Doctors & patients are saying about 'A-Fib.com'...


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

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

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

Jill and Steve Douglas, East Troy, WI 

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

Faye Spencer, Boise, ID, April 2017

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

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


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


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

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

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

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

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

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

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

Ira David Levin, heart patient, 
Rome, Italy

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

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


Drug Therapies

‘A Patient Cured is a Customer Lost’ & Other Facts About Big Pharma

Did you know drug companies spend twice as much on marketing and advertising as on researching and developing new drugs? (I was shocked.)

Of special interest to me is the ‘Direct to Consumer’ drug advertising which has significantly increased drug sales in the U.S.

‘Direct to Consumer’ drug advertising is so misleading that it is banned in all countries except two: the U.S. and New Zealand. (No wonder that 70% of drug companies’ profit comes from the U.S.)

Misleading Drug Ads

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

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

These ads for anticoagulant medications imply that if you just take their pill once a day, you’ve taken care of your A-Fib. Wrong! Don’t fall for the hype.

Bad Pharma—How Drug Companies Mislead Doctors & Harm Patients

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

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

We also learn truths about the internal workings of the medical academia, the U.S. FDA, and medical journals publishing.

The arguments in the book are supported by research and data made available to the reader. The author, Ben Goldacre, is a doctor and science journalist, and advocates for sticking to the scientific method, full disclosure and advocating for the interest of the patients. Read a critical review of Bad Pharma in the British Journal of Clinical Pharmacology.

My Best Advice: ‘Educate Yourself’

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

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

Read the book for FREE: The ebook version is online at U.S. National Library of Medicine PubMedHealth, and you can download the .PDF version (remember to save to your hard drive).

See my post: How Big Pharma Issues Misleading News and Why it Matters.

Features the report by the online watchdog group HealthNewsReview.org.

 

Don’t Settle for a Lifetime on Medications—

Seek your A-Fib Cure

Drugs Don’t Cure Atrial Fibrillation But Merely Keep it at Bay

Advice from Patients Now Free from the Burden of Atrial Fibrillation

Daniel Doane, Sonora, California, USA, shares his mistake:

Daniel D.

“Don’t think that the medication is a long term solution. Don’t put up with nasty side effects.
That was the mistake I made. I thought I could tough out the medication as long as I stayed out of A-Fib.
Terry Dewitt at A-Fib.com

Terry D.

Terry DeWitt, Massachusetts, USA, advises act sooner than later:

“I knew I could continue on medication for several years, but I was concerned about the remodeling of my heart. …I would need an ablation…and sooner seemed better when my heart was still strong.”  

 

Max Jussila, Shanghai, China, says meds are for the short term:

Max J.

“Do not listen to your doctors if they suggests medication as a long-term solution!
The doctors who see medication as a solution commit serious negligence and are ignorant of the terrible nature and consequences of Atrial Fibrillation.”

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

According to Drs. Irina Savelieva and John Camm of St. George’s University of London, London, UK:

“The plethora of antiarrhythmic drugs currently available for the treatment of A-Fib is a reflection that none is wholly satisfactory, each having limited efficacy combined with poor safety and tolerability.”

In general, don’t expect miracles from current medications. Antiarrhythmic drugs are only effective for about 40% of patients; many can’t tolerate the bad side effects. When they do work, the drugs become less effective or stop working over time.

In his, personal A-Fib story, Dr. Sam T. MD, from Tennessee, USA, shares:

“At this time when all medicines and cardiac procedures have their risks and limitations, finding a way to get to NSR [Normal Sinus Rhythm] and staying in NSR is most important.”

The goal should be to end your A-Fib episodes not manage them. Learn more at: Drug Therapies. Always Aim for a Cure!

Drugs Have a Role, but Other Treatment Options Target a Cure.

Resources for this article
CAMM, J, MD. Medical Management of Atrial Fibrillation: State of the Art First published: 03 August 2006 https://doi.org/10.1111/j.1540-8167.2006.00581.x

Savelieva I, Camm J. Update on atrial fibrillation: part II. Clin Cardiol. 2008 Mar;31(3):102-8. doi: 10.1002/clc.20136. PubMed PMID: 18383050. URL: http://www.ncbi.nlm.nih.gov/pubmed?term=PMID%3A%2018383050


From The Top 10 List of A-Fib Patients’ Best Advice’ , a consensus of valuable advice from fellow Atrial Fibrillation patients; Chapter 12, Beat Your A-Fib: The Essential Guide to Finding Your Cure by Steve S. Ryan, PhD.

Go to Top 10 List of A-Fib Patients’ Best Advice
Please, share the advice ♥ 

FAQ Update: For stroke prevention—warfarin (Coumadin), an NOAC or aspirin?

We’ve updated our answer to the Frequently-Asked-Question (FAQ):

“For A-Fib patients, which is the better to A-Fib-related stroke—warfarin (Coumadin), an NOAC or aspirin?”

For decades, people more at risk for A-Fib-related stroke have been on warfarin (Coumadin). In the last few years, many of these patients have switched to the newer NOACs. A-Fib patients with low or no risk factors for stroke are often put on aspirin, or nothing at all.

Differences with the Same Goal

Aspirin is an antiplatelet drug that decreases the stickiness of circulating platelets (small blood cells that start the normal clotting process), so that they adhere to each other less and are less likely to form blood clots. (Cost: dirt cheap.)

Warfarin (brand name Coumadin) is an anticoagulant that works by slowing the production of blood clotting proteins made in the liver. Warfarin is highly effective, reducing the annual risk of stroke by approximately two thirds, but does require periodic lab tests to maintain the proper therapeutic level. (Cost: dirt cheap + lab tests.)

NOACs stands for Novel Oral AntiCoagulants. NOACs are alternatives for vitamin K antagonists (e.g., Warfarin). NOACs don’t require periodic blood testing as with warfarin. The clinical trials indicate NOACs work as well as warfarin. (Cost: Extremely expensive.)

 —Continue reading—for the rest of our answer along with a few takeawys.

FAQs A-Fib Drug Therapy: Natural Blood Thinners

 FAQs A-Fib Drug Therapy: Natural Blood Thinners

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

“Are natural blood thinners for blood clot treatment as good as prescription blood thinners like warfarin?”

There are a number of foods and supplements that are known to thin the blood. These include foods with high amounts of aspirin-like substances called salicylates, omega-3 fatty acids, vitamin E supplements, and foods with natural antibiotic properties.

Healthy adults can greatly reduce the risk of blood clots and cardiovascular disease by modifying their lifestyle and adding nutritional supplements proven to support cardiovascular health. But this site is not recommending or advising that people switch from prescription anticoagulants to natural blood thinners.

No Studies that ‘Natural’ is as Effective as Warfarin

As of yet, there aren’t any double blind studies which demonstrate any natural alternative (or combination) is as effective against stroke as warfarin (Coumadin) or the new NOACs.

Certain foods and supplements may be “natural” and thin the blood, but there’s little research on their effectiveness to prevent clots in those at high-risk for stroke, such as A-Fib patients.

What’s more, there isn’t a way to track their effectiveness in the same way doctors can monitor the action of warfarin through routine blood tests.

If considering a switch to natural blood thinners, do not stop taking your anticoagulation medication. Talk to your doctor first.

Patients with Lone Atrial Fibrillation

Natural blood thinners may be considered for patients with “lone” Atrial Fibrillation, that is, patients who have had A-Fib occur only once or twice, are young, and have an otherwise healthy heart (normal size, no enlarged chambers or leaky valves, not otherwise prone to blood clots or other heart risk factors like diabetes, etc.). These low-risk patients may be candidates for natural alternatives to warfarin (Coumadin). (Historically, these patients may have been put on aspirin.)

If considering a switch to natural blood thinners, do not stop taking your anticoagulation medication. Talk to your doctor first. (But realize that your doctor isn’t likely to tell you to stop taking your warfarin or NOAC prescription.)

Seek Holistic-Minded Practitioners

Instead, you may want to seek out doctors who are holistically-minded and have knowledge of natural medicines; for example, a doctor who practices complementary or integrative medicine or a naturopathic physician. They can partner with you to pursue natural alternatives to prescription medicines. For a listing of such doctors in your area, go to http://www.ACAM.org.

For example, on his website, the Integrative Cardiologist and anti-aging specialist Dr. Stephen Sinatra discusses combating blood clots with this regimen of natural blood thinners:

•  Fish oil (2–3 grams daily)
•  Garlic (1–2 grams daily in capsule form)
•  Nattokinase (100 mg daily)
•  Vitamin E as mixed tocopherols (200–300 IU daily)
•  Bromelain, an enzyme derived from pineapple (600 mg daily)

For additional advice on natural ways to prevent blood clots, visit www.drsinatra.com.

Talk to Your Doctor: Supplements Can Interfere with Coagulation

Always talk to your doctor before adding any supplements to your treatment plan. Some ‘natural’ supplements may interact with your prescription meds (when taken alone or in combination) or interfere with coagulation and increase your bleeding risk.

References for this article
Sinatra, S. The Most Common Blood Thinners. DrSinatra.com website. Last accessed Nov 28, 2014. URL: http://www.drsinatra.com/the-most-common-blood-thinners

Stanger MJ, et al. Anticoagulant activity of select dietary supplements. Nutr Rev. 2012 Feb;70(2):107-17. doi: 10.1111/j.1753-4887.2011.00444.x. http://www.ncbi.nlm.nih.gov/pubmed/22300597

Return to FAQ Drug Therapies
Last updated: Monday, June 18, 2018

FAQ: “Which is the better to prevent A-Fib-related stroke—warfarin (Coumadin), a NOAC or aspirin?

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

FAQs A-Fib Drug Therapy: Stroke Prevention

“For A-Fib patients, which is the better to prevent A-Fib-related stroke—warfarin (Coumadin), a NOAC or aspirin?”

Updated: June 2018. For decades, patients more at risk for A-Fib-related stroke have been on warfarin (Coumadin). In the last few years, many of these patients have switched to the newer NOACs. A-Fib patients with low or no risk factors for stroke are often put on aspirin, or nothing at all.

Differences with the Same Goal

Aspirin is an antiplatelet drug that decreases the stickiness of circulating platelets (small blood cells that start the normal clotting process), so that they adhere to each other less and are less likely to form blood clots. (Cost: dirt cheap.)

Warfarin (brand name Coumadin) is an anticoagulant that works by slowing the production of blood clotting proteins made in the liver. Warfarin is highly effective, reducing the annual risk of stroke by approximately two thirds, but does require periodic lab tests to maintain the proper therapeutic level. (Cost: dirt cheap + lab tests.)

NOACs stands for Novel Oral AntiCoagulants. NOACs are alternatives for vitamin K antagonists (e.g., Warfarin). NOACs don’t require periodic blood testing as with warfarin. The clinical trials indicate NOACs work as well as warfarin. (Cost: Very expensive.)

Takeaways

The FDA approved the NOACs without any recognized method of determining their clot preventing effectiveness (as with warfarin, i.e. INR).

Warfarin has been successfully used for stroke prevention in A-Fib patients at high or intermediate risk for stroke. It’s readily available and inexpensive.

Aspirin is no longer recommended as first-line therapy for Atrial Fibrillation patients according to the 2014 AHA/ACC/HRS Treatment Guidelines for Atrial Fibrillation. And has been downgraded to a class 2B drug.

Microbleeds: We obviously don’t have any data on the long-term effects of taking NOACs for years. Some people on long-term warfarin have been known to develop micro bleeds and dementia. Will this happen with the NOACs? We simply don’t know. But intuitively one would expect the same thing to happen, though probably not to the extent of warfarin.

Weighing the various risk/benefit ratios is a decision for you and your doctor. And should be re-evaluated as you grow older.

Return to FAQ Drug Therapies
Last updated: Monday, June 18, 2018

FAQ: Are Anticoagulants and Blood Thinners the Same Thing? How do they Work?

Drug Therapies for Atrial Fibrillation, A-Fib, AfibFAQs A-Fib Drug Therapy: Warfarin 

“Are Anticoagulants and blood thinners the same thing? How do they thin the blood?” 

Since A-Fib increases your risk of clots and stroke, blood thinners are prescribed to prevent or break up blood clots in your heart and blood vessels and thereby reduce your chance of an A-Fib-related stroke.

Although referred to as “blood thinners”, they don’t actually affect the “thickness” or viscosity of your blood.

Anticoagulant Warfarin chemical diagram

Anticoagulant Warfarin

There are two main types: anticoagulants and antiplatelet agents.  They work differently to accomplish the same end effect.

Anticoagulants work chemically to lengthen the time it takes to form a blood clot.

Common anticoagulants include warfarin (Coumadin), Heparin and the NOACs such as apixaban (Eliquis).

Antiplatelet Aspirin

Antiplatelets prevent blood cells (platelets) from clumping together to form a clot.

Common antiplatelet medications include aspirin, ticlopidine (Ticlid) and clopidogrel (Plavix) .

Final answer: An anticoagulant doesn’t really thin the blood or make it less viscous, but it does help prevent a stroke like blood thinners do.

Note: To read about ‘clot buster’ drugs or treatments that could save you from a debilitating stroke, see my article: Your Nearest ‘Certified Stroke Center’ Could Save Your Life.

Return to FAQ Drug Therapies
Last updated: Tuesday, June 19, 2018

Good News for A-Fib Patients!―FDA Approves Reversal Agent for the NOACs Xarelto and Eliquis

Background: One of the problems for Atrial Fibrillation patients taking anticoagulants is the risk of life threatening or uncontrolled bleeding, particularly if one is injured. Since the introduction of the NOAC anticoagulants, there’s been an increase of hospital admissions and deaths related to bleeding, one of the major complications of anticoagulation.
In the U.S. alone in 2016, there were about 117,000 hospital admissions attributed to factor Xa inhibitor-related bleeding and nearly 2,000 bleeding-related deaths per month. An estimated 4 million people are taking factor Xa inhibitors.

Anticoagulant Reversal Agents

Up to now, only the anticoagulants Pradaxa (dabigatran) and Coumadin (warfarin) had a reversal agent or antidote.

As an example, if you were taking Pradaxa and were injured in an auto accident, doctors in the ER could administer ‘Praxbind’ (idarucizumab), the Pradaxa reversal agent, to stop any uncontrolled bleeding and (probably) save your life.

Many patients with Atrial Fibrillation were put on Pradaxa rather than Xarelto and Eliquis because Pradaxa has had a reversal agent since 2015.

Andexxa: Antidote for Xarelto and Eliquis

Now both Xarelto (rivaroxaban) and Eliquis (apixaban) have the FDA-approved reversal agent Andexxa (Portola Pharmaceuticals) as of May 7, 2018. It probably won’t be available till early June.

Andexxa rapidly and significantly reverses ‘anti-factor Xa’ activity which is the anticoagulant mechanism of both Xarelto and Eliquis.

Should you Switch From Pradaxa?

If you are taking Pradaxa, you may want to discuss with your doctor whether you should switch to another NOAC. (Note: Eliquis tested the best and is the safest of the new anticoagulants. See my article: Pradaxa and the Other New Anticoagulants.)

Are you tolerating Pradaxa well ? Nearly two out of five people (35%) couldn’t― that’s a high rate of adverse reactions. A large number of patients on the 150mg dose of Pradaxa had an increased incidence of gastrointestinal adverse reactions (35%/yr) compared to warfarin (24%/yr). For more see my article: The New Anticoagulants.

Pradaxa’s own fact sheet states common side effects of Pradaxa include:

• Indigestion, Upset Stomach, or Burning
• Stomach Pain

Note: These statements don’t capture the actual human toll—burning throat, roiling intestines, diarrhea, burning anus, lasting intestinal damage, etc. that Pradaxa can produce in some people.

Even if you seem to tolerate Pradaxa well, it may cause permanent GI damage over time.

Anticoagulants are Still Considered High Risk Drugs

FAQs A-Fib afibEven though Xarelto and Eliquis join Pradaxa with an antidote reversal agent, they are all still considered high-risk drugs.

Taking an anticoagulant is not like taking a multi-vitamin.

Anticoagulants work by causing or increasing bleeding. Though they are certainly better than having an A-Fib stroke, they carry their own risks. Read more: Bleeding Risk of Anticoagulants.

Resource for this article
Wending, P. FDA Approves First Factor Xa Inhibitor Antidote, Andexxa. Medscape Medical Nrews, May 4, 2018. https://www.medscape.com/viewarticle/896182

PODCAST: Marijuana—Good, Bad or Ugly for Patients with Atrial Fibrillation?

Click to open in new window

Note: If you prefer to read instead of listening to the audio, click below on the transcript graphic bar to roll down the printed version.

Podcast Introduction 

Our friend, Travis Van Slooten is publisher of LivingWithAtrialFibrillation.com. With marijuana legal in a growing number of U.S. states, he invited Steve to join him on his podcast and share the latest about marijuana use by A-Fib patients. (About 18 min. in length.)

Here are the highlights of this podcast:

We do not have a lot of clinical data on marijuana and atrial fibrillation simply because it’s so new. What we know is often anecdotal at this point.
Some A-Fib patients say it helps them. Others say it puts them into A-Fib.
There has been some research saying that smoking marijuana might lead to the development of A-Fib and it may affect the cardiovascular system, but this is general data without a whole lot of really hard studies confirming that.
If there is any benefit of marijuana for A-Fib, the best form is probably CBD in edible form (but we really don’t know for sure).
An unpublished study followed 6 million heart failure patients. Those in the group that were non-dependent on marijuana were 18% less likely to develop A-Fib. Dependent marijuana users were 31% less likely to experience A-Fib.

Resources mentioned in this episode

States Where Marijuana is Legal
FAQs Coping with A-Fib: Marijuana


Travis Van Slooten was diagnosed with atrial fibrillation on Father’s Day in 2006. He would battle a-fib for nine years before having a successful catheter ablation in March 2015. He’s been a-fib-free since with no drugs! His blog covers his own journey and provides information, inspiration, and support for others with A-Fib. Visit his site.

Transcript: Marijuana and Atrial Fibrillation

Marijuana and Atrial Fibrillation

Into: The host of this podcast is not a medical doctor. The information provided is not intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician prior to starting any new treatment or with any questions you have regarding a medical condition. Now on to the show. Welcome to the Afib podcast, where we provide information, inspiration, and support for afibbers. And now your host, Travis Van Slooten.

Travis Van Slooten: I have a special guest for this episode of the afib podcast. His name is Dr. Steve Ryan. Steve is a former afib patient who was cured of his afib back in April 1998 via catheter ablation. He’s a publisher of one of the most popular afib websites, a-fib.com and he’s the author of the best-selling book Beat Your A-Fib: The Essential Guide to Finding Your Cure.

In this episode Steve and I discussed the topic of marijuana use and atrial fibrillation. We discuss recreational pot smoking versus medical marijuana and how many marijuana may or may not be beneficial for people with afib. So without further ado, let’s roll the tape.

All right, Steve, so I want to talk to you about something that it was a very interesting topic that I honestly had not thought about before. I got an email from one of my readers who wanted to know if it was safe to smoke marijuana while they had afib. First I thought this has got to be some kind of a joke because I honestly had never thought about this before, but it makes sense, you know, recreational marijuana is definitely becoming a morbid thing, it’s currently legal in nine states, and medical marijuana use is legal in 29 States.

Recent poll shows that 64% of Americans support the legalization of marijuana. So this is going to be become – if it hasn’t already – become a more kind of important topic. And then ironically, a week later I got another email from someone that had the same question, so I’m like, “Wow, this is really kind of a big deal.”

So I found an article on your site, Steve, that you just recently wrote about this very topic, marijuana use and afib. And in that article you had discussed a little bit about the differences of recreational marijuana and the prescription form of marijuana which is called marinol, and you kind of discussed that there was some key differences between these two. So what are the differences between the two? .

Steve Ryan: Travis, I apologize that we do not have a lot of clinical data on this subject simply because it’s so new and the answers I give aren’t going to be definitive, but we’re doing the best we can with the information that we have. The marinol is the prescription form of cannabis, and the makers of it have a blanket disclaimer saying “Don’t use this with any kind of heart problem…” you know, it’s kind of legal thing. They haven’t done any clinical studies on this subject to say that but they’re just protecting themselves. There have been some research saying that smoking marijuana might lead to the development of afib and it may affect the cardiovascular system, but this is general data without a whole lot of really hard studies indicating that.

Now, what I’ve done on our website is – since I don’t know enough about it to really give a definitive answer –  I have asked people to tell me their experiences and they vary all across the board. Some say that this is the best thing I’ve ever taken, some people say as soon as I start smoking marijuana I get afib. Now, the reason for that might be the different in the pot they’re smoking or the edibles they’re taking. THC is a component found in the marijuana plant stavia. That’s what makes you feel high.There is a CBD is a component found in the marijuana plant indica. That works better to reduce pain and anxiety and induce sleep. Now the problem is the manufacturers of pot – every state has their own little companies, and some produce CBD and a tincture and an oil, in edibles; but some just mix it all together and it’s really hard depending on the state to find something that is just CBD that you can use to get rid of anxiety and get to sleep, that kind of thing.

Now what is the best product for afib patients? Probably CBD in edible form. Smoking marijuana unfortunately produces a lot of problem just like smoking does because there are a lot of bad things in the cigarette smoke as there is in the marijuana smoke. So people tend to want to use marijuana for medical purposes, they’re probably better off using an edible form with more CBD and THC. Does that make any sense?

Travis Van Slooten: Yeah, absolutely. I mean looking at again that article you wrote and I’ll link to it here to in the show notes so people can reference it. If they have experience smoking marijuana or taking it medically, they can surely reach out to you and share their experience with it. But as I look at your article you do have some anecdotal stories there, and it doesn’t seem that the few that are there that I’ve had that experiences with it were people smoking it. And one of the gentleman that wrote, a guy named Jim, said that it was like a life savior for him, but again, he was taking the medical prescription form of it, so that seems to back up kind of what we’re talking here.

Steve Ryan: Yeah. He has a great statement. He’s the guy who is very under a lot of stress, he has his own business. He comes home at night and his brain was throbbing on a mile a minute and he couldn’t get to sleep. So he use marijuana edibles and the stress goes right away and he seems to sleep very well at night. Just to be honest with you, I’m also some kind of like him. I’m very wound, very tight.

Travis Van Slooten: You’re a Type A?

Steve Ryan: I tend to think of all of the things about afib. I’m thinking about, you know… And to tell you the truth, I take edible marijuana and it gets me really relaxed and I go right to sleep.

Travis Van Slooten: Let’s talk about— for people that aren’t familiar with medical marijuana, I am one of those, by the way, I know nothing about this stuff which is why I find it so fascinating, but when we talk edibles, like, what is it? Is it literally like a brownie, a piece of cake? Is it like a gum? I mean what is it? When you say edible, what is it?

Steve Ryan: There are a lot of different products, and unfortunately every state has their own different companies. We don’t have companies that are nation-wide to put out a standard product, but a lot of them are like a brownie that comes in a package like a cookie. It comes in like 100 mg and you cut it into 10 mg slices. To me that’s a pain, but a lot of people use that. Another way is they have product like this one product is blueberry based. They make the marijuana in with blueberries and you just take one, and one is 5 mg and I usually take two at night. Other forms, let see, brownies.

Travis Van Slooten: Now you mentioned and oil-based, a tincture base…

Steve Ryan: What?

Travis Van Slooten: You mentioned a tincture based. That isn’t edible but that’s a different form.

Steve Ryan: Yeah, the way they do with that is they develop a tincture with CBD in an oil, and you put it on your body and let it absorb into your body, and that’s another… I’ve never tried that. I have no idea how well that works or how good it is.

Travis Van Slooten: And that tincture that isn’t something you… You don’t put it in your mouth; you put it on your skin.

Steve Ryan: Yeah, you put it on your skin. But again, I am not an expert in this field and we’re just doing the best we can with little knowledge that we have, and I beg all the listeners to be aware that this is not something that is definitive and written in stone and this is the way to go. Everything I say may completely change when we get more information on medical marijuana.

Travis Van Slooten: Yeah, absolutely. Like you said, I think it’s just starting to explode right now. Do you know, are there any studies underway right now? Do you know of any?

Steve Ryan: Well, there was a really interesting study that just came out where they studied patients with heart failure. And what they found was that– first of all, patients with heart failure are really in deep doo-doo, we’re talking like an ejection fraction of like low or below 35% normally is 50 to 75. These patients, if they have really serious heart failure it’s like they’re suffocating to death. It’s a terrible way to go if you’re ill and you have congestive heart failure, you just feel terrible from what I understand. I’ve never had it. So what they did was they followed 6 million in US hospitals with heart failure. About 1200 used and depended on marijuana. About 2300 used marijuana, but were not depended on it. So the non-dependent marijuana users were 18% less likely to develop afib. And the dependent users were 31% less likely to experience afib.

Now what that means is that marijuana prevented these patients who had heart failure from developing afib. Now, why is that important? Basically a combination of heart failure and afib is a killer. One is bad, two together like that is much worse. These people are much more apt to die, and marijuana basically prevented these people from developing afib even though they had heart failure. This is really big news because sure, now we’re applying it to heart failure, but what about normal people, would marijuana prevent them from developing afib? We don’t know. But the study indicate that. In study would say definitely that anyone who has heart failure should consider marijuana use in some form because it does seem to prevent them from going into a atrial fibrillation. Now can we go further and say everybody should smoke marijuana to prevent them from developing afib? No, we can’t say that.

Travis Van Slooten: Yeah, absolutely. And the other thing is I suppose we don’t have the details of the study either like what form they were taking, how much they were taking every day. We don’t have that information, do we, from that study? I mean you might not have it on hand, but…

Steve Ryan: I don’t have it on hand but there would probably be some indication of that, and I’d have to look that up and maybe get back to you. Those are some good questions. But you know, in general they usually do these things it’s usually 10 mg a day. That’s a general rule of thumb. But again, I don’t really know the specifics. But people who are dependent, those are probably smokers, and they were probably doing much more smoking of pot than the other group. That worked for them and prevented them from developing afib more so than the other people.

Travis Van Slooten: Now, did that study say they were pot smokers or they were taking the medical prescription form of marijuana? Because we talked earlier that smoking was probably not the good form or as the medicals…

Steve Ryan: Since this is done between 2007 and 2014 we can assume they were smokers.

Travis Van Slooten: And that to me is kind of promising because it’s saying — of course, that leads to more questions, right? Because what’s more effective, the recreational smoking pot or the medical form of it, you know, like the edibles? I mean all these things are still — we have no idea here.

Steve Ryan: We just don’t know yet, we just don’t know. Another part of this study that was interesting was people using marijuana were 46% less likely, and dependent users 58% less likely to die in the hospital. Now that’s good news because one of the main problems with afib is you’re in the hospital so often, and that’s really good news and something that is worth looking into. By the way, this study that I’m talking about hasn’t been published yet.

Travis Van Slooten: Oh, it hasn’t, okay.

Steve Ryan: So that’s why we don’t have the information on all the details of the study. As soon as the study get published we’ll get that information.

Travis Van Slooten: That’s good to know in case someone is listening this and they’re trying to Google this they’re not going to find it right now.

. Steve Ryan: Yeah, right, I don’t think so.

Travis Van Slooten: So the bottom line with this topic then is what’s your bottom line message to someone that would pose that question that was posed to me which is, “Hey, I have afib and I smoke pot, is this good or bad?” Mypersonal response to them Steve is kind of what you said Steve “We don’t know much of anything on this topic right now because it’s kind of so new.” And the other thing is I just told them I would approach it kind of like smoking or drinking; that it’s probably not best to do it heavily on a regular basis. And more importantly, if you smoke pot and you have an episode that’s probably an indication that’s a trigger so you should probably avoid it. But likewise if you are a moderate smoker and it seems to keep your afib episode at bay, then it might be okay to continue to smoke. That was kind of the way I handled it. Is that kind of the way you handle that answer or that question is well?

Steve Ryan: Yes. Some of the people like John wrote to me and said “99% of these afib attacks occurred when I’m under the influence of marijuana.”

Travis Van Slooten: Okay, the obvious trigger.

Steve Ryan: Yeah, and Jonathan writes “I tried a tiny bit of brownie for the first time since being diagnosed with afib. It was okay until about two hours later. I went into afib and a bit later came the closest I ever have to blacking out. I don’t think it’s for me anymore.” On the other hand, Jim writes that he uses it every night and it work for him fine.

Travis Van Slooten: Yeah, so it kind of gets back to the whole what’s trigger, what’s not. And so yeah, I think it’s all fascinating. Definitely I think this is going to become more and more of an issue as I said in the opening here with the marijuana legalization kind of sweeping across the country here. This is going to become a very hot topic, I think.

Steve Ryan: Yes, definitely.

Travis Van Slooten: Well, Steve, I just want to thank you for your time to discuss this topic, and I look forward to talking to you in the next week’s episode. We’re going to be talking about the real cost of living with afib. So Steve, thanks again for your time.

Steve Ryan: You’re welcome.

Outro: Thanks for listening to the podcast.Be sure to visit livingwithatrialfibrillation.com for more information, inspiration and support. Be well, and please join us next time.

Catheter Ablation Compared to Amiodarone Drug Therapy in Heart Failure Patients with A-Fib

Background: I previously reported on the ground-breaking CASTLE-AF study published in 2018 which compared treatment with conventional antiarrhythmic drugs (both rate and rhythm control) versus treatment with catheter ablation. I recently came across another, similar study. While the 2016 AATAC study pre-dates the CASTLE-AF study, it also contributes to our understanding of treatment choices for heart failure patients with A-Fib.

Treating Patients with Both Heart Failure and A-Fib

Heart failure is very common in patients with A-Fib (estimated at 42%). These are very sick patients. For people with advanced heart failure, nearly 90% die within one year.

In patients with both conditions, a cardiologist’s first treatment is most often drug therapy with an antiarrhythmic drug. But is this an effective strategy? Is this really in the patient’s best interest? A 2016 study says NO!

AATAC stands for: Ablation vs Amiodarone for Treatment of Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted ICD/CRTD

AATAC: Catheter Ablation vs. Amiodarone Antiarrhythmic Drug Therapy

In the powerful AATAC multicenter worldwide randomized trial, catheter ablation was compared to drug treatment with amiodarone (the most effective but also the most toxic of the antiarrhythmic drugs).

The 203 enrolled patients had persistent A-Fib and heart failure with an Ejection Fraction of less than 40%. Patients also all had either a dual-chamber implantable cardioverter defibrillator or cardiac resynchronization therapy defibrillator.

All patients in the AATAC study were given optimal medical therapy for congestive heart failure such as ACE inhibitors, etc.

Patients were randomized to receive either a catheter ablation or drug treatment with amiodarone.

Note: The AATAC study should be read in conjunction with the more significant CASTLE-AF study which found similar results.

Group 1: Catheter Ablation

The first group received a catheter ablation of the pulmonary veins (PVI) along with roof lines and extensive ablations on the left atrial posterior wall; if non-PV potentials were found, the superior vena cava was isolated. At their discretion, EPs could ablate complex fractionated electrograms and non-PV triggers.

A ‘re-do procedure’ could be performed during the 3-month blanking period.

Group 2: Amiodarone (AMIO) Drug Treatment

The Amiodarone (AMIO) group was given 400 mg twice a day for 2 weeks followed by 400 mg each day for the next 2 weeks, then they were given a maintenance dose of AMIO 200 mg/day for the balance of the 24 month study period.

Study Follow-up and Results

All patients were followed for a minimum of 24 months. Recurrence was measured by the implantable devices with device interrogation at 3, 6, 12, and 24 months follow-up. Key findings at the end of the trial period include:

Recurrence: 70% of patients in the ablation group were recurrence and A-Fib free (after an average of 1.4 procedures) vs. only 34% of the Amiodarone (AMIO) group.

PVI with/without posterior wall isolation: Higher success was reported in patients undergoing PVI with posterior wall isolation compared to PVI alone (79% vs. 8%).

Amiodarone therapy was found to be significantly more likely to fail.

Cardioversion: During the 3-month blanking period 51% of the Amiodarone (AMIO) group needed cardioversion vs. 3% of the ablation group.

The unplanned hospitalization rate was 31% in the ablation group vs. 57% in the AMIO group. This is a 45% relative risk reduction of hospitalization.

A significantly lower mortality was observed in the ablation group: 8% vs. AMIO 18%.

Summary: Catheter Ablation Superior to Amiodarone Drug Therapy

Heart failure and A-Fib are common cardiac conditions that often coexist.

The AATAC study, the first randomized study of heart failure patients with persistent A-Fib, found that catheter ablation is superior to amiodarone drug therapy in achieving freedom from A-Fib long-term.

In addition, treatment with catheter ablation improved mortality in these patients, increased exercise capacity and Quality of Life (QofL) along with reduced unplanned hospitalizations.

Acknowledging My Bias
I admit to being biased against amiodarone drug therapy due to personal experience and from what others have shared. (For example, see Karen Muccino’s A-Fib story.) I am horrified that anyone would be put on such a high initial dosage of amiodarone as in this study. I would never participate in such a study. But obviously all doctors don’t share my concerns.
If a less potent (and less dangerous) antiarrhythmic drug had been used, it’s probable the study results would have been even more favorable for the ablation group.

What This Means to A-Fib Patients

These patients were in persistent A-Fib along with heart failure. These are some of the most difficult patients to make A-Fib free.

The EPs and A-Fib centers in this study were some of the best in the world. That there was a 70% success rate and no recurrences after 2 years is a testimony to the advanced mapping and ablation skills of these EPs. It’s remarkable how far catheter ablation strategies have improved over the years.

On the downside, not all EPs are equal. The single procedure success rate varied greatly from 29% to 61%. (See Huge Growth in Number of EPs Doing Catheter Ablations, But All EPs Are Not Equal.)

Catheter Ablation Group: Improved Ejection Fractions

Among the 203 enrolled patients, it’s not surprising that there were 26 deaths during this study. These were very sick patients with congestive heart failure and Ejection Fraction below 40%. (An EF below 50% indicates a weakened heart muscle that is no longer pumping efficiently; an EF in the normal range is 50% to 75%.)

The good news is that for many in the catheter ablation group, their ejection fraction was significantly improved and they were no longer in heart failure.

Catheter Ablation Outperforms Antiarrhythmic Drugs

We now have 2 studies which demonstrate that compared to antiarrhythmic drug therapy, catheter ablation lowers death rate among A-Fib patients (with heart failure), improves QofL and lets patients live longer and healthier lives. Other major benefits of ablation include reduced unplanned hospitalizations and increased exercise capacity.

Take-Away for A-Fib Patients

I think we can draw conclusions from the AATAC and the CASTLE AF studies that also apply to A-Fib patients (not in heart failure).

Rather than a life on antiarrhythmic drug therapy, the AATAC and CASTLE AF studies encourage A-Fib patients to seek a catheter ablation (including a second “re-do ablation”, if necessary.)

Bottom-line: Hard research data shows that a catheter ablation is the better choice over drug therapy. An ablation can rid you of your A-Fib symptoms, make you feel better, and let you live a healthier and longer life.

Don’t just live with A-Fib. Seek your cure.

 

Resources for this Article
Di Biase, L., et al. Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device. Results From the AATAC Multicenter Randomized Trial. Circulation. 2016;133:1637-1644. March 30, 2016. http://circ.ahajournals.org/content/133/17/1637 DOI  https://doi.org/10.1161/circulationaha.115.019406

Anticoagulants, Dementia and Atrial Fibrillation

The prevalence of dementia and atrial fibrillation (A-Fib) are both on the rise with the aging population and increasing burden of vascular risk factors.

The association between A-Fib and dementia is well documented. To describe that relationship, researchers use the term “strongly associated” rather than explicitly state that A-Fib causes or leads to dementia. That’s as far as they can go, because there might be other factors at play.

Patients with A-Fib lose 15%-30% of their heart’s ability to pump blood to their brain, and to the rest of their body.

A-Fib Linked with Dementia

As patients, we use more direct language. All things being equal, we say A-Fib leads to and/or causes dementia. It makes intuitive sense, doesn’t it? Patients with A-Fib lose 15%-30% of their heart’s ability to pump blood to their brain, and to the rest of their body. (See: Increased Dementia Risk Caused by A-Fib: 20 Year Study Findings)

Research confirms that older adults with dementia had significantly reduced blood flow into the brain compared with older adults with normal brain function or young adults.

Research Reveals: Anticoagulants Reduce Risk of Dementia

Swedish study investigated the effect of anticoagulation on the development of dementia among A-Fib patients. Research data was collected on patients diagnosed with and treated for A-Fib in Sweden between 2006-2014. This included 444,106 patients, and over 1.5 million patient-years.

The retrospective registry study compared the incidence of dementia developed in A-Fib patients with and without ongoing anticoagulation with warfarin or direct oral anticoagulation (DOAC) (i.e., dabigatran, rivaroxaban, apixaban and edoxaban).

This study of A-Fib patients found that anticoagulant treatment was associated with a 29% reduced risk of dementia. There was no difference in dementia risk between patients treated with warfarin and those treated with direct oral anticoagulants. 

It’s encouraging to know that, if you have A-Fib and must take anticoagulants, they may reduce dementia to a limited degree.

The authors concluded that the risk of dementia is higher among A-Fib patients not treated with anticoagulation.

In fact, absence of anticoagulation treatment was among the strongest predictors for dementia along with age, Parkinson’s Disease, and alcohol abuse.

Anticoagulants May Reduce Micro-Clots

This study did not tell us how anticoagulation achieves this effect.

Some speculate that anticoagulants, while preventing macro-clots (strokes), also prevent or reduce micro-clots and smaller ischemic events which damage the brain over time.

Another Reason to Not Live with A-Fib

This study also raises another reason not to live in A-Fib if at all possible. Unlike macro-clots which cause strokes and which can kill or severely disable, A-Fib tends to produce micro-clots (smaller ischemic events or silent mini-strokes). The effect of micro-clots may not even be noticeable but, nonetheless, damages our brains over time.

Resources for this Article
• Risk of dementia higher without oral anticoagulants for AF. Cardiac Rhythm News. 15th December 2017.  https://cardiacrhythmnews.com/leif-friberg-oac-dementia-af/

• Friberg l, Rosenqvist M. Summary by Geoffrey Barnes. Less Dementia With Oral Anticoagulation in Atrial Fibrillation. American College of Cardiology, Oct. 26, 2017. http://www.acc.org/latest-in-cardiology/journal-scans/2017/10/26/15/38/less-dementia-with-oral-anticoagulation-in-atrial-fibrillation.

• Gallagher, C et al. Reducing Risk of Dementia in AF–Is Oral Anticoagulation the Key? Mayo Clinic Proceedings, February 2018, Volume 93, Issue 2, Pages 127-129. http://www.mayoclinicproceedings.org/article/S0025-6196(17)30920-5/fulltext. DOI: https://doi.org/10.1016/j.mayocp.2017.12.017

 

From My Mailbox: Catheter Ablation Complication Rate: Compared to What?

Frequently I get emails asking about the complication rate of catheter ablation.

I like the suggestion made by Dr. David Keane of St. Vincent’s University Hospital, Dublin Ireland. Complications from A-Fib ablation should be viewed in perspective, that is, compared to the alternative of a lifetime on antiarrhythmic drugs (AADs).

The following is based on his presentation from the 2014 Boston AF Symposium.

Meta-Analysis: RF Catheter Ablation vs. Antiarrhythmic Drugs

In what may be the first systematic literature review and meta-analysis of clinical studies of Radiofrequency Ablation (RFA) vs. Antiarrhythmic Drugs (AADs), the reviewers looked at studies from 1990 to 2007. [Note: RFA wasn’t in use until the mid-1990s.] Included were sixty-three RFA studies and 34 AAD studies.

RF Ablation: From 1990-2007, the single procedure success rate for Radiofrequency Ablation (RFA) without need of post-op Antiarrhythmic Drug (AAD) therapy was 57% [today’s success rates are in the 70%–85% range], multiple procedure success rates without post-op AADs were 71% [today’s success rates are closer to 90%], and the multiple procedure success rate with post-op AADs was 77%.

AAD Therapy: The success rate for AAD therapy alone was 52%.

Note: The meta-analysis included five AADs: amiodarone, dofetilide, sotalol, flecainide, and propafenone. Amiodarone was the most effective. [Amiodarone is the most toxic and dangerous of the five AADs and is usually prescribed only for short periods of time and under close supervision for bad side effects.]

Adverse Event: side effect or any undesirable experience associated with the use of a medical product in a patient. In the US, adverse events are reported to the FDA.

Side Effects Cause Patients to Stop Taking AADs: Because of adverse events (side effects), 10.4% of patients discontinued taking their AADs, 13.5% discontinued AADs because of treatment failure, and 4.2% just didn’t take the AADs.

The overall discontinuation rate of AADs was almost 30%.

Findings: Efficiency and Complications Rates

Based on the meta-analysis, reviewers found Radiofrequency Ablation (RFA) had a higher efficiency rate and a lower rate of complications than AAD Therapy.

Findings: Adverse Events Ablation vs AAD

As a point of reference, the complication rate of the common appendectomy is 18%.

This meta-analysis found adverse events for catheter ablation was 5% vs 30% for AAD studies.

More about AAD Therapy adverse events: The overall death rate for AAD therapy was 2.8% (i.e., sudden death 0.6%, treatment-related death 0.5%, non treatment-related death 1.3%). Other adverse events from AAD therapy were:

•  CV (cardiovascular) Events 3.7%
•  Bradycardia 1.9%
•  GI (Gastrointestinal problems) 6.5%
•  Neuropathy 5.0%
•  Thyroid Dysfunction 3.3%
•  Torsades 0.7%
•  Q-T prolongation 0.2%

Conclusions from Meta-Analysis

Most adverse events associated with antiarrhythmic drugs (AADs) are life altering and permanent. (For example, bradycardia requires a pacemaker.)

Whereas complications from catheter ablation are generally short term and not permanent. (For example, when tamponade is repaired, the heart usually returns to normal.)

While this meta-analysis covered 1990-2007, based on subsequent research the trends are continuing. In general, it appears it’s safer to have an ablation than to not have one while living a life-time on AAD therapy.

D. Keane MD

The Full Report: For the full summary of Dr. Keane’s 2014 Symposium presentation, see: Catheter Ablation Complications: In-depth Review and Comparison with Antiarrhythmic Drug Therapy.

What this Means to Patients

If you are age 70 or 80, antiarrhythmic drugs might be a realistic option.

But if you are younger, it’s inconceivable that you would spend the rest of your life taking AADs. In addition to not working well or losing their effectiveness over time, they can have bad, cumulative side effects as described above.

Today’s ‘Guidelines for the Management of Patients with Atrial Fibrillation’ reflect this fact and allow you to select a catheter ablation without having to spend time trying various antiarrhythmic drugs (while your A-Fib may be getting worse).

In general, research shows it’s safer to have an ablation than to not have one (and live a lifetime on AA drug therapy).

Resources for this Article
•  Deshmukh, A. et al. In-Hospital Complications Associated with Catheter Ablation of AF in US: 2000-2010. Analysis of 93,801 Procedures. Circulation. 2013;128:2104-2112. http://circ.ahajournals.org/content/128/19/2104.abstract

•  Haïssaguerre M. “Electrophysiological End Point for Catheter Ablation of Atrial Fibrillation Initiated From Multiple Pulmonary Venous Foci,” Circulation. 2000;101:p. 1409

•  Jais, P. “Ablation Therapy for Atrial Fibrillation: Past, Present and Future,” Cardiovascular Research, Vol. 54, Issue 2, May 2002, P. 343

•  Cappato R et al. “Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation.” Circulation: Arrhythmia and Electrophysiology. 2010: 3:32-38.

•  AHA/ACC/HRS. 2014 Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014; 130: e199-e267 DOI: 10.1161/CIR.0000000000000041.

New FAQ: Which antibiotics are less liable to cause an A-Fib attack?

A question from Ellen McCall lead me to turn to our world-wide A-Fib.com Advisory Board for an answer. Several EPs shared their opinions, research data and insights from their practices in answer to this question:

FAQ: “Which antibiotics are less liable to cause an A-Fib attack? How is Clindamycin for dental work? In the past I reacted to Azithromycin and Advil.”

Our A-Fib Advisory Board Offers Expert Opinions

One EP’s response: “There is no particular association that I can think of or have seen with antibiotics, but likely more of a personal idiosyncratic reaction to the drug. Everybody is different and has a different trigger.”

From another EP: “Most [antibiotics] do not change the way the heart’s electrical system functions other than prolonging the QT interval, which should have the opposite effect. In the quinolone family, (antibiotics) like Levofloxacin and Ciprofloxacin act like antiarrhythmics.

However, some antibiotics have worse gastric tolerance effects like Azithromycin and Erythromycin which can become a trigger for A-Fib by GI stimulation such as nausea or reflux. Medication to counter that side effect can be used, such as acid reducers.”

Continue reading the experts’ answers to this question…and my summary of their opinions, go to my FAQ: A-Fib Drug Therapy: Medications->

FAQ: Which antibiotics can cause an A-Fib attack?

FAQs A-Fib Drug Therapy: Medications

Drug Therapies for Atrial Fibrillation, A-Fib, Afib“Which antibiotics are less liable to cause an A-Fib attack? How is Clindamycin for dental work? In the past I reacted to Azithromycin and Advil.

To answer these questions, I turned to members of our world-wide A-Fib.com Advisory Board. Several EPs shared their opinions, research data and insights from their practices.

Expert Opinions from Several Members of our A-Fib Advisory Board:

One EP’s response: “There is no particular association that I can think of or have seen with antibiotics, but likely more of a personal idiosyncratic reaction to the drug. Everybody is different and has a different trigger.”

Another EP wrote: Most antibiotics are well tolerated by patients with A-Fib.

A well-known authority on pharmaceuticals and A-Fib stated: “I know of NO data to prove a link between any antibiotic and A-Fib.”

”Most [antibiotics] do not change the way the heart’s electrical system functions other than prolonging the QT interval, which should have the opposite effect…act like antiarrhythmics.”

From another EP: “Most [antibiotics] do not change the way the heart’s electrical system functions other than prolonging the QT interval, which should have the opposite effect. In the quinolone family, (antibiotics) like Levofloxacin and Ciprofloxacin act like antiarrhythmics.

However, some antibiotics have worse gastric tolerance effects like Azithromycin and Erythromycin which can become a trigger for A-Fib by GI stimulation such as nausea or reflux. Medication to counter that side effect can be used, such as acid reducers.”

One EP called our attention to a study that focused on ventricular arrhythmia rather than on A-Fib. (Ventricular arrhythmias can kill you, while an attack of A-Fib usually isn’t life threatening):

“There have been reports of higher rates of ventricular arrhythmias with certain antibiotics (macrolides like Azithromycin and fluoroquinolones like Levofloxacin). It’s possible similar results could be found if looking for atrial arrhythmias, too. (The FDA warned of the risks of possibly lethal heart rhythm when taking Azithromycin or Levofloxacin. [Rao and colleagues.] But the absolute risks were relatively low.)

It’s much more likely that the underlying infection or illness causes A-Fib rather than the antibiotic used to treat it.

This EP further clarified:

A-Fib is more likely to start during times of physical stress, such as after surgery or when your body is fighting an infection. It’s much more likely that the underlying infection or illness causes A-Fib rather than the antibiotic used to treat the infection.”

The General Consensus on Antibiotics and A-Fib

At this time, we can’t identify antibiotics that cause or trigger A-Fib in most patients.

According to most authorities in the A-Fib field, an A-Fib patient’s negative reaction to a particular antibiotic is most likely an individual idiosyncratic response rather than a generalized, population-wide phenomenon.

Thanks to Our A-Fib Advisory Board

I am deeply indebted to these cardiac electrophysiologists and others who offer me their counsel in publishing A-Fib.com. When I have a tough question, I can button hole them at a medical conference, send an email, or telephone them.

While not always agreeing with all my positions, these doctors try to point me in the right direction. It is my honor to acknowledge and thank the world-wide members of the A-Fib.com Advisory Board.

For a list of members, go to the A-Fib.com Advisory Board.

Resources for this Article
• Neale, Todd. Can Antibiotics Trigger Arrhythmias? Medpage Today, March 10, 2014. https://www.medpagetoday.com/cardiology/arrhythmias/44703

• Rao G et al. Azithromycin and levofloxacin use and increased risk of cardiac arrhythmias and death. Ann Fam Med 2014; 12: 121-127. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3948758/ doi:  10.1370/afm.1601

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Last updated: Monday, June 18, 2018

Patients with A-Fib and Kidney Disease: Should You be on Blood Thinners?

If you have Atrial Fibrillation and also suffer from Chronic Kidney Disease (CKG), beware! Being on an anticoagulant may make you more prone to stroke. That’s according to UK researchers.

In a newly published retrospective study from England (The United Kingdom), 7,000 patients over age 65 with chronic kidney disease who later developed A-Fib had more strokes (and hemorrhage bleeding) than those not taking anticoagulants.

Anticoagulant may make you more prone to stroke.

In fact, patients taking anticoagulants were 2.6 times as likely to have a stroke (and 2.4 times as likely to have major hemorrhagic bleeding).

Reduced Kidney Function and Atrial Fibrillation

Reduced kidney function or chronic kidney disease is very common in older people. Chronic kidney disease (CKD) and Atrial Fibrillation (A-Fib) often co-exist. A-Fib can promote or accelerate the progression of chronic kidney disease.

Worldwide, it’s estimated that 15–20% of patients with chronic kidney disease (CKD) also have Atrial Fibrillation.

Research Conclusion

According to the study’s first author, Dr. Shankar Kumar of the UCL Center for Medical Imaging, London:

“As we found in this particular group, their medication (anticoagulant) seems to do the opposite of its intended effect.

…Careful consideration should be given before starting anticoagulants in older people with chronic kidney disease who develop atrial fibrillation.”

A-Fib and Anticoagulation: First Check for Reduced Kidney Function 

How to measure if your kidneys are working? A Glomerular Filtration Rate [GFR) of 60 or higher is normal, while a GFR below 60 may mean kidney disease.

This study only dealt with Chronic Kidney Disease (CKD). But common sense dictates that the findings of this study may also affect anyone with reduced kidney function.

In the early stages of Chronic Kidney Disease, there may be few signs or symptoms. CKD may not become apparent until kidney function is significantly impaired.

From this study, we can say it’s imperative that anyone with A-Fib especially older people, should be checked for reduced or chronic kidney disease before being put on anticoagulants.

Alternatives to Anticoagulants

This study points out the difficulty for A-Fib patients taking anticoagulants who also have chronic kidney disease: The anticoagulants meant to prevent stroke actually increase stroke risk and hemorrhage bleeding.

If you’re in this situation, you may want to consider these two options:

1. Closure of the Left Atrial Appendage (where most A-Fib clots originate). An occlusion device like a Watchman may be an alternative to anticoagulants. (For more, see my article, The Watchman™ Device: An Alternative to Blood Thinners);

2. Free yourself from A-Fib. Consider a catheter ablation procedure (or mini-maze surgery). Reasoning: if you no longer have A-Fib, you can’t have an ‘A-Fib-related’ stroke.

But know that even without A-Fib, you can still have a stroke from other causes. (Right now, we don’t have a therapy that will absolutely guarantee you will never have a stroke.)

What This Means for A-Fib Patients

For A-Fib patients who also have chronic kidney disease, being on an anticoagulant may make you more prone to stroke, not less.

Accordingly, if you have A-Fib and are taking anticoagulants, ask your doctor if you have been checked for ‘reduced kidney function’.

And if in the future, you develop reduced kidney function, discuss these research findings with your doctors (print a copy of this post and include the ‘References for this Article’ below).

Paradox: If you have kidney disease, the anticoagulants meant to prevent stroke actually increase stroke risk and hemorrhage bleeding.

Resources for this Article
• Boseley, S. Blood-thinning drugs designed to cut stroke risk may actually increase it. The Guardian. February 15, 2018. https://www.theguardian.com/science/2018/feb/15/blood-thinning-drugs-designed-to-cut-stroke-risk-may-actually-increase-it

• Kumar, S. et al. Ischemic stroke, haemorrhage, and mortality in older patients with chronic kidney disease newly started on anticoagulation for atrial fibrillation: a population based study from UK primary care. BMJ 2018;360. http://www.bmj.com/content/360/bmj.k342 doi: https://doi.org/10.1136/bmj.k342

• McManus, DD, et al. The Relationship Between Atrial Fibrillation and Chronic Kidney Disease: Epidemiologic and Pathophysiologic Considerations for a Dual Epidemic. J Atr Fibrillation. 2012 Jun-Jul; 5(1): 442. doi: 10.4022/jafib.442

• Kirchhof, P., et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Chronic kidney disease. Europace Advance Access. August 27, 2016 doi:10.1093/europace/euw295.  http://www.arcalazio.com/wp2016/wp-content/uploads/2016/09/europace.euw295.full_.compressed-1.pdf

• Hart RG, et al. Stroke prevention in atrial fibrillation patients with chronic kidney disease. Can J Cardiol 2013;29: S71–78.

Is Warfarin a Protective Factor for Cancer Among A-Fib Patients? Research Finds a Possible Link

A 7-year retrospective study of patients older than 50 years drawn from the Norwegian National Registry and other databases (1,256,725 persons), found a possible link between warfarin use and cancer prevention. Particularly for A-Fib patients.

Study Participants and Design

Warfarin (brand: Coumadin) tablets

Of the over one million patients in the combined databases, 48.3% were male, 51.7% were female, 7.4% were classified as warfarin users, and 92.6% were classified as nonusers. The participants were divided into 2 groups—warfarin users and nonusers.

Warfarin users had to be taking warfarin for at least 6 months and at least 2 years from first prescription to any cancer diagnosis.

A subgroup were persons taking warfarin for atrial fibrillation or atrial flutter.

Study Findings: Warfarin Users vs. Nonusers

During the 7-year follow-up period, 10.6% (132,687) individuals developed cancer. There were 9.4% cancer diagnoses among the warfarin users and 10.6% among the nonusers.

Warfarin Users vs. Nonusers: Among warfarin users as compared with nonusers, there was a significantly lower incidence of cancer in all organ-specific sites (lung, prostate, and breast, except colon cancer).

A-Fib/A-Flutter group: The effect of warfarin use was more pronounced in the subgroup of patients with atrial fibrillation or atrial flutter for all cancers (lung, prostate, and breast). These patients also had a significant reduction in colon cancer associated with warfarin use.

Interpreting the Study Results

Warfarin use may have broad anti-cancer potential (in patients older than 50).

“An unintended consequence of this switch to new oral anticoagulants (NOACs) may be an increased incidence of cancer.”

The study authors believe that warfarin’s vitamin K antagonism is the property that may prevent or hinder the progression of cancer.

They noted that new oral anticoagulants that require less monitoring are being used more often. “An unintended consequence of this switch to new oral anticoagulants may be an increased incidence of cancer, which is an important consideration for public health,” they cautioned.

James Lorens (University of Bergen) and co-investigators say their findings “could have important implications for the selection of medications for patients needing anticoagulation.”

What This Means to Patients

This begs the question, on the basis of this Norwegian study, Should A-Fib patients stop taking the new anticoagulants (NOACs) and switch back to warfarin?”  Probably not.

Warfarin blocks vitamin K and has bad side effects: The bad side effects of warfarin use include increased bleeding, hemorrhagic stroke, and microbleeds in the brain.

In addition, warfarin blocks vitamin K absorption, thereby depositing calcium in our arteries and progressively turns them into stone (hardening of the arteries). Vitamin K is essential for heart and bone health. For more, see my article, Stop Taking Warfarin―Produces Arterial Calcification.

Some comfort: If warfarin is your anticoagulant of choice, it’s good to know that it may have anti-cancer properties.

Resources for this Article
• Haaland, GS et al. Association of Warfarin Use With Lower Overall Cancer Incidence Among Patients Older Than 50 Years. JAMA Intern Med. 2017;177(12):1774-1780. doi:10.1001/jamainternmed.2017.5512 PubMed PMID: 29114736. URL: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2661703?redirect=true.

• Cowen, L. Warfarin shows broad anti-cancer potential. medwireNews and Medicine Matters/ Epidemiology, 08-11-2017.  URL: https://oncology.medicinematters.com/epidemiology/lung-cancer/warfarin-shows-broad-anti-cancer-potential-/15200674

A-Fib Begets A-Fib: The Longer You Have A-Fib, the Greater the Risk


“My advice to other patients: Know that paroxysmal A-Fib becomes chronic. Drugs only work for so long. Get with a great EP or A-Fib clinic and find your cure.”

Joan Schneider, A-Fib free after Catheter Ablation


The Longer You Have A-Fib, the Greater the Risk

‘A-Fib begets A-Fib.’ The longer you have A-Fib, the greater the risk of your A-Fib episodes becoming more frequent and longer, often leading to continuous (Chronic) A-Fib. (However, some people never progress to more serious A-Fib stages.)

Don’t listen to doctors who want to just control your symptoms with drugs. Leaving patients in A-Fib overworks the heart, leads to fibrosis and increases the risk of stroke. The abnormal rhythm in your atria causes electrical changes and enlarges your atria (called remodeling) making it work harder and harder over time.

Don’t let your doctor leave you in A-Fib. Educate yourself. Any treatment plan for A-Fib must try to prevent or stop remodeling and fibrosis.

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

Educate Yourself—and Always Aim for a Cure!

Don’t Just ‘Manage’ Your A-Fib. Learn All Your Treatment Options. Aim for a Cure.


“Get your A-Fib taken care of. It won’t go away. It may seem to get better, but it will return. Don’t think that the medication is long term solution.”

Danel Doane, A-Fib free after Mini-Maze surgery


Don’t Expect Miracles from Current Medications

Antiarrhythmic drugs are only effective for about 40% of patients. Many patients can’t tolerate the bad side effects. When drugs do work, over time, they become less effective or stop working. According to Drs. Irina Savelieva and John Camm of St. George’s University of London, London, UK:

“The plethora of antiarrhythmic drugs currently available for the treatment of A-Fib is a reflection that none is wholly satisfactory, each having limited efficacy combined with poor safety and tolerability.”

Drugs don’t cure A-Fib but merely keep it at bay.

Learn All Your Treatment Options

Educate yourself about all your treatment options, see: Treatments for Atrial Fibrillation and Which of the A-Fib Treatment Options is Best for Me? Finally, discuss these treatment options with your doctor. This should be a ‘team effort’, a decision you and your doctor will make together.

Don’t just ‘manage’ your A-Fib. Seek your Cure.

Increasing Your Quality of Life: Catheter Ablation versus A-Fib Drugs

When seeking your Atrial Fibrillation cure, you’re often faced with the choices of catheter ablation versus antiarrhythmic drugs therapy.

We know from previous research studies that it’s safer to have an ablation versus living a life on antiarrhythmic drug therapy (AAD). (See Ablation Safer Than Life on Antiarrhythmic Drugs.)

But how do the two treatments compare when it comes to improvement in general health and ‘quality of life’?

Measuring ‘Quality of Life’

To determine success after treatment, researchers traditionally measure if A-Fib recurs using periodic ECGs. But this is “hardly a measure of successful treatment”, says Dr. Carina Blomstrom-Lundqvist, principal CAPTAF investigator from Uppsala University in Sweden.

CAPTAF stands for ‘Catheter Ablation compared with Pharmacological Therapy for Atrial Fibrillation‘.

The CAPTAF clinical trial is one of the first studies in which improvement in ‘quality of life’ was the goal. The trial compared the Atrial Fibrillation treatment effects of ablation versus antiarrhythmic drugs.

One-year results were presented in August at the 2017 European Society of Cardiology (ESC) Congress.

The CAPTAF Clinical Study

The CAPTAF trial enrolled 155 symptomatic patients with paroxysmal or persistent A-Fib at four Swedish centers and at one center in Finland.

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

A-Fib Drug Therapies

All enrolled patients had to have failed one drug therapy (rate or rhythm control). The average age of the enrolled patients was 56 years. Nearly three-quarters had paroxysmal A-Fib. On average they had been diagnosed with A-Fib for about 5 years, and 70%-80% of the patients had severe or disabling symptoms.

Catheter ablation (RF)

Patients received a subcutaneously implantable cardiac monitor 2-m onths prior to the start of the study (to establish a baseline ‘burden’ of A-Fib, i.e. the proportion of time in A-Fib). Then participants were randomized to ablation with pulmonary vein isolation or antiarrhythmic drug therapy. (The study protocol required patients randomized to the ablation regimen to be completely off antiarrhythmic drugs by 6 months after their ablation procedure.)

The primary goal of the study was a change in general health-related quality of life.

CAPTAF Results: Overall Health & ‘Quality of Life’ Improved More after Ablation

Overall Health: After 12 months of follow-up, the ablation group showed a greater improvement in average overall health by 11.0 points versus 3.1 points improvement in the drug group (as measured by a standard survey instrument). The 8-point difference in gain between the two groups was statistically significant.

Quality of Life: The quality-of-life domains (general health, physical function, mental health, role-emotional, role-physical, and vitality) improved significantly more in the ablation group than in the drug group. No significant differences were shown in the remaining two domains (bodily pain and social functioning).

AF Burden: The AF burden of the ablation group was decreased by an average of 20% points versus 12% points among the group on antiarrhythmic drugs. The change from baseline did not reach statistical significance between treatment groups.

The complication rates were comparable between treatment groups.

Summarizing the Results

About the difference in quality of life, Dr. Carina Bloomstrom-Lindqvist, principal CAPTAF investigator, explained that continued treatment with an antiarrhythmic drug in the drug group of patients compared with no drug treatment in the ablated patients “is absolutely the explanation” for the observed difference in quality of life.

Regarding her findings, she said, “Using quality of life as the primary endpoint of a trial for the first time, we demonstrated that pulmonary vein isolation [PVI] is significantly more effective than antiarrhythmic drugs…even at an early stage of their disease.”

Want a Better Quality of Life? Get a Catheter Ablation

“Using quality of life as the primary endpoint…PVI is significantly more effective than antiarrhythmic drugs…”

The CAPTAF clinical study, though small, goes much further than previous studies and is a significant milestone for Atrial Fibrillation patients. This was one of the first studies to focus on quality of life after treatment.

The CAPTAF results prove scientifically that ablation works better for A-Fib patients than antiarrhythmic drugs (AADs).

If you have A-Fib and want to improve your quality of life―get a catheter ablation. It makes you feel better than a life on antiarrhythmic drugs.

Remember: Seek your Cure!
Anyone no longer in A-Fib can tell you how wonderful it is
to have a heart that beats normally again.

Resources for this Article
Blomstrom-Lundqvist, Carina. Ablation of Atrial Fibrillation Improves Quality of Life More Than Drugs (CAPTAF). Presentation. ESC Congress, August 2017.

Zoler, M.  A Fib ablation surpasses drugs for improving quality of life. Cardiology News, Aug 30, 2017 URL: http://www.mdedge.com/ecardiologynews/article/145764/arrhythmias-ep/fib-ablation-surpasses-drugs-improving-quality-life

Ablation of atrial fibrillation improves quality of life more than drugs (CAPTAF). Press release. European Society of Cardiologists. Aug 29, 2017. URL: https://www.escardio.org/The-ESC/Press-Office/Press-releases/ablation-of-atrial-fibrillation-improves-quality-of-life-more-than-drugs-captaf

ESC 2017: Ablation of Atrial Fibrillation Improves Quality of Life More than Drugs – CAPTAF Trial Sept 4, 2017. URL: http://www.practiceupdate.com/content/esc-2017-ablation-of-atrial-fibrillation-improves-quality-of-life-more-than-drugs-captaf-trial/57590

 

We’ve Got Answers: Browse Our Q&As About Drug Therapies and Medicines

The various medications or drugs for treatment of Atrial Fibrillation can be overwhelming. What they are for, how they work and how they might affect you, can be confusing. After reading our page Treatment/Drug Therapies, you may still have unanswered questions (perhaps the same others have asked).

We may be able to address your concerns in our Q&A section, Drug Therapies and Medicines (under FAQ: Living with A-Fib). We provide answers to the most frequent inquiries by patients and their families.

Some of the questions we answer are:

Medicines & Drug Therapies at A-Fib.com

Q&A: Medicines & Drug Therapies

• “Is the “Pill-In-The-Pocket” treatment a cure for A-Fib? When should it be used?”

• “Is there a way to get off blood thinners all together? I hate taking Coumadin. I know I’m at risk of an A-Fib stroke.”

I’m worried about the toxic side effects of amiodarone. What should I do?

 • “What are my chances of getting an A-Fib stroke?

Go to Drug Therapies and Medicines to browse all our questions.

You’ll find more answers to questions about therapy, such as about warfarin and Coumadin, foods with Vitamin K, Electrical Cardioversion, aspirin and stroke prevention, and natural blood thinners.

We invite you to browse through all our categories of answered questions. Go to -> FAQs: Coping with Atrial Fibrillation.

 

FREE Download: Keep a List of Your Medications—The Easy Way

 Medication Inventory form complements of Alere at A-Fib.com

Medication Inventory form complements of Alere

Patti wanted to update her list of medications and vitamins, so I just downloaded and printed the Free Medication List form for her.

I thought I’d remind our A-Fib.com readers about the FREE Medication List (PDF) available on our Free Offers and Downloads page.

Keep up with changes to your meds.  Because your medications and dosages can change over time, store blanks with your A-Fib records binder or folder. Use one to collect changes (if desired you can later update your computer-based PDF document.)

List of over-the-counter drugs, too. Over-the-counter drugs, vitamins and mineral supplements can interfere with your medications, so you’ll want to list them, as well.

Download this FREE Medication List (PDF), complements of Alere, and remember to save to your hard drive.

You can open the PDF and type into the document and then print copies. Or, you can print blank forms and fill-in by hand. Give a completed copy to each of your doctors or other medical healthcare providers.

Keep Your Doctors Informed

It’s important to keep your doctor and other healthcare providers up-to-date on all the medications you are taking, the dosages, and for what purpose. Take a copy with you on your next appointment.

My doctor’s office has me verify all my medication on each office visit. My up-to-date printed medication list makes this a snap. – Patti

 

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