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Book Review: “Restart Your Heart: The Playbook for Thriving with AFib” by Dr. Aseem Desai

Review by Steve S. Ryan, PhD

Restart Your Heart by Dr. Aseem Desai

Dr. Aseem Desai’s book Restart Your Heart: The Playbook for Thriving with AFib is written for Atrial Fibrillation patients by a practicing Electrophysiologist. It will be well received and is long overdue.

Caveat: By advocating living with A-Fib and by not telling patients of the dangers of living in A-Fib, Dr. Desai may be doing lasting harm to many A-Fib patients.

Dr. Desai’s Writing Style

One of the best features of Dr. Desai’s book is his patient-friendly writing style. He avoids “medicalize.” What he writes is easy to read and relatable. And he doesn’t shy away from explaining complicated concepts.

He is particularly good at explaining the scientific basis of A-Fib in a way patients can relate to. In particular, his explanation and illustration of Ion Channel Receptors (p. 21-23) is one of the best parts of his book.

A Dangerous and Deceptive Goal for A-Fib Patients

Atrial Fibrillation (A-Fib) is a progressive disease. The longer you have A-Fib, the greater the risk of your A-Fib episodes becoming more frequent and longer, often leading to continuous (Chronic) A-Fib. The abnormal rhythm in your heart causes changes and enlarges your atria (called remodeling), making it work harder over time.

Leaving patients in A-Fib overworks the heart, leads to fibrosis, stretches/expands the atrial heart walls, weakens the heart, increases the risk of  stroke, develops (congestive) heart failure, and leads to dementia because of reduced blood flow to the brain.

I cannot endorse Dr. Aseem Desai’s book because he encourages patients to live with A-Fib. He writes/advocates the following (location noted):

• …Thriving With AFIB” (title)
• …living with a (heart) health condition. (Atrial Fibrillation. p. XVI)
• ‘overcome’ means to succeed in dealing with a problem or difficulty. It does not necessarily mean cure. (p. 83)
• …manage AFib (p. 84)
• …that may mean staying in AFib (p. 139)
• …one treatment outcome is not necessarily better than another. (p. 139)
• …we are not necessarily talking about cure.(p. 176)
• …staying in AFib” (p. 181)

Choosing to Live With A-Fib is a Hopeless and Terrifying Prospect

For most patients with A-Fib, just living with A-Fib and having to take all those A-Fib meds for life is unacceptable and terrifying. It’s a grim future. Unlike what Dr. Desai writes, “overcome…does not necessarily mean cure” (p. 83). Instead people need to know and have hope that there is a cure for A-Fib.

It can be profoundly discouraging for an A-Fib patient to be told you just have to live with A-Fib. If your doctor tells you that, you should get a second opinion. Thanks to today’s incredible advances in A-Fib treatment, very few people need to live in A-Fib.

Dr. Desai is doing A-Fib patients a disservice when he recommends or says it’s acceptable to just live with A-Fib. A-Fib is a heart disease that can wreck your work and family lives and seriously affect your health, including your brain.

A-Fib is Not “Electrical Cancer”

Dr. Desai’s description of A-Fib as “electrical cancer” is unfortunate and not really relevant or helpful to patients. If you are told you have “cancer”, that is a major traumatic experience.

But as bad as an A-Fib episode is, normally it is not life threatening. A-Fib is certainly not cancer and doesn’t work or function like cancer.

Amiodarone is a Dangerous Drug

Dr. Desai’s discussion of amiodarone (p. 90) does mention that it has several organ toxicities. But he should clearly state that amiodarone is a drug of last resort. Patients who take this drug should have exhausted every other treatment possibility.

If administered to A-Fib patients, amiodarone should be used only for short periods of time and in limited doses. Patients taking it should be monitored and tested frequently and scrupulously for damage to organ systems (lungs, thyroid, eyes, liver, skin, heart, neuropathy) both before starting amiodarone and while taking it.

AV Node Ablation and Pacemaker

I’m amazed that Dr. Desai would start his section on Ablation with AV Node Ablation. This is a treatment of last resort after everything else has been tried. No one wants to lose their AV Node and become pacemaker dependent for life.

Rate Control Drugs to “Overcome A-Fib

Patients should not plan on rate control meds (beta blockers) overcoming their A-Fib and keeping them permanently in normal  sinus rhythm (p. 110). Beta blockers are primarily designed to lower heart rate. They do lower adrenaline levels and premature atrial beats (PACs) which can trigger A-Fib, as Dr. Desai points out. But they usually are not as effective a treatment as antiarrhythmic drugs.

From a treatment strategy, beta blockers and rate control meds are not the equivalent of antiarrhythmic drugs, as Dr. Desai seems to imply.

All A-Fib Treatments Are Not Equal

Dr. Desai writes that “one treatment outcome is not necessarily better than another” (p. 139).

This is so wrong from a patient’s perspective.

Anyone who’s had a successful catheter ablation for A-Fib can tell you that going from A-Fib to normal  sinus rhythm is life-changing and transformative! There are few medical treatments that so profoundly affect Quality of Life.

Currently catheter ablation is the only treatment strategy that offers hope of a cure of A-Fib and a life free of Atrial Fibrillation. (But also see The Cox-Maze & Mini-Maze Surgeries and the Hybrid).

Every A-Fib patient should aim to be A-Fib free, not just to live with the disease.

A-Fib is a Progressive Heart Disease Which Gets Worse Over Time

A-Fib is a heart disease. Dr. Desai is basically telling people it’s OK to live with a heart disease that progressively gets worse over time.

This makes no sense, particularly with the major advances being made in treating A-Fib patients.

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