"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

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

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


"Steve Ryan's summaries of the Boston A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation."

Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

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

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

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

Terry Traver, former A-Fib patient

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

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


New FAQ: Risks of Xarelto and 3 Alternatives to Anticoagulants

We’ve posted a new FAQ and answer about the risks of anticoagulants and three alternatives to taking them.

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

You are right to be concerned about the side effects of Xarelto, one of the new Novel Oral Anticoagulants (NOACs). Uncontrolled bleeding is the primary risk (patients have bled to death in the ER.)

Be advised: No anticoagulant will absolutely guarantee you will never have a stroke.

All anticoagulants are inherently dangerous. You bruise easily, cuts take a long time to stop bleeding, you can’t participate in any contact sports; there is an increased risk of developing a hemorrhagic stroke and gastrointestinal bleeding. (Most EPs are well aware of the risks of life-long anticoagulation.)

Anticoagulants cause or increase bleeding. That’s how they work. To decrease your risk of blood clots and stroke, they hinder the clotting ability of your blood. But, they also increase your risk of bleeding. But in spite of the possible negative effects of anticoagulants, if you have A-Fib and a real risk of stroke, anticoagulants do work.

What Else Can You Do? Remove the Reason for an Anticoagulant—Three Options

The best way to deal with the increased risk of stroke and side effects of anticoagulants is to no longer need them. Here are three options…<…continue… to read my full answer…>

FAQs A-Fib Drug Therapy: Anticoagulant Side Effects and Alternatives to Xarelto (NOACs)

 FAQs A-Fib Drug Therapy: Alternatives to Xarelto

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

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

You are right to be concerned about the side effects of Xarelto, one of the new Novel Oral Anticoagulants (NOACs).

All anticoagulants are inherently dangerous. You bruise easily, cuts take a long time to stop bleeding, you can’t participate in any contact sports; there is an increased risk of developing a hemorrhagic stroke and gastrointestinal bleeding. (Most EPs are well aware of the risks of life-long anticoagulation.)

Primary risk: Uncontrolled bleeding is the primary risk (patients have bled to death in the ER.) Anticoagulants cause or increase bleeding. That’s how they work. To decrease your risk of blood clots and stroke, they hinder the clotting ability of your blood. But, they also increase your risk of bleeding.

Normally, clotting is a good thing like when you have a scrape or cut.

Other risks: Do the NOACs have the same long-term problems as warfarin (Coumadin), i.e., microbleeds in the brain, hemorrhagic stroke, early dementia, etc.?

We don’t know yet. The NOACs haven’t been around long enough to determine their side effects. But intuitively one would expect so. (The recent spate of ads from lawyers seeking clients who have been harmed by NOACs would seem to lead to this conclusion.)

Anticoagulants Protect You and Give Peace of Mind

But in spite of the possible negative effects of anticoagulants, if you have A-Fib and a real risk of stroke, anticoagulants do work. You’re no longer 4–5 times more likely to have an A-Fib (ischemic) stroke. Taking an anticoagulant to prevent an A-Fib stroke also may give you peace of mind.

What Else Can You Do? Remove the Reason for an Anticoagulant—Three Options

Be advised: No anticoagulant will absolutely guarantee you will never have a stroke.

Be advised that no anticoagulant or blood thinner will absolutely guarantee you will never have a stroke. Even warfarin [Coumadin] only reduces the risk of stroke by 55% to 65% in A-Fib patients. See Risks of Life-Long Anticoagulation.

The best way to deal with the increased risk of stroke and side effects of anticoagulants is to no longer need them. Here are three options:

#1 Alternative: Get rid of your A-Fib.

As EP and prolific blogger Dr. John Mandrola wrote: “…if there is no A-Fib, there is no benefit from anticoagulation.”

Action: Request a catheter ablation procedure. Today, you can have an ablation immediately (called ‘first-line therapy’). You don’t have to waste a year on failed drug therapies. See Catheter Ablation Reduces Stroke Risk Even for Higher Risk Patients

#2 Alternative: Close off your Left Atrial Appendage (LAA).

The Left Atrial Appendage is where 90%-95% of A-Fib clots originate.

Action: Request a Watchman device. The Watchman device is inserted to close off your LAA and keep clots from entering your blood stream. See Watchman Better Than Lifetime on Warfarin

#3 Alternative: Consider non-prescription blood thinners

Ask your doctor about your CHA2DS2-VASc score (a stroke risk assessor). If your score is a 1 or 2 (out of 10), ask if you could take a non-prescription approach to a blood thinner.

Perhaps you can benefit from an increase in natural blood thinners such as turmeric, ginger and vitamin E or, especially, the supplement Nattokinase. See FAQ: “Are natural blood thinners as good as prescription blood thinners?” 

Bottom Line

Whether or not to take anticoagulants (and which one) is one of the most difficult decisions you and your doctor must make. Talk to your doctor about alternatives to anticoagulants: 

Taking an anticoagulant isn’t like taking a daily vitamin. Only take one if you are at a real risk of stroke.

• Catheter ablation
• LAA closure (Watchman device)
• Non-prescription blood thinners

If you decide to stay on a NOAC, ask your doctor about taking Eliquis instead of Xarelto. Eliquis tested better than the other NOACs and is considered safer. See Warfarin vs. Pradaxa and the Other New Anticoagulants and the FAQ: Is Eliquis Safer.

Thanks to Jim Lewis for this question.

You must be your own best patient advocate.
Don’t settle for a lifetime on anticoagulants or blood thinners.

Don't Settle for a lifetime on medication 10-2015 400 x 500 pix at 300 res

Last updated: Thursday, May 19, 2016 Return to FAQ Drug Therapies

The Year in Review: Highlights and Achievements

By Steve S. Ryan, PhD

When I think about the field of atrial fibrillation in 2013, several thoughts come to mind. There were technical advancements, some new drug therapies, and additions to our understanding of Atrial Fibrillation (and a few accomplishments for our A-Fib.com website).

Heart Imaging And Mapping Systems

Perhaps the most important technical innovations in 2013 for A-Fib patients were the introduction of two new heart imaging and mapping systems. A third system, the Bioelectronic Catheter, represents a whole new technology with tremendous potential for A-Fib patients.

Patients wearing 'vest' lies down for the ECGI.

The ECGI System

The ECGI system, combined with a CT scan, produces a complete 3-D image of your heart along with identifying all the A-Fib-producing spots. Think of it as an ECG with 256 special high resolution electrodes rather than 12. It greatly reduces your ablation time and your radiation exposure.

A day before your ablation, you simply don a special vest with 256 electrodes covering your upper torso, and lay down. The 3-D image created is a road map of your heart with all the focal and rotor areas (A-Fib-producing spots) identified. During your ablation your EP simply ablates the “guilty” areas. Read more of my article…

Topera-FIRMap catheter - three sizes

The FIRM System

The FIRM system uses a different approach to mapping the heart and the A-Fib producing spots. It uses a basket catheter inside the heart to map large areas in a single pass and reveal the location of foci and rotors. Read more of my article…

Why are these two technologies important? ECGI allows your imaging & mapping to be performed the day prior to your ablation, rather than during your ablation. This shortens the length of your ablation procedure.  In addition it reduces your radiation exposure and produces remarkably accurate 3D images of your heart and identifies where A-Fib signals are coming from. The FIRM system, though performed during an ablation rather than before it, may be a significant improvement over the Lasso catheter mapping system now in current use. Both systems may mark a new level of imaging/mapping for A-Fib.

Flexible Biomechanical Balloon Catheter - photo credit: Dae-Hyeong Kim-University of Illinois

Stretchable Electronics Meets the Balloon Catheter

The merging of living systems with electronic systems is called “bioelectronics”. Key is a flexible, pliable circuit made from organic materials—the carbon-based building blocks of life. Bioelectronics have entered the EP lab with a prototype of a ‘bioelectronic catheter’, the marriage of a pliable integrated circuit with a catheter balloon.

In a mapping application, the deflated bioelectronic balloon catheter is slipped into the heart, then pumped up. The inflated integrated circuit conforms to the heart’s grooves and makes contact with hard-to-reach tissue. It can map a hundred electrical signals simultaneously, across a wider area and in far greater detail than had been previously possible. And it’s being developed to function in reverse. For ablation applications, instead of detecting current, it can apply precise electrical burns. This is a potentially breakthrough technology that may well change the way catheter mapping and ablation are performed. (Thanks to David Holzman for calling our attention to this ground-breaking research article.)

This is a remarkable time in the history of A-Fib treatment. Three very different technologies are poised to radically improve the way A-Fib is detected, mapped and ablated. We’ll look back at 2013 as a watershed year for A-Fib patients.

Three New Anticoagulants

In 2013 we saw three new anticoagulants, a welcome development for A-Fib patients. Note: the new anticoagulants are very expensive compared to the proven anticoagulant warfarin.

pradaxa_logo 150 pix 96 res Eliquis apixiban logo 150 pix 96 res Xarelto logo 150 pix 96 res

How do they compare to warfarin?

Warfarin seems to have a slightly higher chance of producing intracranial bleeding.
In general stay away from Pradaxa. There are horrible ER reports of patients bleeding to death from even minor cuts, because there is no antidote or reversal agent. Read more about my Pradaxa warning

Eliquis, in general, tested better than Xarelto in the clinical trials, but it’s so new we don’t have a lot of real-world data on it yet. And, as with Pradaxa, neither have antidotes or reversal agents.
In addition, there was what some consider a major problem with the clinical trials comparing the new anticoagulants to warfarin. ‘Compliance’ rates by warfarin users were poor (many either weren’t taking their warfarin or weren’t in the proper INR range). Did this skew the results?

And finally, unlike warfarin where effectiveness can be measured with INR levels, we don’t have any way to measure how effectively the new blood thinners actually anticoagulate blood. Read more of my article Warfarin vs. Pradaxa and the Other New Anticoagulants“.

Keep in mind: ‘New’ doesn’t necessarily mean ‘better’ or ‘more effective’ for You.

A-Fib with high blood pressure?

High Blood Pressure with Your A-Fib? Is Renal Denervation a solution?

As many as 30% of people with A-Fib also have high blood pressure which can’t be lowered by meds, exercise, diet, etc. There was hope that Renal Denervation would help.

With Renal Denervation, an ablation catheter is threaded into the left and right arteries leading to the kidneys, then RF energy is applied to the nerves in the vascular walls of the arteries, hopefully reducing ‘Sympathetic Tone’, lowering high blood pressure and reducing A-Fib. For many people Renal Denervation seemed the only realistic hope of lowering their high blood pressure. However, the Medtronic Simplicity-3 trial indicated that renal denervation doesn’t work. Read more of this article…  For 2014 news on this topic, read more…

A Study of Obesity and A-Fib: A-Fib Potentially Reversible

Apple and tape measure - weight loss 200 pix by 96 resObesity is a well known cause or trigger of A-Fib, probably because it puts extra pressure and stress on the Pulmonary Vein openings where most A-Fib starts.

In 2013 A research study report focused on obese patients with A-Fib. Those who lost a significant amount of weight also had 2.5 times less A-Fib episodes and reduced their left atrial area and intra-ventricular septal thickness.

Good news! Losing weight can potentially reverse some of the remodeling effects of A-Fib. Related article: Obesity in Young Women Doubles Chances of Developing A-Fib.

Data collected in a typical sleep study

Obstructive Sleep Apnea and A-Fib

Obstructive Sleep Apnea (OSA) is another well recognized cause or trigger of A-Fib. Anyone with A-Fib should be tested for sleep apnea.

Earlier studies have shown approximately two-thirds (62%) of patients with paroxysmal or persistent A-Fib suffer from sleep apnea. In 2013, research reports showed that the worse one’s sleep apnea is, the worse A-Fib can become. In addition, sleep apnea often predicts A-Fib recurrence after catheter ablation.

Before an ablation, Dr. Sidney Peykar of the Cardiac Arrhythmia Institute in Florida, requires all his A-Fib patients be tested for sleep apnea. If they have sleep apnea, they must use CPAP therapy after their ablation procedure.

A-Fib.com: Our New Website’s First Year

A-Fib_com logo The original A-Fib.com web site was created using the phased out software MS FrontPage. Thanks to a  “no strings attached” grant from Medtronic, A-Fib.com was reinvented with a more up-to-date but familiar look, and features more functionality (built on an infra-structure using Joomla and WordPress). We can now grow the site and add features and functions as needed.

It involved a tremendous amount of work. A special thanks to Sharion Cox for building the new site and for technical support. My wife, Patti Ryan, designed the look and all graphics. (I can’t thank Patti enough; I’m so lucky!)

A-Fib.com Project:
Update the Directory of Doctors & Facilities

Steve and A-Fib.com bulk mailing to update the A-Fib.com Directory of Doctors and Facilities

Back when I started A-Fib.com in 2002, there were less than a dozen sites performing ablations for A-Fib. Today our Directory of Doctors and Facilities lists well over 1,000 centers in the US, plus many sites worldwide.

Increasingly, doctors were writing me asking why they weren’t included, or why their info was incorrect since they had moved, etc. To update our records and our service to A-Fib patients, starting in July 2013, we prepared and mailed letters to over 1,000 doctors/facilities. We asked each to update/verify their listing (and include a contact person for our use).

Note to Doctors! If you haven’t updated your listing in our A-Fib.com Directory of Doctors and Facilities, just use our Contact Us form to email me and I’ll send you the form to fill in and return.

The response to our bulk mailing was great. The data input started in October and continued for several months (as time allowed). Recently, we cut over to the ‘new’ Directory menu and pages.


2014 PREVIEW A-Fib.com

What’s Ahead for A-Fib.com in 2014

2014 Boston AFib Symposium Reports: Check out my new reports from the 2014 Boston A-Fib Symposium (BAFS) held January 9-11, 2014 in Orlando FL.

The first two reports are posted. Look for more reports soon. I usually end up with 12-15 reports in total.

Steve and bulk mailing to update the A-Fib.com Directory of Doctors and Facilities

Our a-Fib.com Directory of Doctors & Facilities: Work on updating our listings is still underway. We need to contact those who did not respond to our request for verification or updating of their listing. (Shall we write again or maybe make phone calls?)Beat Your A-Fib by Steve S Ryan, PhD

Amazon Best Sellers list:  Our book sales continue to grow. Did you know that our book ‘Beat Your A-Fib’ has been on Amazon’s Best Sellers list continually in two categories (Disorders & Diseases Reference and Heart Disease) since its debut in March 2012? Visit Amazon.com and read over 40 customer reviews.

Help A-Fib.com Become Self-sustaining: We plan to step up our efforts to make A-Fib.com a self-sustaining site. (Since 2002, Steve and Patti Ryan have personally funded A-Fib.com with an occassional reader’s donation.)

Help UsRemain Ad-Free

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Bookmark this link!
Spreadshirt shop= Beat your a-fib - 4 piece 240 x 150 at 96

Visit our shop at Spreadshirt.com.

In our efforts toward sustainabiliy, several years ago we added a PayPal ‘Donate’ button (you don’t need a PayPal account to donate) and invited donations toward our onlline maintenance costs.

Then, a year or so ago, we added a portal link to Amazon.com. When you use our Amazon.com link, A-Fib.com receives a small commission on each sale (at no extra cost to you).

Our newest effort is our ‘A-Fib can be Cured! shop with T-shirts and more at Spreadshirt.com. With each shirt purchase $2 goes to support A-Fib.com. (We will roll out new designs every quarter or so).

Posted February 2014

Help A-Fib.com become self-sustaining! Help keep A-Fib.com independent and ad-free.
Will 2014 be the year you help support A-Fib.com?

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Last updated: Wednesday, February 11, 2015

Jeff Patten A-Fib Patient Story

A-Fib Patient Story #78

Jeff Patten

15 years in A-Fib: CryoBalloon Ablation, Pradaxa Problems, Second Ablation (RF) for Flutter

By Jeff Patten, Ashby, MA, January 2015

My A-Fib started about fifteen years ago.

That warm September day in 2000, I was tired, had a lot of coffee and was trying to finish a heavy shrub transplanting job. Sweating and breathing heavily, I noticed my heart was not doing what it should.

Alarming! Dehydration?? A couple of hours in ER and it normalized on its own.

After a couple more brief episodes, I decided to get back in better shape – slowly and judiciously! I’d always been active and couldn’t understand why the ole’ ticker was failing me now. They called it lone paroxysmal atrial fibrillation, so there was nothing else wrong.

Flecainide “Pill-In-The-Pocket,” Propafenone, Then CryoBalloon Ablation

The next decade saw no more episodes.

Then, in 2010, my father-in-law died. The recipe of emotional upset, high summer heat, stress (there was a lot of heavy “estate” to handle), and―as they tell me―accumulated age put me back on the A-Fib merry-go-’round.

My A-Fib was very symptomatic with erratic chest pounding, weakness and breathlessness. I took Life easier, and the A-Fib eased―until that autumn’s bout with appendicitis!

My EP put me on flecainide as a pill-in-the-pocket. That seemed to work for a while―until it didn’t

Time to see an electrophysiologist. My newly acquired EP put me on flecainide as a pill-in-the-pocket. That seemed to work for a while―until it didn’t. Episodes got worse. I was put on propafenone and warfarin while waiting for my ablation.

In December 2012, I had a pulmonary vein isolation (PVI). My EP used the newly approved CryoBalloon catheter.

Recovery: A-Fib free, but Pradaxa “Alimentary Torture” and Burning Diarrhea, Switch to Xarelto

After my ablation, I was put on a double dose of the proton pump inhibitor omeprazole (Prilosec), which is done on the theory it will help prevent the very unusual but deadly side effect of PVI known as atrioesophageal fistula by reducing erosive inflammation.

Since my INR numbers on warfarin were hard to control and there was concern about warfarin’s deleterious effect on vascular calcium through its action on vitamin K, I was put on dabigatran (Pradaxa) as an alternative.

Pradaxa comes in a special container to control moisture. The pills must be tossed if not used in four months once opened. They are awkwardly large. They must be taken twice a day. They are formulated with tartaric acid to help absorption. Everyone who takes Pradaxa must contend with all this.

Pradaxa was alimentary torture. Burned on the way down. Burned in my stomach and belly. Burned with diarrhea on the way out.

For me, Pradaxa was alimentary torture. Burned on the way down. Burned in my stomach and belly. Burned with diarrhea on the way out. The label suggests you’ll accommodate.

After six days I called for help and was switched to rivaroxaban (Xarelto). This is a small pill. Tiny, really. No particular moisture issues. No unusual expiration. Once a day. No burning. But the diarrhea continued for more than a couple of months.

Lymphocytic Colitis: From Taking Omeprazole (Prilosec) and/or Pradaxa?

As soon as my ablation was deemed ‘successful’, meaning that I was able to come off my doses of propafenone and Xarelto and omeprazole, I had a colonoscopy to check out the continuing diarrhea.

Diagnosis: lymphocytic colitis. I did a bit of research on this and discovered that very little is conclusively known about this increasing public problem. It is understood that there is an association between this colitis and the use of proton pump inhibitors among other meds such as non-steroidal anti-inflammatories. The diarrhea gradually subsided.

This Pradaxa/omeprazole story is one anecdote. No scientific conclusions can be drawn. I know what I personally conclude about it, however!

Ectopic Beats Turn into Flutter, RF Ablation

The ectopic beats following the ablation got worse.

PACs and PVCs are supposed to be normal and benign. Sometimes mine seemed to string themselves together for a bit. Then in July 2013, they didn’t quit. A heart rate of 130 at rest sent me to the E.R. where I got a diagnosis of atrial flutter, a successful cardioversion, and an appointment for another ablation.

An ablation in August addressed three flutter ‘circuits’. Careful electrical mapping was used this time, and RF-energy was used to break the ‘circuits’.  Apparently flutter such as this often follows on the heels of an A-Fib ablation. Not fully understood.  Yet.

So far, so good. I’ll let you know if anything more of interest happens.

Jeff Patten

Editor’s Comments
Pradaxa and Stomach Problems: It’s unfortunately not unusual to experience the intestinal tract problems Jeff had when taking Pradaxa. Pradaxa’s own fact sheet states the common side effects of Pradaxa include:
• Indigestion, Upset Stomach, or Burning
• Stomach Pain
In Pradaxa’s clinical trials, nearly two out of five people (35%) could not tolerate Pradaxa, which is a high rate of adverse reactions. In an earlier post I wrote “Based on the clinical trial data, there is a danger that Pradaxa over time may cause long-term damage to the gastrointestinal system.” (See The New Anticoagulants [NOACs], 2013 Boston Atrial Fibrillation Symposium). This may be what happened to Jeff when he developed lymphocytic colitis, but we can’t say this for sure.
It’s unusual to be put on a double dose of omeprazole (Prilosec).
Switch from Pradaxa to Eliquis or Go Back to Warfarin: I’d recommend to anyone taking Pradaxa to switch to a different anticoagulant or go back to warfarin if it worked for you. Not only is Pradaxa associated with intestinal tract problems, but it’s been associated with people bleeding to death in the ER. There’s no reversal agent or antidote for Pradaxa as there is for warfarin. (See Stop Prescribing or Taking Pradaxa). Eliquis tested better than the other new anticoagulants and is safer.
With the new anticoagulants (NOACs) now available, no one probably should be taking warfarin anymore. Warfarin produces arterial calcification, and also puts patients at increased risk of osteoporosis and bone fractures. (See Stop Taking Warfarin [Coumadin]!!! Switch to Eliquis [Apixaban].)
Flutter after A-Fib ablation: Many EPs include a Flutter ablation along with an A-Fib PVI. It’s relatively easy to do compared to a left atrium PVI and only adds around 10 minutes to the ablation procedure. It involves making an ablation line in the right atrium (Caviotricuspid Isthmus line) either before or after entering the left atrium. But other EPs are reluctant to make any ablation burns in the heart that aren’t medically necessary. If someone isn’t in right atrium flutter, they wouldn’t do a Flutter ablation. (Personally if I had a choice, I’d ask the EP to do a right atrium Flutter ablation as long as they were already ablating inside my heart anyway.)
However, Jeff had three Flutter circuits which probably meant that some of these Flutter circuits did come from the left atrium. Flutter can develop after an A-Fib ablation or be found later after the inflammation of the ablation scarring settles down. That’s why Jeff needed a second ablation which was RF rather than CryoBalloon.

Oct 2015: FDA Aproves Reversal Agent Praxbind® for the Anticoagulant Pradaxa

The FDA granted “accelerated approval” to Praxbind®, a reversal agent (antidote) to Pradaxa®. Praxbind is given intravenously to patients who have uncontrolled bleeding or require emergency surgery.

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If you find any errors on this page, email us. Y Last updated: Sunday, July 17, 2016

A-Fib and Stroke: A Woman’s Perspective

A-Fib and Stroke: Women Under-Diagnosed & Under-Treated:
A Woman’s Perspective

By Lynn Haye

Clot blocking vein

Stroke prevention is the primary focus for all people with A-Fib; men and women, young and old – regardless of the type of A-Fib. Patients with A-Fib have a 5-fold increased risk of stroke. This risk factor increases steeply with age (1.5% at ages 50-59 to 23.5% at ages 80-89)1 In addition, since A-Fib is often asymptomatic and may go clinically undetected, the stroke risk attributed to A-Fib may be substantially underestimated.

The National Stroke Association estimates that at least 1 in 6 strokes are actually caused by A-Fib and that A-Fib strokes are more debilitating with higher rates of mortality. However, three out of four A-Fib strokes can be prevented in patients who have been diagnosed with A-Fib and are receiving appropriate treatment.2

  Her A-Fib Stroke Risk

Recent publications have highlighted the gender differences in stroke risk.3,4 Women have a higher lifetime risk of stroke from all causes, and this is probably related to both life expectancy and treatment variables. The question of female sex as a separate risk factor for stroke in A-Fib is a bit more complicated.

There are two stroke risk tools currently used by physicians to predict risk in A-Fib patients; CHADS2 in the US and the newer CHA2DS2-VASc in Europe.5  The newer tool adds an independent risk factor for female sex and lowers the age range to 65 for risk. (To read more about CHADS2 and CHA2DS2-VASc see our article: The CHADS2 Stroke-Risk Grading System.) This development puts younger women with A-Fib into consideration for anticoagulation medication. Because of the increased risk for bleeding on these medications, there is concern about putting more and younger patients on them.  Anticoagulants are not like taking vitamins. No one should be on anticoagulants unless there is a real risk of stroke.

A recent Danish study 6 found that while female sex increased stroke risk by 20% in A-Fib patients older than 75, it did not do so in female A-Fib patients age 65-74.  This suggests no increased risk for younger women, while older women remain at risk due to age. The current UK protocol in the GARFIELD study 7may answer this difference as they are evaluating the significance of female sex as an independent risk factor for A-Fib stroke in younger patients, age 65-74.


As with other cardiovascular disorders, women with arrhythmias in the US have been under-treated and under-referred.  This less aggressive and/or less effective treatment for A-Fib may put women at higher risk for stroke overall.  Studies have shown that women with A-Fib have been less likely to receive anticoagulation and ablation procedures compared to men, although their treatment benefits are comparable.4

  Elaine’s Stroke

Let’s take the example of Elaine, a college-educated professional who marries at age 25 to Bob, a 32-year-old accountant. They both lead busy but fulfilling lives and have two wonderful children. Elaine is naturally protected from a stroke during her child-bearing years by her menstrual cycle. The blood she loses every month thins her blood and makes her less susceptible to forming clots and having a stroke. But once Elaine enters menopause and no longer has her menstrual cycle, all too soon her risk of stroke becomes the same as her husband, Bob.

Bob unfortunately passes away at age 76 leaving Elaine a widow at age 69. (Women in the US live an average of five years longer than men.) As Elaine ages she becomes more limited in her physical activities. Her blood becomes thicker and less viscous. Clots can more easily form in her heart, especially in the Left Atrial Appendage (where 90-95% of A-Fib clots form). She may develop A-Fib which is more likely to happen as people get older. At age 81 Elaine has an A-Fib stroke.

Unfortunately this scenario is an all too common for women.

  Preventing Her A-Fib Stroke

Is there anything women can do to reduce their risk of stroke? Some things come to mind:

Recognize Important Signs

If you haven’t been formally diagnosed with A-Fib, be sure to take seriously signs such as palpitations, shortness of breath, fatigue, dizziness, chest pain and fainting.  These signs may be significant, not just moods or the result of an ‘off’ day.  Check your pulse for any irregularity – it’s the rhythm not the rate that should concern you here.  Remember, A-Fib stroke may be avoided with early diagnosis and treatment.

See an Electrophysiologist (EP)

If you are newly diagnosed, have you followed up with a cardiologist or, better still, an electrophysiologist (EP)?  EPs see arrhythmias all the time and are usually more current on treatment options.  Sometimes it feels just ‘too’ serious or inappropriate to contact a ‘heart’ specialist, but it’s really more comforting when you are in the care of someone who regularly treats A-Fib.

If you need help locating an electrophysiologist in your area, check the provider list on this web site.

Be Aware—We Women Communicate Differently

Most women agree that we tend to communicate differently!  Contrary to some popular opinion, we often hesitate to complain or report symptoms – even when we know we should.  Some women still see heart problems as ‘masculine’ and can feel awkward presenting cardiac symptoms, particularly to a male physician. Just watch the comedic video by Elizabeth Banks at the American Heart Association website for a very insightful rendition of how we can minimize symptoms (AHA, Go Red for Women, “Just a Little Heart Attack”). It’s painfully funny….

Prepare for Your Electrophysiologist (EP) Appointment

Your physician may have limited time, so be prepared before going in for your appointment. It helps to take a list of questions or concerns to help you stay focused and make the best use of your time.  This also demonstrates the level of seriousness and concern that you bring to the session.

Importance of Blood Thinners for Women

Anticoagulation therapy is so basic to stroke prevention in A-Fib that any woman diagnosed with non-valvular A-Fib should make sure to discuss this with her physician at her first appointment.  But ‘Blood thinners’ carry the risk of bleeding, so your physician may check your risk on the HAS-BLED score.8 before prescribing blood thinners for you.

The newer, novel anticoagulants such as Pradaxa and Xarelto can make adherence easier for women. This is because the lack of dietary restrictions suits the diet of the typically ‘dieting’ woman.  However, the new, novel anticoagulants do not yet have reversal agents and should be used with caution. The other option, warfarin, requires frequent blood monitoring, and women are often very reluctant to add more required tasks to their already busy schedules.  There is a procedure for those who cannot tolerate anticoagulation medication. This procedure involves closing off the left atrial appendage and involves a more detailed and complex risk-benefit analysis.

Know the Symptoms of Stroke!

•  Sudden numbness or weakness of face, arm, leg—especially on one side of the body.
•  Sudden confusion, trouble speaking or understanding
•  Sudden trouble seeing in one or both eyes
•  Sudden trouble walking, dizziness, loss of balance or coordination
•  Sudden severe headache with no known cause

And the Other Symptoms Unique to women!

•  Sudden face and limb pain
•  Sudden hiccups
•  Sudden nausea
•  Sudden general weakness
•  Sudden chest pain
•  Sudden shortness of breath
•  Sudden palpitations

Call your emergency service (dial 911 in the US or 999 in the UK) if you have any of these symptoms, and make sure that your family and friends know that time is critical with stroke.  Everyone should know the simple test to act F.A.S.T.

F = FACE  Ask the person to smile. Does one side of the face droop?

A= ARMS  Ask the person to raise both arms. Does one arm drift down?

S= SPEECH  Ask the person to repeat a simple phrase. Is their speech slurred or strange?

T= TIME  If you observe any of these signs, call 911 immediately. 2

  Aim to be A-Fib Free

Probably the best thing to know about A-Fib stroke prevention is to not have A-Fib!  As Steve Ryan points out so well in his book, “Beat Your A-Fib”, the best preventive for A-Fib stroke is get rid of your A-Fib, to ‘Beat Your A-Fib’.

(posted October 2013)

Prevent an A-Fib stroke—first ‘treat’—then ‘beat’ your A-Fib!

Photo of Lynn Haye, PhD

Lynn Haye, PhD

LYNN HAYE, Ph.D.  is a clinical psychologist and former A-Fib patient. She studies and writes about current trends in the treatment and diagnosis of atrial fibrillation and has a special interest in women’s health issues. Dr. Haye and her family live in Orange County, CA.

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Last updated: Saturday, August 15, 2015

References    (↵ returns to text)
  1.  American Heart Association, Heart disease and stroke statistics 2013 update. www.heart.org
  2.  National Stroke Association www.stroke.org
  3. True Hills, M., ‘Gender Matters: Why Afib is More Fatal for Women’ EP Lab Digest 2013. www.eplabdigest.com/articles/Gender-Matters-Why-Afib-More-Fatal-Women
  4. Curtis, A.B., Narasimha, D., ‘Arrhythmias in Women’ Clinical Cardiology, 2012 Mar; 36(3)   www.ncbi.nlm.nih.gov/pubmed/22389121
  5. www.mdcalc.com/cha2ds2-vasc-score-for-atrial-fibrillation-stroke-risk/
  6. Mikkelsen, A., et al, ‘Female gender increases stroke risk in AF patients aged greater than 75 years by 20%’ European Society of Cardiology. 2012 www.escardio.org
  7. An international longitudinal registry of patients with atrial fibrillation at risk of stroke (GARFIELD): the UK protocol. 2013 www.biomedcentral.com
  8. Curtis, A.B., Narasimha, D., ‘Arrhythmias in Women’ Clinical Cardiology, 2012 Mar; 36(3) www.ncbi.nlm.nih.gov/pubmed/22389121
  9. www.mdcalc.com/has-bled-score-for-major-bleeding-risk/
  10. National Stroke Association www.stroke.org

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