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"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"



ABOUT A-FIB.COM...


"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."

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Dr. Andrea Natale

New A-Fib Patient Story: Pill-In-The-Pocket Works, Until It Doesn’t

Lise Soares Personal experience story on A-Fib.com

Lise Soares

Our newest patient A-Fib story is told by a retired nurse from Arizona. (Coincidently, her husband had A-Fib, too.) Both are now A-Fib free. Her story begins in an all too familiar way.

I Woke at 2 AM with an Urgent Need to Urinate

My first episode started in September 2006 when I woke up at 2 AM with an urgent need to urinate. My heart was beating so hard that I thought it would come out of my chest. My pulse was irregular, I had chest pain and was dizzy. I was anxious and scared. At the emergency room, just before I was scheduled for a cardioversion, to my great relief, I went back into sinus rhythm.

I was discharged with a ‘pill-in-a-pocket’, Flecainide 100 mg, if I got another episode. I thought I would be free from other episodes. But 10 months later I woke up at 1 AM again with an urgent need to urinate. My heart was beating out of my chest and my pulse was over 130 per minute.

But this time I took Flecainide 100 mg and was back in sinus rhythm at 2:15 AM with a pulse of 68.

My cardiologist instructed me to eat salty foods such as chips and nuts while in A-Fib 

Why Did I Urinate 10-15 During an A-Fib Episode?

As my A-Fib became more frequent, I wanted to know why I urinated so many times (10-15) during an A-Fib episode. Apparently, when in A-Fib, the “atrial natriuretic peptide hormone” in the atria kicks in and acts as a diuretic to lower the blood pressure and regulate the calcium and salt in the body.

My cardiologist instructed me to eat salty foods such as chips and nuts while in A-Fib and drink plenty of water so as not to get dehydrated. I was also told that my A-Fib episodes were vagal… .

To read more of Lise’ A-Fib story and how she beat her A-Fib for more than three years, go to: Retired Nurse: Over 3 Years A-Fib Free (Husband Had A-Fib, Too).

Retired Nurse: Over 3 Years A-Fib Free (Husband Had A-Fib, Too)

Lise Soares Personal experience story

Lise Soares

A-Fib Patient Story #82

Retired Nurse: Over 3 Years A-Fib Free (Husband Had A-Fib, Too) By Lise Soares, November 2015

By Lise Soares, October 2015

My name is Lise Soares, and I live in Arizona with my husband, Robert. We have been happily married for 46 years and we both have had A-Fib. [We hope Robert will also write about his A-Fib experiences.] I write this in the hope that it will help others make proper decisions about their A-Fib.

Healthy Lifestyle But A-Fib Runs in My Family

I am a senior citizen who lives in a healthy manner. Along with my husband, I take care of myself, eat well and exercise regularly. I also try to keep stress out of my life as much as possible.

I would like to mention that A-Fib runs in my family. I have a nephew in Canada who had his first ablation at 18 by a pioneer in the field. It took two more ablations for him to be A-Fib free. Now in his 40’s, he feels he is cured. I have a brother and a sister who also have A-Fib.

September 2006: First A-Fib Attack

My first episode started in September 2006 when I woke up at 2 AM with an urgent need to urinate. My heart was beating so hard that I thought it would come out of my chest. My pulse was irregular, I had chest pain and was dizzy. I was anxious and scared.

Reluctantly, I woke my husband and told him I needed to go to the emergency room. Upon our arrival, the medical staff told me I was in atrial fibrillation and would monitor me until I got out of it. In the morning, the emergency room cardiologist decided that he would do a cardioversion to put me back in sinus rhythm. It was scheduled for 1 PM. At 12:50 PM, to my great relief, I went back into sinus rhythm.

I was discharged from the hospital with a pill-in-a-pocket, Flecainide 100 mg, if I got another episode.

Pill-In-The-Pocket Works, Until It Doesn’t

I thought I would be free from other episodes. But 10 months later I woke up at 1 AM again with an urgent need to urinate. My heart was beating out of my chest and my pulse was over 130 per minute. But this time at 1:47 AM I took Flecainide 100 mg and was back in sinus rhythm at 2:15 AM with a pulse of 68.

Keeping a Log or Diary Important

I kept a log of all my episodes of A-Fib and of my symptoms as I wanted to see how often they were happening and their severity. (In the early years, I got only 2 or 3 episodes.)

A-Fib begets A-Fib, and this pattern was happening to me.

I read on the A-Fib website that A-Fib begets A-Fib, and this pattern was happening to me. Keeping careful notes was important to me as a long-retired nurse. Accurate record keeping often helps doctors make a diagnosis.

In August 2009 (while my husband was in the hospital for a successful ablation by Dr. Andrea Natale), I had an episode that night in my hotel room and, later on that week, another one.

There are many patients who write about keeping an A-Fib Diary about their episodes, triggers, etc. Just enter the word “diary” in the ‘Search’ box in the upper right of this page.

Stops Flecainide, Deals with Excessive Urination

In August of 2010, my internist suggested I see another cardiologist who worked closely with Dr. Natale. My new cardiologist stopped my Flecainide because it made me sick during my A-Fib episodes. He prescribed another antiarrhythmic drug, Multaq, 400 mg/day.

My cardiologist instructed me to eat salty foods such as chips and nuts while in A-Fib and drink plenty of water so as not to get dehydrated.

I also wanted to know why I urinated so many times (10-15) during an A-Fib episode. Apparently, when in A-Fib, the “atrial natriuretic peptide hormone” in the atria kicks in and acts as a diuretic to lower the blood pressure and regulate the calcium and salt in the body.

My cardiologist instructed me to eat salty foods such as chips and nuts while in A-Fib and drink plenty of water so as not to get dehydrated. I was also told that my A-Fib episodes were vagal, from the vagus nerve.

A-Fib Progresses and Becomes More Frequent

From October 2010 to February 2012, I suffered 11 episodes of A-Fib with my symptoms getting more severe every time.

On January 7, 2012, during an A-Fib episode, I borrowed my husband’s Holter monitor to record my episode. My cardiologist made me erase it because it was not “my” monitor. I protested and told him it should be recorded.

Finally, he did give me a monitor to wear 24 hours a day for 30 days. As luck would have it, during that period I did not have any episodes.

(Dr. Natale could not believe that my cardiologist had done this. I subsequently got a new cardiologist, Dr. Timothy Marshall, and he is wonderful.)

Back in the Emergency Room

My episode in February 2012 landed me in the hospital. I woke up at 1:00 AM with an urgent need to urinate, palpitations, irregular pulse, dizziness, chest pain and I felt like I was going to pass out.

I went to the emergency room and was unable to convert back on my own, so I was given Cardizem IV, Lovonox and Magnesium 1000 mg to bring me back into sinus rhythm. While giving me these drugs, the “crash cart” was kept outside the room.

May 2012: Ablation Procedure with Dr. Andrea Natale

After that episode, my cardiologist advised me to have an ablation with Dr. Andrea Natale. I had already made an appointment in March 2012 for a consultation. Dr. Natale said I would be a good candidate for an ablation. I was put on Coumadin two months before my May 2012 ablation procedure and stopped taking it 5 months after my ablation. I now take Aspirin 81 mg daily.

On May 18, 2012, Dr. Natale successfully ablated my pulmonary veins. He did not need to do the left atrial appendage.

Participant in Clinical Trial for Contact Force Sensing Catheter

I was also taking part in a random experiment with a Contact Force sensing catheter. This probe helps the electrophysiologist determine the amount of pressure applied on the heart muscle as he uses the radio-frequency heat catheter.

It wasn’t until a year later, that I found out the Contact Force sensing catheter was used on me.

To read more about the Contact Force Sensing Catheter, see my AF Symposium report: The New Era of Catheter Ablation Technology: Force Sensing Catheters.

Three Years After the Successful Ablation

I have been episode-free for over 3 years–knock on wood. I hope I am cured but I do not dare say as I do not want to tempt fate.

I had GERD at the time Dr. Natale performed the ablation. After the ablation, GERD caused chest pain. When I was discharged from the hospital and came home, I started making my own yogurt and, after eating it for two weeks, I felt much better. It is also excellent for the gut.

The only symptom that keeps persisting is waking up once or twice at night with an urge to urinate. I suspect that the “Atrial Natriuretic Peptic Hormone” or “Atrial Natriuretic Hormone” (ANH for short) is still active in the muscle of my heart, since an ablation does not remove the hormone. I discussed this with my urologist recently, and she said it is quite possible because my urine output is quite large for nighttime (I had measured my urine output for a period of time).

If you have A-Fib, do something about it. Do not wait until it takes control of your life. It will not go away!

My Parting Thoughts

A-Fib.com was a great source of information, and my husband and I are grateful to Dr. Ryan for keeping it up-do-date.  We thank him also for being available when we needed him.

If you have A-Fib, do something about it. Do not wait until it takes control of your life. It will not go away!

If you have questions, please contact Steve Ryan, and he will get in touch with me.

Lise Soares
Arizona, USA

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If you find any errors on this page, email us. Y Last updated: Saturday, July 23, 2016

FREE Report: How & Why to Read An Operating Room Report

Special 12-page report by Steve S. Ryan, PhD

New FREE 12-page report by Steve S. Ryan

In our new FREE 12-page Report, How & Why to Read Your Operating Room Report, we examine the actual O.R. report of the catheter ablation of Travis Van Slooten, publisher of Living With Atrial Fibrillation performed by Dr. Andrea Natale, Austin, TX.

What is an O.R. Report?

An O.R. report is written by the electrophysiologist who performed the catheter ablation. It contains a detailed account of the findings, the procedure used, the preoperative and postoperative diagnoses, etc.

It’s a very technical document. Because of this, it’s usually given to a patient only when they ask for it.

New Report: How & Why to Read Your Operating Room Report

In our new FREE 12-page Report: How & Why to Read Your Operating Room Report, I make it easy (well, let’s say ‘easier’) to learn how to read an O.R. report.

Along with an introduction, I’ve annotated every technical phrase or concept so you will understand each entry. I then translate what each comment means and summarize Travis’ report.

Read more at: Special Report How & Why to Read Your Operating Room Report

Tip: If you’ve had an ablation, ask for your O.R. Report. If you or a loved one is planning a catheter ablation, make a note to yourself to ask for the O.R. report.

Free Report: How & Why to Read An Operating Room Report

Special 12-page report by Steve S. Ryan, PhD

FREE 12-page Report by Steve S. Ryan, PhD

In our free Special Report, How and Why to Read Your OR Report – Special Report by Steve S. Ryan PhD – A-Fib.com, we examine the actual O.R. report of the catheter ablation of Travis Van Slooten, publisher of Living With Atrial Fibrillation performed by Dr. Andrea Natale, Austin, TX.

What is an O.R. Report?

An O.R. report is a document written by the electrophysiologist who performed the catheter ablation. It contains a detailed account of the findings, the procedure used, the preoperative and postoperative diagnoses, etc.

It’s a very technical document. Because of this, it’s usually given to a patient only when they ask for it. You need to call your doctor or his office to obtain it.

Why to Request and Read Your O.R. Report

The O.R. report is a historical record of how you became A-Fib free.
The O.R. report is a blow-by-blow account of your EP’s actions. It’s as close as you’ll get to understanding your own ablation without actually looking over the EP’s shoulder during the ablation. The O.R. report is a historical record of how you became A-Fib free. (File with your A-Fib medical records for future reference.)

If you’ve had an ablation that was less than successful, you want to know why! Your O.R. report would show what they found in your heart, what was done, and possibly why the ablation didn’t fulfill expectations.

Studying an O.R. report can be very revealing…you may decide to change EPs going forward!

Reading an O.R. report can be very revealing. Were there complications? Was your fibrosis more extensive than expected? Was there a problem with the EP’s ablation techniques? Or with the EP lab equipment? This information will help you and your healthcare team decide how next to proceed.

Also, depending on what you read in your O.R. report, you may decide to change EPs going forward!

O.R. Report with closeup

Close-up of O.R. Report with markups

FREE Report: How & Why to Read Your Operating Room Report

In our FREE Special Report: How and Why to Read Your OR Report – Special Report by Steve S. Ryan PhD – A-Fib.com, I make it easy (well, let’s say ‘easier’) to learn how to read an O.R. report.

Along with an introduction, I’ve annotated every technical phrase or concept (in purple text) so you will understand each entry. I then translate what each comment means and summarize Travis’ report.

Get your PDF copy TODAY. Download How and Why to Read Your OR Report – Special Report by Steve S. Ryan PhD – A-Fib.com our FREE 12-page Special Report (Remember: Save to PDF  to your hard drive.)

Tip: If you’ve had an ablation, ask for your O.R. Report. If you or a loved one is planning a catheter ablation, make a note to yourself to ask for the O.R. report.

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If you find any errors on this page, email us. Y Last updated: Monday, July 18, 2016

New Ablation Technique by Dr. Andrea Natale

The AFIB Report mastheadby Steve S. Ryan, PhD

In the June/July 2014 issue of The AFIB Report, Managing Editor, Shannon Dickson describes how Dr. Andrea Natale performed an ablation on his friend who was in persistent A-Fib. Shannon was an observer in Dr. Natale’s operating lab at the Scripps Clinic in La Jolla, CA.

Dr Andrea Natale

Dr Andrea Natale

“Dragging or Gliding” Ablation technique

Instead of using the dot-by-dot or point-by-point ablation technique commonly used in RF ablation, Dr. Natale positioned the catheter tip at an angle to the tissue and in contact with the Lasso circular mapping catheter and dragged or glided the catheter and Lasso together in one movement. Instead of making vertical downward dot-by-dot burns, he made continuous ablation lines or lesions. (This isn’t really a “new” ablation technique in that Dr. Natale has been perfecting this technique over many years.)

This dragging method allowed him to vary power and force depending on the variable wall thickness as he moved along. One result is potentially less inflammation swelling, which can form more readily around each discrete burn in the dot-by-dot technique. In turn, round dots of inflammation around each burn can potentially result is small gaps forming in between each ‘dot’.

Followup: Shannon Dickson’s writes that Dr. Natale’s ablation was a success and his friend is now A-Fib free!

Editor’s Comments:
Dr. Natale’s innovative RF ablation technique for persistent A-Fib patients seems like a major advance in ablation strategy. In addition to making better linear lesions, it’s probably a lot faster than the standard point-by-point RF ablation strategy.
So my next thought is: ‘Is this a technique dependent of the skill of the operator, or can it be taught to all EPs?’ (I will be sure to ask Dr. Natale this question at the next Orlando AF Symposium.)
Once again, I’m amazed that there’s no regulatory body requiring EPs to learn new skills or how to use new, proven equipment. Even if Dr. Natale’s new ablation technique is indeed teachable, it’s probable very few EPs will adopt it.
This is in stark contrast to other professions responsible for human lives. Case in point are commercial airline pilots. Pilots “undergo rigorous, continuing, high stakes assessments and examinations supported by mandatory training and retraining.”
A move in that direction has been started by the American Board of Medical Specialties (ABMS). They have begun a maintenance of certification (MOC) in order for a doctor to retain board certification; but physicians who received their board certification prior to this policy change remain certified for life. The American Board of Internal Medicine, the official “certifying” body of a large proportion of doctors in the US, has established a new re certification program which many doctors are up in arms about.
See Larry Huston’s Three Reasons Why You Don’t Need To Feel Sorry For Doctors

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Last updated: Friday, February 27, 2015

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