ABOUT 'BEAT YOUR A-FIB'...


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

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

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

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

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

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



ABOUT A-FIB.COM...


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

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

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

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

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

Terry Traver, former A-Fib patient

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

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


Cardioversion

FAQs Understanding A-Fib: Which Procedure Has the Best Cure Rates

 FAQs Understanding A-Fib: Best Cure Rate

FAQs Understanding Your A-Fib A-Fib.com15. “I have paroxysmal A-Fib and would like to know your opinion on which procedure has the best cure rate.”

The best cure rate isn’t the only criteria you should consider when seeking your Atrial Fibrillation cure.

Let me first review your top three procedure options: cardioversion, catheter ablation, and surgical Maze/Mini-Maze.

Electrocardioversion: When first diagnosed with Atrial Fibrillation, doctors often recommend an Electrocardioversion to get you back into normal sinus rhythm. But for most patients, their A-Fib returns within a week to a month. (However, you might be lucky like the A-Fib patient who wrote us that he was A-Fib free for 7 years after a successful cardioversion.)

Catheter Ablations: Radio-frequency and CryoBalloon catheter ablations have similar success rates 70%-85% for the first ablation, around 90% is you need a second ablation. Currently, CryoBalloon ablation has a slightly better cure rate with the least recurrence.

It’s crucial you choose the right electrophysiologist (EP), one with a high success rate and the best you can afford.

How to achieve these high success rates? It’s crucial you choose the right electrophysiologist (EP), one with a high success rate and the best you can afford (considering cost and any travel expense). What counts is the EP’s skill and experience.

You want an EP who not only ablates your pulmonary veins, but will also look for, map and ablate non-pulmonary vein (PV) triggers. That may require advanced techniques like withdrawing the CryoBalloon catheter and replacing it with an RF catheter to ablate the non-PV triggers. (See our Choosing the Right Doctor: 7 Questions You’ve Got to Ask [And What the Answers Mean].) 

Cox Maze and Mini-Maze surgeries: Success rates are similar to catheter ablation, 75%–90%. But surgery isn’t recommended as a first choice or option by current A-Fib treatment guidelines. Compared to catheter ablations, the maze surgeries are more invasive, traumatic, risky and with longer (in hospital) recovery times

When should you consider the Maze/Mini-Maze? The primary reasons to consider a Maze surgery is because you can’t have a catheter ablation (ex: can’t take blood thinners), you’ve had several failed ablations, or if you are morbidly obese.

Atrial Fibrillation is not a one-size fits all type of disease.

You should also consider that Mini-Maze surgeries have built in limitations. For example, unlike catheter ablations, mini-maze surgery can’t reach the right atrium, or other areas of the heart where A-Fib signals may originate (non-PV locations). The more extensive surgeries create a great deal of lesions burns on the heart which may impact heart function.

So How Do You Choose the Best Treatment For You?

Atrial Fibrillation is not a one-size fits all type of disease.

Your first step is to see a heart rhythm specialist, a cardiac electrophysiologist (EP), who specializes in the electrical function of the heart.

An EP will work with you to consider the best treatment options for you. If your best treatment option is surgical, your EP will refer you to a surgeon and continue to manage your care after your surgery.

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

Comment

If you find any errors on this page, email us. Last updated: Wednesday, August 24, 2016

Go back to FAQ Understanding A-Fib

New Story: Cardiologists Offer Little A-Fib Advice to Fellow Doctor

John Bennett, MD, practices emergency medicine in Miami, Florida. Dr. Bennett is known for his series of Google Hangouts live videos featuring experts in a variety of medical fields. To learn more, visit his website, Internetmedicine.com, “Where the Internet Meet Medicine.” His Atrial Fibrillation started at age 57.

John Bennett MD personal A-Fib story at A-Fib.com

John Bennett MD

“As a physician, I had the usual knowledge most physicians have about A Fib—which is not much. Especially the care of chronic Atrial Fibrillation. Like most people, I trusted my cardiologist to do the best thing for me.

First Cardiologist No Options But Drugs—I Hated Coumadin

My first cardiologist did the usual workup, and prescribed Coumadin. I hated that medicine. Made me feel tired, no energy, but I accepted it.

Finally, I got tired of being tired, so I started to do some online research.

I found out that you could elect to be cardioverted, which my first cardiologist did not even mention (since, of course, he would lose me as a patient, if I returned to normal sinus rhythm).

Electrocardioversion Works for 7 Years

I then went straight to an Electrophysiologist (EP), who converted me, and it lasted 7 years. Then last year…” Continue reading Dr. John Bennett’s story->

Cardiologists Offer Little A-Fib Advice, Even to a Fellow Doctor!

John Bennett MD personal A-Fib story at A-Fib.com

John Bennett MD

By John Bennett, MD, July 2016

John Bennett, MD, is known for his series of Google Hangouts live videos featuring experts in a variety of medical fields. To learn more, visit his website, Internetmedicine.com, “Where the Internet Meets Medicine.” Previously Dr. Bennett worked in Emergency Medicine in Miami, Florida.

I had the good fortune to run into Steve Ryan, find his website, and get his book. Ultimately I got fine care and returned to having a healthy heart. My story being at age 57 when I suddenly went into Atrial Fibrillation.

I Trusted My Cardiologist

As a physician, I had the usual knowledge most physicians have about A Fib—which is not much, especially the care of chronic Atrial Fibrillation. Like most people, I trusted my cardiologist to do the best thing for me.

My first cardiologist did not even mention cardioversion to get me back in sinus rhythm.

First Cardiologist No Options But Drugs—I Hated Coumadin

My first cardiologist did the usual workup, and prescribed Coumadin. I hated that medicine. Made me feel tired, no energy, but I accepted it.

Finally, I got tired of being tired, so I started to do some online research.

I found out that you could elect to be cardioverted, which my first cardiologist did not even mention (since, of course, he would lose me as a patient, if I returned to normal sinus rhythm).

Electrocardioversion Works for 7 Years

Well, he did. I then went straight to an Electrophysiologist (EP), who converted me, and it lasted 7 years. I was cardioverted again but this time it only lasted 5 months.

Still, no talk of catheter ablation. I had to chase my doctor down the hall to say, “What’s the plan?”

Research and reading  ‘Beat Your A-Fib’, I found I might be a candidate for catheter ablation.

Ablation and A-Fib Free—“Beat Your A-Fib” Book

Next, I went back to the internet where I ran across Steve’s book, ‘Beat Your A-Fib’ and found I might be a candidate for catheter ablation.

July 2015 I had an ablation by Dr. Todd Florin at Mount Sinai Medical Center in Miami Beach (highly recommended, good listener, super team) and returned to normal sinus rhythm.  It’s been one year and I am still in normal sinus rhythm. If you’ve had A-Fib, I don’t have to tell you the difference between A-Fib and sinus rhythm.

I am truly appreciative about Steve’s work [A-Fib.com] and his book. I feel like a real human being again, with normal energy levels.

Lessons Learned

Lessons Learned graphic at A-Fib.com

Take an active role in your care.

Like Steve says, catheter ablation may not be the answer for every patient with A Fib.

But you need to be aware of it! Read. Be aggressive with your cardiologist. Ask about catheter ablation [and other options]. Take an active role in the care of your pump!

Steve’s book, “Beat Your A-Fib,” motivated me to get active and investigate my treatment options.

Isn’t it sad that TWO of my Cardiologists did not care enough to even mention ablation to me? And I am a friggin’ doctor―and they treated me that way!

John Bennet, MD
Miami, Florida

Editor’s comments
Electrocardioversion best for recent-onset A-Fib: Dr. Bennett was very fortunate to have a cardioversion keep him in sinus rhythm for seven years.
Unfortunately for most patients, a cardioversion seldom lasts that long. It works best in cases of recent onset A-Fib. It’s a very safe procedure and is certainly worth a try, but cardioversion is seldom a permanent cure for A-Fib. Don’t be surprised if you’re back in A-Fib within a week to a month.

Amazing! Dr. Bennett’s fellow physicians didn’t tell him about options like electrocardioversion and catheter ablation.

You can’t always trust cardiologists (or the media): What’s most amazing about Dr. Bennett’s story is that his fellow physicians and colleagues (whom he trusted) didn’t tell him about options like Electrocardioversion and catheter ablation.
Today’s media and web sites talk about “Living with A-Fib”.  But living in A-Fib is detrimental to your long-term health.
In contrast, the message at A-Fib.com is: You don’t have to live in A-Fib. Seek your Cure.

Top 10 List #10 Be your own best patient advocate 600 x 530 pix at 300 res

 

Staying in A-Fib Reduces Brain Volume & Cognitive Function

A study of brain atrophy from Iceland found that A-Fib in the elderly caused accelerated loses of brain volume and cognitive function.

Study of brain volume and cognitive function in A-Fib patients

Study of brain volume and cognitive function in A-Fib patients

This is yet another study driving a stake into the heart of the notion that you can just leave patients in A-Fib with anticoagulants and rate control drugs, and they will live happily ever after.

“It’s better for the brain to remain in sinus rhythm than to pursue rate control of A-Fib” stated Dr. David O. Arnar, speaking of the AGES-Reykjavik Study results at the 2015 Euro Society of Cardiology Annual Congress.

The AGES-Reykjavik Study

Over two thousand elderly subjects without dementia (mean age 67 years old) were tested and followed for over 5 years. Participants had brain MRIs and structured cognitive function testing during the duration of the study.

The 2,472 elderly patients fell into three groups: those who remained A-Fib-free throughout the study, those with confirmed A-Fib at the start (121), and those who developed new-onset A-Fib (132) by the end of the study.

AGES Findings: Brain Matter

At the end of the follow-up period, all participants had a reduction in brain grey matter. The amount of reduction varied significantly by group:

• A-Fib-free: 1.8% decrease
• Ongoing A-Fib: 2.79% decrease
• New-onset A-Fib: 6.5% decrease

… Continue reading this report…->

Joe Mirretti A-Fib Story

A-Fib Patient Story #81

Joe Mirretti, Gurnee, IL

Joe Mirretti, Gurnee, IL

Two Months After A-Fib Diagnosis, 62-Year Old Cyclist Has CyroBalloon Ablation; Difficult Three-Month Blanking Period

By Joe Mirretti, Gurnee, IL, May 2015

I just turned 62 and have been an active cyclist all my life. I also run and lift weights. My resting heart rate is 47.

December 2014: First A-Fib Attack

On December 11, I got on the stationary bike, and my pulse was 100 without doing anything. When I started pedaling, it went up to 140. I thought something was wrong with my heart rate monitor. When I drove home, my heart rate was all over the place.

My wife, Wendi, took me to the Emergency Room (ER). One nurse came in and thought I had gone back into sinus rhythm since my pulse was in the 70s, but that was double my normal heart rate. When I stood up, the ER staff became more alarmed—my pulse jumped up to 170-180. They confirmed that I had Atrial Fibrillation (A-Fib).

Electrocardioversions Don’t Last, Drugs Have Bad Side Effects

The A-Fib felt terrible. I was out of breath, had palpitations, I couldn’t exercise, my heart was thumping in my chest.

The A-Fib felt terrible. I was out of breath, had palpitations, I couldn’t exercise, my heart was thumping in my chest….Even with drugs, the A-Fib would wake me up in the middle of the night.

They Electrocardioverted me December 12, 2014. That worked for about a week. But December 17 while lying in bed I sneezed and went right back into A-Fib. I had another Electrocardioversion December 19 which this time only lasted 4-5 days.

For a while I was on Diltiazem 160 mg/d and later flecainide 150 mg/2Xday. They also put me on the blood thinner Eliquis. But I had terrible side effects from these drugs, such as vertigo. When I’d take flecainide, hours after dinner my pulse would even out before going to sleep. But 3-4 hours later the A-Fib would wake me up in the middle of the night.

In early January I had a chiropractic adjustment to my back which seemed to put me back into sinus rhythm for 12 days.

With Active Life Style, Learns About Catheter Ablation

Because of my active life style, my cardiologist at Northwestern in Lake Forest (North of Chicago), Dr. Ian D. Cohen, thought I would probably need a catheter ablation.

He helped me schedule an appointment on January 9 with Dr. Albert C. Lin of the Northwestern Un. Feinberg School of Medicine/Bluhm Cardiovascular Institute which has a branch in Lake Forest. I was very impressed by Dr. Lin. He was very interested in hearing everything we had to say and was confident. I asked him if the chiropractic adjustment was responsible for getting me back into Sinus. He couldn’t say for sure, but he predicted I’d go back into A-Fib. Needless to say, he was right.

Extremely Symptomatic, Decides “I Can’t Live in A-Fib”

My wife, Wendi, and I both agreed that I should have a CryoBalloon ablation as soon as possible. I was so symptomatic I couldn’t live in A-Fib, the drugs caused me terrible side effects, and the cardioversions didn’t work.

I had read that the faster you correct or get A-Fib cured, the better.

I had read that the faster you correct or get A-Fib cured, the better you are. And we liked Dr. Lin. He was very encouraging, but wasn’t telling us we need to do this. He said, “Don’t make a decision now. Go home and discuss it.”

We decided to go with the ablation. Dr. Lin was able to schedule us for a CryoBalloon ablation February 12, 2015.

A-Fib Research Online: Encouraged By Stories on A-Fib.com

I Googled everything on A-Fib as much as I could. The stories and information you gave on A-Fib.com really helped me move forward.

I just think it’s so wonderful they are developing these ablations so quickly and improving them. I read your story how back in 1998 you were in the hospital for nearly two weeks when you had your ablation. (See Steve Ryan’s A-Fib story.) I was only in the hospital overnight.

I’ve always had skipped heart beats. The doctors have seen it on my EKGs and stress tests but were never concerned about it.

I don’t understand how some people don’t feel anything when in A-Fib. I always wore a heart rate monitor when I worked out. I’ve been keeping records of my workouts daily going back 25 years. I noticed a couple of years ago I may have had some brief episodes of A-Fib, but they corrected themselves. However, I didn’t know anything about A-Fib at that time.

I’ve always had skipped heart beats. The doctors have seen it on my EKGs and stress tests but were never concerned about it.

February 2015: My CryoBalloon Ablation Day Arrives

I remember counting the days until the scheduled ablation. That’s how bad the A-Fib symptoms were, and they were getting worse. I had an MRI on February 10, 2015 at Northwestern in Chicago.

The morning of February 12, ablation day, we got up at 4:00 am since I was the first patient of the day. My wife, Wendi, did a great job getting me there, as she does not like to drive in the city, and rush hour in Chicago is crazy. (I had not driven in three weeks because of the vertigo.)

The ablation took about four hours. I woke up in perfect sinus rhythm! Dr. Lin said he CryoAblated all four pulmonary veins, and that everything went as well as possible. He sent me home the next morning on no meds except Eliquis.

Difficult Recovery—Dealing With Weird Sensations and Worry

The recovery was difficult. The next day, out of the hospital I felt pretty rough, like I had been hit by a truck. I had no A-Fib the first 8 days, just occasional rapid heartbeats.

I was encouraged to exercise. The eighth day I got on the stationary bike for an hour. Later I had a short A-Fib attack. Dr. Lin put me back on a ½ dose of flecainide for a while.

Like everyone has said in their stories, A-Fib does such a job on your head. Every time you feel something, it scares you like you’re going back into A-Fib.

That’s been a mental battle. That’s why reading those stories helps, what other people went through those first three months. You’re going to get a number of strange things happening to you during the 3-month blanking period after an ablation. Mine have been very short.

Dr. Lin and his office were terrific during this time. I could call any time, and his assistant or Dr. Lin would call me right back.

I’m not having any A-Fib, my skipped beats and palpitations are getting shorter and shorter.

He said that my heart was otherwise very healthy. Dr. Lin said that clinically everything that has happened to me is very good, I’m not having any A-Fib, my skipped beats and palpitations are getting shorter and shorter. He thought I had around an 80% chance of success, and 90% if I had to go back for a second ablation. He said that my heart was otherwise very healthy.

But it’s a mental battle. What I’ve read is your heart is trying to go back into A-Fib and the beat is now blocked. Your heart is adjusting and getting used to beating normally again.

On and Off Meds During 3–Month Blanking Period

The day I left the hospital Dr. Lin took me off of all meds except Eliquis. But after I got the short bout of A-Fib, he put me back on ½ dose of flecainide, 75 mg 2X/d for one month. Then he put me on a little bit of metoprolol 25 mg because Diltiazem caused me such bad side effects. He said he did that because there is a possibility that the flecainide in rare cases could cause rapid heartbeat.

About a month after my ablation, he took me off of flecainide. Since then I’ve only been on 25 mg of metoprolol and Eliquis. I have given up my morning expresso and only have one glass of wine with dinner.

Lessons Learned: Three Months Post-Ablation 

I am very pleased I went ahead with the ablation. I’ve passed my 3 month blanking period (I was 30 days on a Holter monitor) with no A-Fib. I’m biking for an hour 3 days a week. I hope to encourage others with A-Fib to seek help. There are solutions out there.

If you have A-Fib, I would definitely explore ablation options as soon as possible for many reasons (i.e., avoid side-effects or reactions to meds, increase your chance of success with just one procedure, reduced anxiety and stress, etc.).

It’s helpful to read stories of other A-Fib patients. (Go to A-Fib.com/Personal A-Fib Stories of Hope.) It helps to hear what other people are going through.

After ablation, don’t push too soon. I advice you to get back to exercise slowly to give your heart a chance to heal.

In writing my story, I hope to encourage others with A-Fib to seek help. There are solutions out there. I was very healthy to begin with which probably helped the odds of the ablation being successful.

Point of Interest: Just 8 days after my ablation, my 34-year-old son, Dominic, went into A-Fib! He called me at 10:00 at night. I couldn’t believe it. Happily he’s been in sinus rhythm since they cardioverted him. [Joe and Wendi have five children and six grandchildren.]

Joe Mirretti
Email: mirritaly(at)aol.com

Editor’s Comments:
Ablation as First Choice Treatment: From the date Joe had his first A-Fib attack to his CryoBalloon ablation was barely two months!
I want to commend Dr. Ian D. Cohen, Joe’s cardiologist at Northwestern in Lake Forest. He understood that A-Fib patients don’t have to suffer through months or years while trying different drugs. Current guidelines allow you to get an ablation right away. Based on Joe’s active lifestyle he referred Joe for an ablation. 
More doctors today understand how A-Fib drugs are often ineffective and have intolerable side effects, and how terrible it can be to live in symptomatic A-Fib.
You can have a catheter ablation right away if you want. A catheter ablation is a low risk procedure (it isn’t surgery—there’s no cutting involved). It’s one of the safest cardiac procedures you can have.
Coping with the Blanking Period: We’re grateful to Joe for calling our attention particularly to the mental aspects of dealing with the blanking period after an ablation. We certainly need to develop more help and instruction so that patients can cope better during this time.
The Genetics of A-Fib: Joe’s son developed A-Fib, too. Although the exact incidence of the familial form of atrial fibrillation is unknown, recent studies suggest that up to 30 percent of people with atrial fibrillation may have a relative with the condition.
If you have a family member who has A-Fib, your chances of developing A-Fib are much greater than the average person’s. You need to be more attentive and you ought to see an Electrophysiologist (EP) to get tested for silent A-Fib. (Some people say that all A-Fib is genetic. But we don’t have the research and studies to confirm this hypothesis.)
Patrick T. Ellinor, MD, Mass. General

Genetics research with Patrick T. Ellinor, MD

Join the Genetics Research Studies Underway: Several A-Fib research centers around the US are doing ground-breaking research on genetic A-Fib. If you have 3 or 4 family members with A-Fib, you can join these studies at no cost (except travel). You and your family would be involved in cutting-edge research that is changing the way we identify and treat A-Fib. For further info, contact Dr. Patrick Ellinor at Mass General:
Dr. Patrick T. Ellinor, MD, PhD Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit St., GRB 109, Boston, MA 02114. 617-726-5067 Fax: 617-726-2155 E-mail: pellinor(at)partners.org

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Return to Patient A-Fib Stories

If you find any errors on this page, email us. Y Last updated: Sunday, July 17, 2016

 

Subject Index to A-Fib.com Articles for Additional Reading

Book of heart 2 Red in box 150 x 96Subject Index to A-Fib.com Articles

This index is a growing list of articles found throughout the A-Fib.com site that augment or supplement the major topics (each subject title is a link). If you have a keyword or topic, you can also use the ‘Search’ feature in the upper right corner of every page. New posts are flagged in Red.

Select a subject to browse articles:

♥  Dealing with Atrial Fibrillation

♥  Diagnosis & Testing

♥  Minerals Deficiencies & Supplements

♥  Drug Therapies & Medications

♥  Catheter Ablation, CyroBalloon and Pulmonary Veins Isolation

♥  Surgeries: Maze/Mini-Maze, Convergent, LAA Closure

  AF Symposium Articles by Year: Steve’s Summary Reports

♥  Research and Innovations


Didn’t find what you’re looking for?
Try the ‘Search our Site’ feature (top right of every page)


Return to A-Fib.com home page
Last updated: Monday, March 2, 2015

No Such Thing As Asymptomatic A-Fib?

At the recent AF Symposium in Orlando, Dr. Jeremy Ruskin of Massachusetts General asked, can anyone in A-Fib really be asymptomatic; that is, if you dig deep enough, will you find that A-Fib does affect their life-style or how they feel? In the case being discussed, read why Dr. Ruskin recommended an Electrocardioversion for his patient. Read more.

Can Anyone in A-Fib Really Be Asymptomatic?

AF Symposium 2015

Jeremy Ruskin, MD

Jeremy Ruskin, MD

Can Anyone in A-Fib Really Be Asymptomatic?

Dr. Jeremy Ruskin of Massachusetts General made a statement during the ‘Challenging Cases’ discussions which changed my thinking about the true nature of asymptomatic or ‘silent’ A-Fib.

Not everyone may “feel” their A-Fib symptoms…but losing that amount of blood flow must affect your body and brain in some way

When describing a patient in persistent A-Fib who is “asymptomatic,” Dr. Ruskin wondered whether someone in A-Fib can really be asymptomatic; that is, if you dig deep enough, will you find that A-Fib does affect their life-style or how they feel.

In the case being discussed, Dr. Ruskin recommended an Electrocardioversion to get the asymptomatic patient back in Normal Sinus Rhythm (NSR). Many times patients who are used to living with their A-Fib will indeed notice a difference when returned to NSR—they often feel much better.

Editor’s Comments:
In A-Fib, you lose 15%-30% of your normal pumping blood volume because the atria fibrillate instead of pumping blood down into the ventricles. Not everyone may “feel” A-Fib symptoms like chest pains, palpitation or shortness of breath. But losing that amount of blood flow must affect your body and brain in some way. Patients with persistent A-Fib may adjust their life-style to this loss of blood flow or just get used to it. Or they may compensate with strenuous exercise (making the ventricles suck blood down from the non-functioning atria like a turkey baster). But A-Fib is affecting them, consciously or not.
I have a friend who is in persistent A-Fib and is “asymptomatic.” He is a swimmer and exercises a lot. He does take a blood thinner to prevent an A-Fib stroke (which he doesn’t like. He wants to get a Watchman device installed to close off his Left Atrial Appendage [LAA] so that he doesn’t have to take anticoagulants).
I will now recommend to my friend that he get an cardioversion to see if he notices a difference when he is in Normal Sinus Rhythm (NSR) compared to being in persistent A-Fib. A cardioversion is non-invasive and pretty safe. The only problem is that the result often doesn’t last. But even if it lasts for just a few days, my friend would still be able to compare being in NSR versus living in persistent A-Fib. (I’ll also remind him that the best way to get off of anticoagulants is to cure your A-Fib.)
And returning to NSR after a cardioversion even for a few days is generally a good sign that a successful catheter ablation may fix his A-Fib, that his A-Fib hasn’t progressed so far that he can’t be shocked out of it.

Return to AF Symposium 2015: Brief Reports

Last updated: Friday, February 27, 2015

FAQs A-Fib Ablations: Is 82 Too Old for a PVA?

 FAQs A-Fib Ablations: Is 82 Too Old for a PVA? 

Catheter Ablation

Catheter Ablation

10. I am 82 years old. Am I too old to have a successful Pulmonary Vein Ablation? What doctors or medical centers perform PVAs on patients my age?”

This is a very important question since so many people in their 80s are getting A-Fib. 8-10% of people in their 80s have A-Fib. Recent studies indicate you are certainly not too old to have a successful Pulmonary Vein Ablation.

1. “Age should not preclude patients from A-Fib ablation,” according to the authors of a study comparing catheter ablation to antiarrhythmic drugs (AADs) in the elderly. 412 patients aged 70 years or older with symptomatic persistent A-Fib refractory to at least one AAD choose either ablation or AAD treatment. Pulmonary Vein Isolation (PVI) and right atrium cavotricuspid isthmus (Flutter) ablation were performed in the entire ablation group. 60% also received left atrium linear lesions at the roof and left isthmus.

The AAD group underwent electrical cardioversion (ECV) after four weeks of AAD and continued the AAD thereafter. Catheter ablation in the elderly was more effective in maintaining sinus rhythm (SR) than AAD (76% vs, 46%). And due to the higher rate of SR maintenance, the ablation group was more likely to discontinue AADs (67% vs. 28%) and oral anticoagulants (74% vs. 43%), “with a consequent greater reduction of long-term adverse events (7.7% vs. 23.9%) and greater improvement in quality of life.” (Elderly patients with a previous history of TIA/stroke had more cerebral thromboembolisms (strokes) during the ablation procedure.)

2. In a study of 103 octogenarians (with four over 90 years old) who had an A-Fib ablation and were followed for 18 months, 69% of the octogenarians were A-Fib free without AAD after a single procedure compared to 71% of those younger than 80 (no significant difference). The success rate increased to 87% after two procedures.

3. Another study looked at A-Fib ablation in patients over 80 years old vs. younger patients. The hospital stay was longer in the older patients, but there was no increased risk of complications. One-year survival free of A-Fib or Flutter was 78% in those older than 80 and 75% in those younger (no significant difference).

4. A multicenter study looked at 175 patients older than 75 who underwent catheter ablation for symptomatic A-Fib with a mean follow-up of 20 months. The ablation procedure consisted of pulmonary vein antrum isolation and isolation of the superior vena cava. 73% maintained sinus rhythm (SR) after a single ablation procedure, and the complication rate was 1%. After a second ablation, 82% maintained SR without AADs. An additional 22 patients were able to maintain SR with AADs. Thus 94% of patients older than 75 remained in SR at almost 2 years of follow-up with a very low rate of major procedure-related complications.

Editor’s comments:
The above studies demonstrate conclusively that for people over 80, not only can you have an A-Fib ablation, you probably should—especially compared to living the rest of your life on antiarrhythmic (AADs) and anticoagulant drugs. AADs produce much more long-term adverse events than an A-Fib ablation. But more importantly, a successful A-Fib ablation produces a dramatic improvement in one’s quality of life that is indeed life-changing. Ask anyone who’s had A-Fib what it’s like to have a heart that beats normally again.
If you’re over 80, many cardiologists will put you on antiarrhythmic (AADs) and anticoagulant drugs rather than refer you to an EP for an A-Fib ablation. But, all things considered, this may not be in your best interest. If this happens to you, don’t hesitate about getting a second opinion.
Some say that people over 80 years old shouldn’t have an A-Fib ablation because they are often sicker or more frail than younger people. But that isn’t always the case. People who live into their 80s often have more healthy life habits such as not smoking, good diet, aren’t overweight, low cholesterol, don’t binge drink, are more often female, take better care of themselves, and are more likely to seek good medical care if problems arise. In one study the most elderly (over 85) had a much lower complication rate (2.5%) than younger patients.
If you do have other illnesses besides A-Fib and are over 80 years old, obviously you need to take care of the more life-threatening illnesses first. But an A-Fib ablation may improve your overall health and your other illnesses, because of the improvement in your circulation and blood flow from being in normal sinus rhythm. EPs should do a thorough examination of you before designating you for an A-Fib ablation. They are unlikely to perform an ablation on someone very ill or near death’s door.
Ultimately whether or not to have an A-Fib ablation is a question only you and your doctor can answer based on your individual needs, health, medical history, how your A-Fib affects you, etc.

Centers that perform ablations on 80-year-olds

¤ Dr. Andrea Natale and his colleagues around the US are known for their success in ablating older patients. See:

•  Texas Cardiac Arrhythmia Institute/St. David’s Medical Center/ Univ. of Texas in Austin
•  California Pacific Medical Center in San Francisco, CA
•  Scripps Clinic in La Jolla, CA

¤ Intermountain Heart Rhythm Specialists in Murray, UT (near Salt Lake City)

References
¤  Go, “Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention.” JAMA, 2001:285:2370-2375. Last accessed 9/25/2014. http://www.ncbi.nlm.nih.gov/pubmed/11343485
¤  Blandino et al. Long-term efficacy and safety of two different rhythm control strategies in elderly patients with symptomatic persistent atrial fibrillation. J Cardiovasc Electrophysiol. 2013;July 24(7):731-8. Last accessed 9/25/2014. http://www.ncbi.nlm.nih.gov/pubmed/23551460.  doi: 10.1111/jce.12126. Epub 2013 Apr 1
¤  Santangeli et al. Catheter ablation in octogenarians: Safety and outcomes. J. Cardiovasc Electrophysiol 2012;23:687-693. Last accessed 9/25/2014. http://www.ncbi.nlm.nih.gov/pubmed/22494628 doi: 10.1111/j.1540-8167.2012.02293.x. Epub 2012 Apr 11
¤  Bunch, TJ et al. Long-term clinical efficacy and risk of catheter ablation for atrial fibrillation in octogenarians. Pacing Clin Electrophysiol 2010;33:146-152. Last accessed 9/25/2014. http://www.ncbi.nlm.nih.gov/pubmed/19889181. doi: 10.1111/j.1540-8159.2009.02604.x. Epub 2009 Nov 2.
¤  Corrado, A. et al. Efficacy, safety, and outcome of atrial fibrillation ablation in septuagenarians. J. Cardiovasc Electrophysiol 2008;19:812-814. Last accessed 9/25/2014. http://www.ncbi.nlm.nih.gov/pubmed/18363688.  doi: 10.1111/j.1540-8167.2008.01124.x. Epub 2008 Mar 21
¤  Ellis, E. et al. Trends in utilization and complications of AF Ablation in Medicare patients. Heart Rhythm 2009;6:1267-1273. Last accessed 9/25/2014. http://www.heartrhythmjournal.com/article/S1547-5271%2809%2900618-3/abstract. DOI: http://dx.doi.org/10.1016/j.hrthm.2009.06.009

Return to FAQ Catheter Ablations

Cardioversion to Restore Normal Sinus Rhythm

VIDEO: EKG display of heart in Atrial Fibrillation, A-Fib

EKG display of heart in A-Fib

Cardioversion for Atrial Fibrillation

Your doctor may recommend a cardioversion to restore your heart to normal sinus rhythm (NSR). There are two types of cardioversion: chemical and electrical. Cardioversion through the use of drugs is called chemical cardioversion. Electrical cardioversion uses a low-voltage, timed electrical shock to restore normal rhythm.

Most cardioversions are planned and scheduled several weeks in advance.

On the other hand, if your A-Fib is so irregular and rapid that it is life threatening, you may be sent to the emergency room, given the intravenous anticoagulant Heparin, and an electrical cardioversion performed.

CHEMICAL CARDIOVERSION

The goal of chemical cardioversion is to make your heart beat regularly (in normal sinus rhythm). It is usually done in a hospital. Some combination of medications (see Treatment/Drug Therapies) is administered intravenously, such as Cardizem, verapamil, ibutilide, or adenosine (a class V antiarrhythmic agent). Doctors monitor you closely for adverse side effects.

Chemical cardioversion is often done in combination with Electrical Cardioversion described below.

Electrical Cardioversion

Electrical Cardioversion is a medical term for giving your heart a low-voltage electrical shock to synchronize it, that is, to make it beat regularly (in normal sinus rhythm). It is often used in combination with Chemical Cardioversion.

Note: Electrical cardioversion is not the same as Defibrillation. In defibrillation, doctors use high-voltage shocks to treat life-threatening arrhythmias or a heart that has stopped.

During Electrical Cardioversion you are anesthetized and are unconscious when you receive the shock. The shock causes the signal producing areas of your heart to discharge all at once. This stops all electrical activity in your heart momentarily, hopefully allowing your normal heart rhythm to take over. Usually only one shock is required to restore NSR.

VIDEO 1: Patient video, short animation (:60) explaining the steps in performing an electrical cardioversion for patients in Atrial Fibrillation; By eMedTV 1

Low Risk Treatment But High Risk of Clots Forming

Electrical Cardioversion is considered a low risk procedure. But it is a ‘shock’ to the body and requires general anesthesia. (It’s like a mini electrocution. The metal paddles or patches, for example, can potentially leave burn marks on the chest.)

Cardioversion does carry a high risk of forming clots and causing stroke.2

Why? An Electrical cardioversion “stuns” your heart along with your Left Arial Appendage (LAA). Clots may form in the LAA while your heart is stunned and not beating. The clot can break away and enter the blood stream with the potential of causing a stroke. (The LAA is where most A-Fib clots originate.)

To dissolve potential clots, your doctor will have you take an anticoagulant like warfarin (Coumadin) before the treatment and in the three to four weeks following treatment.

While on warfarin (Coumadin), your blood will be tested for how long it takes to clot (a prothrombin time test, PT). The goal is to keep your INR (International Normalized Ratio) score between 2.0 and 3.0. Your dosage will be adjusted if necessary. You may have to have your blood tested weekly until your doctor determines you are in the proper INR range.

Success Rate of Cardioversion

Electrical Cardioversion (often combined with Chemical Cardioversion) is considered a standard, routine, low risk treatment option, particularly for recent onset A-Fib patients. If your A-Fib has just started, it may be a momentary aberration; and an Electrical Cardioversion may correct it.

Cardioversion has a very high initial success rate, returning up to 95% of A-Fib patients to NSR.

While the conversion rate is high, recurrence of A-Fib is high too. As few as 23% of patients remain in normal sinus rhythm for more than one year post-procedure. For most, their A-Fib returns within the first five days.4

Are Repeated Electrical Conversions Dangerous?

People with A-Fib often ask, “How often can I be Electrical Cardioverted? Does it ever become counterproductive or dangerous?” Right now we just don’t know the answer to this question.

Former Senator and NBA basketball player Bill Bradley had three successful Electrical Cardioversions from 1996-1998 without any apparent ill effects.5 I’ve heard of an A-Fib patient who received an Electrical Cardioversion once a month for a year without any apparent problems.

VIDEO 2: Watch an actual Electrical Cardioversion recorded at the patient’s request: “Me Being Cardioverted” posted by reddy321.6But be advised: the patient in this video is partially awake (this is not the norm). This video is a bit unsettling to watch (but not dangerous or painful for the patient).

Don’t Be Frightened

Don’t let this type of video frighten you. It may look and sound traumatic, but Electrical Cardioversion is in fact non-invasive and is one of the easiest and safest short term treatments available for A-Fib.

And don’t let TV shows with emergency room scenes frighten you either. In fact, those scenes are usually depicting defibrillation, not cardioversion (defibrillators use high-voltage shocks to treat a heart that has stopped beating).

In her Personal Experiences story, Kris tells of accidentally being awake during an electrical cardioversion (see Personal Experiences story #37). According to Kris, the shock is relatively mild compared to what you often see portrayed in medical dramas on TV.

Last updated: Wednesday, April 6, 2016

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Return to Treatments for Atrial Fibrillation

 

 

References    (↵ returns to text)
  1. VIDEO 1: Short animation explaining electrical cardioversion when in Atrial Fibrillation. YouTube video posted by eMedTV; Last accessed Oct 12, 2014; URL: http://www.youtube.com/watch?v=-jkhQ5Tl2fs
  2. Haines, D. “Atrial Fibrillation: New Approaches in Management.” Un. of Virginia multi-media presentation, 1999, p.2. http://www.a-fib.com/HainesUnOfVirginiaAtrialFibrillation.htm
  3. Boos C , More RS, Carlsson J. Persistent atrial fibrillation: rate control or rhythm control. BMJ 2003;326:1411–2.
  4. Gorman, Christine, “A Candidate’s Racing Heart,” TIME, Sunday, Dec. 12, 1999. http://www.time.com/time/printout/0,8816,35831,99.html
  5. VIDEO 2: Me Being Cardioverted YouTube video; Last accessed February 22, 2013; URL: http://www.youtube.com/watch?v=2nsN0vdXZuY&feature=fvw.

Treatments for Atrial Fibrillation

Treatments for Atrial Fibrillation at A-Fib.com

Treatments for Atrial Fibrillation include both short-term and long-term approaches aimed at controlling or eliminating the abnormal heart rhythm associated with A-Fib.

Diagnostic Testing

Doctors have several technologies and diagnostic tests to aid them in evaluating your A-Fib. Go to Diagnostic Testing ->

Additional readings:
• Sleep Apnea: Home Testing Now Available
• A Primer: Ambulatory Heart Rhythm Monitors
Guide to DIY Heart Rate Monitors & Handheld ECG Monitors (Part I) 
• 
Guide to Heart Rate Monitors: How They Work For A-Fib Patients (Part II)
• Understanding the EKG Signal
• The CHADS2 Stroke-Risk Grading System

Mineral Deficiencies

A deficiency in minerals like magnesium or potassium can force the heart into fatal arrhythmias. When you have A-Fib, a sensible starting point is to check for chemical imbalances or deficiencies. Go to Mineral Deficiencies ->

Additional readings:
• 
Frequently Asked Questions: Mineral Deficiencies & Supplements
• ‘Natural’ Supplements for a Healthy Heart
• 
Alternative Remedies and Tips
• Acupuncture Helps A-Fib—Specific Acupuncture Sites Identified
• Low Serum Magnesium Linked with A-Fib

Top 10 Questions Families Ask About A-Fib - Download Free Report

Top 10 Questions Families Ask About A-Fib – Download Free Report

Drug Therapies

Medications (drug therapies) for A-Fib patients are designed to regain and maintain normal heart rhythm, control the heart rate (pulse), and prevent stroke. Go to Drug Therapies ->

Additional readings:
 
Frequently Asked Questions: Drug Therapies and Medicines
 
Anticoagulant Therapy after Successful A-Fib Catheter Ablation: Is it Right for Me? 
• Warfarin vs. Pradaxa and the Other New Anticoagulants
 
Amiodarone: Most Effective and Most Toxic
Research Findings: Anticoagulants for Stroke Prevention
 
Watchman: the Alternative to Blood Thinners

Cardioversion

The goal of cardioversion is to restore your heart to normal rhythm. There are two types of cardioversion: chemical and electrical. Cardioversion through the use of drugs is called chemical cardioversion. Electrical cardioversion uses a timed electrical shock to restore normal rhythm. Go to Cardiversion ->

Catheter Ablation

RF Catheter Ablation and CryoAblation are minimally invasive catheter procedures that block electrical signals which trigger erratic heart rhythms. Go to Catheter Ablation ->

Additional readings: 
• 
New Ablation Technique by Dr. Andrea Natale 
• Frequently Asked Questions: Catheter Ablation, Pulmonary Vein Isolation, CyroBalloon Ablation  

• 
Considering a Catheter Ablation? Know Complication Rates When Choosing Your Doctor 
• 
Ablation Success Rate Much Better With Weight Control 
• 
A-Fib Research: Live Longer―Have a Catheter Ablation 
• Recurrence of A-Fib After Successful Catheter Ablation 
• A Cryo Ablation Primer
• Radiation Exposure During an Ablation Procedure: How to Protect Yourself from Damage
• Risks Associated with Pulmonary Vein Procedure
• 
The Evolving Terminology of Catheter Ablation
• 
Bordeaux Five-Step Ablation Protocol for Chronic A-Fib
Bordeaux Procedures & Costs
 

Cox Maze & Mini-Maze Surgeries & Hybrid Surgery/Ablation

The traditional open-heart Cox-Maze is usually performed concurrent with other heart disease treatments. More common are the various Mini-Maze surgeries which are stand-alone surgeries performed through small port-size incisions in the chest. Go to Maze, Mini-Maze & Hybrid ->

Additional readings:
Advantages of the Convergent Procedure by Dr. James Edgerton
• FAST Trial: Surgical Versus Catheter Ablation―Flawed Study, But Important Results for Patients
• Advances in Surgical Therapy for A-Fib by Dr. David Kess
• Role of the LAA & Removal Issues

Ablation of the AV Node and Implanting a Pacemaker

From a patient’s point of view, this is a procedure of last resort. By ablating or eliminating this AV Node, your Atrial Fibrillation signals can’t get to the ventricles which does stop your heart from racing. But you must have a permanent pacemaker implanted in your heart for the rest of your life. Go to Ablation of the AV Node->

Pacemakers & ICDs

Pacemakers may be implanted for pacing support, or in conjunction with Ablation of the AV Node (see above). Implanting a pacemaker seems to be most helpful if you have a slow heart rate or pauses as a result of taking A-Fib medications. But be advised that pacemakers tend to have bad effects over the long term. Go to Pacemakers & ICDs ->

Decisions About Treatment Options

When considering treatments for atrial fibrillation, you may ask,“Which is the best A-Fib treatment option for me?” This is a decision only you and your doctor can make. Here are some guidelines to help you. I’ve listed A-Fib conditions as patients might describe them. Select one (or more) that best describes your A-Fib and read your possible options. Go to Decision About Treatment Options ->

Remember

A-Fib is a progressive disease – Don’t wait – Seek a CURE as soon as practical.
I Beat my A-Fib—So can YOU!

Last updated: Sunday, January 3, 2016

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