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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



Cardioversion

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.

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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…

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‘.

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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.

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Prayer and CyroAblation: A-Fib Free! But Now Persistent PVCs

AGL's A-Fib Story continues at A-Fib.com

AGL’s A-Fib Story continues

A-Fib Patient Story #93

Prayer and CyroAblation: A-Fib Free! But Now Persistent PVCs

By AGL, December 2016

AGL first shared his story with A-Fib.com readers in August 2016 (My A-Fib Story: The Healing Power of Prayer, #88). Here, he shares the rest of the story…up-to-date and expanded.

In early 2011, I had my first heart episode. I sat down at my desk at work and my heart rate did not slow down. I was sitting there but my heart felt like I was jogging. I thought I’d sleep it off, so I went home and took a nap.

My First A-Fib Episode

It didn’t go away.

I eventually went to the ER where they said my heart rate was 235. They used adenosine which broke the episode, and my heart rate fell to 130s–140s.

They thought I had SVT [Supraventricular tachycardia] since my heart rate was so fast.

At this point they thought I had SVT [Supraventricular tachycardia], since my heart rate was so fast. If it was A-Fib ―it was difficult to determine due to the skewed heart rate graph. Since that was my first episode, I didn’t make any changes [to prevent future episodes]. I couldn’t be sure if it was simply a fluke or not.

Not a One-Time Fluke

But after a few more episodes within a year or two, I knew this wasn’t a one-time fluke.

I went to see a cardiologist who gave me three choices of proceeding: 1) do nothing 2) take medicine or 3) have an ablation. He didn’t recommend I go with an ablation due to risks involved.

I began taking 120mg of Cardizem, but that did not help―it simply slowed my heart rate and lowered by blood pressure. I was also taking 81mg of aspirin daily [for risk of stoke].

A-Fib Confounded by Sleep Disturbance

I wasn’t making progress in my A-Fib battle―and I was sleeping terribly. For three months I woke up every night at 2:30 a.m. Then, the rest of the night’s “sleep” was sketchy. (The sleep disturbance wasn’t caused by my A-Fib.)

After I came across an article online NSAIDs―The Unintended Consequences, 

I told my cardiologist I was finished with taking Cardizem and asked how I could safely stop it.

I learned that NSAIDs [Nonsteroidal anti-inflammatory drugs, such as aspirinibuprofen and naproxen] can suppress the release of melatonin―affecting one’s sleep. Once I stopped the baby aspirin, I began sleeping better.

Another decision is made, I told my cardiologist I was finished with taking Cardizem (120mg). I asked how I could safely stop it—did I need to wean off it or just stop cold turkey? He said, with a 120mg dose, cold turkey was fine. After I stopped taking the medicine, I was sleeping well.

A-Fib Episodes Every 4–6 Months

The A-Fib still hadn’t left. I had an episode every four to six months. My heart rate would go up to about 180 bpm and my heart felt like it was a fish trying to push through my chest.

I’d call 911 aach time and they’d come and either hook me up with Cardizem in my kitchen or in the ambulance to slow my heart rate. Then, while at the ER, my A-Fib would convert on its own.

The medicine they gave me never helped my heart rhythm―only heart rate. My heart rhythm would convert from A-Fib to sinus on its own.

My Pastors Pray for My Healing

As I shared before, being a Christian and believing what God says in the Bible about what He can do―I asked my pastors to anoint me with oil and pray over me for healing―as laid out in the book of James. They did that, and I did not have another A-Fib episode for 15 months.

I asked my pastors to anoint me with oil and pray over me for healing―as laid out in the book of James.

God touched me and stayed the A-Fib for that amount of time.

God’s Timing: Considers CryoAblation

After 15 months I had another A-Fib episode. This was around the beginning of 2013. At that point my cardiologist recommended I consider the CryoAblation.

Now that I look back on the timing of things, I think God chose to get me through the 15 months so more advancements could be made on the CryoAblation procedure for it to be safe for me to have it performed. He has His own reasons for sometimes miraculously and permanently healing some―and not permanently healing others.

I read about the CryoAblation procedure―mostly on StopA-Fib.org. The statistics proved good success rates and low risk―besides the obvious of it being invasive―and involving the heart.

Choosing an EP: High-Volume=Lower Complications

I had read that cardiologists/EPs who perform Cryoablations regularly [20 to 50 ablations/year] had increased safety statistically than compared to the ones who performed only a few. Well, it turned out my EP had performed 50 of them before mine. So, that made me feel a lot more comfortable! [See our article: Catheter Ablation: Complications Highest With Low-Volume Doctors]

So, in mid 2013 I had a CryoAblation for my A-Fib. And, I’m happy to say that the ablation was successful. I have not had an episode of A-Fib since!

I’m A-Fib Free! But Now Persistent PVCs

Life has been uneventful heart-wise until recently.

I have had persistent PVCs for a few months now. I basically have them 24/7…sometimes minutes apart sometimes seconds apart―but I don’t have any side effects except an occasional slight flush feeling in the face, but that’s it.

Testing for Magnesium Deficiency

Magnesium for Atrial Fibrllation patientsAfter some research online, it seems like magnesium deficiency would be something to investigate first. But the common blood serum test [Red Blood Cell Count (RBC)] to determine magnesium levels is unreliable (your body works to keep your blood serum levels consistent or your heart would stop).

What you want tested is your intracellular level of magnesium―which the Exatest [Energy Dispersive X-Ray Analysis] measures. That test is performed by a lab in California named Intracellular Diagnostics. I had that test done, and my intracellular Mg level was 34 while the lowest number within “normal” is 32. [See: Serum vs Intracellular Magnesium Levels]

But, according to an article on livingwithatrialfibrillation.com, Travis’ doctor says that “normal” can be different per person. So, although I’m within the defined “normal” range…maybe my personal normal is 36 or 38 or something.

Electrolytes in Normal Range—But Not Magnesium

Available at Amazon.com and other retailers.

For what it’s worth, the majority of my other electrolytes within the test were spot on in the middle of the “normal” range―while Mg was not. So, I’m taking that as meaning I may be Mg deficient.

So, I have been taking Natural Rhythm’s Triple Calm Magnesium with three types of chelated magnesium. I’ve read it takes a while to raise your intracellular levels of Mg, so it will take time to see if this works or not.

Also, for what it’s worth―my PVCs seem to be affected by the vagus nerve. Sometimes sitting down seems to magnify the PVCs. They also seem more pronounced after heavier meals sometimes. This is an interesting 2011 article about the vagus nerve and PVCs.

Asks God for Guidance

I’ll continue to try what I can, and ask God for guidance all the while. After all, He made the heart! Too bad that in this fallen world it’s susceptible to malfunctioning at times―partly due to it simply being a fallen world and partly because we don’t follow His ways that are designed to keep us from disease.

I’ll hold onto His promise that says:

“And we know that all things work together for good to those who love God, to those who are called according to His purpose.” (Romans 8:28, NKJV)

AGL, ayatingl@gmail.com

Editor’s Comments:
Magnesium Deficiency: Congratulations to AGL for investigating his magnesium level and going beyond the common blood serum test to measure his intracellular level of magnesium.
If you have A-Fib, it’s safe to assume you are magnesium deficient. Most everyone with A-Fib is. Magnesium has been depleted from the soil by industrial scale farming. It’s hard to get enough magnesium from today’s food.
Consider taking magnesium supplements. It takes about 6 months of taking magnesium supplements to build up healthy Mg levels. For more about A-Fib and Magnesium Deficiency, see our articles:
• Cardiovascular Benefits of Magnesium: Insights for Atrial Fibrillation Patients
• Mineral Deficiencies/Magnesium
• Low Serum Magnesium Linked with Atrial Fibrillation
PVCs and PACs (Extra Beats): PVCs (Premature Ventricular Contractions) and PACs (Premature Atrial Contractions) are often considered benign. Everybody gets them occasionally, not just people with A-Fib. But A-Fibbers seem to have more problems with extra beats than healthy people. After a successful A-Fib ablation, patients seem to have more extra beats. But, unlike in AGL’s case, they usually diminish over time as the heart heals and gets used to beating properly.
But the sources of PACs/PVCs signals can also be mapped and ablated just like A-Fib sginals. Also, beta blockers and antiarrhythmic drugs may help diminish those extra beats.
Catheter Ablation can make you A-Fib free: The options AGL’s cardiologist gave him in 2011 really weren’t equal.
• “Doing nothing”. This was impractical for AGL considering how badly A-Fib affected him, how often he had to call the paramedics and go to the ER.
• “Take Medications.” AGL tried Cardizem (a Calcium Channel blocker rate control drug), but it didn’t work for him. He might have tried various antiarrhythmic drugs, but their record isn’t good.
• “Ablation, but not recommended.” Though there is risk with any procedure, even AGL’s cardiologist eventually recommended he get an ablation in 2013.
An ablation is a low risk procedure with a high rate of success. Currently it’s the only option that offers hope of fixing one’s A-Fib and becoming A-Fib free.
A-Fib begets A-Fib: Atrial Fibrillation is a progressive disease. The longer you have it, the greater the risk of your A-Fib episodes becoming more frequent and longer. Over time this can lead to fibrosis making the heart stiff, less flexible and weak, reduce pumping efficiency and lead to other heart problems.
Don’t let your doctor leave you in A-Fib. Educate yourself. And always aim for a Cure! To learn more, read my editorial, Leaving the Patient in A-Fib—No! No! No!

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Urinary Tract Infection Leads to Persistent A-Fib Followed by Two Failed Cardioversions

A-Fib Patient Story #91

Urinary Tract Infection Leads to Persistent A-Fib Followed by Two Failed Cardioversions

by Jay from VA, October 2016

Jay from VA

I am 64 years old and live in Virginia. In January 2016, I was afflicted with a pronounced arrhythmia. I could feel it often. I had a stress test done and a sonogram of my heart. All were good, but they could see I was going in and out of A-Fib.

In early March, I got very sick with a urinary tract infection and a 104° temperature. I could not eat and was in constant A-Fib. After I got well with antibiotics, I stayed in A-Fib.

We tried Cardioversions twice. Each one took me out of A-Fib for 3 days, but then right back into it. I was on blood thinners (Eliquis) then.

Experience of a Lifetime: Ablation at Fairfax Hospital

On May 18 I had an ablation. Wheeling me into the operating room was an experience of a lifetime. This was a brand new hospital building at Fairfax Hospital. The operating room was right out of Star Trek. Huge! The operating table was skinny with 8 people standing around it as I climbed on. None of them were doctors.

This was a brand new hospital building at Fairfax Hospital. The operating room was right out of Star Trek. Huge!

I wasn’t nervous, but for some reason I was feeling VERY sick. I don’t know why. They all got very busy on me. There were 2 computer cubicles off to the side, stainless steel machines hanging from the ceiling, and a floating lap top. IT WAS AMAZING!

It all went well, out of A-Fib. My doctor was Dr. Haroon Rashid at Virginia Heart. He was very good.

Minor Bleeding Complication Post Ablation

During the ablation, they had inserted 2 catheters into veins in my left and right groins. But that night one hole started to bleed. That’s a big problem. They patched it up REAL QUICK. But I could not move for 8 hours total. <!–more.

There was no pain involved after the ablation. But my heart felt like it was bound up with rope, like it was a loose jellyfish before but now it felt tightened up with a rock sitting on the top of it, but not painful, just there. I was still able to go home the next morning.

Recovering Back Home

I had gone to the gym regularly, about 3 times a week for years. After a few weeks, I was able to try that again but really couldn’t do much and then was exhausted for the rest of the day. I was on Eliquis and Multaq. I got short of breath very quickly. This was true for 2½ months. I came off of Multaq, then felt somewhat better, and at 3 months came off Eliquis and felt much better.

I came off of Multaq, then felt somewhat better, and at 3 months came off Eliquis and felt much better.

I had A-Fib 2 weeks after the ablation for 2 days and then again after 6 weeks for a few hours. [This is common during the 3 month ‘blanking ‘period’.] I am at now 4 months post-ablation. I occasionally go into A-Fib for a few hours now, but feel good. Only taking aspirin now.

There is an App for your smartphone called Kardia by AliveCor that can tell you when you are in A-Fib. [See our review of the AliveCor Kardia by Travis Von Slooten]

Lessons Learned

Lessons Learned graphic with hands 400 pix sq at 300 resDon’t worry about having an ablation. The operating room is an amazing experience, and there is no pain. The ablation procedure is very successful.

It won’t feel like you had a serious operation, but you did. It may take months to get back to feeling like yourself. You may feel a large loss of energy and need to sleep a lot. Plan on resting a good deal. 5 months since the ablation, I have only about half the energy I had last year at this time. Do the ablation right away.

Life and your abilities can change overnight. Get done what you want to do. Finish that bucket list.

Jay from Virginia

Editor’s Comments:
Jay didn’t mess around. With persistent A-Fib he wanted results. When 2 cardioversions failed after a few days (most patients’ A-Fib returns in a week to a month), he didn’t waste time with six-months to a year of drug therapies. Just four months after his diagnosis, Jay opted for a catheter ablation. Good for you, Jay!
Is Jay’s ablation a success? Even though Jay from VA still experiences occasional A-Fib episodes, he feels much better than when he was in Chronic A-Fib. His ablation was for him a success and greatly improved his quality of life.
Because of having been in persistent A-Fib and because he may have had paroxysmal (occasional) A-Fib for years, he was probably a more difficult case. If Jay from VA wants to be completely A-Fib free, he may have to return for a second touch-up ablation which has a higher success rate. Rather than having to do a complete Pulmonary Vein Isolation procedure, the EP during a second ablation usually only has to isolate a few A-Fib producing spots or gaps to make Jay A-Fib free.
Why shortness of breath and loss of energy? It’s unusual to feel shortness of breath for as long as 2½ months after an ablation, as Jay did. It’s hard to speculate what may have caused that shortness of breath. Perhaps it was the medications. The bottom line is Jay feels OK now and is back exercising at the gym and living a normal life.
Most people after a successful ablation feel more energetic or at least as energetic than before they developed A-Fib, because their heart is pumping normally. We don’t know why Jay is experiencing a loss of energy. It may be because he still has occasional A-Fib episodes.
I am concerned about his low energy level. Jay should continue to discuss this with his doctor. Together they may find a solution to getting his pre-ablation energy back.

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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 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 currently 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.

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If you find any errors on this page, email us. Last updated: Monday, February 13, 2017

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

A-Fib Patient Story #87

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

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.

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

 

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

“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

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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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Footnote Citations    (↵ 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 and CryoBalloon catheter ablation are minimally invasive procedures that block electrical signals which trigger erratic heart rhythms like Atrial Fibrillation. 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 the AV Node, your Atrial Fibrillation signals can’t get to the ventricles which does stop your heart from racing and improves your Quality of Life. But you must have a permanent pacemaker implanted in your heart for the rest of your life to replace your AV Node functions. And what’s worse, you still have Atrial Fibrillation. 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.

ICDs which shock the heart to return it to normal rhythm are not usually used in A-Fib. Some people describe an ICD shock as like a horse kicking you in the chest. Because A-Fib attacks can occur relatively frequently, repeated ICD shocks can be very painful and disruptive. Patients with ICDs often live in fear of the next shock. Most patients would rather have A-Fib than risk being shocked throughout the day and night. 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: Thursday, June 1, 2017

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