too many people. When he got caught, then encainide was no longer available. (Encainide is a class 1C antiarrhythmic drug no longer used because of its frequent proarrhythmic effects.)

Chelation for Very High Levels of Mercury

I had the highest level of mercury ever seen by the lab in any of their patients.

While all the above was going on, I was tested for heavy metals through urine analysis. It was discovered that I had the highest level of mercury ever seen by the lab in any of their patients (7400 nmol/dl). So I started protocols to take the mercury out of my body using chelation treatments with EDTA and then DMPS and DMSA (metal chelators).

At the same time, my other medical practitioners had me on oral and IV multivitamins and mineral protocols.

Mercury Cleared, Atrial Fibrillation Stops!

By 2000, the mercury was finally out of my system and my atrial fibrillation stopped! It is known mercury can concentrate in nerve tissue. While only a correlative relationship―mercury out of system―my atrial fibrillation did stop.

Chest Pain Condition Worse than Ever

From 2000 to 2010 I had NO atrial fibrillation. But the chest pain condition did not stop, and it got worse.

From 2000 to 2010 I had no atrial fibrillation. But the chest pain condition did not stop, and it got worse extending into my gut region. All medical protocols tried could not alleviate this pain, nor was any etiology discovered as to what was the underlying cause of the pain condition.

Thanks to my resiliency, I was still able to go hiking, skiing, travel and work part-time on my own schedule. But it took great perseverance.

After 10 Years A-Fib Returns―and Heavy Levels of Lead (This Time)!

In 2010, while starting a hike, the atrial fibrillation began again. The A-Fib would last 6-8 hours and occur an average of 2 times per week.

I was immediately tested for heavy metals again, and this time I had high levels of lead, not mercury. Even with thorough investigations of potential sources for this lead contamination in my body, no source was discovered. We worked (and continue to work) on getting these lead levels down (I had no high lead levels back in the 1990’s when tested―only mercury).

Amiodarone Bad Side Effects

I again began doing alternative treatments to deal with the atrial fibrillation and the pain condition, nothing worked. I went to China again for treatments, IV EDTA infusions again, etc., but the pain persisted at high levels and the atrial fibrillation kept getting worse.

A new cardiologist put me on a new drug called amiodarone. This drug lead to paranoia. This is another cardiologist I dropped.

In 2012, I saw a new cardiologist who put me on flecainide again. And when it did not work, he provided me with a new drug called amiodarone. This drug lead to paranoia and left me with an epididymitis in my right testicle which I suffer from to this day. (Epididymitis is inflammation of the tube at the back of the testicle that stores and carries sperm.) He had no compassion for my dilemma. This is another cardiologist I dropped.

Ablation in Vancouver, B.C. Fails―A-Fib Worse and More Chest Pain

By late 2014, the atrial fibrillation was occurring on average every second day and lasting 24-38 hours.  My next cardiologist sent me to the Atrial Fibrillation clinic in Vancouver where I was evaluated by an electrophysiologist. The A-Fib was very debilitating, so I was ready for surgery.

VIDEO: Catheter Ablation For A-Fib: What it is, How it’s Done and What Results Can Be Expected

WATCH A VIDEO: Catheter Ablation For A-Fib: What it is, How it’s Done and What Results Can Be Expected (4:15)

I asked for the most experienced electrophysiologist at the clinic to do the surgery. I waited an extra 3 months for the surgery because this highly qualified electrophysiologist was in so much demand.

Finally, in November 2015 I had the ablation therapy (it took approximately 2.5 hours). I came out of the surgery worse than ever. The atrial fibrillation did not stop, and the pain was worse than ever in my left chest, left shoulder-blade and gut regions.

AV Node Ablation & Pacemaker?―No! No! No!

The electrophysiologist wanted to wait for the 6 month recuperation period after the ablation therapy to see if I would go into regular sinus rhythm. By September 2016 (9 months later), I was worse than ever. In November, I saw my electrophysiologist under the impression that he would do another ablation treatment, since I was told and with my own research had confirmed that ablation treatments may be required for up to four times for the treatment to work.

This “top” electrophysiologist recommended I have a pacemaker put in and the AV node be ablated instead, so that the pacemaker could take over the regular beating of the heart. I asked the electrophysiologist why not do further ablation treatments as per the standard practice. He said if that is what I wanted, he would do another ablation. This was quite disconcerting―I am relying on his extensive knowledge to help me in a field where I am no expert. We agreed to set up a surgical date for a second ablation on December 12, 2016.

My gut said to ‘no longer trust’ this supposed best electrophysiologist at the hospital.

Upon leaving the office and arriving home, I informed my wife of the unpleasant appointment I had with the electrophysiologist, especially his lackadaisical attitude towards my serious heart condition. As a patient, the relationship is somewhat like that of a child with a parent. The patient is naïve, scared, distraught and looking for a path of reassurance from the medical profession. This was not the case in this situation.

This is when “gut instincts” come into play. My gut said to ‘no longer trust’ this supposed best electrophysiologist at the hospital and search for an alternative path. (And I canceled my December 12, 2016 scheduled ablation.)

Counseling with Steve Ryan

Having been a reader of Steve Ryan’s website, I reached out to him and agreed for him to become my advocate and provide me with advice on how to deal with my current concerns over either going along with having a pacemaker placed in my chest along with ablation of the AV node OR to try a second ablation. Steve recommended a second ablation and the Bordeaux Clinic―it was too early to place a pacemaker/ablate the AV node at this stage.

Following this detailed discussion with Steve, I spoke with my wife and got a hold of the Bordeaux Clinic in France on December 2, 2016. With some back and forth email communication, ablation therapy was arranged for December 12, 2016. Somehow with luck and quick action, my wife and I were on an airplane to France and arrived in Bordeaux on December 10.

Second Ablation in Bordeaux and Use of CardioInsight Vest

The surgery on December 12 was done by Prof. Mélèze Hocini. Instead of taking the standard time of 2.5 to 3 hours for the surgery, it took well over 6 hours until approximately 4 pm. Dr Hocini was on her feet and exhausted.

My surgery was much more complicated than envisioned, and there were many areas that had to be ablated not only for the atrial fibrillation but also for atrial flutter.

I was informed the next day that my surgery was much more complicated than envisioned, and there were many areas that had to be ablated not only for the atrial fibrillation but also for atrial flutter. It appeared the “top” specialist I had used in Vancouver had not done his job properly. (Remember that I had been worse for the year after my first ablation).

Dr. Hocini was able to see the numerous sites leading to the atrial fibrillation/flutter in my heart due to an advanced computer assisted mapping vest (CardioInsight) which helps the electrophysiologist see in more detail cells in the heart that are acting erratically.  This system is just starting to be used in the U.S. by a few doctors. (See Bordeaux ECGI CardioInsight)

Successful Ablation—No A-Fib, But Chest Pain Condition Continues

I felt great the day after the surgery, no atrial fibrillation or flutter. Pain syndrome still there. I remained in the hospital for 4 more days and all went well, and then stayed in France for 7 more days sightseeing. No problems. I was to continue on Xarelto to keep the blood thin [for risk of stroke].

At Home A-Fib Returns with Persistent A-Flutter

Upon arriving back in Canada, the atrial fibrillation and flutter returned. Dr Hocini recommended cardioversion which I did twice but I still ended up in persistent atrial flutter with a heartbeat in the 130 range but no longer irregular.

Another cardioversion with sotalol converted my heart beat to sinus rhythm. I have now remained in rhythm since February 17, 2017.

Beta Blockers were tried to lower the heartbeat for a few weeks which did not work. Dr. Hocini recommended another cardioversion with sotalol prescribed for after the cardioversion. This was done on February 17, 2017. The heartbeat converted to sinus rhythm (65 heartbeat and was regular).

Normal Sinus Rhythm―4+ Months So Far

I have now remained in rhythm since February 17, 2017 with a quick flutter occurring once in a while. Since I am sensitive to prescription medications, I was placed on a low dose of 40 mg sotalol 2 times per day.

Minerals, Vitamin IVs for Inflammation of the Heart

With my other medical practitioners, I also had mineral and vitamin IVs during this time to help alleviate the inflammation in my heart from the surgery. I also took (and continue to take) vitamins and supplements as recommended by the other medical professionals treating me to keep the inflammation in the heart down.

Dr. Hocini had stated that since my ablation surgery was so complicated, I might have to go back to Bordeaux for another ablation. I have to get through the recommended 6 month recuperation time frame to see if the surgery has been successful. The last 3 months have me heading in the right direction of recovery.

Lessons Learned: After 23 Years with A-Fib

From this experience I’ve learned to obtain as much knowledge as possible of your condition. Trust your gut feelings if you feel uncomfortable with your surgeon. Increase your intake of nutritious foods and supplements prior to and after the surgery. Steve Ryan’s website provided me with the knowledge to make educated decisions.

If you have the funds and/or a complicated atrial fibrillation situation, please find the best surgeon you can and then still question him/her. Get a second [or third] opinion if your gut tells you to.

Doctors are just human beings with positive and negative traits like the rest of us. My first surgeon did not do his job properly in my first ablation and was flippant in his attitude in recommending a second surgical treatment.

With luck, trusting my gut instinct, educating myself, and a great family support system, I was able to find the best clinic in the world to treat me for this very debilitating medical condition.

I welcome your email if I can be of help to you.

Charn Deol, May 2017
charnee@gmail.com

P.S. FYI: My chest pain problem persists and goes undiagnosed, but that’s a story for another website!

Editor’s Comments:
Three month ‘blanking’ period: Charn’s A-Fib returned after his successful second ablation. This is quite common in more difficult cases. Your heart is ‘learning’ to beat normally again. That’s why doctors wait for at least three months before declaring your ablation a success. In Charn’s case, during the first two months, a couple rounds of cardioversions were followed by a third with sotalol prescribed after the cardioversion. This worked to get his heart back into and stay in normal sinus rhythm (NSR).
Be a proactive patient: Charn’s story is truly inspiring and an example of being proactive and not giving up. Do research yourself, get advice, and check out alternatives! We’ve been conditioned to trust doctors. Sometimes we just have to say “NO! That doesn’t make sense to me”. It’s okay to fire your doctor!
I told Charn an AV Node ablation is a treatment of last resort; it destroys the AV Node, the heart’s natural pacemaker. There’s no going back and you are forever pacemaker dependent.
Instead, I advised Charn to seek a second ablation and supplied him a list of Master EPs who routinely treat difficult, complex cases. Kudos to him for deciding to go to the Bordeaux group, considered the best in the world. [For more about Bordeaux, see my article, ‘2016 Cost of Ablation by Bordeaux Group (It’s Less Than You Might Think)’].
Chelation therapy: Chelation is FDA approved for lead removal and is the preferred medical treatment for metal poisoning. But few doctors perform chelation therapy or provide heavy metal testing. To find a doctor for these therapies, go to: http://www.acam.org. (They also do IV therapy for vitamin C and other vitamins and minerals which seems to have helped Charn.)
Amiodarone drug therapy: Amiodarone is considered the most effective of the antiarrhythmic drugs, but it’s also the most toxic and is notorious for bad side effects, including death. It’s generally prescribed only for short periods of time such as for a few months after a catheter ablation and under very close supervision. (For more about Amiodarone, see my article, ‘Amiodarone: Most Effective and Most Toxic‘.

Read our 12-page free report.

Charn’s second ablation Operating Report: Charn’s ablation was more difficult than most. He had been in A-Fib off and on for 23 years. In addition to having to work around a previous failed ablation, Dr. Hocini had to track down and ablate many non-PV triggers. Using the CardioInsight system, Dr. Hocini found A-Fib sources in the septum and in the anterior Left Atrium (LA) region, and his left and right inferior PVs had to be re-isolated.
But Dr. Hocini didn’t stop there. Using pacing again, Dr. Hocini found peri-mitral flutter in Charn’s left atrium which terminated by completing an anterior mitral line and required high energy because of the thickness of his heart tissue. Dr. Hocini had to work on Charn for six hours to the point of exhaustion.
Charn’s chest pain continues: Charn’s debilitating chest pain seemed to start when he first developed A-Fib. I’m disappointed that being A-Fib-free didn’t get rid of the pain he still experiences. I’ve never heard of pain like this coming from A-Fib. Charn has seen many doctors and tried alternative strategies to no avail.
If anyone has any ideas, strategies, or insights to help Charn’s pain, please email me.

Back to top

Return to Patient A-Fib Stories
If you find any errors on this page, email us. Y Last updated: Sunday, June 4, 2017

 

 

When Tracking Your Heart: Is a Wrist-Worn Heart Rate Monitor Just as Good as a Chest Strap Monitor?

Wrist-worn heart rate fitness trackers like Fitbit and Apple Watch have become trendy wrist accessories, but are they accurate enough for Atrial Fibrillation patients? How do fitness trackers compare to chest strap heart rate monitors (HRMs)?

What’s Behind the Discrepancies? Different Technologies

Chest-band HRM transmitted to wristwatch

Chest strap style heart rate monitors are consumer products designed for athletes and runners, but used by A-Fib patients, too. They measure the electrical activity of the heart. They’re usually a belt-like elastic band that wraps snugly around your chest with a small electrode pad against your skin and a snap-on transmitter.

The pad needs moisture (water or sweat) to pick up any electrical signal. That information is sent to a microprocessor in the transmitter that records and analyzes heart rate and sends it to a wrist watch display or smartphone app.

Optical HRM with LEDs on inside

Wrist fitness trackers typically sit on your wrist and don’t measure what the heart does. Most glean heart-rate data through “photoplethysmography” (PPG) with small LEDs on their undersides that shine green light onto the skin on your wrist.

The different wavelengths of light interact differently with the blood flowing through your wrist, the data is captured and processed to produce understandable pulse readings on the band itself (or transmitted to another device or app).

HRMs Research Study

A 2016 single-center study was designed to find out whether wrist-worn heart rate monitors readings are accurate. Four brands of fitness trackers were compared against the Polar H7 chest strap heart monitor (HRM) and, as a baseline, with a standard electrocardiogram (ECG).

On a personal note, I used a Polar-brand chest-band monitor when I had A-Fib, and that’s what I recommend to other A-Fib patients.

Researchers at the Cleveland Clinic enrolled 50 healthy adults, mean age, 37 years. In addition to ECG leads and the Polar chest-band heart rate monitor, patients were randomly assigned to wear two different wrist-worn heart rate monitors (out of the four).

Participants completed a treadmill protocol, in which heart rate was assessed at rest and at different paces: between two and six miles per hour. Heart rate was assessed again after the treadmill exercise during recovery at 30 seconds, 60 seconds and 90 seconds.

In total, 1,773 heart rate values ranging from 49 bpm to 200 bpm were recorded during the study. Accuracy was not affected by age, BMI or sex. The four wrist-worn heart rate monitors assessed were the Apple Watch (Apple), Fitbit Charge HR (Fitbit), Mio Alpha (Mio Global) and Basis Peak (Basis).1

HRMs Study Results

Chest Strap Monitors: The chest strap monitor was the most accurate, with readings closely matching readings from the electrocardiogram (ECG).

The chest strap monitor was the most accurate, closely matching the ECG; The wrist-bands were best when the heart was at rest.
In general, the chest straps were more accurate because the sensor is placed closer to the heart (than a wristband), allowing it to capture a stronger heart-beat signal.

Wrist-Worn Monitors: Accuracy of wrist-worn monitors was best at rest and became less accurate with more vigorous exercise, which presumably is when you’d most want to know your heart rate.

None of the wrist-worn monitors achieved the accuracy of a chest strap-based monitor. According to the electrocardiograph, some wrist-worn devices over- or underestimated heart rate by 50 bpm or more.

What Patients Need to Know

Blue-tooth chest-band with smartphone app at A-Fib.com

Blue-tooth chest-band with smartphone app

Wrist-band optical heart-rate monitors may be more convenient or comfortable and have advanced over the years. But in this small study, researchers found that chest-strap monitors were always more accurate than their wrist counterparts and more reliable and consistent.

When monitoring your heart beat rate is important to you (while exercising or doing heavy work), you’ll want to stick with an electrode-containing monitor (chest band-style, shirts or sports bras with built-in electrode pads, etc.).

To help you choose a HRM, see Steve’s Top Picks: DIY Heart Rate Monitors for A-Fib Patients at Amazon.

Bottom line 
Leave the wrist-worn trackers for the casual fitness enthusiasts

References for this Article
Footnote Citations    (↵ returns to text)

  1. Safety Recall of Basic Peak Watch, Sept. 16, 2016: http://www.mybasis.com/safety/

The Effect of Diet & Nutrition on Your A-Fib: My Top 5 Articles

Many patients wonder if eating or avoiding the right foods might lessen or improve their A-Fib symptoms. While we don’t know of any diet to “cure” your A-Fib, you might consider the “DASH” eating plan recommended by U.S. National Heart, Lung and Blood Institute which reduces the risk of developing cardiovascular disease.

The following articles may answer some of your A-Fib-related questions involving diet and nutrition:

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

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

3. Personal A-Fib story: “No Way Am I Having an Ablation! But Diet and Meds Disappoint—A-Fib Free After Ablation” by Saul Lisauskas

4. Nutrition: Why are doctors so opposed to nutrition as a way of helping A-Fib. I tried to talk with my doctor about magnesium and other nutritional supplements. ‘There’s no proof that they work,’ was his response.”

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

Be a Sleuth: Keep an Episode Diary

Keep a diary of your A-Fib episodes

To determine if certain foods or beverages may be triggering the number and duration of your A-Fib attacks, start by keeping a log or diary. When an episode occurs, note the day & time, duration and what you were doing, eating or drinking.

As you collect data, scrutinize your log entries for patterns and specific triggers. This may lead you to lessen or eliminate certain foods or beverages or even activities that appear to trigger your A-Fib. You may want to share your log with your doctor.

Updated Steve’s List: US Doctors Installing the Watchman Device

If you are at high risk for stroke but can’t or don’t want to take anticoagulants, your doctor may suggest closing off the Left Atrial Appendage using an occluder such as the FDA approved Boston Scientific WATCHMAN™.

Steve’s List of Specialists Installing the Watchman: My original list of doctors installing the Watchman was limited to those EPs participating in the clinical trials. In 2015 the FDA approved the Watchman for use in the U.S. Since then my list of doctors installing the Watchman has expanded. (Internationally, the Watchman has been available since 2009.)

Watchman device - A-Fib.com

Watchman occlusion device by Boston Scientific

How to Find a Specialist: Today, you can visit the Boston Scientific website to find medical centers installing the Watchman device; just enter a state or postal code.

Use Steve’s List instead: When looking to install a Watchman device, I recommend you seek an electrophysiologist (EP) who is certified in “Clinical Cardiac Electrocardiography”. Use my list which is organized by state and city. Go to, Steve’s List of Specialists Installing the Watchman Device.

To learn more about the Watchman, see: The Watchman Device: My Top 5 Articles.

New FAQ About A-Fib Drug Therapy: Any Guarantee Against Stroke?

The following FAQ is very timely as a close friend of mine just suffered a major stroke, even though she was on Coumadin and her INR was in the correct range. I can’t tell you how discouraging this is, not just for her but for me, too. I worked with her to get the best treatment possible and by one of the best EPs in our area. But she still had a stroke.

Q: “I’ve heard of people with A-Fib on anticoagulants who still had a stroke. What can I do to make sure I never have a stroke?”

A: There is currently no way to absolutely guarantee you will never experience a stroke. “Even when A-Fib patients are effectively anti-coagulated, 14% are still found with clots,” stated Dr. John Camm of St. George’s Medical School, London, England, at the 2008 Boston AF Symposium.

Read more of my answer: how anticoagulants can significantly lower your overall stroke risk by as much as 70%, how closing off your Left Atrial Appendage (LAA) can stop 90%–95% of A-Fib clots which usually originate in the LAA, and whether you should consider combining the Watchman with anti-coagulation… Continue reading… .

FAQ: With A-Fib, Can I Make Sure I Never Have a Stroke?

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

FAQs A-Fib Drug Therapy: Guarantee Against Stroke?

“I’ve heard of people with A-Fib on anticoagulants who still had a stroke. What can I do to make sure I never have a stroke?”

This question is very timely as a close friend of mine just suffered a major stroke, even though she was on Coumadin and her INR was in the correct range. I can’t tell you how discouraging this is, not just for her but for me, too. I worked with her to get the best treatment possible and by one of the best EPs in our area. But she still had a stroke.

There’s No Absolute Guarantee

There is currently no way to absolutely guarantee you will never experience a stroke. “Even when A-Fib patients are effectively anticoagulated, 14% are still found with clots,” stated Dr. John Camm of St. George’s Medical School, London, England, at the 2008 Boston AF Symposium.

Anticoagulants Reduces A-Fib Stroke Risk

Anticoagulants can significantly lower your overall stroke risk. When warfarin was first approved (in 1954 with brand names: Coumadin and Jantoven), it was considered a ‘wonder drug’. It reduced the risk of an A-Fib stroke by as much as 70%―a huge reduction. For the first time, doctors (and patients) had something that would work to significantly lower the risk of an A-Fib stroke.

Caution: Anticoagulants are High Risk Drugs

Be aware that anticoagulants in general are considered high risk medications. They work by causing or increasing bleeding. They aren’t like taking vitamins.

As Thomas J. Moore of the Institute for Safe Medical Practices points out, “Anticoagulant treatment for people with A-Fib ranks as one of the highest risk treatments in older Americans…more than 15% of older patients treated with blood thinners for 1 year have bleeding.”

Nevertheless, for most people, even though anticoagulants are considered high risk meds, they are a welcome trade-off to having an A-Fib stroke.

An Medication Alternative: The Watchman Occlusion Device

The Left Atrial appendage (LAA) is where 90%–95% of A-Fib clots originate. Closing off the LAA is an alternative strategy for people who can’t or don’t want to take anticoagulants. The Watchman Device (Boston Scientific), an occlusion device, is an ingenious method of closing off the LAA. (Other occlusion devices include the Lariat II and AtriClip surgical device.)

Inserting the Watchman is a very low risk procedure which takes as little as 20 minutes. Usually afterwards, the patient doesn’t need to be on an anticoagulant.

Combine the Watchman with an Anticoagulant?

One may wonder: Could combining a Watchman Device with an anticoagulant (to prevent strokes from other parts of your heart) come close to guaranteeing you will never have a stroke?

This treatment strategy is very speculative. I don’t know of any clinical studies on this subject.

However, if you have a Watchman Device installed, you could discuss with your doctor continuing on an anticoagulant as added protection.

Reference for this Article

Return to FAQ Drug Therapies
Last updated: Tuesday, May 16, 2017

 

FAQ: After Ablation—What’s my Chance of Staying A-Fib Free?

There is a tendency for ablated heart tissue to heal itself, regrow the ablated tissue, reconnect, and start producing A-Fib signals again. But if this happens, it usually occurs within the first three to six months of the initial PVA(I).

An A-Fib.com reader sent me this question about recurrence of his A-Fib after a successful ablation:

Illustration of catheter ablation

Illustration of catheter ablation of pulmonary vein

“Since my PVI, I have been A-Fib free with no symptoms for 32 months. What do you think my chances of staying A-Fib free are?”

Regrowth/Reconnection of Ablated Heart Tissue

I think your chances of staying A-Fib free are pretty good.

If your Pulmonary Veins (PV) are well isolated and stay that way, you can’t get A-Fib there again. When the PVs are isolated and disconnected and haven’t reconnected, it seems to be permanent. But it’s too early in the history of PVA(I)s to say this definitively. …read the rest of my answer.

In Persistent A-Fib? Time Matters: Ablate Sooner for Better Outcomes

Note: This research study is important if you have Persistent A-Fib or your Paroxysmal A-Fib has progressed to Persistent A-Fib.

The Cost of Waiting to Ablate

In patients with persistent atrial fibrillation undergoing ablation, the time interval between the first diagnosis of persistent A-Fib and the catheter ablation procedure had a strong association with the ablation outcomes.

Cleveland Clinic researchers found that shorter diagnosis-to-ablation time spans were associated with better outcomes. Longer diagnosis-to-ablation times was associated with a greater degree of atrial remodeling.

When A-Fib becomes persistent A-Fib, the ‘first diagnosis-to-ablation time span’ had a stronger impact on outcomes than the time spent in paroxysmal A-Fib.

According to electrophysiologist Dr. Oussama Wazni, “once the diagnosis of atrial fibrillation is made, it’s important not to spend too much time trying to keep a patient in normal rhythm with medical [drug] therapy” before referring for radio-frequency ablation.” Dr. Wazni is Co-Director of the Center for Atrial Fibrillation at the Cleveland Clinic.

His comments are based on the published analysis of two-year outcomes among 1,241 consecutive patients undergoing first-time ablation of persistent atrial fibrillation over an eight-year period at Cleveland Clinic. All patients had successful isolation of all 4 PVs (pulmonary veins), and the superior vena cava was isolated in 69.6%. In addition, Left Atrium ablations (including complex fractionated electrograms) were performed in 65.6% of patients.

First Diagnosis-to-Ablation Time Span: The Shorter the Better

Importantly, the first diagnosis-to-ablation time interval (of persistent A-Fib) had a stronger impact on outcomes than the time spent with a paroxysmal A-Fib diagnosis or the duration of continuous A-Fib before the ablation procedure.

These findings suggest that A-Fib is a disease with a continuous spectrum…
The findings suggest that A-Fib is a disease with a continuous spectrum, with patients at the extreme end of that spectrum having higher arrhythmia recurrence rates after catheter ablation, whereas patients with shorter diagnosis-to-ablation times having lower recurrence rates.

The analysis was published in the Jan. 2016 issue of Circulation: Arrhythmia and Electrophysiology. (Read online or download as a PDF.)

Reference for this Article

2017 AF Symposium: Live Case of Ablation with FIRM Mapping System

Dr David Wilber Loyola University

D. Wilber, MD

In a live case, Dr. David Wilber from Loyola Un. Medical Center in Chicago, IL showed how he uses the Topera FIRM rotor mapping system to identify rotors in conjunction with a PVI. ‘FIRM’ stands for Focal Impulse and Rotor Modulation.

Patient background: The patient was a 54-year-old male in persistent A-Fib for 7 months, obese with a BMI of 31, hypertension, diabetes, and obstructive sleep apnea. He was symptomatic, with fatigue and decreased exercise tolerance. An MRI showed his Left Atrium was 15.5% fibrotic. (If using Dr. Nassir Marrouche’s Utah I–IV Classification System to rate the patient’s amount of fibrosis, this patient would be “Utah Stage 2”, i.e., a reasonable candidate for a catheter ablation.)

Voltage & FIRM Mapping: Rotors Ablated First

FIRM mapping display of left atrial rotor during atrial fibrillation.

FIRM mapping display of left atrial rotor during atrial fibrillation.

In live video streaming from Chicago, Dr. Wilber described how he first does voltage mapping while the patient is in normal sinus rhythm. He started in the right atrium, then moved to the left; he used the FIRM system to map where rotors were coming from. (In patients with persistent A-Fib, he typically finds as many as 4-8 rotors.) He mapped and ablated until there were no more rotors.

Only after using the FIRM system did he do a Pulmonary Vein ablation (PVI).

He explained that the concept of terminating A-Fib during a PVI ablation doesn’t work with the FIRM system. Instead, he looks to ablate rotational areas (which are usually 2.2 cm across). He does this by using a Contact Force sensing catheter usually at 35 watts for 30 sec.

During this ablation, he found one rotor at the base of the Left Atrial Appendage (LAA). (In the followup panel discussion, Dr. Andrea Natale commented that he and his colleagues now look first for A-Fib signals in the LAA.)

FIRM Rotors Hard to See

VIDEO examples: Dr. Wilber showed a video using FIRM in which [even to my untrained eye] it was easy to see a rotor. But he showed other videos where the overlapping, swirling waves made it difficult to see where exactly a rotor was coming from.

Editor’s Comments:
This patient was at great risk of recurrence after a catheter ablation, because of his various illnesses (comorbidities). By restoring him to normal sinus rhythm, he would be able to exercise and develop life-changing habits to reduce his obesity, diabetes, and hypertension.
ECGI CardioInsight system: Focal and re-entrant driver maps

ECGI CardioInsight system: Focal and re-entrant driver maps

Abbott Topera FIRM vs Medtronic ECGI CardioInsight:  In comparison to the ECGI CardioInsight system where the rotors and focal sources are very obvious (even to untrained observers), the FIRM system display of rotors are often confusing and hard to identify. Dr. Wilber acknowledged that it takes study and experience with the FIRM system to use it effectively.
To me, the Abbott Topera FIRM system seems hard to use. In head-to-head competition with the Medtronic ECGI CardioInsight system, I predict the FIRM system will probably not survive.
The Medtronic ECGI CardioInsight system has been in limited use in Europe and in 2017 has begun a limited rollout in the U.S.

For more on the Medtronic ECGI CardioInsight, see my article: ECGI Mapping Now Available in U.S.

For more about Dr. Nassir Marrouche’s Utah I–IV Classification System, see my article: Fibrosis Risk and the U. of Utah/CARMA website.

Reference for this Article

NOAC or Warfarin for Valvular A-Fib?

Patients with ‘Valvular Atrial Fibrillation’ are often restricted from most A-Fib clinical studies and research. In particular, for NOAC trials, people with Valvular A-Fib have generally been excluded because they may have a higher rate of forming clots (e.g.: left atrial clots). 

“Valvular Atrial Fibrillation” refers to those A-Fib patients with artificial heart valves or mitral stenosis.

Like most A-Fib patients, Valvular A-Fib patients with bioprosthetic or mechanical valves have to be on an anticoagulant which up to now was restricted to warfarin. So, are the new NOACs an option?

Bioprosthetic valves are non-synthetic (usually porcine) devices used to replace a defective heart valve. Compared to mechanical valves, bioprosthetic valves are less likely to cause clots, but are more prone to structural degeneration (35% fail within 15 years).

Warfarin vs Edoxaban (NOAC)

A 2017 study showed that the Novel Oral Anticoagulant (NOAC) edoxaban (brand name: Savaysa) was safer than warfarin in preventing an A-Fib stroke in people with bioprosthetic heart valves.

Edoxaban 30 and 60 mg (Savaysa)

Edoxaban works by inhibiting factor Xa in the coagulation process. The lower dose (30 mg) was associated with a reduced rate of major bleeding, but not the higher dose (60 mg).

Compared to warfarin, edoxaban was associated with lower annual stroke rates, systemic embolic events, major bleeds, and deaths annually.

“Our analysis suggests that edoxaban appears to be a reasonable alternative to warfarin in patients with Afib and remote bioprosthetic valve implantation,” according to Dr. Robert P. Giugliano of Brigham and Women’s Hospital in Boston, MA.

Edoxaban Works With Bioprosthetic Valves But Not Mechanical Ones

For the first time, research indicates that a NOAC (edoxaban) can be used for Valvular A-Fib to prevent an A-Fib stroke―but only in the case of bioprosthetic (porcine) valves.

The NOAC, Edoxaban (Savaysa), was safer than warfarin for A-Fib patients with bioprosthetic valves.

With regards to mechanical valves, the authors cited a study in which dabigatran (Pradaxa) fared poorly in mechanical valves.

What About Other Factor Xa NOACs?

What about the other ‘factor Xa inhibitors’ such as Xarelto and Eliquis? Can they be used like edoxaban? Currently there is little clinical data on this subject. But since all three are factor Xa inhibitors, most likely they will be proven to be effective in A-Fib patients with bioprosthetic valves.

What Patients Need to Know

Do you have Valvular A-Fib and a bioprosthetic valve? Are you on warfarin? If being on warfarin is difficult for you, you now have a choice of anticoagulant. Ask your doctor about switching to the NOAC, edoxaban.

Reference for this Article

2017 AF Symposium: Movin’ it—Protecting the Esophagus During Ablation

2017 AF Symposium

Movin’ it: Protecting the Esophagus During Ablation

Live case presenters: Drs. Rodney Horton, Amin Al-Ahmad and David Burkhardt from the Texas Cardiac Arrhythmia Institute at St. David’s Medical Center in Austin, TX. Moderator: Dr. Andrea Natale.

Patient background: A 79-year-old female needed a ‘re-do’ second ablation. She had persistent A-Fib and hypertension. Her first ablation was August 15, 2016 where they couldn’t terminate her Flutter. Because the temperature probe in her esophagus showed a rise in temperature when they tried to ablate certain areas, “we were not as aggressive as we would have liked.”

The Danger: Esophageal Fistula

During an ablation, doctors take great precautions to not heat or injure the esophagus which lies behind the posterior wall of the left atrium. Injuring the esophagus can, in very rare cases, cause an atrial esophageal fistula which can be fatal.

Fear of causing esophageal injury can cause the EP to modify the ablation lesion set delivery, thereby reducing ablation success by:

1. Reducing the wattage or amount of energy delivered to the left atrium wall which causes less complete scarring; and/or

2. Relocating the ablation lesion to a less desirable area

For this patient: During her first ablation: the doctors noticed a rise in temperature of the probe inserted in her esophagus, so her doctors stopped ablating in that area. Consequently, the A-Fib signal source(s) in that area were not isolated effectively. Result: her A-Flutter was not terminated.

Solution: Esophageal Displacement Tool

The esophagus is not a rigid, inflexible pipe but rather like a hose made out of flexible muscle fibers. It can naturally migrate side-to-side 2-3 cm on its own.

For this live streaming ablation, a new esophagus displacement tool was used: the EsoSure Esophageal Retractor. The tool allows doctors to re-position a section of the esophagus away from the nearby heart tissue and avoid the heat generated during ablation.

The inventor of the device, Steven W. Miller, RN and EP nurse, demonstrated his device to me at the AF Symposium Exhibit Hall.

EsoSure Esophageal Retractor: Shape adjusts to body temperature at A-Fib.com

EsoSure Esophageal Retractor: Shape adjusts to body temperature

At room temperature, the stylet is fairly straight which allows it to be easily inserted into a commonly used gastric tube which is routinely placed down the esophagus by the anesthesia staff. But as the stylet warms to body temperature, it takes on a greater curve. He inserted the stylet into warmed water. You could see how the stylet changed shape and developed a greater curve.

Depending on how the stylet is positioned, it can displace the esophagus up to 2-3 cm to the left or right depending on each person’s anatomy.

Using the EsoSure Retractor, the EP can easily and safely move the esophagus away from any area being ablated. It is FDA approved and has been used by different practitioners more than 700 times without damaging the esophagus.

Live Case Using the EsoSure Retractor

In this re-do ablation, the 79-year-old female patient was in A-Fib when the ablation started. They cardioverted her, but she went right back into A-Fib.

Entrainment (pacing) mapping was used to identify non-PV triggers. Since they had to ablate in the posterior of the left atrium next to the esophagus, they simply moved the EsoSure Retractor up and down to displace the esophagus. It seemed very easy to do.

The EPs mentioned that, with the use of this displacement device, they could now ablate at a higher wattage without fear of harming the esophagus. They also ablated the Left Atrial Appendage area to restore her to sinus rhythm.

What Patients Need to Know

Displacing the esophagus is a major medical advance: The EsoSure Esophageal Retractor is a major medical advance that will significantly improve not only the safety but the effectiveness of catheter ablations. Compared to any other gear in the ablation lab, the EsoSure Retractor is inexpensive ($365-$395 depending on quantity ordered). Any EP lab can and should use it, (or something similar).

Esophagus injury: All too often the esophagus lies behind the right pulmonary vein openings. Doctors have to limit both the placement and the power of their lesions out of fear of damaging the esophagus.

But being able to move the esophagus solves this problem. Ablations will be more effective, and the danger of producing an Atrial Esophageal Fistula (while rare) will be greatly reduced, if not eliminated. It will also reduce ablation procedure time.

Ask your EP: If you are scheduling an ablation, ask your doctors about their plan to prevent esophageal injury.

Return to 2017 AF Symposium Reports
If you find any errors on this page, email us. Last updated: Saturday, March 11, 2017

Reference for this Article

2017 AF Symposium LIVE VIDEO: Can Adding Fibrosis Improve Ablation Success?

Updated March 9: We added two new slides comparing the patient’s initial and subsequent DE-MRI images.

Report 13 from 2107 AF Symposium: In a live ablation from from Mass. General Hospital in Boston, Drs. Heist and Van Houzen demonstrated a pioneering strategy to treat Atrial Fibrillation patients with patchy fibrotic areas of tissue. This tissue perpetuates A-Fib.

First, a DE-MRI scan defines and measures the heart’s areas of fibrosis. Next, the doctors ablated (or filled in) these patchy areas with more fibrosis (i.e., ablation scarring) turning the patchy areas into dense fibrotic areas. Transforming patchy fibrotic tissue to dense fibrotic tissue stops A-Fib signals from perpetuating in that tissue.

It may seem counter-intuitive―create more fibrosis to make patients A-Fib free. Read more about this innovative strategy.

2017 AF Symposium Live Video: Adding Fibrosis to Improve Ablation Success?

2017 AF Symposium

Live Case: Can Adding Fibrosis Improve Ablation Success?

Updated March 13: We added two new slides.

Streaming video of an ablation by Drs. Kevin Heist and Nathan Van Houzen from Massachusetts General Hospital (MGH) in Boston, MA (moderator, Dr. Moussa Mansour).

Patient background: The case of a 62-year-old male with symptomatic persistent A-Fib, despite a previous ablation 8/9/2016. Propafenone, amiodarone, and an electrical cardioversion weren’t effective. The patient had been taken off amiodarone a week before this ablation. They cardioverted him into sinus rhythm to better measure areas of low voltage (areas of fibrosis). Low voltage areas were defined as less than 0.5 V.

Mapping Views: Lesions and Remaining Fibrosis From First Ablation

THE TOP SLIDE: The RF point-by-point ablation lesions from the patient’s first ablation done months before the live case.

RED dots represent a greater force or more time making the lesion; PINK dots represent a lower efficiency lesion due to proximity to the esophagus.

Some of these PINK dot area had reconnected and had to be re-ablated during the live case.

(“PA” is  the left atrium viewed from the back.)

THE BOTTOM SLIDE: The MRI done shortly before the live case. The BLUE areas are normal atrial tissue. The RED areas are fibrotic/scarred areas. Some of the red areas in this PA view were not ablated during the first procedure and represent spontaneous fibrosis.

Live: Ablating Areas of Fibrosis

In this live procedure from Boston, MA, Drs. Heist and Van Houzen did a normal PVI and found evidence that some areas from the patient’s previous ablation had reconnected.

The innovative aspect of this ablation is they also ablated areas of fibrosis. ‘Spontaneous fibrosis’ tends to be patchy in a way that perpetuates A-Fib.

Ablating or filling in these patchy areas with more fibrosis (i.e., ablation scarring) turns the patchy areas into dense fibrotic areas which can’t conduct or perpetuate A-Fib.

They first performed a Delayed Enhancement MRI (DE-MRI) scan of this patient’s heart in order to define and measure the areas of fibrosis.

The EPs then ablated (filled in) areas of this fibrosis, turning these patchy fibrotic regions into denser fibrotic areas. These dense fibrotic areas no longer conducted or perpetuated A-Fib.

Two months after the ablation the patient is doing well in sinus rhythm. Whereas after his first ablation, he experienced early recurrence.

What Patients Need to Know

Who Benefits from this Strategy? Adding or filling in patchy fibrotic areas with more fibrosis through ablation is a very innovative ablation strategy.

It is being applied to patients with persistent or persistent long-standing A-Fib who usually have more fibrosis, but is also being applied to paroxysmal patients who have had a durable (successful) PVI but are still in A-Fib (they often have some fibrotic areas).

The term ‘spontaneous fibrosis’ refers to fibrosis (scarring) which occurs naturally, that is, without a doctor’s procedural intervention.

Impractical for Diffused Fibrosis: This strategy doesn’t work if someone has a generalized distribution of fibrous tissue throughout their atrium. It would require ablation of the whole atrium creating too much fibrosis and causing other heart function problems.

Isn’t Creating More Fibrosis Dangerous for Patients? It certainly does seem counterintuitive―create more fibrosis to make patients A-Fib free. But we are looking at patients who already have patches of fibrosis. (If we could turn these fibrotic areas back into smooth heart muscle, then this strategy wouldn’t be necessary.)

This strategy can make people with difficult A-Fib cases A-Fib free, and make a huge difference for patients who have failed ablations.

While this strategy is exciting, we are only at the very beginning stages of this research.

Acknowledgements:

Nassir Marrouche MD

N. Marrouche MD

Dr. Nassir Marrouche: The concept of ablating areas of fibrosis was conceived by Dr. Nassir Marrouche of the University of Utah (CARMA). Dr. Marrouche has started DECAAF II, a clinical study on fibrosis to compare ablation of fibrosis areas to standard PVI ablation.

Known for the completed DECAAF study, Dr. Mansour is now collaborating with Dr. Marrouche on the DECAAF II study, and Massachusetts General Hospital (the originating site of this live streaming video) is one of the participating sites. For more, see my 2017 AF Symposium article A-Fib Increases Fibrosis.

Dr. Kevin Heist: I would like to thank Dr. Kevin Heist, Mass. General Hospital, for patiently explaining to me the concept, rationale and strategy of ablating areas of fibrosis. (I really needed his help!)

Return to 2017 AF Symposium Reports
If you find any errors on this page, email us. Last updated: Monday, March 13, 2017

Reference for this Article

Follow Us
facebook - A-Fib.comtwitter - A-Fib.comlinkedin  - A-Fib.compinterest  - A-Fib.comYouTube: A-Fib Can be Cured!  - A-Fib.com


A-Fib.com is a
501(c)(3) Nonprofit



Your support is needed. Every donation helps, even just $1.00.



A-Fib.com top rated by Healthline.com for fourth year 2014  2015  2016  2017

A-Fib.com Mission Statement
We Need You

Mug - Seek your cure - Beat Your A-Fib 200 pix wide at 300 resEncourage others
with A-Fib
click to order

Home | The A-Fib Coach | Help Support A-Fib.com | A-Fib News Archive | Tell Us What You think | Media Room | GuideStar Seal | HON certification | Disclosures | Terms of Use | Privacy Policy