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



A-Fib and Dementia: My Top 5 Articles

There’s a growing body of evidence linking atrial fibrillation with early onset of dementia, one of the most feared diseases. (New cases of dementia are diagnosed every four seconds.)

When 65+ year olds were asked what disease or condition they were most afraid of getting, 56 percent cited the memory-robbing dementia.

While both Atrial fibrillation and dementia have been linked to aging, neither is a normal part of growing older.

A-Fib Patients: Reducing Your Risk of Developing Dementia

You CAN impact developing or avoiding dementia. Review these articles to learn more about the link between Atrial Fibrillation and dementia:

1. FAQ: “I’m scared of getting dementia. Can the right minerals help? I’ve read about the link with A-Fib. What does research reveal about this risk?” 

2. Leaving Patients in A-Fib Doubles Risk of Dementia—The Case for Catheter Ablation 

3. Warfarin + Aspirin = Increased Risk of Dementia 

4. FAQ: I’m concerned because Vitamin D deficiency has been tied to both A-Fib and Dementia. What is a normal level of Vitamin D?

5. Risks of Life-Long Anticoagulation Therapy: Patient on Anticoagulation Therapy for 10 years Develops Cerebral Microbleeds and Associated Early Dementia

Strategies for Preventing Dementia

What doesn’t work: current drugs, even statins, don’t work or have mixed results in preventing dementia.

What does work: Catheter ablation to eliminate your Atrial Fibrillation. Patients who get a catheter ablation have long-term rates of dementia similar to people without A-Fib. (This result holds regardless of their initial CHADS2 score.)

Don’t Settle. Seek your A-Fib cure: 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.

Click image to enlarge "Seek your Cure" graphic at A-Fib.com

Click image to enlarge

Reference for this Article

A-Fib.com 2017 Top-Rated by Healthline.com For Fourth Year

Healthline.com list of Best 2017 A-Fib Blogs

We are proud to announce, for the fourth year, Atrial Fibrillation: Resources for Patients (A-Fib.com) has been named to Healthline.com’s short list of 2017 Best A-Fib Blogs. (We proudly display our 2017 Best Blogs badge in our website’s right column.)

From the Healthline.com article: “We’ve carefully selected these blogs because they are actively working to educate, inspire, and empower their readers with frequent updates and high-quality information.”

We also extend our congratulates to our friends who also made the list: Travis Van Slooten (Living with Atrial Fibrillation) Dr. John Mandrola (Dr. John M) and Mellanie True Hills (StopAFib.org).

About Healthline: Over 40 million people turn to Healthline every month. From their website: “Healthline’s mission is to be your most trusted ally in your pursuit of health and well-being.”

Visit the Healthline The 2017 Best A-Fib Blogs to review all the winners.

OUR MISSION: A-Fib.com offers hope and guidance to empower patients to find their A-Fib cure or best outcome. We are your unbiased source of well-researched information on current and emerging Atrial Fibrillation treatments.

To Find Your A-Fib Cure, Build Your ‘Dream Team’

Treating Atrial Fibrillation doesn’t sound like a team sport. But you don’t beat your A-Fib on your own. It takes a team of healthcare professionals and wellness experts to help you seek your A-Fib cure!

While your ‘Dream Team’ will be unique to you, based on your age, symptoms, and other medical conditions, the core members of your Dream Team’ will include:

♥ Your primary care physician: often diagnoses your atrial fibrillation; may prescribe and manage your initial medications (especially for risk of stroke); usually refers you to a cardiologist (hopefully a heart rhythm specialist).

♥ Cardiac Electrophysiologist (EP): a cardiologist who specializes in the electrical functions of your heart; often the leader of your Dream Team! (Read: How to Find the Right Doctor for You.) In addition to your EP, other cardiac professionals may be added to your team including:

▪Cardiac procedure specialist: if you need a catheter ablation, a left atrial appendage occlusion device, i.e. Watchman, AV Node/Pacemaker procedure, pacemaker, etc.

▪Cardiac surgeon: if you need a Maze surgery or Mini-maze surgery

Recruit Beyond Your Team Starters

Don’t stop with just recruiting your star performers. Many of our readers at A-Fib.com have drafted other healthcare practitioners and wellness experts to join their Dream Team. You may benefit from one or more of the following:

Sleep specialist: More than 40% of A-Fib patients also suffer from sleep apnea. Everyone with A-Fib should be tested (Sleep Lab or home study). In fact, your EP may require testing before agreeing to perform a catheter ablation. Learn more about sleep apnea.

♥ Nutritional counselor/Naturopathic physician: Many A-Fib patients have found relief of symptoms through herbal and mineral supplementation (starting with magnesium and potassium). Learn more about a more integrated or natural method of healthcare.

♥ Diet & Exercise specialist: Losing weight through diet and exercise has benefited many A-Fib patients. Some report their A-Fib symptoms have diminished or stopped completely through changes in lifestyle. Read more about a heart-healthy eating plan.

♥ Complementary treatment practitioners:

Acupuncture: Many A-Fib patients have reported relief with acupuncture. Research indicates that acupuncture may have an anti-arrhythmic effect in patients with atrial fibrillation. Read about acupuncture research.

Yoga: Many A-Fib patients practice yoga and report benefits, specifically, the number of symptomatic A-Fib events were down, heart beat and blood pressure dropped, depression eased and anxiety decreased. Read about A-Fib and yoga.

Chiropractor: Several A-Fib.com patients have reported relief with chiropractic treatments. In addition, a few clinical studies have focused on arrhythmia and ‘manipulation’ techniques. Read more.

How to Build Your ‘Dream Team’

Forming your ‘Dream Team’ is an important step toward seeking your A-Fib cure. To build your team, we advise you to use all the resources available to you. Ask for referrals from other A-Fib patients, family and friends, and from your doctors’ nurses, nurse practitioners and physician assistants.

Over 90 stories of inspiration at A-Fib.com

For inspiration!

For inspiration, learn how others have dealt with their atrial fibrillation. Just browse our list of over 90 A-Fib Stories of Hope and Encouragement. Read a few stories with similar symptoms to your own, age group, etc.

Also, consider corresponding with one of our A-Fib Support Volunteers. They’ve all been where you are now. They have been helped along the way, and want to help other A-Fib patients.

Photos of contributors to Personal Experiences on A-Fib.com

A few of our A-Fib Support Volunteers

Remember, above all,
Aim for Your A-Fib Cure!

Reference for this Article

A-Fib Reference: The Best Online Medical Dictionary

Best online medical dictionary - A-Fib.com

Best online medical dictionary

We still love our softcover Concise Medical Dictionary (Oxford Quick Reference). But what about when you’re reading online and don’t have your medical dictionary handy?

The best online medical dictionary we’ve found is on the MedlinePlus website. It’s powered by Merriam-Webster. Check out MedlinePlus/Merriam-Webster Online Medical Dictionary and bookmark the website: https://medlineplus.gov/mplusdictionary.html

More Recommended Online Links

To create our list of over 30 online recommendations, we’ve personally reviewed hundreds of websites in search of the best links for you. For our selected A-Fib online resources, go to our Recommended Online Links.

For more recommendations, see all our Resources & Links for Atrial Fibrillation Patients.

Reader’s Tip: When A-Fib Hits, How He Uses Intense Exercise

Ian’s a 49-year-old male and has had paroxysmal A-Fib for 6 years. He wrote me about how he uses intense exercise to get out of an Atrial Fibrillation attack. But, he adds, this strategy may be too demanding for some people.

“I can bring myself back to a normal sinus rhythm by going for a run up a steep hill near my home. It’s not necessarily a pleasant experience, but has been successful 100% of the time.

Once I’m back into rhythm, I can either continue on a run or head back home to get on with the day. The only issue is when going for a run is inconvenient—on several occasions I’ve had to run at 2 or 3 am.”

Could This Work for You? If you are in otherwise good health and exercise regularly, you might give it a try. Just be cautious. (If you’re in A-Fib, I recommend you don’t run alone. Take a buddy with you.)

Share your tip at A-Fib.com

Email your advice

We appreciate Ian taking the time to write and share what’s working for him in managing his A-Fib symptoms. If you would like to correspond with Ian, you can email him at: ian.ph@hotmail.com.

Do You Have Advice to Share? Something that helps you cope with your Atrial Fibrillation symptoms? Email me with your story.

Did You Get Yours? My A-Fib Alerts April 2017 Issue

Subscribe Today! Steve's A-Fib Alerts at A-Fib.com

Subscribe Today! Steve’s A-Fib Alerts

It’s convenient! Get all your A-Fib news in one compact, easy-to-scan newsletter! Read the latest jam-packed issue here.

Join other readers from around the world. From Chile to China to Canada, Australia to Austria, and the U.S. to the U.K., A-Fib patients are reading Steve Ryan’s A-Fib Alerts April 2017 issue.

Subscribe NOW to get your issues sent directly to your desktop via email. I’ll send you:

 advancements in A-Fib treatments, relevant research findings and evolving technologies
 A-Fib stories of hope and encouragement by patients seeking their cure (or best outcome)
free downloads, online resources and special offers
 Frequently asked & answered questions from patients and their families 

Amazon.com review of Beat Your A-Fib book at A-Fib.comSign-up Bonus: 

SAVE up to 50% off my book, Beat Your A-Fib: The Essential Guide to Finding Your Cure, by Steve S. Ryan, PhD. Sign-up and receive your discount codes by email. (There’s no risk! Unsubscribe at any time.) Subscribe NOW.

Updated: Steve’s Shopping Guides to A-Fib-Related Products

We’ve updated and expanded our page of Steve’s recommendations for A-Fib-related products. Steve’s shopping guides help you sort through the vast array of products of interest to A-Fib patients and their families. These brands and products are available from many online and other retailers.

We invite you to read more about the following shopping guides: Go to Steve’s Steve’s Shopping Guides to Recommended A-Fib-Related Products.

A-Fib Survival Kit for the Newly Diagnosed
A-Fib Reference Books and Guides
Magnesium & Potassium Supplements for A-Fib patients
Seven ‘Natural’ Supplements for a Healthy Heart
DIY Heart Rate Monitors (HRMs)

Steve’s Shopping Guides to Recommended A-Fib-Related Products at A-Fib.com

Steve’s Shopping Guides to Recommended A-Fib-Related Products

Support A-Fib.com When You Shop Online

Use our Amazon.com portal link and support A-Fib.com at the same time (at no extra cost to you). Shop for anything, and your purchases generate a small commission which we apply to the maintenance costs of this website. Bookmark this link.

A-Fib.com portal link to Amazon.com

Bookmark our A-Fib.com portal link to Amazon.com

 

How to Buy Cheap Prescription Drugs Online by Travis Van Slooten

Our friend, Travis Van Slooten, over at Livingwithatrialfibrillation.com has written a comprehensive post about saving money on your prescription medications and why U.S. readers should consider buying online from Canada. Why? He sums it up in one word, cheap!

Best online price for Eliquis in U.S.

The same prescription drugs that you buy in the U.S. can be ordered for a fraction of the cost online from a Canadian pharmacy.

Follow Along: Step-by-Step Shopping Trip

As an example, Travis comparison shops the price of a 30-day supply of the anticoagulant Eliquis which retails for $484.40 in the U.S. The best U.S. price he found online was $404.87.

Read along as he shops at Canadian pharmacies (Canada Drugs, CanadaDrugPharmacy.com and YouDrugStore.com).

Best online price for Eliquis in Canada

VIDEO: The post culminates with a 12 min. video as Travis places his Eliquis order at YouDrugStore. com for $129.99.

Is It Legit & Legal to Buy Prescriptions Online from Canada?

Well, the answer is yes! It is legit and it is legal. It is perfectly legal for a U.S. citizen to purchase prescription drugs from Canada. And it’s perfectly legal for Canadian pharmacies to sell U.S. citizens prescription drugs. Watch the video and you’ll see that everything is on the “up and up” and how seamless and painless the process is.

For all the details on how this works, read Travis’ detailed review at How To Buy Cheap Prescription Drugs Online.

A-Fib, Inc. Earns GuideStar Platinum Seal for Transparency and Accountability in the Non-Profit World

A-Fib.com earns GuideStar Platinum Seal

A-Fib.com earns GuideStar Platinum Seal

A-Fib Inc. has earned GuideStar’s highest rating, the GuideStar Exchange Platinum Seal, a leading symbol of transparency and accountability in the non-profit world.

In order for A-Fib, Inc. to earn the GuideStar Exchange Platinum Seal, we filled in all required and optional sections of the report pages for Bronze, Silver and Gold levels and uploaded requested and additional documents to our profile on www.guidestar.org, including our annual financial report, 990 IRS filings, corporate officers, incorporation documents, etc.

A-Fib.com was first rated by GuideStar in 2014.

Our GuideStar seal is displayed at the bottom of every A-Fib.com page. To learn more about us, visit our A-Fib, Inc.’s GuideStar Profile.

About GuideStar USA, Inc.: GuideStar is the world’s largest source of information on nonprofit organizations and allows nonprofits to supplement the public information that is available from the IRS.

Caution: 1 in 10 Take Aspirin When They Shouldn’t (Warn your Family and Friends)

I have written about how aspirin is no longer recommended as first-line therapy to prevent A-Fib stroke. (See my Update: Aspirin No Longer Recommended as First-Line Therapy for Stroke Prevention.).

But it’s not just A-Fib patients who shouldn’t be on aspirin therapy for stroke prevention.

Data indicates more than 1 in 10 adults take aspirin when they shouldn’t.

Warn your family and friends who are taking daily aspirin: Maybe they shouldn’t be.

Aspirin, acetylsalicylic acid, is a pharmaceutical drug

50 Million in the US Take Aspirin for Prevention of Cardiovascular Disease

The problem with routinely taking aspirin, acetylsalicylic acid (ASA), is an increased risk of bleeding complications. More than one-third of all adults in the U.S. are now taking aspirin for primary and secondary prevention of cardiovascular disease (CVD).

“Primary” means preventing a first event like a heart attack. “Secondary” means preventing a reoccurrence of an event, like a second stroke.

When Aspirin Therapy Is Appropriate

As a “primary” prevention, only patients with a moderate to high 10-year risk of cardiovascular disease and stroke should be on aspirin therapy (estimated using the ACC/AHA risk-prediction calculator or similar calculator).

Aspirin is recommended for “secondary” prevention.

If you’ve had a stroke, aspirin IS appropriate as a means of preventing a re-occurrence or ‘secondary’ event.

When Aspirin Therapy Is Not Appropriate

Aspirin is not appropriate for adults who are at low risk of cardiovascular disease—defined by their 10-year stroke risk score. For these adults, the risks of gastrointestinal bleeding and hemorrhagic strokes outweigh any potential benefit.

“Among the more than 16,000 deaths each year linked to bleeding… about one-third of these deaths occur in those who take low-dose (81-mg) aspirin.” The 2014 an FDA statement warned against widespread use of aspirin in adults of average risk.

Aspirin is a Drug, Just Like Other Blood Thinners

It’s all too easy to take an aspirin―we don’t need a prescription to get it. But taking an aspirin isn’t like taking a vitamin. Aspirin, acetylsalicylic acid (ASA), is a pharmaceutical drug.

Warn Loved Ones Taking Daily Aspirin

Maybe they shouldn’t be! Instead of routinely taking aspirin, adults should discuss aspirin therapy with their doctor just as they’d do for any ‘by prescription’ blood thinner. (Hint: Take along a copy of this post.)

Caution: Suddenly stopping daily aspirin therapy could have a rebound effect that may trigger a blood clot. It’s important to talk to your doctor before making any changes.

References for this article

 

Selecting a New Doctor? 10 Questions You’ve Got to Ask

A-Fib.com Questions for Doctors Worksheet

Free download

Looking for a new cardiologist or electrophysiologist? To help you scrutinize prospective doctors, we’ve written a set of interview questions. The questions help you find the right doctor for your treatment goals.

Our worksheet has the questions to ask each doctor and an area to note their responses. Print a copy of this worksheet for each doctor you talk to.

Afterwards: How to Interpret the Answers You Received

Back home, study your notes about each doctor. To ‘interpret’ the doctors’ answers, see our article, “Choosing the Right Doctor: 10 Questions You’ve Got to Ask (And What Their Answers Mean)“.

We’ve included the various responses you might receive, and what each response means to you when searching for the right doctor for you and your treatment goals.

DON’T FORGET: File your worksheets and other notes in your A-Fib binder or folder for future reference (later, you might want a second opinion).

Download the FREE PDF and save to your hard drive
(separate browser window will open). Print multiple copies.

Find the Right Doctor: Steve’s Directory of Doctors & Medical Centers

Searching for electrophysiologists who treat A-Fib patients? Or looking to change doctors? We make it easier for you with our A-Fib.com Directory of Doctors and Medical Centers. (See the left menu for the Directory link)

Don’t be Fooled by Pay-to-Play Online Doctor Referral Sites

Paying to be listed in a doctor referral service is common among online directories. In addition, doctors can pay extra to be listed first in your database search results.

Don’t fall prey to hype, advertising, or third parties that have something to gain by recommending a particular healthcare provider. See my article: Don’t be Fooled by Pay-to-Play Online Doctor Referral Sites

NOTICE: Unlike some other directories on the web, at A-Fib.com we offer no preferential listings to be in the A-Fib.com Directory of Doctors & Medical Centers. We accept no fee, benefit or value of any kind for listing a specific doctor or medical center. In addition, A-Fib.com is not affiliated with any specific treatment, practice, medical center, device manufacturer or pharmaceutical company.

What Makes our Directory Unique?

We list only those cardiologists, electrophysiologists (EPs) and surgeons who treat Atrial Fibrillation patients. It’s in two parts: U.S. and international. Organized by city/state or country/region, you’ll find doctor’s names and contact information. (This evolving list is offered as a free service and convenience to A-Fib patients.)

Doctor acronyms

Doctor credentials


Tip: Refer to our page, Finding the Right Doctor for You and Your A-Fib. It covers what you need to know to research and select the best doctor for you and your treatment goals. (Also, look at our article: Physician Credentials: Acronyms and What They Mean for Atrial Fibrillation Patients.

Listed in Castle Connolly ‘Top Doctors’

You may see an additional qualification after some doctor’s names: “Listed in Castle Connolly TOP DOCTORS.” Castle Connolly ‘Top Doctors’ are selected through peer nominations, extensive research and screening. Important: Just like the A-Fib.com Directory of Doctors & Medical Centers, Castle Connolly Top Doctors cannot request or pay to be listed.

It’s Back! Print a High-Quality Illustration of the Heart’s Electrical System

Click to download

Update March 24: The Cleveland Clinic has given us permission to host this graphic of the Heart’s Electrical System on A-Fib.com for the viewing and printing by our readers.

Print and keep this illustration handy for the next time you talk with your doctor about the workings of your heart. Draw and make notes directly on the picture. Add comments in the text box we added at the bottom.

To get yours, just download and store on your hard-drive. To have one handy when you need it, print and store copies in your “A-Fib Binder or folder“.

Download the illlustration.

Also see our Free Offers and Downloads page.

FAQ: After Ablation—What’s my Chance of Staying A-Fib Free?

There is a tendency for ablated heart tissue to heal itself, regrow the ablated tissue, reconnect, and start producing A-Fib signals again. But if this happens, it usually occurs within the first three to six months of the initial PVA(I).

An A-Fib.com reader sent me this question about recurrence of his A-Fib after a successful ablation:

Illustration of catheter ablation

Illustration of catheter ablation of pulmonary vein

“Since my PVI, I have been A-Fib free with no symptoms for 32 months. What do you think my chances of staying A-Fib free are?”

Regrowth/Reconnection of Ablated Heart Tissue

I think your chances of staying A-Fib free are pretty good.

If your Pulmonary Veins (PV) are well isolated and stay that way, you can’t get A-Fib there again. When the PVs are isolated and disconnected and haven’t reconnected, it seems to be permanent. But it’s too early in the history of PVA(I)s to say this definitively. …read the rest of my answer.

In Persistent A-Fib? Time Matters: Ablate Sooner for Better Outcomes

Note: This research study is important if you have Persistent A-Fib or your Paroxysmal A-Fib has progressed to Persistent A-Fib.

The Cost of Waiting to Ablate

In patients with persistent atrial fibrillation undergoing ablation, the time interval between the first diagnosis of persistent A-Fib and the catheter ablation procedure had a strong association with the ablation outcomes.

Cleveland Clinic researchers found that shorter diagnosis-to-ablation time spans were associated with better outcomes. Longer diagnosis-to-ablation times was associated with a greater degree of atrial remodeling.

When A-Fib becomes persistent A-Fib, the ‘first diagnosis-to-ablation time span’ had a stronger impact on outcomes than the time spent in paroxysmal A-Fib.

According to electrophysiologist Dr. Oussama Wazni, “once the diagnosis of atrial fibrillation is made, it’s important not to spend too much time trying to keep a patient in normal rhythm with medical [drug] therapy” before referring for radio-frequency ablation.” Dr. Wazni is Co-Director of the Center for Atrial Fibrillation at the Cleveland Clinic.

His comments are based on the published analysis of two-year outcomes among 1,241 consecutive patients undergoing first-time ablation of persistent atrial fibrillation over an eight-year period at Cleveland Clinic. All patients had successful isolation of all 4 PVs (pulmonary veins), and the superior vena cava was isolated in 69.6%. In addition, Left Atrium ablations (including complex fractionated electrograms) were performed in 65.6% of patients.

First Diagnosis-to-Ablation Time Span: The Shorter the Better

Importantly, the first diagnosis-to-ablation time interval (of persistent A-Fib) had a stronger impact on outcomes than the time spent with a paroxysmal A-Fib diagnosis or the duration of continuous A-Fib before the ablation procedure.

These findings suggest that A-Fib is a disease with a continuous spectrum…
The findings suggest that A-Fib is a disease with a continuous spectrum, with patients at the extreme end of that spectrum having higher arrhythmia recurrence rates after catheter ablation, whereas patients with shorter diagnosis-to-ablation times having lower recurrence rates.

The analysis was published in the Jan. 2016 issue of Circulation: Arrhythmia and Electrophysiology. (Read online or download as a PDF.)

Reference for this Article

A-Fib.com Glossary of Terms and Phrases: Recent Additions

Recent additions to our A-Fib.com Glossary of Medical Terms and Phrases:A-Fib.com Glossary of Terms on notepad

Heart Failure:
A “failed” heart is NOT one that has suddenly stopped. Instead, it occurs when the heart is unable to pump enough blood to the other organs to satisfy their need for oxygen and nutrients. It usually manifests as tiredness and weakness, breathlessness and swelling of the legs and abdomen.

Atrial Kick:
The force or strength of the atrial contraction (which forces blood into the ventricles).

Fibrosis:
Fiber-like characteristics that develop in place of the normal smooth walls of the heart making you more vulnerable to A‑Fib…Over time it makes the heart stiff, less flexible and weak, overworks the heart, reduces pumping efficiency and leads to other heart problems…read the entire definition

Check it out. Bookmark it! Refer to it often!

The A-Fib.com Glossary of Medical Terms and Phrases is the most complete online glossary devoted exclusively to Atrial Fibrillation. Each definition is written in everyday language—a great resource for patients and their families.

(See Glossary of Terms in the left menu.) If you don’t find the term you are looking for—email us and we’ll add it to our Glossary.

2017 AF Symposium: FIRM Rotor Mapping System During Live Ablation

Dr David Wilber Loyola University

D. Wilber

In a live case from the 2017 AF Symposium, Dr. David Wilber from Loyola University Medical Center showed how he uses the Topera FIRM rotor mapping system to identify rotors in conjunction with a PVI. (‘FIRM’ stands for Focal Impulse and Rotor Modulation.)

Dr. Wilber described how he first does voltage mapping while the patient is in normal sinus rhythm. He started in the right atrium, then moved to the left; he used the FIRM system to map where rotors were coming from. (In patients with persistent A-Fib, he typically finds as many as 4-8 rotors.) He mapped and ablated until there were no more rotors.

Only after using the FIRM system did he do a Pulmonary Vein ablation…Continue reading my report.

NOAC or Warfarin for Valvular A-Fib?

Patients with ‘Valvular Atrial Fibrillation’ are often restricted from most A-Fib clinical studies and research. In particular, for NOAC trials, people with Valvular A-Fib have generally been excluded because they may have a higher rate of forming clots (e.g.: left atrial clots). 

“Valvular Atrial Fibrillation” refers to those A-Fib patients with artificial heart valves or mitral stenosis.

Like most A-Fib patients, Valvular A-Fib patients with bioprosthetic or mechanical valves have to be on an anticoagulant which up to now was restricted to warfarin. So, are the new NOACs an option?

Bioprosthetic valves are non-synthetic (usually porcine) devices used to replace a defective heart valve. Compared to mechanical valves, bioprosthetic valves are less likely to cause clots, but are more prone to structural degeneration (35% fail within 15 years).

Warfarin vs Edoxaban (NOAC)

A 2017 study showed that the Novel Oral Anticoagulant (NOAC) edoxaban (brand name: Savaysa) was safer than warfarin in preventing an A-Fib stroke in people with bioprosthetic heart valves.

Edoxaban 30 and 60 mg (Savaysa)

Edoxaban works by inhibiting factor Xa in the coagulation process. The lower dose (30 mg) was associated with a reduced rate of major bleeding, but not the higher dose (60 mg).

Compared to warfarin, edoxaban was associated with lower annual stroke rates, systemic embolic events, major bleeds, and deaths annually.

“Our analysis suggests that edoxaban appears to be a reasonable alternative to warfarin in patients with Afib and remote bioprosthetic valve implantation,” according to Dr. Robert P. Giugliano of Brigham and Women’s Hospital in Boston, MA.

Edoxaban Works With Bioprosthetic Valves But Not Mechanical Ones

For the first time, research indicates that a NOAC (edoxaban) can be used for Valvular A-Fib to prevent an A-Fib stroke―but only in the case of bioprosthetic (porcine) valves.

The NOAC, Edoxaban (Savaysa), was safer than warfarin for A-Fib patients with bioprosthetic valves.

With regards to mechanical valves, the authors cited a study in which dabigatran (Pradaxa) fared poorly in mechanical valves.

What About Other Factor Xa NOACs?

What about the other ‘factor Xa inhibitors’ such as Xarelto and Eliquis? Can they be used like edoxaban? Currently there is little clinical data on this subject. But since all three are factor Xa inhibitors, most likely they will be proven to be effective in A-Fib patients with bioprosthetic valves.

What Patients Need to Know

Do you have Valvular A-Fib and a bioprosthetic valve? Are you on warfarin? If being on warfarin is difficult for you, you now have a choice of anticoagulant. Ask your doctor about switching to the NOAC, edoxaban.

Reference for this Article

2017 AF Symposium: Preventing Esophageal Fistula

Report 14 from the 2017 AF Symposium summarizes a live ablation using a new tool to protect the esophagus.

The Problem: During an ablation, doctors take great precautions to not heat or injure the esophagus which lies behind the posterior wall of the left atrium. Injuring the esophagus can, in very rare cases, cause an atrial esophageal fistula which can be fatal.

Fear of causing esophageal injury can cause the EP to modify the ablation lesion set delivery, thereby reducing ablation success.

New Solution: an Esophagus displacement tool.

Use of the esophagus displacement tool, EsoSure Esophageal Retractor

The EsoSure Esophageal Retractor allows doctors to re-position a section of the esophagus away from the nearby heart tissue and avoid the heat generated during ablation.

Live streaming ablation: In this re-do ablation, entrainment (pacing) mapping was used to identify non-PV triggers.

Since they had to ablate in the posterior of the left atrium next to the esophagus, they simply moved the EsoSure Retractor up and down to displace the esophagus. The EPs remarked they could now ablate at a higher wattage without fear of harming the esophagus. …continuing reading my report…

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