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

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

 

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

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.”

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.

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.”

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

Return to FAQ Drug Therapies
If you find any errors on this page, email us. Y Last updated: Monday, March 26, 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

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

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. Savelieva and Camm:

“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

 

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

 

VIDEO: Introduction to Anticoagulant Therapy—Living with Warfarin

Excellent introduction for A-Fib patients to anticoagulant therapy with warfarin (Coumadin). Practical issues associated with taking warfarin are discussed by patients and medical professionals (clinical nurse, doctors, a pharmacist  and clinical dietitian). (16:22 min.)

Produced by Johns Hopkins Medicine and posted Mar 7, 2011.

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: Monday, January 15, 2018

Return to Instructional A-Fib Videos and Animations

Eleven Things I Know About A-Fib Drug Therapy: Seldom a Lasting Cure

Anti-arrhythmic drugs are certainly better than living a life in A-Fib. They are useful for many patients. But Dr. Peter Kowey, Lankenau Heart Institute, describes them as a stopgap, i.e., they don’t deal with the underlying cause, and are seldom a lasting cure for A-Fib.

Eleven Things I Know About A-Fib Drug Therapy

Peter R. Kowey MD

P. Kowey MD

About Dr. Peter Kowey: An internationally respected expert in heart rhythm disorders, his research has led to the development of dozens of new drugs and devices for treating a wide range of cardiac diseases. (Summary of his 2014 American Heart Association (AHA) Scientific Session presentation.)

Fact #1 “An anti-arrhythmic drug is a poison administered in a therapeutic concentration.” Like most meds, anti-arrhythmic drugs, (AADs), are a trade-off between the unnatural and possible toxicity with the power to alleviate our A-Fib symptoms.

Fact #2 “Amiodarone is by far the most effective of the antiarrhythmics but is also the most toxic.” Amiodarone has never been reviewed or approved by the FDA for the treatment of A-Fib (this is called “off label” use).

Fact #3 “Doctors choose anti-arrhythmic drugs based on their relative chances of harm, not comparative efficacy.” That is. the least dangerous anti-arrhythmic first, rather than the drug most likely to suppress A-Fib.

Fact #4 “Anti-arrhythmic drug therapy is highly empiric (based on observable evidence), and exposure-related.” In practice, doctors don’t monitor how much of a drug is actually in a patient’s blood, but instead use a patient’s response to adjust dosage.

Fact #5 “Antiarrhythmics drugs require surveillance of varying intensity.” An example is Amiodarone which requires intense surveillance—lungs, thyroid, eyes, liver, skin and heart.

Fact #6 “Anti-arrhythmic drugs with multi-channel effects may be more effective than those that target single channels or receptors.” For instance, in one study, ‘Pill-In-The-Pocket’ didn’t reduce A-Fib symptoms but did significantly reduce emergency room visits and hospitalizations.

Fact #7 “Anti-arrhythmic drug therapy of A-Fib is imperfect.” It’s treatment without dealing with the underlying cause and not total eradication of symptoms.

Fact #8 “Anti-arrhythmic drug therapy can be creative.” Such as, a strategy like Pill-In-The-Pocket.

Fact #9 “Anti-arrhythmic drugs may supplement the effectiveness of other interventions like catheter ablation.” For instance, used during the 3 month blanking period following a catheter ablation.

Fact #10 “Taking anti-arrhythmic drugs does not preclude the need for stroke prevention.” For example, withdrawal of anti-coagulation therapy after a successful ablation.

Fact #11 “The holy grail is prevention.” But there is no proof that any treatment is conclusively effective.

Dr. Kowey’s Conclusions

• If doctors made better and more intelligent use of anti-arrhythmic drugs, patients would fare better and there’d be fewer ablations.

• Intelligent use requires an in-depth knowledge of pharmacology and familiarity with all aspects of clinical use, especially dosing.

• Anti-arrhythmic therapy is not perfect, but it can improve quality of life and functionality for a significant percentage of A-Fib patients.

Editors Comments:
Dr. Kowey’s statement that “an anti-arrhythmic drug is a poison administered in a therapeutic concentration” should set off alarm bells for patients. In the US, we’ve been conditioned to think, “ if we’re sick, just take a pill”.
But today’s anti-arrhythmic drugs have poor success rates (often under 50%), often have unacceptable side effects, and when they do work they tend to lose their effectiveness over time.
In general, anti-arrhythmic drugs are toxic substances which aren’t meant to be in our bodies―so our bodies tend to reject them.
References for this Article

Don’t Settle. Learn Your Treatment Options


“Don’t Settle…for a lifetime on medication. Seek your A-Fib cure!”

From Beat Your A-Fib: The Essential Guide to Finding Your Cure


Treating patients with drugs but leaving them in A-Fib, overworks the heart, leads to fibrosis and increases the risk of stroke and dementia.

Don’t let your doctor leave you in A-Fib. Educate yourself. Learn your treatment options, see Which of the A-Fib Treatment Options is Best for Me? And always aim for a Cure!

 

Increased Dementia Risk Caused by A-Fib: 20 Year Study Findings

Dementia risk is “strongly associated” with younger patients who develop Atrial Fibrillation. That’s the finding of a 20-year study among 6,196 people without established A-Fib.

Rotterdam Study of Cardiovascular Disease

In a 20-year observational study of participants in the long-term Rotterdam Study, researchers tracked 6,514 dementia-free people. Researchers were monitoring participants for dementia and Atrial Fibrillation. At the start of the study (baseline), 318 participants (4.9%) already had A-Fib. 

“The Rotterdam Study” is a long-term study started in 1990 in Rotterdam, The Netherlands. Cardiovascular disease is just one of several targeted diseases.

Results: A-Fib and Dementia

During the course of the study, among 6,196 people without established A-Fib: 11.7% developed A-Fib
and 15.0% developed incident dementia. Other findings:

• Development of A-Fib was associated with an increased risk of dementia in younger people (<67 years old)

• Dementia risk was strongly associated with younger people (<67 years old) who developed A-Fib

• Dementia risk was not strongly associated in the elder participants who developed A-Fib.

The Rotterdam researchers didn’t state explicitly that A-Fib “causes” dementia. Instead they concluded that A-Fib was “strongly associated” with dementia. Because there may be other factors at play, that’s as far as researchers can go (though they did use regression models to adjust for age, sex, and cardiovascular risk factors).

 The younger you are when you develop A-Fib, the more important it is to seek your A-Fib cure to reduce the associated risk of developing dementia.

A-Fib Leads to or Causes Dementia

As patients we have to conclude that, all things being equal, A-Fib leads to and/or causes Dementia. This makes intuitive sense, doesn’t it?

In A-Fib we lose 15%-30% of our heart’s ability to pump blood to our brain, and to the rest of our body. 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.

What Patients Need To Know

The bottom line, the younger you are when you develop A-Fib and/or the longer you have A-Fib, the greater your risk of developing dementia. Seek your A-Fib cure sooner rather than later.

To decrease your increased risk of dementia, your goal should be to get your A-Fib fixed and get your heart beating normally again. We can’t say it enough:

Do not settle for a lifetime on meds. Seek your A-Fib cure.

References for this article

A-Fib-Related Stroke Risk: Watchman Better Than a Lifetime on Warfarin

Background: The most prescribed anticoagulant, warfarin, reduces the A-Fib-related risk of stroke by 60% to 70%. Most A-Fib clots (90%-95%) come from the Left Atrial Appendage (LAA).

An alternative to anticoagulants, the Watchman occlusion device closes off the LAA. FDA approved, it’s a very low risk procedure that takes as little as 20 minutes to install. Afterward, you would usually not need to be on blood thinners.

CT brain with Ischemic stroke at A-Fib.com

CT brain with Ischemic stroke

Effects of a Lifetime on Warfarin

Warfarin (brand name Coumadin) and other anticoagulants work by causing bleeding and are inherently dangerous.

Among other bad side effects, long-term use of anticoagulants such as warfarin have been known to not only cause hemorrhagic strokes, but also microbleeds in the brain leading to dementia. (For more, see Patient on Anticoagulation Therapy for 10 Years Develops Microbleeds and Dementia).

A 2015 study found evidence of microbleeds in 99% of subjects aged 65 or older. When imaging strength was magnified, even more microbleeds were detected. Microbleeds are thought to be predictive of hemorrhagic stroke.

Conclusion: according to current research, to reduce microbleeds, ditch the anticoagulants. You’d do better having a Watchman device installed than spending a lifetime on warfarin.

Note: there’s no guaranteed way to avoid a stroke altogether.

What About the New Anticoagulants (NOACs)?

Does this research apply to the new anticoagulants like Pradaxa, Xarelto, Eliquis and Savaysa/Lixiana? Technically no. This research only applies to warfarin.

But intuitively one would expect the same general principles to apply. All anticoagulants cause bleeding. That’s how they work.

Caveat—Long-Term Effects of Watchman?

Catheter positioning the Watchman occlusion device at the mouth of the Left Atrial Appendage

Catheter placing Watchman in LAA

What are the long-term effects of leaving a mechanical device like the Watchman inside the heart? We know that, after a few months, heart tissue grows over the Watchman device so that the LAA is permanently closed off from the rest of the heart.

It seems unlikely that complications would develop after a long period of time as has happened with warfarin. But we can’t say that for sure until enough time has passed. The first clinical trial installation of the Watchman device in the US was in 2009 and in Europe in 2004. So far, no long-term complications have developed.

EPs Installing the Watchman Device

Want to learn more about the Watchman? See my article, The Watchman™ Device: The Alternative to Blood Thinners.

To find EPs installing the Watchman, I highly recommend selecting an electrophysiologist (EP) who is certified in “Clinical Cardiac Electrophysiology”. For a list of EPs meeting this criteria, see Steve’s Lists of A-Fib Doctors by Specialty: Doctors Installing the Watchman.

References for this article

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

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

Frances, now A-Fib free after 3 yrs.

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

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

Family History of Atrial Fibrillation

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

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

Six Cardioversions: Not a Long-Term Solution

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

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

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

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

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

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

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

More Interviews: Three Electrophysiologists & Lots of Questions

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

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

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

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

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

At this point I had been in A-fib for 17 months. The first 7 months of this time frame was necessary due to my need for two total hip replacements which were performed 5 months apart. However, the additional 12 month delay was due to my procrastination in seeking a third opinion from another EP.  That was definitely a mistake. This additional delay reduced my success rate for a successful first ablation to approximately 65% and it also increased the chance that I might need a second ablation in the future. (I anticipated I might need a 2nd ablation because of this.) 

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

Ablation for Persistent A-Fib is More Difficult

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

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

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

Pierre Jais MD

Fran’s EP: Pierre Jais MD

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

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

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

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

Difficult Six-Hour Ablation at Bordeaux, then Electrical Cardioversions

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

Fran wearing the mapping vest.

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

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

Normal Sinus Rhythm for 11 Months, then Atypical Flutter

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

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

Suspected Sleep Apnea

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

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

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

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

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

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

Second Ablation by Dr. Vivek Reddy Using CardioInsight ECGI

Dr. Vivek Reddy, Mt Siani Hospital

Dr Vivek Reddy, Mt Sinai Hospital

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

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

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

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

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

Success & Lessons Learned

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

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

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

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

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

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

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

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

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

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

FREE 12-page Report

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

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

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

 

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

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

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

Charn Deol, BC, Canada

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

Mercury Cleared, Atrial Fibrillation Stops!

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

For 10 years He had No Atrial Fibrillation

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

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

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

Charn Deol, B.C., Canada

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

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

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

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

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

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

Alternative Healthcare Practitioners―India & China, Too

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

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

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

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

Encainide Drug Therapy: Up and Out

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

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

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

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

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

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

Chelation for Very High Levels of Mercury

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

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

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

Mercury Cleared, Atrial Fibrillation Stops!

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

Chest Pain Condition Worse than Ever

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

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

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

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

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

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

Amiodarone Bad Side Effects

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Counseling with Steve Ryan

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

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

Second Ablation in Bordeaux and Use of CardioInsight Vest

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

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

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

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

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

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

At Home A-Fib Returns with Persistent A-Flutter

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

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

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

Normal Sinus Rhythm―4+ Months So Far

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

Minerals, Vitamin IVs for Inflammation of the Heart

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

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

Lessons Learned: After 23 Years with A-Fib

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

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

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

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

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

Charn Deol, May 2017
charnee@gmail.com

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

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

Read our 12-page free report.

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

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If you find any errors on this page, email us. Y Last updated: Sunday, June 4, 2017

 

 

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

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

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

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

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

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