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Dr. Douglas L. Packer, MD, FHRS, Mayo Clinic, Rochester, MN

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Jill and Steve Douglas, East Troy, WI 

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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

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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

A-Fib Free Again: My 3rd Ablation for “Very Late Recurrence” by Dr Natale

The return of my A-Fib was captured by my Medtronic Reveal LINQ loop recorder. I was asymptomatic, often referred to as Silent A-Fib. (For more about my recurrence, see my earlier post: My A-Fib’s Back: Need a Touch-Up This Week)

A Medtronic Reveal LINQ Insertable Cardiac Monitor (ICM) is one of the world’s smallest cardiac monitors—inserted just under the skin near the heart.

Medtronic Reveal LINQ insertable heart monitor

Medtronic Reveal LINQ IHM

Each night my Reveal Linq wireless monitor transmits that day’s data by wireless connection to my EP, Dr. Shephal Doshi.

I’m 80 years young and a very active runner, high jumper and weightlifter. While many EPs would likely prescribe A-Fib drugs, I chose a third “touch-up” ablation instead.

Very Late Recurrence: This ablation was for the condition called “Very Late Recurrence” where someone who has been A-Fib free for years develops A-Fib again. (Previously these cases were considered very difficult or even impossible to fix.)

Why does A-Fib sometimes recur many years later? We can only speculate. Perhaps the evolution or development of A-Fib silently continues during the years of being A-Fib free. Is it age-related? Does genetics play a role? Obviously more research needs to be done in this area.

Pre-ablation, Steve Ryan with Dr. Natale and his surgical nurse.

But thanks to the excellent research of Dr. Andrea Natale and his colleagues, “Very Late Recurrence” can now be fixed.

To learn more about Very Late Recurrence, see our article: After Two Years A-Fib Free, What Causes ‘Very Late Recurrence’ in Post-Ablation Patients?

My Third Ablation: My re-do catheter ablation was on August 19, 2021 and was performed by Dr. Andrea Natale at Los Robles hospital in Thousand Oaks, CA.

Research has shown that “very late recurrence” of A-Fib is primarily driven by non‐pulmonary vein triggers especially from the left atrial appendage and coronary sinus. Isolation of these triggers results in a high success rate.

Beautiful quilt, Los Robles Hospital Cardiac admittance; Handmade by two staff nurses.

During my ablation, this is exactly what Dr. Natale found. Therefore, he isolated both my left atrial appendage and my coronary sinus to eliminate the locations of these triggers. (My pulmonary veins had remained isolated.) He also made a roof line and an “infero-posterior” line with RF to isolate the posterior wall of the left atrium. He  found non-PV electrograms/potentials in the left atrial septum, the floor of the left atrium, the left atrial lateral wall, and the anterior roof of the left atrium which he eliminated with RF ablation.

I was in the hospital overnight. Everything went fine. The only complication I had was irritation of the throat from being intubated. I had to return to the Los Robles emergency room, but they took care of that with medication.

A-Fib Free (Again): I’m temporarily on Multaq and of course the anticoagulant Eliquis.

I am in the three-month blanking period. This is the period when my heart is learning to beat normally again.

For now, I’m A-Fib free.


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