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


Causes

Triggering A-Fib at the Dentist: My Post-Ablation Experience

A while back we published a warning by Dr. Sam about how your dentist’s use of local anesthesia containing epinephrine can trigger your A-Fib. I have another warning to add.

My Dental Cleaning After Catheter Ablation

I was reminded of Dr. Sam’s post when I visited my own dentist three days after having my recent catheter ablation (my Atrial Fibrillation returned after 21 years of being A-Fib free).

No-no-no-ultrasonic dental cleaning for me

Upon hearing of my medical procedure, my long-time dentist, Dr. Dave Famili, didn’t want to use the typical ultrasonic type of dental cleaning because it could distrupt my heart rhythm. So, they didn’t use anything electronic. Instead, they did a manual cleaning only, and all was good.

For my chart, he also requested the name and contact information for my EP, Dr. Shepal Doshi, in case he needed to be contacted.

Update Your Medical Records

From my first-hand experience, I remind you to be sure to inform your dentist and other healthcare providers when you have a procedure for your Atrial Fibrillation.

Use of Epinephrine Could Trigger Your A-Fib 

Another concern at the dentist is the use of Epinephrine (Epi or Adrenalin). It is one of the drugs EPs can use when completing a catheter ablation—they try to trigger A-Fib to check that their ablation scars for working. So any local anesthesia with Epinephrine (Epi) potentially can trigger A-Fib.

Local anesthesia (with Epi or Adrenalin) is used by dentists, dermatologists, emergency room personnel and others.

At the Dentist: A retired MD wrote to caution A-Fib patients that local anesthesia containing epinephrine can trigger your A-Fib.

Dr. Sam writes: “I had to have a dental implant and bridgework requiring that I have local anesthesia several times. The dentist uses local anesthesia with Epinephrine (Epi or Adrenalin) to numb your mouth. 

My EP said he thought it would be OK to use. So I had it, and within 30 minutes I was in A-Fib which lasted about 20 minutes and then I went back into NSR.

From then on I requested that my dentist use only local anesthesia without Epi, and I had no more A-Fib episodes. Dentists like to use local anesthesia with Epi because it lasts longer and reduces bleeding locally.

I found very little info online about this, and no studies had been done about dental anesthesia with Epi & A-Fib.”

Tell Your Doctors: Epinephrine Containing Products Can Trigger Your A-Fib

At the Opthamologist: The drops that the eye doctor uses to dilate your eyes are similar to Adrenalin. Ask for an alternative.

At the Dermatologist: Local anesthesia containing epinephrine is used by your doctor to numb skin and reduce bleeding when they remove cysts, limpomas, moles, skin cancer spots, etc. and to close lacerations. Tell them your concern about triggering your A-Fib.

Your GP and at the Emergency Room: Doctors use local anesthesia with Epinephrine to sew up wounds and/or to do small surgical procedures requiring local anesthesia, because it reduces bleeding locally and lasts longer. Remind your GP and discuss your A-Fib with emergency room caregivers. Express your concern about the use of Epinephrine. Ask for an alternative.

Are You Allergic to Medications? As a Caution Include Epinephrine

Allergic to any medications?

Medical staff routinely ask if you are allergic to any medications.

Tell your doctors you have Atrial Fibrillation and discuss your concern that the use of local anesthesia with Epinephrine may trigger your Atrial Fibrillation.

You might want to add Epinephrine as a medication you are allergic to in your medical records along with an explanation.

Early-Onset A-Fib linked With Family History

Blacks and Hispanics/Latinos with A-Fib have higher rates of complications and even death as a result of A-Fib. This is despite research which shows that Blacks and Hispanics/Latinos are less likely than Whites to develop Atrial Fibrillation.

Although research of A-Fib in minority populations has been limited, researchers think they have unlocked one bit of the mystery.

Thanks to the development of a large, diverse registry of patients at the University of Illinois at Chicago, researchers have been studying A-Fib in minority populations.

This study is unique because most prior studies on family history and A-Fib relied on data from mostly White populations, leaving doctors with little research to guide personalized treatment in minority communities.

A-Fib Registry of Blacks, Hispanics/Latinos and Whites: Of the 664 patients enrolled in UIC’s A-Fib registry at the time of the study, 40 percent were white, 39 percent were black and 21 percent were Latino, according to Dr. Dawood Darbar, professor of medicine and head of cardiology at the UIC College of Medicine.

Early-onset A-Fib refers to those younger than 60 years old when diagnosed.

Link with Early-Onset A-Fib diagnosis: The researchers found that there was a family history of A-Fib in 49 percent of patients who were diagnosed with early-onset A-Fib (EOAF), that is, in patients younger than 60 years of age―compared with only 22 percent of patients diagnosed with A-Fib later in life.

Monitoring First-Degree Relatives: This is the first research-based evidence that supports increased monitoring (even including genetic testing) of families who have first-degree relatives with early-onset A-Fib (EOAF) as a preventive measure against complications including strokes.

When broken down by race, the chance of a patient with early-onset A-Fib having a first-degree relative with the condition was more than two-and-a-half times more likely for Blacks and almost 10 times more likely for Latinos, compared with only two-and-a-half times more likely for Whites.

While more research is needed, these findings have important implications for identifying family members at risk for atrial fibrillation

“Many people with A-Fib do not know they have the condition until they present to the emergency room with a stroke,” said Dr. Darbar.

Hispanics/Latinos with early-onset A-Fib are almost 10 times more likely to have a first-degree relative with A-Fib.

What this Means to Patients

For patients diagnosed with early-onset A-Fib, a family history of A-Fib was found in 49 percent of patients. This research holds true across all three races, Whites, Blacks and Hispanics/Latinos.

If you have early-onset A-Fib (EOAF), that is, if younger than 60 years old when diagnosed, your family members should be monitored for A-Fib as a preventive measure against complications including stroke. This is especially true for Hispanics/Latinos.

Resource for this article
• Alzahrani Z, et al. Association Between Family History and Early-Onset Atrial Fibrillation Across Racial and Ethnic Groups. JAMA Network Open. 2018;1(5):e182497. doi:10.1001/jamanetworkopen.2018.2497

• AFib linked to family history in blacks, Latinos. UIC Today. September 21, 2018. https://today.uic.edu/afib-linked-to-family-history-in-blacks-latinos

Causes: How Do You Get Atrial Fibrillation? What Triggers A-Fib?

Expanding your understanding of A-Fib is a core mission here at Atrial Fibrillation: Resources for Patients (A-Fib.com). In that effort, one of our core content pages is Causes of A-Fib.

(A ‘core page’ answers one of the basic questions you [and your family] have about developing or being diagnosed with Atrial Fibrillation.)

Causes of A-Fib at A-Fib.com

Causes of A-Fib

Review of Causes and Triggers

Expand or fill in any gaps in your understanding of A-Fib. Our basic review of the various causes of Atrial Fibrillation covers: Heart Problems, Alcohol Consumption, Severe Body Distress, Mental Stress, Being Overweight and Genetics.

After the list of causes, we then review some of the Triggers that can bring on your A-Fib. We cover: Food-Related Triggers, Sleep Apnea, Mechanically-Induced A-Fib, Physical and Gender Characteristics, Aging and ‘No Known Cause’. Go to What Causes A-Fib?

The Pursuit of Knowledge

The more you understand about Atrial Fibrillation, the better you can cope with your symptoms—and the better you can strive to Seek Your Cure! 

The Effect of Diet & Nutrition on Your A-Fib: My Top 5 Articles

Many patients wonder if eating or avoiding the right foods might lessen or improve their A-Fib symptoms. While we don’t know of any diet to “cure” your A-Fib, you might consider the “DASH” eating plan recommended by U.S. National Heart, Lung and Blood Institute which reduces the risk of developing cardiovascular disease.

The following articles may answer some of your A-Fib-related questions involving diet and nutrition:

1. Caffeine: “Is drinking coffee (tea, colas, other products with caffeine) going to make my A-Fib worse or trigger an A-Fib attack?”

2. Diet: Is a whole food or organic diet helpful for patients with Atrial Fibrillation? Is there any research recommending one or the other?”

3. Personal A-Fib story: “No Way Am I Having an Ablation! But Diet and Meds Disappoint—A-Fib Free After Ablation” by Saul Lisauskas

4. Nutrition: Why are doctors so opposed to nutrition as a way of helping A-Fib. I tried to talk with my doctor about magnesium and other nutritional supplements. ‘There’s no proof that they work,’ was his response.”

5. Holistic Approach:  “I want nutritional counseling and a more integrated approach to my A-Fib treatment plan. How do I find a doctor with a more “holistic” approach?”

Be a Sleuth: Keep an Episode Diary

Keep a diary of your A-Fib episodes

To determine if certain foods or beverages may be triggering the number and duration of your A-Fib attacks, start by keeping a log or diary. When an episode occurs, note the day & time, duration and what you were doing, eating or drinking.

As you collect data, scrutinize your log entries for patterns and specific triggers. This may lead you to lessen or eliminate certain foods or beverages or even activities that appear to trigger your A-Fib. You may want to share your log with your doctor.

More About Stroke and Dementia…Link to Artificial Sweeteners

It’s commonly assumed that both sugarsweetened and artificially-sweetened soft drinks have been linked to cardiometabolic risk factors, which increase the risk of cerebrovascular disease and dementia.

But results from the well-known Framingham Heart Study Offspring indicate otherwise.

Researchers studied 2,888 participants over 45 years old for incidents of stroke, and 1484 participants over 60 years old for incidents of dementia. Adjustments were made for age, sex, education (for analysis of dementia), caloric intake, diet quality, physical activity, and smoking.

A-Fib, Stroke Risk and Dementia at A-Fib.com

A-Fib, Stroke Risk and Dementia

Risks of Ischemic Stroke, All-Cause Dementia

Researchers found that higher recent-intake and higher cumulative-intake of artificially sweetened soft drinks “were associated with an increased risk of ischemic stroke, all-cause dementia, and Alzheimer’s disease dementia.”

But results were not the same for sugar! Sugar-sweetened beverages were not associated with a higher risk of stroke and dementia.

What Patients Need To Know

The bad news: For those of us worried about an A-Fib stroke and dementia, we need to avoid artificially-sweetened beverages.

The (somewhat) good news: The same warning doesn’t seem to apply to sugar-sweetened beverages. (This doesn’t necessarily mean that sugary drinks are healthy or good for you.)

For more about Dementia: see A-Fib and Dementia: My Top 5 Articles.

Reference for this Article
Pase, MP et al. Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia: A Prospective Cohort Study. Stroke/American Heart Association, 2017. STROKEAHA. 116.016027, April 20, 2017. http://stroke.ahajournals.org/content/early/2017/04/20/STROKEAHA.116.016027

Can I Prevent Familial A-Fib with Diet? Supplements?

I’ve posted a new Frequently Asked Question and Answer about A-Fib that runs in families:

“Both my uncles and my Dad have Atrial Fibrillation. I’m 50 years old and so far I don’t have A-Fib (yet), but I’m worried. How can I avoid developing A-Fib? Can dietary changes help? Or lifestyle changes?”

A-Fib does run in families and is called Familial A-Fib. Research says you have a 40% increased risk of developing A-Fib yourself. And the younger your uncles and dad were when they got A-Fib, the more likely you are to develop A-Fib. So, you are correct to be concerned about getting A-Fib.

My answer covers:

• What can someone with A-Fib in the family do to avoid getting A-Fib?
• Is there a diet to prevent A-Fib? The Mediterranean diet? A whole-food organic diet?
• What are the causes of A-Fib that can be controlled?
• Do mineral deficiencies cause A-FIb?
• What are the vitamins and supplements known to improve your overall heart health?  (I take these myself to help stay A-Fib free after my 1998 catheter ablation which isolated only one of my pulmonary vein, common at the time.)

Read my full answer at FAQs: Can I Prevent Familial A-Fib with Diet? Supplements?

FAQs: Can I Prevent Familial A-Fib with Diet? Supplements?

FAQs Coping with A-Fib: Diet & Lifestyle

“Both my uncles and my Dad have Atrial Fibrillation. I’m worried. How can I avoid developing A-Fib? Can dietary changes help? Or lifestyle changes? I’m 50 years old and so far I don’t have A-Fib (yet), ”

A-Fib does run in families and is called Familial A-Fib. Research says you have a 40% increased risk of developing A-Fib yourself. And the younger that family member was when they got A-Fib, the more likely you are to develop A-Fib. So, you are correct to be concerned about getting A-Fib. 

Note: Most heart health eating plans aim to improve the ‘plumbing’ of the heart, whereas A-Fib is primarily an ‘electrical’ problem.

A Heart Healthy Diet and Lifestyle

While there’s no “Atrial Fibrillation diet” proven to prevent, stop or cure A-Fib, anything that improves your overall heart health might indirectly affect developing A-Fib.

Start with a ‘heart healthy’ diet and healthy lifestyle. There are lots of on-line resources and books about eating healthy for your heart.

• The U.S. National Heart, Lung and Blood Institute recommends the “DASH” eating plan which reduces the risk of developing cardiovascular disease;
• A Mediterranean diet may reduce the risk of atrial fibrillation, according to a article by Case Adams, a board-certified Naturopath;
• A whole-food organic diet is “preferred” for A-Fib patients, states Naturopathic doctor (ND) Dan Carter. But he doesn’t claim that this diet will prevent or cure A-Fib.

For more about a whole food or organic diet, read my FAQ answer.

A-Fib Causes: Some are Under Your Control

The four main causes or co-morbidities of A-Fib are sleep apnea, obesity, hypertension and diabetes. If you have any of these conditions, it’s important to get them under control.

Binge drinking has been known to start one’s A-Fib, as well as smoking and excessive stress or anxiety. Avoid these as much as you can. (Also, many patients develop A-Fib post-surgery due to sudden low levels of magnesium.)

Dehydration can contribute to A-Fib. Too much alcohol or caffeine and too little water can alter the fluid levels in your body. Consume an adequate amount of water especially on hot days and when exercising.

Minerals Quad- flat 200 pixVitamins, Supplements and Herbs

Several vitamins, supplements and herbs have been shown to reduce or eliminate A-Fib symptoms. Magnesium and Potassium deficiencies are prevalent among A-Fib patients, as well as Calcium overload. Read more on our Mineral Deficiencies page.

For a list of 7 other vitamins and supplements known to improve your overall heart health, see my article: ‘Natural’ Supplements for a Healthy Heart’. (I take these myself to help stay A-Fib free after my 1998 catheter ablation which isolated only one of my pulmonary vein, a common treatment strategy at the time.)

What This Means to Families of A-Fib Patients

With A-Fib running in your family, you have a 40% increased risk of developing A-Fib yourself. And the younger your uncles and dad were when they got A-Fib, the more likely you are to develop A-Fib.

The younger your uncles and dad were when they got A-Fib, the more likely you are to develop A-Fib.

While there’s no diet to prevent A-Fib, you can get control of co-morbidities such as obesity, sleep apnea, diabetes and high blood pressure. And you can avoid lifestyle choices like binge drinking, smoking, excessive stress and anxiety that increase your odds of A-Fib. (If you have surgery, ask your doctor about Magnesium IV post-op).

Above all, choose a healthy heart lifestyle, exercise, don’t overindulge and eat well.

References for this article
How Can Atrial Fibrillation Be Prevented? U.S. National Heart, Lung and Blood Institute. URL: http://www.nhlbi.nih.gov/health/health-topics/topics/af/prevention

Carter, D. Treating Atrial Fibrillation and Decreasing Risk Naturally. Naturopathic Doctor News & Review (NDNR) Oct 1, 2011. Last accessed March 11, 2016 URL: http://ndnr.com/cardiopulmonary-medicine/treating-atrial-fibrillation-and-decreasing-risk-naturally/

“DASH” eating plan. U.S. National Heart, Lung and Blood Institute. URL: http://www.nhlbi.nih.gov/health/health-topics/topics/dash

Roth, E. What Are the Triggers for Atrial Fibrillation? Healthline. July 16, 2013. Last accessed March 11, 2016 URL: http://www.healthline.com/health/atrial-fibrillation/triggers#1

Martínez-González MÁ, et al. PREDIMED Investigators. Extra virgin olive oil consumption reduces risk of atrial fibrillation: the PREDIMED (Prevención con Dieta Mediterránea) trial. Circulation. 2014 Jul 1;130(1):18-26. doi: 10.1161/CIRCULATIONAHA.113.006921.

Case, A. Mediterranean Diet Cuts Risk of Atrial Fibrillation and Other Heart Conditions. GreenMedInfo. September 26th 2014. Last accessed March 11, 2-16. URL: http://www.greenmedinfo.com/blog/mediterranean-diet-cuts-risk-atrial-fibrillation-and-other-heart-conditions

Back to FAQs: Coping with Your A-Fib 
Last updated: Monday, June 18, 2018

Women with A-Fib: Mother Nature and Gender Bias—Or—Get Thee to an EP ASAP

Research on Atrial Fibrillation

by Patti J. Ryan, August 2015

Several studies have established that the symptoms and consequences of A-Fib are more profoundly felt in women.

Mother Nature and A-Fib Symptoms in Women

Females tend to develop A-Fib at a later age than men. They are also more likely to seek medical attention, are usually more symptomatic, and have higher heart rates. A-Fib tends to affect their physical quality of life more severely. Women suffer more from A-Fib related anxiety which in turn increases the risk of being misdiagnosed as panic disorders.

Women have a lower incidence of A-Fib than men. While men as a group develop A-Fib twice as often as women, there are twice as many females as males in the age group with the highest percentage of A-Fib, mainly because women live longer than men. Around five times as many males undergo catheter ablation than females.

Cardiovascular mortality rates are 2.5-fold greater for women with A-Fib. Women have a 4.6-fold higher rate of stroke. Post menopausal women are especially at risk for a stroke. The estrogen deficiency that comes with menopause causes a weakness in the arterial walls and an increase in proinflammatory molecules in the brain called cytokines. A-Fib is the most frequent cause of disabling stroke in elderly females.

Remember: you don’t have to live with A-Fib! Seek your cure.

What can you do about it? As a female with A-Fib, you may have more symptoms, quality of life issues, and are at greater risk of an A-Fib-related stroke. But you don’t have to live with A-Fib. As soon as practical, get a referral to a heart rhythm specialist (an Electrophysiologist (EP)—a cardiologist with a specialty in electrophysiology). Early diagnosis means less damage to your heart and more treatment options.

Drug Therapies for Women with A-Fib and Risk of Stroke

Women fail more antiarrhythmic drugs therapies than men. Women don’t do well on some antiarrhythmic drugs (estrogen may prolong the QT interval). (Women have a longer QT interval than men.) When treated with antiarrhythmic drugs, women are more likely to have life-threatening adverse events. Women with A-Fib have about the same stroke risk as men, though they are less likely to receive anticoagulation.

Antiarrhythmic drug therapy in women with hypertension is associated with more major cardiovascular events. (Some research indicates that women may have more hypertension than men, 55.2% vs 40%).

What this means to patients: Drugs don’t cure A-Fib but merely keep it at bay,” says heart rhythm specialist, Dr. Dhiraj Gupta. Antiarrhythmic drugs only work for about 50% of patients, and often stop working after a period of time. Many can’t tolerate the side effects.

Don’t spend a year in A-Fib trying different medications or combinations of medications only to find none work for you. In addition, anticoagulants, like warfarin, for your increased stroke risk, have their own health risks. Don’t live a life on medication. Seek your cure.

Differences in Catheter Ablation for Females with A-Fib

Women, in general, have smaller cardiac chambers so that catheter manipulation is more of a challenge (40.6 mm on average for women vs 44.6 mm for men). (However, since research data shows there is a significant delay in referral for ablation in women, it is feasible that they may have larger left atrial sizes due to remodeling, making this a moot point.)

Run, don’t walk to the best heart rhythm specialist (an electrophysiologist) you can find. 

Females have more non-PV triggers and have lower ablation success rates.

Females tend to have more ablation complications like pericardial tamponade, vascular complications, and bleeding.

What can you do about it? Don’t delay. “Run, don’t walk” to the best heart rhythm specialist (an electrophysiologist) you can find, advises former A-Fib patient Sheri Weber. A-Fib is a progressive disease. Consult an EP after your diagnosis. Don’t wait for your A-Fib to get worse. (A-Fib rarely gets better.)

Gender Bias Also Plays a Role

Women are referred to A-Fib specialists three times less often than men. Men with A-Fib are managed more aggressively (such as more cardioversions) prior to seeking a catheter ablation.

Women often have developed a larger left atrium because of being referred to EPs later in their treatment plan than men (60 months for females vs 47 months for males).

Women are referred to A-Fib specialists three times less often than men.

Women are referred for catheter ablation less frequently and later into their treatment plan than men. When referred, they are older on average than men (61.6 years old vs 56.9 years old for men).

Consequently, they have more complex symptoms, and their procedure success rate is lower with more complications.

What can you do about it? When you go to your GP or cardiologist with your A-Fib symptoms or complaints, anticipate gender bias! Don’t let it deter you. A-Fib is a progressive disease. Don’t waste time. Don’t let your A-Fib worsen over time by remodeling or enlarging your heart. Request a referral to a heart rhythm specialist―an electrophysiologist (EP). Until you consult an EP, you may not be getting the best and most up-to-date A-Fib treatment advice. You deserve nothing less.

Don’t just take your meds and get used to being in A-Fib.

Why is there Gender Bias in the Treatment of Women with A-Fib?

In many cultures and societies, doctors are more conservative in their treatment of women with A-Fib. Some doctors, concerned with safety, may be reluctant to perform or recommend any invasive procedures in women.

Social and family pressures may delay medical consultation and treatment (“I can’t be sick. My family needs me.”) Access to health care may be limited for some women.

And, of course, there’s plain ol’ bias by male doctors against female patients. “Your symptoms are all in your mind.” or “Just take your meds and get used to being in A-Fib.” (These are actual quotes from A-Fib.com readers about their doctors’ advice.)

What can you do about it? Be prepared for your doctor appointment with a list of questions or concerns. Don’t leave until you have answers. Don’t be afraid to ‘fire’ your doctor. Get a second, or third opinion. Find a doctor who will partner with you to find your cure or best outcome. (For help, use the Finding the Right Doctor for You resources on A-Fib.com.)

Good News: EPs Less Likely to Have Gender Bias

Research indicates female gender bias tends to disappear when a woman sees an electrophysiologist (EP), particularly concerning catheter ablation. This suggests that treatment bias may be more at the primary care level, i.e., your GP or general cardiologist.

What this means to patients: It’s reassuring to be in the care of someone who regularly treats A-Fib patients. A-Fib is an electrical problem. Don’t waste you time. Don’t settle for just ‘managing’ your A-Fib. See a heart rhythm specialist, an electrophysiologist, a cardiologist who specializes in the electrical function of your heart. An EP will discuss all your treatment options. EPs want to free you from the burden of A-Fib.


Patti J Ryan, writer and editor, a-Fib.com

About the Author: Patti J. Ryan is editor of A-Fib.com and regularly contributes her writing and graphics expertise.  She is also publisher of Beat Your A-Fib: The Essential Guide to Finding Your Cure by Steve S. Ryan, PhD (BeatYourA-Fib.com), an Amazon.com Top 100 Seller in two health-related categories.

References for this article
Patel, D. et al. Atrial Fibrillation Catheter Ablation in Females. Expert Rev Cardiovasc Ther. 2011;9(11):1391-1395. http://www.medscape.com/viewarticle/753555Forleo, G. et al. Gender-related differences in catheter ablation of atrial fibrillation. Europace 9, 613-620 (2007). Last accessed Aug 13, 2015. http://europace.oxfordjournals.org/content/9/8/613.short

Roten L, et al. Gender differences in patients referred for atrial fibrillation management to a tertiary center. PACE 32, 622–626 (2009). Specifically examines the proportion of males to females referred for ablation in a specialized outpatient clinic. Women were referred three-times less frequently than males to the clinic.

Friberg J, et al. Comparison of the impact of atrial fibrillation on the risk of stroke and cardiovascular death in women versus men (The Copenhagen City Heart Study). Am. J. Cardiol. 94, 889–894 (2004).

Patel D, et al. Outcomes and complications of catheter ablation for atrial fibrillation in females. Heart Rhythm 7, 167–172 (2010). The largest study to date that evaluates the safety and efficacy of catheter ablation in females.

Feinberg WM, et al. Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch. Intern. Med. 155, 469–473 (1995).

Humphries KH, et al. New-onset atrial fibrillation: sex differences in presentation, treatment, and outcome. Circulation 103, 2365–2370 (2001). Evaluated the effects of gender on atrial fibrillation presentation, management and outcomes.

Dagres N, et al. Gender-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Heart Survey on Atrial Fibrillation. J. Am. Coll. Cardiol. 49, 572–577 (2007).

Fang MC, et al. Gender differences in the risk of ischemic stroke and peripheral embolism in atrial fibrillation: the Anticoagulation and Risk Factors In Atrial fibrillation (ATRIA) study. Circulation 112, 1687–1691 (2005).

Dagres N, et al. Significant gender-related differences in radiofrequency catheter ablation therapy. J. Am. Coll. Cardiol. 42, 1103–1107 (2003). Evaluated gender-related differences in catheter ablation in patients with accessory pathways and/or atrioventricular nodal re-entrant tachycardia.

Fuster V, et al. ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 7, 257–354 (2006).

Shallenberger, Frank. The Connection Between Stroke and Frailty – And How to Avoid Both, Second Opinion, February 2020, Vol. XXX, No.2, p. 1.

VIDEO: Atrial Fibrillation—A Conversation with Dr. Steve S. Ryan

Resources & Links

Video Interview: Steve S. Ryan, PhD, Author of Beat Your A-Fib

Host Skip E. Lowe interviews Steve S Ryan, PhD, about Atrial Fibrillation. Topics include A-Fib symptoms, causes, cures and Dr. Ryan’s book, Beat Your A-Fib – The Essential Guide to Finding Your Cure. Skip E. relays his own experiences with A-Fib. Dr. Ryan warns about incorrect A-Fib information found on the internet and in print media.  Recorded in W. Hollywood, CA. 14:53 min.

About Steve S. Ryan, PhD: An advocate for patients with Atrial Fibrillation, Dr. Ryan is publisher of the patient education website ‘Atrial Fibrillation: Resources for Patients’  (A-Fib.com), author of the award-winning book, ‘Beat Your A-Fib: The Essential Guide to Finding Your Cure’ (BeatYourA-Fib.com) and known as The A-Fib Coach for his one-to-one mentoring of A-Fib patients.

Return to Videos Featuring Steve S. Ryan, PhD

Last updated: Tuesday, April 21, 2015

 

Research: Catheter Ablation Reduces Stroke Risk even for Higher Risk Patients

Catheter Ablation Reduces Stroke Risk Even for Higher Risk Patients

by Steve S. Ryan, Last updated: March 24, 2018

Research You Can Use at A-Fib.comIn a study of nearly 38,000 people, patients with A-Fib who had a catheter ablation had about as many strokes as the people without A-Fib, while people on just medication had about twice as many strokes. (This isn’t a surprising finding. If you no longer have A-Fib, by definition you can’t have an A-Fib stroke.)

But what is surprising is that even patients at greater risk of stroke had a reduced stroke risk after catheter ablation. “Across all CHADS2 profiles and ages, A-Fib patients with ablation had a lower long-term risk of stroke compared to patients without ablation.” Even those at higher risks of stroke had a reduced risk of stroke.

Catheter Ablation Reduces Stroke Risk to That Of A Normal Person

And, more importantly, if someone had a catheter ablation, stroke risk decreased to that of a normal person. “A-Fib ablation patients had similar long-term risks of stroke across all CHADS2 profiles and ages compared to patients with no history of A-Fib…Freedom from A-Fib was the strongest predictor of stroke-free survival.”

Warfarin Not Needed After Successful Catheter Ablation

Some patients after a catheter ablation are still put on warfarin-for-life depending on their CHADS2 score. But research indicates that “A-Fib patients after ablation with moderate to high risk CHADS2 scores in which warfarin was discontinued do not show a higher risk of stroke compared to those in which warfarin is continued.”

Editor’s Comments:
This study is medical breakthrough news, similar to another important study in which a successful catheter ablation reduced by 60% the expected rate of cardiovascular mortality. (See Live Longer—Have a Catheter Ablation.)
For anyone who has had a successful catheter ablation or who is thinking of having one, this study also is a game changer!
Even if you are at a theoretical high risk of stroke (high CHADS2), you don’t have to be on warfarin for the rest of your life after a successful catheter ablation. A successful catheter ablation reduces your stroke risk to that of a normal person (though obviously normal people do have strokes).
We already know that a catheter ablation significantly improves our well being. We certainly feel healthier in sinus rhythm. Few other medical procedures produce such a dramatic and nearly immediate improvement in our quality of life. This study confirms the long-term benefits of catheter ablation even for people who are sicker.
We don’t have to live a life on meds! A-Fib can be cured by a catheter ablation. And when you are made A-Fib free, not only do you feel better, but your risk of stroke is reduced to that of a normal person! This is terrific news for the A-Fib community.
References for this Article

First published April 2015

• Bunch, T.J. et al. Atrial fibrillation ablation patients have long-term stroke rates similar to patients without atrial fibrillation regardless of CHADS2 score. Heart Rhythm. Volume 10, Issue 9, Pages 1272-1277, September 2013. Last accessed 10/18/14. http://www.heartrhythmjournal.com/article/S1547-5271(13)00726-1/abstract DOI: http://dx.doi.org/10.1016/j.hrthm.2013.07.002

• Bunch, T.J. et al. Patients treated with catheter ablation for atrial fibrillation have long-term rates of death, stroke, and dementia similar to patients without atrial fibrillation. J. Cardiovasc Electrophysiol. 2011;22:839-845. http://www.ncbi.nlm.nih.gov/pubmed/21410581. doi: 10.1111/j.1540-8167.2011.02035.x. Epub 2011 Mar 15.

• Hunter, RJ et al. Maintenance of sinus rhythm with an ablation strategy in patients with atrial fibrillation is associated with a lower risk of stroke and death. Heart. 2012;98:48-53. http://www.ncbi.nlm.nih.gov/pubmed/21930724. doi: 10.1136/heartjnl-2011-300720.

• Kornej, J. et al Renal Dysfunction, Stroke Risk Scores (CHADS2, CHA2DS2-VASc, and R2CHADS2), and the risk of Thromboembolic Events After Catheter Ablation of Atrial Fibrillation. Circ Arrhythm Electrophsiol, 2013;6:868-874. http://circep.ahajournals.org/content/6/5/868.abstract. doi: 10.1161/CIRCEP.113.000869

• Oral, H. et al. Risk of thromboembolic events after percutaneous left atrial radiofrequency ablation of atrial fibrillation. Circulation. 2006;114:759-765. http://circ.ahajournals.org/content/114/8/759.short.

• Kulkarni, Shefali S. Procedure may reduce stroke risk with irregular heartbeat. Reuters. New York Mon Aug 5, 2013. Last accessed 10/18/14. http://www.reuters.com/article/2013/08/05/us-stroke-risk-idUSBRE9740UR20130805

• Themistoclakis, S. et al. The risk of thromboembolism and need for oral anticoagulation after successful atrial fibrillation ablation. J Am Cardiol. 2010;55:735-743. http://content.onlinejacc.org/article.aspx?articleid=1140481 doi:10.1016/j.jacc.2009.11.039 Posted January 2015

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Last updated: Saturday, March 24, 2018

 

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