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


Stress

PODCAST: 15 Ways to Manage the Fear & Anxiety of Atrial Fibrillation

Open in a new window: How to Combat Fear and Anxiety from Atrial Fibrillation

Don't Let A-Fib in Your Head at A-Fib.com

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

A Podcast: Managing the Fear And Anxiety that Often Comes with Atrial Fibrillation

Atrial Fibrillation is often accompanied by Fear, Anxiety and Stress. That’s the topic of this podcast between Steve and our friend, Travis Van Slooten, publisher of LivingWithAtrialFibrillation.com. We discuss many ways that may help you with the emotional component of A-Fib. This is a longer episode (37 min.) as Travis and I had a lot to share and discuss!

Highlights from this Podcast

Note: Resources mentioned in this Podcast, plus others, are included below as hyperlinked text.

1.Knowledge is power. Knowledge is control.
2. Keep an Anxiety Thought log. (See Beat the A-Fib Mental Games: Try an Anxiety Thoughts Log)
3. Give yourself a daily “worry period” and then move on.
4. Keep a daily diary. Get your thoughts, anxiety, and worry on paper. (See Big Payoff: An A-Fib Diary Helps You Cope)
5. Consider yoga, meditation, and other relaxation techniques.
6. Engage in light-to-moderate exercise such as daily walks.
7. Natural remedies to try: lavender oil, pharma GABA, L Theanine, magnesium, Relora, chamomile, and Gotu Kola (Centella asiatica).
8. Prescription drugs such as Xanax and Ativan may help.
9. Professional counseling – especially Cognitive Behavioral Therapy (CBT) can help.
10. Reach out to A-Fib.com’s Support Volunteers.
11. Contact A-Fib.com’s Positive Thought/Prayer group.
12. Talk to your friends, family, and co-workers; explain how A-Fib makes you feel. (See our Free Report: Answers to the ‘Top 10 Questions Families Ask About Atrial Fibrillation)
13. Don’t become socially isolated because of your A-Fib. Stay connected with others!
14. Spiritual beliefs can help combat fear and anxiety. Pray. Go to your place of worship. Meditate.
15. Medical devices can help give you control over A-Fib and ease fear and anxiety. (See Guide to DIY Heart Rate Monitors [HRMs] & Handheld ECG Monitors)

Transcript: The Fear and Anxiety from Atrial Fibrillation
Travis Van Slooten: All right, for today’s episode of The A-Fib Podcast I invited Dr. Steve Ryan back again.

Steve is a former A-Fib patient who was cured of his A-Fib back in April 1998 via a catheter ablation. He’s the publisher of one of the most popular A-Fib websites, a-fib.com, and he’s the author of the bestselling book, Beat Your A-Fib: The Essential Guide to Finding Your Cure.

In this episode, Steve and I discover various things afibbers can try to do to help combat the mental and emotional challenges that come with having atrial fibrillation. So with that, let’s have a listen.

All right, Steve, what I want to talk about today is the mental and emotional challenges that afibbers face, because as you know A-Fib is a lot more than just the physical aspects of the condition. In fact, often times it’s the mental and emotional challenges that are harder to overcome than the physical aspects of A-Fib.

Steve Ryan: Yes indeed.

Travis Van Slooten: And I’m talking about those things like anxiety, fear, worry, confusion, frustration, depression, and of course, even anger. But as you noted, Steve, on your website so eloquently, A-Fib may be in your heart but it doesn’t need to be in your head. So with that Steve, I want you and I to give afibbers a variety of things that they could consider doing to combat some of these mental or emotional challenges. So with that, Steve, what are some of the things then that afibbers can do to overcome these things?

Steve Ryan: First, Travis, let me thank you for bringing up this subject; it’s perhaps one of the most important subjects that patients have to deal with. Let me start off by giving you a personal example. 20 years ago I had my first afib attack, and I can remember it like it was yesterday. I came home from work – I was working on the soap opera Days of Our Lives as part of the technical crew; best job I ever had besides what I’m doing now – and my wife wasn’t home. She was out of town. I walked in the door — five minutes later my heart started going crazy on me. It felt like my heart was trying to jump out of my chest. I had all this pounding and confusion and naturally you’re asking yourself: what’s going on? Am I dying? Am I having a heart attack? You know? You’re terrorized by this thing. Because what was, you know, I wasn’t thinking straight and just drove to the hospital, the ER, and by the time I got there the episode was over.

But anyway, one of the hardest things to deal with is the terror and confusion and anxiety, like all the things you mentioned; I went through all of them in one night. And especially anger; for me anger was the key. I was so angry. I’m in perfect shape. I’m running. I’m doing everything I should, and I didn’t talk to my heart but I mean, you know? I say why are you doing this to me? I’m taking good care of you, why are you behaving like this?

Travis Van Slooten: Yeah, I’ve been there.

Steve Ryan: So, unfortunately, when you have something like this and you go to the typical ER doctor you don’t expect much help. They’ve been trained to deal with the physical aspect of A-Fib, not the emotional and psychological. They don’t have that kind of training; they don’t have that kind of interest. So unfortunately we’re left to ourselves, and I wish I had a guaranteed way to help everybody but we’re doing the best we can. The first thing is knowledge is power, knowledge is control, and the more you learn about A-Fib…Let’s say for instance in my example; if someone had told me “Well, you’re not going to die from an A-Fib attack, that’s not what happened; it feels terrible but it isn’t going to kill you.” Well, if I had known I would have been much more relieved because I didn’t know that at the time.

And just to know that A-Fib is a heart condition, that as bad as it feels it’s not going to kill you immediately, that’s very stress relieving. And the more you read, the more you can get involved in websites — and good websites, not these fly-by-night things: Mayo Clinic, Cleveland Clinic, our sites, my book. Anything you can do to develop more knowledge about A-Fib will give you more control, will give you a sense that, hey, I don’t have to live with this disease, it’s not going to kill me. I know what to do now. I know what causes it, any kind of knowledge that you can get to help relieve this anxiety.

Also, I’d like to mention that on our site we have over a hundred stories of people who have had A-Fib and been cured. Not all of them have been cured. But read some of those. If you find out that other people have symptoms like you and have been cured, that’s a real relief, that helps anxiety and gets you over the hump, so to say.

Travis Van Slooten:  Oh absolutely. I just want to backup a second. I’m just curious, Steve, so when you were first diagnosed what did your doctor tell you about A-Fib, or did they not say anything?

Steve Ryan: Again, it’s been 20 years so I can’t tell you exactly, but what I remember is they just gave me drugs. I tried every conceivable medication known to man at that time and they all didn’t work, and that’s all they could do. I don’t remember exactly what they said but they considered it a serious disease. They didn’t blow me off and say, “Don’t worry about it. There’s nothing to worry about. Everybody gets things like that.” No, they didn’t do that, they considered it seriously and they were trying to do what they can to get me out of it, but 20 years ago they didn’t know very much about A-Fib.

Travis Van Slooten: So that was very different. My experience was actually just the opposite. I actually consider myself very fortunate because like you said I went to the ER my first time and the ER doc, as you mentioned, they’re not trained to give you any real education, they’re just there to help you out and get you out the door. And I had a great ER doc and she cardioverted me and when I was done my discharge paper she just said, “Okay, you had an A-Fib episode. It’s called atrial fibrillation, and you might want to follow up with a cardiologist,” and she didn’t freak me out at all. She didn’t make it sound like it was a big deal. It wasn’t like, “Oh, this is very serious, don’t delay.” I remember her specifically telling me you might want to go see a cardiologist sometime…

Steve Ryan: Wow, really?

Travis Van Slooten: Yeah, so I was like, “Okay, this can’t be a big deal,” but I, being the kind of person I am, type A person, I made the appointment the next day. And fortunately my cardiologist was an elderly cardiologist, and I didn’t know it at the time but he was nearing retirement. So he was in his upper 70s and he just was like, “Yeah, you have atrial fibrillation. It’s not a big deal. I’m going to put you on a Holter monitor. We just want to make sure that your heart is fine,” and so they sent me on my way for a 24-hour Holter monitor.

When I turned it back in he said everything looked fine. He said it’s no big deal. He said if these come back again—he said we have three options: we can cardiovert you again like you just went through, we can try some drugs as a lot of times that works, and if it doesn’t they have this thing called an ablation where we just go in and burn the spots, and you know, it’s not a big deal.

And so I was very fortunate because I had both the ER doc and the cardiologist telling me that it wasn’t really a big deal so I went for the first several years of my atrial fibrillation thinking it wasn’t a big deal. So it was, for me, I didn’t even really need to get knowledge because my doctors were telling me “Ah, it’s not a big deal.” I don’t know if that’s necessarily the right approach either. I think they’re somewhere in between, but for me, I didn’t really have too much anxiety or anything in the first few years of my A-Fib journey just because of the way they handled it. So I just find it interesting how different experiences we had.

Steve Ryan: Well, you know, again, I think they erred on the side of being too cavalier.

Travis Van Slooten: Yeah, exactly.

Steve Ryan: Let’s face it, you don’t want your heart to be in a disease condition if you can avoid it.

Travis Van Slooten: Yes.

Steve Ryan: And also let face it, one of the things I faced was I never knew when I was going to have another attack; they would come and go. For instance, I know some people keep a log and try to determine what they eat. I tried at that, it was no use at all. I have attacks—whenever A-Fib felt like coming it came. I had no control over it. And that kind of thing really put you on edge, you know, you just can’t relax, you never know when you’re going to have an attack.

That breathes anxiety and fear, and that’s something that we need to help patients cope with as much as we can. One thing that someone suggested to me that I thought seemed to work very well—I didn’t use it, but what he called it was an Anxiety Thought Log. This is from Anthony Bladen. And what he basically did was he recognized that in his subconscious all kinds of crazy things were going on. He was in fear, his subconscious was saying, without being explicit, “you’re going to die, you’re going to have another heart attack, you’re going to have a stroke, you are never going to get over this.” All these are things that are going around in his subconscious.

What he did was he tried to write each of these bad thoughts down specifically, make them specific and he called it an anxiety thought log; write down word for word what the anxious log was when and what was the trigger. Confront each fearful thought and try to restate it in a more reasonable frame of mind.

Another thing that people suggest is have a worry period, say, 20  Minutes a day; I’m just going to let all my thoughts go crazy, I’m going to worry about everything that I probably never should worry about and I’m going to let all these thoughts go and I’m going to do this for 20 minutes and then I’m going to go watch a movie or cooking show, whatever it takes to get into a different frame of mind and not try to worry about this any other time. These anxiety thought logs can be very helpful. And that’s one of the things we recommend for coping with the psychological and emotional effects of A-Fib.

Travis Van Slooten: Absolutely. And I’ll just piggyback on that too, I think just dairying in general— you did mentioned in an episode diary. I tried doing that as well, it didn’t really work for me, but I know some people have emailed me saying for them it’s— for some people actually kind of tracking when they have the episodes it gives them kind of a sense of control. So that might not necessarily work for all people, like you said for some it actually might create anxiety, but for some people it might give them some sense of control so that’s another type of diary that you could do as well.

Steve Ryan: Yes. Another thing that seems to help a lot is yoga relaxation technique, meditation. There is a real interesting study done by this doctor Lakkireddy at the University of Kansas. He had a bunch of his patients on monitors, and some of them were going to the same yoga class all together at the same time. And he noticed that, hey, these people, their A-Fib stops during this period of time, all of them. And he said, what’s going on here?

So he found out that they were going to a yoga class, and all of a sudden the light bulb went on and he said, “Maybe I better check this out,” and he started doing testing. And basically what he did was he took these people – again, it’s a short study so it wasn’t really comprehensive – he took them and the for three months he assessed their frequency of their A-Fib episode, how long they were, their anxiety, depression, their quality of life. Then months later he switched them to take in yoga classes for three. Specifically, this was iyengar yoga, which I don’t know about, but that’s what he particularly used.

I guess it uses breathing control exercises, yoga postures that you hold for 30 to 60 seconds and meditation relaxation techniques. And he found that doing these yoga exercises cut their episodes by 40 or 50%, and also improved their emotional well-being; their heartbeat and blood pressure dropped, their depression and anxiety eased. He didn’t know exactly why this happened but he speculates it. Here’s what he says—why he thinks yoga works to help relieve anxiety and depression and as well as A-Fib symptoms; “Yoga can be actually a very good intervention here because yoga reduces the number of episodes of A-Fib so that means it is decreasing the probability of you developing more systemic inflammation. It is also clearly established that doing yoga reduces the overall inflammatory burden on your body.”

Now a lot of people think that inflammation is one of the main causes of A-Fib and that may be one of the reasons why yoga works, but he added later “It’s not going to cure A-Fib; it’s going to help. It’s going to improve the burden. It’s going to help your anxiety and depression and things like that but it only makes A-Fib less burdensome, it isn’t a cure all.”

Travis Van Slooten: Yep. Now, I wonder what do you think; would you get the same benefits from doing light exercise like brisk walks and the like? I wonder if you get the same…

Steve Ryan: Oh yeah. Now, walking is very good. Walking at the same time of the day 20 minutes with the fresh air, and that is very relaxing and can be a great help to just relieving overall anxiety and depression, and improving blood pressure. Again, whenever you do anything like yoga, like we always recommend, always check with your doctor first before you do anything like this. It may seem that’s not going to cause any problem but you should always talk to your doctor about this to make sure everything is kosher.

Travis Van Slooten:  Well, especially if you’re in persistent A-Fib and you’re already having issues breathing or whatever because you’re in A-Fib — absolutely. Awesome. Other things you mentioned on your website Steve were natural remedies, lavender oil, aromatherapy. I never did that. Steve Ryan: Travis, I forgot one thing. Can I go back?

Travis Van Slooten: Oh yeah, absolutely.

Steve Ryan: I forgot to mention a meditation technique called mindfulness. This is advocated by Harvard Pilgrim nurse case manager Linda Bixby. And what it is — now this may sound counter-intuitive, but what it is, instead of rebelling and being frightened by an A-Fib attack is to sort of embrace it, look at it; what am I going through? How does this feel? Okay, I see, my heart is beating a little faster, I’m getting a little dizzy, whatever it takes.

It’s to observe rather than resist and worry. Let an A-Fib attack run its course. And like this one guy says; “What I do is just take it in and letting myself feel the physical A-Fib experience was actually relaxing.” Now, again, I’m not saying this will work for everyone but it’s a meditation technique that might help you. Okay, now let’s go back to what you mentioned about the natural remedies.

Travis Van Slooten: Yeah, you had mentioned on your site natural remedies like lavender oil, aromatherapy – again, I never got into that – Pharma GABA. I also want to add L Theanine. I like Suntheanine specifically. I found Pharma GABA and Suntheanine to help a little bit to kind of take the edge off anxiety. Also just throw some other ones here magnesium, Relora , I’ve never heard of that actually. Chamomile and other herbal teas, and you have this other thing called Gotu Kola. I’m not even sure what that is, but talk to me about some of the natural remedies.

Steve Ryan: Yeah, I can’t speak from experience on this because I’ve been cured of A-Fib for 20 years but I know I’ve tried lavender oil and it’s very soothing. It seems to smell really good and be relaxing. As far as the other one, Pharma GABA works on the same pathway as chemical things like Xanax and Valium but it doesn’t have all the negative side effects and it’s not addictive. It’s a bioidentical form of GABA which is gamma-aminobutyric acid. It’s a calming agent. It sort of calms your nerves.

Travis Van Slooten: And like I said, I’ve tried that. I actually was taking that up until recently just to kind of take the edge off. Supplements are so different than drugs. With supplements you don’t feel like an immediate hit like you do with a drug. I just want people listening to this, if you’re taking any of these supplements it’s not something that you’re going to pop and you’re going to feel right away, it’s usually kind of a gradual thing that you actually kind of have— it takes time actually for the effect the kick in, and by that I mean taking it kind of daily. But I don’t know if it ever really worked or not, I just took it. I seemed to be more calm than not, but I don’t know…Who knows, it could have been a placebo effect for all I know. But yeah, these are all things that people should have on their radar as potential ways to help them with their…

Steve Ryan: It’s worth a try.

Travis Van Slooten: Yeah, absolutely.

Steve Ryan: I mentioned Xanax; I should preface this by saying Xanax does have anti-arrhythmic properties but it’s addictive so you’ve got to be careful of it. There have been testimonials from people who take Xanax on a regular basis. I can’t recommend that again because it is addictive. Pharma GABA might be a better alternative for that.

The others I mentioned Relora  I have never tried it, I really have no idea. It’s supposed to reduce cortisol levels and promote feelings of relaxation. Chamomile tea, that’s been well known to reduce irritability and headaches and abdominal pain coming from anxiety. What you do is you substitute chamomile tea for caffeinated beverage or take 60 drops of chamomile tincture in two ounces of water four times a day before and after meals or add two drops of concentrated chamomile essential oil to a hot bath at night. Again, those are things that you can do that aren’t going to cause you any medical problems most likely, again, everybody is different.

And in terms of Gotu Kola, I really have not had any experience with that. It’s supposed to restore health to brain and nerve cells by promoting blood circulation to the brain which has a calming effect. And as you know, A-Fib reduces blood circulation to the brain, so anything that improves blood circulation to the brain should be a help.

Travis Van Slooten: Yeah, absolutely. And I’ll just say too with the magnesium, you could take that as an oral supplement or a spray. But another thing that I actually use even today – and I’m not suffering from A-Fib, knock on wood, thanks to my ablation – but I will do foot soaks with magnesium in the water, and I find that actually very relaxing.

Steve Ryan: Epsom salt baths.

Travis Van Slooten: Absolutely, very relaxing.

Steve Ryan: The one thing you need to be careful of is don’t go whole hog on magnesium right away because excess magnesium if your body isn’t ready for it can produce diarrhea which defeats the purpose of the magnesium.

Travis Van Slooten: Yeah, exactly.

Steve Ryan: So take it easy. If you use magnesium, start it gradually and work up to ideally 600 or 800 mg of magnesium a day.

Travis Van Slooten: Yeah absolutely. I want to segue here and get into the meds just a little bit because you’d mentioned it. Again, I’m not a big advocate of meds but there’s no doubt there is a time and place for them. You mentioned Xanax. One of the meds that I was prescribed and that I even take today from time to time is Ativan, but these are drugs as you’ve mentioned can be highly addictive so you’ve got to be really careful about them.

And typically when doctors prescribe these they’re very careful about how they prescribe it and they’re very careful to monitor how much you’re taking. But these are drugs at that, you know, like I said, I’m not a big fan of them but a lot of people — I know I get emails from a lot of people that say Xanax and Ativan helps them a great deal particularly during an episode. It just helps calm them and relax them. So I don’t want to discount meds. Again, it’s not something I recommend, but it is something certainly worth considering because they might in fact play a role for some people.

Steve Ryan: Again, this goes along with counseling. If A-Fib is really bothering you, especially if you’re a guy, don’t hesitate to get professional counseling and they will indicate to you maybe if you need meds to take or that kind of thing. But guys especially we tend to tough it out “I don’t have to put up with this.” Get professional counseling if it helps, just someone to talk to about what you’re going through with A-Fib and your anxieties and what you’re worried about and how it’s affecting your family and how to cope with it. That can be important, so don’t hesitate to get professional counseling. It can be very helpful.

Travis Van Slooten: Huge. And one of my readers had emailed me the other day actually. I had posted a question on Facebook and just asked hey, what do you guys do to combat anxiety? One woman contacted me and said she had tremendous success with Cognitive Behavioral Therapy or CBT. And so I kind of looked into that a little bit, and it turns out that CBT (Cognitive Behavioral Therapy) is one of the most effective natural ways to combat anxiety. So that’s definitely counseling and specifically cognitive behavioral therapy; these are things that definitely you want to have on your list.

Steve Ryan: Yes, yes indeed, good.

Travis Van Slooten: And you mentioned professional counseling, and on your site Steve you also have A-Fib support volunteers. Now, these aren’t professional counselors. Tell me a little bit about this program.

Steve Ryan: Well, professional counseling is one thing, but these people are sort of like friends who have had A-Fib. They’re not professional counselors, they’re just friends you can talk to and share experiences with. And we have about 60 or 70 people on our website from all around the world who volunteer their time to talk to people and to be – how shall I say it – A-Fib friends; someone they can talk to about what they’re going through because they’ve been through the same experience.

Not all of them have been cured; some are still in A-Fib. So you’re getting a wide spectrum of different people with different experiences. But that is very helpful. And we also have something that I don’t—well, let me talk about it and you’ll see what I mean.

We have a positive thought prayer group, an A-Fib positive thought prayer group. Now what that means, if people are so inclined, what I do for instance when I go to church on Sunday I will have the names of people who are coming up for an ablation and I will ask people at church to pray for them, and if someone, let’s say, is coming up for an ablation and they join the positive thought prayer group they will get emails and prayers and positive thoughts from people all around the world.

It’s very… well, I’ve experienced it myself. I recently had a colon surgery and I said to myself “Oh, gee wiz, why don’t I use this positive thought prayer group. You know, it’s not a fib but they can certainly be of help to me.” So I sent my information into them, and I was moved to tears by all the wonderful responses I got from people. Obviously, since I started the program I’m probably going to get more responses than the average person, but nevertheless, it was really heartwarming.

I mean it brings tears to my eyes right now thinking about all the wonderful people who emailed me and who prayed for me and who thought positive thoughts about me when I had my surgery. It’s really wonderful.

Travis Van Slooten: Yeah, and I’ll just attest to that because I’m actually on that list and so I get the emails that come through periodically. And you’re right though, I mean it’s very powerful. And you mentioned you might get more responses than someone else but I’ll just say that someone else actually they’ll get a lot of responses. It’s a very positive program, and I highly, highly recommend it. Now if they want to do the A-Fib support volunteer or this positive thought prayer group, they just go to your website, Steve? I assume there’s a link to these two different things.

Steve Ryan: Yes, they have a link there that they can sign up for. Right now we don’t have a coordinator for the support volunteers, but we do have a great coordinator for the positive thought prayer group. But they still are functioning very well and people can make use of those resources.

Travis Van Slooten: Absolutely. And the beauty of those types of resources—because the other thing I wanted to mention on our list here Steve, was list support from friends and family.

Steve Ryan: Yes indeed.

Travis Van Slooten: Well, that’s definitely important, but one of the things that I hear from a lot of people, and I’m one of them, friends and family, you know, they can only take you so far because if they can’t empathize what you’re going through. A-Fib is such a unique condition that so many people just have a real hard time kind of understanding. So sometimes even though you reach out to friends and family you can still feel so isolated because they don’t really know what to tell you or how to support you. And that’s the beauty of your support volunteer group and the positive thought prayer group; these are people that have been there, they know exactly what you’re going through.

Steve Ryan: It’s not like you’re bleeding or you have a broken leg; it’s hard for your family to identify with what you’re going through. You need to realize that A-Fib is going to affect you not only emotionally and mentally but socially as well. Maybe not necessarily your immediate family, but your friends, your co-workers; you need to sit down and talk to them and explain what atrial fibrillation is like and ask for understanding and try to communicate to them what you’re going through, because people go to work and all of a sudden they can’t do anything anymore because their brain is in a fog because if their A-Fib. It’s really scary when you have A-Fib, and you need to help your friends and support people understand what you’re going through. That’s very important.

Travis Van Slooten: Yeah, and it can be very easy to get into this rut where you get into a situation where you start to isolate yourself from your friends and family, particularly if you have persistent A-Fib where you’re constantly feeling like crap, you know, you got friends inviting you out to do things and go golfing with you or whatever and you can’t because you’re in A-Fib. You get in the situation where you’re “No, I can’t go.” And like you said, it’s not a good idea to keep things to yourself; communicate with your friends and family, let them know, “Hey, this is what’s going on. I’m not trying to be antisocial but I just kind of feel like crap right now.” Because if they understand more it’s just going to help you in these situations.

Steve Ryan: Yes.

Travis Van Slooten: Let’s see here; you mentioned again the positive thought prayer group, and with that, you know, just religion and prayer can help a lot of people. I’m a Christian, I go to church regularly, I read the Bible daily. I try to make a point to listen to inspiring sermons on a daily basis, and I make it a point to meditate on God’s words every day if I can. So I don’t want to discount—I know some people may not be religious, but for a lot of us religion and prayer can go a long way in relieving anxiety and fear.

Steve Ryan: Yeah, most of the people on the positive thought prayer a-fib websites are Christians but not all; many are of other religions, many have no religion. There have been studies that show that positive thoughts by itself can help other people, can help them improve their health. There have been studies on that. It’s not just a ‘we’re just making it up’ kind of thing; it’s really does have an effect on people.

Travis Van Slooten: Absolutely. And then the final thing, Steve, I think that can help relieve anxiety and fear and all these negative emotions and mental challenges is – and it’s going to sound kind of weird – but medical devices accessories can go a long way. And I’ll just give you some examples from my end, and Steve you may have some as well from your readers and followers of your website, but one of my readers sent me an email; she wears a medical ID bracelet that she pushes a button and it calls 911 and she says that just helps her – she’s an elderly lady with A-Fib – and she says that just gives her a sense of security and control that if something happens she can click on this thing and help will be on its way.

Others have had implantable heart monitors; and just knowing that your heart’s being monitored and so if anything weird goes on beyond A-Fib the doctor is going to be on the other line monitoring what’s going on with your heart.

And of course, I’m a huge fan of Alivecor’s Kardia heart monitor. That thing, I cannot tell you Steve how much that got me through my A-Fib episodes; just having that device there to kind of walk me through what was going on because as I was going through an episode I could grab my Kardia heart monitor and confirm I was in A-Fib—because I was on pill in the pocket therapy at that time so I would pop my flecainide, but before I would do that I wanted to make sure I was actually in A-Fib so I used this monitor, the Kardia monitor, and then after the flecainide kicked in and I cardioverted I would use the monitor again just to confirm that I was out of A-Fib so that device was a savior for me. So these medical devices can go a long way in giving you a sense of control over this condition.

Steve Ryan: Yes, and now they are developing a watch that you wear, and you just hit two buttons on that watch and it tells everything that’s going on. It’s perhaps one of the best things that has happened to patient care in maybe the last 10 years. Why? Almost everyone over 65 should have some kind of testing for atrial fibrillation, and instead of going through EKG and maybe there is nothing going on and having a 30-day monitor or something like that, you just put on this watch and it tells you all that information, and it tells the doctor everything. From a public health aspect, if we can get this going there may come a day when no one has a silent A-Fib anymore because everyone who turns 65 gets one of these watches and it can tell the doctors whether they’re in A-Fib or not. It’s really one of the most amazing breakthroughs in medical therapy for A-Fib that I’ve seen. We’re not there yet, but we’re close.

Travis Van Slooten: Oh, yeah.

Steve Ryan: We’re close.

Travis Van Slooten: And I would say we’re rapidly heading there though so that’s the good part of that. The medical devices are just—they’re awesome. Well, Steve is there any other summary thoughts here on this topic that you want to…

Steve Ryan: Well, I really want to mention something. A lady, Pat Truesdale, said she keeps a log of everything that seems to bring on her A-Fib. And she kept this log: ice, drinks, caffeine, every meals, going to sleep at night, and she also developed symptoms that are indications of A-Fib coming: high blood pressure, belching, heartburn where she can anticipate whether she’s going to develop an A-Fib attack. And I encourage anyone who might want to read her story on our website –they might be helped by this. Now, she also has a unique story in that she’s probably the one who has had the fastest catheter ablations in history. She develops A-Fib, eight weeks later she had an ablation and was A-Fib free. I’ve never heard of something happening that fast.

Travis Van Slooten: That is fast. So she’s A-Fib-free today then?

Steve Ryan: Yes.

Travis Van Slooten: Oh wow, that’s fantastic. Definitely I’ll link to her story because I know which one you’re talking about there so we’ll definitely link to that. Awesome. All right, well perfect. Steve I appreciate you joining me today and talking about this because it is a very, very important topic. I know when I threw this question out on Facebook it was the most responded to thing I’ve ever put on Facebook.

Steve Ryan: Really?

Travis Van Slooten: Yeah, there are a lot of people that struggle with the mental and emotional challenges with A-Fib. So I’m glad we’re having this discussion, and Steve….

Steve Ryan: They won’t get much help from their doctors. That’s one of the problems.

Travis Van Slooten: And even the good doctor’s like my local EP is a fantastic doctor, I absolutely love this guy, but he gives me zero information on this stuff. So even as good as he is they’re just not trained I don’t think to do that stuff. Is that the issue? Steve Ryan: Yes. That’s the issue, yeah. In other words, psychiatry, that’s another field for them.

Travis Van Slooten: Fantastic. Steve, as always, thanks for joining me today. Steve Ryan: You’re welcome.

Travis Van Slooten: All right, bye now.

Beat the A-Fib Mental Games: Try an Anxiety Thoughts Log

Up to 40% of patients say their ‘quality of life’ has suffered due to their Atrial Fibrillation. For many that manifests as stress, fear and anxiety. It’s my opinion, electrophysiologists (EPs) generally don’t focus on, or effectively help patients deal with the distress that A-Fib often creates.

In his personal A-Fib story, Anthony Bladon shared his techniques for dealing with the mental stress of his A-Fib. He wrote, “The constant lurking fear that A-Fib may spontaneously return, is insidious. I absolutely needed to develop coping mechanisms.”

Anthony’s Two Anxiety-Busting Techniques

Anthony Blandon photo

Anthony Blandon

First, he used a 17-minute audio relaxation exercise 1 on a daily basis (or more often) for months. He then went on to describe his second technique:

“In addition I developed an “anxiety thoughts log,” making myself write down word-for-word what the anxious thought was, as well as noting the physical event that seemed to trigger it.

By confronting my most extreme fears very explicitly (i.e., ‘Is this a TIA or A-Fib?’ ‘I’m afraid of a stroke, I might die or be disabled.’ I can’t contemplate a third ablation!’), it became easier to re-state and contextualize them in a more reasonable frame of mind, thereby reducing my anxiety.

And lastly, he offer this advise:

If fears of A-Fib prey on your mind, I encourage you to seek out the help of a professional psychologist, as I did. After a few sessions of consultation, and with the continued use of tools like these, I was fully able to cope.”

To read all of Anthony Bladon’s A-Fib story, go to: Two CryoAblations, Difficult Recovery Period, Dealing with the Fear that A-Fib May Return.

Coping with Fear and Anxiety; Overview of Atrial Fibrillation

Coping ideas

Beat the Mental Stress of A-Fib

Fight your fears! Ambush your anxiety! Seek your freedom from anxiety and improve the quality of your life.

You may also want to read my article, Seven Ways to Cope with the Fear and Anxiety of Atrial Fibrillation.

A-Fib may be in your heart—
But it doesn’t have to be in your head. 

Footnote Citations    (↵ returns to text)

  1. Still available: You can listen to the free 17 minute audio relaxation exercise on the Dr. Dean Given website (or download the free mp3) at http://drdeangiven.com/?page_id=76.

My 7 Ways of Coping With the Psychological Distress of Atrial Fibrillation

The psychological and emotional effects of Atrial Fibrillation can be debilitating. Recent research indicates that “psychological distress” worsens the severity of A-Fib symptoms.

(Don’t expect much help from your cardio doctors. When it comes to the psychological and emotional aspects of A-Fib, most doctors aren’t trained or often have little effective experience in dealing with it.)

A-Fib stress attack

Coping with A-Fib

Don’t be ashamed to admit how A-Fib makes you feel (especially if you’re a guy). Your psyche is just as important as your physical heart. Just acknowledging you have some of these symptoms is a step in the right direction.

Read my article Coping With the Fear and Anxiety of Atrial Fibrillation for seven ways to fight your fears and ambush your anxiety!

Atrial Fibrillation may be in your heart— 
But it doesn’t have to be in your head.

A-Fib Patients: Is Stress Really Bad For You?

Stanford University psychologist Kelly McGonigal, PhD, author of The Upside of Stress: Why Stress Is Good for You, and How to Get Good at It, has challenged the conventional view that stress is bad for you. I found a few insights from her book encouraging for A-Fib patients.

Researchers who followed 30,000 US Americans for eight years found that the risk for death from any cause rose by 43% among participants who had high levels of stress. But that number applied only to people who believed that the stress they were experiencing was bad for their health.

From the Upside of Stress by Kelly McGonigal

From the Upside of Stress by Kelly McGonigal

Study participants who reported similar levels of stress but who did not consider it to be bad for their health, had survival rates that were actually better than those of people with relatively stress-free lives.

Dr. McGonigal recommends telling yourself “I’m excited” rather than stressed. Try to look at stress as simply your body’s response when something you care about is at stake. The pounding heart or faster breathing is your body’s way of heightening your senses so that you are mentally focused and motivated to do well.

Look at stress as a challenge rather than a looming threat.

So What Does this Mean for A-Fib Patients? Stress, by itself, is not usually a trigger for an A-Fib attack. (You could be totally stress-free, lounging on a swing on a tropical isle and still have an A-Fib attack.)

But stress can play a role in the intensity and duration of your A-Fib attacks.

Beyond the physical, A-Fib has psychological and emotional effects as well. Recent research indicates that “psychological distress” worsens the severity of A-Fib symptoms.

Kelly G book cover - Upside of Stress 75 pix wide at 300 res

Buy this book

Give Dr. McGonigal’s Advice a Try. So, when feeling stressed, try mentally ‘reframing’ the stress as a ‘challenge’ rather than as a looming threat. Tell yourself “I’m excited” rather than stressed. It may help lessen your A-Fib symptoms. (Let me know if this works for you! Email me.)

Sounds like this approach could help in many areas of our lives.

For other ways to cope with your stress, see our A-Fib.com article, Coping With the Fear and Anxiety of Atrial Fibrillation.

For more about stress from Kelly McGonigal, read her The Washington Post interview, or her book, The Upside of Stress: Why Stress Is Good for You, and How to Get Good at It.

Israeli Study Contradicts Recent CHA2DS2-Vasc Guidelines: Being Female Not a Risk Factor for Stroke

CHAD2DS2VAC Medium 100 pix at 96 resby Steve S. Ryan, May 2015

This is another powerful study contradicting the recent CHA2DS2-VASc guidelines which gives every women with A-Fib one point on the stroke risk scale because of her female gender, no matter how healthy she is otherwise.

An Israeli study tracked nearly 100,000 patients who developed A-Fib. They were followed for approximately four years between  2004 and 2011. The purpose of this observational study was to re-evaluate the risk of ischemic stroke, major bleeding and death in men and women with A-Fib.

Controversial CHA2DS2-VASc Risk Data and Analyses?

Previous controversial data and analyses showed an increased risk of stroke among women. The recent CHA2DS2-VASc risk score states that being a female is a risk factor for stroke.

“In light of our findings, we suggest to use a similar anticoagulant strategy in [both] men and women with atrial fibrillation over the age of 65.”

But in this Israeli study, “the risk of ischemic stroke was similar in men and women.” Women who developed A-Fib were older than men by four years (74 vs, 70) and had more hypertension, but lower prevalence of diabetes, congestive heart failure and ischemic heart disease. The rates of ischemic stroke were identical between male and female patients, 5.3% for both genders.

Factors associated with increased stroke risk were previous stroke, age older than 65, hypertension, congestive heart failure and diabetes. Adjusting for the age difference between the men and women who developed A-Fib in this study, death risk was associated with male gender, age over 65, previous stroke or heart attack, and diabetes.

Study Conclusion

The authors concluded, “In light of our findings, we suggest to use a similar anticoagulant strategy in men and women with atrial fibrillation over the age of 65.”

Editor’s Comments:

Intuitively it doesn’t make sense that simply being a woman makes you more at risk of having an A-Fib stroke. This study seems to confirm what common sense would indicate.
Women in their child-bearing years are much less at risk of stroke because of the blood-thinning effect of losing blood each month. And even after menopause women have less risk of stroke. But eventually they do have more strokes. But not because of an innate inferiority, but because women live longer than men. Stroke and hypertension are age related. In this israeli study women who developed A-Fib were four years older than men.
Be advised that the original European guidelines were written by doctors with major conflicts of interest. These guidelines may be a not so very subtle form of gender bias. Also, just adding one point to a person’s stroke risk score translates into a huge increase in sales for pharmaceutical companies.
References for this article
Amson, Yoav et al. Are There Gender-Related Differences In Management, And Outcome Of Patients With Atrial Fibrillation? A Prospective National Study. Arrhythmias and Clinical EP. Acc.15. JACC. March 17, 2015, Volume 65, Issue 10S. doi: 10.1016/S0735-1097(15)60469-7 Last accessed March 23, 2016. URL:http://content.onlinejacc.org/article.aspx?articleid=2198096&resultClick=3

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Last updated: Monday, March 28, 2016

FAQs from Newly Diagnosed Patient

You are not alone. A-Fib.comFrequently Asked Questions by Newly Diagnosed Patients

Newly diagnosed Atrial Fibrillation patients have many questions about living with A-Fib. These are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer)

1.  Cause: Did I cause my Atrial Fibrillation? Am I responsible for getting A-Fib?”

2.  Severity: My doctor says I had an attack of Atrial Fibrillation. How much trouble am I in?”

Related Question:Is Atrial Fibrillation a prelude to a heart attack?”

Related Question: “Can I die from my Atrial Fibrillation? Is it life threatening?”

3.  Anomaly?Could my Atrial Fibrillation go away on its own? I don’t want to take any medication. Can I just wait and see?”

Related Question: “Is it possible to have a single Atrial Fibrillation attack and not have any others? I had a single episode of A-Fib and was successfully converted in the ER with meds.”

Related Question:How can I tell when I’m in A-Fib or just having something like indigestion?”

4.  Sex/Exercise:Should I cool my sex life? Can I exercise if I have Atrial Fibrillation? Should I exercise?”

5.  Driving:Can I drive my car if I have Atrial Fibrillation?”

6.  Nutrition:Is drinking coffee (tea, colas, other products with caffeine) going to make my Atrial Fibrillation worse or trigger an A-Fib attack?”

Related Question: “Is there a diet I could follow which would cure my Atrial Fibrillation?”

7.  Medical ID:Should I carry a wallet card or a medical ID? I have A-Fib and take Coumadin (warfarin). In case of an A-Fib emergency, what information should I include?”

8.  Coping:I have a lot of stress at work. Does this stress cause or trigger my Atrial Fibrillation?”

Related Question:I live in fear of my Atrial Fibrillation. I never know when I’m going to get an A-Fib attack or how long it will last. How do I deal with the anxiety?”

Related Question: “Is there anything I can do to get out of an Atrial Fibrillation episode? How do others deal with their episodes?”

9.  Specialist?Should I see a cardiologist for my Atrial Fibrillation and not just my primary care doctor? (He wants to prescribe medication.) Should I also see an A-Fib specialist?”

10.  Cure?Is Atrial Fibrillation curable? Or can you only treat or control it? Should I seek a cure?”

11. Disability Benefits? “Can I get government social security disability benefits if I have Atrial Fibrillation?

If you find any errors on this page, email us. Last updated: Monday, October 2, 2017
Return to Frequently Asked Questions

FAQs Coping with A-Fib: Being Supportive

 FAQs Coping with A-Fib: Spouse Support

FAQs A-Fib afib“What can I do for my husband when he has an Atrial Fibrillation episode? How can I be supportive?”

First, determine if this episode is typical. If you both know from experience that this A-Fib attack will pass, you can help by getting him to sit or lay down and relax as much as possible. Maybe he needs to be reassured—remind him that this isn’t life threatening. That may help to keep you both calm and to get you through it. (I know how hard it is to “relax” when your heart feels like it’s going to jump out of your chest and is totally out of control.)

You might suggest he try one or more of these tips shared by other A-Fib patients:

•  Putting cold compresses or ice on the back of one’s neck.
•  Laying down and trying to relax in a darkened room.
•  Moderate exercise. For some, moderate exercise may help terminate an A-Fib attack. But for others, exercise may trigger or increase an A-Fib attack.
•  Deep breathing and holding one’s breathe while pressing down hard on the diaphragm.
•  A-Fib is sometimes triggered by body position—lying or leaning on the left side. Lying on one’s back and relaxing the chest may help terminate A-Fib episodes triggered by lying on the left side.
•  Putting one’s head between one’s legs and deep breathing.

If this episode is unusual and your spouse is in great discomfort with his heart beating very rapidly and irregularly, consider calling emergency services (dial 911 in the US.) or drive him to a hospital emergency room. The emergency room staff can use a defibrillator and medications to electrically shock him back into normal sinus rhythm. Or convert him back into sinus rhythm using drugs.

Learn more at: Why & How to Create Your ‘A-Fib Episode Action Plan’

Back to FAQs: Coping with Your A-Fib
Last updated: Monday, June 18, 2018

FAQs Coping with A-Fib: Develop a Plan

FAQs Coping with A-Fib: An Action Plan

FAQs A-Fib afib“During an A-Fib episode, when should I call paramedics (911 in the US) and/or take my husband to the hospital? I’m petrified. My husband’s A-Fib is getting worse. Our doctors say don’t worry unless he shows signs of a heart attack or stroke. I need a plan.”

Keep in mind, as bad as it feels, an A-Fib attack usually isn’t life threatening. (A-Fib doesn’t cause or immediately lead to a heart attack.)

Develop an Action Plan: for your own peace of mind, you and your husband need to work out an ‘A-Fib action plan’ with his doctors.

You and your husband should know:

•  when to contact his doctor
•  your doctor’s cell number or email address for emergencies
•  when to go to the emergency room
•  whether or not to call your doctor from the ER
•  if your doctor will call and talk with the ER staff
•  when your husband should “just ride out” the episode
•  the signs of stroke, and what you should be watching for

You need specific steps and a specific plan of action. Having a plan is reassuring and helps you stay calm. When having an A-Fib attack, you and your husband will be confident you’re taking the right action.

If you feel your doctor isn’t working with you (to develop a specific action plan) and/or if your spouse is getting worse, it may be time to interview and change doctors.

Read more at: Why & How to Create Your ‘A-Fib Episode Action Plan’

Having a plan is reassuring and helps you stay calm… and be confident you’re taking the right action.

Back to FAQs: Coping with Your A-Fib
Last updated: Monday, June 18, 2018

FAQs Newly Diagnosed with A-Fib: Stress

 FAQs Newly Diagnosed with A-Fib: Stress

Maze heart You are not alone - with outline 175 pix at 96 res“I have a lot of stress at work. Does this stress cause or trigger my A-Fib?”

There’s always going to be some stress in life. Nobody lives a stress-free life. Life events like the sudden death of a family member or friend can’t help but affect us in every part of our body and mind. But it’s not the danger of stress but how we respond to it that matters. If you can, take the stress in stride as part of the human condition.

Stanford University psychologist Kelly McGonigal, PhD, has challenged the conventional view that stress is bad for you. From her book, The Upside of Stress: Why Stress Is Good for You, and How to Get Good at It:

From Kelly McGonigal website quote 200 pix sq at 300 resResearchers who followed 30,000 US Americans for eight years found that the risk for death from any cause rose by 43% among participants who had high levels of stress. But that number applied only to people who believed that the stress they were experiencing was bad for their health. Study participants who reported similar levels of stress but did not consider it to be bad for their health, had survival rates that were actually better than those of people with relatively stress-free lives.

Dr. McGonigal recommends telling yourself “I’m excited” rather than stressed. Try to look at stress as simply your body’s response when something you care about is at stake. The pounding heart or faster breathing is your body’s way of heightening your senses so that you are mentally focused and motivated to do well.

Look at stress as a challenge rather than a looming threat.

Stress, by itself, is not usually a trigger for an A-Fib attack. (You could be totally stress-free, lounging on a swing on a tropical isle and still have an A-Fib attack.)

But stress can play a role in the intensity and duration of your A-Fib attacks.

Beyond the physical, A-Fib has psychological and emotional effects as well. Recent research indicates that “psychological distress” worsens the severity of A-Fib symptoms.

If you do get mired in a constant state of mental, emotional and physical tension due to stress, this can obviously affect your health and increase A-Fib. Should this happens to you, try to get medical, emotional and psychological help. We all need that kind of support from time to time.

For ways to cope with your stress, see our article, Coping With the Fear and Anxiety of Atrial Fibrillation.

For more about stress from Kelly McGonigal, read her The Washington Post interview, or her book, The Upside of Stress: Why Stress Is Good for You, and How to Get Good at It.

References for this article
McGonigal, Kelly. Stress Can Be Good for You—you just need to have the right mind-set… Bottom Line Health, July 2015, p. 8.

Schulte, Brigid. Science shows that stress has an upside. Here’s how to make it work for you. The Washington Post, May 4, 2015 URL: http://www.washingtonpost.com/news/inspired-life/wp/2015/05/04/stress-doesnt-have-to-be-so-stressful-heres-how-to-make-it-work-in-your-favor/

Go back to FAQ for the Newly Diagnosed A-Fib Patient
Last updated: Monday, June 18, 2018

FAQs Newly Diagnosed with A-Fib: Fear and Anxiety

 FAQs Coping with A-Fib: Fear & Anxiety

Maze heart You are not alone - with outline 175 pix at 96 res“I live in fear of my A-Fib. I never know when I’m going to get an A-Fib attack or how long it will last. How do people deal with this constantly lurking fear and anxiety?”

Don’t be ashamed to admit how A-Fib makes you feel (especially if you’re a guy). A-Fib has psychological and emotional effects as well as physical. Recent research indicates that “psychological distress” worsens A-Fib symptoms’ severity.

PODCAST
For my most recent report, listen to my Podcast:

15 Ways to Manage the Fear & Anxiety of Atrial Fibrillation

Go to Podcast

Seven WAYS TO COPE WITH YOUR A-FIB FEAR AND ANXIETY

1. Knowledge is Power and Control!

Read about your treatment options, learn about your A-Fib. Read how others have dealt with their A-Fib. Search the list of Personal Experiences published on his site. With over 90 stories, you’re sure to find a few patients with similar symptoms as yourself. Knowing others have beaten their A-Fib is a tremendous psychological relief. This helps replace fear with hope!

2. Anxiety Thought Log

Confront your A-Fib fears directly. Don’t let them mill around in your subconscious. Former A-Fib patient, Anthony Bladon, suggests you keep an ‘anxiety thoughts log.’ Write down word-for-word what the anxious thought was, when, and what was the trigger. Confront each fearful thought and try to re-state it in a more reasonable frame of mind, thereby reducing the anxiety. (See Anthony Bladon and his anxiety log.)

This may sound a bit bizarre, but try repeating anxious thoughts to yourself. Express a fear to yourself over and over. Let the monotony make your mind wander to more enjoyable thoughts. Or set aside a 20 minute worrying time during the day and refuse to think about troubling fears at any other time.

3. Yoga, Relaxation Techniques and Meditation 

In preliminary studies, Yoga has been demonstrated to improve A-Fib symptoms and to reduce A-Fib attacks, as well as improve quality of life, depression and anxiety. (See also FAQ: I do Yoga. It relaxes me and helps with my stress level. Is there any evidence on Yoga helping with other A-Fib symptoms?“)

Relaxation techniques and meditation may also offer you relief from your anxieties.

A specific type of meditation called ‘Mindfulness’ is recommended by Harvard Pilgrim nurse case manager Linda Bixby. The technique is to ‘Observe and Feel the Physical Sensations’ of the A-Fib Episodes. At first this may seem counter-intuitive and may not work for you. The idea is to observe rather than resist or worry. You allow a frightening health event like an A-Fib attack to just run its course. For example, Neil Blanchette was diagnosed with A-Fib when he was 17. Meditation and “mindfulness” was a great help to him. “Just taking it in and letting myself feel the physical A-Fib experience was actually relaxing.” (Thanks to David Holzman for calling our attention to this article.)

4. Natural Remedies:

Lavender Oil Aromatherapy: the light, soothing fragrance of lavender oil has long been used to ease anxiety (and insomnia). One example of many is Nature’s Way Calm Aid. “It contains Silexan, a type of lavender oil shown in clinical studies to ease anxiety as effectively as the benzodiazepine drug lorazepam (Ativan).”

PharmaGABA: is a bioidentical form of GABA (gamma-ami­nobutyric acid), which serves as a critical calming agent in the central nervous system, works on the same chemical pathways as Xanax, Valium, and other drugs—without all the negative side effects; helps combat stress and anxiousness. One example is Natural Factors PharmaGABA

Relora: a blend of two botanical extracts (Magnolia officinalis and Phellodendron amurense) that helps reduce cortisol levels and promotes feelings of relaxation.

5. Counseling and Meds

Recognize that you may need professional help. Don’t be embarrassed to seek counseling. In addition, discuss if anxiety medication would be appropriate or helpful. (See Jay Teresi’s story, “Anxiety the Greatest Challenge” and Kelly Teresi’s story “A Young Wife Copes with Husband’s A-Fib” in my book, Beat Your A-Fib, pgs. 101-105)

6. Our A-Fib Support Volunteers

It might calm your fears to talk with or email someone who knows first-hand how A-Fib makes you feel. Each of our A-Fib Support Volunteers has gone through a lot to be cured of their A-Fib. They were helped along the way and now they want to return the favor by offering you support and hope. Learn more on our A-Fib Support Volunteers page (under Resources and Links).

7. Enlist Support From Your Loved Ones

Recognize that A-Fib can have significant consequences on your social interactions with your family and colleagues. Sit down and have a talk with your significant other(s), your friends and co-workers. Explain what A-Fib is, how it affects you and how it makes you feel. Ask for their understanding. They will want to help you, so be prepared to answer their questions.

Takeaway: Fight your fears! Ambush your anxiety! Atrial Fibrillation may be in your heart but it doesn’t have to be in your head. Seek your freedom from anxiety and improve the quality of your life.

Other ideas? If you have suggestions or programs that helped reduce your A-Fib-related anxiety, please email me and let me know.
References for this Article
• Gehi AK at al. Psychopathology and symptoms of atrial fibrillation: implications for therapy. J Cardiovasc Electrophysiol. 2012 May;23(5):473-8. doi: 10.1111/j.1540-8167.2011.02264.x. Epub 2012 Mar 19. http://www.ncbi.nlm.nih.gov/pubmed/22429764
• Neale, T. Yoga May Calm Afib. MedscapeToday.com. Jan 23, 2013. Last accessed Jan 23, 2014. URL:http://www.medpagetoday.com/Cardiology/Arrhythmias/37121
• Harvard Pilgrim Health Care. Your Health, Fall 2014.
• Lucile, H. (DrHollyLucille.com) Natural remedy for anxiety, Bottom Line Health, April, 2014, p. 16.
• Whitaker, J. PharmaGABA Chewables for Immediate Stress Relief. Whitaker Wellness Institute website. Last accessed March 29, 2014. URL: http://www.whitakerwellness.com/pharmagaba/
• Whitaker, J. Innovations in Wellness Medicine, Natural Solutions for Stress Relief. Dr. Whitaker’s Health & Healing, March 2015, Vol. 25, No. 3.
• Starbuck, Jamison. The Natural Way/No More Drugs for Anxiety. Bottom Line Health, Volume 29, Number 10, October 2015, p. 10.

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FAQ for the Newly Diagnosed A-Fib Patient
Last updated: Monday, June 18, 2018

A few of our many A-Fib.com Support Volunteers

Our A-Fib.com Support Volunteers are just an email away.

Seven Ways to Reduce A-Fib Fear and Anxiety

7 Ways to Cope with the Fear and Anxiety of Atrial FibrillationCoping With the Fear and Anxiety of Atrial Fibrillation

by Steve S. Ryan, PhD

For a substantial portion of A-Fib patients, the impact on ‘quality of life’ extends beyond our beating heart. Atrial Fibrillation wreaks havoc with your head as well as your heart. Anxiety, fear, worry, confusion, frustration and depression. And at times, anger.

The psychological and emotional effects of Atrial Fibrillation can be debilitating. Recent research indicates that “psychological distress” worsens A-Fib symptoms’ severity.

(Don’t expect much help from your heart doctors. They aren’t trained or often have little effective experience in dealing with the psychological and emotional aspects of A-Fib.)

Don’t be ashamed to admit how A-Fib makes you feel (especially if you’re a guy). Your psyche is just as important as your physical heart. Just acknowledging you have some or all of these symptoms is a step in the right direction.

Seven WAYS TO COPE WITH YOUR A-FIB FEAR AND ANXIETY

1. Knowledge is Power and Control!

Read about your treatment options, learn about your A-Fib. Read how others have dealt with their A-Fib. Search the list of Personal Experiences published on his site. With over100 stories, you’re sure to find a few patients with similar symptoms as yourself. Knowing others have beaten their A-Fib is a tremendous psychological relief. This helps replace fear with hope!

2. Anxiety Thought Log

Confront your A-Fib fears directly. Don’t let them mill around in your subconscious. Former A-Fib patient, Anthony Bladon, suggests you keep an ‘anxiety thoughts log.’ Write down word-for-word what the anxious thought was, when, and what was the trigger. Confront each fearful thought and try to re-state it in a more reasonable frame of mind, thereby reducing the anxiety. (See Anthony Bladon and his anxiety log.)

This may sound a bit bizarre, but try repeating anxious thoughts to yourself. Express a fear to yourself over and over. Let the monotony make your mind wander to more enjoyable thoughts. Or set aside a 20 minute worrying time during the day and refuse to think about troubling fears at any other time.

3. Yoga, Relaxation Techniques, Meditation and Walking 

In preliminary studies, Yoga has been demonstrated to improve A-Fib symptoms and to reduce A-Fib attacks, as well as improve quality of life, depression and anxiety. (See also FAQ #8 I do Yoga. It relaxes me and helps with my stress level. Is there any evidence on Yoga helping with other A-Fib symptoms?)

Relaxation techniques and meditation may also offer you relief from your anxieties.

A specific type of meditation called ‘Mindfulness’ is recommended by Harvard Pilgrim nurse case manager Linda Bixby. The technique is to ‘Observe and Feel the Physical Sensations’ of the A-Fib Episodes. At first this may seem counter-intuitive and may not work for you. The idea is to observe rather than resist or worry. You allow a frightening health event like an A-Fib attack to just run its course. For example, Neil Blanchette wrote online that he was diagnosed with A-Fib when he was 17. Meditation and “mindfulness” was a great help to him. “Just taking it in and letting myself feel the physical A-Fib experience was actually relaxing.”

Walking curbs anxiety. Try to walk outdoors at approximately the same time each day. Breathing fresh air and having an established routine enhance the calming and relaxing effects of walking. But even if you can’t walk at the same time or outdoors, 20 minutes of walking daily reduces anxiety.

4. Natural Remedies:

Lavender Oil Aromatherapy: the light, soothing fragrance of lavender oil has long been used to ease anxiety (and insomnia). One example of many is Nature’s Way Calm Aid. “It contains Silexan, a type of lavender oil shown in clinical studies to ease anxiety as effectively as the benzodiazepine drug lorazepam (Ativan).”

PharmaGABA: is a bioidentical form of GABA (gamma-ami­nobutyric acid), which serves as a critical calming agent in the central nervous system, works on the same chemical pathways as Xanax, Valium, and other drugs—without all the negative side effects; helps combat stress and anxiousness. One example is Natural Factors PharmaGABA

Relora: a blend of two botanical extracts (Magnolia officinalis and Phellodendron amurense) that helps reduce cortisol levels and promotes feelings of relaxation.

Chamomile: “calms the nerves, reduces irritability and lessens the muscle spasms, headache and abdominal pain that can accompany anxiousness.” Substitute chamomile tea for caffeinated beverages, or take 60 drops of chamomile tincture in two ounces of water four times a day before or after meals, or add two drops of concentrated chamomile essential oil to a hot bath at night.

Gotu Kola: restores health to brain and nerve cells by promoting blood circulation to the brain which has a calming effect.

5. Counseling and Meds

Recognize that you may need professional help. Don’t be embarrassed to seek counseling. In addition, discuss if anxiety medication would be appropriate or helpful. (See Jay Teresi’s story, “Anxiety the Greatest Challenge” and Kelly Teresi’s story “A Young Wife Copes with Husband’s A-Fib” in my book, Beat Your A-Fib, pgs. 101-105)

6. Our A-Fib Support Volunteers

It might calm your fears to talk with or email someone who knows first-hand how A-Fib makes you feel. Each of our A-Fib Support Volunteers has gone through a lot to be cured of their A-Fib. They were helped along the way and now they want to return the favor by offering you support and hope. Learn more on our A-Fib Support Volunteers page (under Resources and Links).

7. Enlist Support From Your Loved Ones

Recognize that A-Fib can have significant consequences on your social interactions with your family and colleagues. Sit down and have a talk with your significant other(s), your friends and co-workers. Explain what A-Fib is, how it affects you and how it makes you feel. Ask for their understanding. They will want to help you, so be prepared to answer their questions.

Takeaway: Fight your fears! Ambush your anxiety! Atrial Fibrillation may be in your heart but it doesn’t have to be in your head. Seek your freedom from anxiety and improve the quality of your life.

Other ideas? If you have suggestions or programs that helped reduce your A-Fib-related anxiety, please email me and let me know.
References for this Article
• Gehi AK at al. Psychopathology and symptoms of atrial fibrillation: implications for therapy. J Cardiovasc Electrophysiol. 2012 May;23(5):473-8. doi: 10.1111/j.1540-8167.2011.02264.x. Epub 2012 Mar 19. http://www.ncbi.nlm.nih.gov/pubmed/22429764

• Neale, T. Yoga May Calm Afib. MedscapeToday.com. Jan 23, 2013. Last accessed Jan 23, 2014. URL:http://www.medpagetoday.com/Cardiology/Arrhythmias/37121

• Harvard Pilgrim Health Care. Your Health, Fall 2014. • Lucile, H. (DrHollyLucille.com) Natural remedy for anxiety, Bottom Line Health, April, 2014, p. 16.

• Whitaker, J. PharmaGABA Chewables for Immediate Stress Relief. Whitaker Wellness Institute website. Last accessed March 29, 2014. URL: http://www.whitakerwellness.com/pharmagaba/

• Whitaker, J. Innovations in Wellness Medicine, Natural Solutions for Stress Relief. Dr. Whitaker’s Health & Healing, March 2015, Vol. 25, No. 3.

• Starbuck, Jamison. The Natural Way/No More Drugs for Anxiety. Bottom Line Health, Volume 29, Number 10, October 2015, p. 10.

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Return to Dealing with A-Fib

If you find any errors on this page, email us. Y Last updated: Saturday, April 7, 2018

What Causes Atrial Fibrillation?

Causes of Atrial Fibrillation at A-Fib.com

What are the Causes of A-Fib?

It’s estimated as many as 5.1 million people in the U.S. have A-Fib. By the year 2050, the number will be 12-16 million. Each year there are over 340,000 new cases in the US. A-Fib is the most common heart arrhythmia. In the U.S. people over 40 have a one in four lifetime risk of developing A-Fib.

Worldwide the number of cases is estimated to be 33.5 million or 0.5% of the world’s population. A-Fib has rightly been called an emerging epidemic.

Risk Factors: HOW DO YOU GET A-FIB?

Heart Problems

If you’ve had other heart problems, this could lead to diseased heart tissue which generates the extra A-Fib pulses. Hypertension (high blood pressure), Mitral Valve disease, Congestive Heart Failure, coronary artery disease, and obesity seem to be related to A-Fib, possibly because they stretch and put pressure on the pulmonary veins where most A-Fib originates. Coronary artery disease reduces blood flow and oxygen (stagnant hypoxia) which can trigger A-Fib.

Coronary artery disease reduces blood flow and oxygen (stagnant hypoxia) which can trigger A-Fib.

A lot of A-Fib seems to come from uncontrolled high blood pressure. Many EPs recommend that all hypertension patients get a home BP monitor and aggressively work at controlling their blood pressure.

About 25% to 35% of stroke survivors experience atrial fibrillation; Up to 40% of patients get A-Fib after open heart surgery. “Pericarditis”—inflammation of the pericardium, a sack-like membrane surrounding the heart—can lead to A-Fib.

Alcohol Consumption

Heavy drinking may trigger A-Fib, what hospitals call “holiday heart”―the majority of A-Fib admissions occur over weekends or holidays when more alcohol is consumed. No association was found between moderate alcohol use and A-Fib. (Heavy drinking reduces the ability of cells to take up and utilize oxygen [histotoxic hypoxia] which in some people may produce or trigger A-Fib. [Thanks to Warren Stuart for this insight.])

See the personal A-Fib story by Kris: “Binge Drinking Leads to Chronic A-Fib, Amiodarone Damages Eyesight” pp. 144-150 in my book, Beat Your A-Fib.

But if you already have A-Fib, even moderate use may trigger an A-Fib attack, “…people with atrial fibrillation had almost a four and a half greater chance of having an episode if they were consuming alcohol than if they were not. (Thanks to David Holzman for calling our attention to this article.)

Otherwise healthy middle-aged women who consumed more than 2 drinks daily were 60% more likely to develop A-Fib.

Steve Walters writes “that red wine brings on A-Fib attacks for him, but not beer, white wine, or cordials. Has anyone else had similar experiences with red wine?” E-mail: bicwiley(at)gmail.com.

Neville writes that “taking a heavy dose of Magnesium/Potassium tablets and bananas for breakfast kept him out of A-Fib during a golfing weekend with significant drinking.” He uses the same strategy to get out of an A-Fib attack. mfa@optusnet.com.au 

Severe Body & Mind Stress

Severe infections, severe pain, traumatic injury, and illegal drug use can be a trigger. Low or high blood and tissue concentrations of minerals such as potassium, magnesium and calcium can trigger A-Fib. Thyroid problems (hyperthyroidism), lung disease, reactive hypoglycemia, viral infections and diabetes.

To learn the impact of anxiety and emotional stress on A-Fib, see Jay Teresi’s personal story “Anxiety the Greatest Challenge

Extreme fatigue, anxiety and emotional stress can trigger A-Fib. (Even “minor” stress may trigger A-Fib. Harlan writes that something as simple as watching an emotional or scary movie or TV show may trigger his A-Fib.)

Smoking can trigger A-Fib. Smoking reduces the ability of the blood to carry oxygen (anemic hypoxia). Smoking cigarettes raises the risk of developing A-Fib even if one stops smoking, possibly because past smoking leaves behind permanent fibrotic damage to the atrium which makes later A-Fib more likely.

Being Overweight

As we put on pounds, our risk of developing A-Fib increases. In recent studies overweight adults were 39% more likely, and obese adults 87% more likely, to develop A-Fib than their normal-weight counterparts.

Health problems linked to obesity, like high blood pressure and diabetes, can contribute to A-Fib. And obesity may put extra pressure on the pulmonary veins and induce A-Fib. Left atrial hypertension is a common finding in obese patients.

Genetics

See the personal story and VIDEO by Susan Klein: My Family’s A-Fib was Misdiagnosed for Years.

Research has identified a Familial A-Fib where A-Fib is passed on genetically. Do you have a parent or other immediate family member with A-Fib? Research says you have a 40% increased risk of developing A-Fib yourself. And the younger that family member was when they got A-Fib, the more likely you are to develop A-Fib.

According to Dr. Dan Roden of Vanderbilt University, genetic research may become important to A-Fib patients. He postulates that “Lone A-Fib” (A-Fib without a known cause) may actually be caused by genetics.

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A-FIB TRIGGERS

We’ve had reports that A-Fib can be triggered by antihistamines, bronchial inhalants, local anesthetics, medications such as sumatriptan, a headache drug, tobacco use, MSG, cold beverages and eating ice cream, high altitude, and even sleeping on one’s left side or stomach. One person writes that hair regrowth products seem to trigger his A-Fib.

When I had A-Fib, I used to include caffeine (coffee, tea, sodas, etc.) in this list, but some research suggests that coffee and caffeine in moderate to heavy doses (2-3 cups to 10 cups/day) may not trigger or induce A-Fib. Coffee (caffeine) may indeed be antiarrhythmic and may reduce propensity and inducibility of A-Fib both in normal hearts and in those with focal forms of A-Fib.

Possible Food-Related Triggers

Chocolate in large amounts may trigger attacks. Chocolate contains a little caffeine, but also contains the structurally related theobromine, a milder cardiac stimulant.

Another reader writes that the natural sweetener and sugar substitute Stevia seems to trigger her A-Fib.

GERD (heartburn) and other stomach problems (like H. pylori) may be related to or trigger A-Fib. If so, antacids and proton pump inhibitors like Nexium may help your A-Fib. A report from England suggests that the veterinary antibiotic “Lasalocid” found in eggs and poultry meat may cause or trigger A-Fib.

Sleep Apnea

Recent research indicates sleep apnea (where your breathing stops while you are sleeping) may contribute to A-Fib, probably by causing stress on the Pulmonary Vein openings and/or by depriving the lungs and body of adequate oxygen supply (Hypoxemic Hypoxia).

Over 25 million Americans currently have sleep apnea, but 80% of these people don’t know they have it.

In one study of patients with A-Fib, 43% had sleep apnea. (An additional 31% had “central sleep apnea/Cheyne-Stokes respiration” which is a different type of sleep apnea.) 

If you have A-Fib, it’s wise to have yourself checked for sleep apnea. You can do a “quick” check of how much oxygen is in your blood with a Pulse Oximeter, such as the Contec Pulse Oximeter for about $20 from Amazon.com and in drug stores. A reading below 90% would indicate you need to have a sleep lab study.

Gail writes that “both her sleep apnea and her A-Fib were cured by a CPAP [Continuous Positive Airway Pressure] breathing machine.” (E-mail her: gail(at)bonairwine.com.)

To learn more, see Sleep Apnea: When Snoring Can Be Lethal and Sleep Apnea: Home Testing with WatchPAT Device and the Philips Respironics

Mechanically Induced A-Fib

Be careful if you work around equipment that vibrates. Certain frequencies and/or vibrations may possibly trigger or induce A-Fib. (If anyone has any info on how or why high frequencies and/or vibrations may possibly affect A-Fib, please email me.)

Jerry writes that “high powered magnets, such as the N50, may trigger A-Fib due to the electromagnetic fields they generate.” (If you have any info on this, please email me.)

Physical and Gender Characteristics

Men get A-Fib more than women. But women may have more symptoms.

Athletes are more prone to A-Fib perhaps because they have larger hearts where there is more room for these extra electrical signals to develop and propagate, and possibly because of the extra pressure they put on their pulmonary veins through aerobic exercise. A-Fib is often found in tall people, particularly basketball players.

Men get A-Fib more than women. But women fail more antiarrhythmic drugs therapies than men and may have more symptoms. For more see my article: The Facts About Women with A-Fib: Mother Nature and Gender Bias.

Aging

A-Fib is associated with aging of the heart. As patients get older, the prevalence of A-Fib increases, roughly doubling with each decade. 2-3% of people in their 60s, 5-6% of people in their 70s, and 8-10% of people in their 80s have A-Fib. Approximately 70% of people with A-Fib are between 65 and 85 years of age.

This suggests that A-Fib may be related to degenerative, age-related changes in the heart. Inflammation may contribute to the structural remodeling associated with A-Fib.

No Known Cause

But in many A-Fib cases (around 50% of Paroxysmal A-Fib, there is no currently discernible cause or trigger (called “Lone” or “Idiopathic A-Fib”). (Some research suggests that inflammation may initiate Lone A-Fib.)

Explore Treatments for A-Fib

Regardless of the cause of your A-Fib, we make it easy to explore the various treatments for Atrial Fibrillation. Both short-term and long-term approaches aim to control or eliminate the abnormal heart rhythm associated with A-Fib. Go to Treatments.

Resources for this article
▪ Miyasaka, Yoko, et al, Secular Trends in Incidence of Atrial Fibrillation in Olmsted County, Minnesota, 1980 to 2000, and Implications on the Projections for Future Prevalence Circulation, 2006;114:119-125. Last accessed Feb 15, 2013. URL: http://www.circ.ahajournals.org/cgi/content/full/114/2/119

▪ Nelson, Bryn. “Places In The Heart,” NYU Physician. Spring, 2009, p. 8.

▪ Van Wagoner, David “Atrial selective strategies for treating atrial fibrillation.” Drug Discovery Today: Therapeutic Strategies Vol 2, No. 3, 2005. “We have detected increased levels of the systemic inflammatory marker C-reactive protein (CRP) in patients with A-Fib.”

▪ S. S. Chugh, et al. Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study. Circulation, 2013; DOI: 10.1161/CIRCULATIONAHA.113.005119

▪ Camm, “Stroke in atrial fibrillation: Update on pathology, new antithrombotic therapies, and evolution of procedures and devices.” Annals of Medicine, 39:5, 371-391, 2007

▪ The Link Between Infections and Inflammation in Heart Disease. Life Extension Vitamins. Last accessed November 5, 2012 http://www.lifeextensionvitamins.com/cadico6otco.html

▪ Bottom Line Personal, October 15, 2014, p. 11. Kallmunzer, Bernd et al. Peripheral pulse measurement after ischemic stroke. Nuerology, Published Online May 6, 2014 http://www.neurology.org/content/83/7/598.abstract?sid=f532228b-5314-46d3-bdca-a7db9bc7fa7d

▪ Frost L., et al. “Atrial fibrillation and flutter after coronary artery bypass surgery: epidemiology, risk factors and preventive trials. International Journal of Cardiology. 1992;36:253-262.

▪ Calkins, H. and Berger, R. “Atrial Fibrillation The Latest Management Strategies.” The Johns Hopkins Medicine Library, p. 10.

▪ Alcohol May Trigger Serious Palpitations in Heart Patients. American Journal of Cardiology (August 1, 2012) http://www.newswise.com/articles/alcohol-may-trigger-serious-palpitations-in-heart-patients

▪ Conen D, Tedrow UB, Cook NR, Moorthy MV, Buring JE, Albert CM (December 2008). “Alcohol consumption and risk of incident atrial fibrillation in women”. JAMA 300 (21): 2489 96. doi:10.1001/jama.2008.755. PMID 19050192. PMC 2630715. http://jama.ama-assn.org/cgi/content/full/300/21/2489.

▪ Heeringa J, et al. Cigarette smoking and risk of atrial fibrillation: the Rotterdam Study. Am Heart J. 2008 Dec;156(6):1163-9. doi: 10.1016/j.ahj.2008.08.003. Last accessed Jan 6, 2013 URL: http://www.ncbi.nlm.nih.gov/pubmed/19033014

▪ Brugada R. “Identification of a genetic locus for familial atrial fibrillation,” New England Journal of Medicine 1997;336:p. 905-911. Ellinor et al., 2005, 2008. Sinner et al., 2011.

▪ The Link Between Infections and Inflammation in Heart Disease. Life Extension Vitamins. Last accessed November 5, 2012 http://www.lifeextensionvitamins.com/cadico6otco.html

▪ Katan, M, Schouten, E. Caffeine and arrhythmia1,2,3. Am J Clin Nutr March 2005 vol. 81 no. 3 539-540. Last accessed November 5, 2012 http://www.ajcn.org/cgi/content/full/81/3/539

▪ Rashid, Abdul et al. “The effects of caffeine on the inducibility of Atrial fibrillation.” J Electrocardiol. 2006 October, 39(4): 421-425. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2257921/

▪ Barclay, L. Caffeine Not Associated With Increased Risk of Atrial Fibrillation. Mar 10, 2005. Medscape News Today. Last accessed November 5, 2012. http://www.medscape.com/viewarticle/501279?src=search

▪ Bitter, T. et al. Sleep-disordered Breathing in Patients With Atrial Fibrillation and Normal Systolic Left Ventricular Function. Dtsch Arztebl Int 2009; 106(10): 164-70  http://www.aerzteblatt.de/pdf/di/106/10/m164.pdf. DOI: 10.3238/arztebl.2009.0164

▪ “The tallest patients in a recent study were 32% more likely to have A-Fib than the shortest ones. Doctors estimate that for every six-inch increase in height, the risk for A-Fib increases by 50%.” Bottom Line Health, July, 2006, p. 1

▪ Go, “Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention.” JAMA, 2001:285:2370-2375.

▪ Philip A. et al. Atrial Fibrillation: A Major Contributor to Stroke in the Elderly: The Framingham Study. Arch Intern Med 1987;147:1561-1564.

▪ Feinberg, “Prevalence, age distribution, and gender of patients with atrial fibrillation: analysis and implications.” Arch Intern Med 1995;155:469-473. ▪ Laish-Farkash, A. et al. Atrial Fibrillation in the Elderly—To Ablate or Not to Ablate, J Cardiovasc Electrophysiol. 2013;24(7):739-741. http://www.medscape.com/viewarticle/807303.

▪ Van Wagoner, David “Atrial selective strategies for treating atrial fibrillation.” Drug Discovery Today: Therapeutic Strategies Vol 2, No. 3, 2005. “We have detected increased levels of the systemic inflammatory marker C-reactive protein (CRP) in patients with A-Fib.“ Allessie, Maurits A. et al. “Pathophysiology and Prevention of Atrial Fibrillation.” Circulation. 2001;103:769.

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