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


Patients with A-Fib and Kidney Disease: Should You be on Blood Thinners?

If you have Atrial Fibrillation and also suffer from Chronic Kidney Disease (CKG), beware! Being on an anticoagulant may make you more prone to stroke. That’s according to UK researchers.

In a newly published retrospective study from England (The United Kingdom), 7,000 patients over age 65 with chronic kidney disease who later developed A-Fib had more strokes (and hemorrhage bleeding) than those not taking anticoagulants.

Anticoagulant may make you more prone to stroke.

In fact, patients taking anticoagulants were 2.6 times as likely to have a stroke (and 2.4 times as likely to have major hemorrhagic bleeding).

Reduced Kidney Function and Atrial Fibrillation

Reduced kidney function or chronic kidney disease is very common in older people. Chronic kidney disease (CKD) and Atrial Fibrillation (A-Fib) often co-exist. A-Fib can promote or accelerate the progression of chronic kidney disease.

Worldwide, it’s estimated that 15–20% of patients with chronic kidney disease (CKD) also have Atrial Fibrillation.

Research Conclusion

According to the study’s first author, Dr. Shankar Kumar of the UCL Center for Medical Imaging, London:

“As we found in this particular group, their medication (anticoagulant) seems to do the opposite of its intended effect.

…Careful consideration should be given before starting anticoagulants in older people with chronic kidney disease who develop atrial fibrillation.”

A-Fib and Anticoagulation: First Check for Reduced Kidney Function 

How to measure if your kidneys are working? A Glomerular Filtration Rate [GFR) of 60 or higher is normal, while a GFR below 60 may mean kidney disease.

This study only dealt with Chronic Kidney Disease (CKD). But common sense dictates that the findings of this study may also affect anyone with reduced kidney function.

In the early stages of Chronic Kidney Disease, there may be few signs or symptoms. CKD may not become apparent until kidney function is significantly impaired.

From this study, we can say it’s imperative that anyone with A-Fib especially older people, should be checked for reduced or chronic kidney disease before being put on anticoagulants.

Alternatives to Anticoagulants

This study points out the difficulty for A-Fib patients taking anticoagulants who also have chronic kidney disease: The anticoagulants meant to prevent stroke actually increase stroke risk and hemorrhage bleeding.

If you’re in this situation, you may want to consider these two options:

1. Closure of the Left Atrial Appendage (where most A-Fib clots originate). An occlusion device like a Watchman may be an alternative to anticoagulants. (For more, see my article, The Watchman™ Device: An Alternative to Blood Thinners);

2. Free yourself from A-Fib. Consider a catheter ablation procedure (or mini-maze surgery). Reasoning: if you no longer have A-Fib, you can’t have an ‘A-Fib-related’ stroke.

But know that even without A-Fib, you can still have a stroke from other causes. (Right now, we don’t have a therapy that will absolutely guarantee you will never have a stroke.)

What This Means for A-Fib Patients

For A-Fib patients who also have chronic kidney disease, being on an anticoagulant may make you more prone to stroke, not less.

Accordingly, if you have A-Fib and are taking anticoagulants, ask your doctor if you have been checked for ‘reduced kidney function’.

And if in the future, you develop reduced kidney function, discuss these research findings with your doctors (print a copy of this post and include the ‘References for this Article’ below).

Paradox: If you have kidney disease, the anticoagulants meant to prevent stroke actually increase stroke risk and hemorrhage bleeding.

Resources for this Article

New Video: The Maze Open-Heart Surgery From The Cleveland Clinic

In a new video we’ve added to our library, cardiac surgeon Edward Soltesz, MD, discusses who is a good candidate for the Maze surgical-based treatment for Atrial Fibrillation.

Image from the video ‘The Maze Open-Heart Surgery’

The full Maze open-heart surgery is typically performed in conjunction with surgery to correct another heart condition such as valve disease or coronary disease but can also be performed as a standalone treatment.

Interviews, animation, illustrations and surgical footage. (3:19) Produced and posted by the Cleveland Clinic. Go to video->

Related Videos: Mini-Maze Surgery

You may also be interested in our videos about the Mini-Maze:

Mini-Maze Ablation for Persistent A-Fib: With Cardiac Surgeon Dr. Dipin Gupta
In-Depth: Mini-Maze Surgery: Inside the O.R. with Dr. William Harris, Cardiovascular Surgeon

A-Fib Library of Videos and Animations

We have carefully selected the A-Fib-related videos in our Video Library. They have been selected for the reader who learns visually through motion graphics, audio, and personal interviews.

Our collection of short videos are organized loosely into three levels: introductory/basic, intermediate and in-depth/advanced. Click to browse our video library.

2018 AF Symposium Live Procedures: Four New Reports

The live cases are what I like best about attending the AF Symposiums. From world-wide locations via streaming video, we join doctors in their various EP labs while a procedure is underway. The EPs address the symposium audience directly, often fielding questions.

AF Symposium 5-floor-to-ceiling video monitors at the Hyatt Regency Orlando

AF Symposium 5-floor-to-ceiling video monitors

We watch these live procedures on floor-to-ceiling high monitor screens. You feel like you are actually in the EP lab with these doctors.

My Favorite and My Most Difficult

While I like live cases the best, they are also my biggest challenge when it comes to writing quality reports.

My difficulty is they are often dealing with devices or treatments I have never heard of before. I take notes as best I can while trying to understand and follow the new concepts and treatments. Happily, I can often send my reports to the doctors involved so they can correct any mistakes and misconceptions.

Four New Live Case Reports

EP and attendee during live case

I’ve posted my first four reports on the live cases (2 more to come). From Belgium to Boston and Texas to Prague, all relate to performing catheter ablations: a device to protect the esophagus, two related to the Left Atrial Appendage (LAA), and a clinical trial of mapping software to better identifying rotors and drivers.

The DV8 Retractor: an Esophageal Deviation Tool from Manual Surgical Sciences with Drs. Kevin Heist, Conor Barrett and Moussa Mansour, all from Massachusetts General in Boston, MA

LAA ClosureInstalling a Coherex WaveCrest LAA Occlusion Device with Dr. Tom De Potter from Aalst, Belgium

RADAR―A Software Breakthrough in Mapping and Identifying A-Fib Rotors and Drivers? with Dr. Petr Neuzil from Prague, Czech Republic

Isolating the Left Atrial Appendage using RF Energy with Dr. Rodney Horton, Texas Cardiac Arrhythmia Institute, Austin, TX

Just Like Being There

These live cases are probably the closest symposium attendees can come to visiting all of these various global locations and observing these world-class master electrophysiologists and their teams.

For many attendees the live cases are often the most innovative and rewarding of the AF Symposium presentations.

Looking for all my 2018 reports?
Go to my 2018 AF Symposium page (link in the left menu column).

My 2018 reports: more to come

Is Warfarin a Protective Factor for Cancer Among A-Fib Patients? Research Finds a Possible Link

A 7-year retrospective study of patients older than 50 years drawn from the Norwegian National Registry and other databases (1,256,725 persons), found a possible link between warfarin use and cancer prevention. Particularly for A-Fib patients.

Study Participants and Design

Warfarin (brand: Coumadin) tablets

Of the over one million patients in the combined databases, 48.3% were male, 51.7% were female, 7.4% were classified as warfarin users, and 92.6% were classified as nonusers. The participants were divided into 2 groups—warfarin users and nonusers.

Warfarin users had to be taking warfarin for at least 6 months and at least 2 years from first prescription to any cancer diagnosis.

A subgroup were persons taking warfarin for atrial fibrillation or atrial flutter.

Study Findings: Warfarin Users vs. Nonusers

During the 7-year follow-up period, 10.6% (132,687) individuals developed cancer. There were 9.4% cancer diagnoses among the warfarin users and 10.6% among the nonusers.

Warfarin Users vs. Nonusers: Among warfarin users as compared with nonusers, there was a significantly lower incidence of cancer in all organ-specific sites (lung, prostate, and breast, except colon cancer).

A-Fib/A-Flutter group: The effect of warfarin use was more pronounced in the subgroup of patients with atrial fibrillation or atrial flutter for all cancers (lung, prostate, and breast). These patients also had a significant reduction in colon cancer associated with warfarin use.

Interpreting the Study Results

Warfarin use may have broad anti-cancer potential (in patients older than 50).

“An unintended consequence of this switch to new oral anticoagulants (NOACs) may be an increased incidence of cancer.”

The study authors believe that warfarin’s vitamin K antagonism is the property that may prevent or hinder the progression of cancer.

They noted that new oral anticoagulants that require less monitoring are being used more often. “An unintended consequence of this switch to new oral anticoagulants may be an increased incidence of cancer, which is an important consideration for public health,” they cautioned.

James Lorens (University of Bergen) and co-investigators say their findings “could have important implications for the selection of medications for patients needing anticoagulation.”

What This Means to Patients

This begs the question, on the basis of this Norwegian study, Should A-Fib patients stop taking the new anticoagulants (NOACs) and switch back to warfarin?”  Probably not.

Warfarin blocks vitamin K and has bad side effects: The bad side effects of warfarin use include increased bleeding, hemorrhagic stroke, and microbleeds in the brain.

In addition, warfarin blocks vitamin K absorption, thereby depositing calcium in our arteries and progressively turns them into stone (hardening of the arteries). Vitamin K is essential for heart and bone health. For more, see my article, Stop Taking Warfarin―Produces Arterial Calcification.

Some comfort: If warfarin is your anticoagulant of choice, it’s good to know that it may have anti-cancer properties.

Resources for this Article

2018 AF Symposium Debate: ‘Can Anticoagulants be Stopped after AF Ablation?’

A topic of great interest to A-Fib patients. An interesting debate between Dr. Francis Marchlinski of the Un. of Pennsylvania Health Center in Philadelphia, PA and Dr. Elaine M. Hylek of Boston Un. Medical Center.

“Can Anticoagulants be Stopped after AF Ablation?”

• Dr. Francis Marchlinski took the “Yes” position (anticoagulation can be stopped).
• Dr. Elaine M. Hylek took the “No” position (anticoagulation should not be stopped).

(Though labeled a “debate”, there was no debate winner or loser; It was a more dramatic way of presenting different views on ablation.)

Dr. Marchlinski began by describing what he hears from patients, that they don’t want to be on anticoagulants. They ask me, “Doc, would you use anticoagulation if I didn’t have A-Fib? Because I’m telling you, I’m not having Atrial Fibrillation.”

In general, he said patients don’t want to have to take anticoagulants, especially after a successful ablation when they are A-Fib free. They are reluctant to take anticoagulation in the absence of EKG and other methods of monitoring when combined with no symptoms of A-Fib.

Pro: Stop Anticoagulation after Ablation

Dr. Marchlinski spoke first in favor of stopping anticoagulation. He anticipated several points that Dr. Hylek might argue, then added his response. ‘Dr. Hylek might say’…

• …there are no randomized studies proving that anticoagulation can be safely stopped after a successful ablation. True, he said. (Later in the debate, he and Dr. Hylek both agreed on this point.)

• …there are some observational studies and registries that indicate there is a high risk of stroke when stopping anticoagulation after an ablation. He countered by pointing out that many of these studies included patients who still had A-Fib after their ablation. …Continue reading this report->

Health-Related Websites: How Do You Find Sources You Can Trust?

Everyday there are more and more websites offering consumer health-related information. While many online health resources are credible and valid, others may present inaccurate, biased or misleading information.

How do you find sources you can trust? How do you evaluate the content on websites?

Key Facts to Ask About Health Websites

Anyone can put up a website. Not all online health information is accurate, legitimate and authoritative. Be cautious when you evaluate health-information on the Internet.

The U.S. National Institutes of Health advises to be suspicious, especially if the site…

… Is selling something
… Includes outdated information
… Makes excessive claims for what a product can do
… Is sponsored by an organization whose goals differ from yours.

Checking Out a Health Website: Five Quick Questions

If you’re visiting a health-related website for the first time, these five quick questions can help you decide whether the site is a helpful and legitimate resource.

Always ask yourself: ‘Who is paying for this website? What is their agenda?’

Who? Who runs the website? Can you trust them? Beware of bias, who is paying for or funding the site?

What? What does the site say? Do its claims seem too good to be true? Be a cyber-skeptic.

When? When was the information posted or reviewed? Is it up-to-date?  Who verifies the information before it is put on the web page?

Where? Where did the information come from? Is it supported by scientific research? Look for recognized authorities and know who is responsible for the content.

Why? Why does the site exist? Is it selling something?

Don’t Rely Exclusively on Online Resources

If you are researching a health-related topic online, review several high-quality websites to see if similar information appears in a number of places. Looking at many good sites will also give you a wider view of a health issue.

When making decisions about your health, don’t rely exclusively on online resources. Online information is not a substitute for medical advice. Before taking any of the advice that you have found online, confer with your doctors and health care providers, get referrals and recommendations from other patients, and ask opinions from family and friends.

You must do your due diligence to find the right treatment(s) for you. I know it’s a lot of effort. To make the best decisions, educate yourself on all your treatment options.

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

From ‘Beat Your A-Fib”

2018 AF Symposium: The Innovative iCLAS Cyro Catheter

My first report from the 2018 International AF Symposium is about an innovative, ultra-low temperature Cryo catheter, the iCLAS catheter from Adagio Medical.

Various positions possible with the iCLAS catheter from Adagio Medical

I knew it was something special by the incredibly high-powered, renowned presenters: two of the most important people in the treatment of Atrial Fibrillation―Dr. James Cox of the original Cox Maze operation and Prof. Michel Haissaguerre of the original PVI catheter ablation.

One Catheter. Unlimited Shapes.

The iCLAS catheter is a Cryo catheter that uses ultra-low temperatures and is unlike anything currently on the market. The catheter can be manipulated into many different configurations depending on the lesions which need to be made.

When I visited the Adagio booth, it was fascinating to see how easily the catheter could be designed into unlimited profiles.

Using its full length, the catheter can produce ultra low temperatures along its whole span (110mm). It has 20 electrodes which can also produce cryo-mapping of the atria.

For Flutter Ablations in the Caviotricuspid Isthmus in the right atrium, a shorter catheter is used … continue reading my report–>.

Big Payoff: An A-Fib Diary Helps You Cope

Pat Truesdale’s Atrial Fibrillation was very symptomatic and she could not tolerate any of the medications. In her personal A-Fib story, she shares how keeping an A-Fib Diary helped her cope. Through interpreting her log entries, she learned what triggered her A-Fib, what signs indicated an A-Fib attack was coming on, and some actions she could do that helped her during an A-Fib episode:

63. Personal Experience of Pat Truesdale

Pat Truesdale, now A-Fib free

“…I began to learn what activated my A-Fibs and what helped during my episodes. This was a real discovery about me! I learned that ice drinks, full meals, and caffeine all triggered my A-Fibs. I started a diary to record all my symptoms.

With Steve’s [Ryan] suggestion and my local cardiologist’s, I now know I have Vagal Lone A-Fib. This means certain conditions can trigger my A-Fib attacks. This is what I learned triggers my A-Fib:

• Iced Drinks
• 
Caffeine
• 
Heavy meals
• 
Quiet times relaxing
• 
Sleep time at night
• 
Medicines
• 
Blood pressure going up
• 
Low pulse

Here are some symptoms I discovered that are indications an A-Fib episode is coming!

• High blood pressure
• 
Belching
• 
Heartburn
• 
Frequent need to pee (also ISH symptom—Isolated Systolic Hypertension)
• 
Low pulse while exercising (A-Fibs never happened during exercise)
• 
Flutters or skipped heart beats
• 
Light headache (BP is higher)

Here are some things that help me during my A-Fibs:

• Knowing A-Fib would occur after exercising while I am resting.
• Take a tablespoon of Mylanta
• Yoga breathing
• lf ice water brings it on, ice water sometimes reverts it!
• Drink plenty of water all day
• Blowing into a straw lowers the pulse rate, but does not stop the A-Fib
• Don’t Panic – Have a “This Too Shall Pass” attitude
• Walk around, but don’t exercise since my pulse is too high already

• Take 200 mg of magnesium 3X a day 

• Take a B complex vitamin every day

Doing her detective work helped her make a treatment choice:

…I wanted to get this procedure over quickly. I wanted to start feeling like a normal human being again! So, I trusted my local cardiologist’s choice and had the [ablation] procedure.”

Pat’s diary of her A-Fib triggers is not unusual, especially for people with Vagal A-Fib (though not everyone will be affected by the same triggers).

But the symptoms she describes as predicting or forewarning her A-Fib attack are new and very insightful. (Thanks for sharing, Pat.) Her list of things that helped her get through A-Fib episodes may also be helpful to you.

Be a Sleuth: Keep an Episode Diary

Take your A-Fib binder to your appointments

Share your log with your doctors

You, too, may be able to predict when you’re going to have an A-Fib attack. Start by keeping a log or diary of your A-Fib episodes for three or six months. When an episode occurs, note the day & time, duration and what you were doing, eating or drinking.

As you collect data, scrutinize your log entries for patterns and specific triggers. This may lead you to lessen or eliminate certain foods or beverages or even activities that appear to trigger your A-Fib. You may want to share your log with your doctor.

Don’t be discouraged if you don’t find a pattern, not every log will be revealing. A-Fib seems to have a mind and schedule of its own that’s often hard to predict.

A-Fib Cured in Record Time

Pat probably has set a record for getting cured of A-Fib in the shortest time. Current guidelines recognize catheter ablation as a first line therapy for treating A-Fib (remember: she couldn’t tolerate the medications). After only eight weeks of being in A-Fib, she had a successful CryoBalloon Ablation. To read Pat’s personal A-Fib story, go to Active 64-Year-Old with Family History of A-Fib Gets a CryoBalloon Ablation Eight Weeks after First A-Fib Attack.

Cloud graphic - Michele Straube, A-Fib-free after 30 years - A=Fib.com

Michele Straube, A-Fib-free after 30 years.

FAQ: Does Your Information About Atrial Fibrillation Apply to A-Flutter, As Well?

I received an email from Jack Owens asking about Atrial Fiutter and our coverage of the topic on A-Fib.com. Here’s what he asked me, followed by my reply:

“I have A-Flutter and not A-Fib. Can I assume that most of the topics discussed on this site apply to both A-Fib and A-Flutter? I would very much like to see more information on your site about A-Flutter. There are a lot of us out here with it. Your web site is the best by far I have found on this subject.”

Atrial Flutter a Form of A-Fib

Consider Atrial Flutter as a milder, more organized form of A-Fib. However, because Flutter is more organized and regular, it often makes the ventricles beat faster. Sometimes it’s harder to control the pulse rate of Flutter compared to A-Fib.

During a catheter ablation for A-Fib, as the electrophysiologist (EP) ‘isolates’ A-Fib areas, the patient’s heart often progresses or improves into Atrial Flutter, then into tachycardia, and finally into normal sinus rhythm (NSR).

ECG: example of heart in A-Fib (actual pattern will vary)

ECG: Example of heart in A-Flutter (actual patterns will vary)

ECG: Heart in normal sinus rhythm

Flutter and Atypical Flutter

There are basically two forms of Atrial Flutter:

 Atrial Flutter: Comes from the right atrium and is easily isolated by what is called a ‘Caviotricuspid Isthmus line ablation’ of the right atrium. This is a very simple procedure which can take as little as 10 minutes to complete. It’s often done in addition to an ablation for Atrial Fibrillation either before or after leaving the left atrium.

Atypical Flutter: A second type is often called “atypical Flutter.” At the end of a more complex catheter ablation, sometimes a patient remains in ‘atypical’ Flutter. This Flutter circuit can be difficult to map and isolate and is often one of the hardest arrhythmias to find and fix.

Often when I talk with patients with atypical flutter, I recommend them to Master EPs who have special mapping and ablation skills and more experience.

Flutter Can Be Considered a Form of A-Fib or Related to A-Fib

Almost every article on A-Fib.com can also relate to Atrial Flutter. It’s true, we often don’t mention Atrial Flutter specifically. But Atrial Flutter is often related to and can be a form of Atrial Fibrillation.

In fact, a patient’s Atrial Flutter may mask that they also have Atrial Fibrillation. Likewise, as many as half of all patients who have an ablation specifically for Atrial Flutter, later develop Atrial Fibrillation.

For more, read my article: Atrial Fibrillation and Atrial Flutter: Cause and Effect

VIDEO:

To see an animation of a heart in Atrial Flutter with narration, go to Fast Heartbeat Arrhythmia (the first of three videos on the page)  (:28 sec.)

New Video: Impact of Lifestyle Factors on Patients with Atrial Fibrillation with John Mandrola, MD

We’ve posted a new video with Dr. John Mandrola, MD, a cardiac electrophysiologist from Louisville, KY (Patti’s hometown).

Dr Mandrola on Impact of Lifestyle Factors on A-Fib

In this interview, Dr Mandrola talks about the impact of lifestyle factors on patients with atrial fibrillation. He explains how in the past 5–10 years doctors have started to understand that A-Fib can be caused through “upstream” factors that affect atrial health, things that stretch the atrium like high blood pressure, obesity, diabetes, even stress and anxiety, and over exercise like endurance exercise.

He describes how managing these risk factors can reduce the patient’s risk of stroke, and make a significant impact on the patient’s heart rhythm and overall health. (5:29) Go to video->

Dr John Mandrola is the chief cardiology correspondent for Medscape—a web resource for health professionals (see ‘Trials and Fibrillations with Dr John Mandrola’). In addition, he maintains a general health and fitness blog, Dr John M, and is active on social media, especially Twitter, where he can be found @DrJohnM.

2018 International AF Symposium: My First Report

Held Jan. 11-13, 2018 in Orlando, FL, the annual International AF Symposium is an intensive and highly focused three-day scientific forum which brings together the world’s leading medical scientists, researchers, cardiologists and electrophysiologists to share the most recent advances in the treatment of atrial fibrillation.

The 45 distinguished faculty were leaders in the Atrial Fibrillation field from around the world (the U.S., England, Canada, France, Italy, Germany, Switzerland, Ireland, The Netherlands, Russia, Taiwan, South Korea, the Czech Republic, and two members of the U.S. FDA [Food and Drug Administration].

I made it to every presentation despite being sick with some kind of a virus I caught on the plane to Orlando. I was running on fumes.

Hot Topics

KISS OF DEATH FOR FIRM?

In a late-breaking presentation, the interim results of REAFFIRM trial were presented by Dr. John Hummel from the Ohio State University Wexner Medical Center. The success rate for PVI plus FIRM was not significantly different (78%) for patients receiving only a standard PVI (70%).

Barring further research, this may mean the end of the FIRM system as an effective player in A-Fib ablation. See my upcoming report for more.

FOCUS ON LEFT ATRIAL APPENDAGE

Like last year, there was great interest in and examination of the importance of the Left Atrial Appendage (LAA). Four of the six live case presentations dealt with the LAA. Ten of the more than 62 presentations focused on the LAA.

…To continue reading… Go to My Overview of the 2018 International AF Symposium->

Jeremy Ruskin, MD, Mass. General Hospital and AF Symposium

Dr. Ruskin

“Steve Ryan’s summaries of the A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation.” — Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

Steve’s Mailbox: Harlan Shares How He Gets Out of A-Fib Within 15 minutes

Harlan Alpern, M.D., Cooperstown, New York, wrote me about his unusual A-Fib trigger and a way he successfully controls his A-Fib attacks:

“I am a 72-year-old retired physician who developed atrial fib (lone and paroxysmal) at age 61. My initial trigger was a strong emotional stress event.

Although I have the common triggers for A-Fib including alcohol, coffee, and lying on my left side, the principal trigger for me for A-Fib is emotional stress (and negative emotions especially since I have given up alcohol and caffeine.). This can come from something as simple as watching an emotional or scary movie or television show. I had such an episode this evening which prompted my email to you.”

An Unusual A-Fib Episode Treatment

Xanax, generic name: alprazolam

Dr. Alpern went on to describe an A-Fib episode treatment that works quickly for him. Maybe it will work for you, too.

“I have found a therapy that gets me out of A-Fib within 15 minutes. I take a 1 mg tablet of Xanax and lie on my back in the dark. I occasionally check my heart with my stethoscope. Within 15 minutes I am back into sinus rhythm.

My current cardiologist told me he was not aware of Xanax being a therapy to affect cardio version from A-Fib into sinus rhythm, however my internist kindly provides me a prescription for the Xanax. (I have a New York state medical license but dropped my DEA license after I retired in 2007 so that I cannot order it for myself.)”

I read Dr. Alpern’s email with interest and wrote back to him:

Thank you for sharing what gets you out of an A-Fib attack. I have one similar story about Xanax (a minor tranquilizer). An A-Fib.com reader, Sally, wrote me that her A-Fib comes on at night and is very severe, preventing her from sleeping. “I get up and take Xanax 0.5 mg, and within 15 minutes or so, the A-Fib stops. And I can go to sleep.”

Conquering Your A-Fib Episodes

Share what’s working-email me.

Xanax and Beta-Blockers: Xanax (alprazolam), though primarily used for the treatment of anxiety disorders, appears to have beta-blocker properties. Beta-blockers are typically prescribed to treat high blood pressure and heart problems, and they are prescribed off-label for anxiety. Xanax is a different kind of drug, a benzodiazepine, that is a type of tranquilizer.

But be advised it’s recommended to not take Xanax on a regular basis for more than 2-3 weeks because of the danger of addiction.

Using Xanax for Your A-Fib? Anyone else using Xanax to help with their A-Fib attacks? To tell me about it, just email me.

Scary Movie A-Fib Trigger: I have never heard of a simple emotional stress such as a scary movie triggering an A-Fib episode. Does anyone else have a similar trigger? Email me and share your experience.

Always aim for a cure! As we continue our correspondence, I’ll encourage Dr. Alpern to seek his A-Fib cure.

Eleven years of living in A-Fib is a long time. I’ll urge him to talk with his electrophysiologist about a catheter ablation. (I had mine 20 years ago and am still A-Fib free. I’m age 77 and very active.)

The Costs and Consequences of Living with Atrial Fibrillation

Our mission at A-Fib.com is, in part, “to empower patients to find their A-Fib cure or best outcome.” We often advise:

Don’t listen to doctors who want to just control your symptoms with drugs. Leaving patients in A-Fib overworks the heart, leads to fibrosis and increases the risk of stroke. The abnormal rhythm in your atria causes electrical changes and enlarges your atria (called remodeling) making it work harder and harder over time. Seek your Cure.

A Few CDC Facts About A-Fib

I was recently reminded of the other costs of living with Atrial Fibrillation when I re-read the  A-Fib Fact sheet from the U.S. Centers for Disease Control and Prevention.

In part it reads: “More than 750,000 hospitalizations [in the U.S.] occur each year because of Atrial Fibrillation (A-Fib). The death rate from A-Fib as the primary or a contributing cause of death has been rising for more than two decades.”

The A-Fib stat that jumped out at me was:

“Medical costs [in the U.S.] for people who have A-Fib are about $8,705 higher per year than for people who do not have A-Fib.”

How disconcerting! A-Fib costs you in many ways. Beyond the physical toll, staying in A-Fib with medication is costly to your wallet. Besides the annual costs of your medications, the odds of your being hospitalized increases. Just in terms of dollars and cents, A-Fib on average costs you an additional $8,700 a year.

To learn more, read my editorial, Leaving the Patient in A-Fib—No! No! No!

How Much Will You Pay to Stay in A-Fib?

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.)

When you add up all the costs (physical, emotional and monetary) of living in A-Fib, doesn’t it make sense to ‘Seek you Cure’?

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

Resources for this Article

Ronny, Our Newest A-Fib Support Volunteer—Not Cured—Yet!

We welcome Ronny Sullivan, a new A-Fib Support Volunteer, who’s from West Seattle, WA, USA. Our newest recruit is not cured and is still fighting to fix his A-Fib.

His history with Atrial Fibrillation spans 10-15 years and includes two failed ablations, a stroke, and several cardioversions. Along the way, he’s done extensive research about his condition.

“I know how scary A-Fib is at first, and how much mis-information is out there.

Ronny Sullivan, West Seattle, WA

I am still not cured, but have had recent success with Betapace (sotalol) and deep breathing. I will have another ablation at some point, probably with Dr. Natale.”

Ronny has gone through a lot while seeking his A-Fib cure. He wants to help others who are also dealing with Atrial Fibrillation. He welcomes your email (ronnysullivan(at)yahoo.com) or you can phone him at (206) 396-7682 (Pacific time zone).

Our World-Wide Network of Volunteers

Our A-Fib Support Volunteers offer their support and hope through exchanging emails and sharing their stories. We invite you to learn more about our world-wide network and browse our list of volunteers. Go to A-Fib Support Volunteers.

Ronny: I’m glad to have you with us, and thanks for volunteering to help others with Atrial Fibrillation.

“Steve’s website provides a central resource to which we should all contribute with information about our own experiences where we think they can help others… .” Neville Greenwell, Perth, Western Australia

Causes: How Do You Get Atrial Fibrillation? What Triggers A-Fib?

Expanding your understanding of A-Fib is a core mission here at Atrial Fibrillation: Resources for Patients (A-Fib.com). In that effort, one of our core content pages is Causes of A-Fib.

(A ‘core page’ answers one of the basic questions you [and your family] have about developing or being diagnosed with Atrial Fibrillation.)

Causes of A-Fib at A-Fib.com

Causes of A-Fib

Review of Causes and Triggers

Expand or fill in any gaps in your understanding of A-Fib. Our basic review of the various causes of Atrial Fibrillation covers: Heart Problems, Alcohol Consumption, Severe Body Distress, Mental Stress, Being Overweight and Genetics.

After the list of causes, we then review some of the Triggers that can bring on your A-Fib. We cover: Food-Related Triggers, Sleep Apnea, Mechanically-Induced A-Fib, Physical and Gender Characteristics, Aging and ‘No Known Cause’. Go to What Causes A-Fib?

The Pursuit of Knowledge

The more you understand about Atrial Fibrillation, the better you can cope with your symptoms—and the better you can strive to Seek Your Cure! 

Did You Get Yours? Steve’s A-Fib Alerts for January 2018

The A-Fib Alerts January 2018 issue is out and being read from the U.S. to Chile and Australia to Spain, the UK and Denmark.

This issue includes a link to free training on reading your own ECG, summary of research comparing A-Fib Mortality Rates in Urban vs. Rural Hospitalizations, list of my Top 5 Advanced-level Videos…and more! Read it online today.

My A-Fib Alerts is presented in a condensed, easy-to-scan format. It’s convenient! Get all your A-Fib news in one compact, easy-to-scan newsletter! …Or make it more convenient to read and have our A-Fib Alerts newsletter sent directly to you via email. 

Amazon.com review of Beat Your A-Fib book at A-Fib.comSubscribe NOW. It’s Risk Free! You can unsubscribe at any time! Join TODAY!

Special Signup Bonus: Subscribe and receive discounts codes to SAVE up to 50% off my book, Beat Your A-Fib: The Essential Guide to finding Your Cure by Steve S. Ryan, PhD.

Encourage Another with A-Fib—Become an A-Fib Support Volunteer!

There are many ways you can participate at A-Fib.com. One important role is being an A-Fib Support Volunteer— someone who offers another A-Fib patient hope and encouragement.

Atrial Fibrillation changes your life. When diagnosed, it helps to talk with someone who has (or had) A-Fib. That’s the role of our A-Fib Support Volunteers—someone who has “been there” and is there for other patients. These volunteers have been helped along the way and want to return the favor.

We Offer One-to-One Support

We’re not like most A-Fib discussion groups and other online support groups. Our Volunteers offer one-to-one support and hope by exchanging emails, being a sounding board and sharing their own A-Fib story.

We are blessed to have many generous people from all corners of the globe who have volunteered to help others get through their A-Fib ordeal. Most A-Fib Support Volunteers are not medical personnel  They are not paid. They come from widely different backgrounds.

Note: Not all Support Volunteers are ‘cured’ of their A-Fib, but have found the best outcome for themselves.

A few of our many A-Fib.com Volunteers at A-Fib.ccom

A few of our many A-Fib.com Volunteers

How About You? Want to be an A-Fib Support Volunteer?

You can help someone struggling with A-Fib, offer emotional support and encourage another patient to seek their cure.

If this interests you, browse the A-Fib Support Volunteers page and see my article: ‘Want to become a A-Fib Support Volunteer?’

A-Fib Positive Thoughts/Prayer Group: Another Support Group. To learn about our A-Fib Positive Thoughts/Prayer Group and how to send in your request, go to our A-Fib.com Positive Thoughts/Prayer Group.

More FREE ‘Learn the Heart’ ECG Online Review Courses

Recently I posted about a FREE online course ‘ECG Basics‘ at Healio/LearnTheHeart.com designed to expand your understanding of Electrocardiograms (ECG or EKG) (see our description page).

More ‘Learn the Heart’ ECG Review Courses

This week I expanded the list of Healio ECG short courses that may be of interest to Atrial Fibrillation patients. Each includes examples of 12-lead ECGs and, where appropriate, specific criteria. Check out the following:

Illustration: Healio 'Atrial Fibrillation ECG Review‘

Illustration: Healio ‘Atrial Fibrillation ECG Review‘

Atrial Fibrillation ECG Review
Atrial Flutter ECG Review
Premature Atrial Contractions (PACs) ECG Review
Left Atrial Enlargement (LAE) ECG Review
Atrioventricular Nodal Reentrant Tachycardia (AVNRT) ECG Review

ECG Quizzes, Too

You can also challenge yourself with the Beginner ECG Quiz featuring detailed answers and links to pertinent explanation pages. Or test your overall knowledge of Atrial Fibrillation with a multiple choice Atrial Fibrillation Quiz.

Steve’s Brief Overview: The EKG Signal

If you want just a brief overview of the ECG waveform signal and how to “read” an ECG tracing, go to my report, Understanding the EKG Signal.

My Top 5 Picks: Advanced-Level Atrial Fibrillation Videos

The A-Fib.com Video Library is for those readers who learn visually through motion graphics, audio, personal interviews and animations.

These are my top 5 picks of advanced-level videos. For the reader wanting a more in-depth look inside the EP lab and surgery, and at advanced topics relating to atrial fibrillation.

1. Step-by-Step: Cardioversion Demonstration by ER Staff

Step-by-Step: Cardioversion Demonstration by Alfred Sacchetti

Step-by-Step: Cardioversion

The goal of electrocardioversion is to convert the patient’s rhythm from atrial fibrillation back to normal sinus rhythm.

In this video, emergency room medical personnel demonstrate the equipment, pads placement and procedures of cardioversion. The video describes where pads are properly placed on the patient; how medication is chosen to produce deep sedation; and how after the shock is delivered, a successful cardioversion is confirmed by viewing a normal sinus rhythm on the cardiac monitor.

Close-up of the equipment is shown along with the monitor display. (2:10 min.) Uploaded by Alfred Sacchetti. Go to video->

2. Your Heart’s Ejection Fraction (EF): What You Need to Know

Ejection Fraction with Dr Robert Fishel

Ejection Fraction with Dr Robert Fishel

In the following three short videos, cardiac electrophysiologist, Dr. Robert Fishel, discusses the ejection fraction (EF) a measurement of the pumping efficiency of the heart and why cardiac patients should know their EF percentage.

Video 1: What is the ejection fraction? (:54 sec.) Cardiac Ejection Fraction (EF) is the percentage of blood pumped from the heart’s main chamber during each heartbeat, and why it’s important.

Video 2: Who should know their ejection fraction (EF)? (:34 sec.) Measurement of your Ejection Fraction (EF) is an important test and why A-Fib patients need to know their EF number.

Video 3: How is an ejection fraction measured? (:56 sec.) Ejection Fraction (EF) can be measured by various techniques including an echocardiogram.

Videos hosted by Share.com. Go to videos-> 

3. Mini-Maze Surgery In-Depth: Inside the O.R. with Dr. William Harris, Cardiovascular Surgeon 

Video still of Mini-Maze Surgery at A-Fib.com

In-Depth: Mini-Maze Surgery

Cardiovascular Surgeon, Dr. William Harris describes the Mini-Maze surgery for Atrial Fibrillation. In the Mini-Maze the heart is accessed through small incisions in the chest.

Of interest to A-Fib patients who can not tolerate blood thinners and thus do not qualify for a Catheter Ablation. The Mini-maze surgery is a highly effective with an 85%–95% success rate. (4:49 min.) Dr. Harris is with Baptist Medical Center, Jackson, Miss. Go to video->

4. Pulmonary Vein Isolation In-Depth: Step-by-Step Inside the EP Lab Using Mapping & CT Scan

PVI Step-by-Step Inside the EP Lab video at A-Fib.com

Pulmonary Vein Isolation Step-by-Step Inside the EP Lab

Cardiac Electrophysiologist Dr. James Ong begins with a brief tour of the EP lab and control room; Dr. Ong explains how pulmonary vein isolation is done with radiofrequency ablation to cure atrial fibrillation.

Included are: Mapping technology; the Virtual Geometrical shell of the heart displayed next to the CT scan; Placement of the catheter, real time tracking; the Complex Fractionated Electrogram (CFE) Map used to identify and eliminate the extra drivers (aside from the pulmonary veins). (6:01 min.) From a series of videos by Dr. Ong, Heart Rhythm Specialists of Southern California. Go to video->

5. Long-Standing Persistent A-Fib: A Live Case of Catheter Ablation Through 3D Mapping & ECG Images

Long-Standing Persistent A-Fib: Catheter Ablation Through 3D Mapping & ECG Images Video at A-Fib.com

Long-Standing Persistent A-Fib: Catheter Ablation Through 3D Mapping & ECG Images

Presented entirely through 3D mapping and ECG images, a live demo of ablation for long-standing, persistent A-Fib is followed from start to finish. Titles identify each step (no narration).

3D mapping and ECG images show the technique of transseptal access, 3D mapping, PV isolation, and ablating additional drivers of A-Fib. (8:03 min.) With Dr. James Ong, Heart Rhythm Specialist of Southern California. Go to video->

Note: These videos may require basic understanding of cardiac anatomy and A-Fib physiology.

Visit our A-Fib.com Video Library
for more Advanced-Level Videos

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

Atrial Fibrillation Hospitalizations: Urban-Rural Differences in Mortality Rates

A new study suggests U.S. patients hospitalized for atrial fibrillation in rural areas may be more likely to die than those hospitalized in urban areas. 

In-hospital mortality was defined as death due to any cause during hospitalization.

Researchers examined nationwide information on 248,731 adults hospitalized for atrial fibrillation between 2012 and 2014. Mean age was 69 years; 78% white; 48% women. Of these, 218,946 (88%) were from urban hospitals and 29,785 (12%) were from rural hospitals.

Study Results: Urban vs. Rural

Patients admitted to rural hospitals had a 17% increased risk of death as compared with those admitted to urban hospitals. (Around 1.3 percent of atrial fibrillation patients died in rural hospitals, compared and 1 percent in urban facilities.) The study accounted for differences in patient characteristics including high blood pressure, diabetes, heart failure and kidney damage.

“…appropriate anticoagulation and…advanced options such as ablation, are lower in rural than urban settings.” Dr. Thomas Deering

According to lead study author Dr. Wesley O’Neal of Emory University School of Medicine: “Presumably, a higher risk of death in patients from rural regions was related to differences in practice patterns and access to specialists.” 

From a related editorial: “There is also some limited data suggesting that several atrial fibrillation outcomes, for example appropriate anticoagulation usage and appropriate referral for advanced procedural options such as ablation, are lower in rural than urban settings,” wrote Dr. Thomas Deering of Piedmont Heart Institute in Atlanta.

This study examination wasn’t a controlled experiment. Further research is needed to understand these findings.

What This Means to A-Fib Patients

Atrial Fibrillation is not a one-size fits all type of disease. Don’t choose your Atrial Fibrillation healthcare provider just because their office is nearby with local hospital privileges.

When seeking treatment for your Atrial Fibrillation, your first step is to see a heart rhythm specialist (a cardiac electrophysiologist) who specializes in the electrical function of the heart (and the best you can afford). You may need to travel, but it may be worth it to you for your peace of mind.

For more see Finding the Right Doctor for You and Your A-Fib and the A-Fib.com Directory of Doctors Treating A-Fib: Medical Centers and Practices.

Resources for this Article

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