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


5-Year CABANA Trial: Compares Catheter Ablation with Antiarrhythmic Drug Therapy

The catheter ablation procedure for Atrial Fibrillation has been around for 20+ years.

In a randomized controlled trial, the 5-year CABANA study is the largest to compare the A-Fib treatments of catheter ablation (PVI) and antiarrhythmic drug therapy (AAD).

CABANA stands for Catheter Ablation versus Antiarrhythmic Drug Therapy.

CABANA Trial Design

Worldwide, 2,204 patients with new onset or undertreated Atrial Fibrillation were randomized between two treatments: catheter ablation (PVI) or antiarrhythmic drug (AAD) therapy. Patient participants were followed for nearly 5 years.

Patients details: Many patients had concurrent illnesses with Atrial Fibrillation: cardiomyopathy (9%), chronic heart failure (15%), prior cerebrovascular accidents or TIAs (mini-strokes) (10%).

Over half of participants (57%) had persistent or long-standing persistent A-Fib [i.e. harder types of A-Fib to cure].

Drug details: Antiarrhythmic drug (AAD) therapy was mostly rhythm control (87.2%), some received rate control drug therapy.

Anticoagulation drug therapy was used in both groups.

CABANA Trial Results

Crossover a Major Problem: Many in the AAD therapy arm decided to have a catheter ablation instead (27.5%). And some in the ablation arm decided not to have an ablation (9.2%). [One can not blame patients or their doctors for making these life-impacting choices.] 

The CABANA results showed catheter ablation was significantly better than drug therapy for the primary endpoint (a composite of all-cause mortality, disabling stroke, serious bleeding or cardiac arrest). [See Additional Research Findings below.] Mortality and death rate were also significantly better for catheter ablation.

CABANA Findings: Ablation vs AAD Therapy

▪ Catheter Ablation significantly reduced the recurrence of A-Fib versus AAD therapy.

▪ Catheter Ablation improved ‘quality of life’ (QofL) more than AAD therapy, though both groups showed substantial improvement.

▪ Catheter Ablation patients had incremental, clinically meaningful and significant improvements in A-Fib-related symptoms. This benefit was sustained over 5 years of follow-up.

▪ Catheter Ablation was found to be a safe and effective therapy for A-Fib and had low adverse event rates.

Take-Aways for A-Fib Patients

Ablation Works Better than Antiarrhythmic Drugs: Rather than a life on antiarrhythmic drug therapy, the CABANA trial and other studies show that a catheter ablation is the better choice over antiarrhythmic drug therapy.

For related studies, see CASTLE AF: Live Longer-Have a Catheter Ablation and AATAC AF: Catheter Ablation Compared to Amiodarone Drug Therapy.

In an editorial in the Journal of Innovations in Cardiac Rhythm Management, Dr. Moussa Mansour, Massachusetts General Hospital, wrote about the CABANA trial:

“It confirmed our belief that catheter ablation is a superior treatment to the use of pharmacological agents, and corroborates the findings of many other radomized clinical trials.” 

Lower Recurrence: What’s also important for patients is the lower risk of recurrence of A-Fib versus AAD therapy.

Reduced Ablation Safety Concerns: Ablation significantly improved overall mortality and major heart problems.

Immeasurable Improvement in Quality of Life! Perhaps even more important for patients on a daily basis, catheter ablation significantly improved quality of life.

Don’t Settle for a Lifetime on Drugs

Over the years, catheter ablation for A-Fib has become an increasingly low risk procedure with reduced safety concerns. (Ablation isn’t surgery. There’s no cutting involved. Complication risk is similar to tubal ligation or vasectomy.)

An ablation can reduce or entirely rid you of your A-Fib symptoms, make you feel better, and let you live a healthier and longer life (for people who are older, too). A catheter ablation significantly improves your quality of life (even if you need a second “re-do ablation” down the road).

For many, many patients, A-Fib is definitely curable. Getting back into normal sinus rhythm and staying in sinus rhythm is a life-changing experience, as anyone who’s free from the burden of A-Fib can tell you.

See also:  Does a Successful Catheter Ablation Have Side Benefits? How About a Failed Ablation?

Additional Study Findings
Primary endpoints: Results of the primary endpoints were not significant. This is probably due to the crossovers and the lower than expected adverse event rates (5.2% for ablation versus 6.1% for AAD therapy).

Deeper Analysis of Data: The researchers performed sensitivity analyses on the primary results using “treatment received” and “per protocol” rather than “intent to treat”.

Research Terms: Primary endpoint—specific event the study is designed to assess. Intent to treat—all assigned to the AAD group compared to the assigned ablation group (even though 1/4 crossed over to the ablation group). Treatment received—compared all who received an ablation to all who received AAD therapy.
References for this article
• Packer, Douglas. CABANA trial provides important new data on clinical and quality of life effects of ablation for atrial fibrillation. Cardiac Rhythm News: October 18, 2018, Issue 42. P. 1.

• Mansour, Moussa. Letter from the Editor in Chief. The Journal of Innovations in Cardiac Rhythm Management, June 2018. DOI: 10.19102/icrm.2018.090609.

Is 2019 the Year You Fire Your A-Fib Doctor?

Consider this question: “What would you tell your healthcare providers about living with A-Fib?”

That’s the question Mellanie True Hills, StopAFib.org, posed in 2017 to A-Fib patients on several online forums. Around 1,000 A-Fib patients and caregivers from around the world responded.

(How would you answer her question?)

A Top 10 List from A-Fib Patients to Their Doctors

After culling the patient comments, Ms. Hills distilled them into a top 10 list: 5 things A-Fib patients do not want to hear from their doctors and 5 things they do want to hear. She shared these insights with an AMA audience of doctors and later in a journal article for Electrophysiologists. For the full article with the accompanying explanations, go to her journal article.

Five Things A-Fib Patients Do Not Want To Hear

Ms. Hills’ survey results and several research studies tell us that some doctors underestimate the impact Atrial Fibrillation has on a patient’s quality of life. Many doctors treat A-Fib as a benign heart ailment. But patients report how A-Fib can reek havoc in their lives.

Responding A-Fib patients in this survey have said they do not want their healthcare providers to say:

  1. “A-Fib won’t kill you.”
  2. “Just get on with your life and stop thinking about your A-Fib.”
  3. “Stay off the Internet and only listen to me.”
  4. “I’ll choose your treatment, not you.”
  5. “You’re just a hysterical female.”

How Does Your A-Fib Doctor Measure Up?

Did anything on this list sound (or feel) familiar to you?

Think about your doctor’s manner and personality. Is this someone who works with you? Someone who listens to how A-Fib makes you feel? Does this doctor inspire confidence? Is this someone you’re comfortable with and trust with your health care?

Even if a doctor is the best in their field and an expert in your condition, that may not help you if they don’t communicate well with you and they don’t respect you.

If your doctor is condescending or dismisses your concerns, you’re getting poor care. If a doctor is too busy to talk with you and answer your concerns, he’s probably too busy to take care of you properly.

It may be time for you to change doctors.

Five Things A-Fib Patients Do Want To Hear

Those doctors who recognize the serious effects atrial fibrillation can have on patients will foster meaningful and productive partnerships with their patients. To bolster the doctor–patient relationship, here are five things A-Fib patients do want their healthcare providers to say:

  1. “I respect you and will listen.”
  2. “I want to be sure you understand.”
  3. “Let’s customize a treatment that works with your lifestyle.”
  4. “I understand your values and preferences.”
  5. “Here are some resources about A-Fib.”

Is 2019 the Year You Fire Your Doctor?

Your relationship with your doctor is important. Do the comments on this second list sound like your doctor?

If you don’t have this kind of rapport with your current doctor(s), it’s worth looking elsewhere for a new doctor (even if they’re “the best” in their field).

When your doctor respects you and listens to you, you’re more likely to collaborate on a treatment plan tailored to you and your treatment goals.

Developing a good relationship helps you feel comfortable asking questions and getting feedback in a give-and-take environment. And you’re more likely to accept and follow their advice.

Changing Doctors Can Be Scary

The researcher in doctor-patient communication, Robin DiMatteo, of U. of Calif.- Riverside, says of changing doctors: ”I really think it’s a fear of the unknown. But if the doctor isn’t supporting your healing or health, you should go.”

We can help you. Learn more about how to Find The Right Doctor For You and Your Treatment Goals.

Helping Doctors Understand A-Fib from the Patients’ Point-of-ViewRead about my own experience talking to over 200 cardiologists and surgeons about the emotional stress of A-Fib from a patient’s point of view.

Resources for this article
Mellanie True Hills presentation, 2017 American Heart Association Scientific Sessions in Anaheim, California, November 11-15, 2017.

Recognize AFib Patient Values by Mellanie True Hills. PowerPoint Presentation. From Improving Outcomes for Patients with AFib. American Heart Assoc. Non-CME Webinar. May 3, 2018. https://www.heart.org/-/media/files/health-topics/atrial-fibrillation/improving-outcomes-for-patients-with-afib-ucm_500972.pdf?la=en&hash=CDE25CF86D94CE01B9D5662E45E86619F20FF809

Hills, M T.  The transformative power of understanding and trust in AF care: How doctors can provide better treatment by understanding the hearts―and minds―of AF patients. Journal of Cardiovascular Electrophysiology. Point of View. Volume 29, Issue 4, April 2018. Pages: 641-642. https://doi.org/10.1111/jce.13443

‘A-Fib-Zebub’ Whispers in your Ear …”A-Fib’s not that Bad”

That little voice has a name: A-Fib Zebub.

This little character is called “That Demon A-Fib-Zebub“. He’s that tiny voice that’s whispers in your ear…“You don’t look sick! A-Fib’s not that bad. You can live with it”.

Don’t Listen to A-Fib-Zebub!

Any time A-Fib-Zebub pops up in your head, it’s time to remember that A-Fib is not benign, but a progressive disease. It’s not a “nuisance arrhythmia” as some doctors consider it.

And don’t, as one doctor told his patient, just “take your meds and get used to it”.

Don’t Settle for a Lifetime on Meds: Aim for a Cure

Who wants this demon on their shoulder for the rest of their lives? Don’t listen to A-Fib-Zebub! Instead seek your A-Fib cure like I did (see my personal A-Fib story: Finding my Cure).

For many, many patients, A-Fib is definitely curable.

Always Aim High! If you have A-Fib, no matter how long you’ve had it, you should aim for a complete and permanent cure. Shoot for the moon, as they say, and you’ll find the best outcome for you and your type of A-Fib.

Personal Stories of Hope and Lessons Learned

To help bolster your resolve, seek encouragement from other patients. Other A-Fib patients have been where you are right now and have shared their personal experiences (starting with story #1 by Steve Ryan).

Each story is told in their own words. Some stories are told in a few paragraphs while other stories are longer, spanning years, even decades. Symptoms will vary, and treatments choices run the full gamut.

Browse through our list of over 99 Personal A-Fib stories of Hope. Look for patients with similar symptoms or situations as your own. Many writers have included their email address if you want to contact them directly. Read a story or two to learn how others are dealing with this demon we call Atrial Fibrillation. Their hope and courage is contagious.

Do not learn to live with Atrial Fibrillation.
Seek Your Cure!

For Inspiration: ‘A-Fib’s Demise’ a Poem by Emmett Finch, the Malibu Poet

At the beginning of this new year, we offer you a poem written for A-Fib patients by our friend Emmett Finch, the Malibu Poet. We met Emmett when we researched his personal A-Fib story for our book, Beat Your A-Fib (“40-Year Battle With A-Fib Includes AV Node Ablation With Pacemaker”).

Emmett F.

Emmett honored us with a special poem ‘A-Fib’s Demise’. It’s for people of faith who look for hope and help from the Divine but also see doctors, medicines, supplements, etc. as manifestations of the “creative power we call God.”

We hope A-Fib’s Demise will inspire you during this coming year to seek your A-Fib cure!  (Note: You can download and print the PDF.)

Emmett's Poem - A-Fib_s Demise

Wishing you a blessed year to come
filled with good heart health.

It Takes Time to Find the Right Treatment Plan for You: Learn all Your Options

A-Fib begets A-Fib. The longer you have A-Fib, the greater the risk of your A-Fib episodes becoming more frequent and longer, often leading to continuous A-Fib. (However, some people never progress to more serious A-Fib stages.)

Most Atrial Fibrillation patients should look beyond the typical antiarrhythmic drug therapy. These drugs don’t cure A-Fib but merely keep it at bay. According to Drs. Irina Savelieva and John Camm of St. George’s University of London:

“The plethora of antiarrhythmic drugs currently available for the treatment of A-Fib is a reflection that none is wholly satisfactory, each having limited efficacy combined with poor safety and tolerability.”

Educate Yourself: Learn All Your Options

A-Fib is not a “one-size fits all” type of disease. You need a personalized treatment plan. To begin, first educate yourself about Atrial Fibrillation, and then review all your treatment options. See Overview of A-Fib, Find the Right Doctor for You and Treatments for Atrial Fibrillation. A-Fib treatments include both short-term and long-term approaches aimed at controlling or eliminating the abnormal heart rhythm associated with A-Fib.

Next, you can move on to the guidelines we’ve posted: Which of the A-Fib Treatment Options is Best for Me? You are then prepared to discuss these treatment options with your doctor. Keep in mind, this should be a ‘team effort’, a decision you and your doctor will make together.

Build a Support System: We Can Help

You are not alone. Many, many others with A-Fib have been where you are now and are ready to share their experiences and insights.

Our A-Fib Support Volunteers: Having someone you can turn to for advice, emotional support, and a sense of hope that you can be cured, may bring you peace of mind. Our support volunteers offer you one-to-one support through exchanging emails and sharing their stories. To learn more, go to our page A-Fib.com’s A-Fib Support Volunteers.

Positive Thoughts/Prayer Group: At A-Fib.com we believe in healing through hope, belief, prayer and in the power of positive thoughts. To learn more about our group and how to send in your request, go to our A-Fib.com Positive Thoughts/Prayer Group.

Build Your A-Fib Treatment Plan: Know All Your Options

Resources for this article
Savelieva I, Camm J. Update on atrial fibrillation: part II. Clin Cardiol. 2008 Mar;31(3):102-8. Review. PubMed PMID: 18383050. URL Retrieved Nov 17, 2011. http://www.ncbi.nlm.nih.gov/pubmed?term=PMID%3A%2018383050

Reading our A-Fib Alerts for December 2018 Yet?

Beat Your A-Fib book link

Signup and save up to 50% on my book at A-Fib.com

Did you miss it? Our A-Fib Alerts: December 2018 issue is out and being read around the world from Australia to Israel, France to Finland, and Brazil to the UK! Don’t miss the easy way to get your A-Fib news. Read online now. (Includes an update on our experiences surviving the Malibu/Woolsey fires in CA.)

Not a subscriber yet? Special Bonus: Sign up for our A-Fib Alerts and get special discount 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.

Get the eBook for just $12 ($24.95 retail). Or get the softcover book for only $24 ($32.95 retail). Sign-up and you’ll get your special discount codes by return email. Sign-up TODAY!

Read Canadian Rani Minhas' A-Fib story at A-Fib.com

Read Canadian Rani Minhas’ A-Fib story.

Give the Gift of Hope: Steve’s Guides to A-Fib-Related Products

Give the gift of hope this gift-giving season with our ideas for family members and patients with Atrial Fibrillation. We’re often overwhelmed when we shop for A-Fib-related items.

Steve’s Shopping Guides help you sort through the vast array of products of interest to those touched by Atrial Fibrillation. These brands and products are available from many online and other retailers.

We invite you to browse our page with the following shopping guides from books to supplements and heart rate monitors. Go to Steve’s Steve’s Shopping Guides to Recommended A-Fib-Related Products including:

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)

Support A-Fib.com When You Shop Amazon.com

Amazon.com portal link for A-Fib.comUse our Amazon.com portal link and support A-Fib.com at the same time (at no extra cost to you). Your purchases generate a small fee which we apply to the costs of publishing this website. Bookmark this link. Use it every time!

“Hi Steve and Patti, I just spent $200+ on Amazon and used the A-Fib.com portal link [to generate commissions for the website]. I, too, want to keep the A-Fib.com website independent and ad free.

I bookmarked your portal link and will continue to use it for every Amazon purchase.” 

Barbara Cogburn, Renton, Washington, U.S. 

 

Help Keep A-Fib.com Independent and Ad-Free

http://tinyurl.com/Shop-Amazon-for-A-FibEach purchase you make generates a small commission for us (at no extra cost to you.) We apply it towards the monthly costs of publishing A-Fib.com.

Our goal is to make A-Fib.com a self-sustaining site and maintain our ‘no third-party advertising’. No distracting Google or product ads that interrupt your reading.

Your support is needed and much appreciated. Bookmark this link (http://tinyurl.com/Shop-Amazon-for-A-Fib). Use it every time you shop Amazon.com.

After using the A-Fib.com portal link to shop Amazon.com, Mary Jo Hamlin, Liverpool, NY writes:

“I’m happy to donate [to A-Fib.com]. Steve has always been very helpful answering my questions. You guys do a great job for a good cause! God bless.”

VIDEO: Compares Apple Watch 4 EKG to Hospital 12-Lead EKG

Image from C/NET video

C/NET.com has posted a very informative short video featuring Dr. Gregory Marcus at the UCSF Medical Center who compares a 1-lead ECG from the Apple Watch Series 4 to the results of a traditional hospital 12-lead electrocardiogram (ECG/EKG).

Hooked up to a traditional electrocardiogram monitor, C/NET Senior Editor Vanessa Hand Orellana uses an Apple Watch 4 app to take her 30 second ECG reading.

Compare ECGs: See comparisons of Vanessa’s readings from her 12-lead electrocardiogram (ECG) monitor and her Apple Watch ECG.

EKG monitor from C/NET video

Learn the technology of how the Apple Watch captures the heart beat.

Dr. Marcus talks about appropriate uses of the Apple Watch ECG and the role of the electrocardiogram. (Note: Other wearable devices also let you take an ECG outside the doctor’s office.)

Go to video: Animations with location footage and on-camera interview. 4:26 min video. See the video–> Apple Watch EKG tested against a hospital EKG

Personal Update: Surviving the Woolsey/Malibu Fire

For our earlier posts and fire photos, see On a Personal Note: Malibu Fires and Mandatory Evacuation and Personal Update on the Malibu Fires.

Wow! The last 30 days have been an experience I hope you never have to live through.

The left sign post was burned, but not the right.

We evacuated our Malibu, CA, home on November 9th due to the Woolsey brush fire that was burning its way toward us and the Pacific Ocean. We were in a motel for 11 days. Then we got word our home was okay. When road blocks were lifted, we returned home but without electricity, no heat, spoiled food in the frig/freezers, no phone landline and no internet access (FIOS). But we had water and our cell phones worked.

Fire damage: The fire did come down the land on either side of our home, singed the trunks of our palm trees near the street, but only burned a few isolated spots (see our Island sign). Our structures were spared but the soot and ash were throughout the house, even the closets (despite closed windows).

Making do without and filing claims: First came treks to the library to charge our devices and get on the internet. Cold drinks were out of a styrofoam cooler, hot food from a drive-thru. We burned a lot of candles at night. Next, came insurance, FEMA, SBA disaster claims paperwork. After about two weeks without power we bought a gas powered generator. Over several days (and lots of industrial extension cords) I got power for our devices, hot water heater (and satellite TV) then furnace and laundry. But it required daily trips for gasoline (Patti could now use her CPAP at night).

The green brush and tree mark our property line; The rains caused the hill side erosion next to us.

Then the mud slides. Then came the dreaded rains. We had been advised where to place the free sand bags from the fire station to protect our property and propane tank. We had little mud but you can see the erosion next door where the fire burned the brush that had been securing the soil.

Thank God for Friday: This weekend was a big one for us. Friday, after 28 days with no power, the electric company discovered and replaced a fried transformer next door and restored our electricity!

About 12 cleaners descended on our home and started three days of cleaning. Our insurance paid for us to move out while Service Master cleaned our entire house (inside and out), frig and freezers, closets, rugs, etc. to get rid of the soot and odors (and will pay to wash or dry clean the clothes in our closets). On Saturday, surprise! our phone service and internet access were restored.

Home sweet home after 30 days: When you read this, we will be back in our freshly cleaned home. We still have a bunch of work to do, but we now have everything we need in one place.

Thoughts and prayers: We thank God our home was spared and the disaster center services and our insurance claim agent were there to help. Blessed be all the firefighters, first responders, evacuation center volunteers and all the utility company workers.

Please keep all those who lost their homes in your thoughts and prayers. No matter your income level or the size of your home, the loss is still devastating.

Blood Thinner Myths Debunked by Healthcare Monitor Guide to AFIB

Every Atrial Fibrillation patient has to deal with the increased risk of clots and stroke and that often includes taking a blood thinner or anticoagulant.

At my doctor’s office I came across one of those “free take home copy” publications about Atrial Fibrillation. Healthcare Monitor Guide to Living with AFib 2018 had an interesting sidebar with a few myths and truths about blood thinners. I’d like to share a few misconceptions they list:

Guide to Living with AFib 2018

• “I’m afraid of shaving because I hear it’ll take forever to stop bleeding.”
• “Blood thinners will make me feel tired.”
• “It seems I bruise much more easily now-and that can’t be good.”

Do any of these ring a bell with you? Are you concerned with the same issues? Healthcare Monitor debunks these as myths and explains way.

Blood Thinner Myths Debunked

“I’m afraid of shaving because I heart it’ll take forever to stop bleeding…If bleeding while shaving is a problem, consider using an electric shaver. And remember: Even if you seem to bleed more easily now, suffering a stroke could cost you your life.

Blood thinners will make me feel tired. There’s no evidence that blood thinners cause or worsen fatigue. In fact, fatigue has not been identified as a problem in numerous studies done in thousands of patients. Of course, several things can effect your energy levels, including other medications you’re taking and lack of sleep. If you’re feeling more exhausted than usual, bring it up with your doctor.

It seems I bruise much more easily now-and that can’t be good. It’s true that bruising may be somewhat increased while you’re on a blood thinner. Although this can be a nuisance, it is important to remember that you are taking this medication to lower the risk of stroke. So the trade-off—accepting a slight increase in bruising—is worth the protection from dangerous clots.”

An Alternative to Blood Thinners

Catheter positioning the Watchman occlusion device at the mouth of the Left Atrial Appendage

Catheter placing Watchman in LAA

But blood thinners are not like taking vitamins. They have their own set of risks and side effects. However, preventing a stroke is for most people a welcome trade-off for any bad effects of anticoagulants.

If you can’t or don’t want to take blood thinners, an option is to have a device installed to close off the Left Atrial Appendage. The LAA is a small pocket of heart tissue located above the left atrium where 90%-95% of A-fib strokes originate.

To learn more see my articles: Watchman: the Alternative to Blood Thinners or LAA Occlusion for A-Fib Patients: The Lariat II Versus the Watchman Device.

Or watch the 3:28 min. video: The Watchman Device: Closure of the Left Atrial Appendage.

Resource for this article
Blood thinner myths debunked. Healthcare Monitor Guide to Living with AFib. 2018. print publication, p 21. healthmonitor.com.

How Wide-Spread is Silent Brain Damage in A-Fib Patients?

A-Fib patients are at increased risk for cognitive problems and dementia, even in the absence of stroke. But why?

Swiss researchers devised a study to determine what causes A-Fib patients to experience more cognitive dysfunction.

Mechanisms of A-Fib Cognitive Decline

The Swiss-AF research is an observational study designed to identify the mechanisms of cognitive decline in A-Fib patients. The study enrolled A-Fib patients between 2014 and 2017 from 14 centers in Switzerland.

Analyzed were 1,389 A-Fib patients with no history of stroke or transient ischemic attack (TIA)

All patients had standardized brain magnetic resonance imaging (MRI). Analyzed were 1,389 A-Fib patients with no history of stroke or transient ischemic attack (TIA). The average age of the A-Fib patients was 72 years. Most (89%) were being treated with oral anticoagulants.

Study Findings: Types of Silent Brain Damage

The MRI scans showed that 569 (41%) had at least one type of previously unknown (silent) brain damage.

 15% (207) had a cerebral infarct (dead tissue resulting from a failure of blood supply)
 19% (269) had small bleeds in the brain (microbleeds)
 16% (222) had small brain lesions

41% had at least one type of previously unknown (silent) brain damage

Oral Anticoagulants and Silent Brain Damage: In this study the researchers couldn’t determine if the cerebral infarcts and other brain lesions occurred before or after patients started taking oral anticoagulants.  But the researchers did state:

“The findings nevertheless raise the issue that oral anticoagulation might not prevent all brain damage in patients with atrial fibrillation.”

Additional analysis incomplete: The patients in this study underwent extensive cognitive testing to determine if patients with silent brain damage also have impaired cognitive function. But this analysis hasn’t been completed.

What A-Fib Patients Need to Know

The Swiss-AF research was a small study in one country over four years with 1,389 A-Fib patients. The risk of silent brain damage was found in 4 of 10 A-Fib patients. But the findings are alarming and worth continued research.

For A-Fib patients these findings can be frightening―especially for older patients. On top of that, it’s likely further analysis will show ‘cognitive decline’ as well in patients with these types of brain damage.

So, what can you do?

• Aim to get cured of A-Fib as soon as practical, such as by a catheter ablation. (Don’t let anyone tell you that you’re too old to have an ablation. People in their 90s have successful ablations.)

• Seek ways to avoid taking oral anticoagulants, if possible. Intuitively one suspects that anything that causes or increases bleeding in the brain like anticoagulants can be risky and dangerous for older patients. Consider installing a device to close off the Left Atrial Appendage (LAA) where 90%-95% of A-Fib clots originate.

Learn More About Risks for Cognitive Problems and Dementia

To learn more about how A-Fib patients are at increased risk for cognitive problems and dementia, see my articles: Anticoagulants, Dementia and Atrial Fibrillation and Increased Dementia Risk Caused by A-Fib: 20 Year Study Findings.

Also see my answer to this 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?”

Resources for this article
Conen, David. The Swiss Atrial Fibrillation Cohort (Swiss-AF). A presentation at the European Society of Cardiology Congress 2018, Munich, Germany. August 2018. As reported in the Cardiac Rhythm News, October 18, 2018, Issue 42, p. 14.

Conen, David. Hidden AFib Risk. Bottom Line Health. Volume 32, Number 12, December 2018, p.1.

 

A-Fib Patients: 2018-2019 Top Rated Hospitals for Cardiology & Heart Surgery

Out of nearly 5,000 hospitals evaluated, U.S. News has published their 2018-2019 Best Hospitals rankings and ratings which also includes rankings for 16 specialties. The top 16 Best Hospitals national specialty rankings are updated annually.

U.S. News estimates that nearly 2 million hospital inpatients a year face the prospect of surgery or special care that poses either unusual technical challenges or significantly heightened risk of death or harm. The rankings can help patients find sources of especially skilled inpatient care.

Top Cardiology & Heart Surgery Hospitals for 2018-2019

Atrial Fibrillation patients may be most interested in the Top Hospitals for Cardiology & Heart Surgery. A partial list of the top rated hospitals follows (click a score card for the hospital’s full review):

Cardiology & Heart Surgery

#1 Cleveland Clinic (Cleveland, OH); score card 100/100
#2 Mayo Clinic (Rochester, MN); score card 99.6/100
#3 Smidt Heart Institute at Cedars-Sinai (Los Angeles, CA); score card 84.3/100
#4 New York-Presbyterian Hospital-Columbia and Cornell (New York, NY); score card 83.3/100
#5 Massachusetts General Hospital (Boston, MA); score card 79.8/100
#6 Hospitals of the University of Pennsylvania-Penn Presbyterian (Philadelphia, PA); score card 78.0/100
#7 Northwestern Memorial Hospital (Chicago area); score card 76.9/100

On their website, U.S. News provides information about 613 hospitals in Cardiology & Heart Surgery that see many challenging patients, including those needing heart transplants, those with cardiovascular disease and other complex heart conditions.The 50 top-scoring hospitals are ranked. The rankings should just be a starting point when choosing a hospital.

How Are the Top Hospitals Chosen? A complete description of the data analysis, the 2018-19 Best Hospitals Methodology Report, is available as a viewable and downloadable PDF.

Look up Your Local Hospital

Is your local hospital one of the over 600 listed? Go to the Best Hospitals for Cardiology & Heart Surgery page to search for any hospital treating heart patients to read their rating information. The 50 top-scoring hospitals are ranked, followed by high performing hospitals.

Search for any hospital and any expertise: On the same page, you can also reset the parameters and search by specialty or procedure and by location or zip code.

Choosing the Right Doctor for You and Your A-Fib

To learn how to find the right doctor and medical center for you and your treatment goals, go to our page, Finding the Right Doctor for You where we take you step by step through it all.

Steve’s Directory of Doctors and Medical Centers is unlike other directories—we accept no fee to be included.

Also see Steve’s Directory of Doctors & Medical Centers. Our list is unique because we list only those cardiologists, electrophysiologists (EPs) and surgeons who treat Atrial Fibrillation patients. The directory is divided into three categories: U.S., international and Steve’s Lists: Doctors by Specialties. (Unlike other directories, we accept no fee to be included.)

Organized by U. S. city/state, country/region or specialty, you’ll find doctor’s names and contact information. (This evolving list is offered as a free service and convenience to A-Fib patients.)

A-Fib Patients (and Others): Should You Be Prescribed Fewer Drugs?

Did you know you can outgrow your medication? Perhaps your lifestyle has changed with more physical activity, better nutrition or weight loss and subsequently you may no longer need medications for diabetes, cholesterol or high blood pressure.

But you keep taking them, because no one told you to stop.

Simple errors can occur, too. Dr. Michael A. Steinman, a geriatrician at the University of California, San Francisco, recalled asking a patient to bring in every pill he took for a so-called ‘brown bag review’. He learned that the man had accumulated four or five bottles of the same drug without realizing it, and was ingesting several times the recommended dose.

“We spend an awful lot of money and effort trying to figure out when to start medications and shockingly little on when to stop.”

Dr. Caleb Alexander, Johns Hopkins Center for Drug Safety and Effectiveness

De-Prescribing: A Brown Bag Review

Always keep an accurate and updated list of medications you are taking. (See our free download form below.)

Periodically ask your physicians or pharmacist for a ‘brown bag review’. Discuss whether to continue or change any of your regimens. Ask about:

▪ any medicines you no longer need?
▪ any medications you can do without?
▪ if a lower dose would work for any of your medicines?
▪ if any of your medications might interact with another?
▪ any non-pharmacologic alternatives?

If your doctor agrees to ‘de-subscribe’ a medication, realize it isn’t as simple as saying “stop” taking it. It’s a process requiring caution and skill by your doctor. (Afterwards, remember to update your list of medications.)

Free Download: Keep an Inventory List of Your Medications

Medications List from Alere at A-Fib.comKeep your doctor and other healthcare providers up-to-date on all the medications you are taking by using this Medications List from Alere. Download (and remember to save the PDF to your hard drive).

Besides prescriptions, the form has sections to list over-the-counter drugs, vitamins, herbs and mineral supplements, too (as they can interact).

Print several copies of the blank form and keep handy in your A-Fib file or binder. When completed, give a copy of your inventory to each of your healthcare providers.

Also see my article: Are Your Herbal Supplements Interacting With Your Medicines?

Resources for this article
• Kantor ED, et al. Trends in Prescription Drug Use Among Adults in the United States From 1999-2012. JAMA. 2015;314(17):1818–1830. doi:10.1001/jama.2015.13766

• Mishori, R. Why doctors should be prescribing less drugs. The Independent. 30 January 2017. http://www.independent.co.uk/life-style/health-and-families/healthy-living/prescribing-drugs-is-good-so-is-deprescribing-a7552971.html

• Qato DM, et al. Changes in Prescription and Over-the-Counter Medication and Dietary Supplement Use Among Older Adults in the United States, 2005 vs 2011. JAMA Intern Med. 2016 Apr;176(4):473-82. doi:10.1001/jamainternmed.2015.8581.

 

Personal Update on the Malibu Fires

An update to our earlier post about evacuating our home because of the Malibu brush fires. Rest assured we are okay. Got back into our home this past Tuesday. Still no power, but water (and toilet) is working. Local hotel hosted all evacuees for Thanksgiving dinner. God bless all our fires fighters, first responders and volunteers.

Our home is okay, just a few singed palm trees and spots of burnt brush. Thanks to God.

A few photos for you. Continue to pray and send us your positive thoughts. Will write more soon.

The Mental Games that A-Fib Plays―Anthony Offers Ways to Cope

For a substantial portion of A-Fib patients, the impact on ‘quality of life’ extends beyond our beating heart. Atrial Fibrillation wreaks havoc with your head as well.

In his A-Fib story, Anthony Bladon wrote:

“The mental games that A-Fib play are insidious. The constant lurking fear that A-Fib may spontaneously return. I absolutely needed to develop coping mechanisms. I firmly encourage you to do the same!”

Recent research indicates that “psychological distress” worsens the severity of A-Fib symptoms.

How Anthony Learned to Cope

Now A-Fib free, Anthony recommends several coping techniques: frequent short rests, staying hydrated and practicing relaxation exercises to help you remain unstressed.

He advises you to confront your A-Fib fears directly. Don’t let your fears mill around in your subconscious. Another suggestion is to:

“…set aside a 20 minute worrying time during the day and refuse to think about troubling fears at any other time.”

In addition, he developed what he calls an ‘anxiety thoughts log’ for writing down word-for-word what the anxious thought was, when, and what was the trigger. He explained how it helped him:

“By confronting my most extreme fears very explicitly (‘Is this a TIA or A-Fib?’ or ‘I’m afraid of a stroke, I might die or be disabled’, or ‘I can’t contemplate a third ablation!’), it became easier to re-state and contextualize them in a more reasonable frame of mind, thereby reducing my anxiety.”

Anthony is pleased with the eventual outcome of his two CryoAblations. After being A-Fib free for two years he wrote, “I feel like a new man!” To read more, see Anthony’s A-Fib story.

Fight your Fears! Ambush your Anxiety!

The emotional effects of Atrial Fibrillation can be debilitating. Recent research indicates that “psychological distress” worsens the severity of A-Fib symptoms.

A-Fib wreaks havoc with your head as well as your heart. Anxiety, fear, worry, confusion, frustration and depression. And at times, anger.

But, don’t expect much help from your heart doctors. They aren’t trained or often have little effective experience in dealing with the psychological and emotional aspects of A-Fib.

Don’t be ashamed to admit how A-Fib makes you feel (especially if you’re a guy). Your psyche is just as important as your physical heart. Anthony shared about seeking professional advice:

“If fears of A-Fib prey on your mind, I encourage you to seek out the help of a professional psychologist, as I did. After a few sessions of consultation, and with the continued use of tools like these, I was fully able to cope.”

Tell yourself: It’s okay to seek professional help to deal with the emotions that often accompany A-Fib. (Just acknowledging you have some or all of these symptoms is a step in the right direction.)

For more ideas, see our article: Seven Ways to Cope With Your A-Fib Fear and Anxiety

Have you tried any of Anthony’s coping techniques? Or do you have other ideas? If you have suggestions or programs that helped reduce your A-Fib-related anxiety, please email me and let me know.

Where it All Began: Steve Ryan’s A-Fib Story (A-Fib.com’s 1st Personal Experience)

Steve Ryan had his first A‑Fib attack in early 1997 at age 56 when in apparent good health. He ran 400 meter dashes and 5K’s, lived in Los Angeles, CA and worked on the camera crew of the NBC-TV soap opera “Days of Our Lives”. He had to take disability leave when episodes of erratic heart beats lead to dizzy spells making it unsafe for him to work around heavy equipment.

Steve shares that since finding his Atrial Fibrillation cure in April 1998, his mission has been to spare others the frustration, depression, and debilitating quality of life that Atrial Fibrillation caused him.

Steve Ryan, Bordeaux France before his 1998 ablation - A-Fib.com

Steve with 10-lead portable monitor before PVI, Bordeaux hospital, April 1998

“…before I decided to go to CHU Hopitaux de Bordeaux in France, I was on and off many, many different medications over the course of 15 months or so. None of them seemed to do much good. Then I had two catheter ablations of the right atrium, and one aborted attempt of the left atrium. All to no effect.
During my ten-day stay in the Bordeaux hospital, I had a successful “Focal Point Catheter Ablation” (now called Pulmonary Vein Ablation/Isolation) in the left atrium. Due to recurrence, I had a second ablation a week after the first. (So does that add up to two failed right atrium ablations and two left-atrium ablations?)
Looking back to 1997, I see that the two right atrium ablations were probably a waste of effort as we now know that A-Fib usually originates in the left atrium (and A-Flutter from the right atrium). For that reason, most of today’s EPs will ablate the left atrium for A-Fib, but as a precaution, will also ablate the right atrium against any rogue A-Fib signals and to address diagnosed (or undiagnosed) A-Flutter.”

Learn How Steve Found his A-Fib Cure

Steve Ryan, Bordeaux France before his 1998 ablation - A-Fib.com

Steve with monitor

Continue reading to learn how Steve educated himself about his Atrial Fibrillation and sent his records to the best EPs in the U.S. for advice.

And how he decided to travel to France to see Dr. Michel Haissaguerre, the world-reknown researcher and cardiac electrophysiologist who discovered the link between A-Fib and the Pulmonary Veins and who invented the PVI procedure.

Go to the first A-Fib.com personal experience story: Steve S. Ryan: Finding My A‑Fib Cure by Early Focal Catheter Ablation Procedure in 1998.

Rainbow over Steve’s hospital room after his second PVI; We took it as a blessing for his cure!

Heart-Filled Thanks to our A-Fib.com Advisory Board of Electrophysiologists and Surgeons

To publish A-Fib.com I seek advise and opinions from many expert cardiac electrophysiologists and surgeons many of whom are members of our A-Fib.com Advisory BoardWe invite readers to browse the names of members and their affiliations.

Since the start of A-Fib.com in 2002, many cardiac electrophysiologists (EP) and surgeons have given me invaluable advice and support. They have helped make our website the ‘go-to’ destination for over 350,000 visitors a year. (In fact, we’ve been recognized by Healthline.com as a top A-Fib blog since 2014).

It’s a great blessing to be able to tap into the knowledge and experience of these talented professionals when writing on a difficult A-Fib subject or to get help for an A-Fib.com reader with a difficult case.

From all regions of the U.S., and from France, The Netherlands, Switzerland, Italy and Australia, these doctors may not always agree with all my positions, but they try to point me in the right direction.

Sharing the names and affiliations of The A-Fib.com Advisory Board with you is one way to publicly thank the board members and acknowledge their continued support.

I encourage you to go to The A-Fib.com Advisory Board page and review the list of members. (You can also find the link at “About Us“.) 

Holiday Season Warning: How Drinking Too Little Can Trigger Your A-Fib!

With the holiday season approaching, we want to remind Atrial Fibrillation patients that cold weather, dry air and drinking too little water can lead to dehydration which can trigger an Atrial Fibrillation episode.

Many people don’t realize how quickly and deeply dehydration can set in, especially since the early warning signs are subtle.

The Good News, The Bad News

The good news is that usually dehydration on its own won’t cause an Atrial Fibrillation episode. The bad news, when combined with other well-known triggers, it will.

For example: You risk dehydration when traveling by air (low humidity) during the hectic holidays (tired and stressed), drinking too much coffee (diuretic effect), and vacationing in the desert (dry climate).

Hydration Affects the Rhythm of Your Heart

Your body contains significant amounts of water. A change in fluid levels in your body can affect a number of bodily functions, including heart function. When you have atrial fibrillation, drinking enough water is important.

When you’re dehydrated, your body’s electrolytes (electrolytes in general, and sodium and potassium in particular) are crucial for heart health. Electrolyte levels plummet when you’re dehydrated. This can lead to abnormal heart rhythm.

Dehydration Risk Factors Beyond Sweating and Heat

Your risk of dehydration isn’t just from sweating during exercise or from the extreme heat of summer. Other risks include high altitudes, the arid desert, exhaustion and increased stress, missing meals or a change in eating patterns, and vomiting or diarrhea.

Do you travel by plane often? Flying dehydrates you because the humidity level on a plane is usually less than 10%. How about your choice of beverages? Alcohol and caffeinated drinks also dry you out.

Cold weather can also dehydrate you. When it’s cold, the body works to maintain its core temperature, and works less to keep ideal fluid balance. And since you don’t feel thirsty when it’s cold, you often don’t think about drinking extra water.

A-Fib Patients: Preventing Dehydration

Under normal conditions, 64 to 80 ounces of water per day is considered enough. On a plane, a good rule of thumb is 6 to 12 ounces of water (or club soda) for every hour in the air.

Drink at least 64-80 oz of water a day or more when…

Be aware of the not-so-obvious signs of dehydration: dry mouth, constipation, feeling tired and sleepy, low urine output, dry skin and dizziness or lightheadedness. Furthermore, your body may misinterpret the need for water as the need for food making you feel hungry, when what you really need is more water.

Drink more water when…the weather is too hot or too cold, when traveling by plane, when you’ve skipped meals, when exhausted or you’re sick. For each coffee or alcohol beverage, have a glass or two of water.

Check your hydration level. Each body has individual needs for water intake. If you’re drinking enough, look at the color of your urine when you go to the washroom. If your urine is clear or light yellow, you are well hydrated. If it’s darker, you need to drink more water.

Stay Aware—Stay HydratedThe A-Fib and Dehydration link at A-Fib.com

Dehydration is never a healthy state, but the mineral imbalance that results can be especially troublesome for A-Fib patients. Sometimes it’s the lack of a dietary staple that causes the heart to misfire, and in many cases, that substance is water.

Many Thanks to Our Patrons and A-Fib Readers

We wish to thank all those A-Fib.com readers who support our mission and this website financially.

As you might know, since its founding in 2002, A-Fib.com has been funded personally by Patti and Steve Ryan who research and write its content. (See About Us to learn more.)

Donate with PayPal: All donations made by using our orange PayPal “Donate” button (see right column) and through our Facebook page are applied toward the out-of-pocket costs to publish A-Fib.com and keep it on the web (without relying on third-party ad revenues).

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These revenue sources help us continue our ongoing A-Fib.com Mission to empower A-Fib patients as their unbiased source of well-researched information and advice on current and emerging A-Fib treatments.

One-Time Donation or Make it a Monthly or Annual Affair

Any donation to A-Fib.com is appreciated and needed. Even a $1 donation helps. Just click our orange PayPal button. (You can also send us a personal check.)

We’re especially grateful for recurring donations. We have received annual donations, and for several months now a generous patron donates to A-Fib.com every month. It’s easy to set up.

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Financial Transparency: You can review our financials and other A-Fib, Inc. records by going to the A-Fib, Inc profile on GuideStar. (GuideStar is the world’s largest source of information on nonprofit organizations; It encourages nonprofit transparency and allows nonprofits to supplement the public information that is available from the IRS.)

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Many Ways to Contribute to A-Fib.com

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Or, write an article about a topic you’re passionate about. (We welcome other ideas too.)  Learn more at Participate at A-Fib.com.

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