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"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."

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"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."

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electrocardioversion

No Such Thing As Asymptomatic A-Fib?

At the recent AF Symposium in Orlando, Dr. Jeremy Ruskin of Massachusetts General asked, can anyone in A-Fib really be asymptomatic; that is, if you dig deep enough, will you find that A-Fib does affect their life-style or how they feel? In the case being discussed, read why Dr. Ruskin recommended an Electrocardioversion for his patient. Read more.

Can Anyone in A-Fib Really Be Asymptomatic?

AF Symposium 2015

Jeremy Ruskin, MD

Jeremy Ruskin, MD

Can Anyone in A-Fib Really Be Asymptomatic?

Dr. Jeremy Ruskin of Massachusetts General made a statement during the ‘Challenging Cases’ discussions which changed my thinking about the true nature of asymptomatic or ‘silent’ A-Fib.

Not everyone may “feel” their A-Fib symptoms…but losing that amount of blood flow must affect your body and brain in some way

When describing a patient in persistent A-Fib who is “asymptomatic,” Dr. Ruskin wondered whether someone in A-Fib can really be asymptomatic; that is, if you dig deep enough, will you find that A-Fib does affect their life-style or how they feel.

In the case being discussed, Dr. Ruskin recommended an Electrocardioversion to get the asymptomatic patient back in Normal Sinus Rhythm (NSR). Many times patients who are used to living with their A-Fib will indeed notice a difference when returned to NSR—they often feel much better.

Editor’s Comments:
In A-Fib, you lose 15%-30% of your normal pumping blood volume because the atria fibrillate instead of pumping blood down into the ventricles. Not everyone may “feel” A-Fib symptoms like chest pains, palpitation or shortness of breath. But losing that amount of blood flow must affect your body and brain in some way. Patients with persistent A-Fib may adjust their life-style to this loss of blood flow or just get used to it. Or they may compensate with strenuous exercise (making the ventricles suck blood down from the non-functioning atria like a turkey baster). But A-Fib is affecting them, consciously or not.
I have a friend who is in persistent A-Fib and is “asymptomatic.” He is a swimmer and exercises a lot. He does take a blood thinner to prevent an A-Fib stroke (which he doesn’t like. He wants to get a Watchman device installed to close off his Left Atrial Appendage [LAA] so that he doesn’t have to take anticoagulants).
I will now recommend to my friend that he get an cardioversion to see if he notices a difference when he is in Normal Sinus Rhythm (NSR) compared to being in persistent A-Fib. A cardioversion is non-invasive and pretty safe. The only problem is that the result often doesn’t last. But even if it lasts for just a few days, my friend would still be able to compare being in NSR versus living in persistent A-Fib. (I’ll also remind him that the best way to get off of anticoagulants is to cure your A-Fib.)
And returning to NSR after a cardioversion even for a few days is generally a good sign that a successful catheter ablation may fix his A-Fib, that his A-Fib hasn’t progressed so far that he can’t be shocked out of it.

Return to AF Symposium 2015: Brief Reports

Last updated: Friday, February 27, 2015

FAQs A-Fib Treatments: Medicines and Drug Therapies

FAQs A-Fib Treatments: Medicines and Drug Therapies

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

Drug Therapies for Atrial Fibrillation

Atrial Fibrillation patients often search for unbiased information and guidance about medicines and drug therapy treatments. These are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer.)

1. Which medications are best to control my Atrial Fibrillation?” “I have a heart condition. What medications work best for me?

2. “Is the “Pill-In-The-Pocket” treatment a cure for A-Fib? When should it be used?”

3. “I take atenolol, a beta-blocker. Will it stop my A-Fib.”

4. I’ve been on amiodarone for over a year. It works for me and keeps me out of A-Fib. But I’m worried about the toxic side effects. What should I do?”

5. Should everyone who has A-Fib be on a blood thinner like warfarin (Coumadin)?”

6. Which is the better anticoagulant to prevent stroke—warfarin (Coumadin) or aspirin?

7. What’s the difference between warfarin and Coumadin?

8. I’m on warfarin. Can I also take aspirin, since it works differently than warfarin? Wouldn’t that give me more protection from an A-Fib (ischemic) stroke?

9. “What are my chances of getting an A-Fib stroke?

10. “I’m worried about having to take the blood thinner warfarin (brand name Coumadin). If I cut myself, do I risk bleeding to death?

11. “I am on Coumadin (warfarin) to thin my blood and prevent A-Fib blood clots. Do I now need to avoid foods with Vitamin K which would interfere with the blood thinning effects of Coumadin?” UPDATED

12. “The A-Fib.com web site claims that an A-Fib stroke is often worse than other causes of stroke. Why is that? If a clot causes a stroke, what difference does it make if it comes from A-Fib or other causes? Isn’t the damage the same?

13. “I just had an Electrical Cardioversion. My doctor wants me to stay on Coumadin for at least one month. Why is that required? They mentioned something about a “stunned atrium.” What is that?

14. Are natural blood thinners for blood clot treatment as good as prescription blood thinners like warfarin?”

15. “How long do I have to be in A-Fib before I develop a clot and have a stroke?

16. I have to be on aspirin for stroke prevention. Which is better—the low-dose baby aspirin (81 mg) or a high dose (325 mg)? Should I take the immediate-release (uncoated) or the enteric-coated aspirin?

17. I don’t want to be on blood thinners for the rest of my life. I’ve had a successful catheter ablation and am no longer in A-Fib. But my doctor says I need to be on a blood thinner. I’ve been told that, even after a successful catheter ablation, I could still have “silent” A-Fib—A-Fib episodes that I’m not aware of.  Is there anything I can do to get off of blood thinners?

18. “My last cardiologist had me on Pradaxa. My new cardiologist wants me to switch to Eliquis. Is Eliquis easier to deal with if bleeding occurs?

19. “My doctor told me about the Tikosyn drug option that I want to consider in getting rid of my 5-month-old persistent A-Fib. That seems like something that should be discussed on your web site.

20. “I hate taking Coumadin. Is there a way to get off blood thinners all together? I know I’m at risk of an A-Fib stroke.”

21. “I”ve read about a new anticoagulant, edoxaban, as an alternative to warfarin (Coumadin) for reducing risk of stroke. For A-Fib patients, how does it compare to warfarin? Should I consider edoxaban instead of the other NOACs?

22. “Do you have information about Hormone Replacement Therapy (HRT) and if it might help or hinder my atrial fibrillation?

23. Are Anticoagulants and blood thinners the same thing? How do they thin the blood?

24. I have A-Fib, and my heart doctor wants me to take Xarelto 15 mg. I am concerned about the side effects which can involve death. What else can I do?

25. “Is the antiarrhythmic drug Multaq [dronedarone] safer than taking amiodarone? How does it compare to other antiarrhythmic drugs?”

Last updated: Wednesday, May 25, 2016

Back to FAQs by Patients with Atrial Fibrillation

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