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Jill and Steve Douglas, East Troy, WI 

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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.”

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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

Catheter Ablation Compared to Amiodarone Drug Therapy in Heart Failure Patients with A-Fib

Background: I previously reported on the ground-breaking CASTLE-AF study published in 2018 which compared treatment with conventional antiarrhythmic drugs (both rate and rhythm control) versus treatment with catheter ablation. I recently came across another, similar study. While the 2016 AATAC study pre-dates the CASTLE-AF study, it also contributes to our understanding of treatment choices for heart failure patients with A-Fib.

Treating Patients with Both Heart Failure and A-Fib

Heart failure is very common in patients with A-Fib (estimated at 42%). These are very sick patients. For people with advanced heart failure, nearly 90% die within one year.

In patients with both conditions, a cardiologist’s first treatment is most often drug therapy with an antiarrhythmic drug. But is this an effective strategy? Is this really in the patient’s best interest? A 2016 study says NO!

AATAC stands for: Ablation vs Amiodarone for Treatment of Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted ICD/CRTD

AATAC: Catheter Ablation vs. Amiodarone Antiarrhythmic Drug Therapy

In the powerful AATAC multicenter worldwide randomized trial, catheter ablation was compared to drug treatment with amiodarone (the most effective but also the most toxic of the antiarrhythmic drugs).

The 203 enrolled patients had persistent A-Fib and heart failure with an Ejection Fraction of less than 40%. Patients also all had either a dual-chamber implantable cardioverter defibrillator or cardiac resynchronization therapy defibrillator.

All patients in the AATAC study were given optimal medical therapy for congestive heart failure such as ACE inhibitors, etc.

Patients were randomized to receive either a catheter ablation or drug treatment with amiodarone.

Note: The AATAC study should be read in conjunction with the more significant CASTLE-AF study which found similar results.

Group 1: Catheter Ablation

The first group received a catheter ablation of the pulmonary veins (PVI) along with roof lines and extensive ablations on the left atrial posterior wall; if non-PV potentials were found, the superior vena cava was isolated. At their discretion, EPs could ablate complex fractionated electrograms and non-PV triggers.

A ‘re-do procedure’ could be performed during the 3-month blanking period.

Group 2: Amiodarone (AMIO) Drug Treatment

The Amiodarone (AMIO) group was given 400 mg twice a day for 2 weeks followed by 400 mg each day for the next 2 weeks, then they were given a maintenance dose of AMIO 200 mg/day for the balance of the 24 month study period.

Study Follow-up and Results

All patients were followed for a minimum of 24 months. Recurrence was measured by the implantable devices with device interrogation at 3, 6, 12, and 24 months follow-up. Key findings at the end of the trial period include:

Recurrence: 70% of patients in the ablation group were recurrence and A-Fib free (after an average of 1.4 procedures) vs. only 34% of the Amiodarone (AMIO) group.

PVI with/without posterior wall isolation: Higher success was reported in patients undergoing PVI with posterior wall isolation compared to PVI alone (79% vs. 8%).

Amiodarone therapy was found to be significantly more likely to fail.

Cardioversion: During the 3-month blanking period 51% of the Amiodarone (AMIO) group needed cardioversion vs. 3% of the ablation group.

The unplanned hospitalization rate was 31% in the ablation group vs. 57% in the AMIO group. This is a 45% relative risk reduction of hospitalization.

A significantly lower mortality was observed in the ablation group: 8% vs. AMIO 18%.

Summary: Catheter Ablation Superior to Amiodarone Drug Therapy

Heart failure and A-Fib are common cardiac conditions that often coexist.

The AATAC study, the first randomized study of heart failure patients with persistent A-Fib, found that catheter ablation is superior to amiodarone drug therapy in achieving freedom from A-Fib long-term.

In addition, treatment with catheter ablation improved mortality in these patients, increased exercise capacity and Quality of Life (QofL) along with reduced unplanned hospitalizations.

Acknowledging My Bias
I admit to being biased against amiodarone drug therapy due to personal experience and from what others have shared. (For example, see Karen Muccino’s A-Fib story.) I am horrified that anyone would be put on such a high initial dosage of amiodarone as in this study. I would never participate in such a study. But obviously all doctors don’t share my concerns.
If a less potent (and less dangerous) antiarrhythmic drug had been used, it’s probable the study results would have been even more favorable for the ablation group.

What This Means to A-Fib Patients

These patients were in persistent A-Fib along with heart failure. These are some of the most difficult patients to make A-Fib free.

The EPs and A-Fib centers in this study were some of the best in the world. That there was a 70% success rate and no recurrences after 2 years is a testimony to the advanced mapping and ablation skills of these EPs. It’s remarkable how far catheter ablation strategies have improved over the years.

On the downside, not all EPs are equal. The single procedure success rate varied greatly from 29% to 61%. (See Huge Growth in Number of EPs Doing Catheter Ablations, But All EPs Are Not Equal.)

Catheter Ablation Group: Improved Ejection Fractions

Among the 203 enrolled patients, it’s not surprising that there were 26 deaths during this study. These were very sick patients with congestive heart failure and Ejection Fraction below 40%. (An EF below 50% indicates a weakened heart muscle that is no longer pumping efficiently; an EF in the normal range is 50% to 75%.)

The good news is that for many in the catheter ablation group, their ejection fraction was significantly improved and they were no longer in heart failure.

Catheter Ablation Outperforms Antiarrhythmic Drugs

We now have 2 studies which demonstrate that compared to antiarrhythmic drug therapy, catheter ablation lowers death rate among A-Fib patients (with heart failure), improves QofL and lets patients live longer and healthier lives. Other major benefits of ablation include reduced unplanned hospitalizations and increased exercise capacity.

Take-Away for A-Fib Patients

I think we can draw conclusions from the AATAC and the CASTLE AF studies that also apply to A-Fib patients (not in heart failure).

Rather than a life on antiarrhythmic drug therapy, the AATAC and CASTLE AF studies encourage A-Fib patients to seek a catheter ablation (including a second “re-do ablation”, if necessary.)

Bottom-line: Hard research data shows that a catheter ablation is the better choice over drug therapy. An ablation can rid you of your A-Fib symptoms, make you feel better, and let you live a healthier and longer life.

Don’t just live with A-Fib. Seek your cure.


Resources for this Article
Di Biase, L., et al. Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device. Results From the AATAC Multicenter Randomized Trial. Circulation. 2016;133:1637-1644. March 30, 2016. DOI

Read Steve’s A-Fib Alerts for April 2018

The A-Fib Alerts April 2018 issue is ready for you and presented in a condensed, easy-to-scan format. Read it online today.

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Know All Your Treatment Options Before Making Important Decisions

Treatments for Atrial Fibrillation include both short-term and long-term approaches aimed at controlling symptoms or totally eliminating the abnormal heart rhythm associated with A-Fib. To learn about all your treatment options, go to our page, Treatments for Atrial Fibrillation.

Which of the A-Fib Treatment Options is Best for You?

Choosing from the Atrial Fibrillation treatment options is a decision only you and your doctor can make. But depending on your symptoms and type of A-Fib you have, we offer some guidelines which may help you. We list A-Fib conditions as described by those with A-Fib. Select one (or more) that best describes your A-Fib and read your possible options. Go to Which of the A-Fib Treatment Options is Best for Me?

Leaving the Patient in A-Fib—No! No! No!

Remember: ‘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 (Chronic) A-Fib. (However, some people never progress to more serious A-Fib stages.) To learn more, read my editorial, Leaving the Patient in A-Fib—No! No! No!

Don’t let your doctor leave you in A-Fib. 
Educate yourself. Learn all your treatment options.

Looking for the Best Doctor, Online Ratings are Unlikely to be Much Help

According to the Journal of the American Medical Association, nearly 60 percent of patients say they like to use online reviews when searching for a physician.

As healthcare consumers, you need to know about the limitations of each of these kinds of sites.

“Consumers should be careful about giving them too much credence, whether they are comments or starred assessments”, says Dr. Mark W. Friedberg, director of the Boston office of the RAND Corporation and one of the co-authors of a study that analyzed ProPublica’s surgeon website. ProPublica is one of a wide range of doctor rating sites available to consumers online.

Keep in mind is that there’s no way of knowing who’s posting many online doctor reviews…it could be Russian bots.

Some websites, like ProPublica, post objective medical performance measures. Other websites like HealthgradesVitals, and Yelp post star ratings and comments written by patients.

Keep in mind that there’s no way of knowing who’s posting many online doctor reviews or what motivated the reviewer to write about the physician.

Dr. Friedberg warns, “You never know who’s writing these. It could be the doctor, or his friends and family members. It could be a patient who had an unusually good or bad experience…it could be Russian bots. It’s the Wild West. Buyer beware.”

Research Results: Online Physician Ratings Unlikely to be Much Help

Looking for the best doctor, online ratings are unlikely to be much help according to researchers at Cedars-Sinai Medical Center in Los Angeles. They compared reviews of 78 of the medical center’s specialists on five popular ratings sites with a set of internal quality measures and found there was essentially no correlation.

“There was little correlation between performance metrics and how patients assessed them on the websites.”

The study, published in the Journal of the American Medical Informatics Association, compared measures developed by Cedars-Sinai with users’ ratings on five sites: Healthgrades, Yelp, Vitals, RateMDs and UCompareHealthCare. Cedars-Sinai’s internal performance metrics include reviews from doctors’ colleagues and administrators, how often patients are readmitted, how long they remain in the hospital, and adherence to practice guidelines.

According to the study, there was little correlation between the doctors’ performance scores and how their patients assessed them on the websites.

‘Pay-to-Play’ Doctor Listings Common

Furthermore, 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.

Doctors can pay to be in your search results

The article ABC News Investigates Top Doctor Awards: Are They Always Well Deserved?’ includes a warning:

“Don’t be confused by sound-alike websites like ‘’. ‘’ does not claim to rank doctors in any way. In fact, regardless of true top doctor status, a spot at is available to any physician who pays for membership. The cost to buy a spot on the website ranges anywhere from $1,500 to $10,000, in addition to an annual fee of $1,600.”

Don’t fall prey to hype, advertising, or third parties that have something to gain by recommending a particular healthcare provider.

Are Consumer Ratings of Doctors Any Better?

Some people believe that patient ratings are the best source of information on doctors. Unfortunately, that is a misguided assumption. Patients may be able to rate a doctor’s “bedside manner,” but they know little about the complexity of medical care.

In fact, an article in Forbes magazine stated:

“The current system might just kill you. Many doctors, in order to get high ratings (and a higher salary), over-prescribe and over-test, just to “satisfy” patients who probably aren‘t qualified to judge their care. And there’s a financial cost, as flawed patient survey methods and the decisions they induce, produce billions more in waste.”

What Patients Need to Know

Some web sites for A-Fib patients may be biased, often for financial gain. When searching online for any health-related information, always ask yourself:

“Who is paying for this website, and what is their agenda?”

When searching for any doctor, especially a cardiologist or electrophysiologist, do not rely entirely on doctor ratings or doctor referral sites in isolation.

Instead, get personal referrals. If you know nurses or staff who work in the cardiology field, they can be great resources. Ask for referrals from other A-Fib patients.

Refer to our Directory of Doctors and Medical Centers who treat A-Fib patients. Then do your own research on each doctor. For guidance, see our page: Finding the Right Doctor for You.

At, we accept no fee, benefit or value of any kind to be listed in our Directory of Doctors and Medical Centers. is not affiliated with any practice, medical center or physician.

Caution - when searching A-Fib websites always ask: who is paying for this site and what is their agenda?

A word to the wise…

References for this article

Abdelmalek, M et al. ABC News Investigates Top Doctor Awards: Are They Always Well Deserved? July 14, 2012. Accessed March 18, 2016. URL: Id=16771628.

Falkenberg, K.  Why Rating Your Doctor Is Bad For Your Health. Jan 2, 2013 and Forbes magazine January 21, 2013 issue. Online accessed March 20, 2016. URL:

Castaneda, R.. Rating Doctors: What You Need to Know. Feb. 15, 2018.

Tracer, Z. Don’t Yelp Your Doctor. Study Finds Ratings Are All Wrong., September 8, 2017.

Daskivich, TJ, et al. Online physician ratings fail to predict actual performance on measures of quality, value, and peer review. Journal of the American Medical Informatics Association, Volume 25, Issue 4, 1 April 2018, Pages 401–407,

Anticoagulants, Dementia and Atrial Fibrillation

The prevalence of dementia and atrial fibrillation (A-Fib) are both on the rise with the aging population and increasing burden of vascular risk factors.

The association between A-Fib and dementia is well documented. To describe that relationship, researchers use the term “strongly associated” rather than explicitly state that A-Fib causes or leads to dementia. That’s as far as they can go, because there might be other factors at play.

Patients with A-Fib lose 15%-30% of their heart’s ability to pump blood to their brain, and to the rest of their body.

A-Fib Linked with Dementia

As patients, we use more direct language. All things being equal, we say A-Fib leads to and/or causes dementia. It makes intuitive sense, doesn’t it? Patients with A-Fib lose 15%-30% of their heart’s ability to pump blood to their brain, and to the rest of their body. (See: Increased Dementia Risk Caused by A-Fib: 20 Year Study Findings)

Research confirms that older adults with dementia had significantly reduced blood flow into the brain compared with older adults with normal brain function or young adults.

Research Reveals: Anticoagulants Reduce Risk of Dementia

Swedish study investigated the effect of anticoagulation on the development of dementia among A-Fib patients. Research data was collected on patients diagnosed with and treated for A-Fib in Sweden between 2006-2014. This included 444,106 patients, and over 1.5 million patient-years.

The retrospective registry study compared the incidence of dementia developed in A-Fib patients with and without ongoing anticoagulation with warfarin or direct oral anticoagulation (DOAC) (i.e., dabigatran, rivaroxaban, apixaban and edoxaban).

This study of A-Fib patients found that anticoagulant treatment was associated with a 29% reduced risk of dementia. There was no difference in dementia risk between patients treated with warfarin and those treated with direct oral anticoagulants. 

It’s encouraging to know that, if you have A-Fib and must take anticoagulants, they may reduce dementia to a limited degree.

The authors concluded that the risk of dementia is higher among A-Fib patients not treated with anticoagulation.

In fact, absence of anticoagulation treatment was among the strongest predictors for dementia along with age, Parkinson’s Disease, and alcohol abuse.

Anticoagulants May Reduce Micro-Clots

This study did not tell us how anticoagulation achieves this effect.

Some speculate that anticoagulants, while preventing macro-clots (strokes), also prevent or reduce micro-clots and smaller ischemic events which damage the brain over time.

Another Reason to Not Live with A-Fib

This study also raises another reason not to live in A-Fib if at all possible. Unlike macro-clots which cause strokes and which can kill or severely disable, A-Fib tends to produce micro-clots (smaller ischemic events or silent mini-strokes). The effect of micro-clots may not even be noticeable but, nonetheless, damages our brains over time.

Resources for this Article
• Risk of dementia higher without oral anticoagulants for AF. Cardiac Rhythm News. 15th December 2017.

• Friberg l, Rosenqvist M. Summary by Geoffrey Barnes. Less Dementia With Oral Anticoagulation in Atrial Fibrillation. American College of Cardiology, Oct. 26, 2017.

• Gallagher, C et al. Reducing Risk of Dementia in AF–Is Oral Anticoagulation the Key? Mayo Clinic Proceedings, February 2018, Volume 93, Issue 2, Pages 127-129. DOI:


From My Mailbox: Catheter Ablation Complication Rate: Compared to What?

Frequently I get emails asking about the complication rate of catheter ablation.

I like the suggestion made by Dr. David Keane of St. Vincent’s University Hospital, Dublin Ireland. Complications from A-Fib ablation should be viewed in perspective, that is, compared to the alternative of a lifetime on antiarrhythmic drugs (AADs).

The following is based on his presentation from the 2014 Boston AF Symposium.

Meta-Analysis: RF Catheter Ablation vs. Antiarrhythmic Drugs

In what may be the first systematic literature review and meta-analysis of clinical studies of Radiofrequency Ablation (RFA) vs. Antiarrhythmic Drugs (AADs), the reviewers looked at studies from 1990 to 2007. [Note: RFA wasn’t in use until the mid-1990s.] Included were sixty-three RFA studies and 34 AAD studies.

RF Ablation: From 1990-2007, the single procedure success rate for Radiofrequency Ablation (RFA) without need of post-op Antiarrhythmic Drug (AAD) therapy was 57% [today’s success rates are in the 70%–85% range], multiple procedure success rates without post-op AADs were 71% [today’s success rates are closer to 90%], and the multiple procedure success rate with post-op AADs was 77%.

AAD Therapy: The success rate for AAD therapy alone was 52%.

Note: The meta-analysis included five AADs: amiodarone, dofetilide, sotalol, flecainide, and propafenone. Amiodarone was the most effective. [Amiodarone is the most toxic and dangerous of the five AADs and is usually prescribed only for short periods of time and under close supervision for bad side effects.]

Adverse Event: side effect or any undesirable experience associated with the use of a medical product in a patient. In the US, adverse events are reported to the FDA.

Side Effects Cause Patients to Stop Taking AADs: Because of adverse events (side effects), 10.4% of patients discontinued taking their AADs, 13.5% discontinued AADs because of treatment failure, and 4.2% just didn’t take the AADs.

The overall discontinuation rate of AADs was almost 30%.

Findings: Efficiency and Complications Rates

Based on the meta-analysis, reviewers found Radiofrequency Ablation (RFA) had a higher efficiency rate and a lower rate of complications than AAD Therapy.

Findings: Adverse Events Ablation vs AAD

As a point of reference, the complication rate of the common appendectomy is 18%.

This meta-analysis found adverse events for catheter ablation was 5% vs 30% for AAD studies.

More about AAD Therapy adverse events: The overall death rate for AAD therapy was 2.8% (i.e., sudden death 0.6%, treatment-related death 0.5%, non treatment-related death 1.3%). Other adverse events from AAD therapy were:

•  CV (cardiovascular) Events 3.7%
•  Bradycardia 1.9%
•  GI (Gastrointestinal problems) 6.5%
•  Neuropathy 5.0%
•  Thyroid Dysfunction 3.3%
•  Torsades 0.7%
•  Q-T prolongation 0.2%

Conclusions from Meta-Analysis

Most adverse events associated with antiarrhythmic drugs (AADs) are life altering and permanent. (For example, bradycardia requires a pacemaker.)

Whereas complications from catheter ablation are generally short term and not permanent. (For example, when tamponade is repaired, the heart usually returns to normal.)

While this meta-analysis covered 1990-2007, based on subsequent research the trends are continuing. In general, it appears it’s safer to have an ablation than to not have one while living a life-time on AAD therapy.

D. Keane MD

The Full Report: For the full summary of Dr. Keane’s 2014 Symposium presentation, see: Catheter Ablation Complications: In-depth Review and Comparison with Antiarrhythmic Drug Therapy.

What this Means to Patients

If you are age 70 or 80, antiarrhythmic drugs might be a realistic option.

But if you are younger, it’s inconceivable that you would spend the rest of your life taking AADs. In addition to not working well or losing their effectiveness over time, they can have bad, cumulative side effects as described above.

Today’s ‘Guidelines for the Management of Patients with Atrial Fibrillation’ reflect this fact and allow you to select a catheter ablation without having to spend time trying various antiarrhythmic drugs (while your A-Fib may be getting worse).

In general, research shows it’s safer to have an ablation than to not have one (and live a lifetime on AA drug therapy).

Resources for this Article
•  Deshmukh, A. et al. In-Hospital Complications Associated with Catheter Ablation of AF in US: 2000-2010. Analysis of 93,801 Procedures. Circulation. 2013;128:2104-2112.

•  Haïssaguerre M. “Electrophysiological End Point for Catheter Ablation of Atrial Fibrillation Initiated From Multiple Pulmonary Venous Foci,” Circulation. 2000;101:p. 1409

•  Jais, P. “Ablation Therapy for Atrial Fibrillation: Past, Present and Future,” Cardiovascular Research, Vol. 54, Issue 2, May 2002, P. 343

•  Cappato R et al. “Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation.” Circulation: Arrhythmia and Electrophysiology. 2010: 3:32-38.

•  AHA/ACC/HRS. 2014 Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014; 130: e199-e267 DOI: 10.1161/CIR.0000000000000041.

Our Many First-Person A-Fib Stories—Will You Write Our 100th?

Other A-Fib patients have been where you are right now. So far, 99 patients have shared their personal experience with Atrial Fibrillation (starting with the Steve Ryan’s story in 1998).

Each story is told in the the writer’s own words. Some stories are brief and concise, some are retold like diary entries, other stories read like a suspense novel. Some stories are straightforward, others unfold and span years, even decades. Symptoms vary, and treatments choices run the full gamut. Many writers include their email address if readers want to contact them directly.

While many writers are now A-Fib free, some are not, but have found the best outcome for their situation.

Nevertheless, all our writers have the same objective—to offer you hope, to encourage you, and to bolster your determination to seek a life free of A-Fib.

Will Your Story be our 100th?

Are you thinking of sharing your A-Fib story? To learn more (including how to send in your story), see Contribute Your A-Fib Story, Share Your Lessons Learned.

It’s encouraging to read how someone else has dealt with their A-Fib. Won’t you reach out to others with A-Fib? Let them know they are not alone.

With your story, we can soon start using our new graphic poster (we can add your photo, too!)

My First-Hand Experience with our Positive Thoughts/Prayer Group

One of the best things we’ve ever done at is setting up the Positive Thoughts/Prayer support group. When you have an important treatment decision or an upcoming procedure or surgery, you can contact our volunteer group and ask for their support.

My Personal Experience: Prayer and Positive Thoughts

At, we believe in the healing power of prayer and of positive thoughts!

Instead of just writing about this phenomenon, I experienced it myself when I asked the group for positive thoughts & prayers for the success of my upcoming intestinal surgery on March 28, 2018.

So may people emailed me such heartfelt support it brought tears to my eyes. It was very encouraging to know I wasn’t alone, that so many cared about me. Can’t thank you all enough! (BTW: My post-op is going well.)

Are You Seeking Guidance from a Higher Power?

Are you in need of prayer? Positive thoughts? To learn how to send in your request, go to our Positive Thoughts/Prayer Group.

Additional Reading

The Anatomy of Hope: How People Prevail in the Face of Illness by Jerome E. Groopman. Written by an oncologist and citing actual patient cases (mostly cancer), Dr. Groopman explores the role of hope in fighting disease and healing. Top scientists are interviewed who study the biological link between emotion and biological responses; the most relevant studies are reviewed.

The author shows how hope, belief and expectations can alter the course of our lives, and even of our physical body. HOPE works! (Read my review on

Listen to an audio interview with The Anatomy of Hope author, Dr. Groopman on NPR’s Fresh Air program (recorded Sept. 2004; 20 min.)

Story Update: Ashley Mogg, a 23-Year Old Jamaican, Now A-Fib Free!

I’ve seldom been so happy to write about an A-Fib success story (actually an update)! A story that had such a miserable beginning.

A-Fib at 17 and Started Losing Sight!

Eighteen months ago, I wrote a story about 21-year-old Ashley Mogg from Jamaica. Her A-Fib was horrible. Her first A-Fib attack came at age 17 when she had just stopped playing field hockey. Ashley wrote:

Ashley Mogg from Jamaica

“I was feeling extremely unfit. My heart rate sped up and my chest got tight. My throat felt like it was closing, and I was starving for a breath. Then the most frightening thing happened―I started losing my sight! Pitch black was all I saw. I could hear my friend talking to me through it. It was so scary for me.”

Her doctor told her losing sight was a symptom of pre-faint or pre-syncope. Her stress test showed a heart rate that at times went up to 270 bpm.

Clinical Depression Sets In

To make matters worse, her cousin died suddenly. Then Ashley had to have an appendectomy which revealed a low grade Neuroendocrine tumor (cancer). Coupled with her dreadful A-Fib symptoms, she became extremely depressed and anxious (clinical depression is all too common in new A-Fib patients). She also suffered weight loss and became very thin.

No A-Fib Centers in Jamaica

Unfortunately, when I researched resources for her I couldn’t find any A-Fib centers or Electrophysiologists in Jamaica. It was heart breaking that such a young woman had such a debilitating case of A-Fib, and I couldn’t find anyone near her to take care of her.

November 2016: Asking for Funding and Help for Ashley

What I did was publish her story on and ask for donations to pay for her to see an EP in the U.S. (Read Jamaican Woman, 21, Living in A-Fib with Meager Treatment)

Dr. Natale confirmed that there was no EP lab in Jamaica and would try to find money from the A-Fib industry to help Ashley.

In addition, I sent Ashley’s story to Dr. Andrea Natale, a master EP with a world-wide reputation. A colleague of his, Dr. Francesco Santoni, emailed me that he tries to help arrhythmia patients in Jamaica through the Rotary Club and another foundation. Travis Smith, President of the Rotary Club of Downtown Kingston, Jamaica championed Ashley’s cause.

Dr. Natale suggested we work with Dr. Lisa Hurlock in Kingston, Jamaica at the University of the West Indies who could follow her arrhythmia. She met with Ashley and her mother, Loretta. Dr. Natale confirmed that there was no EP lab in Jamaica. He said he would try to find money from the A-Fib industry to help Ashley.

Dr. Natale’s Heroic Efforts to Help Ashley―Biosense Webster Donation

Dr Andrea Natale

Dr Andrea Natale

Dr. Natale obtained a donation from Biosense Webster (Johnson & Johnson) to cover travel expenses for Ashley and her mother to St. David’s Medical Center, Austin, TX including lodging, food and transportation. He also arranged for St. David’s to waive all fees for Ashley’s catheter ablation. The Texas Cardiac Arrhythmia Foundation accepted donations to help Ashley. Barbara Thomas and Amy Dixon coordinated everything at St. David’s.

(I probably don’t have all the names of everyone involved in helping Ashley. Please email me if I haven’t mentioned you or someone else who helped.)

Ashley, mom Loretta and hospital staff

July 2017: Ashley Has Her Ablation & is A-Fib Free!

On July 19, 2017, Ashley had her ablation. She is now A-Fib free. It was performed by Dr. Natale and his team at St. David’s Medical Center, Austin, TX. Since then, she has written that she is doing fine and has started college in Jamaica (she wants to go to medical school).

In an excerpt from her personal story (written before her ablation became a reality), Ashley shared these lessons learned:

“Educate Yourself―Find the Best Doctors Available. If you live in a country like myself where there are very few Electrophysiologists or heart rhythm specialists, find a reliable cardiologist as well as a general doctor who know your history. Do maximum research on your own and with your doctor and health care professionals. Stay informed.
…Stay positive…You are NOT ALONE!”

Remarkable for a 21-year old who has had a rapid beating heart since childhood.

March 2018 Update: Email from Ashley’s Mother

Loretta Mogg, Ashley’s mother recently wrote me:

Ashley and her mom, Loretta

“I am Loretta Mogg, the mother of Ashley Mogg. I want to express a heartfelt thanks to you for posting my daughter’s story and seeking help for her.
Just a little update. After nearly a year since her ablation, she is back in University and doing well. She is still determined to become a doctor.
Thank you for allowing God to use your own experience to change the life of another. Blessings to you and your family.”

Thanks to All, Especially to Dr. Natale

It’s impossible to adequately thank everyone, especially Dr. Natale, who helped Ashley in her incredibly difficult A-Fib journey.

I don’t know if we’ll ever understand how a young 17-year-old woman could develop such awful A-Fib symptoms. (Perhaps it related to her cancerous appendectomy.)

Faith and a Purposeful Life

Kudos to Ashley for not giving up with all she went through! She’s an incredible young woman. She had to grow up fast. She became a woman of faith with a purposeful life. In her own words, “It takes prayers and positive thinking to keep living with peace of mind.”

Be Inspired: You, too, Can Help Others With A-Fib

One-to-One, our A-Fib Support Volunteers are just an email away at A-Fib.comOne way to live a life of faith and purpose is to help others suffering with Atrial Fibrillation. Join our Prayer and Positive Thoughts group or our A-Fib Support Volunteers group.

Offering hope: Having someone you can turn to for advice, emotional support, and a sense of hope that you can be cured, may bring A-Fib patients (and their families) peace of mind.

We are blessed to have many generous people who have volunteered to help others get through their A-Fib ordeal (not all are ‘cured’). To learn more and how you can join the effort, see my article: ‘Want to Become a A-Fib Support Volunteer?

New FAQ: Which antibiotics are less liable to cause an A-Fib attack?

A question from Ellen McCall lead me to turn to our world-wide Advisory Board for an answer. Several EPs shared their opinions, research data and insights from their practices in answer to this question:

FAQ: “Which antibiotics are less liable to cause an A-Fib attack? How is Clindamycin for dental work? In the past I reacted to Azithromycin and Advil.”

Our A-Fib Advisory Board Offers Expert Opinions

One EP’s response: “There is no particular association that I can think of or have seen with antibiotics, but likely more of a personal idiosyncratic reaction to the drug. Everybody is different and has a different trigger.”

From another EP: “Most [antibiotics] do not change the way the heart’s electrical system functions other than prolonging the QT interval, which should have the opposite effect. In the quinolone family, (antibiotics) like Levofloxacin and Ciprofloxacin act like antiarrhythmics.

However, some antibiotics have worse gastric tolerance effects like Azithromycin and Erythromycin which can become a trigger for A-Fib by GI stimulation such as nausea or reflux. Medication to counter that side effect can be used, such as acid reducers.”

Continue reading the experts’ answers to this question…and my summary of their opinions, go to my FAQ: A-Fib Drug Therapy: Medications->

We’ve Got Answers: Browse Our Q&As About Catheter Ablation for Atrial Fibrillation

After reading our page about Catheter Ablation: Pulmonary Vein Ablation, you may have many questions. At, we have answered thousands of questions from A-Fib patients—many of the same questions you may have.

In the realm of catheter ablation, the range of issues and questions can be staggering. Topics including RF energy vs Cryo, enlarged heart and heart failure, PV vs non-PV potentials/triggers, recurrences, O.R. Reports and many more.

At, we provide answers. Here are a few of the questions we answer in FAQ: Catheter Ablation Procedures:

Steve S. Ryan observing ablation by Dr. Sidney Peykar, Cardiac Arrhythmia Institute

Radiation exposure:How dangerous is the fluoroscopy radiation during an ablation? I’m worried about radiation exposure.”

Blanking Period:How long before you know a Pulmonary Vein Ablation procedure is a success?

Clots/Blood Thinners: “I was told that I will have to take an anticoagulant for about 2-3 months after my ablation. Afterwards shouldn’t there be even less need for a prescription anticoagulant rather than more?”

Non-PV Triggers:Are there other areas besides the pulmonary veins with the potential to turn into A-Fib hot spots?

 A-Fib cure?I’ve read that an ablation only treats A-Fib symptoms, that it isn’t a ‘cure.

Browse our Q&A: Catheter Ablation: Pulmonary Vein Ablation, CyroBalloon Ablation

Additional topics we cover: the heart’s blood pumping capacity, the age range for a successful ablation, time length of a typical ablation, developing a clot during an ablation, resuming ‘normal’ exercise after a PV, who’s a candidate for a Pulmonary Vein Ablation, and more.

Go to FAQ About A-Fib Treatments Options: Catheter Ablation Procedures to browse all our posted questions and ‘click’ on any question to jump to the answer.

More Categories of Question & Answers

For all our Q & A lists, go to our page Frequently Asked Questions (FAQs) by Patients with Atrial Fibrillation.

AF 2018: New Report on the CASTLE AF Clinical Trial—Most Important Study for Patients

Most people who’ve had a successful catheter ablation can tell you how wonderful it feels to have a heart that beats normally again. Thanks to Dr. Marrouche and his colleagues, we now have hard data that a catheter ablation doesn’t just feel good but lets us live a healthier, longer life.

CASTLE-AF stands for Catheter Ablation versus Standard conventional Treatment in patients with LEft ventricular dysfunction and Atrial Fibrillation.

Dr. Nassir Marrouche & CASTLE AF Clinical Trial

At the 2018 AF Symposium, Dr. Nassir Marrouche presented results of the full CASTLE-AF study. (I reported briefly on initial findings last October (see CASTLE AF Study: Live Longer―Have a Catheter Ablation).

The 9-year, multicenter CASTLE-AF trial started in 2008 and focused on patients with A-Fib and systolic heart failure. The 398 participants were at 31 sites in 9 countries across Europe, Australia and the U.S.

Study participants had A-Fib and advanced heart failure (i.e., low ejection fraction less than 35%) and were randomized to receive either radiofrequency catheter ablation or conventional drug treatment. The median follow-up period was 37.8 months.

Results―Ablation Improves Quantity and Quality of Life

Dr. Marrouche listed key results of the CASTLE-AF Clinical Trial:

▪ Catheter ablation lowered the death rate by 47% vs conventional drug therapy..
▪ Even though 94% of the patients were taking Coumadin, the catheter ablation group’s stroke rate was ½ of the conventional drug treatment group.
▪ Heart failure hospital admissions improved immediatelycontinue reading Dr. Marrouche’s findings

At Medical Centers: Why to Always Ask for a Specific EP

In talking with A-Fib patients, I’ve found a disturbing trend when they seek an Electrophysiologist (EP) at a medical center when they don’t have the name of a specific doctor.

Often the medical center’s office will assign the newest and/or least experienced EP on staff.

Not good. Instead, you want an experienced EP with a high success rate at getting A-Fib patients back into normal rhythm. (You deserve nothing less.)

Your Search for the Right EP

First, seek recommendations from your General Practitioner (GP) or cardiologist. If you know nurses or staff who work in the cardiology field, they can be great resources. Ask for referrals from other A-Fib patients.

Begin your own research with our page, Find the Right Doctor for You. Then check our Directory of Doctors Treating A-Fib.

All EPs Are Not Equal

After you’ve done your research, you’ll have a list of EPs you know are more experienced in getting A-Fib patients back into normal sinus rhythm. (For example, someone with the initials FHRS after his name, and/or a ‘Castle Connolly Top Doctor’).

Then, you can contact a medical center and ask for a particular EP.

Especially when you are seeking an ablation, all EPs are not equal. Selecting the right EP isn’t like getting a haircut at SuperCuts where any stylist will do.

Read My March 2018 A-Fib Alerts! Signup & Get 50% Off My Book

From Chile and Brazil, to Australia, Canada and the UK, patients around the world are reading my March 2018 A-Fib Alerts newsletter. Read it here

Or sign-up to get my FREE monthly A-Fib Alerts sent directly to with:

News about A-Fib treatments and relevant research
 FREE downloads and special Videos
Links to new Personal A-Fib stories
Answers to Frequently Asked Questions (FAQ)

Sign Up Today - Round Blue buttion 200 pix at 300 resSpecial 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.

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Left Atrial Appendage (LAA): An Under-Recognized Trigger Site of Atrial Fibrillation

Recurrence of A-Fib after an ablation is very disappointing and frustrating both for patients and for EPs performing the ablation.

A link to the source of A-Fib recurrence may have been found. A study by Dr. Di Biase and his colleagues established that the LAA is responsible for a great deal of A-Fib recurrence.

Research: LAA Responsible for 27% of Recurrences

The multi-center study enrolled patients at leading medical centers in Austin, Texas, San Francisco and Palo Alto, Calif, Rome and Venice, Italy, Cleveland and Akron, Ohio.

In the study of 987 patients undergoing redo catheter ablations, 266 (27%) showed a prevalence of A-Fib triggers firing from the LAA.

In 32+% of these 266 patients, the LAA was the only source of arrhythmia signals.

Trial Design of LAA for Recurrences

The 266 patients were divided into three groups with different treatments. Each group was followed for 12+ months with these results:

  • Group 1. The LAA was not ablated (isolated); 74% of this group had recurrences of A-Fib.
  • Group 2. The LAA was ablated with focal lesions. 68% of this group had recurrences of A-Fib.
  • Group 3. The LAA was ablated by a circular catheter at the ostium of the LAA. 15% of this group had recurrences of A-Fib.

Trial Findings: LAA Responsible for Much A-FibLeft Atrial Appendage heart illustration

While this study was limited, as it only looked at redo ablations and recurrences, it’s significant. The patients (Group 3) who were ablated by a circular catheter at the ostium of the LAA, had a recurrence rate of only 15%!

Compared to 68% and 74%, this is a major, significant reduction in recurrences. This is great news for A-Fib patients undergoing a catheter ablation.

Trial results indicate that the LAA is responsible for a great deal of arrhythmia signals, probably more than any other area of the heart.

A-Fib Ablations: Check LAA for Non-PV Signals

Many EPs today aren’t aware of the importance of the LAA as a source of A-Fib signals and never even look at the LAA when doing an ablation. In the words of the study’s authors, “the LAA is an underestimated site of initiation of atrial fibrillation.

It’s good news that an increasing number of EPs after performing a PVI, then as their second step, map and ablate the LAA. This is especially in cases of persistent A-Fib and those with non-PV triggers. After the PVs are isolated, the LAA should be the next place to look. (Make sure your EP is one those who check the LAA!)

What This Means to Ablation Patients

This research is important not just for patients undergoing a redo catheter ablation but for any A-Fib patient seeking a catheter ablation.

Important when selecting your EP: When having a catheter ablation, no matter what kind of A-Fib you have, make sure your EP knows how, is experienced at, and routinely maps and ablates the LAA.

This may produce a more successful ablation and save you from a recurrence of A-Fib.

To learn more about the Left Atrial Appendage, see my article, The Role of the Left Atrial Appendage (LAA) & Removal Issues.

Resources for this Article
Di Biase et al. Left Atrial Appendage: An Underrecognized Trigger Site of Atrial Fibrillation. Circulation. 2010;122:109-118.

Updated Video: Zio Patch Single-Use Ambulatory Cardiac Monitor

The Zio® Patch by iRhythm is an interesting advancement in single-use ambulatory heart monitors. It looks like a big band-aid! After use, you return it to your doctor for downloading of the data.

The ZIO XT Patch

My first-hand experience: I wore one awhile back, after a prostate exam when my heart appeared to briefly be in A-Fib. As a followup, my cardiologist had me wear a Zio® Patch for two weeks. Result: no A-Fib! It turned out to be a one-time occurrence brought on by the medical test.

Updated Video: Zio® XT Patch

We’ve posted an updated video of the the Zio® XT Patch (iRhythm):

Patient with a Zio Patchvo

Description: The Zio® Patch cardiac monitor (iRhythm) looks similar to a 2-by-5-inch adhesive bandage and sticks to a patient’s chest.
In the video, Electrophysiologists, Dr Parri Dominic and Dr Ryan Jones of LSU Health Sciences Center, talk about this single-use ambulatory, continuously cardiac monitor that records for up to 14 days. No need to removal during exercise, sleeping or bathing. (2:04 min.) Posted by University Health News Network. Go to video->

New A-Fib Story: Relentless After 2 Failed Ablations―Leads to a 3rd Using the ECGI Vest

We’ve posted a new personal A-Fib story by Martin Johnson from Champaign, IL. His story also includes a post-script by his doctor, Dr. Phillip Cuculich, Barnes-Jewish/Washington University . Martin did a lot of research in his years with A-Fib. He learned about the Medtronic ECGI vest, an advanced mapping technology and about its inventor, and the benefits of the contact force sensing catheter.

Martin Johnson

Martin’s A-Fib first occurred in 2003 during a game of underwater hockey (an extreme sport requiring swimming under water while pushing a lead puck from one end of the pool to the other).

Martin shares with us:

At first, I thought “well I did just swim 25 yards under water as fast as I could, so maybe this is just normal”. It lasted about 20 seconds. The attacks quickly increased their duration to a couple hours each over the next couple months. I was forced to give up the game I’d been playing since age 37.
For the first couple of years I only got attacks after physical exertion. As time went on, less and less exertion was required to trigger one. After going through 6 different drugs, most of which had no effect, one of which almost killed me and another that modified my attacks, I had no net improvement. 

“My EP’s prognosis was―’ever more often, ever longer attacks until I would be in permanent A-Fib’”.

After seven years with A-Fib, I was getting approximately 24-hour long attacks about every four days plus occasional attacks triggered by physical exertion.
I had my first RF ablation in July of 2010. Two hours after the ablation, I was in A-Fib again.

My A-Fib attack timing continued without letup— 24-hour-long attacks every 4 days. I agreed to a second ablation 6 months later. …Continue reading Martin’s A-Fib story->

2018 AF Symposium: Kiss of Death for FIRM Mapping? The REAFFIRM Trial

In a late-breaking presentation, the interim results of the REAFFIRM trial were presented by Dr. John Hummel from the Ohio State University Wexner Medical Center.

Focal impulse and rotor modulation (FIRM)

FIRM stands for Focal impulse and rotor modulation (FIRM) and is used for mapping electrical signals of the heart.

The trial was intended to assess the safety and effectiveness of FIRM mapping used with conventional ablation (including PVI) versus a standard PVI procedure for the treatment of persistent atrial fibrillation.

REAFFIRM Trial Design

In a prospective multi-center trial, 350 patients with persistent or long-standing persistent A-Fib who had not had a previous ablation were randomized in a 1:1 fashion. The trial was designed to compare FIRM mapping used with standard catheter ablation (including PVI) versus PVI without use of FIRM mapping.

The non-FIRM ablation control group included…Continue reading this report->

Review All My Reports

To browse all my 2018 reports, go to my 2018 AF Symposium page (or use the link in the left menu column).

My 2018 reports

2018: Again Earns HON Certificate for Quality and Trustworthiness of Health Information has again earned the Health On the Net Foundation (HON) Certification for quality and trustworthiness of medical and health online information. (We were first certified in 2009.)

The voluntary HONcode accreditation program sets out a standardized criterion of eight principles of good practice for health information websites. Each applicant is checked for compliance by a review committee including medical professionals.

The Health On the Net Foundation (HON) Code of Conduct helps protect citizens from misleading health information.

Our 2018-2019 Active Certification & Dynamic Seal

Our HON seal is displayed in the footer of our web page and is directly linked to the HONcode certificate located on the HON website.

Read more about the HON Certificate on our website. Or learn about the criterion of eight principles of good practice at Health On the Net Foundation (HON) Certification.

When visiting other health-related websites, look for the HON Code of Conduct badge to be assured of the site’s quality and trustworthiness of medical and health online information.

2018 AF Symposium My Last 2 Live Procedures Reports

The Left Atrial Appendage was a popular topic at the 2018 AF Symposium. My last live case reports present two more ways for isolating the Left Atrial Appendage, one an occlusion device and the other using a CryoBalloon catheter.

Amplatzer Anulet

Installing an Amplatzer™ Amulet™ LAA Occluder

Dr. Claudio Tondo from Milan, Italy, demonstrated an LAA closure by inserting the Amplatzer Amulet LAA closure device. Because of the patient’s history of major bleeding, Dr. Tondo decided to close off her LAA first while postponing a PVI until later. (In Europe, a LAA occluder can be inserted at the same time as a catheter ablation). (See also, Installing a Coherex WaveCrest LAA Occlusion Device.)

The Amplatzer has two lips which close over both the outside and the inside of the LAA―like a sandwich…Continue reading this report->

CryoBalloon catheter

CryoBalloon catheter

CryoBalloon Catheter for Isolation of the LAA

To isolate the Non-PV triggers originating in the patient’s Left Atrial Appendage, Dr. Knight used a CryoBalloon catheter in order to penetrate deeper into the LAA tissue.

Using the CryoBalloon Catheter for this procedure is an “off-label use”, i.e., a new use not described in the FDA approved device labeling. (Also see, Isolating the Left Atrial Appendage using RF Energy) Dr. Knight used a 28mm CryoBalloon catheter… Continue reading this report>

Read My Other Live Case Reports

To browse all my 2018 reports, go to my 2018 AF Symposium page (or use the link in the left menu column).

My 2018 reports: more to come

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