"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

"Your book [Beat Your A-Fib] is the quintessential most important guide not only for the individual experiencing atrial fibrillation and his family, but also for primary physicians, and cardiologists."

Jane-Alexandra Krehbiel, nurse, blogger and author "Rational Preparedness: A Primer to Preparedness"


"Steve Ryan's summaries of the Boston 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

"I love your [A-fib.com] website, Patti and Steve! An excellent resource for anybody seeking credible science on atrial fibrillation plus compelling real-life stories from others living with A-Fib. Congratulations…"

Carolyn Thomas, blogger and heart attack survivor; MyHeartSisters.org

"Steve, your website was so helpful. Thank you! After two ablations I am now A-fib free. You are a great help to a lot of people, keep up the good work."

Terry Traver, former A-Fib patient

"If you want to do some research on AF go to A-Fib.com by Steve Ryan, this site was a big help to me, and helped me be free of AF."

Roy Salmon Patient, A-Fib Free; pacemakerclub.com, Sept. 2013

choosing a doctor

CryoBalloon Ablation: All EPS Are Not Equal (Part II)

Second in a two-part series by Steve S. Ryan, PhD

In Part I of this article, I shared my dismay at reading two O.R. reports of Cyroballoon Ablations that left me alarmed and disturbed. The first case was performed at one of the most prestigious A-Fib centers in New York City.
In each case, what’s alarming is what the EP didn’t do! The CryoBalloon ablation was less than the standard. The very minimum steps were taken.

Is Performing CryoBalloon Ablations Too Easy?

That relative ease has lead some EPs to cut corners. They just isolate the PVs without doing anything else.
CryoBalloon ablation is relatively easy to perform compared to RF (point-by-point) ablation.

That relative ease has lead some EPs to cut corners. They just isolate the PVs without doing anything else—they don’t bother to identify where A-Fib signals (potentials) are coming from and they don’t try to induce A-Fib after the ablation.

Some EPs performing CryoBalloon ablations may not have a full skill set. Others may lack the motivation to hunt for non-PV triggers.

My fear: If this becomes a trend, I fear CryoBalloon may become a step backwards as a treatment for A-Fib patients. Could CryoBalloon Ablation turn into a second-tier or inherently inferior procedure?

Choosing an EP for a Cryoballoon Ablations

Are you considering a catheter ablation (RF or Cyro)? Before selecting your electrophysiologist (EP), you must do your research and check their credentials and experience. For guidelines, see our Find the Right Doctor for You and Your A-Fib.

When choosing an EP for a Cyroballoon Ablation, you should research:

1. Are they certified in Clinical Cardiac Electrophysiology (CCE)?
2. Did they have a good track record doing RF ablation before they switched to CryoBalloon ablation?
3. Do they perform at least 25 ablations a year to maintain their proficiency?
4. Will this EP commit to pursue and ablate non-PV triggers?

Take Away: All EPS Are Not Equal

You want an EP with a proven track record in RF ablation who can call on those skills if needed to identify and ablate non-PV triggers.

You don’t want an EP new to the field who is only doing CryoBalloon ablations because they are so much easier to do. EPs don’t all have the same training, skill level, and motivation. Indeed, many non-CCE certified EPs perform catheter ablations for A-Fib.

You want an EP with a proven track record in RF ablation who can call on those skills if needed to identify and ablate non-PV triggers. The EP should have established protocols for doing this and should be able to explain them to you. For example, something like this:

“If you are still in A-Fib after Cryoablation of the pulmonary veins, I will withdraw the CryoBalloon catheter and replace it with an RF catheter. I’ll identify the non-PV trigger spots, then isolate each with the RF catheter.”

All EPs are not equal. To become A-Fib-free, do your homework! Find the right EP for your Cyroballoon ablation.

Additional reading: To learn more about O. R. reports see our Special Report: How & Why to Read Your Operating Room Report

Do You Trust Your Doctor?—It’s Important For Your Health

Do you like and trust your doctor?

Do you like and trust your doctor?

by Steve S. Ryan, PhD, February 2015

In our A-Fib.com section, Finding the Right Doctor for You and Your A-Fib, we stress the importance of a good doctor-patient relationship. Indeed, recent research proves that patients do better when they have a good rapport with their doctor.

Results from Studies of Doctor-Patient Relationships

Researchers at Massachusetts General Hospital analyzed the results of 13 high-quality studies of doctor-patient relationships.

Those patients who were treated by doctors trained in “relationship-based strategies”—such as providing more eye contact, careful listening and goal setting—did better than patients in control groups.

According to Dr. Gerald B. Hickson of Vanderbilt, patients who trust their doctors are more likely to follow their advice, ask questions and discuss how treatments are working. Doctors in turn may be more engaged.

Recent research proves that patients do better when they have a good rapport with their doctor.

‘Interview’ to Find  the Right Doctor for You

Don’t just go to a doctor because their office is nearby. Get referrals from friends and co-workers. Check credentials online. Narrow your list to 2–3 doctors then schedule a consultation appointment with your #1 choice.

When you meet the doctor, consider it an ‘interview’. Tell the doctor what you are looking for in your doctor (do need someone who’s easy to get to see, or someone with special expertise, or someone who will team with you to cure a specific illness, etc.)

Here’s an excerpt from our page, Finding the Right Doctor for You and Your A-FibYour Consultation Appointments: ‘Questions for Doctors’:

“You’ll also want to assess the doctor’s manner and personality. Is this someone who will work with you? Someone who listens to how A-Fib makes you feel? Does this doctor inspire confidence? Is this someone you feel comfortable with and trust with your health care? Does he/she respect you? Women in particular should be wary of condescending behavior. “It’s all in your mind.” “Take a Valium.” (Women in the US often don’t receive the proper diagnosis and treatment of their A-Fib.)

Rudeness, bad temper, boorish behavior, etc. from a doctor, no matter how highly recommended, should be a red flag for you. That kind of behavior is not only personally offensive but can be dangerous for your health.

Does the poor behavior also extend to how the doctor treats his staff? Patients of doctors “who don’t show respect for their medical staff have much higher rates of adverse effects, than patients of their more congenial colleagues.” “As a patient, you’re also a member of the health-care team,” explains Gerald B. Hickson, MD of Vanderbilt University Medical Center.

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

But do give the doctor a break. They may be having a bad day or may have heard your questions too many times before. So, say something, speak up! Or contact the patient-relations representative at the heart center. They want to know if a doctor is rude (those patients are more likely to sue!). Once a doctor’s bad behavior is called to his attention, they are likely to do better. And so will you.”

If the first doctor you interview doesn’t meet your needs, move on the second doctor on your list, etc. Yes, I know it takes time and energy, but a good doctor-patient relationship is important. You’ll do better when you have a positive rapport with your doctor.

Read more at How to Find the Right Doctor for You and Your Treatment Goals.

References for this Article

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Return to Research and Innovations in Atrial Fibrillation

Last updated: Sunday, March 13, 2016

Your Personal A-Fib Medical Summary

Your Personal Medical Summary

Your Personal Medical Summary

Your Personal A-Fib Medical Summary

by Patti J. Ryan

Doctors appreciate knowledgeable, informed, and prepared patients. Each doctor will probably ask you much the same questions. For efficiency, prepare your ‘Personal A-Fib Medical Summary’ and include a copy with each packet of medical records you send to doctors.

In their special report Atrial Fibrillation: The Latest Management Strategies, Drs. Calkins and Berger suggest before your appointment that you prepare answers to the following questions about your Atrial Fibrillation.

•  What particular symptoms are bothering you?
•  When did you first begin to experience these symptoms?
•  Did you start taking any new vitamins, supplements, or prescription drugs before the onset of symptoms?
•  Are these symptoms paroxysmal (occasional or intermittent, beginning and stopping on their own), or persistent (present all the time, or lasting at least a week at a time continuously)?
•  On a scale of 1 to 5, with 1 being little of no bother and 5 being severely bothersome, how would you rate your symptoms?
•  Is there anything that appears to worsen your symptoms?
•  Is there anything that appears to lessen your symptoms?

Include other pertinent information such as names and contact information for doctors you see regularly and why. Type up your summary and attach a copy to each set of medical records you send to doctors. And add a copy to your three-ring binder.

Healthcare trend: ‘The Personal Health Record’ (PHR)

There is growing momentum to encourage consumers to take another health-related step: to maintain their own health records.

The idea behind the personal health record (PHR) is that the more consumers know about their health, the more control they will take over it and the healthier they will be. PHRs also encourage consumers to collect and share more health-related information with each of their providers. For this reason, healthcare providers, employers, insurers, vendors, and the federal government are all interested inpromotingPHRs.

What is a personal health record (PHR)?

Shoe pocket by Vital ID;  Your Portable Medical Information Kit

Shoe pocket by Vital ID

USB credit card-size by ER Card

Credit card-size USB by ER Card

A personal health record (PHR) is a means of storing, managing, and sharing your personal medical information. PHRs can be paper based or electronic. Electronic records can be kept on different media, including personal computers, “smart” cards, thumb drives, CDs, or web-based applications.

Of the two types, paper records may be easier to secure, but electronic records are more convenient.

If you are considering a PHR to maintain your health records, look for a list of resources and a ‘Quick Guide to Creating a PHR‘ from the American Health Information Management Association (AHIMA), a national non-profit professional association.

Also see our article, Your Portable Medical Information Kit for a sampling of small, easy to store and carry USB devices for the print and digital versions of your PHR info.

References for this article

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Return to Dealing with A-Fib

Last updated: Monday, August 24, 2015

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