We’ve add a video to our library of Atrial Fibrillation videos:
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.
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.
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
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…->
I’ve been a busy writer since attending the 2017 AF Symposium in January. Here are two more summary reports.
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.
He described his experiments with overweight sheep. A 30% weight lost reduced fibrosis as well as inflammation and incidence of A-Fib. Continue reading….
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.
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.
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.”
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 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.
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.
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.
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.
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?
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.)
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.
Special Signup Bonus: Subscribe HERE and receive discounts codes to save up to 50% off my book, Beat Your A-Fib: The Essential Guide to finding Your Cure by Steve S. Ryan, PhD.
The 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…->
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
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?
Have 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!
My third and fourth reports from the 2017 AF Symposium:
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.
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).
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…
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.
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
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…
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.
We hear it every day on TV, ads about ‘living with Atrial Fibrillation’. In today’s media, the message is about how to ‘manage’ your A-Fib. You’re advised to ‘just take our anticoagulant’ and you’ll live happily ever after.
But recent research (and common sense) indicates otherwise.
Mega Research Analysis of Your Additional Risks
Researchers at Oxford University, Oxford, UK and Massachusetts Institute of Technology (MIT), Cambridge, MA, USA, conducted a systematic review and analysis of 104 different studies involving nearly 10 million people, of which, over a half-million had A-Fib.
They found that Atrial Fibrillation is associated with not just stroke, but also with:
• Heart Disease
• Heart Failure
• Kidney Disease
• Sudden Death
• Death from All Causes
Heart failure: The strongest association was with heart failure, which was five times more likely in people with A-Fib. Because your heart isn’t pumping properly, it’s not surprising that A-Fib leads to heart disease, heart failure and sudden death.
Kidney disease: A surprising association is that A-Fib is tied to kidney disease and peripheral arterial disease, probably because of poor circulation due to A-Fib.
Death from all Causes: This isn’t such a surprising finding as A-Fib affects the whole body. A-Fib damages your heart, brain and other organs. It reduces the heart’s pumping capacity by about 15%-30% which may cause weakness, fatigue, dizziness, fainting spells, swelling of the legs, and shortness of breath.
Patients with A-Fib, even if they don’t have a stroke or heart failure, are more likely to die from other causes compared with people in normal sinus rhythm (NSR).
Note: this study didn’t examine the known link between dementia and A-Fib. See Leaving Patients in A-Fib Doubles Risk of Dementia—The Case for Catheter Ablation
Don’t be Misled by Pharmaceutical Ads
For patients with A-Fib, it isn’t enough to simply take an anticoagulant!
We need to worry not just about stroke, but also about the risks and potential damage of A-Fib to our overall health.
Contrary to today’s media, your goal shouldn’t be to just ‘manage your A-Fib’. It’s a Pollyanna fantasy to just ‘Take a pill (anticoagulant) and live happily ever after’.
That misconceoption is propagated by drug manufacturers who want you to stay an A-Fib patient and thus a customer for life.
Don’t Just Live with A-Fib
Don’t Settle. Seek your A-Fib cure. Your goal should be to get your heart beating once again in normal sinus rhythm (NSR). We can’t say it enough…
Do not settle for a lifetime on meds. Seek your A-Fib cure.
We first heard from AGL this past summer (My A-Fib Story: The Healing Power of Prayer, #88) Here he shares the rest of the story…up-to-date and expanded.
“In early 2011, I had my first heart episode. I thought I’d sleep it off, so I went home and took a nap. It didn’t go away. I eventually went to the ER where they said my heart rate was 235. They used adenosine which broke the episode, and my heart rate fell to 130s–140s. At this point they thought I had SVT [Supraventricular tachycardia], I couldn’t be sure if it was simply a fluke or not.
After a few more episodes within a year or two, I knew this wasn’t a one-time fluke. I went to see a cardiologist who gave me three choices of proceeding: 1) do nothing 2) take medicine or 3) have an ablation. He didn’t recommend I go with an ablation due to the risks involved.
I began taking 120mg of Cardizem, but that did not help―it simply slowed my heart rate and lowered my blood pressure. I was also taking 81mg of aspirin daily [for risk of stoke].
A-Fib Confounded by Sleep Disturbance
I wasn’t making progress in my A-Fib battle―and I was sleeping terribly. For three months I woke up every night at 2:30 a.m. Then, the rest of the night’s “sleep” was sketchy…Continue reading…
Sharing the gift of Hope is a wonderful way to start this new year. Inspire others to seek their A-Fib cure…
Pass on this heart to encourage others with Atrial Fibrillation.
You don’t have to live a life on medications. Seek your cure. For encouragement, browse our library of over 90 first-person stories by patients, many now A-Fib-free. Go to our Personal A-Fib Stories of Hope.
You can be free of the burden of Atrial Fibrillation.
Graphic by Patti J. Ryan, A-Fib.com. #afib
‘Tis the season when many people end up in a hospital’s emergency room (ER) for treatment of “Holiday Heart Syndrome”, i.e., Atrial Fibrillation triggered by alcohol binging.
Overindulging in alcohol (six or more drinks) can cause surges in the body’s adrenalin, rises in the levels of free fatty acids, alterations of how sodium moves in and out of the heart cells, and a lowering of the levels of sodium, potassium, and magnesium in the body through diuresis.
Does Alcohol Alone Explain Holiday Heart Syndrome?
Excessive alcohol is not the only culprit. Recreational use of marijuana can compound the risk as well. Other factors include the nicotine effect in smokers (active and passive), large quantiles of rich food, and even cold weather. In addition, fireplace fires and bonfires can release ultra-fine particles in the air from burnt materials and can be bad for the heart.
New Year’s Eve Party Time: Be Aware
As you celebrate, encourage others to avoid heavy alcohol consumption and try to minimize eating large quantities of food at one time. Look for the symptoms of “holiday heart” among your relatives (hereditary A-Fib) and friends. Anyone with any heart symptoms should go to the ER. If they’re lucky, it will be a one time event.
Share the Cheer of the Season
Finally, if you know someone who is depressed, alone, or isolated during the holiday season, reach out and cheer them up. It may be the best thing you do for their heart as well as yours.
If you read this blog regularly, you’ve read our 10-part series of posts based on ‘The Top 10 List of A-Fib Patients’ Best Advice’ from my book, Beat Your A-Fib.
The list is a consensus of valuable advice from fellow patients who are now free from the burden of Atrial Fibrillation. Click to see the full image.
The Series of Posts
If you missed a post, or simply want to re-read the original posts in this series, just click on the following links:
#1: What’s an EP?
#2: Dump Your Doctor?
#3: Don’t Believe Everything You’re Told About A-Fib
#4: Don’t Just Manage Your A-Fib with Meds. Seek your Cure.
#5: Don’t Let A-Fib Wreak its Havoc! Seek Your Cure ASAP
#6: Be Courageous. Be Aggressive.
#7: Persevere—More Than One Treatment May be Needed
#8: Get Emotional Support for the Stress and Anxiety
#9: Learn All Your Treatment Options Before Making Decisions
#10: Become Your Own Best Patient Advocate
From Chapter 10 of Beat Your A-Fib: The Essential Guide to Finding Your Cure, by Steve S. Ryan, PhD.