Doctors & patients are saying about 'A-Fib.com'...
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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
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.
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.)
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 sugar–sweetened 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
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.
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.
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.
Vitamins, 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.
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.
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
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. The risk of A-Fib is higher with increasing pregnacies. Women have increased atrial fibrosis and a higher incidence of non-pulmonary vein triggers.
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.
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 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.)
Females have more non-PV triggers and have lower ablation success rates. Around five times as many males undergo catheter ablation than females.
Females tend to have more ablation complications like pericardial tamponade, vascular complications, and bleeding. Women also have worse left atrial appendage function, which may contribute to the higher risk of s troke.
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 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.
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.
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.
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
In 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.
Return to Treatments for A-Fib
Last updated: Saturday, March 24, 2018
