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
Abbott’s LAA Closure Device Amplatzer Amulet FDA Approved for A-Fib
Atrial Fibrillation patients now have a second effective way to close off the Left Atrial Appendage (LAA) to prevent strokes and to no longer be required to take anticoagulants for life. Abbott’s Amplatzer Amulet Left Atrial Appendage closure device was approved by the FDA in August 2021.
Amulet Clinical Trial
In a clinical trial sponsored by Abbott, the Amplatzer Amulet was compared head-to-head with the earlier version of the Watchman device, (not with the more recent Watchman FLX commonly in use today).
Amplatzer Amulet Occluder device positioned in Left Atrial Appendage (LAA)
The Amplatzer Amulet device features a lobe which fills the body of the Left Atrial Appendage (LAA) and a disc to close off the opening into the LAA.
In the Amulet LAA Occluder clinical trial, 80% of Amulet patients were discharged without anticoagulant therapy. Only 20% were discharged on anticoagulants (usually dual antiplatelet therapy, clopidogrel plus aspirin). The FDA-approved label recommends this to prevent clot formation before the device is completely closed off by heart tissue growing over the device (reendothelialization).
In this study most Watchman patients (82%) were discharged requiring anticoagulant therapy. The Watchman usually requires a short course (45 days) of warfarin followed by dual antiplatelet therapy anticoagulants (usually clopidogrel plus aspirin) until 6 months after LAA closure.
Major Advantage of Amulet Over Watchman
Why is the Amulet important for some Atrial Fibrillation patients? The Amulet doesn’t usually require the use of anticoagulants after it is inserted. (Some patients can’t take anticoagulants, others don’t want to be on anticoagulants, even for a short period.)
No Data Yet on Amulet vs. Newest Watchman FLX
The Amulet did close off the LAA better than the 2015 version of the Watchman, but not by much (98.9% vs. 96.8%).
We don’t have data comparing the current Watchman FLX to the Amulet.
Editor’s Comments
Atrial Fibrillation patients considering an Amulet should probably wait till after they are free of Atrial Fibrillation and after a thorough mapping and isolation of all non-PV triggers, especially those coming from the LAA.
Metal Exposure: The Watchman FLX features reduced metal exposure, whereas the Amulet outside disc is a large protruding piece of metal inserted into the heart. (I personally would not want that huge piece of metal disc in my heart.)
Occluders: Watchman on left; Amplatzer Amulet on right
What if one’s LAA continues to produces A-Fib signals? It’s difficult or impossible to isolate the LAA if the Amulet disc covers the LAA opening. The Watchman doesn’t protrude into the heart like the Amulet does.
No or Reduced Need for Anticoagulants with Amulet: The Amulet doesn’t usually require anticoagulants. This is great news for those who can’t tolerate anticoagulants. One of the major motivations to getting one’s LAA closed off is to no longer have to take anticoagulants which are high risk drugs.
It’s Great for A-Fib Patients to Now Have a Choice of LAA Closure Devices: It’s amazing how research has improved for patients with A-Fib. Who would have thought that we would now have two effective ways to close off the LAA to prevent strokes−with no requirement of anticoagulants therapy for life?
Which is Better―the Amulet or Watchman? Which Should I Choose? Unless you can’t tolerate anticoagulants for 6 months, stick with the Watchman FLX. We know it works in the real world after years of experience. While the Amulet is used in Europe, it has just been FDA approved in the US. We need more real-world experience with it.
On a Personal Note: As many readers know after 21 years, my A-Fib returned. Not to worry. I’m once again A-Fib free after two catheter ablations by Dr. Shephal Doshi and Dr. Andrea Natale. But Dr. Natale did recommended I close off my Left Atrial Appendage (LAA). So in a few months, I’ll be getting the Watchman FLX occlusion device. I’ll write about the experience.
Additional reading: Don’t Want to Take Anticoagulants? Three Alternatives for A-Fib Patients; and Anticoagulants Increase Risk of Hemorrhagic-Type Strokes
A-Fib & Anticoagulants: Bleeding Risk If combined with OTC meds, Supplements
More than a third (33%) of people taking anticoagulants also take at least one nonprescription drug daily or most days of the week. This combination can cause dangerous side effects.
If you are taking an anticoagulant, such as Eliquis, Xarelto, Pradaxa or Savaysa, be aware that taking it along with some over-the-counter drugs and supplements can cause dangerous internal bleeding.
These over-the-counter drugs include painkillers such as aspirin, Advil (ibuprofen), and Tylenol (acetaminophen) and dietary supplements such as fish oil, turmeric, ginger and other herbs.
Internal Bleeding Risk: NOACs/DOACs Hard to Measure
The older anticoagulant, warfarin, required regular blood tests of INR (International Normalized Ratio) to measure how much warfarin was actually working in a patient’s blood to prevent a stroke.
But the newer anticoagulants (NOACs, DOACs), such as Eliquis, Xarelto, Pradaxa or Savaysa, aren’t normally measured by anticoagulation clinics or health care professionals using standardized tests such as INR. (The FDA, under pressure for new anticoagulants, approved the NOACs without there being any established or universally recognized method of determining their clot preventing effectiveness.)
Be aware that your doctor probably doesn’t test to see how much your NOAC is actually working in you. They hope it is, but doesn’t know for sure. Blood levels of your NOAC depends on factors such as how well or how poorly your kidneys are functioning.
Not all of your NOAC may actually be working for you. Pradaxa, for example, is 80% cleared by the kidneys. This means there may be lower anticoagulant levels in your blood stream, and a lot of your clot prevention is being flushed away by your kidneys. (Eliquis, Xarelto and Savaysa fare better with only 25%, 33% and 35% being cleared by the kidneys, respectively.)
Check With Your Doctor About Increased Internal Bleeding Risk
If you take an anticoagulant along with over-the counter drugs and supplements, ask your doctor which combinations to avoid. But be aware that many doctors are clueless about natural dietary supplements.
(Don’t ask them how effectively your NOAC is working in you. They probably don’t know and can’t easily test for that.)
New FAQ: What is Atypical Flutter?
“I have Atrial Flutter that my EP describes as “atypical”. What does that mean? Is it treated differently than typical Flutter? (I’ve had two ablations, many cardioversions, and a Watchman installed to close off my LAA.)”
Atrial Flutter is similar but different from Atrial Fibrillation. Atrial Flutter is characterized by rapid, organized contractions of individual heart muscle fibers (see graphic below).
In general, there are two types of Atrial Flutter:
• Typical Flutter (from the right atrium)
• Atypical Flutter (can come from anywhere)
Typical Flutter originates in the right atrium (whereas A-Fib usually comes from the left atrium).
Atypical Flutter can come from anywhere and is one of the most difficult arrhythmias to map and ablate.
To learn more, read my full answer, go to: “I have Atrial Flutter that my EP describes as “atypical”. What does that mean?”
A-Flutter usually comes from the right atrium (A-Fib usually comes from the left atrium).
2020 AF Symposium: 5 Abstracts on Pulsed Field Ablation
The 2020 AF Symposium abstracts are one-page descriptions of A-Fib research, both published or unpublished. The abstracts are supplemental to the Symposium live presentations, panels discussions and spotlight sessions. This year the printed digest contained 55 abstracts. I choose only a few to summarize.
My Summaries of Select PFA Abstracts
Pulsed Field Ablation (PFA) was the single most important topic at this year’s Symposium. I summarized five of the PFA abstracts of most interest to A-Fib patients.
• Lesion Durability and Safety Outcomes of Pulsed Field Ablation
The durability of PFA lesions is the focus of Dr. Vivek Reddy’s abstract. His research study followed 113 patients who each received a PFA ablation.
• Pulsed Field Ablation with CTI Lesions Terminates Flutter in a Small Study
The use of Pulsed Field Ablation (PFA) may significantly improve CTI ablation lesions to block the Flutter signal. (CTI: Cavo-Tricuspid Isthmus)
• Durability of Pulsed Field Ablation Isolation Over Time: Preliminary Study
Pulsed Field Ablation (PFA) is a new treatment. This study asked the question of whether PFA electrical isolation (lesions) regresses over time.
• Pulsed Field Ablation vs RF Ablation: A Study in Swine
PFA is “tissue-specific”. This study tested if surrounding non-heart tissue (the esophagus) would be affected. PFA ablation was compared to RF ablation. Swine (pigs) were used so tissue could be dissected and examined.
• Using MRI to Check Pulsed Field Ablations (PFA)
Normally, during a RF or cryo ablation, doctors move the esophagus as far away as possible from where they are ablating. In this study they took no such precautions.
My Summary Reports
For more from the 2020 AF Symposium, go to My Summary Reports Written for A-Fib Patients. Remember, all my reports are written in plain language for A-Fib patients and their families.
COVID-19: White House Pushes Unproven Drugs—Risk of Arrhythmias and Sudden Death
by Steve S. Ryan
Note: I have already written about the risk of COVID-19 for patients with A-Fib (and other cardiovascular diseases). See my post: COVID-19 Virus: Higher Risk for A-Fib Patients.
In recent coronavirus pandemic press conferences, President Donald Trump has repeatedly advocated the use of the drugs hydroxychloroquine (HCQ) and azithromycin (Z-Pak) to treat the COVID-19 virus.
He often says, “What have you got to lose?” About treating patients, he also said these drugs can “help them, but it’s not going to hurt them.” (Really?)
Hydroxychloroquine & Azithromycin Danger―“What Have You Got to Lose?”
The drugs hydroxychloroquine and azithromycin are currently gaining attention as potential treatments for COVID-19. Hydroxychloroquine sulphate (Plaquenil) is an antimalarial medication. Azithromycin (Z-Pak) is an antibiotic. (Antibiotics in general are ineffective against viruses.)
Each has potential serious implications for people with existing cardiovascular disease.
Contrary to Mr. Trump’s statements, you do have a lot to lose. Medical groups warn that it’s dangerous to be hawking unproven remedies.
Recently, three U.S. heart societies published a joint statement to detail critical cardiovascular considerations in the use of hydroxychloroquine and azithromycin for the treatment of COVID-19.
According to the “Guidance from the American Heart Association, the American College of Cardiology and the Heart Rhythm Society”:
Complications include severe electrical irregularities in the heart such as arrythmia (irregular heartbeat), polymorphic ventricular tachycardia (including Torsade de Pointes) and long QT syndrome, and increased risk of sudden death.
The effect on QT or arrhythmia of these two medications combined has not been studied.
With these increased dangers in mind, we must not take unnecessary (or foolish) risks in the rush to find a treatment or cure for COVID-19.
What We Know So Far About These Drugs and COVID-19
COVID-19 Virus: Higher Risk for A-Fib Patients
COVID-19, the disease caused by the new coronavirus SARS-CoV-2, has sickened hundreds of thousands and continues to kill large numbers of people worldwide.
Typically, it’s considered a threat to the lungs, but COVID-19 also presents a significant threat to heart health, according to recently published research.
“But It’s Just the Flu, Right?”
“During most flu epidemics, more people die of heart problems than respiratory issues like pneumonia,” according to Dr. Mohammad Madjid, McGovern Medical School at UTHealth. He expects similar cardiac problems among severe COVID-19 cases.
In addition, COVID-19 can worsen existing cardiovascular disease. For example, Atrial Fibrillation patients may develop myocarditis, an inflammation of the heart muscle. If left untreated, myocarditis may lead to symptoms of heart failure.
And for otherwise healthy people, COVID-19 can cause new heart problems.
Comorbid Conditions Increase Fatality Rate
Many A-Fib patients also suffer from other chronic conditions such as diabetes and hypertension. With comorbid conditions, COVID-19 can increase the severity and fatality of the virus.
According to research from the Chinese Center for Disease Control and Prevention (CCDC), COVID-19 patients from mainland China who reported no comorbid conditions had a case fatality rate of 0.9%.
While patients with the following comorbid conditions had much higher rates:
+ 10.5% for those with cardiovascular disease
+ 7.3% for diabetes
+ 6.3% for chronic respiratory disease
+ 6.0% for hypertension
+ 5.6% for cancer.
Among critical cases, the case fatality rate is unsurprisingly highest at 49%.
Take Away: A-Fib Patients at Higher Risk for COVID-19
Patients with underlying cardiovascular disease (i.e., A-Fib) are at higher risk for developing COVID-19 and have a worse outlook. Prior heart disease is a risk factor for higher mortality from COVID-19. Cardiovascular patients are encouraged to take additional, reasonable precautions to avoid contact with the COVID-19 virus. And to stay current with vaccinations, especially for influenza and pneumonia. Since people can spread the COVID-19 virus before they know they are sick, it is important to stay away from others when possible, even if you or they have no symptoms. • Stay at least 6 feet (2 meters) from other people Social distancing is especially important for people who are at higher risk of getting very sick including older adults and people of any age who have serious underlying medical conditions. For more information: see the article “How to Protect Yourself & Others” from the Centers for Disease Control and Prevention (CDC).A-Fib Patients: Practice Social Distancing and Stay Safe at Home
• Do not gather in groups
• Stay out of crowded places and avoid mass gatherings
Our Patient-to-Patient Resources: Help from Others with Atrial Fibrillation
To help you cope with your Atrial Fibrillation, we offer you the resources to educate yourself about A-Fib and your treatment options, and to arm yourself with the skills to navigate a path to a life without Atrial Fibrillation.
Our Personal A-Fib stories of Hope and Courage and our A-Fib Support Volunteers are two resources to help answer your questions and bolster your resolve to Seek Your A-Fib Cure (or best outcome for you).
A-Fib Patient Stories of Hope, Courage and Lessons Learned
Your first experiences with Atrial Fibrillation have changed your life in a number of ways: dealing with your A-Fib symptoms, the emotional toll as well, and the impact on your family.
It’s encouraging to read how someone else has dealt with their A-Fib. In our 99+ Personal A-Fib Stories of Hope, A-Fib patients tell their stories to encourage and offer you hope. (The first story is Steve Ryan’s in 1998). Many writers have included their email address if you want to contact them directly. To browse our patient experiences, go to Personal A-Fib Stories of Hope and Courage.
Offering Hope: 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 A-Fib Support Volunteers have gone through a lot while seeking their A-Fib cure. They have been helped along the way and want to return the favor. They answer questions and offer you encouragement through exchanging emails and sharing their stories.
Our volunteer listings are organized by geographic locations, within the U. S. and internationally by country and/or region. Learn how to contact our A-Fib Support Volunteers.
Readers post their stories and volunteer to help you to
Seek your Cure.
A-Fib Patients: How Does Your Doctor Talk to You?
I recall an email sent to me by a woman from England who described her horrendous A-Fib symptoms—palpitations, extreme fluttering, breathlessness, “absolute extreme fatigue.” She recalled how the doctor said her symptoms had nothing to do with A-Fib, that the symptoms were all in her head, and that she was exaggerating her breathlessness and exhaustion.
Wow! First, I reassured her that her symptoms are very real for many A-Fib patients. I then suggested she change doctors. (I also recommended she contact our A-Fib Support Volunteers.)
How’s the Rapport With Your Doctor?
There’s an insightful article in the Journal of Cardiovascular Electrophysiology (I’d like to send a copy to her doctor) “How doctors can provide better treatment by understanding the hearts―and minds―of AF patients.“
In brief, it’s a Top 10 list: 5 things A-Fib patients do not want to hear from their doctors and 5 things they do want to hear. (Go to the journal article.)
Five Things A-Fib Patients Do Not Want To Hear
Several research studies tell us that some doctors underestimate the impact Atrial Fibrillation has on a patient’s quality of life. Many doctors treat A-Fib as a benign heart ailment. But patients report how A-Fib can wreak havoc in their lives.
Responding to a survey, A-Fib patients said they do not want their healthcare providers to say:
1. “A-Fib won’t kill you.”
2. “Just get on with your life and stop thinking about your A-Fib.”
3. “Stay off the Internet and only listen to me.”
4. “I’ll choose your treatment, not you.”
5. “You’re just a hysterical female.”
Did anything on this list sound (or feel) familiar to you?
If your doctor is condescending or dismisses your concerns, you’re getting poor care. If a doctor is too busy to talk with you and answer your concerns, he’s probably too busy to take care of you properly.
Like the patient from England, it may be time for you to change doctors.
Five Things A-Fib Patients Do Want To Hear
Those doctors who recognize the serious effects atrial fibrillation can have on patients will foster meaningful and productive partnerships with their patients. From the same survey, here are five things A-Fib patients do want their healthcare providers to say:
1. “I respect you and will listen.”
2. “I want to be sure you understand.”
3. “Let’s customize a treatment that works with your lifestyle.”
4. “I understand your values and preferences.”
5. “Here are some resources about A-Fib.”
Do the comments on this second list sound like your doctor?
When your doctor respects you and listens to you, you’re more likely to collaborate on a treatment plan tailored to you and your treatment goals.
If you don’t have this kind of rapport with your current doctor(s), it’s worth looking elsewhere for a new doctor (even if they’re considered “the best” in their field).
Changing Doctors Can Be Scary: We Can Help
As a researcher in doctor-patient communication, Robin DiMatteo, of U. of Calif.- Riverside, says of changing doctors: ”I really think it’s a fear of the unknown. But if the doctor isn’t supporting your healing or health, you should go.”
At A-Fib.com, we can help you. First, learn more about how to Find The Right Doctor For You and Your Treatment Goals.
Then check our Directory of Doctors and Facilities. We list US & international physicians and medical centers treating Atrial Fibrillation patients. This evolving list is offered as a service and convenience to A-Fib patients. (Important: Unlike other directories, we accept no fee to be included.)
A-Fib.com is Your Independent Source of Unbiased Information
Who can you trust? Did you know…the drug and medical device industries operate or influence almost every health/heart related web site on the Internet?
For example, the drug company Eli Lilly is a “partner” with WebMD (WebMD Health Corp.) which includes the websites, Medscape.com, MedicineNet, eMedicine.com, eMedicineHealth, RxList, theHeart.org, and Drugs.com.
Consider for a moment how that may affect the information you read on their websites. Can you trust these sites to be impartial?
Beholden to No One Except Our Readers
Reader Paul O.
Former A-Fib patient, Paul V. O’Connell of Baltimore, MD, wrote about A-Fib.com publisher, Steve Ryan:
“Steve’s probably the world’s best informed patient advocate when it comes to understanding atrial fibrillation and its treatment.
Most important, Steve is not owned by the AMA or Big Pharma—so he is not beholden to anyone except his readers.”
Health On the Net and GuideStar Certified
A-Fib.com has earned and maintained the Health On the Net Foundation (HON) Certification for quality and trustworthiness of medical and health online information. The Health On the Net Foundation (HON) Code of Conduct helps protect citizens from misleading health information. 
A-Fib Inc. has earned GuideStar’s highest rating, the GuideStar Exchange Platinum Seal, a leading symbol of transparency and accountability in the non-profit world.
A-Fib.com is Independent and Unbiased with No Affiliations
From our start in 2002, Steve has maintained an independent and unbiased viewpoint. To assure our integrity, A-Fib.com is deliberately not affiliated with any medical school, device manufacturer, pharmaceutical company, HMO, or medical practice.
At A-Fib.com, Steve accepts no third-party advertising, does not charge for inclusion in our Directory of Doctors & Facilities and accepts no fee (cash or other kind) for a listing in Steve’s Lists of Doctors by Specialty. Not many healthcare websites or patient education sites can make these same claims.
A-Fib.com is your independent source of unbiased information
about Atrial Fibrillation and its resources and treatments.
Join our Mission. Support A-Fib.com.
Every donation helps. Even $1.00.
Our A-Fib.com Video Library and My Top 5 Picks for the Newly Diagnosed
We have screened hundreds of A-Fib-related videos over the years and have carefully selected a short list for you. Our A-Fib library of videos and animations are for the reader who learns visually through motion graphics, audio, and personal interviews. These short videos are organized loosely into three levels:
Browse our curated A-Fib Video Library
♥ Introductory/Basic Level is for the newly diagnosed patient. Fundamentals of the heart’s electrical system, stroke risk and anticoagulation therapy, ECG/EKG, and catheter/surgical treatments. Helpful for the family and friends of an A-Fib patient, too.
♥ Intermediate Level is for the more informed patient. Videos offer details of the heart’s functions, types of heart monitoring devices, specifics of catheter ablation, maze and hybrid surgeries, and closure of the Left Atrial Appendage.
♥ Advanced Level videos offer a more extensive look at cardioversion, ECGs/EKGs, ejection fraction, catheter ablations/EP lab and maze/mini-maze surgeries. (May requires basic understanding of cardiac anatomy and A-Fib physiology.)
We invite you to browse our A-Fib library of videos and animations and try out a few of our titles.
Top 5 Videos for the Newly Diagnosed Patient
The newly diagnosed A-Fib patient has lots of questions. What is A-Fib? How do I deal with my symptoms? What are my treatment options? How does it impact my family? For answers, start with these videos.
1. Introduction to How a Normal Heart Pumps Blood
A short video about the path of a red blood cell through the heart’s four chambers to deliver oxygen to the body and then return to be re-oxygenated. Animation with narration. (Don’t worry about remembering the terminology, just follow the flow of the red blood cell). By The Children’s Hospital of Philadelphia. (1:00 min.) Go to video.
2. Stroke Prevention in A-Fib and Anticoagulant Therapy
Through interviews and animations explains how atrial fibrillation can cause stroke and why anticoagulation is so important; Discussion of: warfarin (Coumadin), the required monitoring, interactions with food, alcohol and other drugs: newer anticoagulants (NOACs) that do not require regular testing, aren’t affected by foods [but are expensive]. On-camera interviews with AF Association CEO, Trudie Lobban MBE and other experts (5:36) Developed in association with the drug maker, Boehringer Ingelheim. Go to video.
3. The EKG Signal and Conduction System of the Heart
The EKG signal
Excellent illustration of the heart and a fully labeled graphic of the ‘Conduction System of the Heart’. Descriptive text accompanies each step in the animation. First a normally beating heart, the electrical signal path and corresponding EKG tracing. Then the same heart in Atrial Fibrillation with EKG tracing of the heart in A-Fib. Go to video on the American Heart Association website.
4. About Magnesium Deficiency with Dr. Carolyn Dean
Most A-Fib patients are deficient in Magnesium. “The Best Way to Supplement Magnesium” with Dr. Carolyn Dean, the author of The Magnesium Miracle. Getting nutrients through food is not always possible; discusses side effects of too much and how you can tell if you have a deficiency. (3:39). Go to video. See also: “Importance of Balancing Calcium & Magnesium“ (1:00)
5. When Drug Therapy Fails: Why Patients Consider Catheter Ablation
Dr. Susan M. Sharma discusses why patients with atrial fibrillation turn to ablation when drug therapy doesn’t work. Presenting research findings by David J. Wilber MD; Carlo Pappone, MD, Dr. Sharma discusses the success rates of drug therapy versus catheter ablation. Transcript of the narration is provided. (3:00 min.) From Insidermedicine.com. Go to video.
Disclaimer: Videos provided for your convenience only; we make no endorsement of a specific treatment, physician or medical facility.
For more videos,
visit our A-Fib.com Video Library
Steve Ryan Videos
We’ve edited Steve’s most interesting radio and TV interviews to create several short (3-5 min.) videos. Check out Videos Featuring Steve S. Ryan, PhD, publisher of A-Fib.com.
