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


marijuana

PODCAST 2: What Do You REALLY Pay to Continue Living with Atrial Fibrillation?

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Note: If you prefer to read instead of listening, click the transcript graphic bar below for the printed version.

The REAL Cost of Living with Atrial Fibrillation 

What does A-Fib REALLY cost you? To you physically? To your Quality of Life (QoL)? And to your pocketbook? That’s the topic of this podcast between Steve and our friend, Travis Van Slooten, publisher of LivingWithAtrialFibrillation.com. (About 28 min. in length.)

Here are the highlights of our conversation:

There are two costs of living with atrial fibrillation: financial and quality of life costs. Both are very high!

Financial Costs

 A-Fib costs the United States about 6 billion each year.
 Medical costs for people who have A-Fib are about $8,705 higher per year than for people who do not have A-Fib.
 There are 750,000 hospitalizations each year because of A-Fib.

Quality of Life Costs

 Atrial fibrillation is a progressive disease that tends to get worse over time.
 Frequent A-Fib episodes enlarge and weaken your heart and can lead to other heart problems, including heart failure and other cardiovascular problems.
 Ongoing A-Fib can remodel your heart (change how your heart works), produce fibrosis (fiber-like, immobile tissue) or permanently scar your heart.
 You’re losing 15% to 30% of your normal pumping ability of your heart when you’re in A-Fib.
 Frequent or prolonged episodes of atrial fibrillation tend to stretch and dilate your left atrium. In the extreme, you lose all contracting ability and function of your left atrium.
 If you leave someone in A-Fib, the A-Fib attacks tend to become longer and more frequent.
 One study showed that half the people who managed their A-Fib with rate control drugs went into long-standing persistent A-Fib within a year. (CB de Vos, 2010)
 A-Fib is strongly linked with developing dementia (because you’re not getting enough blood to your brain and to the rest of your body).
 The aim should be to stop an A-Fib episode NOT just control an episode (i.e. slow the heart rate while in A-Fib).
 Today’s anti-arrhythmic drugs only work about 40% of the time, have bad side-effects or don’t work at all. If they do work, they often lose their effectiveness over time.
 Patients with persistent or long-standing persistent A-Fib: If you have been told there is no treatment besides taking drugs to manage your A-Fib, DON’T BUY IT! You have options!
 The Castle AF Trial reveals ablations on heart failure patients with paroxysmal or persistent atrial fibrillation resulted in a 47% reduction in death rates. In the catheter ablation group, 60% improved their ejection fraction by more than 35%! And after 5 years, 60% of the ablation group were in normal sinus rhythm compared to 22% receiving normal drug therapy.
 The goal for every A-Fib patient should be to end their A-Fib and not just manage or tolerate it!

Resources mentioned in this episode

 Atrial Fibrillation Fact Sheet from the CDC
♥ Editorial: Leaving the Patient in A-Fib—No! No! No!
♥ de Vos CB, et all. Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis. (J Am Coll Cardiol. 2010)
♥ 2018 AF Symposium: Findings from the CASTLE-AF Clinical Trial
♥ Catheter Ablation for Atrial Fibrillation with Heart Failure (N Engl J Med 2018)


Travis Van Slooten was diagnosed with atrial fibrillation on Father’s Day in 2006. He would battle a-fib for nine years before having a successful catheter ablation in March 2015. He’s been a-fib-free since with no drugs! His blog covers his own journey and provides information, inspiration, and support for others with A-Fib. Visit his site.

Transcript: The REAL Cost of Living with Atrial Fibrillation

Travis Van Slooten: I invited Dr. Steve Ryan back again for today’s episode of the afib podcast. Steve is a former patient who was cured of his back in April 1998 via catheter ablation. He is the publisher of one of the most popular websites, A-Fib.com and he is the author of the best-selling book, Beat Your A-Fib: The Essential Guide to Finding Your Cure.

So in this episode Steve and I discussed a topic that we are both extremely passionate about. And that topic being “The Real Cost of Living with Atrial Fibrillation,” and why it’s imperative to seek a cure for your afib, rather than just living with your afib. The financial and quality of life cost of living with afib are absolutely staggering. And so in this episode we discussed those costs, and again we really emphasize why it’s so important to find a cure and not just settle with a life of afib. So with that, let’s roll the tape.

All right, Steve, our topic today is really near and dear to my heart – no pun intended – and I know it’s very near and dear to you as well. And I know when I’ve spoken with you in the past you and I are both very passionate about this topic, and it’s the topic of the real cost of living with atrial fibrillation. And of course, when we talked about the cost of living with afib — well, first of all, I should say when we say we’re living with afib, for most people that means they’re just tolerating it, they’re basically managing it as best as they can instead of trying to seek a cure. But the cost of doing that of just kind of tolerating your a favor rather than trying to see a cure, there are really two big cost there. There is the financial cost, but probably just as important, if not more important, is a health or quality of life cost.

Dr. Steve Ryan: Absolutely, yes.

Travis Van Slooten: Yeah, absolutely. So let’s talk about the financial costs, Steve. You found some interesting stats on the CDC website. Can you talk about these financial costs?

Dr. Steve Ryan: Yes, Travis. The CDC has some very interesting figures. Afib costs the United States about 6 billion each year. Medical costs for people who have afib are about $8,000 – and I’m reading from the CDC statement here – are about $8,705 higher per year than per people who do not have afib. Now who has $8,700 to throw around every year trying to cope with the…

Travis Van Slooten: Yeah, and unfortunately with the health care plans that are out there today a lot of people that won’t even meet their deductibles, so that usually probably out-of-pocket cost. Yeah, that’s on fortunate.

Dr. Steve Ryan: Yeah, it’s medication, it’s doctor visits, it’s ambulance, it’s trips to the ER it’s you know, all kinds of stuff goes into that that run up the bills cost. The CDC says there are 750,000 hospitalizations each year because of afib, and afib contributes to an estimated 130,000 deaths each year. The death rate from afib has a primary or a contributing cause of death as been rising for more than two decades. Now that’s because the more and more people are getting afib because it’s a condition of aging, but those are really staggering figures.

Travis Van Slooten: Yeah, tell me about it. And I can attest to those because until I seek my cure which was an ablation, those figures are actually pretty accurate. I mean I remember specifically one year I spent easily $8,000. My trip to the ER was $4,000 alone. Because it was my first episode and I was in an ambulance so the ambulance ride alone was like $1,500. I mean it was crazy, but the financial costs are unbelievable.

But what’s even scarier than the financial cost – and those are scary – is again the health and quality of life cost. And Steve this is where you and I really are passionate about this because I get — I cannot tell you Steve how many emails I get from people saying, “Well, my doctor says it’s no big deal, take these beta-blockers or take these rate control drugs, you know. It’s no big deal. We don’t need to fix it.” And a lot of times they’ll come to me and say, “Is that true?” Or I’ll get people that will say, “You know, my afib is really not that bad. When I have my episodes I’m a little winded but it’s no big deal, do I really need to think about having an ablation?” And I just want to cringe because it’s just like, ugh…

Dr. Steve Ryan: Same here.

Travis Van Slooten: You know it’s just like… So, Steve let’s talk about this. What are the health and quality of life issues that go into “living with afib“?

Dr. Steve Ryan: Well, it seems you and Travis, we both have had afib and we know how wonderful it feels to go from afib to normal sinus rhythm, and to feel wonderful, your body is alive again, you can do everything that you used to do. And leaving people in afib just makes no sense. Let’s say, I mean afib is a disease, it’s a progressive disease that tends to get worse over time and wreck your life and wreck your heart.

Let’s say someone had, God forbid, pancreatic cancer and the doctor told them, “Well, we’re just going to leave you in pancreatic cancer. We’re going to give you a few meds just to keep the pain away.” You look at that doctor and say, “You’re out of your mind.” Why leave someone’s heart in a disease state where you know they’re going to get worse and maybe eventually die from it? It makes no sense at all to me.

Travis Van Slooten: And I think part of the reason for this is with afib, you know, for some people when they have their episodes they don’t feel that bad, especially with people with silent or asymptomatic afib where they don’t really feel the episodes. But even if they have bad episodes, you know, for a lot of people they have an 8-hour, 10-hour episode that goes away and they’re good for another month, but I think what happens is they fail to realize the long-term picture here of what happens to your heart if it’s left in afib. So let’s talk about that. I think that’s the crux of the issue here is that people think “We’ll hey, it’s not that bad now,” but what they don’t realize is if you keep your heart in that states, as you talked about, down the road the end game is it could ultimately lead to heart failure. That’s the issue, right?

Dr. Steve Ryan: Yes, and many other things. Leaving people in afib is a death sentence. There’s all kinds of that document that. Here’s what afib does to you. Let’s say you give them the example of someone who has maybe a 10-hour episode once or twice a month. Having episodes like that enlarges and weakens your heart, and it leads to other heart problems and heart failure and cardiovascular problems. Afib, because it is a progressive disease it remodels your heart. I mean when we talk remodeling we’re saying your heart is changing permanently because of afib.

Now afib produces what is called fibrosis. Now fibrosis is if you look inside a heart you’d say smooth — in a normal heart you’d seem normal smooth heart tissue. It looks very healthy and red and everything is proper. When the heart becomes fibrotic, that smooth heart tissue turns into fibrous tissue. It turns it to basically dead tissue. There’s no transport function, there is no nerve going through, there’s no contraction. It’s dead. It’s like having dead tissue in your heart. And that’s what afib produces. And unfortunately, even though many of the remodeling effects of afib can be corrected by a catheter ablation, fibrosis is usually irreversible.

Now the other thing that afib does because when your heart is functioning normally, the atria, the upper part of your heart squeezes down, squeezes blood down into your ventricles and the ventricles and sends the blood to the lungs.

In afib instead of that squeezing down, that pumping down blood…if you look in your heart your heart is fibrillating, it’s vibrating it’s quivering, it’s not pumping properly. I mean, you’re losing 15 to 30% of your normal pumping ability of your heart. And this action tends to stretch and dilate your left atrium. If it goes too far you lose contractual ability of your left atrium to function at all.

And obviously if you leave someone in afib, the afib attacks tend to become longer and more frequent. There’s been a study where they followed people who developed afib for a year and they were just on rate control meds to control the heart from beating too fast, but leave them in afib, almost half within a year went into a chronic all-the-time afib (long standing persistent atrial fibrillation). Yeah, so the odds are really — I guess a lot of people don’t…I mean, how many people stay in paroxysmal occasional afib for years but the odds are against them.

Travis Van Slooten: I was one of those. I went 8 years, and then it was the 8th year where it spiraled out of control and became a weekly thing, and at that point I put the brakes on that and I had my ablation.

Dr. Steve Ryan: Yeah, good for you. And some of the other things that afib does is because you’re not getting enough blood to your brain to the rest of your body, people tend to develop dementia.

I’ve heard people describe being in afib like they’re in a brain fog. You know, they go to work and they can function. Things they used to do, no problem, all of a sudden they can’t even remember what they’re doing or how to do it. Or they used to speak a foreign language now they can’t anymore because they’re in afib.

One doctor gave at a conference gave an amazing example. His patient would be talking to him normally like a normal patient, he would go into afib and he could no longer talk. That’s the kind of thing that happens with afib. It just has really bad effects over time, and to leave people in afib like that is a death sentence – all too often.

Travis Van Slooten: And so what do you tell the person that again, they go to the doctor they have paroxysmal afib, which is just occasional episodes here and there that end on their own. They go to their doctor, they’re newly diagnosed — let’s say they’re, I don’t know, let’s say they’re 50 years old they’ve had one episode and so they go in the diagnosed “Yep, yep paroxysmal afib,” and the doctor typically in this scenario is going to say, “You’re fine for now. Here’s are some beta blockers,” or maybe “here’s a pill-in-the-pocket or whatever.” So that person will come to me or probably to you too Steve and I’m sure they’ll say, ‘Do I really need to be thinking about an ablation already at this point?” I mean, how do you handle that? What do you typically advise them to do?

Dr. Steve Ryan: Well the example you gave — in other words, if they’re taking flecainide as a pill-in-the-pocket they’re doing something, they’re trying to stop the afib, and they’re trying to stay in sinus with them. That’s good. I mean it may not be the best strategy but it may be something that will work for them for a while. But just the bad thing is to let people stay in afib and just give them a rate control beta blocker to keep their heart from beating too fast. That is what will kill somebody. But if they’re taking chemicals for drugs that will stop their afib, or if they have an attack will stop that attack, that’s good; it’s not the ideal but certainly they’re doing something to keep themselves out of afib, and that’s a good thing.

Travis Van Slooten: So the message here – and this is where I wanted to get to and I’m glad that we’re going there – is the message we’re sending here is — because I know it’s semantics, but if you were diagnosed with afib you have afib but then there are the actual episodes. To my mind they are two different things like I have afib but I’m not always in afib, I don’t always have episodes, at least for some people. So for the person that, okay, they’ve been diagnosed with afib but they’re not, they don’t have episodes all the time, in other words, they’re paroxysmal, the course of action may be fine to just stick with the drugs, but the key should be you’re taking those drugs, as you mention Steve, to get out of afib but not just stay in afib and make it tolerable.

Dr. Steve Ryan: Right, and of course we must say that anti-arrhythmic drugs are very imperfect, there’s no magic pill that anyone can take that will cure them of atrial fibrillation so they never have to worry about it again. The problem with today’s anti-arrhythmic drugs is that they don’t work or if they do work for a time they lose their effectiveness eventually, or they have bad side effects that they get impossible to take them. And they’ve done a number of studies where they have compared catheter ablation to taking anti-rhythmic drugs, and catheter ablation is much more healthy. It’s, you know, all the bad things that can come from staying like a lifetime on anti rhythmic drugs versus a catheter ablation where you’re cured of afib and you don’t have to worry about it anymore, there’s no comparison.

Travis Van Slooten: Yeah, absolutely. And then certainly for someone then that has persistent afib which means your episode is a week or longer or you have long-standing persistent afib, certainly those people should not accept the diagnosis that they should just live with their afib and here’s some drugs to make it more tolerable. Those are the people we especially are saying look, there is a cure or a potential cure out there for you and it’s probably going to be an ablation or a surgical procedure, but by all means you do not have to live with afib.

Dr. Steve Ryan: Right. Now in the example you gave we should tell patients that someone who has been in persistent afib for a while is not going to be as easy as someone who just developed afib. They may have to go to a master EP and they have to go through two ablations; one to get the main spot and second for a touch-up ablation, but it’s still a lot better than living with afib. And they should realize that if you have persistent afib you do not have to live in a fib. There is a cure out there. It may not be the easiest thing to do, or you may have to research and find the best EP doctor you can find, but there is light at the end of the afib tunnel. You don’t have to live for the rest of your life in afib.

Travis Van Slooten: And I think that’s such an important message because I get so many emails from people that are in persistent afib and they tell me you know my doctor says I’m not a candidate for an ablation because I’ve been in persistent afib for 2 years and they don’t want to touch me so they just keep me on drugs. Is that true? I mean that’s kind of the gist of a lot of the emails that I get, and I always tell them that’s absolutely not true. There is hope for you.

Dr. Steve Ryan: Yeah, and I can understand many of — first of all, not all electrophysiologists (EPs) are equal. Some are better than others, some are more experienced, some do not want to fool around with anyone who has been…in fact they will say in their statement on their websites, “We don’t take anyone who has been in persistent afib for over a year.” Why? Because it’s too difficult. But that’s not the case for some of the better people like you had your ablation by Dr. Natale, Andrea Natale, right?

Travis Van Slooten: Yes.

Dr. Steve Ryan: I mean people like him take those cases all the time.

Travis Van Slooten: Yeah, I mean 75% of his caseload is just that. But like you said, your path to a cure may not be necessarily easy but certainly do not give up and say, “Well this is my life and I just got to tolerate this for as long as I can with the drugs until my time is up.” That’s not the case. Good stuff.

Dr. Steve Ryan: I’ve got one other thing. At the last AF Symposium in January there was a presentation by a Dr. Marrouche that was perhaps the most important presentation in the last 10 or 20 years for patients. I mean it’s a groundbreaking study, and it relates to what we were talking about.

It’s called The Castle AF Clinical Trial. Now what they did was they took patients who had real bad heart problems, we’re talking ejection fraction of below 35%. These are people who probably without help would die within the next year. These are patients who had really sick hearts and they had ICDs or some kind of a monitoring device inside their heart that could tell the doctors whether they were in afib or not and what was going on in their heart. Dr. Marrouche started off by saying, he gave the example of a 50 year old patient of his who had an ejection fraction of 24%, I mean that’s really low. That guy is near death. So he had an ablation and he, by the way had moved from paroxysmal afib to persistent. He had taken anti-arrhythmic drugs that didn’t work; sotalol and Amiodarone, which Amiodarone is a killer.

Travis Van Slooten: Very toxic.

Dr. Steve Ryan: He had failed electrocardioversions. So he gave him an ablation and cured his afib and right away his ejection fraction improved from 24% to 44%.

Travis Van Slooten: Wow!

Dr. Steve Ryan: Now, what that means in practice is that this guy’s life was saved. He was no longer in danger of dying from congestive heart failure. And so he went on and described The Castle AF study with a bunch of patients like this and they found that after catheter ablation there was a 47% reduction in death rates. Now you’re saying, 47%, is that good? That’s fantastic! These patients were near death, and a 47% reduction in death rate for patients who had failing hearts, that’s incredible. In the catheter ablation group, 60% improved their ejection fraction by more than 35%. That is amazing.

Travis Van Slooten: That’s amazing.

Dr. Steve Ryan: That means that these patients who had a catheter ablation basically had their lives saved. They went from a heart that wasn’t functioning to a heart that was beating normally again. And after 5 years, 60% of the ablation group were in normal sinus rhythm compared to 22% receiving normal drug therapy. And that was you know, it could be rate control, it could be amiodarone, whatever people wanted to do. And there is a 38% reduction all across mortality. Heart failure emissions were radically improved. They didn’t go to the hospital anymore because they were cured, and obviously the quality of life was just amazingly better.

Now I want to read you something. I was at the conference and one of the interesting things about it was the question-and-answer afterwards. And I want to quote you something from Dr. Hugh Calkins at Johns Hopkins said, “This is such an unbelievably fantastic study. This is the first study to show that AF ablation improves mortality and heart failure; hats off to you for getting this done. All of us believed in this procedure but people kept asking us for hard endpoints, which you have provided.”

Here we have you and I both know how wonderful it feels to go from afib to sinus rhythm, but there were no studies up to this point that said it makes any difference. In other words, so what? So you’re in sinus rhythm, you still have the same mortality according to the AFFIRM study which is an old study that nobody follows anymore.

But now we have hard data that proves catheter ablation not only removes your symptoms, makes you afib free but lets you live longer. You live a better life and you live a longer life and the more healthy life. Now Dr. Douglas Parker from the Mayo Clinic added in the Q&A he said, I mean this is a little hyperbole, he’s exaggerating but he gets the point. “People everywhere were screaming with delight when they saw the results of your paper!” He’s right.

When you were there at that meeting it was like you were watching history unfold in a way. I mean historical finding that now everybody with afib knows that a catheter ablation will not only cure you and make you feel better but will let you live longer and more healthy life. That’s really important, probably the most important to study to come out for patients in the last 10 years.

Travis Van Slooten: Yeah, and that’s a published study so we can link to that and I can dig that up?

Dr. Steve Ryan: Yes, that’s a published study in January.

Travis Van Slooten: Perfect. And I think it’s important to, that study like you said these were people that were near death, so if they experienced that great transformation, imagine the guy that’s pretty much healthy and has paroxysmal afib, I mean the benefits for him are going to be… I mean, it’s amazing. Again, that’s why Steve and I are so passionate about this topic. There is no excuse to stay in afib.

Dr. Steve Ryan: Can you imagine, let’s say you’re someone with congestive heart failure; it feels like you’re suffocating, it feels like you’re going to die any minute. And 90% of people in this condition die within a year. And all of a sudden you have a catheter ablation and your heart is normal again, you’re having a normal ejection fraction. All of a sudden you’re out walking around, you’re talking to friends, you feel great. I mean you don’t feel perfect because it’s not…but your life you have your life back. Can you imagine what that means for these patients? It’s wonderful.

Travis Van Slooten: Yeah, and their families and friends. It’s just amazing. Thanks for sharing that study. Definitely I’ll be sure to link to that in the show notes so people can look at that. Awesome. Anything else that we need to discuss on this?

Dr. Steve Ryan: No.

Travis Van Slooten: So the message here Steve is clear. The goal for every afib patient should be to end their afib and not just manage it or tolerate it, correct?

Dr. Steve Ryan: Exactly. And we’re talking rate control where they just leave you in afib and don’t try to get you out of afib.

Travis Van Slooten: Yes, awesome. Well Steve it’s been a real pleasure talking to you and I just want to thank you for your time.

Dr. Steve Ryan: My pleasure.

Travis Van Slooten: And Steve you can be found at A-Fib.com, correct?

Dr. Steve Ryan: Yes.

Travis Van Slooten: Awesome. And just a quick plug too, Steve’s got a great book, Beat Your A-Fib, available on his website and on Amazon as well. And Steve, are you going to be rolling out an updated version of that book, because I remember at one point you had mentioned you were going to work on an update. What’s the status of that?

Dr. Steve Ryan: Well, we’re working on the second edition but it hasn’t been coming along very well. We’ll keep trying. There’s just been a lot of changes in the last 4 years that needed to be addressed. The book right now is very factual and timely and helpful, but it’s just, there’s a lot of new developments like this Castle AF study. Those are the things that need to be added to the book.

Travis Van Slooten: Yeah, and the beauty of the book is as the title implies, “Beat Your A-Fib,” not live with your Afib so that’s why I wanted to put a plug in there for that book. Steve again, thanks for your time and we’ll talk to you soon. Thanks Steve.

Dr. Steve Ryan: You’re welcome.

Outro: Thanks for listening to the podcast. Be sure to visit livingwithatrialfibrillation.com for more information, inspiration and support. Be well, and please join us next time.

PODCAST: Marijuana—Good, Bad or Ugly for Patients with Atrial Fibrillation?

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Note: If you prefer to read instead of listening to the audio, click below on the transcript graphic bar to roll down the printed version.

Podcast Introduction 

Our friend, Travis Van Slooten is publisher of LivingWithAtrialFibrillation.com. With marijuana legal in a growing number of U.S. states, he invited Steve to join him on his podcast and share the latest about marijuana use by A-Fib patients. (About 18 min. in length.)

Here are the highlights of this podcast:

We do not have a lot of clinical data on marijuana and atrial fibrillation simply because it’s so new. What we know is often anecdotal at this point.
Some A-Fib patients say it helps them. Others say it puts them into A-Fib.
There has been some research saying that smoking marijuana might lead to the development of A-Fib and it may affect the cardiovascular system, but this is general data without a whole lot of really hard studies confirming that.
If there is any benefit of marijuana for A-Fib, the best form is probably CBD in edible form (but we really don’t know for sure).
An unpublished study followed 6 million heart failure patients. Those in the group that were non-dependent on marijuana were 18% less likely to develop A-Fib. Dependent marijuana users were 31% less likely to experience A-Fib.

Resources mentioned in this episode

States Where Marijuana is Legal
FAQs Coping with A-Fib: Marijuana


Travis Van Slooten was diagnosed with atrial fibrillation on Father’s Day in 2006. He would battle a-fib for nine years before having a successful catheter ablation in March 2015. He’s been a-fib-free since with no drugs! His blog covers his own journey and provides information, inspiration, and support for others with A-Fib. Visit his site.

Transcript: Marijuana and Atrial Fibrillation

Marijuana and Atrial Fibrillation

Into: The host of this podcast is not a medical doctor. The information provided is not intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician prior to starting any new treatment or with any questions you have regarding a medical condition. Now on to the show. Welcome to the Afib podcast, where we provide information, inspiration, and support for afibbers. And now your host, Travis Van Slooten.

Travis Van Slooten: I have a special guest for this episode of the afib podcast. His name is Dr. Steve Ryan. Steve is a former afib patient who was cured of his afib back in April 1998 via catheter ablation. He’s a publisher of one of the most popular afib websites, a-fib.com and he’s the author of the best-selling book Beat Your A-Fib: The Essential Guide to Finding Your Cure.

In this episode Steve and I discussed the topic of marijuana use and atrial fibrillation. We discuss recreational pot smoking versus medical marijuana and how many marijuana may or may not be beneficial for people with afib. So without further ado, let’s roll the tape.

All right, Steve, so I want to talk to you about something that it was a very interesting topic that I honestly had not thought about before. I got an email from one of my readers who wanted to know if it was safe to smoke marijuana while they had afib. First I thought this has got to be some kind of a joke because I honestly had never thought about this before, but it makes sense, you know, recreational marijuana is definitely becoming a morbid thing, it’s currently legal in nine states, and medical marijuana use is legal in 29 States.

Recent poll shows that 64% of Americans support the legalization of marijuana. So this is going to be become – if it hasn’t already – become a more kind of important topic. And then ironically, a week later I got another email from someone that had the same question, so I’m like, “Wow, this is really kind of a big deal.”

So I found an article on your site, Steve, that you just recently wrote about this very topic, marijuana use and afib. And in that article you had discussed a little bit about the differences of recreational marijuana and the prescription form of marijuana which is called marinol, and you kind of discussed that there was some key differences between these two. So what are the differences between the two? .

Steve Ryan: Travis, I apologize that we do not have a lot of clinical data on this subject simply because it’s so new and the answers I give aren’t going to be definitive, but we’re doing the best we can with the information that we have. The marinol is the prescription form of cannabis, and the makers of it have a blanket disclaimer saying “Don’t use this with any kind of heart problem…” you know, it’s kind of legal thing. They haven’t done any clinical studies on this subject to say that but they’re just protecting themselves. There have been some research saying that smoking marijuana might lead to the development of afib and it may affect the cardiovascular system, but this is general data without a whole lot of really hard studies indicating that.

Now, what I’ve done on our website is – since I don’t know enough about it to really give a definitive answer –  I have asked people to tell me their experiences and they vary all across the board. Some say that this is the best thing I’ve ever taken, some people say as soon as I start smoking marijuana I get afib. Now, the reason for that might be the different in the pot they’re smoking or the edibles they’re taking. THC is a component found in the marijuana plant stavia. That’s what makes you feel high.There is a CBD is a component found in the marijuana plant indica. That works better to reduce pain and anxiety and induce sleep. Now the problem is the manufacturers of pot – every state has their own little companies, and some produce CBD and a tincture and an oil, in edibles; but some just mix it all together and it’s really hard depending on the state to find something that is just CBD that you can use to get rid of anxiety and get to sleep, that kind of thing.

Now what is the best product for afib patients? Probably CBD in edible form. Smoking marijuana unfortunately produces a lot of problem just like smoking does because there are a lot of bad things in the cigarette smoke as there is in the marijuana smoke. So people tend to want to use marijuana for medical purposes, they’re probably better off using an edible form with more CBD and THC. Does that make any sense?

Travis Van Slooten: Yeah, absolutely. I mean looking at again that article you wrote and I’ll link to it here to in the show notes so people can reference it. If they have experience smoking marijuana or taking it medically, they can surely reach out to you and share their experience with it. But as I look at your article you do have some anecdotal stories there, and it doesn’t seem that the few that are there that I’ve had that experiences with it were people smoking it. And one of the gentleman that wrote, a guy named Jim, said that it was like a life savior for him, but again, he was taking the medical prescription form of it, so that seems to back up kind of what we’re talking here.

Steve Ryan: Yeah. He has a great statement. He’s the guy who is very under a lot of stress, he has his own business. He comes home at night and his brain was throbbing on a mile a minute and he couldn’t get to sleep. So he use marijuana edibles and the stress goes right away and he seems to sleep very well at night. Just to be honest with you, I’m also some kind of like him. I’m very wound, very tight.

Travis Van Slooten: You’re a Type A?

Steve Ryan: I tend to think of all of the things about afib. I’m thinking about, you know… And to tell you the truth, I take edible marijuana and it gets me really relaxed and I go right to sleep.

Travis Van Slooten: Let’s talk about— for people that aren’t familiar with medical marijuana, I am one of those, by the way, I know nothing about this stuff which is why I find it so fascinating, but when we talk edibles, like, what is it? Is it literally like a brownie, a piece of cake? Is it like a gum? I mean what is it? When you say edible, what is it?

Steve Ryan: There are a lot of different products, and unfortunately every state has their own different companies. We don’t have companies that are nation-wide to put out a standard product, but a lot of them are like a brownie that comes in a package like a cookie. It comes in like 100 mg and you cut it into 10 mg slices. To me that’s a pain, but a lot of people use that. Another way is they have product like this one product is blueberry based. They make the marijuana in with blueberries and you just take one, and one is 5 mg and I usually take two at night. Other forms, let see, brownies.

Travis Van Slooten: Now you mentioned and oil-based, a tincture base…

Steve Ryan: What?

Travis Van Slooten: You mentioned a tincture based. That isn’t edible but that’s a different form.

Steve Ryan: Yeah, the way they do with that is they develop a tincture with CBD in an oil, and you put it on your body and let it absorb into your body, and that’s another… I’ve never tried that. I have no idea how well that works or how good it is.

Travis Van Slooten: And that tincture that isn’t something you… You don’t put it in your mouth; you put it on your skin.

Steve Ryan: Yeah, you put it on your skin. But again, I am not an expert in this field and we’re just doing the best we can with little knowledge that we have, and I beg all the listeners to be aware that this is not something that is definitive and written in stone and this is the way to go. Everything I say may completely change when we get more information on medical marijuana.

Travis Van Slooten: Yeah, absolutely. Like you said, I think it’s just starting to explode right now. Do you know, are there any studies underway right now? Do you know of any?

Steve Ryan: Well, there was a really interesting study that just came out where they studied patients with heart failure. And what they found was that– first of all, patients with heart failure are really in deep doo-doo, we’re talking like an ejection fraction of like low or below 35% normally is 50 to 75. These patients, if they have really serious heart failure it’s like they’re suffocating to death. It’s a terrible way to go if you’re ill and you have congestive heart failure, you just feel terrible from what I understand. I’ve never had it. So what they did was they followed 6 million in US hospitals with heart failure. About 1200 used and depended on marijuana. About 2300 used marijuana, but were not depended on it. So the non-dependent marijuana users were 18% less likely to develop afib. And the dependent users were 31% less likely to experience afib.

Now what that means is that marijuana prevented these patients who had heart failure from developing afib. Now, why is that important? Basically a combination of heart failure and afib is a killer. One is bad, two together like that is much worse. These people are much more apt to die, and marijuana basically prevented these people from developing afib even though they had heart failure. This is really big news because sure, now we’re applying it to heart failure, but what about normal people, would marijuana prevent them from developing afib? We don’t know. But the study indicate that. In study would say definitely that anyone who has heart failure should consider marijuana use in some form because it does seem to prevent them from going into a atrial fibrillation. Now can we go further and say everybody should smoke marijuana to prevent them from developing afib? No, we can’t say that.

Travis Van Slooten: Yeah, absolutely. And the other thing is I suppose we don’t have the details of the study either like what form they were taking, how much they were taking every day. We don’t have that information, do we, from that study? I mean you might not have it on hand, but…

Steve Ryan: I don’t have it on hand but there would probably be some indication of that, and I’d have to look that up and maybe get back to you. Those are some good questions. But you know, in general they usually do these things it’s usually 10 mg a day. That’s a general rule of thumb. But again, I don’t really know the specifics. But people who are dependent, those are probably smokers, and they were probably doing much more smoking of pot than the other group. That worked for them and prevented them from developing afib more so than the other people.

Travis Van Slooten: Now, did that study say they were pot smokers or they were taking the medical prescription form of marijuana? Because we talked earlier that smoking was probably not the good form or as the medicals…

Steve Ryan: Since this is done between 2007 and 2014 we can assume they were smokers.

Travis Van Slooten: And that to me is kind of promising because it’s saying — of course, that leads to more questions, right? Because what’s more effective, the recreational smoking pot or the medical form of it, you know, like the edibles? I mean all these things are still — we have no idea here.

Steve Ryan: We just don’t know yet, we just don’t know. Another part of this study that was interesting was people using marijuana were 46% less likely, and dependent users 58% less likely to die in the hospital. Now that’s good news because one of the main problems with afib is you’re in the hospital so often, and that’s really good news and something that is worth looking into. By the way, this study that I’m talking about hasn’t been published yet.

Travis Van Slooten: Oh, it hasn’t, okay.

Steve Ryan: So that’s why we don’t have the information on all the details of the study. As soon as the study get published we’ll get that information.

Travis Van Slooten: That’s good to know in case someone is listening this and they’re trying to Google this they’re not going to find it right now.

. Steve Ryan: Yeah, right, I don’t think so.

Travis Van Slooten: So the bottom line with this topic then is what’s your bottom line message to someone that would pose that question that was posed to me which is, “Hey, I have afib and I smoke pot, is this good or bad?” Mypersonal response to them Steve is kind of what you said Steve “We don’t know much of anything on this topic right now because it’s kind of so new.” And the other thing is I just told them I would approach it kind of like smoking or drinking; that it’s probably not best to do it heavily on a regular basis. And more importantly, if you smoke pot and you have an episode that’s probably an indication that’s a trigger so you should probably avoid it. But likewise if you are a moderate smoker and it seems to keep your afib episode at bay, then it might be okay to continue to smoke. That was kind of the way I handled it. Is that kind of the way you handle that answer or that question is well?

Steve Ryan: Yes. Some of the people like John wrote to me and said “99% of these afib attacks occurred when I’m under the influence of marijuana.”

Travis Van Slooten: Okay, the obvious trigger.

Steve Ryan: Yeah, and Jonathan writes “I tried a tiny bit of brownie for the first time since being diagnosed with afib. It was okay until about two hours later. I went into afib and a bit later came the closest I ever have to blacking out. I don’t think it’s for me anymore.” On the other hand, Jim writes that he uses it every night and it work for him fine.

Travis Van Slooten: Yeah, so it kind of gets back to the whole what’s trigger, what’s not. And so yeah, I think it’s all fascinating. Definitely I think this is going to become more and more of an issue as I said in the opening here with the marijuana legalization kind of sweeping across the country here. This is going to become a very hot topic, I think.

Steve Ryan: Yes, definitely.

Travis Van Slooten: Well, Steve, I just want to thank you for your time to discuss this topic, and I look forward to talking to you in the next week’s episode. We’re going to be talking about the real cost of living with afib. So Steve, thanks again for your time.

Steve Ryan: You’re welcome.

Outro: Thanks for listening to the podcast.Be sure to visit livingwithatrialfibrillation.com for more information, inspiration and support. Be well, and please join us next time.

Reminder About “Holiday Heart”: Binging Alcohol, Marijuana or Rich Foods

Be aware! It’s the time of year when many people end up in a hospital’s emergency room (ER) for treatment of “Holiday Heart Syndrome”, i.e., Atrial Fibrillation triggered by binging—on alcohol, heavy foods and recreational marijuana.

Overindulging in alcohol (six or more drinks) can cause surges in the body’s adrenalin, rises in the levels of free fatty acids, alterations of how sodium moves in and out of the heart cells, and a lowering of the levels of sodium, potassium, and magnesium in the body through diuresis (increased or excessive production of urine).

Does Alcohol Alone Explain Holiday Heart Syndrome?

Recreational Marjuana and A-Fib at A-Fib.com

Trigger: marijuana use

Excessive alcohol is not the only culprit. Recreational use of marijuana can compound the risk as well. Other factors include the nicotine effect in smokers (active and passive), large quantities of rich food, and even cold weather. In addition, fireplace fires and bonfires can release ultra-fine particles in the air from burnt materials and can be bad for the heart.

New Year’s Eve Party Time: Be Aware

As you celebrate, encourage others to avoid heavy alcohol consumption and try to minimize eating large quantities of food at one time. Look for the symptoms of “holiday heart” among your relatives (hereditary A-Fib) and friends. Anyone with any heart symptoms should go to the ER. If they’re lucky, it will be a one time event.

Share the Cheer of the Season

Finally, if you know someone who is depressed, alone, or isolated during the holiday season, reach out and cheer them up.

It may be the best thing you do for their heart as well as yours.

Resources for this article
Castillo, R. Beware of the ‘holiday heart’ hazard. Philippine Daily Inquirer, December 27, 2016. http://lifestyle.inquirer.net/248983/beware-holiday-heart-hazard/

Bunch, TJ, Preventing Holiday Heart Syndrome. EverydayHealth.com. 11/26/2013. http://www.everydayhealth.com/columns/jared-bunch-rhythm-of-life/preventing-holiday-heart-syndrome/

Laposata EA, Lange LG. Presence of nonoxidative ethanol metabolism in human organs commonly damaged by ethanol abuse. Science. Jan 31 1986; 231(4737):497-9.

Ettinger PO, Wu CF, De La Cruz C Jr, Weisse AB, Ahmed SS, Regan TJ.  Arrhythmias and the “Holiday Heart”: alcohol-associated cardiac rhythm disorders.  Am Heart J. 1978; 95(5):555-62

FAQ: Updated Answer About A-Fib and Marijuana Use

During the past few years compelling evidence has developed that marijuana has significant effects on the cardiovascular system. Recently, we’ve updated our answer to this question regarding marijuana use by A-Fib patients:

Q: “Is smoking medically prescribed marijuana or using Marinol (prescription form) going to trigger or cause A-Fib? Will it help my A-Fib“?

There isn’t much clinical research on this subject. But due to the increased use of medical marijuana in California and other states, we should soon be getting more data on marijuana’s effects on A-Fib.

Feedback from A-Fib Patients About Marijuana

Recreational Marjuana and A-Fib at A-Fib.com

A-Fib and marijuana

THC and CBD: From speaking to actual marijuana users, the THC component, such as is found in the marijuana plant Stavia, is what makes you feel “high.”

The CBD component, such as is found in the marijuana plant Endica, works better to reduce pain and anxiety and induce sleep.

Best Marijuana Product for A-Fib Patients? Probably the edible forms of marijuana using primarily the CBD component seem to be something that A-Fib patients might want to investigate. Read my full answer->

Personal Experiences: You may want to read the personal experiences of A-Fib patients Jim, John, William, Jonathan and Scott who share how marijuana use has improved or provoked their A-Fib episodes. Read more->

“Holiday Heart”: Binging Alcohol, Marijuana & Rich Foods

‘Tis the season when many people end up in a hospital’s emergency room (ER) for treatment of “Holiday Heart Syndrome”, i.e., Atrial Fibrillation triggered by alcohol binging.

Overindulging in alcohol (six or more drinks) can cause surges in the body’s adrenalin, rises in the levels of free fatty acids, alterations of how sodium moves in and out of the heart cells, and a lowering of the levels of sodium, potassium, and magnesium in the body through diuresis.

Does Alcohol Alone Explain Holiday Heart Syndrome?

Recreational Marjuana and A-Fib at A-Fib.com

Trigger: recreational marijuana

Excessive alcohol is not the only culprit. Recreational use of marijuana can compound the risk as well. Other factors include the nicotine effect in smokers (active and passive), large quantiles of rich food, and even cold weather. In addition, fireplace fires and bonfires can release ultra-fine particles in the air from burnt materials and can be bad for the heart.

New Year’s Eve Party Time: Be Aware

As you celebrate, encourage others to avoid heavy alcohol consumption and try to minimize eating large quantities of food at one time. Look for the symptoms of “holiday heart” among your relatives (hereditary A-Fib) and friends. Anyone with any heart symptoms should go to the ER. If they’re lucky, it will be a one time event.

Share the Cheer of the Season

Finally, if you know someone who is depressed, alone, or isolated during the holiday season, reach out and cheer them up. It may be the best thing you do for their heart as well as yours.

Resources for this article
Castillo, R. Beware of the ‘holiday heart’ hazard. Philippine Daily Inquirer, December 27, 2016. http://lifestyle.inquirer.net/248983/beware-holiday-heart-hazard/

Bunch, TJ, Preventing Holiday Heart Syndrome. EverydayHealth.com. 11/26/2013. http://www.everydayhealth.com/columns/jared-bunch-rhythm-of-life/preventing-holiday-heart-syndrome/

Laposata EA, Lange LG. Presence of nonoxidative ethanol metabolism in human organs commonly damaged by ethanol abuse. Science. Jan 31 1986; 231(4737):497-9.

Ettinger PO, Wu CF, De La Cruz C Jr, Weisse AB, Ahmed SS, Regan TJ.  Arrhythmias and the “Holiday Heart”: alcohol-associated cardiac rhythm disorders.  Am Heart J. 1978; 95(5):555-62

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