Doctors & patients are saying about ''...

" is a great web site for patients, that is unequaled by anything else out there."

Dr. Douglas L. Packer, MD, FHRS, Mayo Clinic, Rochester, MN

"Jill and I put you and your work in our prayers every night. What you do to help people through this [A-Fib] process is really incredible."

Jill and Steve Douglas, East Troy, WI 

“I really appreciate all the information on your website as it allows me to be a better informed patient and to know what questions to ask my EP. 

Faye Spencer, Boise, ID, April 2017

“I think your site has helped a lot of patients.”

Dr. Hugh G. Calkins, MD  Johns Hopkins,
Baltimore, MD

Doctors & patients are saying about 'Beat Your A-Fib'...

"If I had [your book] 10 years ago, it would have saved me 8 years of hell.”

Roy Salmon, Patient, A-Fib Free,
Adelaide, Australia

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

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

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

Dr. Wilber Su,
Cavanaugh Heart Center, 
Phoenix, AZ

"...masterful. You managed to combine an encyclopedic compilation of information with the simplicity of presentation that enhances the delivery of the information to the reader. This is not an easy thing to do, but you have been very, very successful at it."

Ira David Levin, heart patient, 
Rome, Italy

"Within the pages of Beat Your A-Fib, Dr. Steve Ryan, PhD, provides a comprehensive guide for persons seeking to find a cure for their Atrial Fibrillation."

Walter Kerwin, MD, Cedars-Sinai Medical Center, Los Angeles, CA


Video: What is the Upright Tilt Table Test?

Do you experience dizziness or fainting spells? The upright tilt table test is a simple and effective way for collect important data for a diagnosis. In this short video, Natalie Zalmanova, NYCVA physician assistant, explains the steps of the tilt table test. With footage of in-progress test. (1:15 min.) Posted by New York Cardiovascular Associates on Oct 19, 2012.

YouTube video playback controls: When watching this video, you have several playback options. The following controls are located in the lower right portion of the frame: Turn on closed captions, Settings (speed/quality), Watch on YouTube website, and Enlarge video to full frame. Click an icon to select.

If you find any errors on this page, email us. Y Last updated: Tuesday, February 20, 2018 Return to Instructional A-Fib Videos and Animations

Video: The Zio® Patch (iRhythm) Single-Use Ambulatory Cardiac Monitor

The Zio® Patch cardiac monitor (iRhythm) looks similar to a 2-by-5-inch adhesive bandage and sticks to a patient’s chest. Electrophysiologists, Dr Parri Dominic and Dr Ryan Jones of LSU Health Sciences Center, talk about this single-use ambulatory, continuously cardiac monitor that records for up to 14 days. No need to removal during exercise, sleeping or bathing. (2:04 min.) 

Posted by University Health News Network, Sept 25, 2017.

YouTube video playback controls: When watching this video, you have several playback options. The following controls are located in the lower right portion of the frame: Turn on closed captions, Settings (speed/quality), Watch on YouTube website, and Enlarge video to full frame. Click an icon to select.

If you find any errors on this page, email us. Y Last updated: Tuesday, February 20, 2018

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More FREE ‘Learn the Heart’ ECG Online Review Courses

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

More ‘Learn the Heart’ ECG Review Courses

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

Illustration: Healio 'Atrial Fibrillation ECG Review‘

Illustration: Healio ‘Atrial Fibrillation ECG Review‘

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

ECG Quizzes, Too

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

Steve’s Brief Overview: The EKG Signal

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

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

Start with the ‘ECG Basics’ course

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

‘Learn the Heart’: A Review or ECG Basics

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

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

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

Reviews and Quizzes, Too

Healio ‘Atrial Fibrillation ECG Review‘ ECG graphic

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

Other ‘Learn the Heart’ ECG Review Courses

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

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

Steve’s Brief Overview: The EKG Signal

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

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

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

FREE ECG Training Course

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

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

VIDEO: Graphic Display of Actual Heart in Atrial Fibrillation

Click to go to video

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

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


New Video: EKG of Actual Heart in Atrial Fibrillation

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

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

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

EKG tracing

How to Interpret an ECG Signal

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

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

Video: EKG of Heart in Atrial Fibrillation on Monitor

Graphic display of actual heart in Atrial Fibrillation. How it could look to your doctor on an EKG/ECG monitor; (Your EKG may look different, but will be fast and erratic). Notice the changing heartbeat rate in the lower left. Compare to normal ECG below.

Share with you family and friends when you talk about your A-Fib. (:59 sec) Posted by jason king, Published on Aug 24, 2017.

Graphic: ECG of Heart in Normal Heart Rhythm and in Atrial Fibrillation

In the case of Atrial Fibrillation, the consistent P waves are replaced by fibrillatory waves, which vary in amplitude, shape, and timing (compare the two illustrations below).

How to Interpret an ECG Signal

EKG signal components at

EKG signal components

An electrocardiogram, ECG (EKG), is a test used to measure the rate and regularity of heartbeats, as well as the size and position of the chambers, the presence of any damage to the heart, and the effects of drugs or devices used to regulate the heart.

The ECG signal strip is a graphic tracing of the electrical activity of the heart. To learn more, see our article, Understanding the EKG Signal.

If you find any errors on this page, email us. Y Last updated: Friday, September 8, 2017

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

Three short videos about Ejection Fraction with Dr. Robert Fishel at

Three short videos about Ejection Fraction with Dr. Robert Fishel

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

Video 1: What is the ejection fraction? (:54 sec.)

Dr. Robert Fishel explains that cardiac ejection fraction (EF) refers to the percentage of blood pumped from the heart’s main chamber during each heartbeat, and relays its importance to A-Fib patients.

Video 2: Who should know their ejection fraction (EF)? (:34 sec.)

Measurement of your Ejection Fraction (EF) is an important test for cardiac patients to know. Dr. Robert Fishel explains why A-Fib patients need to know their EF number.

Video 3: How is an ejection fraction measured? (:56 sec.)

Ejection fraction (EF) can be measured by various techniques including an echocardiogram, ventriculogram and other methods.

Dr. Fishel is Director of Cardiac Electrophysiology, JFK Medical Center Atlantis, FL. Dr. Fishel graduated from New York University School of Medicine in 1987 and has been in practice for 30 years. He is board certified in Electrophysiology and Clinical Cardiac Electrophysiology. 

If you find any errors on this page, email us. Y Last updated: Monday, January 15, 2018

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The Threat to Patients with “Silent A-Fib” How to Reach Them?

‘Silent A-Fib’ is a serious public health problem. Anywhere from 30%-50% of those with A-Fib aren’t aware they suffer from A-Fib and that their heart health is deteriorating.

In his A-Fib story, Kevin Sullivan, age 46, wrote about his diagnosis of Silent A-Fib.

“I was healthy, played basketball three times per week, and lifted weights. I started to notice on some days playing basketball, I was having some strange sensations in my chest. And sometimes, difficultly catching my breath. But the next day I would feel fine. I assumed this was just what it felt like to get old.”

He writes, that at the time, he happened to see a cardiologist about medication for high cholesterol:

“I went to see a cardiologist. They looked at my heart with ultrasound and asked if I could feel “that.” I asked them what they were talking about, and they told me that I was having atrial fibrillation. That was the first time I had ever heard of the phrase.”

‘Silent A-Fib’ vs. ‘Symptomatic A-Fib’

Silent (asymptomatic) A-Fib can have similar long-term effects as A-Fib with symptoms. Silent A-Fib may progress and get worse just like symptomatic A-Fib. Increased fibrosis may develop, the atrium may become stretched and dilated, the frequency and duration of the unnoticed A-Fib attacks may increase over time (electrical remodeling).

Silent A-Fib may progress and get worse just like symptomatic A-Fib.

Is “Silent A-Fib” Really Silent? Some people question whether “silent” A-Fib is really silent (from a clinical aspect). Even with Silent A-Fib, one loses 15%-30% of normal blood flow to the brain and other organs which certainly has an effect. (For Kevin Sullivan, he experienced occasional pain in his chest and shortness of breath while playing basketball.)

Those with Silent A-Fib may get used to their symptoms, or they write off the tiredness, dizziness or mental slowness like Kevin Sullivan did. Nonetheless, almost everyone in Silent A-Fib is affected and changed by their A-Fib to some extent.

‘Silent A-Fib’ More Dangerous: Increased Risk of A-Fib Stroke

When left untreated, A Fib patients have a 5X higher chance of stroke, and a greater risk of heart failure. Often, an A-Fib patient is hospitalized or dies from an A-Fib-related stroke without anyone ever knowing the patient had A-Fib.

And if the patient with A-Fib survives, they have about a 50% higher risk of remaining disabled or handicapped (compared to stoke patients without A Fib).

Tactics to Find Undiagnosed ‘Silent A-Fib’

Today, during a routine physical exam, general practitioners (GPs) will listen to your heart with a stethoscope and would notice if your heart beat was irregular. After a certain age, your exam may also include an ECG (EKG), and the tracing would show if you are in Atrial Fibrillation, even if your not aware of it. Cardiologists routinely perform an ECG and catch Silent A-Fib (like Kevin Sullivan’s cardiologist did).

But, to be detected, A-Fib must be present at the time of the ECG, and we know that A-Fib is often intermittent. If intermittent A-Fib is suspected, your EP has an array of A-Fib wearable event monitoring devices (like the band-aid-size ‘Zio patch’ monitor).

What if A-Fib isn’t even on the patient’s radar? What’s the remedy? More frequent and regular screenings! But how? First, by healthcare personnel teaching ‘at-risk age groups’ how to use pulse-taking palpation (which can be readily taught). See also the VIDEO: “Know Your Pulse” Awareness Campaign.)

Second, through community-sponsored health screening events when patients who are interacting with their healthcare provider for another reason, such as an annual flu vaccination.

Think of the lives and permanent disabilities that would be saved by inexpensive screening and easily administered monitoring for Silent A-Fib. 

The Future of Screening for Silent A-Fib: Heart-monitoring apps and devices are growing in popularity. Two FDA-approved devices are the iPhone app called Cardio Rhythm, and the AliveCor Kardia device that connects to a app-equipped smartphone.

In this emerging era of ‘wearable’ technology, the wearer, themselves, may be the first to detect an irregular heart beat.

These devices display an ECG tracing, and an irregular reading may direct the user to their doctors. In this emerging era of ‘wearable’ technology, the wearers, themselves, may be the first to detect an irregular heart beat.

What Patients Need to Know

If you have A-Fib, discuss it with your family and friends. Answer their questions. Because A-Fib runs in families, urge your immediate family members to discuss A-Fib with their doctors.

Encourage your friends over 60 years old to do the same. Support community-sponsored health screening events.

References for this Article

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

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

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

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

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

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

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

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

Be a Sleuth: Keep an Episode Diary

Keep a diary of your A-Fib episodes

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

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

Updated Article on Sleep Apnea Home Testing

Philips Respironics "Alice NightOne Sleep Apnea in-home test at

Philips’ Alice NightOne

We’ve updated our article: Sleep Apnea: Home Testing with WatchPAT Device and the Philips Respironics.

There are several FDA-approved sleep study devices you can use in the comfort of your own bedroom to determine if you have sleep apnea. And it’s convenient (especially if being away from home overnight is problematic).

Everyone with A-Fib should be tested for sleep apnea. It’s now available at a fraction of the cost of an in-lab sleep study ($250-$300 vs. $1100-$2,000).

We’ve added the Philips Alice™ NightOne home test. Continue to the updated article…


Sleep Apnea: When Snoring Can Be Lethal

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

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

Got Sleep Apnea? Your Life-Threatening Risks

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


The Wisconsin Sleep Cohort Study

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

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

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

More EPs are Sending Patients for Sleep Studies

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

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

Take Action: Sleep Apnea Can be Lethal

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

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

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

Learn More About Sleep Studies

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

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

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

Resources for this article

Infographic: A-Fib & Sleep Apnea—The Life-Threatening Risks

Sleep Apnea is common amount Atrial Fibrillation

At least 43% of patients with Atrial Fibrillation suffer from Obstructive Sleep Apnea (OSA) as well.

Sleep Apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

It is now established that there’s a correlation between Sleep Apnea and A-Fib.


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

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

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

AliveCor Kardia attached to a smartphone

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

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

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

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

Request to Our Readers

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

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

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

Resource for this article

My Top 5 Picks: DIY Heart Rate & Handheld ECG Monitors

By Steve S. Ryan, PhD, Updated Dec 10, 2016

Many A-Fib patients want to monitor their heart rate when exercising or when performing physically demanding activities, i.e., mowing the lawn, loading equipment, etc. (I wore one when I had A-Fib.) A consumer ‘DIY” monitor or Handheld ECG monitor may meet this need.

My Top 5 Picks for DIY Heart Rate & Handheld ECG Monitors

To get you started, here are my Top 5 Picks. 
These products are available from many online sources, but to make it easy for you and to read my other recommendations, see my ‘Wish List’ on (Note: Use our Amazon portal link, and your purchases help support 

Polar Ft1 Heart Rate Monitor on Amazon.com1. Polar FT1 Heart Rate Monitor

Used by runners and other athletes, this basic model has a clear, LARGE number display of your heart rate (as number).

The included Polar T31 chest strap picks up the electrical signals from your heart and transmits to the wrist watch. Simple one-button start. With ‘Getting Started Guide’; Band size: 8.5 “ from last hole across band to plastic just before buckle. Price: around $28.


2. Polar RS300X Heart Rate Monitor

A more advanced Polar model. Water resistant. Many built-in fitness features in addition to displaying your heart rate as a number (not a tracing). The included H1 heart rate sensor chest strap sends a continuous heart rate signal to the wrist watch. Price: around $88.

Also look at Polar FT4; in colors.

Polar H7 Bluetooth Heart Rate Sensor & Fitness Tracker 150 x 75 pix at 300 res3. Polar H7 Bluetooth Heart Rate Sensor (Chest Strap)

Bluetooth-compatible heart rate sensor chest strap; Pair it with an app on your iPhone, iPad and Android device (instead of the Polar wrist watch). Price: around $49.

AliveCor heart rate monitor for Smartphone and Tablets at A-Fib.com4. AliveCor Kardia Mobile ECG for Apple and Android devices

For ECG tracings. Works with smartphones and tablets. Records and displays an actual medical-grade ECG in just 30 seconds that you can share with your doctor. Kardia shows whether your heart rhythm is normal or if atrial fibrillation is ‘detected’. See our Oct 2016 review: http://tinyurl​.com/Kardia-rev​iew-a-fib-com. Price: about $99.

BioMedetrucs Performance Monitor with heart rate monitor at A-Fib.com5. BodiMetrics Performance Monitor

For ECG tracings & more. Stand alone unit captures and displays actual ECG and other vitals in less than 20 seconds. Palm-size, slips into your pocket or purse. Wireless, syncs with your Android or iPhone. More than just heart activity, set goals with daily reminders, etc. Price: about $289.

BONUS: Facelake Fl400 Pulse Oximeter

Many A-Fib patients also suffer with sleep apnea. An easy way to check is to measure your blood’s oxygen level, just insert your finger. A reading of 90% or lower means you should talk to your doctor, you may need a sleep study. About $13.


Consumer Heart Rate Monitors by Polar

Guides to DIY HRMs

Learn More About DIY Heart Rate Monitors

For more information about these monitors, see my Guide to DIY Heart Rate Monitors & Handheld ECG Monitors (Part I).

To learn how they work, see DIY Heart Rate Monitors: How They Work For A-Fib Patients (Part II).

2016 AF Report: 2 Challenging, Difficult Catheter Ablation Cases with LAA Closure

AF Symposium 2016

Steve Ryan at 2016 AF Symposium

Steve Ryan at 2016 AF Symposium

Two Challenging, Difficult Catheter Ablation Cases with LAA Closure

by Steve S. Ryan, PhD

One of the most interesting and practical sessions was “Challenging Cases in Catheter Ablation and LAA Closure for AF”.  Featured were a panel with some of the world’s ‘master’ Electrophysiologists (EPs). Each presented one or two cases of their most challenging and difficult cases from the past year. The panelists were:

• Dr. David Keane, St. Vincent’s University Hospital, Dublin, Ireland (Moderator).
• Dr. Moussa Mansour, Massachusetts General Hospital, Boston, MA.
• Dr. Andrea Natale, Texas Cardiac Arrhythmia Institute, Austin, TX
• Dr. Douglas Packer, Mayo Clinic, Rochester, MN
• Dr. Vivek Reddy, Mount Sinai Hospital, New York, NY
• Dr. Miguel Valderrabano, Houston Methodist Hospital, Houston, TX
• Dr. David Wilber, Loyola University Medical Center, Chicago, IL

Two cases of Persistent A-Fib stood out as significant for readers of To learn why, see my ‘Take Away’ comments that follow each case description.

Electrically Dead Left Atrium

Dr. Miguel Valderrabano

Dr. Miguel Valderrabano

Dr. Valderrabano presented the case of a 48-year-old female patient with symptomatic Persistent A-Fib. She had been cardioverted several times and had tried several antiarrhythmic drugs including amiodarone. She had had Pulmonary Vein Isolations (PVI) by other EPs before being referred to Dr. Valderrabano.

Her left atrium was enlarged. Dr. Valderrabano ablated her again but couldn’t isolate her Left Atrial Appendage (LAA) where A-Fib signals were still coming from. He used the Lariat (SentreHeart, Inc.), a noose-like suture delivery device, to close off and electrically remove her LAA.

After these steps, she had a leak from her closed-off LAA which had to be plugged. She was A-Fib free but developed Atrial Flutter which had to be ablated.

After all these ablations, she was finally in sinus rhythm. But at what cost? All the extensive ablations and scarring had made her Left Atrium electrically dead and unable to contract normally (“Stiff Left Atrium”).

The patient knew she might lose contraction of her left atrium, but was most happy to be in sinus rhythm after years of symptomatic A-Fib.


Lariat to Prevent A-Fib Signals from the LAA: The Lariat is an occlusion device, and like the Watchman, is normally used for closing off the Left Atrial Appendage (LAA) to prevent A-Fib clots breaking loose and causing a stroke. It’s particularly useful for people who can’t or don’t want to take anticoagulants.

In this case, the LAA was the source of non-Pulmonary Vein (PV) signals (and often is). By removing it, patients can often be restored to sinus rhythm. (Master EPs now consider the LAA the most important source of non-PV triggers. Unfortunately, many EPs are unaware of the LAA’s importance and don’t check it for non-PV triggers during an ablation.)

Stiff Left Atrium: No one wants to lose their Left Atrium’s ability to contract and pump. But in extreme cases, this may happen.

I talked to one of the most experienced EPS in the world who has had to do several ablations which restored a patient to sinus but also rendered their left atrium electrically dead and unable to contract normally. [Note: the Left Ventricle does most of the heavy-duty pumping work.]

His patients, even though they knew the risks, were overjoyed to finally be in normal sinus rhythm. After years of symptomatic A-Fib, they had their life back again.

FIRM Advantages and Problems

Dr. Vivek Reddy, Mt Siani Hospital

Dr Vivek Reddy, Mt Siani Hospital

Dr. Vivek Reddy presented the case of a 63-year-old male in Persistent A-Fib who had had several ablations before being referred to him. After wearing a Holter monitor for one-week, the data showed an A-Fib burden of 27%, i.e., his A-Fib was very symptomatic and burdensome.

Dr. Reddy did a FIRM-guided ablation, but the patient was still in A-Fib.

Upon closer examination and manual mapping, the ‘renegade’ A-Fib signal source was found and ablated, which restored the patient to sinus rhythm.

Dr. Reddy had discovered the A-Fib signal in the area where the FIRM basket catheter didn’t map. As mentioned in other Symposium presentations, due to design problems, the FIRM basket catheter maps only slightly more than ½ of the left atrium. (New basket catheters to correct this problem are being developed by the manufacturer, Abbott/Topera.)


Limited but Extensive Data with Fast Results: Even though the FIRM mapping and ablation system seems to currently have built-in limitations, master EPs still use the FIRM basket mapping catheter because it provides a great deal of important information very quickly. It is especially useful in cases of Persistent A-Fib where it identifies non-PV triggers such as rotors and focal drivers. As Dr. Reddy stated earlier, this is the future of A-Fib ablation.

Choose an EP Who Can Compensate for FIRM Limitations: When choosing an EP to do your ablation, it isn’t enough to select someone who uses the FIRM system. You need an EP who knows the limitations of the FIRM system and how to find and ablate non-PV triggers the FIRM system may miss. The fact that an EP uses the FIRM system is not a guarantee you will have a successful ablation.

Wrap Up

The two cases I chose to write about were the most informative for those A-Fib patients seeking to understand the most current treatment options. This Saturday afternoon session was the last of the 2016 AF Symposium.

For more about the Lariat occlusion device, see my brief article: Lariat II Suture Delivery Device.
For more about the FIRM mapping system, see my brief article: FIRM Mapping System—Should Ablation Patients Avoid It?

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If you find any errors on this page, email us. Y Last updated: Monday, February 15, 2016

Bordeaux New ECGI Ablation Protocol—Re-Mapping during Ablation

AF Symposium 2016

Bordeaux New ECGI Ablation Protocol—Re-Mapping During Ablation

by Steve S. Ryan, PhD, February 2016

CardioInsight ECGI vest-like device with 256 electrodes for 3-D non-invasive mapping

CardioInsight ECGI vest-like device with 256 electrodes for 3-D non-invasive mapping

Updated Feb. 2017: The CardioInsight system was approved by the US FDA Feb. 3, 2017 and is being made available to A-Fib centers in the U.S. Dr. Vivek Reddy at Mount Sinai Medical Center in New York City was the first to use the system commercially in the U.S.

Why ECGI/ECVUE is Important

ECGI/ECVUE is probably the most significant, game changing improvement in treating A-Fib (along with Contact Force sensing catheters), particularly for people with persistent A-Fib.

ECGI will not only change the ways mapping and ablations are done, but possibly how you and I are examined and diagnosed in our doctor’s office.

Image a Future Physical Without an EKG

Imagine when you go in for a physical that, instead of getting an EKG, you simply put on an ECGI vest which tells the doctor where and how many A-Fib producing potentials you have in your heart, all without you having to be in A-Fib. Admittedly, this is pie-in-the-sky speculation right now. But the ECGI vest has tremendous potential to change the way A-Fib is diagnosed and treated.

Dr. Michel Haissaguerre & New Uses of ECGI/ECVUE

Dr Haissaguerre

Dr Michele Haissaguerre, The Bordeaux Group

Dr. Michel Haissaguerre of Central Hospital, Bordeaux, France presented new developments in how the Bordeaux group now uses ECGI/ECVUE Cardio Insight body surface mapping for persistent A-Fib. His talk was entitled “Monitoring of AF Drivers During Catheter Ablation for Persistent AF.” (For a detailed description and discussion of the ECGI system, see 2013 BAFS: Non-Invasive Electrocardiographic Imaging [ECG]). See also How ECGI Works.)

Patient Prep with the ECGI Vest

Typically, the day before an ablation, a technician (it doesn’t have to be the EP ablationist) uses a ECGI vest to map and identify sites in the heart producing A-Fib signals (rotors and focal sources). The next day, using this map combined with a CT scan which produces a very detailed 3D color map of the heart, the EP ablates and isolates these sites.

What’s New: Bordeaux Group Also Re-Maps Using the ECGI Vest

What’s brand new about how the Bordeaux group is using ECGI is that, if a patient’s A-Fib has not been terminated after the ablation, they then re-map using the ECGI vest. This often reveals missed, changed or new A-Fib drivers. They then ablate/isolate these regions.

If a patient’s A-Fib has not been terminated after the ablation, they then re-map using the ECGI vest.

The ideal or goal is for A-Fib to terminate into sinus rhythm or Atrial Tachycardia (AT). Atrial Tachycardia (a heartbeat that is in sinus rhythm but faster than normal) can then also be mapped and ablated into Normal Sinus Rhythm (NSR). (Atrial Tachycardia, for the average persistent patient, feels a lot better than being in A-Fib.)

If after re-mapping and ablation, the patient is still in A-Fib, they use Electrocardioversion to try to shock the patient back into sinus.

See the AF Symposium Live Case Presentations: Dr. Mélèze Hocini of the Bordeaux group ablated a 40-year-old male with persistent A-Fib. She found four areas of rotor/focal activity in his heart. After ablating the third area, the patient’s persistent A-Fib terminated. Dr. Hocini did not have to re-map or ablate the fourth area.)

Slides of Before and After ECGI Ablation

Dr, Haissaguerre showed slides of before and after an ablation using ECGI. Ablation at a driver region transformed rapid, complex signals into slower, organized signals.

In the AFACART study in which eight different centers used the ECGI system, ablations in driver regions varied from 38 to 98 minutes of cumulative RF energy delivery time per center despite similar patients and targets (indicating the current lack of standardized ablation techniques). (For more on the AFACART study, see AF Symposium 2015: AFACART Clinical Trial.)

Persistent A-Fib Case: In the case of a 48-year-old female in Persistent A-Fib for four months, four target areas were identified: the inferior Left Atrium (LA), the LA Septum, the anterior of the LPV (Left Pulmonary Vein) to the LAA, and the posterior area of the RPV (Right Pulmonary Vein). (They divide the left and right atria into seven general physical areas.) A-Fib continued after these driver areas were ablated. On re-mapping, the septum area was found to be still active. After 2 more minutes of RF delivery to that septum area, A-Fib terminated into normal sinus rhythm.

Ablation Failure From Thicker Atrial Tissue?

Dr. Haissaguerre pointed out that ablation failure happens particularly in the right and left atrial appendages because of thicker atrial tissue. He showed a slide where he ablated one driver area, then six months later ECGI showed a new driver region at the LAA ridge.

Right Atrium Drivers Reduced After Left Atrium Ablation

Next, he showed slides where the ECGI mapping system initially showed driver activity in the Right Atrium (RA). But after Left Atrium (LA) ablation, this driver activity was greatly reduced. He suggested that RA drivers might mirror or be a projection of LA drivers.

Right Atrium drivers might mirror or be a projection of Left Atrium drivers.

(This is a new research finding that may be very important and may change the way the right atrium is ablated in persistent A-Fib cases.)

ECGI After Prior Extensive PVIs

Dr. Haissaguerre showed slides of patients who had had two or three prior PVIs. ECGI clearly showed where there were still driver regions. Each patient’s persistent A-Fib was terminated into normal sinus rhythm.

Mapping of Atrial Tachycardias (ATs)

The ECGI system can also map Atrial Tachycardias (AT). Dr. Haissaguerre found that half the ATs found were focal ATs, “mostly localized reentry”; 68% were from driver regions previously ablated; 32% were from new sites.

The other half of the ATs were “Macroreentries” and required linear ablations to terminate.

Limitations of ECGI NonInvasive Driver Mapping

According to Dr. Haissaguerre:

• Body filtering (ECGI) may miss small local AF Signals, while showing the main propagating waves in a panoramic scope
• Extensive ablation may affect egm (electrogram) quality and analysis
• Besides ‘drivers’, other mechanisms of AF perpetuation may coexist, particularly in longer lasting (>1 year) AF

Dr. Haissaguerre’s Conclusions

• Remapping can confirm elimination or persistence of drivers or show new drivers (requiring further ablation)
• This dynamic information will probably increase the rate of AF termination
• Further improvement expected with rapid mapping of Atrial Tachycardias

What Patients Need to Know

The ECGI/ECVUE Cardio Insight body surface mapping seems like a major improvement and development, particularly for patients in persistent A-Fib, usually the hardest to cure.

ECGI is probably the most significant, game changing improvement in the treatment of A-Fib (along with Contact Force sensing catheters).

This ECGI system is being carefully developed in eight centers in Europe (AFACART clinical trial). It was recently purchased by Medtronic and is headquarted in Dublin, Ireland.

(No one at the Medtronic booth at the AF Symposium exhibit hall could tell me when the ECGI system will be available for examination and use in the US and worldwide. I’ll update this report when I know.)

Re-Mapping a Major Improvement in ECGI: We’re grateful to Dr. Haissaguerre and the Bordeaux group for developing the technique of re-mapping during an ablation. It’s certainly a major improvement in what was already a very good mapping and ablation system.

Mapping and Ablating Atrial Tachycardias (ATs): From a patient’s perspective, it’s great to know that ECGI can be used to identify and ablate atrial tachycardias (fast heart rates).

A-Fib termination can result in normal sinus or ATs which are a form of sinus rhythm. For most people, ATs are certainly better than being in A-Fib. But they can be annoying and disruptive. It’s good to know they can be mapped and ablated just like A-Fib signals.

ECGI May Miss Small Local ATs and A-Fib Signals: ECGI isn’t perfected yet. Dr. Haissaguerre showed that many of the local ATs found came from driver regions previously ablated.


 CHU Hopitaux de Bordeaux logoDr. (Prof.) Michel HaïssaguerreCentral Hospital, Bordeaux, France, and his colleagues invented pulmonary vein catheter ablation for A-Fib (PVA/I). The Bordeaux Group is considered one of the top A-Fib centers in the world and noted for their cutting edge research in the treatment of Atrial Fibrillation. Interesting fact: I (Steve Ryan) was their first US patient in 1998.

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If you find any errors on this page, email us. Y Last updated: Saturday, May 6, 2017

DIY Heart Rate Monitors: How They Work For A-Fib Patients (Part II)

Polar Heart Rate Monitors

Go to: DIY Heart Rate Monitors

by Steve S. Ryan, PhD, Updated April 2015

A-Fib patients sometimes use consumer ‘DIY” Heart Rate Monitors (HRM) when exercising or performing physically demanding activities (For specific models and options, see our article, DIY Heart Rate Monitors & Handheld ECG Monitors Part I.)

How Do DIY Heart Rate Monitors Work?

Basic HRMs use a chest strap to pick up the electrical signals from the heart. However, due to the inherent design of the chest strap, the accuracy is somewhat limited and is no replacement for the signals recorded by a Holter or Event Monitor.

Heart-Rhythm-Monitors-EKG - 325 pix wide at 96 resA HRM keeps track of your heart’s R-R interval or the time between R peaks. Without getting too technical, the R peak on a generic ECG waveform (see the diagram) corresponds to the ventricle beat (depolarization) and has the largest amplitude (height) of the complete waveform.

When the amplitude (picked up as a voltage differential) exceeds a certain threshold, a “beat” is picked up by the chest strap and transmitted wirelessly to the HRM. It is the time between these R peak “beats” that is used by the HRM to determine instantaneous heart rate. It is only going to pick up episodes of arrhythmia as are manifested in ventricle beats (the R on the waveform).

Learn more about the EKG signal, see Steve’s article: Understanding the EKG (ECG) Signal.

So if your arrhythmia manifests itself in funky R activity (higher than normal rate) you will see a corresponding readout on the HRM. In this same light, an irregular or unevenly spaced R peaks will not be picked up by the HRM.

This is one of the fundamental differences in how data is recorded by HRMs (R-R interval) versus Holter/Event Monitors (actual waveform).

In fact, this is what Polar has to say:

Polar products are not designed to detect arrhythmia or irregular rhythms and will interpret them as noise or interference. The computer in the wrist unit will make error corrections, so that arrhythmia beats are not included in the averaged beats per minute. The blinking heart symbol in the face of the unit, however, will continue to show all heart beats received.

In most cases the Polar products will work fine for persons with arrhythmia.

Example PC interface capability of a Polar PC program.

Graphic example PC interface capability of a Polar PC program.

HRM Recording Capability

Most HRMs provide some internal storage recording capability. While lower cost HRMs simply record low, high and average heart rate, upper end models allow you to download heart rate data to your PC.

App-enabled smartphones are changing how this data is viewed, collected and saved for future review.

How To Setup and Use an HRM

On most of the HRMs, you can set a heart rate zone, and the watch monitor (or app-enabled smartphone) will record how long you stayed in that zone.

You could then program a high heart rate zone which you might only enter if you were in A-Fib. That way you could record how long you stayed in A-Fib and what your max heart rate was. This data could be reviewed on the watch monitor (or app-enabled smartphone) without having to download it to a PC.

On HRMs with PC interface capability, you can view data in a graphic form (on some watches/smartphones you can view the graphic data but with lower resolution.) This analyses could tell you when you were at a higher heart rate—A-Fib—and how long you stayed there. Of course these kinds of features require some PC skills, but typically the programs are pretty user friendly. (See the above graphic example of a Polar PC program).

For more, see our article, DIY Heart Rate Monitors & Handheld ECG Monitors.

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Last updated: Tuesday, April 14, 2015

Do-It-Yourself ECG: A Review of Consumer Handheld ECG Monitors

by Steve S. Ryan, PhD, Updated April 2017

This category of consumer heart rate monitors has been growing of late. Going beyond just monitoring your heart rate and pulse, these units capture data and display it as an ECG (EKG) in real time (Note: not a replacement for an ECG performed by your doctor).

AliveCor Kardia Heart Monitor

For a full, detailed review, see: 2016 Update: AliveCor Kardia Review by Travis Van Slooten.

Detects A-Fib. The Kardia monitor is a FDA-approved device that works with your smartphone (or tablet) and allows you to take an ECG recording of your heart from the comfort of your home, office, or anywhere.

The Kardia consists of two parts: the device itself, a small, wireless component that attaches or sits in close proximity to a cell phone or tablet, and it syncs to the second component, a smartphone app.

Three ways to hold the Alivecor Kardia to capture an ECG reading at

Three ways to hold the Kardia to capture an ECG reading.

It’s very straight forward to use the device. After you download the app to your smartphone, open and click on “Record Now”; then press your fingers to the device. As soon as you click on the green “Record Now” button, with your fingers on the device, the app displays an ECG reading of your heart in real-time and records it.

Your data is accessible through the AliveECG app, also stored on secure, encrypted servers, so you can view them anywhere and share them with your doctor. Retails for under $100.

The HeartCheck™ PEN handheld ECG device from CardioComm Solutions

Heart Check Pen

The HeartCheck™ PEN handheld ECG device from CardioComm Solutions

The HeartCheck™ PEN handheld ECG device is the only device of its kind cleared by the FDA for consumer use. No prescripton required. (There is second device that does require a prescription to order it, the HeartCheck™ ECG Handheld Monitor.)

The pocket-sized PEN allows you to take heart readings from anywhere, the moment symptoms appear. Then using the USB cable provided, connect the device to your PC and run ‘GEMS™ Home’ program to upload your heart rhythm files containing your ECGs and send it to a physician or ECG Coordinating Center (for a fee). The  ECG Coordinating Center or physician will create an ECG report on your heart analysis identifying any potential issues. The report will be made available on your PC through the GEMS™ Home program.

There’s a good review of the Heart Check pen by  over at (posted Sept. 2013). Robert goes into great detail about how to “unlock” your device to you can see the actual reading, the costs of reports (the first one is free), and the details about how all this works. There’s also a video at:

Keep in mind that the HeartCheck™ PEN reports aren’t meant to be used for diagnosis in an emergency. Reviews on are mixed, but it may work for you. Read one or both of the reviews mentioned above. Order direct at the online store or Price: $259 – $350.

Heal Force PC-80A/PC-80B/Prince180B ECG Monitor

Heal Force PC-80A portable EKG monitor -

Heal Force PC-80A

The PC-80/180B is a state-of-the-art 1-lead, handheld ECG device with very sophisticated but intuitive and easy-to-use software. The user does need to be somewhat ECG savvy.

It has a large, well-lighted color display with options for different lengths of recording including continuous and can even be used like a Holter monitor! (Be sure to get the right model if you want this feature.) It comes with both finger contacts (choose palm, chest or leg meausurement) and lead-wire cables. To upload to your computer, you have options of USB cable or Bluetooth wireless.

FDA-approved. Marketed by several different companies: Heal Force PC-80B, Creative Easy ECG Monitor PC-80B and Cardio-B Palm ECG (with various versions). Read more details on the PC-80B at the Heal Force website. Price: about $110-150.

Note: James W. Grier also has an extensive review he PC-80B ECG Monitor in his Comparison of handheld, 1-Lead/Channel ECG / EKG recorders.

Heal Force 180D Color Portable ECG Monitor With 3-Lead Cables

180D using 3-ECG lead Cables

180D using 3-lead Cables

You might want to step up to the Heal Force model with 3-lead cables, the 180D Color Portable ECG Monitor. It’s also FDA-approved.

Heal Force 180D EKG portable monitor

3-Lead Heal Force 180D

Quick measurement by built-in metal electrodes, or 3 external lead wires. Equipped with more advanced functions and features than the Prince 180-B (above).

Like the PC-80A/PC-80B/Prince180B ECG Monitor, it’s small, lightweight, and easy to carry. ECG waveform and interpretation of results are displayed clearly on a color dot-matrix LCD screen.

High capacity built-in memory, up to 30 hours ECG waveform storage for single channel continuous measurement. Download results via USB port to PC or use a thumb drive and take to your doctor.

The instruction manual is clearly translated from Chinese. Learn more about the Heal Force 180D at Heal Force site. Price: about $180.

BodiMetrics Performance Monitor

BodiMetrics Performance Monitor review at

BodiMetrics Performance Monitor

The BodiMetrics Performance Monitor captures and displays an actual ECG tracing and can store up to 100 records. All information is transmitted via Bluetooth to the BodiMetrics app on your iOS or Android device.

Startup screen for multi-function health monitor

More than just for ECGs. The BodiMetrics Performance Monitor is a multi-function health monitor.

This FDA approved devise will collect blood oxygenation levels (SpO2), body temperature, and systolic blood pressure. Capture steps, stride, calorie burn and Target Heart Rate Zone for optimal work outs. Set goals with daily reminders and medication alerts. Provides audible and visual usage instruction. Palm-size, slips into your pocket or purse.

VIDEO: watch a 1:09 min video of the BodiMetrics in actual use including audible instructions. Several models. Also marketed as the Viatomtech CheckMe Monitor (Lite or Pro). Price: starts around $280.

Handheld ECG Monitor CMS-80A from FaceLake (or Contec)

Facelake Hand-Held Single Channel ECG, ECG 80A Link

Facelake Hand-Held ECG 80A

Note: Read about how Tom Burt used the CMS-80A in his Personal Experience story. He writes, “This came in very handy as a way to inform my EP when I did get out of rhythm. This was done by faxing him a strip of the printout.”

The CMS-80A is a single channel, 12 lead monitor which can provide data via one of three ways: on the unit display, via the thermal printer internal to the unit or via a USB connection to a PC. The printout from the unit offers the easiest and most accurate means to view lead output. While you can view lead output on the display, you will find that it is not to the same level of detail as the printout.

Like most normal ECG monitors, 10 electrodes are attached to the body as follows: 6 suction cup leads to the chest and 4 alligator clip leads to the arms and legs. The unit does not rely on the normal press-on style contacts but rather takes a simpler approach with its reusable contacts. Personally, I [Ed Webb] wasn’t too impressed with the suction cup style contacts as they feel funny and leave a mark as if you had been attacked by an octopus. But they seemed to do the job. The alligator clips, while funky, were quick and easy to attach.

The waveforms presented are not what you would expect from an ECG in your cardiologist’s office, but they can provide the simple basics to make a quick determination whether you are in A-Fib. In particular, by examining the output from Lead II, or perhaps Lead aVF, you can quickly observe the absence of a P wave—one sign that you may be in A-Fib. Additionally, examining R-R intervals and whether they are uniformly spaced can be another means to aid in that determination.

Thermal printout from the Handheld ECG Monitor CMS-80A ECG

From a practical perspective, it could be that you choose to only attach the alligator leads to your arms and legs and forego using the chest leads. You will obviously not have the data from the chest leads (V1 to V6), but that information may not be needed for A-Fib purposes.

Note: This unit does not require a prescription from your doctor. For more info and to see what the display looks like, use this link to go to The CMS-80A (ECG-80A) can be purchased directly from and other retail outlets (price $299-$380).

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 In-Depth Report Of ECG Monitors

For an extensive evaluation of the above three hand-held ECG monitor with multiple photos and scans see James Grier’s Comparison of Handheld, 1-Lead/Channel ECG/EKG Recorders” at

Report: Comparison of Handheld, 1-lead/Channel ECG/EKG Recorders

I’m pleased to share a great resource for anyone considering one of the newer hand-held ECG monitors. Comparison of handheld, 1-lead/channel ECG / EKG recordersby James W. Grier, Emeritus Professor of Biological Sciences, North Dakota State University. This report is extremely detailed and extensive (and was last updated March 19, 2014).

He tests and compares eleven units, includes multiple photos of each step of testing and multiple print outs of the results. (Jim’s first report was posted in 2006 and has been updated in 2008, 2013, and in March 2014).

It’s the most thorough report on the topic you will find anywhere. (BTW: We hope to get Jim to write an article or two for about his own A-Fib. (He’s also involved with an upcoming A-Fib medical study about scuba diving that’s being developed by the dive-medical organization, Divers Alert Network, or DAN.)

Jim Grier’s report,Comparison of handheld, 1-lead/channel ECG / EKG recorders includes the three monitors we discuss below. Go to

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Last updated: Sunday, April 9, 2017

The Virtual Heart Computerized Simulation – Dr. Natalia Trayanova

AF Symposium 2015

Dr. Natalia Trayanova, Johns Hopkins University

Dr. Natalia Trayanova

The Virtual Heart Computerized Simulation

by Steve S. Ryan, PhD

The most hopeful, promising research of the 2015 AF Symposium was presented by Dr. Natalia Trayanova of Johns Hopkins Un., Baltimore, MD. She described the “virtual heart”—a computerized model to simulate an individual patient’s heart.

A Computerized Model

The idea is to build computerized models that can be used to guide an individual patient’s therapy. She previously simulated a heart attack in a specific region of an individual heart and how it affected the dynamics of that specific heart.

Using the virtual heart computerized simulation, she can, for example, program in not only how much fibrosis an individual heart has but its structure. (Is the fibrosis circularly-distributed? Does it have a complex shape or is it patchy?)

The Bordeaux Group Patient Data

Dr. Trayanova is rapidly developing more atria data and experience. The Bordeaux group is providing her patient data from their ECGI body surface potential mapping system (CardioInsight). She has done approximately a dozen retrospective studies using the virtual heart technology (as of January 2015).

The Virtual Heart Simulation images

The Virtual Heart Simulation images

How it Works

Dr. Trayanova and her team start by doing an MRI scan. Then they hyper-enhance segments which correspond to areas of fibrotic remodeling.

The next step is to develop a computational mesh that incorporates representations of ion channels, calcium cycling and other electrophysical aspects of an individual’s atria. All this is incorparated into patient-specific geometry of the model.

What the Model Can Reveal

Then they let the model run and see what the arrhythmia looks like. Does the fibrotic substrate anchor rotors in particular locations? What are the spatial characteristics of the regions where they are located? Can these spatial metrics guide where the proper ablation should be?

Dr. Trayanova’s team merges these virtual atria with a CARTO map to predict where the catheter should ablate.

Editor’s Comments:
The potential of Dr. Trayanova’s research for A-Fib patients is incredible! Imagine getting an MRI and knowing where your A-Fib is coming from, how your A-Fib affects and works in your heart both now and in the predictive future, how various A-Fib drugs can be expected and predicted to affect your heart, how much and what kind of fibrosis you have, how you can expect your fibrosis to progress and affect you over time, what therapies should be done in your particular case, if you need a catheter ablation, where exactly in your heart the EP needs to ablate, and to be able to accurately predict whether or not or how fast you will progress from paroxysmal to persistent A-Fib based on computer models that mirror your own heart.
Dr. Trayanova’s research has the potential to radically change the way A-Fib is treated. Almost all the uncertainties EPs and A-Fib patients now have to deal with can potentially be eliminated with the virtual computer reconstruction of individual A-Fib hearts.
References for this article

Return to 2015 AF Symposium: News and Views

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Last updated: Thursday, April 16, 2015

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