Doctors & patients are saying about 'A-Fib.com'...
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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
“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
Book Review: “Your Complete Guide to AFib” by Percy Morales, MD
Review by Steve S. Ryan, PhD
I received an advance copy of “Your Complete Guide to AFib―The Essential Manual for Every Patient With Atrial Fibrillation” by Dr. Percy Morales and was asked for a review. The opinions given are my own.
Caveat: $149.95 to be Cured of AFib
Abbreviations for Atrial Fibrillation include: AFib, A-Fib and AF.
Dr. Morales’ book encourages readers to sign up for his “takecontroloverafib.com” program at $149.95 a pop. It’s very surprising to see a medical doctor engage in a direct marketing-type sales hustle. His “Guide to Healthy Living” reads like a Tony Robbins motivational presentation but applied to AFib.
[I personally was very discouraged and depressed reading Dr. Morales’ work.]
Style of Dr. Morales’ Book
“Your Complete Guide to AFib” is written by a working Electrophysiologist (EP). It’s a thin book, 119 pages, without a lot of content. But what’s there is clear and based on Dr. Morales’ own experience.
In terms of style, Dr. Morales’ book is a dull read with too many proofreading errors for such a small volume.
Instead of standard footnotes, he cites actual web sites which doesn’t work well. (Website addresses and pages change every day. As a solo source, they are not a reliable one.)
Is There No Cure for AFib?
A major shortcoming of Dr. Morales’ book is he doesn’t acknowledge that AFib can be cured, that you don’t have to live in AFib. This is discouraging and a turn-off for many readers. He isn’t big on hope.
Causes of AFib
Under “Causes of AFib” Dr. Morales doesn’t discuss or acknowledge Lone AFib where people who are perfectly healthy get AFib and don’t have any comorbidities (around 50% of AFib cases, including me) (p. 16). But on page 99 he does acknowledge that, “some younger patients will be diagnosed with AFib where there is no clear cause for it.”
Most people who develop AFib are not sick with other diseases. And even if one is sick with, for example, high blood pressure, we can’t say for sure that high blood pressure “caused” a particular person’s AFib.
Is AFib Your Fault?
Dr. Morales implies that it’s a patient’s fault that they developed AFib, because they let themselves get sick with “comorbidities” which brought on their AFib (p. 16).
[In general, it’s not your fault that you have AFib (with the possible exception of aberrant behavior like binge drinking or smoking). We can’t stress this point enough. IT’S NOT YOUR FAULT that you have AFib. Think of AFib as Karma or Fate rather than something you caused yourself.]
Seek Treatment Early
One of the most important points Dr. Morales makes is “it is imperative to seek treatment early to ensure that (AFib) does not progress into more serious stages” (p. 23.) [I agree]
He says that about 10 to 30 percent of paroxysmal patients progress towards persistent AFib in about a year. [That progression rate is probably higher than Dr. Morales states.] He states that AFib may become more persistent rather quickly. “After about a year, many people find that their AFib episodes have become more persistent, or more frequent, and may last in excess of one week [i.e. Persistent AFib] (p. 19).
Women One Point on Stroke Risk Score Because of Gender―NO!
In discussing the risk of stroke, Dr. Morales states that simply being a woman is worth one point on the stroke risk score (p. 30). [This is a controversial point among doctors. I think it’s absurd! It doesn’t make any sense intuitively nor is it research based.1 If you are a woman, don’t let a possible form of gender bias intimidate you.]
Heart Healthy Diet
As most other AFib authors, Dr. Morales recommends a heart healthy diet. But in general, he isn’t very specific and detailed about how or why diet choices may affect AFib. With one exception: “Foods with high sodium, such as processed lunch meats, may trigger AFib episodes.” (p. 40; no reference or documentation provided.)
If a more healthy diet improves overall heart health, Dr. Morales assumes this will also improve AFib. [We know that a healthful diet may improve, for example, cholesterol. But AFib is an electrical, not a plumbing problem. Compared to antiarrhythmic drugs, we really don’t know if, how, or which diet choices directly affect AFib.]
Alcohol and AFib
“Alcohol and AFib do not mix.” “Moderate alcohol consumption of no more than a drink per day can also worsen symptoms in AFib patients if they do not give up drinking.” “AFib and alcohol are not compatible.” “Frequent drinking of small alcohol servings is detrimental for your heart rhythm and increases risk of AFib.” (p. 48-50). [Dr. Morales’ advice is somewhat contradictory. He also writes….]
In his “Guide to Healthy Living” he states, “In general, unless alcohol is a clear trigger for your AFib, I usually tell my patients it is ok to drink alcohol in moderation, limiting to 1-2 drinks in a setting, and only 1-2 times a week.”
Standard, Common-Sense Recommendations
Dr. Morales is to be commended for discussing the importance of magnesium for AFib. But he states, “there is no long-term study to indicate that magnesium supplements are of any help in treating AFib.” (p. 44). [This simply isn’t true. Read more.2]
He isn’t a fan of natural supplements “There is no natural supplements (sic) that can permanently cure or fix atrial fibrillation.3 [Supplements may not cure A-Fib. But, do lessen AFib symptoms.]
Dr. Morales joins with most writers about AFib to advocate for exercise, dealing with sleep apnea, coping better with stress, no smoking, and losing weight if necessary.
Catheter Ablation
Dr. Morales states that, “an ablation procedure is not the first line choice for treating AFib due to inherent risks for any invasive procedure.” (p. 77). [This is wrong. Current AFib Management guidelines recognize catheter ablation as a legitimate first choice for AFib patients.4]
[Dr. Morales doesn’t discuss that a catheter ablation can make you A-Fib free, can transform your life. For Dr. Morales, catheter ablation is just another treatment.]
Surgery
Dr. Morales discusses what he calls “Surgical Ablation Procedures.” This is a very confusing use of terms. The term “procedure” is generally used for non-surgical treatments where there is no cutting involved.
In this section Dr. Morales doesn’t discuss the Cox Maze (IV) surgery which is considered the gold standard of surgical treatments for AFib. This is a surprising omission.
He states that surgeons access the heart through small incisions on both sides of the chest (p. 84). More commonly today, they go through the diaphragm. [They then cut into the outside of the heart to interrupt electrical signals from the pulmonary veins (PV).]
He also states that surgeons performing the Mini-Maze surgery also treat (ablate, destroy) the ganglionic plexi. [This is a highly controversial area that not all surgeons routinely destroy.]
He also states that some smaller studies have reported “a higher success rate with surgical ablations like a mini-maze versus a typical catheter ablation.” On page 117, Dr. Morales states, “These surgeries are typically more thorough then (sic) a catheter procedure.” [Not true. A typical Wolf mini-maze only isolates the Pulmonary Veins. Catheter ablation can isolate not only the PVs but also identify and ablate other areas of the heart producing AFib signals.]
He also states that in cases of persistent or long-standing persistent AFib “a surgical ablation may offer a higher success rate than a catheter-based ablation.” [This isn’t the case with a standard mini-maze operation.]
Anticoagulation for Life
Dr. Morales states that for patients cured of A-Fib by a catheter ablation, they still have to be on anticoagulants for life. [Not true.]
“A strategy for stroke risk reduction is necessary even for patients who undergo catheter ablation” (p. 116). [This doesn’t make much sense. You can’t have an AFib stroke if you no longer have AFib.]
Dr. Morales’ $149.95 Program
On page 114, Dr. Morales promotes his website, www.takecontroloverafib.com, and online program for which he charges $149.95. This online presentation was a very difficult, painful read for me. When I accessed it, the program constantly stopped and re-started which drove me crazy.
Instead of serious study, it’s filled with repetitious marketing drivel that goes on for over ½ hour, all to make you buy his program. It’s the worst experience I’ve ever had reading works about AFib.
Review Conclusion
I can’t recommend this book. There are many incorrect, outdated or false statements, as well as limited independent, unbiased research to support his statements.
Do your own research: You are better going to major medical centers’ websites like The Cleveland Clinic and Cedar Sinai Hospital to get accurate and impartial information.
For top ranked A-Fib centers (with website links) see A-Fib Patients: 2018-2019 Top Rated Hospitals for Cardiology & Heart Surgery.
1 For more about Women and A-Fib, see my post: Women in A-Fib Not at Greater Risk of Stroke.
2 For more about Magnesium, see my posts: Cardiovascular Benefits of Magnesium: Insights for Atrial Fibrillation Patients and Low Serum Magnesium Linked with Atrial Fibrillation. These are only a few of the many studies of about Magnesium and A-Fib which have been published over the years.
3 In Europe, upon entering the hospital, doctors often give A-Fib patients an IV of magnesium.
4 Current AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation recognize catheter ablation as a legitimate first choice for A-Fib patients. “The role of catheter ablation as first-line therapy, prior to a trial of a Class I or III antiarrhythmic agent, is an appropriate indication for catheter ablation of AF in patients with symptomatic paroxysmal or persistent AF.”
A word to the wise…
