ABOUT 'BEAT YOUR A-FIB'...


"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"



ABOUT A-FIB.COM...


"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


Atrial Fibrillation and Atrial Flutter: Cause and Effect?

About Atrial Fibrillation and Atrial Flutter…are they linked? Does one precede the other? Can one procedure fix both? Can a typical catheter ablation fix both Atrial Fibrillation and Atrial Flutter at the same time? Can Maze surgery or Mini-maze surgery fix both?

Surgery vs. Ablation

In general, Atrial Flutter originates in the right atrium and Atrial Fibrillation in the left atrium.

Maze/Mini-maze surgical approaches typically don’t access the right atrium, and therefore can’t fix A-Flutter.

Maze/Mini-maze surgical approaches typically don’t access the right atrium, and therefore can’t fix A-Flutter. If you have both A-Fib and A-Flutter, a Maze procedure needs to be followed by a catheter ablation to fix the Atrial Flutter.

A catheter ablation procedure for A-Flutter is relatively easy and it’s highly successful (95%). It usually involves making a single line in the right atrium which blocks the A-Flutter (Caviotricuspid Isthmus line).

A Catheter Ablation Two-Fer? 

If you are having a catheter ablation, many doctors make this Caviotricuspid Isthmus ablation line while doing an A-Fib ablation (in the left atrium)—even if you don’t have A-Flutter at the time.

Catheter inserted into the heart and through septum wall into Left Atria

Catheter inserted into the heart and through septum wall into Left Atria

Catheters enter the heart through the right atrium. At the beginning of a catheter ablation for atrial fibrillation, doctors enter the heart through the right atrium. While there they may elect to make the right atrium ablation line at this point which takes 10-20 minutes.

They then go through the wall separating the right and left atria (transseptal wall) to do the ablation for A-Fib in the left atrium. (Some doctors chose to place the right atrium ablation line at the end of an ablation when they withdraw from the left atrium into the right atrium.)

Some say one should “do no harm” and not make this right atrium ablation line if there is no A-Flutter. Saying it can always be done later in another catheter ablation at little risk to the patient.

Research: Are A-Fib and A-Flutter Linked?

While you can have A-Flutter without A-Fib, more often than not, they are linked. When you have A-Flutter, A-Fib often lurks in the background or develops later.

Patients did much better if they had an ablation for both A-Fib and a A-Flutter at the same time even though they appeared to only have A-Flutter.

Some A-Flutter may originate in the left atrium, or the A-Flutter may mask A-Fib which may appear later after a successful A-Flutter ablation.

As many as half of all patients ablated for A-Flutter may later develop A-Fib.

In a small research study, patients did much better if they had an ablation for both A-Fib and a A-Flutter at the same time even though they appeared to only have A-Flutter.

What Patients Need to Know

But right now we can’t say for sure if one causes the other. We do know that A-Flutter usually comes from the right atrium, while A-Fib usually comes from the left atrium.

Resources for this article

New Research into Alcohol & A-Fib: How Many Drinks are Too Many?

“There has been a lot of attention in recent years about the benefits of drinking small amounts of alcohol for the heart,” writes head researcher Dr. Pater Kistler of Baker IDI Heart and Diabetes Institute in Melbourne, Australia.

“While moderate amounts of alcohol appear protective for the ‘plumbing,’ or blood supply to the heart muscle, the benefits of alcohol do not extend to the electrical parts of the heart, or heartbeat.”

Over time, drinking may actually change the electrical signals, triggering irregular heartbeat (arrhythmias).

“The benefits of alcohol do not extend to the electrical parts of the heart.”

Risk per Daily Alcohol Drink

A new study found the risk of atrial fibrillation grew by 8 percent for each daily alcoholic drink. The findings were similar for men and women. The authors looked at previous studies that tracked almost 900,000 people over 12 years.

Fibrosis: The study doesn’t establish a direct cause-and-effect relationship. Nevertheless, “cell damage from habitual drinking may lead to small amounts of fibrous tissue within the heart that causes the irregular, quivering heartbeat”, the study authors said.

Post-catheter ablation: The review found that people who continue to drink are more likely to have ongoing irregular heartbeats even after catheter ablation.

Weekly recommendation: “..No more than one alcoholic drink per day with two alcohol-free days a week.”

Weekly Alcohol Recommendation

Dr. Pater Kistler recommended that those with irregular heartbeat “should probably drink no more than one alcoholic drink per day with two alcohol-free days a week.”

He added they had no randomized data that tells what a ‘safe’ amount is to consume. The study authors called for more research to determine whether avoiding alcohol completely is required for patients who have irregular heartbeats.

Know Your Triggers

Some Atrial Fibrillation patients have sworn off alcohol altogether. Though trial and error, they’ve found that any amount of alcohol contributes to or triggers their A-Fib episodes.

Dr. Kistler’s research is helpful for the balance of A-Fib patients. It offers some research-based guidelines to minimize the impact of alcohol consumption to their A-Fib.

For additional reading, see my article:Holiday Heart”: Binging Alcohol, Marijuana & Rich Foods.

Resources for this article

 

New FAQ: Do Ablations Only Treat A-Fib Symptoms and Not a “Cure”?

We’ve posted a new FAQ and answer about curing Atrial Fibrillation with catheter ablation versus successful drug therapy:

Q: “I’ve read that an ablation only treats A-Fib symptoms, that it isn’t a “cure.” If I take meds like flecainide which stop all A-Fib symptoms and have no significant side effects, isn’t that a ‘cure?’”

My answer: A successful catheter ablation doesn’t just treat A-Fib symptoms, it physically changes your heart.

Isolates PVs: An ablation closes off the openings around your pulmonary veins (PVs) so A-Fib signals from the Pulmonary Veins (PVs) can no longer get into your heart.

It electrically ‘isolates’ your PVs, and if successful and permanent, you should be protected from developing A-Fib that originates from your PVs (where most A-Fib originates).

Recurrence Rates: Older research showed that recurrence of A-Fib after an ablation occurred at a 7% rate out to five years. But this was before the use of the newer techniques of Contact Force Sensing catheters and CryoBalloon ablation which make more permanent lesion lines around your Pulmonary Veins.

Also, people with comorbidities, like sleep apnea…continue reading my answer…

2017 AF Symposium: Three New Reports—Genetic A-Fib and LIVE Streaming Video Ablations

Live Streaming Video from AF Symposium at A-Fib.com

To my 2017 AF Symposium Overview, I added how we observed in-progress A-Fib procedures via streaming video from five locations spanning the globe, and heard from the EPs performing the ablations. Continue to the Video Overview…

Report 11: LIVE! Ablation Using CardioFocus Laser Balloon

CardioFocus HeartLight Laser Balloon catheter

CardioFocus HeartLight Laser Balloon catheter

Video streaming from Na Homolce Hospital in Prague, The Czech Republic. Drs. Peter Neuzil, Jan Petru and Jan Skoda did an ablation using the CardioFocus HeartLight Endoscopic Visually Guided Laser Balloon (FDA approved April 4, 2016).

The doctors showed how they could directly see the Pulmonary Vein opening they were ablating (unlike RF and CryoBalloon systems). The center of the catheter has an endoscopic (looking inside) camera.

(To me, this is a major advantage and ground-breaking improvement for patients.)

Read more of my report, and see a short video clip with an actual view of the pulmonary veins during an ablation. …Continue reading my report….

Report 10: LIVE! Two Procedures—but Different Left Atrial Appendage Occlusion Devices

Featuring the Amplatz Amulet from St. Jude Medical and the LAmbre from LifeTech Scientific.

Amplatz Amulet occlusion device by St. Jude Medical - A-Fib.com

Amplatz Amulet occlusion device by St. Jude Medical

Live from Milan, we watched the doctors insert an Amplatz Amulet into the LAA of a 78-year-old women who had a high risk of bleeding.

These doctors did something I had never seen before. They made a physical model of the woman’s LAA, then showed how the Amplatz Amulet fit into the model. This helped AF Symposium attendees see how the Amplatz Amulet actually worked. …Continue reading my report…

Report 9: World-Wide Studies on Genetic A-Fib

DNA: Double helix graphic at A-Fib.com

Dr. Patrick Ellinor of Mass. General Hospital, Boston MA, reported the biggest news is that A-Fib genetic research is increasing exponentially. The AFGen Consortium website lists 37 different studies and world-wide institutions studying A-Fib genetics with over 70,000 cases. Within the next 10 years, Dr. Ellinor and his colleagues hope to identify over 100 different genetic loci for A-Fib.

Dr. Ellinor reported that using a genetic “fingerprint” of A-Fib helps to identify those patients at the greatest risk of a stroke. (There’s a 40% increased risk of developing A-Fib if a relative has it.)…Continue reading my report…

About the Annual AF Symposium

The annual AF Symposium brings together the world’s leading medical scientists, researchers and EPs to share recent advances in the treatment of atrial fibrillation. You can read all my summary reports on my 2017 AF Symposium page.

Steve’s A-Fib Alerts: February 2017 Issue is Out

Check your email boxes! Our A-Fib Alerts: February 2017 issue is out and being read around the world.

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My Atrial Fibrillation Story: I was Told to “Just Live with It.”

Roger Finnern from Tempe, AZ, wrote to share his journey back to normal sinus rhythm (NSR) after 4 years in chronic asymptomatic Atrial Fibrillation. He writes about being on amiodarone, how he did a sleep apnea study (at home), and used acupuncture to help reduce his A-Fib symptoms:

Roger Finnern

Steve, I contacted you last in December 2015 as I was in chronic A-Fib without symptoms, age 67, and had a cardiologist who wanted me to do nothing but take a low dose aspirin and live with it.
After two years of being in Chronic A-Fib, I went out on my own. With your recommendation, I contacted Dr. Vijay Swarup, Arizona Heart Rhythm Center. I ended up getting a RF ablation in early February 2016.

After Ablation, Back in A-Fib after 2 days

After my ablation, I was in rhythm only 2 days before it reverted. They performed cardioversion twice before releasing me from the hospital, and each worked only for a minute before reverting back.
Dr. Swarup was a bit miffed as he had tested all ablated points and could not produce any response back to A-fib. He said something to the effect that my heart was highly irritated. They put me on the antiarrhythmic drug amiodarone to convert at home.

Amiodarone image

Amiodarone Works—finally A Normal EKG!

The amiodarone worked, and one week later I saw my doctor and had my first normal EKG since 2013! On August 2, six months post-ablation, I was taken off amiodarone. (I was kept on amiodarone longer than normal, due to the rough time we had getting into rhythm initially.) …Continue reading Roger’s story…

2017 AF Symposium More Reports: Obesity & A-Fib and Increasing Fibrosis

Another two summary reports from the January 2017 AF Symposium. Here’s the entire list of my reports from the 2017 AF Symposium.

Report 7: A-Fib Increases Fibrosis by 5%-10% Per Year

Dr. Nassir Marrouche of the University of Utah (CARMA), Salt Lake City, UT continued his ground-breaking work using MRI to investigate Atrial Fibrillation. Some of the major contributions Dr. Marrouche’s MRI research has made include that patients with high fibrosis levels are at greater risk of stroke and that they may be precluded from a successful catheter ablation.

He showed how current MRI testing also measures fibrosis in 3D to better gauge its thickness. Read about his latest research on A-Fib patients and fibrosis.

Report 8: New Insights into the Effects of Obesity on Atrial Fibrillation

Dr. Jose Jalife of the University of Michigan, Ann Arbor, MI, discussed the “Obesity Paradox”, a hypothesis that obesity may be protective and associated with greater survival with certain chronic diseases. Dr. Jalfie showed how and why this is not the case with A-Fib.

Under normal conditions, the surface of the heart is covered by fat stored in the tissue. A-Fib is often associated with increased volume of epicardial fat… Continue reading Dr. Jalife’s research findings.

See the entire list of my reports from the 2017 AF Symposium.
Look for another report soon.

New Video Added to A-Fib Library

We’ve add a video to our library of Atrial Fibrillation videos:

Mechanism and effects of Atrial Fibrillation

An Impulse That’s Lost its Way

A medical description of the mechanism and effects of Atrial Fibrillation (i.e., initiating triggers, abnormal substrate, electrical and structural remodeling, blood stasis and hypercoagulable state, etc.). Animation with narration.

Difficulty level: Intermediate. 3:24 min. Watch video.

A-Fib.com Library of Videos and Animations

We have loads of A-Fib-related videos in our Video Library. For the reader who learns visually through motion graphics, audio, and personal interviews, these short videos are organized loosely into three levels: introductory/basic, intermediate and in-depth/advanced. Click to browse our video library.

Click image to go to video.

A Popular Video: Buyer Beware of Misleading or Inaccurate A-Fib Information’, with Steve Ryan and host, Skip E. Lowe. Click image to go to video.

Steve Ryan Videos: We’ve edited Steve’s most interesting radio and TV interviews to create several short (3-5 min.) videos. Check out Videos Featuring Steve S. Ryan, PhD, publisher of A-Fib.com.

3:59 min. Click to Watch video.

New Research on NOACs: Which has More Bleeding Risk―Which is Safer?

Do you take the anticoagulant, Xarelto? Or one of the newer NOACs? Which is safest? Which has the least GI bleeding?

NOACs Research Study Results

The New NOACs - anticoagulants graphic at A-Fib.com

Which is safer?

A Mayo Clinic study indicated that the risk of gastrointestinal (GI) bleeding is higher for patients taking Xarelto than for other anticoagulants in its class.

The researchers compared the gastrointestinal (GI) safety profile of three rival oral anticoagulants: Xarelto (rivaroxaban), Pradaxa (dabigatran) and Eliquis (apixaban). All of the patients in the study had Atrial Fibrillation.

Bleeding occurrence: GI bleeding occurred more frequently in patients taking Xarelto compared to Pradaxa (approximately 20% increased risk), while Eliquis had the lowest GI bleeding risk.

Age factor: They also found that the risk of GI bleeds increased with age. In particular, patients over the age of 75 were at an increased risk.

Safety: Eliquis had the most favorable GI safety profile, even among very elderly patients, and Xarelto had the least favorable. … Continue reading this report…->

2017 AF Symposium: New Reports on Reversing Fibrosis and Hypercoagulability & NOACs

I’ve been a busy writer since attending the 2017 AF Symposium in January. Here are two more summary reports.

Report 5Some Forms of Fibrosis May Be Reversible: Research with Overweight Sheep 

In a very hopeful study for Atrial Fibrillation patients, Dr. Stanley Nattel of the University of Montreal, Montreal, Canada concluded that some forms or types of fibrosis are indeed reversible.

Steve with Shannon Dickson, editor of The A-Fib Report

Steve with Shannon Dickson, editor of The A-Fib Report

He described his experiments with overweight sheep. A 30% weight lost reduced fibrosis as well as inflammation and incidence of A-Fib. Continue reading….

Report 6: Hypercoagulability May Cause A-Fib, NOACs May Prevent It 

Novel oral anticoagulants (NOACs) may both prevent and stop A-Fib, according to a thought-provoking hypothesis by Dr. Ulrich Schotten of the University of Maastricht, Maastricht, The Netherlands.

His different, somewhat contrary hypothesis flips the current thinking― that hypercoagulability increases and promotes A-Fib (versus A-Fib increasing hypercoagulability).

Working with specially designed mice with increased thrombin activity (hypercoagulated mice), Dr. Schotten found that these mice had increased atrial fibrosis and A-Fib, and a hypercoagulated state promotes atrial fibrosis…Continue reading….

See the entire list of my reports from the 2017 AF Symposium.
Look for three more reports soon.

FDA Approved: CardioInsight (ECGI) Mapping and Ablation System Now Available in U.S.

CardioInsight 3D system vest - A-Fib.com

CardioInsight 3D system vest

Medtronic’s CardioInsight Noninvasive 3D Mapping System (ECGI) has received FDA clearance for use in the U.S. The CardioInsight system is the first non-invasive mapping system in the world.

Dr. Vivek Reddy at Mount Sinai Medical Center in New York City was the first to use the system commercially in the U.S.

CardioInsight Noninvasive 3D Mapping System (ECGI)

The CardioInsight system allows physicians to locate the origin of a patient’s irregular heart rhythms (arrhythmias). Cardiac mapping is traditionally achieved by inserting a catheter into the heart via an artery or vein.

The CardioInsight 3D system instead uses a 252-electrode sensor vest to non-invasively (from outside the heart) map irregular rhythms like A-Fib. The vest is a single-use, disposable multi-electrode vest that gathers cardiac electrophysiological data from the body surface. The 3D mapping system combines these signals with CT scan data to produce and display simultaneous 3-D cardiac maps.

The vest technology contours to the patient’s body and allows for continuous and simultaneous panoramic mapping of both atria or both ventricles, which cannot be achieved with current invasive methods. The 3D cardiac maps can be created by capturing a single heartbeat, and enable rapid mapping of these heart rhythms.

VIDEO: To learn how the vest is applied to the patient, see the vest application instructional video at the Medtronic CardioInsight™ Mapping Vest webpage.

ECGI is a Major Breakthrough in Treating A-Fib

ECGI mapping is certainly one of, or even the most important new development in the treatment of A-Fib.

In 2013, I started reporting about this ECGI system. Prof. Haissaguerre and his colleagues in Bordeaux, France, were very active and instrumental in the use of the CardioInsight system. They are credited with the greatest number of presentations and publications on the system. CardioInsight expanded its rollout to eight different venues in Europe where it tested as well as it did at Bordeaux. It’s now available in the U.S.―great news for patients.

Back then, I predicted that “the ECGI system, barring unforeseen circumstances, would rapidly supersede all other mapping systems and will become the standard of care in the treatment of A-Fib patients.”

David Neth wearing ECGI vest before ablation by the Bordeaux Groups - A-Fib.com

David Neth wearing ECGI vest before ablation by the Bordeaux Group

Not only does the CardioInsight (ECGI) system produce a complete, precise, 3D, color video of each spot in a patient’s heart producing A-Fib signals, but also the video can be done by a technician before the procedure right at the patient’s bedside rather than by the  electrophysiologist (EP) during an ablation. It also can be used during the procedure, for example to re-map an ablated area.

Dr Vivek Reddy stated: This system shifts mapping away from the EP lab, potentially saving time and enhancing the patient experience.”

The CardioInsight map is a better, more accurate, more complete map than an EP can produce by using a conventional mapping catheter inside the heart.

Should You Wait on Your Ablation for ECGI Mapping?

From a patient’s perspective, CardioInsight (ECGI) reduces both the time it takes to do an ablation and the number of burns a patient receives.

The question for patients is, should you wait on having an ablation till a CardioInsight  mapping system is available at your center?

The CardioInsight mapping system is most effective in cases of persistent or long-standing persistent A-Fib.

The CardioInsight mapping system is most effective in cases of persistent or long-standing persistent A-Fib where non-PV triggers have developed. Most cases of short-duration, paroxysmal A-Fib haven’t usually developed a lot of non-PV triggers.

Hence, if you’ve only been in A-Fib for a relatively short time and are still paroxysmal, it’s probably not worth the wait.

Medtronic Rollout of CardioInsight System

Medtronic will employ a strategic rollout of the technology in the geographies where it is cleared. I will try to report when an A-Fib center in the U.S. receives a CardioInsight system..

To read more about the CardioInsight (ECGI) system, see my article, How ECGI (Non-Invasive Electrocardiographic Imaging) Works.

Disclosure: Dr Vivek Reddy consults for and receives research funding from Medtronic.

Resources for this article

Inherited A-Fib? Is it More Risky for Family Members?

Many A-Fib patients wonder if they will pass their Atrial Fibrillation on to their offspring. Called Familial A-Fib, your first-degree family members are at higher risk of developing A-Fib.

A-Fib accounts for one-third of all strokes in patients above the age of 65 and is also associated with an increased mortality.

Several studies have shown an association of genetic variants with A-Fib and indicated that Familial A-Fib increases the risk of developing A-Fib. Familial A-Fib may account for as many as 20% of A-Fib patients.

But there is good news. A Danish registry study found that a diagnosis of Familial A-Fib carries no greater risk of death and stroke than in the general Atrial Fibrillation population.

The Danish Familial A-Fib Study

The study from Danish nationwide registry data included 8,658 patients diagnosed with A-Fib from 1995 through 2012 with both parents known, matched 1:1 for familial A-Fib status as well as age, year of A-Fib diagnosis, and sex.

Familial A-Fib is more common in men than women and with median age of 50.

Study Findings: Compared with the entire A-Fib registry population, the familial A-Fib patients were less likely to be female (21% women versus the overall registry’s 47% women) and were younger at diagnosis (median age 50 vs 77).

An element to be taken into account is that families with long life expectancy, for any reason, may be at higher risk for familial A-Fib due to the longevity of relatives.

What Patients Need to Know

We have heard of many fathers and sons and sets of brothers with A-Fib as well as three-generations with A-Fib.

If you have Atrial Fibrillation, your first-degree family members (parents, siblings, offspring) may have Atrial Fibrillation and not know it. They may have ‘silent A-Fib’ with no or few apparent symptoms but with an increased risk of stroke.

Encourage family members to discuss Familial A-Fib with their doctors.

Be your family’s health advocate. Encourage family members to discuss Familial A-Fib with their doctors. A-Fib is usually easy to detect by taking your pulse and/or by an electrocardiogram (EKG or ECG). Early detection and treatment may avoid early health complications and prevent a cardiovascular event (i.e. A-Fib-related stroke).

For more about Familial A-Fib, see FAQs: Can I Prevent Familial A-Fib with Diet? Supplements?

A-Fib Personal Story on A-Fib.comDoes A-Fib Run in Your Family? 

Would you share your A-Fib story with our readers? We would love to hear from you. Our Personal Experiences stories are one of the most visited areas of A-Fib.com. Email me and tell me your story. (Or, read how to write and submit your A-Fib story.)

Resources for this article

Read it Today: Our A-Fib Alerts: January 2017 Issue

From Chile to Ireland, Australia to Canada and Greece to Denmark, A-Fib patients around the world are reading our A-Fib Alerts January 2017 issue.

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Book Review: The Empowered Patient: How to Get the Best Medical Care Every Time

the-empowered-patient-cover-400-x-600-pix-at-300-resThe Empowered Patient: How to Get the Right Diagnosis, Buy the Cheapest Drugs, Beat Your Insurance Company, and Get the Best Medical Care Every Time

by Elizabeth Cohen

Review by Steve S. Ryan, PhD

For many, today’s healthcare system is overwhelming and confusing. Gone are the days of the paternal family doctor who managed your overall medical care. Today, you must step up and take responsibility for managing your own health care.

This Review: Important Material all Patients Should Consider

‘The Empowered Patient’, written by a CNN Senior medical Correspondent, is a short, easily read book. Chapters are organized in categories with common problems and practical solutions.

This review discusses important material for all patients to consider. If you read the softcover book, I recommend having a highlight marker and some post-it tabs handy for marking particular passages of personal interest for follow-up and future reference.

Trust No One Completely

When it comes to medicine, trust no one completely. Each year, 99,000 patients die from infections they acquire in hospitals, and another 98,000 die from medical mistakes in hospitals. … Continue reading this report…->

Reader Tip: Ends Vagal A-Fib Attack with Short Intense Exercise

If your A-Fib occurs at night, after a meal, when resting after exercising, or when you have digestive problems, then you may have ‘Vagally-Mediated’ A-Fib. The Vagus Nerve controls the abdomen and is part of the Parasympathetic Nervous System that tends to slow the heart and dilate blood vessels. Vagal A-Fib is uncommon.

I received an email from ‘A-Fibber in California’ with Vagal A-Fib who’s otherwise healthy and active. He wrote to tell about his success getting out of an A-Fib attack. ‘A-Fibber in California’ writes:

“I have the classic presentation of vagal A-Fib. Good heart, younger age bracket, typically in shape; A-Fib starts at night when I am relaxed and the parasympathetic part of the nervous system is more prominent.

The A-Fibs go away sometime during the day, usually at work when the sympathetic aspect is more prominent. I am an avid cyclist, and in shape, as are many patients with vagal A-Fib. I have a stationary bicycle trainer at home.

Short Maximum Intensity Exercise Stops My A-Fib

The Vagal Nerve - A-Fib.com

Click image to enlarge: The Vagal Nerve

I usually have A-Fib episodes once a week for anywhere from 10 hours to 24 hours.

I wondered if after warming up, if my doing a short bout of maximum intensity exercise, 60 seconds all-out, on my stationary bike, if that would stop an A-Fib episode?

Could the short maximum intensity exercise drive a very strong, sympathetically-mediated, sinoatrial node signal to the atrium? And then would it override the chaotic cardiac Central Nervous System nuclei signals that kept the heart in A-Fib? 

Yes. It worked!

In the morning of each of my past 5 A-Fib episodes, which have taken place in the space of 6 weeks, I got back to sinus rhythm immediately after getting off the bike following the maximum-intensity exercise noted above.

I used a pulse oximeter and stethoscope to confirm. This signal-overriding approach to sinus rhythm has worked so far to end an A-Fib attack.

Theory Why it Didn’t Work One Evening

There was one instance, however, when it did not. That time the A-Fib had begun, as is typical for vagally-mediated A-Fib, in the early part of the night/late evening. The short intensity exercise did not stop the A-Fib at that time. However, when I waited until morning and did it again, I returned to sinus rhythm immediate after stopping.

I wonder. Could attempting to stop the A-Fib when the body’s circadian rhythm places greater emphasis on parasympathetic/vagal tone, make it be more difficult to bring the heart back to sinus rhythm through a sympathetic nervous system activation?

Technique More Effective in the Morning? Short intensity exercise may be more effective in the morning, when the body’s sympathetic system starts to be activated more.

Perhaps my experience may help others who have vagal A-Fibs and can exercise this way.” – A-Fibber in California

Our reader, ‘A-Fibber from California’, also writes that he has scheduled his PV CryoBalloon ablation. Perhaps after his three-month ‘blanking’ period, his vagal A-Fib will be a thing of the past. We’ll follow and report on this progress.

Do You Have a Tip to Share?

Share your tip at A-Fib.comHave some advice to pass on to others with A-Fib? Something that’s working to lessen your A-Fib symptoms, or reduce your frequency or duration of your episodes? Perhaps some ‘Lessons learned the hard way’?

Why not share it with others? Take a few minutes and send me an email about it. Short or long, your tip offers insights that can help others.

Sharing encourages others with A-Fib
to seek their cure!

2017 AF Symposium: Two New Reports on Rotors and Predicting A-Fib

My third and fourth reports from the 2017 AF Symposium:

The Virtual Heart - Dr Natalia Trayanova

“Virtual Heart” image

Report 3: 3D Virtual Heart’ Predicts Location of Rotors. You may recall my 2015 report about Dr. Natalia Trayanova of Johns Hopkins University, and her ground breaking presentation on the 3D “Virtual Heart”. Her 2017 presentation was a continuation of her innovative research, this time about Atrial Fibrillation signals from rotors and fibrosis.

Dr. Trayanova constructed three-dimensional computer models of the atria in A-Fib from MRI data and assessed the propensity of each model to develop arrhythmia. Read how the predictive ability of her models compare to actual ECGI mapping cases…continue reading…

Report 4: Links Between Inflammation, Oxidative Stress and A-Fib. One of the most important frontiers of A-Fib research is trying to determine why and how Atrial Fibrillation develops. Dr. David Van Wagoner of the Cleveland Clinic, Cleveland, OH talked about the mechanistic links between inflammation, oxidative stress, and A-Fib.

Stressors like sleep apnea and obesity impact arrhythmia substrate changes.

Preventing and Preventing A-Fib: Oxidative stress can cause oxidants to interact with lipids and proteins and cause previously functional proteins to become dysfunctional. Processing dysfunctional proteins is impaired as in diseases like Alzheimer’s.

A-Fib hemodynamic stress or ‘stress activated’ changes (for example, by stressors like hypertension or obesity) produce reactive oxygen species (ROS) generation…continue reading…

Look for more of my 2017 AF Symposium reports
in the coming weeks and months.

New 2017 European A-Fib Stroke Risk Guidelines Changes

My second report from this month’s 2017 AF Symposium. Dr. John Camm from St. George’s Medical Center, London, UK discussed the new 2017 ESC (European) AF Stroke Risk Guidelines (i.e. CHA2DS2-VASc).

Dr. John Camm - A-Fib.com

Dr. John Camm

Gender Bias: The big news is that in the 2017 ESC Stroke Risk Guidelines for Atrial Fibrillation “gender is no longer an important consideration.”

The previous CHA2DS2-VASc risk scale automatically gave every woman an additional 1 risk point for just being female. Under the new 2017 Guidelines, anticoagulation recommendations are the same for men with 1 point and women with 2 points. (Sc stands for sex i.e. female gender). This is a major change in anticoagulation treatment for women.

Anticoagulant Therapy: Under the 2017 European Guidelines, the newer NOACs (Novel Oral Anticoagulants)…continue reading…

My First Report: Overview of the 2017 AF Symposium

I returned Saturday night from the annual AF Symposium held at the Hyatt Regency, Orlando, FL. The mood of the three-day atrial fibrillation conference seemed to be somewhat somber.

AF Symposium panel - A-Fib.com

AF Symposium panel

The coming Trump presidency seemed to cast a shadow of discouragement and even fear. Occasional discussions would reflect on the profound changes expected, especially about Obamacare.

The AF Symposium brings together the world’s leading medical scientists, researchers and cardiac electrophysiologists (EPs) to share the most recent advances in the treatment of atrial fibrillation.

Hot Topic: Left Atrial Appendage

Steve in Orlando

The most talked about topic at this year’s AF Symposium was the Left Atrial Appendage (LAA). This represents a major change in the way doctors now see the importance of the LAA and the LAA’s role in atrial fibrillation.

(For A-Fib patients, this is a most welcome change. All too many doctors still consider the LAA of little importance. For example, when doing an ablation, all too many EPs never look at the LAA to see if it is producing non-PV triggers.) Continue reading my first report

Memorial Sloan Kettering’s App of Herbs, Vitamins, and Dietary Supplements

Determining whether herbs, vitamins, and other over-the-counter dietary supplements can be helpful or harmful to you can be challenging.

Our favorite resource is the About Herbs database at the Memorial Sloan Kettering (MSK) website.

Web-based ‘About Herbs’ app

The database is continually updated and managed by a pharmacist and a botanicals expert with assistance from other MSK Integrative Medicine Service experts.

You can search by product or by medical condition to find objective and evidence-based information about:

• traditional and proven uses
• potential benefits
• possible adverse effects
• interactions with other herbs or medicines

Download App or Use Web Version

iTunes Store

Use the web-based service, or the About Herbs app that’s compatible with iPad, iPhone, and iPod Touch devices and other mobile devices.

Download the free About Herbs app from the iTunes App Store or

Or go to the web-based version.

Your Doctor Needs to Know

If you are using a dietary supplement, keep your doctor or other healthcare professional informed. Why? The active ingredient in the product could interact with—increase or lessen—the effect of other medicines you’re taking.

Attending the 2017 AF Symposium in Orlando, FL

I’m in Orlando, FL, for several days attending the AF Symposium 2017.

The annual AF Symposium (formerly called the Boston AF Symposium) is an intensive and highly focused three-day scientific forum that brings together the world’s leading medical scientists, researchers and cardiologists to share the most recent advances in the treatment of atrial fibrillation.

I attend in order to offer A-Fib.com readers the most up-to-date A-Fib research findings and developments that may impact the treatment choices of patients who are seeking their A-Fib cure (or best outcome).

Look for my reports and brief summaries in the coming weeks and months.

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