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


Treatments

Updated Article: Treating Mineral Deficiencies in A-Fib Patients

When you have A-Fib, a sensible starting point may be to check for chemical imbalances or deficiencies. A deficiency in minerals like magnesium or potassium can force the heart into fatal arrhythmias.

If you haven’t recently read our Mineral Deficiencies page under Treatments, you might want to review it. We’ve updated and added some new content.

The Top Four Minerals/Vitamins

vitamins and minerals for A-Fib patients - A-Fib.com

We cover the four main minerals of special concern to patients with Atrial Fibrillation:

Magnesium
Calcium
Potassium
Vitamin D

For each we describe the mineral’s role and function in our body. Then, we cover how to test for deficiency (or overload). We describe the food or natural sources, then the various forms and choices of each supplement and recommended dosages.

You’ll find the topics to discuss with your doctors including recommended tests and alternative choices. All backed up with our usual well researched citations. Go to our Mineral Deficiencies page.

Reliable, Unbiased Information on Vitamins and Minerals

In our search for unbiased information sources about vitamins and mineral supplements, we looked at many, many informational directories.

Three searchable databases rose to the top of our list. See Our Top 3 Sources for Reliable, Unbiased Info on Vitamins and Supplements.

AF Symposium Two New Reports: Ablation Without Touching Heart and New RF Balloon Catheter

I’ve posted two of my reports from the 2019 AF Symposium.

Automated Robotic Ultrasound Ablation

From the Czech Republic via streaming video, a catheter ablation using an incredible new technology―Ultrasound Mapping and Ablation (Low-Intensity Collimated Ultrasound, LICU) from Vytronus, Inc. The catheter never touches the tissue!

From Vytronus VIDEO: Ultrasound Mapping and Ablation

The EP created a robotic lesion path for the ultrasound catheter to follow. Using electromagnetic navigation, the catheter automatically went to the spots and path the operator drew.

We watched as the catheter hovered over the heart surface while the highly directional ultrasound energy beam created the lesion lines—never touching the tissue. It was amazing to watch!

To learn more...go to my full report: Ablation Without touching the Heart Surface Using Ultrasound―Live Case from Prague.

Multi-Electrode Radio-Frequency (RF) Balloon Catheter

Multi-Electrode Radio-Frequency (RF) Balloon Catheter from Biosense Webster

The new irrigated Multi-Electrode RF Balloon Catheter from Biosense Webster is a “one-shot” delivery of RF energy and can burn lesions to isolate the Pulmonary Veins in minutes. And because the electrodes can be programmed to deliver less energy levels (for example near the esophagus), the RF Balloon Catheter can be safer and more effective than traditional RF point-by-point ablation.

It has 10 gold surface electrodes or heating bars which can be turned on and off or set to deliver different energy levels simultaneously. Each electrode is powered by its own generator.

While the AF Symposium audience watched the RF ablation live, the EP took just 7 seconds to isolate a particular vein―quite remarkable compared to the time involved for traditional RF.

To read my full report, go to: Multi-Electrode RF Balloon Catheter―Live Case from Boston Mass. General

“Do Not Use This Product” Warnings on Decongestants: Which are Safe for A-Fib Patients

by Steve Ryan
First published Dec. 2017. Last updated: February 16, 2019

It’s cough and cold season and millions of cold sufferers are reaching for an over-the-counter (OTC) decongestant capsule or nasal spray to clear a stuffy nose.

As an A-Fib patient, did you notice these over-the-counter decongestants often contain a warning such as:

“Do not use this product if you have heart disease, high blood pressure, thyroid disease, diabetes, or difficulty in urination due to enlargement of the prostate gland, unless directed by a doctor.”

What does this warning mean for patients with Atrial Fibrillation?

Decongestants, Heart Disease and A-Fib

When you have a stuffed up nose from a cold or allergies, a decongestant can cut down on the fluid in the lining of your nose. That relieves swollen nasal passages and congestion. (In general, an antihistamine doesn’t help with this symptom.)

The Problem: When taking a decongestant, heart rate and blood pressure go up, the heart beats stronger, blood vessels constrict in nasal passages reducing fluid build-up. In general that’s okay for most patients.

But not for patients with high blood pressure, heart disease or, specifically, Atrial Fibrillation. Decongestants cause the blood vessels to shrink and blood pressure to rise. Perfect conditions that can trigger or induce an episode of their A-Fib.

Another concern for A-Fib patients is that some over-the-counter (OTC) medications can interact with the anti-arrhythmic medication they’re taking.

Check your Cold Medicine: The main active ingredient in many decongestants is pseudoephedrine, a stimulant. It is well known for shrinking swollen nasal mucous membranes.

To find out if your cold medicine contains a decongestant, start by reading the label. You can lookup the ingredients of any OTC medication at Drugs.com. Just search by product name or active ingredient.

In addition, you can consult your pharmacist who can check the label of a medicine and let you know if it’s safe for someone with atrial fibrillation and/or high blood pressure.

Drugs.com makes it easy to check the ingredients of any OTC medication, just search by product name or active ingredient.

OTC Decongestants to Avoid: Some OTC decongestants tablets, capsules and nasal sprays to avoid if you have atrial fibrillation include:

• AccuHist DM® (containing Brompheniramine, Dextromethorphan, Guaifenesin, Pseudoephedrine)
• Advil Allergy Sinus® (containing Chlorpheniramine, Ibuprofen, Pseudoephedrine)
• Advil Cold and Sinus® (containing Ibuprofen, Pseudoephedrine)
• Sudafed (pseudoephedrine)
• Afrin and other decongestant nasal sprays and pumps (oxymetazoline)

Phenylephrine: a Safe Substitute? Maybe. A substitute for pseudoephedrine is phenylephrine. In general, phenylephrine is milder than pseudoephedrine but also less effective in treating nasal congestion. As with other decongestants, it causes the constriction of blood vessels and increases blood pressure.

There is anecdotal evidence that products with the substitute phenylephrine might be less of a trigger for A-Fib than products with pseudoephedrine. Products with phenylephrine:

Sudafed PE Congestion tablets
Dimetapp Nasal Decongestant capsules
Mucinex Sinus-Max Pressure and Pain caplets (Sue Greene writes that she has used Guaifenesin (Mucinex) for years which has never put her into A-Fib, 2/15/19. Lompocsue(at)yahoo.com.)

Decongestant-Free Products: These tablets, capsules and nasal sprays are decongestant-free and safe for patients with Atrial Fibrillation (They are marketed for those with High Blood Pressure):

Coricidin HBP line of products (Chlorpheniramine)
DayQuil HBP Cold & Flu (dextromethorphan hydrobromide)
NyQuil HBP Cold & Flu (dextromethorphan hydrobromide)
• non-medicated inhalers such as Vicks VapoInhalers (Levmetamfetamine)

What About Antihistamines?

Antihistamines reduce the effects of histamine in the body which can produce sneezing, runny nose, etc. Though they can lessen your symptoms, some can aggravate a heart condition, or be dangerous when mixed with blood pressure drugs and certain heart medicines.

Antihistamines can be dangerous when mixed with blood pressure drugs and certain heart medicines.

Heart-safe Antihistamines: Compared to decongestants, antihistamines are often better tolerated by people with A-Fib. Some heart-safe antihistamines that can help with a stuffy nose from a cold include:

Claritin tablets (loratadine)
Zyrtec tablets (cetirizine)
Allegra tablets (fexofenadine)
• Chlor-Trimeton (chlorpheniramine)

Non-Drug Alternatives for Cold Relief

If you want to avoid medications altogether, you can try a variety of things to clear your head.

Breathe Right nasal strips may help you breathe better at night. Use saline nasal spray (like Ocean or Basic Care) to help flush your sinuses, relieve nasal congestion and curb inflammation of mucous membranes.

A steamy shower or a hot towel wrapped around the face can also relieve congestion. Drinking plenty of fluids, especially hot beverages (like chicken soup), keeps mucus moist and flowing.

Recommendations for A-Fib Patients

Antihistamines and decongestants can give much-needed relief for a runny or congested nose. But A-Fib patients should pay attention to the warnings for heart patients. Here’s some products and procedures to consider:

Decongestant-free: Look for decongestant-free products (e.g. Coricidin HBP, DayQuil HBP Cold & Flu, NyQuil HBP Cold & Flu and Vicks VapoInhalers).

One possible exception are those decongestant products with the active ingredient phenylephrine (e.g. Sudafed PE, Dimetapp and Mucinex Sinus).

Heart-safe antihistamines: You can try one of the heart-safe antihistamines (e.g. Claritin, Zyrtec and Allegra).

Drug-free alternatives: Try drug-free substitutes (e.g. Breath Right nasal strips, saline nasal spray and a steamy shower).

The best advice for you and your A-Fib: Always consult your cardiologist or EP. Ask what’s the best option for your stuffy nose or allergies. And ask about interactions with your other heart medications (especially if you have high blood pressure).

References for this article
• Don’t let decongestants squeeze your heart. Harvard Health Publishing, Harvard Medical School. March, 2014. https://www.health.harvard.edu/newsletter_article/dont-let-decongestants-squeeze-your-heart

• Atrial fibrillation: Frequently asked questions. University of Iowa Health Care. Last reviewed: December 2015. https://uihc.org/health-topics/atrial-fibrillation-frequently-asked-questions

• Wieneke, H. Induction of Atrial Fibrillation by Topical Use of Nasal Decongestants. Mayo Clinic Proceedings , July 2016, Volume 91, Issue 7, Page 977. https://doi.org/10.1016/j.mayocp.2016.04.011

• Terrie, YC. Decongestants and Hypertension: Making Wise Choices When Selecting OTC Medications. Pharmacy Times, December 20, 2017. https://www.pharmacytimes.com/publications/issue/2017/december2017/decongestants-and-hypertension-making-wise-choices-when-selecting-otc-medications

2019 AF Symposium: Common Fluoroscopy Technology Converted to Real-Time 3D Images

Fluoroscopy is a type of medical imaging that shows a continuous 2D X-ray image on a monitor, (like an X-ray movie).

by Steve S. Ryan

Another medical breakthrough at this year’s AF Symposium featured an innovative mapping technology which turns normal fluoroscopy into real-time 3D imagery.

During a live CryoBalloon ablation from Milwaukee, WI, the system was used by Drs. Sabir Jra and Dr. Mohamed Hani of Aurora Health Care.

The Navik 3D Cardiac Mapping System from APN Health was FDA approved in 2016 and was first clinically used in March 2018. Dr. Jra is also the developer.

Real-Time Converting 2D to 3D: How the System Works

Commonly found in most every Electrophysiology lab is equipment for fluoroscopy. It’s a type of medical imaging that shows a continuous 2D X-ray image on a monitor (like an X-ray movie).

Monitor images Navik 3D system

The genius of Dr. Jra’s system is converting the familiar fluoroscopy into 3D real-time images.

The Navik 3D Cardiac Mapping System uses a complex mathematical formula and fast processor calculations to locate any opaque object (such as a catheter or a pulmonary vein opening) within regular X-ray fluoroscopy and turn it into a 3D image.

The Navik system uses real-time 2D, single-plane fluoroscopy images along with body surface ECG data and intracardiac echo signals to create a synchronized, real-time 3D visual map.

Real-Time 3D Images

As AF Symposium attendees watched the live CryoBalloon ablation, the mapping seemed to be very fast. It created and displayed real-time 3D maps of the cardiac chambers during the ablation, though the images appeared somewhat different from images from other 3D mapping systems.

Dr. Jra’s system can be integrated into a normal electrophysiology lab using typical procedure equipment. During the live procedure, his lab looked like other EP labs I’ve seen.

Editor’s Comments
3D Huge Improvement over Fluoroscopy: Dr. Jra’s work is innovative and a true medical breakthrough. It’s incredible—being able to convert, in real-time, fluoroscopic images into 3D images. Any electrophysiologist (EP) using fluoroscopy could, in theory, use Dr. Jra’s system.
Instead of X-ray images which are 2D and not all that clear, 3D images are a potentially huge improvement and would make the EP’s work more easily and clearly viewed.
Easy to Install and Use: The Navik 3D Cardiac Mapping System seems relatively easy and cost-effective to install. It doesn’t require major changes to an existing EP lab. But does require one addition piece of equipment, a body surface ECG system under the patient exam table.
Will 3D Fluoroscopy Become Widely Accepted and Used? Considering how many different excellent mapping and ablation systems are now being used, one wonders if Dr. Jra’s 3D fluoroscopy system will become accepted in today’s A-Fib marketplace, I’ll watch the rollout of the Navik 3D Cardiac Mapping System and report on its progress.
References for this article
Djelmami-Hani, M. Novel Approach to Cardiac 3-D Mapping. EP Lab Digest, Vol 18. Issue 9, Sept. 2018. URL: https://www.eplabdigest.com/novel-approach-cardiac-3d-mapping.

APN Health Receives FDA Clearance for Navik 3D Cardiac Mapping System. Diagnostic and Interventional Cardiology, February 29, 2016. URL: https://www.dicardiology.com/product/apn-health-receives-fda-clearance-navik-3d-cardiac-mapping-system

If you find any errors on this page, email us. Y Last updated: Friday, February 8, 2019

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AF Symposium: New Product Vascular Closure Device for Catheter Ablations

I just got off the phone with Andy who was telling me about his RF Ablation and his post-op experience. He had to lie on his back for 15 hours before his groin incision stopped bleeding and he was safe to go home. He said it was quite painful to be immobile that long.

Delivery disc of the  ASCADE MVP implants the collegan plug

My first report from the 2019 AF Symposium is about a new product used during catheter ablations and is designed to help patients like Andy go home sooner after their ablation.

The problem? Post-op bleeding from the catheter insertion point in the groin. Typically, the patient lies on their back for about 6 hours while the insertion point heals and stops bleeding enough so they can be discharged. (For guys, especially, it’s no fun having to use a Foley catheter to pee.)

Cardiva Medical has solved this problem. A simple, ingenious device closes off the insertion point(s) in the groin with a “collagen plug”.

Collagen plug like a cork in a bottle

How it’s used: After completing the ablation, the EP withdraws the ablation catheter, then replaces it with the VASCADE MVP which has a expandable/collapsible delivery disc to implant a collagen plug. This plug acts like a cork in a bottle and stops all bleeding leakage. (The FDA was so impressed with the VASCADE that it approved it within weeks.)

I give it a try: In the Exhibitors Hall, Michael Gebauer of Cardiva Medical demonstrated it to me. It takes a whole 5 seconds to insert the VASCADE MVP.

Continue reading (for how to get the cork out of the bottle, and more)go to my full report: Cardiva Medical ASCADE MVP Vascular Closure Device.

2019 AF Symposium: Multi-Electrode RF Balloon Catheter―Live Case from Mass. General

by Steve S. Ryan

Live streaming video-2019 AF Sympoium; A-Fib.comMassachusetts General Hospital in Boston, MA was the origination site for an ablation using a new irrigated Multi-Electrode Radiofrequency (RF) balloon catheter from Biosense Webster. Live via streaming video, were Drs. Moussa Mansour, Andrea Natale and Kevin Heist.

Multi-Electrode RF Balloon Catheter from Biosense Webster

While the AF Symposium audience watched the RF ablation live, the EP took just 7 seconds to isolate a particular vein―quite remarkable compared to the time involved for a traditional RF point-by-point ablation.

Multi-Electrode RF balloon catheter from Biosense Webster; A-Fib.com

Multi-Electrode RF balloon catheter from Biosense Webster

Catheter design: This new irrigated Multi-Electrode RF balloon catheter has 10 gold surface electrodes or heating bars which can be turned on and off or set to deliver different energy levels simultaneously. Each electrode is powered by its own generator.

In addition, rather than a fixed size, the 28 mm balloon is “compliant” and can fit into different-sized and shaped pulmonary vein openings.

Balloon catheters: This is the first RF balloon catheter in use for pulmonary vein (PV) ablation. Up to now balloon catheter technology has been used mainly with Cryoablation of the PV veins.

Approvals: In Europe, 200 patients have been treated with the Multi-Electrode RF balloon catheter. It is in trials in the U.S. and hasn’t yet been approved by the FDA.

Balloon Catheter also Creates 3-D Mapping

The 10 electrodes in the balloon also function as a circular mapping catheter to produce a 3-D map of the atrium and can pace the heart as well.

The liquid used to cool the RF burns flows at 35 nl/min. The RF is unipolar and heats at a maximum of 15 watts. RF lesions are made for 60 seconds, but the time can be reduced to 20 seconds when working on areas such as the posterior wall near the esophagus.

 RADIANCE stands for “PV Isolation with a Novel Multi-electrode Radiofrequency Balloon Catheter that Allows Directionally-Tailored Energy Delivery”

RADIANCE multicenter study: The RADIANCE study was a multicenter study conducted between Dec. 2, 2016 and March 8, 2017 in Europe. A total of 39 patients with paroxysmal atrial fibrillation were treated with the Biosense Webster multi-electrode radio frequency (RF) balloon catheter at four centers with nine different operators from both the U.S. and Europe.

In the RADIANCE study, 100 percent of the treated pulmonary veins were electrically isolated without the need for “touch-up” lesions with a RF focal catheter (referred to as “one-shot” delivery).  The study showed the RF balloon catheter could deliver directionally-tailored energy using multiple electrodes for efficient acute PVI in patients with paroxysmal A-Fib. For more about the RADIANCE Study see Multi-Electrode RF Balloon Efficient for Acute Pulmonary Vein Isolation Study.

Editor’s Comments
Advantages of the new RF Balloon Catheter:
It is difficult with an RF point-by-point catheter to produce a solid circular lesion around the PVs in a beating heart. It can take hours.
By comparison, this new irrigated RF Balloon Catheter is a “one-shot” delivery of energy and can isolate (burn lesions) in the PVs in minutes. And because the electrodes can be programmed to deliver less energy levels (for example near the esophagus), the RF Balloon Catheter can be safer and more effective than traditional point-by-point ablation.
Compared to CryoBalloon Ablation: The question from a patient’s perspective is which is better or more effective? The newer RF Balloon catheter ablation (when FDA approved in the U.S.), or the current, already proven CryoBalloon ablation? Right now, there isn’t enough data to answer this question.
The RF Balloon ablation does have an advantage over traditional CryoBalloon ablation. It can deliver different energy levels to prevent deeper ablation damage. (Currently, potential damage to the esophagus is handled with displacement tools which move the esophagus away from ablation sites. For more on this, see Esophageal Displacement Tool.)
Bottom Line for Patients: Promising! I’m excited about the Multi-Electrode Radiofrequency (RF) balloon catheter from Biosense Webster. I’ll report on it again, hopefully when it receives FDA approval for use in the U.S.
Reference for this article
Fornell, D. Multi-Electrode RF Balloon Efficient for Acute Pulmonary Vein Isolation. Study presented at the Heart Rhythm Society’s 2017 Late-Breaking Clinical Trials Section. DAIC, May 17, 2017. https://www.dicardiology.com/article/multi-electrode-rf-balloon-efficient-acute-pulmonary-vein-isolation

If you find any errors on this page, email us. Y Last updated: Wednesday, February 6, 2019

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AF Symposium 2019: Live from Prague—Ablation Without touching the Heart Surface Using Ultrasound

By Steve S. Ryan

On the second day of the AF Symposium attendees viewed, live from the Czech Republic, a catheter ablation using an incredible new technology―Ultrasound Mapping and Ablation (Low-Intensity Collimated Ultrasound, LICU) from Vytronus, Inc.

“Collimated” refers to focusing ultrasound rays so that they are parallel and spread out minimally with minimum divergence.

The procedure was via live streaming video from Na Homolce Hospital in Prague. The doctors performing the A-Fib ablation were cardiac electrophysiologists Jan Petru, Moritoshi Funasako, and Petr Neuzil.

Near-Real Time Ultrasonic Imaging of the Heart

The system first robotically scanned the left atrium and Pulmonary Veins (PVs) to create a 3-D global image of the heart anatomy in near-real time using the same dual-purpose transducer tip that makes the ablation lesions. (Later the same process was used to verify ablation lesions and the effectiveness of the ablation.)

Automated Robotic Ultrasound Ablation

In this automated robotic ablation, the LICU ultrasound catheter with a dual-purpose transducer tip didn’t touch the heart surface to make ablation lines.

The EP created a robotic path for the ultrasound catheter to follow. Using electromagnetic navigation, the catheter automatically went to the spots and path the operator drew.

We watched as the catheter hovered over the heart surface while the highly directional ultrasound energy beam created the lesion lines.

It was amazing to watch!

If the heart surface was thicker, the ultrasound catheter slowed down thereby increasing the ultrasound dose and energy delivered. This made the continuous lesions deep enough and transmural. The catheter didn’t touch or make contact with the heart surface.

Flowing Blood in the Heart Doesn’t Affect the Ultrasound Beam

The choice of ultrasound frequency (approximately 10 MHz) means that the ultrasound beam is affected very little by blood in the heart. Blood is “transparent” to the ultrasound beam.

This also means that the distance from the catheter tip to the targeted tissue isn’t critical and can vary. Also, the ultrasound catheter tip is irrigated to cool the tissue and prevent the formation of char or thrombus.

Color-Coded Range Map

The system uses a color-coded ultrasound-generated range map which displays how far the tip of the catheter is from the tissue to be ablated in order to create good lesions.

If the operator sees purple, blue or green, the catheter is within therapeutic ablation range. Yellow, orange and red indicate the catheter is beyond therapeutic range. The therapeutic range can vary from 5 mm to 50 mm.

During the live ablation, the EP said that dark blue is the best, while purple may be too close.

VIDEO: Product Animation. Ultrasound Mapping and Ablation (Low-Intensity Collimated Ultrasound, LICU) from Vytronus, Inc. (2:22 min.)

Video playback controls: Controls are located in the lower right portion of the frame: Click on arrow icon to select.

Editor’s Comments:
Background: In the past, high-intensity focused ultrasound (HIFU) caused esophageal injury and was withdrawn from clinical use. But Low-Intensity Collimated Ultrasound (LICU) operates at a lower acoustic intensity than the previous HIFU. Lesion formation occurs at a more gradual fashion.
Though not yet approved for use in the U.S., development of an ultrasound LICU ablation catheter and mapping system is a most important innovation for A-Fib patients.
Near-Real-Time Mapping: The ability of the ultrasound catheter to create 3-D images of the atrium and PVs at almost the same time as the ablation is a major advantage over other mapping systems. It creates more accurate rendering of the targeted heart features. In other systems there can be map drifts/shifts, inaccuracies from heart motion, respiratory motion, and volume-related chamber enlargement.
Non-Contact Ablation: In an ultrasound LICU ablation the catheter doesn’t touch the heart tissue. The EP doesn’t have to worry about “contact force” measurement, i.e., whether they are applying enough or too much force to make good transmural lesions.
Robotically Controlled Ablation Process: To me the robotic ultrasound LICU system seems easier to use. The ultrasound lesions were created automatically. As compared to standard point-by-point RF ablation or even CryoBalloon ablation, it’s remarkably simple and requires much less EP involvement and skill.
From a patient’s perspective, you aren’t as dependent on the skill and manual dexterity of the EP (or whether they are on top of their game that day).
A Breakthrough but Not Yet Available: It was obvious to everyone in the AF Symposium audience that we were witnessing the dawn of a potential new age in catheter ablation.
Though still investigational and not yet approved in the U.S., robotic low-intensity ultrasound mapping and ablation seems like a radical breakthrough in ablation treatment.
More Studies Needed: Many studies of its safety and efficacy need to be made before ultrasound ablation becomes available to patients. But low-intensity robotic ultrasound ablation looks really promising.
References for this article
Koruth, J.S. et al. Pre-Clinical Investigation of a Low-Intensity Collimated Ultrasound System for Pulmonary Vein Isolation in a Porcine Model. JACC: Clinical Electrophysiology, Vol. 1, No. 4, August 2015 http://electrophysiology.onlinejacc.org/content/1/4/306. DOI: 10.1016/j.jacep.2015.04.011

Vytronus, Inc. Ultrasound Mapping and Ablation (Low-Intensity Collimated Ultrasound, LICU),  the Vytronus LICU® system. URL: https://www.vytronus.com/technology/

If you find any errors on this page, email us. Y Last updated: Wednesday, February 6, 2019

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Medical Marijuana: A-Fib Patients Offer Personal Experiences

Due to the increased use of medical marijuana in California and other states, we should soon be getting more data on marijuana’s effects on Atrial Fibrillation.

Several readers with A-Fib have emailed me to share their experiences and observations with marijuana. There seems to be a lot of interest every time I write about this topic.

How about you? I’d love to get more first-hand feedback from A-Fib users. Please email me.

First-Hand Experiences: A-Fib and Medical Marijuana

Jim, an A-Fib patient, has kindly shared his personal use of marijuana and how it helps him. He has tried various meds, cardioversion, and had a failed ablation. He owns his own business in California and is under a lot of stress.

♥ JIM: “Because of all of this, I was having trouble sleeping and was getting very stressed out. But instead of taking something pharmaceutical, I turned to medical marijuana. It changed my life. I come home at night, have some marijuana edibles, and the stress goes away. I sleep wonderfully at night, waking up fresh and ready for another day.

I told my doctor who understands. He says that marijuana edibles shouldn’t have anything to do with A-Fib, and that I can continue to take them.”

On the other hand, John writes that:

♥ JOHN: “99% of his A-Fib attacks occurred while under the influence of marijuana.”

And others add their experiences:

♥ JONATHAN: “I tried a tiny bit of brownie for the first time since being diagnosed with A-Fib (occasional episodes). It was OK until about two hours later. I went into A-Fib and, a bit later, came the closest I ever have to blacking out. I don’t think it’s for me anymore.”

You can join the discussion, too. If you have used marijuana to help with your A-Fib symptoms, email me and share your experience.

♥ WILLIAM: “The A-Fib ablation has been very successful, except the two times that I went into A-Fib after smoking marijuana. I’m a lifelong recreational marijuana smoker, also smoke to relieve the pain from six surgeries on my right arm. Both times that I’ve gone into A-Fib since my last ablation have been after smoking marijuana. After the latest episode I’ve quite smoking marijuana because of the evidence that it can lead to A-Fib.”

♥ SCOTT: “I am currently 55 years old and have been through 15 cardioversions due to A-Fib. I smoked marijuana pretty much daily and noticed that, when I smoked, my heart rate went up. So, I stopped smoking altogether. Since quitting smoking marijuana 7 years ago, I have not had a single case of going into A-Fib. I’m positive that the two are related.”

Scott added that he also stopped drinking which helped. He used to drink a six pack daily.


PODCAST: Marijuana—Good, Bad or Ugly for Patients with A-Fib?

For my most recent report about A-Fib and Marijuana, listen to my Podcast with Travis Van Slooten, publisher of LivingWithAtrialFibrillation.com. (About 18 min. in length.) Includes transcript.

PODCAST

Marijuana—Good, Bad or Ugly for Patients with A-Fib?

With Steve Ryan and Travis Van Slooten (18 min.)

Go to Podcast

References for this article
Korantzopoulos, P. et al. Atrial Fibrillation and Marijuana Smoking. International Journal of Clinical Practice. 2008;62(2):308-313.

Petronis KR, Anthony JC. An epidemiologic investigation of marijuana- and cocaine-related palpitations. Drug Alcohol Depend 1989; 23: 219-26.

Rettner, R. Marijuana Use May Raise Stroke Risk in Young Adults. LiveScience.com, MyHealthNewsDaily February 08, 2013. Last accessed Nov 5, 2014. URL: http://www.livescience.com/26965-marijuana-smoking-stroke-risk.html

Why am I Angry at Some Doctors Treating Atrial Fibrillation Patients?

I can’t tell you how angry I am at cardiologists who want to leave their patients in Atrial Fibrillation.

It doesn’t matter even if a patient has no apparent symptoms. Just putting a patient on rate control meds and leaving them in A-Fib can have disastrous consequences.

Silent A-Fib Discovered During a Routine Physical

Discovered during routine exam

I corresponded with a fellow who had just found out he was in “silent” Atrial Fibrillation (no symptoms).

I told him he was very lucky (and should buy his doctor of bottle of spirits). His doctor discovered his A-Fib during a routine physical exam. If his silent A-Fib had continued untreated, he might easily have been one of the 35% who suffer a debilitating A-Fib-related clot and stroke.

I would normally commend his cardiologist, but his doctor just put him on the rate control drug, diltiazem, and left him in A-Fib.

That is so wrong for so many reasons!

Rate control drugs aren’t really a “treatment” for A-Fib. They leave you in A-Fib.

Rate Control Drugs Don’t Really “Treat” A-Fib

Rate control drugs aren’t really a “treatment” for A-Fib. Though they slow the rate of the ventricles, they leave you in A-Fib.

They may alleviate some A-Fib symptoms, but do not address the primary risks of stroke and death associated with A-Fib.

Effects of Leaving Someone in A-Fib

A-Fib is a progressive disease. Just putting patients on rate control meds (even if they have no apparent symptoms) and leaving them in A-Fib can have disastrous consequences. Atrial Fibrillation can:

Infographic at A-Fib.com A-Fib is a Progressive Disease

• Enlarge and weaken your heart often leading to other heart problems and heart failure.

• Remodel your heart, producing more and more fibrous tissue which is irreversible.

• Dilate and stretch your left atrium to the point where its function is compromised.

• Progress to Chronic (continuous) A-Fib often within a year; Or longer and more frequent A-Fib episodes.

• Increase your risk of dementia and decrease your mental abilities because 15%-30% of your blood isn’t being pumped properly to your brain and other organs.

What Patients Need to Know

For many, many patients, A-Fib is definitely curable. You don’t have to settle for a lifetime of “controlling” your Atrial Fibrillation.

Normal Sinus Rhythm: The goal of today’s AHA/ACC/HRS A-Fib Treatment Guidelines is to get Atrial Fibrillation patients back into normal sinus rhythm (NSR) and stay in sinus rhythm.

Unless too feeble, there’s no good reason to just leave someone in A-Fib (see note below).

Don’t let your doctor leave you in A-Fib. Educate yourself. Learn your treatment options.

Always Aim High! No matter how long you’ve had A-Fib, you should aim for a complete and permanent cure. Shoot for the moon, as they say, and you’ll find the best outcome for you and your type of A-Fib.

Note for this article
A rebuttal: A cardiologist may cite the 2002 AFFIRM study to justify keeping patients on rate control drugs (and anticoagulants), while leaving them in A-Fib. But this study has been contradicted by numerous other studies since 2002.
References for this article
• AHA/ACC/HRS. 2014 Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014; 130: e199-e267 DOI: 10.1161/CIR.0000000000000041.

• AHA/ACC/HRS 2014 Guideline for the Management of Patients With Atrial Fibrillation. Circulation. published online March 28, 2014, 4.2.1. Antiplatelet Agents, p 29.doi: 10.1161/CIR.0000000000000041 Last accessed Nov 23, 2014.URL: From http://content.onlinejacc.org/article.aspx?articleid=1854230

Q&A: Natural Therapies & Holistic Treatments For Atrial Fibrillation

You probably have a long list of questions about your Atrial Fibrillation. At A-Fib.com, we have answered thousands of patient questions—perhaps some of the same questions you may have right now. We’ve organized these questions and answers into several topics and treatment groups.

CC use credit - Nikodem_Nijak

Complementary and Natural Therapies

Under FAQ about Living with A-Fib, we discuss Natural Therapies & Holistic Treatments.

Here we focus on topics such as naturopathic doctors, complementary or integrated medicine as well as mind/body practices such as chiropractic, acupuncture, yoga and meditation.

Some of the questions we answer: How do I find a doctor with a more “holistic” approach?,  Is there any evidence on Yoga helping with A-Fib symptoms? and Do A-Fib patients find chiropractic adjustment useful?

We also answer questions about whole food or organic diets, A-Fib and supplements, and the vagal maneuver’.

We invite you to browse through the lists of questions. To read more, just ‘click’ on the question to be taken to the answer page.

Go to Q&A: Natural Therapies & Holistic Treatments

From the U.S. National Institutes of Health (NIH):

“Most people use non-mainstream approaches along with conventional treatments. The boundaries between complementary and conventional medicine overlap and change with time.”  

5-Year CABANA Trial: Compares Catheter Ablation with Antiarrhythmic Drug Therapy

The catheter ablation procedure for Atrial Fibrillation has been around for 20+ years.

In a randomized controlled trial, the 5-year CABANA study is the largest to compare the A-Fib treatments of catheter ablation (PVI) and antiarrhythmic drug therapy (AAD).

CABANA stands for Catheter Ablation versus Antiarrhythmic Drug Therapy.

CABANA Trial Design

Worldwide, 2,204 patients with new onset or undertreated Atrial Fibrillation were randomized between two treatments: catheter ablation (PVI) or antiarrhythmic drug (AAD) therapy. Patient participants were followed for nearly 5 years.

Patients details: Many patients had concurrent illnesses with Atrial Fibrillation: cardiomyopathy (9%), chronic heart failure (15%), prior cerebrovascular accidents or TIAs (mini-strokes) (10%).

Over half of participants (57%) had persistent or long-standing persistent A-Fib [i.e. harder types of A-Fib to cure].

Drug details: Antiarrhythmic drug (AAD) therapy was mostly rhythm control (87.2%), some received rate control drug therapy.

Anticoagulation drug therapy was used in both groups.

CABANA Trial Results

Crossover a Major Problem: Many in the AAD therapy arm decided to have a catheter ablation instead (27.5%). And some in the ablation arm decided not to have an ablation (9.2%). [One can not blame patients or their doctors for making these life-impacting choices.] 

The CABANA results showed catheter ablation was significantly better than drug therapy for the primary endpoint (a composite of all-cause mortality, disabling stroke, serious bleeding or cardiac arrest). [See Additional Research Findings below.] Mortality and death rate were also significantly better for catheter ablation.

CABANA Findings: Ablation vs AAD Therapy

▪ Catheter Ablation significantly reduced the recurrence of A-Fib versus AAD therapy.

▪ Catheter Ablation improved ‘quality of life’ (QofL) more than AAD therapy, though both groups showed substantial improvement.

▪ Catheter Ablation patients had incremental, clinically meaningful and significant improvements in A-Fib-related symptoms. This benefit was sustained over 5 years of follow-up.

▪ Catheter Ablation was found to be a safe and effective therapy for A-Fib and had low adverse event rates.

Take-Aways for A-Fib Patients

Ablation Works Better than Antiarrhythmic Drugs: Rather than a life on antiarrhythmic drug therapy, the CABANA trial and other studies show that a catheter ablation is the better choice over antiarrhythmic drug therapy.

For related studies, see CASTLE AF: Live Longer-Have a Catheter Ablation and AATAC AF: Catheter Ablation Compared to Amiodarone Drug Therapy.

In an editorial in the Journal of Innovations in Cardiac Rhythm Management, Dr. Moussa Mansour, Massachusetts General Hospital, wrote about the CABANA trial:

“It confirmed our belief that catheter ablation is a superior treatment to the use of pharmacological agents, and corroborates the findings of many other radomized clinical trials.” 

Lower Recurrence: What’s also important for patients is the lower risk of recurrence of A-Fib versus AAD therapy.

Reduced Ablation Safety Concerns: Ablation significantly improved overall mortality and major heart problems.

Immeasurable Improvement in Quality of Life! Perhaps even more important for patients on a daily basis, catheter ablation significantly improved quality of life.

Don’t Settle for a Lifetime on Drugs

Over the years, catheter ablation for A-Fib has become an increasingly low risk procedure with reduced safety concerns. (Ablation isn’t surgery. There’s no cutting involved. Complication risk is similar to tubal ligation or vasectomy.)

An ablation can reduce or entirely rid you of your A-Fib symptoms, make you feel better, and let you live a healthier and longer life (for people who are older, too). A catheter ablation significantly improves your quality of life (even if you need a second “re-do ablation” down the road).

For many, many patients, A-Fib is definitely curable. Getting back into normal sinus rhythm and staying in sinus rhythm is a life-changing experience, as anyone who’s free from the burden of A-Fib can tell you.

See also:  Does a Successful Catheter Ablation Have Side Benefits? How About a Failed Ablation?

Additional Study Findings
Primary endpoints: Results of the primary endpoints were not significant. This is probably due to the crossovers and the lower than expected adverse event rates (5.2% for ablation versus 6.1% for AAD therapy).

Deeper Analysis of Data: The researchers performed sensitivity analyses on the primary results using “treatment received” and “per protocol” rather than “intent to treat”.

Research Terms: Primary endpoint—specific event the study is designed to assess. Intent to treat—all assigned to the AAD group compared to the assigned ablation group (even though 1/4 crossed over to the ablation group). Treatment received—compared all who received an ablation to all who received AAD therapy.
References for this article
• Packer, Douglas. CABANA trial provides important new data on clinical and quality of life effects of ablation for atrial fibrillation. Cardiac Rhythm News: October 18, 2018, Issue 42. P. 1.

• Mansour, Moussa. Letter from the Editor in Chief. The Journal of Innovations in Cardiac Rhythm Management, June 2018. DOI: 10.19102/icrm.2018.090609.

It Takes Time to Find the Right Treatment Plan for You: Learn all Your Options

A-Fib begets A-Fib. The longer you have A-Fib, the greater the risk of your A-Fib episodes becoming more frequent and longer, often leading to continuous A-Fib. (However, some people never progress to more serious A-Fib stages.)

Most Atrial Fibrillation patients should look beyond the typical antiarrhythmic drug therapy. These drugs don’t cure A-Fib but merely keep it at bay. According to Drs. Irina Savelieva and John Camm of St. George’s University of London:

“The plethora of antiarrhythmic drugs currently available for the treatment of A-Fib is a reflection that none is wholly satisfactory, each having limited efficacy combined with poor safety and tolerability.”

Educate Yourself: Learn All Your Options

A-Fib is not a “one-size fits all” type of disease. You need a personalized treatment plan. To begin, first educate yourself about Atrial Fibrillation, and then review all your treatment options. See Overview of A-Fib, Find the Right Doctor for You and Treatments for Atrial Fibrillation. A-Fib treatments include both short-term and long-term approaches aimed at controlling or eliminating the abnormal heart rhythm associated with A-Fib.

Next, you can move on to the guidelines we’ve posted: Which of the A-Fib Treatment Options is Best for Me? You are then prepared to discuss these treatment options with your doctor. Keep in mind, this should be a ‘team effort’, a decision you and your doctor will make together.

Build a Support System: We Can Help

You are not alone. Many, many others with A-Fib have been where you are now and are ready to share their experiences and insights.

Our A-Fib Support Volunteers: Having someone you can turn to for advice, emotional support, and a sense of hope that you can be cured, may bring you peace of mind. Our support volunteers offer you one-to-one support through exchanging emails and sharing their stories. To learn more, go to our page A-Fib.com’s A-Fib Support Volunteers.

Positive Thoughts/Prayer Group: At A-Fib.com we believe in healing through hope, belief, prayer and in the power of positive thoughts. To learn more about our group and how to send in your request, go to our A-Fib.com Positive Thoughts/Prayer Group.

Build Your A-Fib Treatment Plan: Know All Your Options

Resources for this article
Savelieva I, Camm J. Update on atrial fibrillation: part II. Clin Cardiol. 2008 Mar;31(3):102-8. Review. PubMed PMID: 18383050. URL Retrieved Nov 17, 2011. http://www.ncbi.nlm.nih.gov/pubmed?term=PMID%3A%2018383050

Blood Thinner Myths Debunked by Healthcare Monitor Guide to AFIB

Every Atrial Fibrillation patient has to deal with the increased risk of clots and stroke and that often includes taking a blood thinner or anticoagulant.

At my doctor’s office I came across one of those “free take home copy” publications about Atrial Fibrillation. Healthcare Monitor Guide to Living with AFib 2018 had an interesting sidebar with a few myths and truths about blood thinners. I’d like to share a few misconceptions they list:

Guide to Living with AFib 2018

• “I’m afraid of shaving because I hear it’ll take forever to stop bleeding.”
• “Blood thinners will make me feel tired.”
• “It seems I bruise much more easily now-and that can’t be good.”

Do any of these ring a bell with you? Are you concerned with the same issues? Healthcare Monitor debunks these as myths and explains way.

Blood Thinner Myths Debunked

“I’m afraid of shaving because I heart it’ll take forever to stop bleeding…If bleeding while shaving is a problem, consider using an electric shaver. And remember: Even if you seem to bleed more easily now, suffering a stroke could cost you your life.

Blood thinners will make me feel tired. There’s no evidence that blood thinners cause or worsen fatigue. In fact, fatigue has not been identified as a problem in numerous studies done in thousands of patients. Of course, several things can effect your energy levels, including other medications you’re taking and lack of sleep. If you’re feeling more exhausted than usual, bring it up with your doctor.

It seems I bruise much more easily now-and that can’t be good. It’s true that bruising may be somewhat increased while you’re on a blood thinner. Although this can be a nuisance, it is important to remember that you are taking this medication to lower the risk of stroke. So the trade-off—accepting a slight increase in bruising—is worth the protection from dangerous clots.”

An Alternative to Blood Thinners

Catheter positioning the Watchman occlusion device at the mouth of the Left Atrial Appendage

Catheter placing Watchman in LAA

But blood thinners are not like taking vitamins. They have their own set of risks and side effects. However, preventing a stroke is for most people a welcome trade-off for any bad effects of anticoagulants.

If you can’t or don’t want to take blood thinners, an option is to have a device installed to close off the Left Atrial Appendage. The LAA is a small pocket of heart tissue located above the left atrium where 90%-95% of A-fib strokes originate.

To learn more see my articles: Watchman: the Alternative to Blood Thinners or LAA Occlusion for A-Fib Patients: The Lariat II Versus the Watchman Device.

Or watch the 3:28 min. video: The Watchman Device: Closure of the Left Atrial Appendage.

Resource for this article
Blood thinner myths debunked. Healthcare Monitor Guide to Living with AFib. 2018. print publication, p 21. healthmonitor.com.

A-Fib Patients (and Others): Should You Be Prescribed Fewer Drugs?

Did you know you can outgrow your medication? Perhaps your lifestyle has changed with more physical activity, better nutrition or weight loss and subsequently you may no longer need medications for diabetes, cholesterol or high blood pressure.

But you keep taking them, because no one told you to stop.

Simple errors can occur, too. Dr. Michael A. Steinman, a geriatrician at the University of California, San Francisco, recalled asking a patient to bring in every pill he took for a so-called ‘brown bag review’. He learned that the man had accumulated four or five bottles of the same drug without realizing it, and was ingesting several times the recommended dose.

“We spend an awful lot of money and effort trying to figure out when to start medications and shockingly little on when to stop.”

Dr. Caleb Alexander, Johns Hopkins Center for Drug Safety and Effectiveness

De-Prescribing: A Brown Bag Review

Always keep an accurate and updated list of medications you are taking. (See our free download form below.)

Periodically ask your physicians or pharmacist for a ‘brown bag review’. Discuss whether to continue or change any of your regimens. Ask about:

▪ any medicines you no longer need?
▪ any medications you can do without?
▪ if a lower dose would work for any of your medicines?
▪ if any of your medications might interact with another?
▪ any non-pharmacologic alternatives?

If your doctor agrees to ‘de-subscribe’ a medication, realize it isn’t as simple as saying “stop” taking it. It’s a process requiring caution and skill by your doctor. (Afterwards, remember to update your list of medications.)

Free Download: Keep an Inventory List of Your Medications

Medications List from Alere at A-Fib.comKeep your doctor and other healthcare providers up-to-date on all the medications you are taking by using this Medications List from Alere. Download (and remember to save the PDF to your hard drive).

Besides prescriptions, the form has sections to list over-the-counter drugs, vitamins, herbs and mineral supplements, too (as they can interact).

Print several copies of the blank form and keep handy in your A-Fib file or binder. When completed, give a copy of your inventory to each of your healthcare providers.

Also see my article: Are Your Herbal Supplements Interacting With Your Medicines?

Resources for this article
• Kantor ED, et al. Trends in Prescription Drug Use Among Adults in the United States From 1999-2012. JAMA. 2015;314(17):1818–1830. doi:10.1001/jama.2015.13766

• Mishori, R. Why doctors should be prescribing less drugs. The Independent. 30 January 2017. http://www.independent.co.uk/life-style/health-and-families/healthy-living/prescribing-drugs-is-good-so-is-deprescribing-a7552971.html

• Qato DM, et al. Changes in Prescription and Over-the-Counter Medication and Dietary Supplement Use Among Older Adults in the United States, 2005 vs 2011. JAMA Intern Med. 2016 Apr;176(4):473-82. doi:10.1001/jamainternmed.2015.8581.

 

After 18 years in A-Fib, Triathlete Mike Jones Asked, “Could I Be so Fortunate?”

In his A-Fib story, Mike Jones writes that he’d been a very physically active middle age man who competed in running, triathlons and handball. It was difficult for him to accept that “something was wrong”.

In fact, he had paroxysmal A-Fib episodes for at least three years before his official diagnosis. Over the many years, he had been on various drug therapies, but nonetheless, his A-Fib episodes become very debilitating. He shares:

Mike Jones

“For many years, surgical intervention was out of reach, and financially out of the question for me. And, in those days, there was only the “Maze”. Along the way, I read a little bit about the Mini Maze, which did not inspire me much either.
It wasn’t until I found “A-Fib Resources for Patients” [A-Fib.com] that I began to take a real interest in researching PVI/PVA [Pulmonary Vein Isolation/Ablation] .”

Mike recalls the day after his life-changing catheter ablation:

“On the drive home the following afternoon, I thought about all those years that I had spent….with all of the drugs, and all of the depressing hours, with all of the sacrifices, and all of the fear…nearly 15 years of it.
Then, my long-awaited PVI procedure. In a 2 day period of time, with little discomfort (and within my budget!) all of that might now be behind me.
Could I be so fortunate?
I feel a little foolish now, a little sheepish, that I had made such a big thing out of getting this procedure done.”

Life After His Ablation

In the ten months following his ablation, Mike writes that he only had two episodes early on and that he continues to take soaks in Epson salts once a week to keep his magnesium levels up.

He writes about his life now that it is free of A-Fib:

 “I do not take any blood thinners, and no heart medication whatsoever. In my 70’s now, I won’t be running any endurance races, and my conditioning level is too low for any serious handball (yet).
But my energy level is high enough that I live a very normal life. I am a hobby woodworker, and I typically spend anywhere from 4 to 6 hours a day in my shop. I walk, swim, cut wood, and, when nobody is looking…I dance.
“I walk, swim, cut wood, and, when nobody is looking…I dance.”
I understand that the A-Fibs might one day return, but I would have no hesitation in returning for a tune up if, or when, that day should ever arrive.”

―Mike Jones, Redding, CA, Now A-Fib free after an ablation using both CryoBalloon and RF methods 

A-Fib is a Progressive Disease

It’s really remarkable that Mike could live in paroxysmal A-Fib for 18 years and not progress to Persistent or Longstanding Persistent A-Fib. In one study over half the people who developed paroxysmal A-Fib turned Persistent after only one year. Perhaps Mike’s athleticism and fitness kept his A-Fib from getting worse.

In most people, A-Fib is a progressive disease that remodels the heart and gets worse over time. To avoid this happening to you, aim to be A-Fib free as soon as you can.

For more about Mike, read his A-Fib story, Triathlete 18 years in A-Fib, on Amiodarone for eight years―then A-Fib free after ablation by Dr. Padraig O’Neill.

For more A-Fib stories to encourage and inspire you, go to Personal A-Fib Stories of Hope.

How One Reader Detects if He’s in (Silent) A-Fib

Some people have A-Fib with no obvious symptoms. This can be dangerous, lead to a stroke and, over time, to a deteriorating heart. Many of these patients do a self-check during the day to monitor for an irregular pulse. Here’s another idea from a fellow A-Fib patient.

Taking Your Pulse

After reading our article, A-Fib Self-Care Skills: How to Check Your Heartbeat and Heart Rate, our reader, Frank, wrote us about how he goes beyond just a self-check to determine if he’s in A-Fib.

“I read your self-care skills articles and wanted to comment.
I check for when I’m in A-Fib very easily. I purchased a pulse oximeter. And whenever my reading is significantly above my normal resting pulse, then I know I’m in A-Fib. I don’t believe there’s any other reason for my resting heart rate to be elevated unless I’m in atrial fib.
A good oximeter is not very expensive at all, and it may be a very useful tool for others.”

Our thanks to Frank for sharing his advice.

How Pulse Oximeters Measure Pulse Rate

Masimo‘s MightySat fingertip pulse oximeter

Pulse oximeters are easily recognized by their associated clip-type probe which is typically applied to a patient’s finger. They are lightweight and intuitive to use.

When your heart beats, it pumps blood through your body. During each heartbeat, the blood gets squeezed into capillaries, whose volume increases very slightly. Between heartbeats, the volume decreases. This change in volume affects the amount of light (such as the amount of red or infrared light) that will transmit through your finger.

Though this fluctuation is very small, it can be measured by a pulse oximeter.

Not Just for Pulse Rates but Blood Oxygen Levels, Too

Measuring your blood oxygen saturation level (SpO2) is also important for A-Fib patients, because a very low blood oxygen level puts a strain on your heart (and your brain).

Blood oxygen saturation

Using the same type of setup to measure pulse rate, an oximeter indirectly measures the amount of oxygen that is carried by your blood. By measuring the light that passes through the blood in your finger, your blood oxygen saturation level (SpO2) is calculated and expressed as a percentage.

Accuracy: The American Thoracic Society reports that the oxygen level from a pulse oximeter is reasonably accurate. The best reading is achieved when your hand is warm, relaxed, and held below the level of your heart. Most oximeters give a reading 2% over or 2% under what your saturation would be if obtained by an arterial blood gas test. (For example, if your oxygen saturation reads 92% on the pulse oximeter, it may be actually anywhere from 90 to 94%.)

Pulse Oximeters and Sleep Apnea 

Another application for a pulse oximeter. We’ve written about using a fingertip oximeter as an inexpensive way to check if you might have sleep apnea. A blood oxygen saturation level of 90% or lower means you should talk to your doctor, that you may need a sleep study. For more, see Possible Sleep Apnea? Oximeter is DIY Way to Check your Blood’s Oxygen Level

Know Your Pulse Rate and Blood Oxygen Level

Starting at about $25, an assortment of pulse oximeters are available at Amazon.com and other retailers. One CE and FDA approved unit is the Pulse Oximeter Portable Digital Oxygen Sensor with SPO2 Alarm ($23).

On a personal note: As many of our readers know, I’ve been A-Fib free for 20 years. But nonetheless I often will check my pulse using an oximeter at night before going to sleep. Just as Frank describes, it’s very easy to do.

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Bookmark and use every time you shop at Amazon.com.

Part 3 Update: PVCs/PACs and My Medtronic Reveal LINQ Insertable Monitor

I’ve had my Medtronic Reveal LINQ insertable monitor since the middle of September. (See Has my A-Fib Returned?)  It has produced a lot of false positives. The other day, I visited my EP’s office and reviewed my LINQ data results with the nurse/Reveal LINQ specialist.

Steve Ryan: My Medtronic Reveal LINQ is inserted just under my skin near my heart: at A-Fib.com

My Medtronic Reveal LINQ is inserted just under my skin near my heart:

The LINQ data showed I had Premature Ventricular Contractions (PVCs) and Premature Atrial Contractions (PACs) which made my heart beat irregular but were not A-Fib.

No A-Fib for me: My data showed I always had the P wave component in my EKG signal—which is lost when one has Atrial Fibrillation.

Most PVCs/PACs benign: Most A-Fib doctors aren’t overly concerned about extra beats Premature Ventricular Contractions (PVCs) or Premature Atrial Contractions (PACs), because they are considered benign.

I’m not worried. Everybody gets PVCs and PACs, not just people with A-Fib.

Take a Look at My Premature Atrial Contractions (PACs)

When you look at my LINQ ECG signal (see excerpt below), notice how the PAC comes before one would expect a normal beat. The irregularities above the R wave indicate the signal is coming from atria above the ventricles and is a PAC.

PAC beats comes before one would expect a normal beat

…and a Look at My Premature Ventricle Contractions (PVCs)

When you look at another section of my ECG signal (see excerpt below), the R wave spikes are thicker and wider than the normal R waves indicating they are coming from the ventricles and are Premature Ventricle Contractions (PVCs).

PVCs: R wave spikes are thicker and wider than the normal

Detection Settings for A-Fib Only

To avoid false positives such as PACs and PVCs, the nurse adjusted the settings and sensitivity of the Reveal LINQ monitor to detect A-Fib only. (For Medtronic settings, see below.)

I will return to Dr. Doshi’s office in a month to see if these new setting are working properly. Look for my next update on data from my Medtronic Reveal LINQ insertable monitor.

ECG waveform diagram

ECG waveform diagram

Learn to Read Your ECG/EKG

An electrocardiogram, ECG (EKG), is used to measure the rate and regularity of heartbeats, as well as the size and position of the chambers, the presence of any damage to the heart, and the effects of drugs or devices used to regulate the heart.

The ECG signal strip is a graphic tracing of the electrical activity of your heart.

To learn to read your own ECG/EKG signal, see Understanding the EKG Signal.

My Medtronic Reveal LINQ is inserted just under my skin near my heart: For you tech types, here are the new settings:

AT/AF Detection—On
Type—AF only
AF Detection—Balanced Sensitivity
Ectopy Rejection—Aggressive (this is probably the most important change in the settings)
AT/AF Recording Threshold—Episodes >= 60 min

A-Fib Self-Care Skills: How to Check Your Heartbeat and Heart Rate

Some Atrial Fibrillation patients know immediately when their heart is in A-Fib. They experience one or more symptoms including shortness of breath, palpitations, heart flutters, etc. Other A-Fib patients may have subtle symptoms (or silent A-Fib) and can’t be sure.

The following self-care skills will reassure you any time you suspect you’re in A-Fib—how to check for an irregular heartbeat and how to tell if your heart rate is too fast or too slow.

Self-Check if Your Heartbeat is Regular or Irregular

I found an informative post with these self-care skill steps on the Scope Blog by Stanford University School of Medicine. To check whether your heartbeat is regular or irregular:

♥ Begin by placing your right hand on the left side of your chest while seated and leaning forward.
♥ Position your hand so that you feel your heartbeat most strongly with your fingertips.
♥ A normal heart rhythm should feel like a regular drum beat cadence; you can usually anticipate when each beat will come after the last beat.
♥ Because heart rate and the strength of the heartbeat can vary with breathing, sometimes holding your breath for a few seconds is helpful. With an irregular rhythm, it will be hard to predict when the next beat will come.
♥ In addition, some irregular beats will be softer (less strong) than other beats, so the strength as well as the timing may not be consistent.

Self-Check If Your Heart Rate is Too Fast or Too Slow

The Stanford blog continues with a second set of self-care skill steps—how to measure if your heart rate is too fast or too slow so you know when to seek medical care. (An optimal heart rate is 50–100 bpm when you are at rest.) To check your heart rate:

♥ Place your right hand over your heart so that you feel your heart beating under your fingertips.
♥ Use a watch or timer and count the number of beats for 15 seconds.
♥ Be sure to count all heartbeats; including beats that are not as strong or that come quickly following one another.
♥ Take the number of beats you’ve counted and multiply it by four. For example, if you count 30 beats in 15 seconds, then you would calculate 4 x 30 = 120 beats per minute.
♥ Repeat this process three times right away, writing down each heart rate to later share with your doctor.
Stethoscope and EKG tracing at A-Fib.com

While an Electrocardiograph (ECG or EKG) or Holter monitor are the only sure ways to document you are in A-Fib, you can use the above self-care skills to recognize A-Fib symptoms of an irregular heart beat or if beating too fast or too slow.

These skills with help you remain calm and confident when you suspect you may be in A-Fib.

Resource for this article
Stafford, R. Understanding AFib: How to measure your own heart rate and rhythm. Scope/Stanford Medicine, October 25, 2018. URL: https://scopeblog.stanford.edu/2018/10/25/understanding-afib-how-to-measure-your-own-heart-rate-and-rhythm/

“Normal” Has a New Meaning for Jim After His Ablation

Before you developed Atrial Fibrillation, did you lead an active lifestyle? Has A-Fib robbed you of your energy and replaced it with fatigue? That’s what happened to Jim. After years of drug therapy that didn’t work, read how Jim recovered his active lifestyle post-ablation.

Three years after his ablation, Jim McGauley of Macclenny, FL, shared his personal A-Fib story with our A-Fib.com readers. His atrial fibrillation had been detected several years earlier but was not controlled effectively with drug therapy.

Jim underwent a catheter ablation in the summer of 2009. His procedure was performed without complications by Dr. Saumil Oza and his team at St. Vincent’s Medical Center, Bridgeport, CT.

He writes that, after a brief period of recuperation, he resumed normal activity.  In his story, After Years in A-Fib, New Energy and Improved Life, Jim shares: 

“Within a matter of days [of my ablation], I realized that “normal” had a new meaning.
I had lived with the atrial fibrillation for years, and it took the ablation and resulting corrected heart rhythm to bring about a marked surge in my energy level with less fatigue and an overall sense of “fitness”.
I have always maintained an active lifestyle, but post-ablation I was able to increase significantly my exercise regimen. I now run 2-3 miles three times a week and include modest weight training to keep my upper body toned.”
Jim McGauley, Publisher, The Baker County Press, Macclenny, FL. After failed drug therapy, now A-Fib free via catheter ablation.

Catheter Ablation Can Have Life-Altering Effects

Atrial Fibrillation patients seeking a cure and relief from their symptoms often have many questions about catheter ablation procedures. To learn more, see:

• VIDEO: When Drug Therapy Fails: Why Patients Consider Catheter Ablation (3:00 min., includes transcript)
• Treatments/Catheter Ablation
• Frequently Asked Questions: Catheter Ablation, Pulmonary Vein Isolation, CyroBalloon Ablation

About the ablation experience itself, Jim went on to share:

“The ablation itself is minimally invasive considering that it is correcting an abnormality inside the heart itself, and the recovery period was brief and generally comfortable.

I would readily recommend it… to anyone qualifying as a candidate to correct atrial fibrillation.”

―Jim McGauley, now A-Fib free after catheter ablation 

‘A Patient Cured is a Customer Lost’ & Other Facts About Big Pharma

Did you know drug companies spend twice as much on marketing and advertising as on researching and developing new drugs? (I was shocked.)

Of special interest to me is the ‘Direct to Consumer’ drug advertising which has significantly increased drug sales in the U.S.

‘Direct to Consumer’ drug advertising is so misleading that it is banned in all countries except two: the U.S. and New Zealand. (No wonder that 70% of drug companies’ profit comes from the U.S.)

Misleading Drug Ads

To be specific, I hate those misleading TV commercials that target A-Fib patients. What these ads for anticoagulants don’t tell you is:

• You are on their meds for life! (they want lifelong customers!)
• These meds do nothing to treat your A-Fib (only your risk of stroke)
• A-Fib can be cured (you don’t have to be on meds for the rest of your life)

These ads for anticoagulant medications imply that if you just take their pill once a day, you’ve taken care of your A-Fib. Wrong! Don’t fall for the hype.

Bad Pharma—How Drug Companies Mislead Doctors & Harm Patients

The author of Bad Pharma does an excellent job of shining a light on the truths that the drug industry wants to stay hidden.

Bad Pharma by Ben GoldacreThose truths include how they mislead doctors and the medical industry through sales techniques, and manipulate consumers into becoming life-long drug customers. (For doctors, that industry influence begins in medical school and continues throughout their practice.)

We also learn truths about the internal workings of the medical academia, the U.S. FDA, and medical journals publishing.

The arguments in the book are supported by research and data made available to the reader. The author, Ben Goldacre, is a doctor and science journalist, and advocates for sticking to the scientific method, full disclosure and advocating for the interest of the patients. Read a critical review of Bad Pharma in the British Journal of Clinical Pharmacology.

My Best Advice: ‘Educate Yourself’

One of our tenets at A-Fib.com, is ‘Educate Yourself’! if you want to be a more savvy consumer of health care services (I highly recommend Bad Pharma. I also recommend Ben Goldacre’s other book, Bad Science).

Bonus Idea: If you pair this book withKnow Your Chances: Understanding Health Statistics by Steven Woloshin, you’ll have a complete course on how the drug industry skillfully markets their products. Read my review.

Read the book for FREE: The ebook version is online at U.S. National Library of Medicine PubMedHealth, and you can download the .PDF version (remember to save to your hard drive).

See my post: How Big Pharma Issues Misleading News and Why it Matters.

Features the report by the online watchdog group HealthNewsReview.org.

 

Don’t Settle for a Lifetime on Medications—

Seek your A-Fib Cure

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