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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

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

Coping with Atrial Fibrillation

FAQs Coping with A-Fib: Predicting Attacks

FAQs Coping with A-Fib: Predicting Attacks

FAQs A-Fib afibIs there any way to predict when I’m going to have an A-Fib attack?”

Try being a private detective! Start by keeping a log or diary of your A-Fib episodes for three or six months. Then analyze your log for patterns.

By studying your log you may find, for example, that your A-Fib episodes come mostly at night, or after a meal which may mean you have Vagal A-Fib. What is the interval between your A-Fib episodes? Some people have very regular intervals between A-Fib attacks. A-Fib Support Volunteer, Max, for example, had regular A-Fib episodes every morning at 7am. (Read Max’s A-Fib story #43: A-Fib Causes Devastating Effects—From Shanghai to Bordeaux..) Knowing these patterns may help you deal with your A-Fib.

But not every log will be revealing. A-Fib seems to have a mind and schedule of its own that’s often hard to predict.

When I had A-Fib, I had little success predicting attacks. I had very short episodes no longer than five minutes often during the day. I was never able to predict when they would occur, or identify what may have triggered them.

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

FAQs Newly Diagnosed with A-Fib: Ending Episodes

 FAQs Newly Diagnosed with A-Fib: Ending Episodes

Last updated: January 28, 2019

Maze heart You are not alone - with outline 175 pix at 96 res“Is there anything I can do to get out of an A-Fib episode? How do others deal with their episodes?”

One approach to ending your A-Fib episode is a drug therapy called “pill-in-the-pocket”. Under a doctor’s direction, you take the antiarrhythmic meds flecainide (brand name Tambocor) or propafenone (Rythmol) whenever you feel the start of an attack of A-Fib. The dosage is determined by your doctor.

Note: If your A-Fib episode is longer than normal, or if it doesn’t terminate on its own, you may need to contact your doctor or visit the emergency room. The E.R. doctor may use electrical cardioversion or chemical cardioversion (medication like a Cardizem drip) to end your A-Fib episode.

Anecdotal Tips from other A-Fib Patients: Most of the following is anecdotal, what people have reported, rather than based on scientific studies. Please use discretion in trying any of the following:

•  Magnesium and/or Potassium supplements have been reported to help A-Fib attacks.
•  Some people soak in Epsom salts for twenty minutes to get out of an A-Fib episode. Magnesium Chloride flakes are better than Magnesium Sulfate (Espson salts). See Treatments/Mineral  Deficiencies/Magnesium and ‘Natural’ Supplements for a Healthy Heart.
•  Ian in Australia recommends a Martin and Pleasance product called “Magnesium Phosphate Spray” (available only in Australia/New Zealand) and Magnesium Orotate.
•  Mild exercise has been reported to be helpful in getting out of an A-Fib episode, but in other cases exercise may trigger A-Fib.
•  Resting and lying down in a darkened room during an A-Fib episode.
•  One person suggests, “…lying down on my bed without a pillow, relaxing my body and mind, and keeping my body very warm.”
•  The application of cold compresses or ice packs to the back of the neck.
•  Putting one’s head between one’s knees and/or breathing down hard on one’s diaphragm.
•  Taking a hot bath or shower (which seems to contradict the use of cold packs above).

(If you have any remedies which have worked for you to bring you out of an A-Fib attack, please let me know. Send me an email: Contact Us. I’ll add them to this list.)

Go back to FAQ for the Newly Diagnosed A-Fib Patient
Last updated: Monday, January 28, 2019

FAQs Coping with A-Fib: Diagnosis

 FAQs Coping with A-Fib: Diagnosis

FAQs A-Fib afib“How can I tell when I’m in A-Fib or just having something like indigestion?”

Without medical help you may not be able to tell the difference. (It’s been reported that indigestion is sometimes a side effect of an A-Fib attack.) Only a doctor can determine if you have A-Fib.

To verify if you have A-Fib, a doctor will use an ECG test or have you wear a monitoring system such as a Holter or an event monitor. To read more about these monitors, see my report: A Primer: Ambulatory Heart Rhythm Monitors.

If you want to monitor yourself (which may not necessarily be a good idea), you can start by taking your own pulse.

VIDEO: “Know Your Pulse” Awareness Campaign A short video on why and how to take your pulse. From the Arrhythmia Alliance (A-A) and The Heart Rhythm Charity in the UK. (Our British friend Trudie Lobban is Founder and Trustee.) (1:56 min)

Or you can use an over-the-counter DIY heart monitoring device such as those used by runners and other athletes

Consumer Heart Rate Monitors by Polar

Consumer Heart Rate Monitors by Polar

It’s worn around your chest and transmits a signal to a wristwatch that beeps when your pulse goes too high. You can check the digital display on the watch to see how fast your pulse is. For an in-depth review of DIY/sports monitors, see my report: Consumer (DIY) Heart Rate Monitors and my Shopping Guide to DiY Monitors.

Warning: any over-the-counter device is no substitute for monitoring and treatment by a doctor. You should not use over-the-counter devices to diagnose yourself.

Go back to FAQ for the Newly Diagnosed A-Fib Patient
Last updated: Monday, June 18, 2018

FAQs Newly Diagnosed with A-Fib: Carry Medical ID

 FAQs Newly Diagnosed with A-Fib: Medical ID

Maze heart You are not alone - with outline 175 pix at 96 res“Should I carry a wallet card or a medical ID? I have A-Fib and take Coumadin. In case of an A-Fib emergency, what information should I include?”

According to a paramedic with 25 years experience, knowing about your A-Fib and Coumadin (warfarin) use is “nice-to-know” rather than life-saving, necessary info. Emergency responders don’t normally carry meds to treat A-Fib or blood thinners.

In case of an accident when one is bleeding, techniques to stop the bleeding such as compresses, tourniquets, etc. will be used whether or not one is taking Coumadin.

USB credit card-size by ER Card 100 pix tall

Credit card-size USB by ER Card

It’s generally a good idea to carry some form of medical ID in case of an emergency, whether or not one has A-Fib. For example, a medical ID bracelet or ‘dog tags’ is often noticed by emergency personnel.

What information should you carry with you? For a list of the data to include, see our article, Your Portable Medical Information Kit. We also give you various ways to store and carry your information (i.e. a credit card-size USB flash drive and QR code-based helmet sticker). Includes a link to generate a FREE medical emergency information wallet card.

Thanks to Darrel Seife for this question.

Go back to FAQ for the Newly Diagnosed A-Fib Patient
Last updated: Saturday, February 16, 2019

FAQs Coping with A-Fib: Medical Marijuana

 FAQs Coping with A-Fib: Marijuana

Recreational Marjuana and A-Fib at

A-Fib & marijuana

“Is smoking medically prescribed marijuana or using Marinol (prescription form) going to trigger or cause A-Fib? Will it help my A-Fib?”

During the past few years an increasing number of case reports indicate an association between marijuana smoking and the development of A-Fib.

Compelling evidence is accumulating that marijuana has significant effects on the cardiovascular system. Studies show that cannabis smoking can result in “an increased risk of of both acute coronary syndrome and chronic cardiovascular disease associated with cannabis use.”

Research data shows marijuana smoking in relatively small doses leads to a slight increase in blood pressure and a decrease in oxygen capacity requiring the heart to work harder. Smoking higher doses of marijuana, especially in older individuals, may result in dizziness, fainting and falls.

Form Matters: The form of marijuana, the preparation and method of consumption affect the biological response and may have a different physiological impact.

Recently marijuana has been implicated in neurological complications such as headache, transient ischemic attacks and stroke. Middle age stroke patients were 2.3 times more likely to be pot smokers than healthy middle age control patients.

About palpitations: Marijuana smoking is independently associated with an increased incidence of palpitations (although the underlying cause of this finding was not yet clear).

(Added 7/30/19: A July 2018 study of heart failure and cannabis use may potentially change our thinking about marijuana and A-Fib. Researchers found that among patients admitted to a hospital for heart failure, those using cannabis were less likely to have A-Fib, “cannabis users have lower odds of (developing) AF when compared to non-users.”)

THC and CBD: From speaking to actual marijuana users, the THC component, such as is found in the marijuana plant Stavia, is what makes you feel “high.” The Sativa strain is better for energy, mood, and appetite.

The CBD component, such as is found in the marijuana plant Indica, works better to reduce pain and anxiety, promote relaxation, and induce sleep.

Best Marijuana Product for A-Fib Patients? Probably the edible forms of marijuana using primarily the CBD component seem to be something that A-Fib patients might want to investigate.

An even better choice might be the sublingual form. (A materials science engineer emailed me that the sublingual form might be “much safer than edibles, since that kind of oil production has a very high safety standard, and having a B2C end product requires a lot of regulations.”

But obviously, talk to your doctor first. (This observation and discussion is, at this time, very speculative. Much more research needs to be done in this area.)


Richards JR et al. Cannabis use and acute coronary syndrome. Clin Toxical (Phila). 2019 APR 9:1-11. doi: 10.1080/15563650.2019.1601735. [Epub ahead of print]

Adegbala, O et al. Relation of Cannabis Use and Atrial Fibrillation Among Patients Hospitalized for Heart Failure. Am J Cardiol 2018 July 1;122(1): 129-134. doi: 10.1016/j.amjcard.2018.03.015.

For my recent Marijuana report, listen to my Podcast:

Marijuana—Good, Bad or Ugly for Patients with A-Fib?

Go to Podcast

Personal Experiences Advice

JIM: Jim, an a-Fib patient, has kindly shared his personal experiences about how marijuana helps him. He has tried various meds, cardioversion, and had a failed ablation. He owns his own business in California and is under a lot of stress.

“Because of all of this, I was having trouble sleeping and was getting very stressed out. But instead of taking something pharmaceutical, I turned to medical marijuana. It changed my life. I come home at night, have some marijuana edibles, and the stress goes away. I sleep wonderfully at night, waking up fresh and ready for another day. I told my doctor who understands. He says that marijuana edibles shouldn’t have anything to do with A-Fib, and that I can continue to take them.”

JOHN: On the other hand, John writes that “99% of his A-Fib attacks occurred while under the influence of marijuana.”

WILLIAM: “The A-Fib ablation has been very successful, except the two times that I went into A-Fib after smoking marijuana. I’m a lifelong recreational marijuana smoker, also smoke to relieve the pain from six surgeries on my right arm. Both times that I’ve gone into A-Fib since my last ablation have been after smoking marijuana. After the latest episode I’ve quite smoking marijuana because of the evidence that it can lead to A-Fib.”

JONATHAN: “I tried a tiny bit of brownie for the first time since being diagnosed with A-Fib (occasional episodes). It was OK until about two hours later. I went into A-Fib and, a bit later, came the closest I ever have to blacking out. I don’t think it’s for me anymore.”

SCOTT: “I am currently 55 years old and have been through 15 cardioversions due to A-Fib. I smoked marijuana pretty much daily and noticed that, when I smoked, my heart rate went up. So, I stopped smoking altogether. Since quitting smoking marijuana 7 years ago, I have not had a single case of going into A-Fib. I’m positive that the two are related.” (Scott writes that he also stopped drinking which helped. He used to drink a six pack daily.)

More Research Needed on Medical Marijuana

Due to the increased use of medical marijuana in California and other states, we should soon be getting more data on marijuana’s effects on A-Fib.

Please email me if you have experiences or observations to share about marijuana and A-Fib.
References for this article
Korantzopoulos, P. et al. Atrial Fibrillation and Marijuana Smoking. International Journal of Clinical Practice. 2008;62(2):308-313.

Petronis KR, Anthony JC. An epidemiologic investigation of marijuana- and cocaine-related palpitations. Drug Alcohol Depend 1989; 23: 219-26.

Rettner, R. Marijuana Use May Raise Stroke Risk in Young Adults., MyHealthNewsDaily February 08, 2013. Last accessed Nov 5, 2014. URL:

Back to FAQs: Coping with Your A-Fib
Last updated: Sunday, January 5, 2020

FAQs Coping with A-Fib: Excess Iron

 FAQs Coping with A-Fib: Excess Iron

FAQs A-Fib afib14. “Can excess iron in the blood (Iron Overload Deficiency, IOD) cause Atrial Fibrillation? How do I know if I have IOD? What can I do about it?”

Not only does excess iron in the blood trigger or predispose you to A-Fib, it injures and eventually can kill a variety of body organs like the liver and gall bladder.

According to the Iron Disorder Institute: “Excess iron in vital organs, even in mild cases of iron overload, increases the risk for liver disease (cirrhosis, cancer), heart attack or heart failure, diabetes mellitus, osteoarthritis, osteoporosis, metabolic syndrome, hypothyroidism, hypogonadism, numerous symptoms and in some cases premature death. Iron mismanagement resulting in overload can accelerate such neurodegenerative diseases as Alzheimer’s, early-onset Parkinson’s, Huntington’s, epilepsy and multiple sclerosis.

Excess iron is toxic and can injure every part of the body, including the brain. Iron Overload is a much more widespread condition than people are aware of affecting approximately 1 out of 6 people in the United States. One can develop excess iron by absorbing too much from supplements, iron-rich diet, tobacco and other sources.

When you have your annual physical exam, your doctor should check for iron overload. The most common tests are:

1. Transferrin saturation (TS), also called “Percentage of Saturation.” After fasting, blood is taken to measure Total Iron Binding Capacity (TIBC) and Serum Iron (SI). SI is divided by TIBC to get the Percentage of Saturation. A safe range is 12-44%. Over that is considered iron overload.
2. Serum ferritin concentration (stored iron). A safe range is 5-150. (If the TS test comes out OK, this test may not be done.)
3. Hemoglobin: Iron is used by the body for hemoglobin production. Hemoglobin is the iron-containing respiratory pigment in red blood cells. The top normal level is 14 for women, 15 for men.
4. Red blood cells: the percentage by volume of packed red blood cells in a given sample of blood after centrifugation (i.e., the percentage of red blood cells in your blood). The top normal level is 42 for women, 45 for men.
5. The Unbound Iron Binding Capacity (UIBC) is another test used less frequently. A safe range is above 146. If you’re below that, you should be treated for iron overload.

Pre-menopausal women normally loose blood monthly thereby lowering their iron levels. In men the iron just accumulates with age. “Unfortunately, the body has no way to rid itself of excess iron.”

To get your iron levels down, you may have to give blood through a phlebotomy program at your doctor’s office or blood bank as often as once or twice a week. Drugs known as chelators can also remove excess iron from the blood.

To prevent iron overload (IOD), many of us, particularly men, would benefit from donating blood on a regular basis.  “When you donate blood, the life you save may be your own.” (But be advised that some A-Fib medications like some blood thinners may preclude you from giving blood at the Red Cross.)

Thanks to Isabelle Horowitz for much of this info on IOD.

¤  Iron Overload. Iron Disorders Institute website. Last accessed March 29, 2014. URL:
¤  Iron Overload Diseases Association, Inc (IOD) website. Last accessed March 29, 2014
¤  Hereditary Hemochromatosis (Iron Overload). website. Last accessed March 29, 2014.
¤  Iron Overload Diseases Association, Inc (IOD) website. Last accessed March 29, 2014
¤  Iron: The Double-Edged Sword. Physicians Committee for Responsible Medicine website. Last accessed March 29, 2014.

Back to FAQs: Coping with Your A-Fib

FAQs Coping with A-Fib: Iron Deficiency

 FAQs Coping with A-Fib: Iron Deficiency

FAQs A-Fib afib15. “Can too little iron in the blood (anemia) cause Atrial Fibrillation? What can I do about iron deficiency?”

A-Fib patient, Sally Mertens, wrote about iron deficiency and offers this advice:

“Based on my experience dealing with chronic A Fib, I would stress the importance of having ferritin [iron storage protein] level checked.

My doctor (gynecologist, not my cardiologist!) figured out that my chronic A-Fib might be related to my low ferritin level which was at 9. After only 6 weeks of taking Repliva (82 mg/day iron), my ferritin level was up to 29 and my A Fib had stopped. (Another over-the-counter iron supplement is Floradix.)

I haven’t had one A Fib attack since I started the Repliva. I have concurrently stopped donating blood (which I was doing as frequently as possible) and began eating beef—at least 8 ounces per week (after 3 years as a vegetarian).

Normal serum ferritin (SF) ranges differ by gender, ethnicity and age. The ideal serum ferritin range for adults is 50-150ng/mL

My GYN would like to see my ferritin level at about 50 and told me it would take about 6 months for me to get my blood “stores” back to normal.

I feel extremely lucky and grateful that when I moved to a new town, I got referred to a GYN who was well aware of the link between anemia in pregnancy and heart conditions.

(As a footnote, every time I donated blood, I passed the Red Cross hemoglobin test. My GYN understood how that was possible, but I didn’t understand the explanation well enough to share it with you here.)

I’m well past child-bearing age and thus, as a precaution, my GYN also sent me for a colonoscopy to rule out internal bleeding as a factor in my low ferritin.”

Thanks Sally for your insights.

In addition: Mike writes that taking a product like Geritol boosts his red blood cells and improves his heart valve problems and his A-Fib.

Lesson Learned: A-Fib patients should ask their doctor to verify they have a Normal serum ferritin (SF) level.

Back to FAQs: Coping with Your A-Fib

FAQs Coping with A-Fib: Is a Single Episode Possible?

 FAQs Coping with A-Fib: Single Episode?

“Is it possible to have a single A-Fib attack and not have any others? I had a single episode of A-Fib 17 months ago and was successfully converted in the emergency room with medication (Cardizem drip). Other than an occasional PAC of PVC, I haven’t felt any A-Fib symptoms since.”

Once an area or areas in your heart start producing A-Fib pulses, it’s usually hard to turn them off again.

But whatever you did seems to have worked for you. Since your episode over a year ago, I’m assuming that your doctor has taken an annual ECG, and that you don’t have ‘silent A-Fib’.

Have your doctor keep track of your blood chemistry to make sure you don’t get into chemical imbalances that might trigger A-Fib again. (When you went to the hospital for that single episode of A-Fib, what kind of imbalances did they find from your blood tests?)

You may want to look into taking supplements or foods that help keep your heart chemistry in balance. (See my article, Natural’ Supplements for a Healthy Heart.)

PACs and PVCs are considered benign—people with normal hearts have them too. But with A-Fib, they often seem to be precursors of an A-Fib episode.

For your own peace of mind, ask your doctor for a Holter or other type of monitor which you would wear for one to three days or longer. The test results would tell if you have developed “silent” A-Fib which you may not be aware of, but which can be just as dangerous as symptomatic A-Fib. (Some would say that silent A-Fib is even more dangerous because of the progressive risk of stroke and unnoticed heart deterioration over time.)

Thanks to Joan for this question.

Go back to FAQ for the Newly Diagnosed A-Fib Patient
Last updated: Monday, June 18, 2018

FAQs Coping with A-Fib: Irregular, Not Rapid Heart Rate

 FAQs Coping with A-Fib: Irregular, Not Rapid

FAQs A-Fib afib“Can I have A-Fib when my heart rate stays between 50-60 BPM? My doctor tells me I have A-Fib. I usually have episodes which last under an hour, but I don’t always have a rapid heart rate. Sometimes when I lie down to go to sleep, an episode comes on. When I check my heart rate, it’s irregular but not rapid.” 

In some cases it’s possible to have A-Fib and still have what appears to be a regular heart rate. Your atria can be fibrillating, even though your heart doesn’t beat rapidly. How can that be? When you take your pulse, you’re counting the beats of your ventricles, not your atria. So, your atria can be fibrillating, while your heart beat appears normal. 

When listening to your heart through a stethoscope—you’re listening to your ventricles, not your atria.

Let’s say, for example, that you have A-Fib and your left atrium is fibrillating (quivering, beating) around 300 times a second. But in your case, your AV Node circuitry may be functioning very well, like a gatekeeper, to minimize the rate at which your atrial A-Fib pulses affect your heart rate (i.e. ventricular beats).

In another instance, some people have “silent” A-Fib (A-Fib with no symptoms) and appear to be in normal sinus rhythm (NSR). Their Atrial Fibrillation may only be discovered when they have a routine physical exam that includes an EKG. We don’t know enough about silent A-Fib, but untreated, it can kill you. Many people who suffer strokes are later found to have silent A-Fib.

Older people sometimes can have a slower form of A-Fib which can look like normal sinus rhythm, but they still have symptoms such as fatigue-tiredness and difficulty with exertion. Some forms of Atrial Flutter (4:1 ratio or slower) may also look like a normal heart rhythm.

But for most patients, their Atrial Fibrillation appears as an irregular and faster heart rate.

Thanks to Walt and Jim Ward for this question.

Back to FAQs: Coping with Your A-Fib 
Last updated: Saturday, February 16, 2019

FAQs Coping with A-Fib: Pacemaker for Too Slow a Heart?

 FAQs Coping with A-Fib: Pacemaker

FAQs A-Fib afib“Now my doctor says I need a pacemaker, because my heart rate is too slow and because I’m developing pauses.

I’m an athlete with A-Fib and have a naturally slow heart rate. Since I developed A-Fib, I was put on atenolol (a beta blocker) which really slows down my heart rate.  What should I do?”

Get a second opinion. It’s crazy to go through the risks and lifestyle disruptions of having a pacemaker implanted just to be able to continue taking atenolol.

Because you are an athlete, your heart rate is naturally slow. But it’s normal for you.

As long as you feel fine and aren’t fainting from lack of blood flow, don’t be talked into getting a pacemaker. A slow or even very slow heart rate usually doesn’t cause any harm. As for heart rates, “normal” is indeed a wide swath.

In the words of Dr. John Mandrola:

“Do not implant pacemakers in patients with nonsymptomatic bradycardia (slow heart rate).The same holds for pauses, though they are certainly of more concern than a slow heart rate. Nonsymptomatic slow heart rate or pauses don’t justify exposing patients to the risks of implanting a pacemaker.”

But be advised that pacemakers tend to have bad effects over the long term, “…long-term morbidity (is) associated with a pacemaker.”

 Another consideration is that implanting pacemaker ‘leads’ in the veins of the upper chest often prevents or hinders future procedures that require vascular access like a PVI. A pacemaker usually isn’t implanted unless your heart rate is too slow or you have Sinus Node and/or Atrioventricular (AV) Node problems.

Resources for this article
¤  Mandrola, John “Choosing wisely: The electrophysiology list of five don’ts.” ¤  Atrial Fibrillation Educational Material” University of Pennsylvania. 2002, p. 3. ¤  “Should atrial fibrillation ablation be considered first-line therapy for some patients?” Circulation 2005;112:1214-1231, p. 1228.

Back to FAQs: Coping with Your A-Fib 
Last updated: Tuesday, August 20, 2019

FAQs Coping with A-Fib: Improving Circulation

 FAQs Coping with A-Fib: Circulation

FAQs A-Fib afib“I am in Chronic A-Fib. I feel tired and a little light-headed, probably because my atria aren’t pumping properly. How can I improve my circulation, without having to undergo an Ablation or Surgery?”

In theory, yes. In Chronic A-Fib it’s not unusual to feel tired and light-headed. Your atria are fibrillating instead of pumping blood into the ventricles. Blood flow to your brain and other organs is reduced by about 15%-30%. But your ventricles still function by suctioning blood from the atria much like a turkey baster sucks up liquid.

To some extent, you can improve the strength and capacity of your ventricles by exercise, such as by walking on a treadmill or at the shopping mall.

Oxygen Concentrator. You can also improve the oxygen saturation of your blood by using an Oxygen Concentrator ($500-$1,000). While on a treadmill, for example, you can breath in concentrated oxygen through a cannula, a flexible tube you insert into your nostrils. You can measure how much oxygen is in your blood by using an pulse oximeter ($50). The desired range is 95-100% oxygen saturation. (Some athletes with good circulation use this technique to improve their athletic performance.)

Don’t dismiss the treatment options of catheter ablation or mini-maze surgery. Both have high success rates with low rates of complication. With Chronic A-Fib, the longer you wait to cure your A-Fib, the harder it gets.

Be cautious: While improved circulation is good for your overall health, don’t over do the exercising. It could be counterproductive. With Chronic A-Fib your heart is already working harder than a normal healthy heart. Adding even more demand can lead to more enlargement and remodeling.

Enhanced External CounterpulsationSee also or FAQ about the out-patient heart therapy that improves circulation called EECP (Enhanced External Counterpulsation). Will EECP Heart Therapy Help my Circulation?

The Bottom Line: the real question is whether these techniques will improve your A-Fib symptoms of feeling tired and light-headed. I’m unaware of any studies demonstrating the effectiveness of the above techniques for the symptoms of Chronic A-Fib.

Resources for this article
¤  The Link Between Infections and Inflammation in Heart Disease. Life Extension Vitamins. Last accessed November 5, 2012 ¤  Atrial Flutter. Heart Rhythm Society website. Last accessed March 30, 2014. URL: ¤  “Atrial Fibrillation Educational Material” University of Pennsylvania. 2002, p. 3.

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

FAQs Newly Diagnosed with A-Fib: Fear and Anxiety

 FAQs Coping with A-Fib: Fear & Anxiety

Maze heart You are not alone - with outline 175 pix at 96 res“I live in fear of my A-Fib. I never know when I’m going to get an A-Fib attack or how long it will last. How do people deal with this constantly lurking fear and anxiety?”

Don’t be ashamed to admit how A-Fib makes you feel (especially if you’re a guy). A-Fib has psychological and emotional effects as well as physical. Recent research indicates that “psychological distress” worsens A-Fib symptoms’ severity.

Anxiety by itself can produce physical symptoms such as gastrointestinal distress, sleep issues, shortness of breath, exhaustion, muscle aches, shaking and trembling, sweaty palms, difficulty swallowing, a racing heart like in A-Fib, getting colds frequently because of a depressed immune system.

For my most recent report, listen to my Podcast:

15 Ways to Manage the Fear & Anxiety of Atrial Fibrillation

Go to Podcast


1. Knowledge is Power and Control!

Read about your treatment options, learn about your A-Fib. Read how others have dealt with their A-Fib. Search the list of Personal Experiences published on this site. With over 90 stories, you’re sure to find a few patients with similar symptoms as yourself. Knowing others have beaten their A-Fib is a tremendous psychological relief. This helps replace fear with hope!

2. Anxiety Thought Log

Confront your A-Fib fears directly. Don’t let them mill around in your subconscious. Former A-Fib patient, Anthony Bladon, suggests you keep an ‘anxiety thoughts log.’ Write down word-for-word what the anxious thought was, when, and what was the trigger. Confront each fearful thought and try to re-state it in a more reasonable frame of mind, thereby reducing the anxiety. (See Anthony Bladon and his anxiety log.)

This may sound a bit bizarre, but try repeating anxious thoughts to yourself. Express a fear to yourself over and over. Let the monotony make your mind wander to more enjoyable thoughts. Or set aside a 20 minute worrying time during the day and refuse to think about troubling fears at any other time.

3. Yoga, Relaxation Techniques and Meditation 

In preliminary studies, Yoga has been demonstrated to improve A-Fib symptoms and to reduce A-Fib attacks, as well as improve quality of life, depression and anxiety. (See also FAQ: I do Yoga. It relaxes me and helps with my stress level. Is there any evidence on Yoga helping with other A-Fib symptoms?“)

Relaxation techniques and meditation may also offer you relief from your anxieties.

A specific type of meditation called ‘Mindfulness’ is recommended by Harvard Pilgrim nurse case manager Linda Bixby. The technique is to ‘Observe and Feel the Physical Sensations’ of the A-Fib Episodes. At first this may seem counter-intuitive and may not work for you. The idea is to observe rather than resist or worry. You allow a frightening health event like an A-Fib attack to just run its course. For example, Neil Blanchette was diagnosed with A-Fib when he was 17. Meditation and “mindfulness” was a great help to him. “Just taking it in and letting myself feel the physical A-Fib experience was actually relaxing.” (Thanks to David Holzman for calling our attention to this article.)

4. Natural Remedies:

Lavender Oil Aromatherapy: the light, soothing fragrance of lavender oil has long been used to ease anxiety (and insomnia). One example of many is Nature’s Way Calm Aid. “It contains Silexan, a type of lavender oil shown in clinical studies to ease anxiety as effectively as the benzodiazepine drug lorazepam (Ativan).”

PharmaGABA: is a bioidentical form of GABA (gamma-ami­nobutyric acid), which serves as a critical calming agent in the central nervous system, works on the same chemical pathways as Xanax, Valium, and other drugs—without all the negative side effects; helps combat stress and anxiousness. One example is Natural Factors PharmaGABA

Relora: a blend of two botanical extracts (Magnolia officinalis and Phellodendron amurense) that helps reduce cortisol levels and promotes feelings of relaxation.

5. Counseling and Meds

Recognize that you may need professional help. Don’t be embarrassed to seek counseling. In addition, discuss if anxiety medication would be appropriate or helpful. (See Jay Teresi’s story, “Anxiety the Greatest Challenge” and Kelly Teresi’s story “A Young Wife Copes with Husband’s A-Fib” in my book, Beat Your A-Fib, pgs. 101-105)

6. Our A-Fib Support Volunteers

It might calm your fears to talk with or email someone who knows first-hand how A-Fib makes you feel. Each of our A-Fib Support Volunteers has gone through a lot to be cured of their A-Fib. They were helped along the way and now they want to return the favor by offering you support and hope. Learn more on our A-Fib Support Volunteers page (under Resources and Links).

7. Enlist Support From Your Loved Ones

Recognize that A-Fib can have significant consequences on your social interactions with your family and colleagues. Sit down and have a talk with your significant other(s), your friends and co-workers. Explain what A-Fib is, how it affects you and how it makes you feel. Ask for their understanding. They will want to help you, so be prepared to answer their questions.

Takeaway: Fight your fears! Ambush your anxiety! Atrial Fibrillation may be in your heart but it doesn’t have to be in your head. Seek your freedom from anxiety and improve the quality of your life.

Other ideas? If you have suggestions or programs that helped reduce your A-Fib-related anxiety, please email me and let me know.
References for this Article
• Gehi AK at al. Psychopathology and symptoms of atrial fibrillation: implications for therapy. J Cardiovasc Electrophysiol. 2012 May;23(5):473-8. doi: 10.1111/j.1540-8167.2011.02264.x. Epub 2012 Mar 19.
• Neale, T. Yoga May Calm Afib. Jan 23, 2013. Last accessed Jan 23, 2014. URL:
• Harvard Pilgrim Health Care. Your Health, Fall 2014.
• Lucile, H. ( Natural remedy for anxiety, Bottom Line Health, April, 2014, p. 16.
• Whitaker, J. PharmaGABA Chewables for Immediate Stress Relief. Whitaker Wellness Institute website. Last accessed March 29, 2014. URL:
• Whitaker, J. Innovations in Wellness Medicine, Natural Solutions for Stress Relief. Dr. Whitaker’s Health & Healing, March 2015, Vol. 25, No. 3.
• Starbuck, Jamison. The Natural Way/No More Drugs for Anxiety. Bottom Line Health, Volume 29, Number 10, October 2015, p. 10.

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FAQ for the Newly Diagnosed A-Fib Patient
Last updated: Friday, March 15, 2019

A few of our many Support Volunteers

Our Support Volunteers are just an email away.

FAQs Coping with A-Fib: Exercise While in A-Fib

 FAQs Coping with A-Fib: Exercise While in A-Fib

FAQs A-Fib afib“Can I damage my heart if I exercise in A-Fib? When I have A-Fib symptoms, should I go ahead and exercise or skip it and rest? ”

This is a hard question to answer, because it depends so much on the type of A-Fib you have and how A-Fib affects you individually. It’s really a judgment call for you and your doctor.

Light exercise: In some people light exercise helps get them out of an A-Fib attack (Vagal A-Fib). In others, exercise makes it worse. When you first start exercising, your heart rate tends to be very rapid and disturbing. If you have A-Fib symptoms, try light exercise for a short time to see if it will get you out of an A-Fib attack. If not, you should probably skip it and rest. Try to exercise when you’re in Normal Sinus Rhythm.

Possible dangers of exercising in A-Fib: When exercising in A-Fib, you may be pushing your heart into higher pulse levels, putting added strain on your atria, getting your heart used to beating in A-Fib and staying in A-Fib longer, etc. But unfortunately we don’t know this for sure.

Some regularly exercise in A-Fib: I have a friend who is in persistent no-symptom A-Fib. He is an active swimmer. His swimming probably improves his A-Fib compromised circulation. He feels better when he can exercise. If you don’t feel bad when exercising in A-Fib, the exercise probably does improve your circulation, in addition to the regular benefits of exercise.

Exercise if you can: In general, with A-Fib, do whatever you can to still exercise. If you can exercise without your heart rate becoming too rapid and you feel like exercising, you probably should. But check with your doctor. If exercising feels bad or brings on an A-Fib attack, skip the exercise. No one’s going to hold it against you if you miss a day of exercise.

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

Your Personal A-Fib Medical Summary

Your Personal Medical Summary

Your Personal Medical Summary

Your Personal A-Fib Medical Summary

by Patti J. Ryan

Doctors appreciate knowledgeable, informed, and prepared patients. Each doctor will probably ask you much the same questions. For efficiency, prepare your ‘Personal A-Fib Medical Summary’ and include a copy with each packet of medical records you send to doctors.

In their special report Atrial Fibrillation: The Latest Management Strategies, Drs. Calkins and Berger suggest before your appointment that you prepare answers to the following questions about your Atrial Fibrillation.

•  What particular symptoms are bothering you?
•  When did you first begin to experience these symptoms?
•  Did you start taking any new vitamins, supplements, or prescription drugs before the onset of symptoms?
•  Are these symptoms paroxysmal (occasional or intermittent, beginning and stopping on their own), or persistent (present all the time, or lasting at least a week at a time continuously)?
•  On a scale of 1 to 5, with 1 being little of no bother and 5 being severely bothersome, how would you rate your symptoms?
•  Is there anything that appears to worsen your symptoms?
•  Is there anything that appears to lessen your symptoms?

Include other pertinent information such as names and contact information for doctors you see regularly and why. Type up your summary and attach a copy to each set of medical records you send to doctors. And add a copy to your three-ring binder.

Healthcare trend: ‘The Personal Health Record’ (PHR)

There is growing momentum to encourage consumers to take another health-related step: to maintain their own health records.

The idea behind the personal health record (PHR) is that the more consumers know about their health, the more control they will take over it and the healthier they will be. PHRs also encourage consumers to collect and share more health-related information with each of their providers. For this reason, healthcare providers, employers, insurers, vendors, and the federal government are all interested inpromotingPHRs.

What is a personal health record (PHR)?

Shoe pocket by Vital ID;  Your Portable Medical Information Kit

Shoe pocket by Vital ID

USB credit card-size by ER Card

Credit card-size USB by ER Card

A personal health record (PHR) is a means of storing, managing, and sharing your personal medical information. PHRs can be paper based or electronic. Electronic records can be kept on different media, including personal computers, “smart” cards, thumb drives, CDs, or web-based applications.

Of the two types, paper records may be easier to secure, but electronic records are more convenient.

If you are considering a PHR to maintain your health records, look for a list of resources and a ‘Quick Guide to Creating a PHR‘ from the American Health Information Management Association (AHIMA), a national non-profit professional association.

Also see our article, Your Portable Medical Information Kit for a sampling of small, easy to store and carry USB devices for the print and digital versions of your PHR info.

References for this article

Calkins, H, Berger, R. Atrial Fibrillation: Management Strategies. Scientific American Special Health Reports. Last accessed August 24, 2015. URL:

Posted October 2014

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Last updated: Monday, August 24, 2015

3 Ways to Request Copies of your Medical Records

How to Request Medical Records

Request Medical Records

by Patti J. Ryan, Updated March 2016

Before meeting with any electrophysiologist or surgeon, you will want to send each a packet with your medical records, test results and any images/X-rays. (You should be collecting this information all along in a three-ring binder or file folder.) So, how do you gather copies of medical records you’re missing?

Your Right to Your Medical Records

To begin, you may ask, “Do I have a legal right to my medical records?” Yes.

Be aware that while your medical information or data belongs to you (the patient), the physical pieces of paper, X-ray film, etc. belong to the hospital or health care provider.

Patients have the legal right to access both paper and electronic records, to view the originals and to obtain copies of their medical records.

This right is guaranteed in the U.S. by the Health Insurance Portability and Accountability Act of 1996 [HIPAA]. If you live outside the US, know that over 89 countries have adopted Data Privacy Laws. For example, Canada has the Personal Information Protection and Electronic Documents Act (PIPEDA) and in Europe there’s the EU Data Protection Reform.

Keep your medical records in a binder or folder.

Keep file copies of your medical records

Do an Inventory of Your Medical Records

You want to compile a list of the offices you need to contact. (You may already have many of these records in your A-Fib binder/folder and just need to identify those you are missing.)

Begin with a list of all the doctors, emergency rooms, labs, specialists and other health care providers and facilities who have provided you with medical services related to your A-Fib.

Request your prescription records, as well, from pharmacies and health plans. (You may already have online access to this information, depending on your service provider.)

Also, request records of any major medical event from the past two years (i.e., surgeries, medical emergencies, allergic reactions, etc.)

Review Your Records for Accuracy

Before requesting copies, you have the right to review your health records (not just ask for copies).

Your doctor’s medical records staff can help guide you to find the information you are interested in reading. Look over your records to make sure they are correct. Ask questions. If you spot any errors, ask to have them corrected before they are shared with another doctor or hospital.

Make Medical Record-Keeping a Habit: Don’t leave your doctor’s office or medical canter without a copy of every test they performed (if the test result isn’t immediately available, have them mail it to you). Store in a three-ring binder or file folder.

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Three Ways to Request Your Records

1. You’ll find the instructions for requesting records for each provider in their ‘Notice of Privacy Practices’—you signed and received a copy of this notice on your first visit. (It’s also posted at the facility where patients may see it.) It should provide instructions for requesting records as well as contact information for asking questions or filing complaints. Follow the instructions to request your records.

2. Or, if visiting the medical office, ask for an ‘Authorization for Release of Health Information’ form. You can complete and submit the authorization form in person or take it home. Many medical practices post the ‘Authorization for Release of Health Information’ form on their website for download.

3. You can also write your own ‘Request Your Medical Records’ letter (see sample below). The Privacy Rights Clearinghouse offers a sample letter template to help you compose your own letter asking for your medical records. (See sample letter below at end of this article.) Fax or mail your request letter.

Plan ahead: It may take some time for your request to be processed. It’s a good idea to ask when you can expect to receive the information and an estimate of the reproduction cost.

Will You be Charged for Copies?

For hard copies expect to pay duplication costs. HIPAA allows doctors/practices to charge a “reasonable, cost-based fee.”  They can charge for supplies, staff time for copying and processing, and mailing costs, if applicable.

For no cost copies, ask if they will copy electronic files to your USB Flash drive or to a disc/CD you supply.

However, they may not charge for the time a staff member spends searching for the record.  In addition, they should not adopt a policy of charging a flat fee or charging a patient to view a record.

Note: U.S. state laws may limit the amount the doctors/practices charge for duplicating records.

You’ll Need Multiple Copies

You may receive paper copies, x-ray film and/or electronic records (on CDs or USB flash drive). You can ask for multiple copies or make your own. (For duplication services, check office supply retailers like Office Depot or Staples.)

If you expect to interview three to five doctors, have a packet made for each doctor (better to have an extra packet rather than too few).

Take your A-Fib binder to your appointments.

As a backup, take your A-Fib binder to your appts.

File Originals and Backup Digital Records

Store your originals in your binder or file folder. Store CDs in binder sleeves or copy to your PC. Make backup copies of any digital records.

Day of Your Appointment

When you arrive at the EP’s office, make sure they have indeed received your up-to-date medical records. As a back-up, bring your own three-ring binder with the originals.

Don’t Forget: take along a pen and your ‘office visit notebook‘.

Sample Letter Format and Template to Request Your Medical Records

Download this sample letter as PDF file (then save to your hard drive).

[Your name]
[Your address]
[Name of care provider or facility]

RE: [Your medical identification number or other identifier used]

Dear [Name of care provider or facility]

The purpose of this letter is to request copies of my medical records as allowed by the Health Insurance Portability and Accountability Act (HIPAA) and Department of Health and Human Services regulations.

I was treated in your office [at your facility] between [fill in dates]. I request copies of the following [or all] health records related to my treatment.

[Identify records requested, e.g. medical history form you provided; physician and nurses’ notes; test results, consultations with specialists; referrals.]

[Note: HIPAA also allows you to request a summary of your medical records. If you prefer a summary, you should agree to a fee beforehand.]

I understand you may charge a reasonable fee for copying the records, but will not charge for time spent locating the records. Please mail the requested records to me at the above address. [If you request that the records be mailed, you may also be charged for postage.]

I look forward to receiving the above records within 30 days as specified under HIPAA. If my request cannot be honored within 30 days, please inform me of this by letter as well as the date I might expect to receive my records.

[Your signature]
[Your name printed]

Never see a doctor alone - 350 wide at 300 res

References for this article
• Greenleaf, G. Global Data Privacy Laws: 89 Countries, and Accelerating (February 6, 2012). Privacy Laws & Business International Report, Issue 115, Special Supplement, February 2012; Queen Mary School of Law Legal Studies Research Paper No. 98/2012. Available at SSRN:

• Personal Information Protection and Electronic Documents Act. (PIPEDA or the PIPED Act). URL:

• Protection of personal data. European Commission’s Directorate General for Justice and Consumers. URL:

• Reproduced with permission from the Privacy Rights Clearinghouse, Fact Sheet 8. Last accessed October 17, 2014, URL:

• Under HIPAA you can be charged a treasonable fee for copying records. You may also be charged for postage if you ask that records be mailed to you. HIPAA allows 30 days for a provider to respond to your request for records, with one 30-day extension for good reason.

• Your state laws may include a lower fee for copies of records or a shorter time for the provider to respond to your request.

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Last updated: Thursday, April 4, 2019

Intense Exercise and A-Fib: Lessons from Elite Athletes

Exercising with A-Fib

Intense Exercise and A-Fib: Lessons from Elite Athletes

by Steve S. Ryan, Updated December 2019

A 2009 study stated, “Vigorous exercise increases the risk of atrial fibrillation.” But a close examination of the observational study used to support this statement showed that A-Fib is associated only with men under 50 years of age who jogged/ran over four miles a day 5-7 times a week. This is a level of running usually associated with elite athletes.

Other types of vigorous exercise such as cycling, swimming or racquet sports were not associated with an increased risk of A-Fib.

Why elite runners develop A-Fib

The authors of this study hypothesized that several factors might explain the increased risk of A-Fib in elite male runners under 50 years old.

▪ left atrial enlargement
▪ left ventricular hypertrophy
▪ left ventricular dilation
▪ inflammatory changes in the atrium
▪ an increase in parasympathetic tone (the most commonly cited factor)

“Jogging in particular results in greater enhancement of the parasympathetic nervous system compared to other exercise types.” “Heightened parasympathetic tone has been associated with A-Fib onset in patients with structurally normal hearts; and in animal and human studies, parasympathetic stimulation frequently induces and maintains A-Fib.”

Vigorous Exercise good for most people

The authors of this study recognized the benefits of vigorous exercise for most people. “Exercise has multiple beneficial effects on cardiovascular health that may lower A-Fib risk.” In particular, exercise lowers blood pressure, improves lipid profile and glucose control, decreases risk of cardiovascular disease, has positive effects on traditional risk factors such as hypertension, diabetes, cholesterol and obesity, improves arterial elasticity which tends to deteriorate with age, and extends life expectancy.

(Physical inactivity and a sedentary life style is a far bigger health problem for most people than excessive physical activity.)

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New Swedish study—intense exercise linked to A-Fib

A new study from Sweden is more critical of vigorous exercise and the risk of developing A-Fib. Men who exercised more than 5 hours/week when they were in their 30s had a 19% higher risk of developing A-Fib later in life than those who exercised less than one hour/week. “Vigorous long-time physical activity seems to increase the risk for atrial fibrillation…Leisure-time exercise at younger age is associated with an increased risk of A-Fib.” But this study was primarily concerned with older men aged 45-79 years (mean age=60).

It also found that high levels of leisure-time exercise at an older age did not increase the risk of developing A-Fib. The authors hypothesized that leisure-time exercise may be of lower intensity at an older age.

They also found that more leisurely activities such as brisk walking or cycling at age 60, even if over 60 minutes a day, were associated with a 13% decrease in A-Fib over those who got no exercise at all. An accompanying editorial suggested when it comes to exercising “maximum cardiovascular benefits are obtained if performed at moderate doses, while these positive aspects are lost with (very high) intensity and prolonged efforts.”

(This study didn’t address the interval exercise technique often used in sports training and in gym workouts of varying intensity exercising—pushing oneself to the max, resting, then alternating with less vigorous workouts.)

What about those of who love to compete at a very high fitness level?

Dr. T. Jared Bunch of the Intermountain Heart Institute in Utah sees a number of very highly skilled endurance athletes. They go from marathons to triathlons to 100-mike bike races. Even though they are amazingly fit, they tend to develop A-Fib. The A-Fib develops despite these athletes having normal blood pressure levels and heart function.

Studies have confirmed an increased incidence of A-Fib in healthy older world-class endurance athletes. But, other than A-Fib, they usually had no other medical or heart problems.

A new study (March 2017), indicated that 82% of marathon runners developed acute kidney injury during races, but the kidney injury subsided within two days after the marathon. “The kidney responds to the physical stress of marathon running as if it’s injured, in a way that’s similar to what happens in hospitalized patients when the kidney is affected by medical and surgical complications.” according to Dr. Chirag Parikh, the study’s lead researcher.

There are many potential reasons why. These extreme athletes often develop what is called an ‘athletic heart’. The heart chambers are slightly enlarged. These adaptive changes allow for a higher cardiac output during exercise. However, some of these changes may also promote abnormal heart rhythms by changing the underlying architecture of the atrial chambers.

It is possible that repetitive wear and tear from the intense daily workouts is a factor and results in small areas of fibrosis in the upper and lower heart chambers which promote A-Fib and other arrhythmias. With improved MRI cardiac imaging, these small areas of fibrosis can now be visualized. Also, changes in the autonomic nervous system may irritate tissues responsible for generating A-Fib.

Finally, the personalities that often allow excellence in endurance athletes may also promote heart disease by the way the body and mind responds to stress. In total, endurance athletes put significant stress on their heart.

Should Intense athletes stop running and training?

Should intense athletes stop running and training? No! The intense athlete lifestyle reduces other heart risk factors and improves quality of life, not to mention the personal satisfaction and sense of fulfillment that comes from competing at a high level or winning a race. In the above Swedish study, low activity level people (couch potatoes) had more disease-related deaths.

Dr. T. Jared Bunch gives the following recommendations, which intense athletes can use to help their heart health:

▪ In periods in which they are not training, interval training that allows the heart to recover during exercise, can be used to maintain aerobic function and muscle strength.

▪ Intense athletes who train early in the morning should make a conscious effort to get restorative sleep. For most of us this means about 8 hours of sleep.

▪ Intense athletes who have prolonged training schedules need to pay close attention to maintaining their electrolytes. Loss of sodium, potassium, magnesium, and calcium are sources of heart electrical irritability.

▪ All athletes need to get routine screening of their blood pressure, cholesterol, and fasting sugar. Most of the time these are normal. But in those with genetic risks, they can be abnormal. If treatment is started early, lower doses of therapy can be used that do not impact athletic performance as much as treating the disease later in life.

Editor’s Comments:

Intense Athletes More at Risk of Developing A-Fib

Intense athletes have to face the fact that we’re more at risk of developing A-Fib and conditions like small heart injuries and fibrosis, and therefore need to monitor our heart health more carefully. (I don’t know if I qualify as an intense athlete. But at 78 years young, my favorite exercise is maximum speed sprinting and Masters Track Meets, along with some distance training.)

Know Your Heart—Palpitations Mean You Need to See an EP

‘Knowing your heart’ is the best tool in prevention. Understand your heart rate: your normal rate at rest, early in exercise, during peak exercise, and in recovery.
If you develop changes in this normal heart rate spectrum or start to feel palpitations, you may need to see an Electrophysiologist (EP) before A-Fib develops. Testing may include an MRI to look for heart function and fibrosis as well as an ultrasound of the heart (echocardiogram) and a heart monitor. Your EP should measure the diameter of your left atrium and monitor for enlargement over time. (I personally have a Medtronic Reveal LINQ loop recorder heart monitor.)

Don’t Stop Running!—Just Be Smart About It

That doesn’t mean you have to stop running, but you have to be smart about it. Did you give yourself enough time to recover after the last race? What did the EP tell you about your overall heart health? Are you taking time to rest, sleep, and decrease other stressors in life?  Is your diet a healthy one, centered on whole foods?

Worst Case Scenario—You May Have to Change your Life Style. (That’s Not the End of the World)

The intense athlete might think: “But if I develop A-Fib, I can just have a catheter ablation (PVI), can’t I? I’ll be A-Fib free and can resume my training and racing.” Not necessarily. Even though your pulmonary veins have been isolated, it’s possible to develop A-Fib in other parts of your heart. The conditions (intense running and training) that pushed you into A-Fib are still there. We can’t say for sure that you will develop A-Fib again, but we also can’t say that you won’t (though it’s less likely).
As an intense athlete you may not want to hear this. But if you develop A-Fib, you may have to think seriously about changing your life style or training schedule. You will find that alternative exercises and programs yield positive benefits. Of these, Yoga and walking seem to have the strongest beneficial effect on A-Fib. For intense athletes, walking is part of life, but Yoga may not be. Yoga is a great way to shape up both mind and body and help with the body’s stress response.

Don’t Worry About Developing A-Fib Again. Live Your Life Like You’re Cured!

After a successful ablation, the intense athlete, may decide to just live with the risk of developing A-Fib again. The risks of developing A-Fib a second time are small, even for intense athletes. (And there’s always a possible second ablation.)
If you do reach a time in your life when you transition to lower daily intensity programs, your risk of developing A-Fib may start to come down.
References for this Article
• Aizer, A. et al. “Relation of Vigorous Exercise to Risk of Atrial Fibrillation.” The American Journal of Cardiology, Volume 103, Issue 11, Pages 1572-1577, June 1, 2009 URL: DOI:

• Bunch, T. Jared. Vigorous Exercise Can Be Problematic When Trying to Prevent Atrial Fibrillation. Heart Health/ May 19, 2014. Last accessed Sept. 25, 2014. URL:

• Drca, N. et al. Atrial fibrillation is associated with different levels of physical activity levels at different ages in men. Heart, published online May 14, 2014. URL: DOI:10.1136/heartjnl-2013-305304

• Kessler, A. Intense Exercise Linked to Atrial Fibrillation. Life Extension publication. September 2014


• Mons, Ute, et al. A reverse J-shaped association of leisure time physical activity with prognosis in patients with stable coronary heart disease: evidence from a large cohort with repeated measurements. Heart. Published Online First 14 May 2014. DOI:10.1136/heartjnl-2013-305242

• Myrstad, M. et al. Increased risk of atrial fibrillation among elderly Norwegian men with a history of long-term sport practice. Scand J Med Sci Sports. 2014 Aug:24(4):e238-44. doi: 10.1111/sms.12150. Epub 2013 Nov 21.

• Parikh, CR et al. Kidney Injury and Repair Biomarkers in Marathon Runners. American Journal of Kidney Disease, March, 2017. DOI:


Posted September 2014

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Last updated: Tuesday, December 10, 2019



Weight Loss Key to Reverse Atrial Fibrillation, Improve Ablation Success

Weight Loss Key to Reverse Atrial Fibrillation, Improve Ablation Success

Weight Loss Key to Ablation Success

by Steve S. Ryan, PhD, September 2014

Even though North America is a land of immigrants, the prevalence of A-Fib is much greater in the US than in our ancestral countries. There is ten-times more A-Fib in North America than, for example, in Asia. But once these Asians immigrate to the US, the incidence of A-Fib closely approximates that of other Americans.

Whatever protective effect Asians enjoyed in their native countries is lost when they immigrate. And the A-Fib epidemic is occurring not just in the US but also in most developed countries around the world.


Dr. John D. Day of Intermountain Healthcare in Utah has performed more than 3,000 A-Fib ablation procedures. But he asks, “Am I even making a dent in this disease? I cannot remember seeing so many new patients, even young patients, with atrial fibrillation when I began my cardiology fellowship nearly 20 years ago.”

A-Fib has increased 71% in the last 20 years. The general consensus is we are seeing more A-Fib due to our aging population (and also because we are looking more for A-Fib and have better tools to diagnose it).

But that doesn’t explain why A-Fib is increasing more than our aging population.

Though he poses it as a question, Dr. Day suggests strongly that obesity is causing the increase in A-Fib. “Could the lifestyle of modern civilization and our obesity epidemic explain the marked spike in new atrial fibrillation cases we are now seeing?”


In a study at the Mayo Clinic, bariatric surgery helped to prevent A-Fib in patients with morbid obesity. New onset A-Fib occurred in only 6.4% of patients with bariatric surgery, compared to 16.1% in the control group.

Dr. Day described a new program (DARE—Drive Atrial fibrillation into Remission Evaluation) started at Intermountain Healthcare in January, 2014, to encourage aggressive lifestyle modification.

Even though less than 5% of people successfully change their lifestyle to maintain long-term weight loss, 92% of his patients are still actively engaged in this lifestyle modification program.

They’ve lost an average of 16 pounds over the last few months and a 42% reduction in their A-Fib symptom burden. They “feel better than they have ever felt before.” Patients who had failed multiple ablations were now A-Fib free.

A-Fib can be prevented or reversed by lifestyle changes. Dr. Day encourages doctors to take a holistic approach, to not just treat A-Fib but to help patients become aware of and overcome the toxic lifestyles of our culture. “A large percentage of cases in the USA are unnecessary.”

Weight loss improves A-Fib ablation success & symptoms

Researchers in Australia found that obese patients who had a catheter ablation and then lost weight, had nearly a five-fold greater probability of staying A-Fib free.

Two groups of obese patients had catheter ablations for A-Fib. The first group agreed to participate in an aggressive risk factor management program. Each group was monitored for two years. The life-style change weight management group experienced more weight loss, better systolic blood pressure, better glycemic control and lipid profile.

Ablation success rate much better with weight control

The single procedure A-Fib free rate was greater for the weight management group (32.9% vs 9.7%), while the multiple procedure results were markedly better (87% vs 17.8%). [A 32.9% success rate is relatively low compared to other centers.] A-Fib frequency, duration, severity, and symptom severity were better in the aggressive risk factor management group.

A previous study had found that a weight management program for highly symptomatic A-Fib patients reduced symptom burden and severity and reduced antiarrhythmic drug use. The authors wrote that these benefits, “may be attributable to a decrease in left atrial area and ventricular wall thickness, thereby reducing the left atrial hypertension that is a common finding in obese patients.”

The authors concluded that current A-Fib management guidelines should be changed to include risk management when treating A-Fib.

Editor’s Comments
Before this study, many doctors were already requiring that A-Fib patients with pre-existing conditions or risk factors get these taken care of before getting a catheter ablation. If they didn’t, they were much more likely to have a recurrence than other patients. These Australian researchers also developed risk factor management strategies not only for weight, but also for hypertension, diabetes, sleep apnea, cholesterol, alcohol use and smoking.
Catheter Ablation often isn’t enough if pre-existing health problem
The beauty of this Australian research is it confirms scientifically what we already knew, that just performing a catheter ablation on someone with a pre-existing health problem like obesity, isn’t enough. Doctors must take a holistic approach and treat not just the A-Fib, but also the pre-existing health condition that caused or triggered the A-Fib in the first place. Let’s take the example of an obese patient who has a catheter ablation and is A-Fib free. That person’s PVs are isolated. But the ongoing obesity (which produces left atrial hypertension) can potentially trigger other areas of the heart to produce A-Fib signals.
Holistic Approach
Many doctors today emphasize a holistic approach. For example, new patients with A-Fib are routinely tested for sleep apnea. The EP works with other doctors in his practice to develop a sleep apnea strategy for this patient. The patient isn’t given a catheter ablation till they address their sleep apnea problem.

For more about a taking a more holistic approach, see our FAQs: Natural Therapies & Holistic Treatments

References for this Article
• Aggressive lifestyle management helps improve success rate of AF after ablation. Cardiac Rhythm News. Issue 25, June 2014.—latest-news/aggressive-lifestyle-management-helps-improve-success-rate-after-af-ablation-

• Day, John D. What is the best strategy for managing atrial fibrillation? Cardiac Rhythm News. June 2014, p. 4 and 16.—features/what-is-the-best-strategy-for-managing-atrial-fibrillation

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Last updated: Sunday, February 15, 2015

Free Report: Top 10 Questions Families Ask About Atrial Fibrillation from

The Top 10 Questions Families Ask About Atrial Fibrillation from A-Fib.comFree Report: Answers to the ‘Top 10 Questions Families Ask About Atrial Fibrillation’

by Steve S. Ryan, PhD

When a patient is diagnosed with Atrial Fibrillation, family members often struggle to understand what their loved one is going through. A-Fib can be a life altering disease―yet people with A-Fib often don’t look sick

A-Fib not only impacts the patient’s health and quality of life but also the lives (and often livelihood) of their loved ones and co-workers.

Since 2002, we’ve fielded hundreds of questions from patients and answered the most common ones on our Frequently Asked Questions (FAQ) pages.

For National Atrial Fibrillation Awareness Month, we compiled the answers to the ten most often asked questions by families into a special Free Report: The Top 10 Questions Families Ask About Atrial Fibrillation.

Download the 5-page .PDF Report here-> The Top 10 Questions Families Ask About A-Fib. Print, or, to keep a copy, SAVE the PDF to your hard drive.

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Can I exercise While In Atrial Fibrillation?

Can I Exercise While In Atrial Fibrillation (During an Episode)?

Exercising while in A-Fib?

Exercising while in A-Fib?

A reader with Paroxysmal Atrial Fibrillation wrote me and asked:

“When I’m having A-Fib symptoms, should I go ahead and exercise as I would normally? Can I damage my heart if I exercise while having an A-Fib episode?”

This is a hard question to answer because it depends how A-Fib affects you individually. Ultimately this is a judgment call for you and your doctor. Let me share my thoughts as a former A-Fib patient.

Let’s start with the basics

The general rules or principles you need to keep in mind when making a decision in your own case are:

•  An attack of A-Fib, as bad as it may feel, isn’t generally life-threatening (with the exception of a very fast heart rate which can be dangerous and cause you major problems). A-Fib isn’t like having a heart attack.

•  A-Fib reduces your overall capacity to exercise, because your heart isn’t pumping properly.

•  As much as possible, don’t let A-Fib stop you from exercising and leading a fulfilling life (unfortunately A-Fib often results in much lower activity and exercise levels, in spite of our best intentions).

Light exercise

In some people light exercise helps get them out of an A-Fib attack (Vagal A-Fib). In others (like me when I had A-Fib), exercise makes it worse. When you first start exercising, your heart rate tends to be very rapid and disturbing. If you have A-Fib symptoms, try light exercise for a short time to see if it will get you out of an A-Fib attack. If not, you should probably skip it and rest. Try to exercise when you’re in Normal Sinus Rhythm.

Possible dangers of exercising in A-Fib

When I had A-Fib, I used a Polar Heart Rate monitor which you wear around your chest. It transmits your pulse to a wrist watch which you can set to sound an alarm if your pulse goes too high. When I’d run and the heart rate alarm would sound, I’d usually stop running and walk back.

But sometimes I got so mad at the A-Fib that I’d keep on running in spite of the alarm and A-Fib. In retrospect, I don’t think that was very smart.

If running or exercising in A-Fib feels bad, your body is probably telling you that you shouldn’t be doing this. When exercising in A-Fib, you may be pushing your heart into higher pulse levels, putting added strain on your atria, getting your heart used to beating in A-Fib and staying in A-Fib longer, etc. But unfortunately we don’t know this for sure.

Some regularly exercise in A-Fib

I have a friend who is in persistent no-symptom A-Fib. He is an active swimmer. His swimming probably improves his A-Fib compromised circulation. His ventricles during exercise act kind of like a turkey baster sucking more blood down from his poorly functioning atria. He feels better when he can exercise. If you don’t feel bad when exercising in A-Fib, the exercise probably does improve your circulation, in addition to the regular benefits of exercise.

Exercise if you can

In general, do whatever you can to stay active and exercise normally, even though you have A-Fib. If you can exercise without your heart rate becoming too rapid and you feel like exercising, you probably should. But check with your doctor. There isn’t a lot of research and clinical studies on this subject. says, “Take comfort from the experts. They say that physical activity is usually good for people with A-Fib, but it’s still wise to take precautions.”

Bottom-line: If exercising make you feel bad, skip the exercise. No one’s going to hold it against you if you miss a day of exercise.

Editor’s Comments:
I don’t think this is the definitive answer to this question. So, if anyone has any suggestions or comments, please let me know.
Note: In the WebMD online article referenced above, Dr. R. Morgan Griffin is quoted saying: “It’s very possible to live a normal life (in A-Fib) for many years.”
I strongly disagree with this statement (I suppose one needs to define “normal” life, and the quality of one’s life.) Leaving someone in A-Fib for many years overworks the heart and leads to remodeling and fibrosis which increase stroke risk and contribute to eventual heart failure. Instead you need to aim for a cure. To read more about remodeling and fibrosis, see “A-Fib remodels your heart and is a progressive disease” on our Overview page.
References for this Article
Griffin, R. Morgan. Exercise and Atrial Fibrillation. WebMD. Last accessed August 20, 2014. (Note: WebMD is owned and operated in part by the drug company Eli Lily.)

Posted August 2014

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Last updated: Wednesday, July 12, 2017


Visiting the EP Labs as an Observer Instead of as a Patient

SSR at BAFS 2014by Steve S. Ryan, PhD

Every year I attend the Boston A-Fib Symposium to learn the state of the art in Atrial Fibrillation research and development. This year it was held in Orlando, Florida. (See my reports at 2014 BAFS.)
I traveled to Florida a few days early so I could make a couple of side trips. I was privileged to visit with two of the best Electrophysiologists (EPs) in Florida, Dr. Robert Fishel of Florida Electrophysiology Associates in Atlantis, FL,  and Dr. Sidney Peykar of Cardiac Arrhythmia Institute in Port Charlotte, FL.
I visited their EP labs and observed each doctor as he treated A-Fib patients with Pulmonary Vein Ablation/Isolation (PVI) and other procedures. It was a great learning experience for me.

Day 1: Dr. Robert Fishel in Atlantis, FL

Dr. Robert Fishel graciously allowed me to observe him performing ablations at JFK Medical Center in Atlantis, FL. I had to wear scrubs, a mask, radiation vest, booties and a hair cap. (And I had to keep out of the way.)

Dr Robert Fishel and Steve S. Ryan. PhD

Dr. Fishel would do one ablation, then move to another EP lab where the patient was already anesthetized and everything was already set up for him to do another ablation. Then he moved to an operating room where he replaced a pacemaker. He continued these tightly schedules procedures all day long. (He never seemed to get tired. I’m fairly athletic, but had trouble keeping up with him.)

Video Dr Fishel - Treatments of Afib

VIDEO: “Inside the EP Lab During a Catheter Ablation Procedure with Dr. Robert S. Fishel.”

One of his patients was in persistent A-Fib which is usually harder to cure. Dr. Fishel had to make extra ablation lines, but still made the patient A-Fib free in around two hours.

After observing 2-3 procedures, I couldn’t figure out how he was doing the transseptal punctures without using monitors. Only after I was back in the rental car, did it dawn on me that he was doing the transseptal punctures by feel and from his years of experience.

VIDEO: We have a video of Dr. Fishel in our A-Fib Video Library, see “Inside the EP Lab During a Catheter Ablation Procedure with Dr. Robert S. Fishel.”

Day 2: Dr. Sidney Peykar in Port Charlotte, FL

The next day I drove to Fawcett Memorial Hospital in Port Charlotte, FL, where Dr. Sidney Peykar kindly hosted me and allowed me to observe him during several PVI procedures.

He used slightly different equipment and mapping technology than Dr. Fishel. He used a vascular ultrasound probe to insert the catheter in a vein in the groin and Transesophageal Echocardiogram (TEE) for transseptal guidance and to rule out a left atrial appendage clot.

(With the help of Drs. Peykar and Fishel, I will write an extensive description of the stages of an ablation and all the equipment and personnel involved, so that patients can better understand and not be fearful of a PVI procedure.)

Steve S. Ryan, PhD and Dr Sidney PeykarAfter several PVIs, he moved to another procedure room and did an electrical cardioversion on a patient. He returned him to normal sinus rhythm after only one shock.

Dr. Peykar and I also talked about a particular area of concern: A-Fib patients with Sleep Apnea. Obstructive sleep apnea (OSA) is prevalent among patients with A-Fib and has prompted significant research to understand the relationship. Because Sleep Apnea can easily cause a recurrence of A-Fib after a successful PVI, Dr. Peykar insists his patients with Sleep Apnea receive treatment (like using a CPAP machine at bedtime). (BTW: He’s quite informed on the topic and had all the relevant research articles on his smart phone which he emailed to me with a few key strokes.)


What impressed me most about both doctors was how relatively easy and uncomplicated it is for good EPs to make patients A-Fib free by the end of the procedure (with no apparent complications, at least not while I was there.)

I’m grateful to both Dr. Peykar and Dr. Fishel for letting me experience several PVI procedures from the doctor’s perspective (my only previous experience was years ago as an A-Fib patient).GFX TV set Lights Camera Action

BTW: This first hand experience in the EP lab better prepared me for first day of the 2014 Boston A-Fib Symposium when seven procedures were performed LIVE via satellite. See my report: Live via Satellite: Seven Ablation Cases from The Netherlands, France, Italy, Germany, Russia, Boston & Michigan, USA.

References for this article
Dr. Robert Fishel, Florida Electrophysiology Associates/Palm Beach Heart Associates, West Palm Beach/Atlantis, FL 33462 Toll Free: 888-VTACHMD, (561)-434-0353 Web site:

Dr. Sidney Peykar, Cardiac Arrhythmia Institute, Port Charlotte, FL, 33952 & Sarasota, FL 34239 (800) 771-7164 Web Site:

Goyal SK, Sharma A. Atrial fibrillation in obstructive sleep apnea. World J Cardiol. 2013 Jun 26;5(6):157-63. doi: 10.4330/wjc.v5.i6.157. PubMed PMID: 23802045; PubMed Central PMCID: PMC3691496.

Posted February 2014

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Last updated: Saturday, February 14, 2015

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