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



Pacemakers & ICDs

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.

 

Videos: Arrhythmias Animations by St. Jude Medical

Three short animations: Atrial Flutter, Pacemaker, and Implantable Defibrillator (ICD) treatment options from St Jude Medical.

Atrial Flutter: Fast Heartbeat Arrhythmia (00:28)

Pacemaker Treatment Option (too slow of heart beat) (:49)

Implantable Defibrillator (ICD) Treatment Option (too fast heart beat) (:57) 


If you find any errors on this page, 
email us. Y Last updated: Sunday, February 19, 2017

Return to Instructional A-Fib Videos and Animations

With 3-4 Second Pauses, Do I Need a Pacemaker?

We’ve answered a new FAQ about understanding A-Fib with long pauses and if a pacemaker is appropriate.

“I have paroxysmal A-Fib with “pauses” at the end of an event. I can’t tell how many of these I have experienced. Will they stop if my A-Fib is cured?
My cardiologist recommends a pacemaker to prevent blackouts during a pause as well as other serious heart problems. I am willing, but want to learn more about these pauses first.”

I had the same problem. I’d get pauses as long as 6 seconds and get dizzy, I felt like I was about to faint, etc. It was very frightening. But the pauses completely disappeared when my A-Fib was cured by a catheter ablation back in 1998.

Pauses are “Normal” in A-Fib

Pauses of up to 4 seconds duration in atrial fibrillation are considered as ‘normal’. Just because you have pauses doesn’t mean there is something wrong with your Sinus or AV Node and doesn’t mean that you need a pacemaker. When you are returned to normal sinus rhythm (NSR), these pauses usually disappear.

Unfortunately, many cardiologists don’t know this and will try to rush you into having a pacemaker implant…Read the rest of my answer… .

 

FAQs Understanding A-Fib: With A-Fib Pauses—Do I Need a Pacemaker?

 FAQs Understanding A-Fib: Pacemaker for Pauses?

FAQs Understanding Your A-Fib A-Fib.com14. “I have paroxysmal A-Fib with “pauses” at the end of an event. I can’t tell how many of these I have experienced. Will they stop if my A-Fib is cured?

My cardiologist recommends a pacemaker to prevent blackouts during a pause as well as other serious heart problems. I am willing, but want to learn more about these pauses first.”

I had the same problem. I’d get pauses as long as 6 seconds and get dizzy, I felt like I was about to faint, etc. It was very frightening. But the pauses completely disappeared when my A-Fib was cured by a catheter ablation back in 1998.

Pauses are “Normal” in A-Fib

Pauses of up to 4 seconds duration in atrial fibrillation are considered as ‘normal’. Just because you have pauses doesn’t mean there is something wrong with your Sinus or AV Node and doesn’t mean that you need a pacemaker. When you are returned to normal sinus rhythm (NSR), these pauses usually disappear.

Unfortunately, many cardiologists don’t know this and will try to rush you into having a pacemaker implant.

Monitoring Your Symptoms

Are you symptomatic? Do you fall or faint from these pauses? (This is different from occasionally feeling lightheaded or dizzy.)

If your cardiologist hasn’t yet suggested it, you may need to wear a holter or similar monitor for a few days (or up to a month or longer).

Monitoring will tell your doctor exactly how long your pauses are and how often you have them.

Avoid Getting a Pacemaker, if You Can

I can understand your cardiologist’s concern, but try to avoid getting a pacemaker, if you can.

If you do have to get a pacemaker, make sure the cardiologist guarantees that it can and will be easily removed once you are restored to normal sinus rhythm (NSR). You don’t want to be saddled with a pacemaker for life when you don’t need it.

Depending on how a pacemaker is installed, it may make a catheter ablation more difficult. You may have to go to a more experienced EP for your ablation.

Be assertive. You may have to be very assertive about this. Most cardiologists will insist that you keep the pacemaker forever. (But it isn’t so.)

Cure Your A-Fib=No More Pauses

Ask your doctor about antiarrhythmic drugs. They generally don’t “cure” A-Fib but may reduce your pauses.

If your pauses cause you problems, consider a catheter ablation to cure your A-Fib.

Once you no longer have A-Fib, those pauses should stop and your heart should beat again in normal sinus rhythm.

To read a first-hand story about pacemakers, see Personal A-Fib Story #50: Pacemaker & A-Fib Ablation—You Can Have an A-Fib Ablation if You Have a Pacemaker

References for this article

Last updated: Monday, February 13, 2017

Go back to FAQ Understanding A-Fib

FAQs Coping with A-Fib: Pacemaker for Too Slow a Heart?

 FAQs Coping with A-Fib: Pacemaker

FAQs A-Fib afib“Now my doctor says I need a pacemaker, because my heart rate is too slow and because I’m developing pauses.

I’m an athlete with A-Fib and have a naturally slow heart rate. Since I developed A-Fib, I was put on atenolol (a beta blocker) which really slows down my heart rate.  What should I do?”

Get a second opinion. It’s crazy to go through the risks and lifestyle disruptions of having a pacemaker implanted just to be able to continue taking atenolol.

Because you are an athlete, your heart rate is naturally slow. But it’s normal for you.

As long as you feel fine and aren’t fainting from lack of blood flow, don’t be talked into getting a pacemaker. A slow or even very slow heart rate usually doesn’t cause any harm. As for heart rates, “normal” is indeed a wide swath.

In the words of Dr. John Mandrola:

“Do not implant pacemakers in patients with nonsymptomatic bradycardia (slow heart rate).The same holds for pauses, though they are certainly of more concern than a slow heart rate. Nonsymptomatic slow heart rate or pauses don’t justify exposing patients to the risks of implanting a pacemaker.”

But be advised that pacemakers tend to have bad effects over the long term, “…long-term morbidity (is) associated with a pacemaker.”

 Another consideration is that implanting pacemaker ‘leads’ in the veins of the upper chest often prevents or hinders future procedures that require vascular access like a PVI. A pacemaker usually isn’t implanted unless your heart rate is too slow or you have Sinus Node and/or Atrioventricular (AV) Node problems.

References:
¤  Mandrola, John “Choosing wisely: The electrophysiology list of five don’ts.” http://blogs.theheart.org/trials-and-fibrillations-with-dr-john-mandrola/2012/4/9/choosing-wisely.
¤  Atrial Fibrillation Educational Material” University of Pennsylvania. 2002, p. 3.
¤  “Should atrial fibrillation ablation be considered first-line therapy for some patients?” Circulation 2005;112:1214-1231, p. 1228.

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

Back to FAQs: Coping with Your A-Fib

Pacemakers & ICDs

Pacemakers & Implantable Cardioverter Defibrillator (ICD)

Pacemakers

Illustration of Pacemaker for Atrial Fibrillation, A-fib, afib, a fib

Pacemakers

A pacemaker is a small device that sends electrical impulses to the heart muscle to maintain a regular heart rate. In general, pacemakers are not very effective for preventing A-Fib.

Implanting a pacemaker seems to be most helpful if you have a slow heart rate or pauses (4+ seconds) as a result of taking A-Fib medications. But there is a danger for patients with this approach. A slow or even very slow heart rate usually doesn’t cause any harm. As for heart rates, “normal” is indeed a wide swath. Some people, particularly athletes, can have a very slow heart rate and be perfectly healthy. The same holds for asymptomatic pauses.

In the words of Dr. John Mandrola:

“Do not implant pacemakers in patients with non-symptomatic bradycardia (slow heart rate).1

Non-symptomatic slow heart rate or pauses don’t justify exposing patients to the risks of implanting a pacemaker. Another consideration is that implanting pacemaker leads in the veins of the upper chest often prevents or hinders future procedures that require vascular access like a Pulmonary Vein Ablation/Isolation (PVI/A).

A pacemaker usually isn’t implanted unless your heart rate is too slow2 or you have Sinus Node and/or Atrioventricular (AV) Node problems. But be advised that pacemakers tend to have bad effects over the long term, “…a long-term morbidity (is) associated with a pacemaker.”3

For more information on Pacemakers, you may want to visit the pacemaker chat site: pacemakerclub.com.  (Thanks to Mara for alerting us to this site.)

[I admit to not knowing much about pacemakers. Happily one of the A-Fib.com’s contributors installs pacemakers and offers the following observations.

“I like to tell patients who receive pacemakers that, after a couple of months, they can have a VERY active, normal lifestyle. All of the current pacers have a “rate responsive” mode, meaning they are designed specifically for activity. The more active you are, the faster the pacer goes. Three triathlon runners, and two NFL players have pacers. Most people forget they have a pacemaker.

A recent trend is to implant the ventricular lead on the septum vs. the right ventricular apex, which gives better cardiac output and a more ‘normal’ heartbeat. You might want to ask your doctor about this possibility. Even if your doctor does not prefer this technique, he/she will be impressed that you did your homework.

In addition, you always want a dual chamber pacer which will give better cardiac output. It will also attempt to synchronize between the atria and ventricles, unless the patient is in Chronic A-Fib. If the A-Fib is intermittent, the pacer will temporarily switch modes to VVIR (ventricular only pacing) during the A-Fib, and then back to normal DDDR (dual chamber) pacing when the A-Fib terminates. This is all done by the device memory/logic program.

So, during A-Fib, the DDDR pacer will switch to VVIR and pace only the ventricle during the A-Fib.”

Key to the acronyms.4 

Implantable Cardioverter Defibrillator (ICD)

Implantable cardioverter defibrillator (ICD) for Atrial Fibrillation, A-fib, afib, a fib

Implantable Cardioverter Defibrillator (ICD)

An implantable cardiac defibrillator (ICD) is a device that is put within the body and is designed to recognize certain types of abnormal heart rhythms (arrhythmias) and correct them by delivering precisely calibrated and timed electrical shocks, when needed, to restore a normal heartbeat.

Having a defibrillator implanted in your heart is, from the point of view of most A-Fib patients, not a probable option.  A defibrillator shock is painful, like being “kicked in the chest.” Most people would rather have A-Fib than risk being shocked throughout the day and night. Also, it does not address the underlying problem or condition of your heart that causes your A-Fib.

Fewer than 10% of patients get shocked when a shock isn’t needed, according to Edward K. Kasper, MD of The Johns Hopkins Hospital..5 In another study 18% of patients with A-Fib received inappropriate first shocks.6 

More than 30% of people who have ICDs develop emotional problems such as anxiety and depression—in part due to worry and uncertainty over whether the device will deliver an unnecessary shock and the fear of being shocked.7

What’s it like living with an ICD and A-Fib? Roby T. shared:

“The worst part was the ICD firing,” he recalls. “It hit me like a baseball bat and knocked me over.” His wife, Mary, was afraid to leave him alone. And the anxiety levels took their toll, even during sleep. “He became really anxious expecting a firing at any time,” she says. “You could see the fear in his eyes,” she reluctantly remembers. “He had to start taking antidepressants.”8

Our A-Fib.com pacemaker expert writes:

“Defibrillators are far more complicated (than pacemakers). When people report getting a big shock (500-700 volts) from the unit, that was probably for V (ventricular) Fib, not A-Fib, if the unit is programmed properly.
One good thing about the V-Fib is that it is usually (not always) proceeded by Ventricular Tachycardia, a much slower, organized rhythm that often responds to painless anti-tachycardia pacing. We will attempt anti-tachycardia overdrive pacing for several different patterns before we finally give up and go to the full output shock.”

Last updated: Tuesday, March 21, 2017

 Return to Treatments for Atrial Fibrillation

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Footnote Citations    (↵ returns to text)

  1. Mandrola, John “Choosing wisely: The electrophysiology list of five don’ts http://www.medscape.com/viewarticle/802018
  2. “Atrial Fibrillation Educational Material” University of Pennsylvania. 2002, p. 3.
  3. Prystowsky, “Should atrial fibrillation ablation be considered first-line therapy for some patients?” Circulation 2005;112:1214-1231, p. 1228.
  4. Key to the acronyms used in the Pacemaker quote:
    “DDD” signifies a dual chamber pacer, capable of sensing and pacing in both the atrium and the ventricle
    “VVI” is ventricle only
    “AAI” is atrium only
    “R” signifies Rate Response, a programmable on/off feature which increases the pacing during activity
  5. Kasper, Edward K., MD. The Johns Hopkins Hospital,”How to Save Your Life If You Have Heart Failure.” Bottom Line Health, May, 2012, p. 9.
  6. Cesario, D. et al. The Role of Atrial Fibrillation in CRT-D Patients: The ATTITUDE Study Group. The Journal of Innovations in Cardiac Rhythm Management. 6 (2015), 1873-1880.
  7. Kasper, Edward K., MD. The Johns Hopkins Hospital,”How to Save Your Life If You Have Heart Failure.” Bottom Line Health, May, 2012, p. 9
  8. Roby’s Arrhythmia Story. Published on MyFastHeartBeat.com Last accessed November 5, 2012.

A Primer: Ambulatory Heart Rhythm Monitors

A Primer: Ambulatory/Long-term Heart Rhythm Monitors

By Steve S. Ryan, PhD

ECG pads positioned

Source: www.afa.org.uk patient education brochure

If your arrhythmia is intermittent, your doctor may have you wear a mobile type of heart rhythm monitor to capture the electrical activity of your heart. As a general rule, in order to make a diagnosis of an arrhythmia, some form of electrocardiographic recording (i.e., EKG,) must be made at the time the arrhythmia is occurring.

If an arrhythmia becomes persistent and is present day-in and day-out, as often is the case for A-Fib, the diagnosis is quite easy with a routine EKG done in the physician’s office.

The challenge is when an arrhythmia occurs intermittently (on and off) or is self-limiting. In this case, an EKG performed in between A-Fib episodes can be completely normal. To circumvent this problem, one would go to the next level of evaluation with a long-term monitor.

Long-term monitors

Long-term monitors basically are EKG recorders that patients can take with them (ambulatory). They fall into two major categories: continuous recording (Holter) and intermittent recording (Event).

The Holter Monitor

Mortara H12+ Continuous 12-lead Holter recorder

Mortora H12+ Continuous 12-lead Holter recorder

A Holter Monitor (named after Dr. Norman Holter, go figure) records continuously the EKG of a patient, usually for 24 – 48 hours. More modern Holter units record onto digital flash memory devices. The data are uploaded into a computer where software analyzes the input, counting ECG complexes, calculating summary statistics such as average heart rate, minimum and maximum heart rate, and finding candidate areas in the recording worthy of further study.

The advantage of a Holter is that every single heartbeat during that day is recorded and can be analyzed. The disadvantage is that if an arrhythmia did not happen on that particular day, the Holter data would not be useful.

The Event Monitor

Cardionet wireless event monitor

Cardionet wireless event monitor

An Event Monitor, on the other hand, is a long-term monitor that can be used for up to 30 days or longer. The advantage is that the longer the recording period, the better chance of “catching” an intermittent arrhythmia. The disadvantage is that an Event Monitor must be activated by the patient and downloaded telephonically, a task that requires a certain amount of manual dexterity and may be difficult for some patients.

Some event monitors are patient activated when having an episode and save the last several minutes of data; others detect the irregular heart rate and automatically record the data.

Number of Electrodes

The number and position of electrodes varies by model, but most Holter monitors employ between three and eight, whereas the Event Monitors typically use two. Both the Holter and Event monitors record electrical signals from the heart via a series of electrodes attached to the chest. The Loop (event) monitor is not attached to the patient but is instead pressed to the chest by the patient when experiencing an A-Fib episode.

Implantable ambulatory event monitors

Medtronic Reveal® DX insertable cardiac monitor (ICM) continuously monitors

Medtronic Reveal® DX insertable cardiac monitor (ICM) continuously monitors

Implantable event monitors are also available for those instances where individuals experience such infrequent symptoms that extended monitoring is needed.

These devices are inserted just under the skin in the chest area during an outpatient surgical procedure. The device may remain implanted for over one year.

Implantable loop recorders have the ability to record events either automatically (auto activated) or by manual activation (self-activated).

Real Time Remote Cardiac Recording

CardioNet MCOTos Event wireless event monitor

CardioNet MCOTos Event wireless event monitor

An example of the newer monitoring technologies is the Ambulatory Cardiac Telemetry (ACT), a wireless cardiac telemetry system.  This event monitor is designed for remote arrhythmia monitoring in any location.

A small transmitter worn on the patient sends the ECG data to a portable handheld device where it is analyzed.  If an arrhythmia is identified, the data is automatically transmitted to a Monitoring Center for immediate review. Integrated into a state-of-the-art mobile phone, the ACT provides next generation cardiac arrhythmia monitoring. What’s interesting is the transmitter is a dongle type device worn around the neck with leads placed on the chest. You carry or have available what, in essence, is a mobile phone (it’s actually more than a phone). It is small and not cumbersome.

No patient input is required. Data collected from the monitors is transmitted to the monitoring center via a cellular network, the internet, or over the phone (based on model). Data from the monitors is not intended to be used directly by the patient but rather by the monitoring center and your cardiologist.

Next-Generation: the ‘Smart Band-Aid’ Zio Patch

Steve wearing a Zio Patch

Steve wearing a Zio Patch

The ‘Smart Band-Aid’ provides the next-generation ambulatory cardiac monitoring service with beat-to-beat, real time analysis, automatic arrhythmia detection and wireless ECG transmission.

The sensors in the Band-Aid can be modified to monitor a number of different tasks as they can also provide a comprehensive suite of post-symptom, looping, and auto trigger event monitors as part of its turn-key cardiac event monitoring service.

Additional Reading

For a scholarly review of medical heart rate monitors, see: New Methodologies in Arrhythmia Monitoring by Anderson & Donnelly.

References for this article

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Return to Index of Articles: Diagnostic Testing

Last updated: Thursday, September 3, 2015

>

Treatments for Atrial Fibrillation

Treatments for Atrial Fibrillation at A-Fib.com

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

Diagnostic Testing

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

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

Mineral Deficiencies

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

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

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

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

Drug Therapies

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

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

Cardioversion

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

Catheter Ablation

RF and CryoBalloon catheter ablation are minimally invasive procedures that block electrical signals which trigger erratic heart rhythms like Atrial Fibrillation. Go to Catheter Ablation ->

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

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

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

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

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

Ablation of the AV Node and Implanting a Pacemaker

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

Pacemakers & ICDs

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

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

Go to Pacemakers & ICDs ->

Decisions About Treatment Options

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

Remember

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

Last updated: Monday, November 21, 2016

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