"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

"Your book [Beat Your A-Fib] is the quintessential most important guide not only for the individual experiencing atrial fibrillation and his family, but also for primary physicians, and cardiologists."

Jane-Alexandra Krehbiel, nurse, blogger and author "Rational Preparedness: A Primer to Preparedness"


"Steve Ryan's summaries of the Boston A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation."

Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

"I love your [A-fib.com] website, Patti and Steve! An excellent resource for anybody seeking credible science on atrial fibrillation plus compelling real-life stories from others living with A-Fib. Congratulations…"

Carolyn Thomas, blogger and heart attack survivor; MyHeartSisters.org

"Steve, your website was so helpful. Thank you! After two ablations I am now A-fib free. You are a great help to a lot of people, keep up the good work."

Terry Traver, former A-Fib patient

"If you want to do some research on AF go to A-Fib.com by Steve Ryan, this site was a big help to me, and helped me be free of AF."

Roy Salmon Patient, A-Fib Free; pacemakerclub.com, Sept. 2013

 FAQs Understanding A-Fib: Asymptomatic Longstanding Persistent A-Fib

FAQs Understanding Your A-Fib A-Fib.com16. “I am 69 years old, in permanent A-Fib for 15 years, but non-symptomatic. My left atrium is over 55mm, and several cardioversions have failed. My EP won’t even try a catheter ablation. I exercise regularly and have met some self-imposed extreme goals. What more can I do?

As you already know, being in permanent (long-standing persistent) Atrial Fibrillation can cause other long term problems like fibrosis, increased risks of heart failure and dementia. So you are wise to be concerned.

I’m not surprised your electrophysiologist (EP) is reluctant about a catheter ablation. Being asymptomatic with 15 years of long-standing persistent A-Fib and a Left Atrium diameter of 55mm, most EPs wouldn’t recommend or perform a catheter ablation on you.

Drug Therapy Option: Tikosyn

Tikosyn (dofetilide) for long-standing persistent atrial fibrillation at A-Fib.com

Tikosyn (dofetilide)

Have you tried the newer antiarrhythmic drug Tikosyn (generic name dofetilide)?

Tikosyn was designed for cases like yours. It’s a Class 1A drug that works by blocking the activity of certain electrical signals in the heart that can cause an irregular heartbeat.

The only inconvenience of Tikosyn drug therapy is you have to be in a hospital for 3 days for observation and to get the dosage right.

Benefits of Activity and Exercise on Your A-Fib

You are truly blessed to be so active and without noticeable symptoms in spite of being in A-Fib. While exercise will not reduce the size of your LA, your activity level may compensate for the lack of pumping of your left atrium. In fact, your ventricles may be acting kind of like a turkey baster sucking blood down from your non-functioning LA before pushing blood out to the rest of your body.

Catheter Ablation and Surgical Options

Catheter ablation: Studies of non-paroxysmal A-Fib have shown that a successful catheter ablation can significantly reduce atrial dilation and improve ejection fraction. But, with your A-Fib being persistent long-standing, this may not apply.

Surgery: A Cox Maze IV surgery may reduce the volume and size of your left atrium while hopefully making you A-Fib free, but surgeons may be reluctant to tackle your case since the success rate is under 80%. A Cox Radial Maze is open heart surgery which is very traumatic and risky. It may be hard to justify open heart surgery if you’re asymptomatic.

My Recommendations

1. If you haven’t tried it yet, ask your EP about taking the newer antiarrhythmic drug Tikosyn.

2. If you’ve tried Tikosyn and it doesn’t help you, I recommend you consult an EP who specializes in longstanding persistent A-Fib. See Steve’s Lists. You may need to travel, but it may be worth it to you for your peace of mind. Also, ask the EP if surgery may be a helpful option.

3. Based on the results of the EP consult, I’d seek the opinion of a cardiac surgeon who performs the Cox Maze IV surgery. (See Steve’s Lists of surgeons who treat A-Fib patients.)

Making an Informed Choice

Armed with the above information you will be able to determine how you want to proceed. This is a decision only you can make.

With no A-Fib symptoms and a fulfilled life with plenty of body and soul enriching exercise, you may decide you are content with your present A-Fib status.

Resources for this article

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

Go back to FAQ Understanding A-Fib

Related Posts

Follow Us
facebook - A-Fib.comtwitter - A-Fib.comlinkedin  - A-Fib.compinterest  - A-Fib.comYouTube: A-Fib Can be Cured!  - A-Fib.com

A-Fib.com is a
501(c)(3) Nonprofit

Your support is needed. Every donation helps, even just $1.00.

A-Fib.com top rated by Healthline.com for fourth year 2014  2015  2016  2017

A-Fib.com Mission Statement
We Need You

Mug - Seek your cure - Beat Your A-Fib 200 pix wide at 300 resEncourage others
with A-Fib
click to order

Home | The A-Fib Coach | Help Support A-Fib.com | A-Fib News Archive | Tell Us What You think | Media Room | GuideStar Seal | HON certification | Disclosures | Terms of Use | Privacy Policy