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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


FAQ

Frequently-Asked-Questions

Copy of 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.”

Do not implant pacemakers in patients with nonsymptomatic bradycardia. This includes the wide spectrum of sinus node dysfunction (SND), asymptomatic pauses in patients with permanent AF, and young patients with medication-induced bradycardia. Humans exhibit tremendous variation of heart rate, and impressively slow heart rates frequently cause patients no harm. As for heart rates, ”normal” is indeed a wide swath. Unlike the more sinister high-degree AV block, SND is not immediately fatal. In 2012, there exist many strategies for the treatment of arrhythmia that do not include exposing patients to the risks of implanting a permanent intravascular device.

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.” http://blogs.theheart.org/trials-and-fibrillations-with-dr-john-mandrola/2012/4/9/choosing-wisely.

¤  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: Wednesday, August 26, 2020

Update->FAQs Coping with A-Fib Stroke: What Your Family Should Learn Now

 FAQs Coping with A-Fib: Stroke Action Plan

FAQs A-Fib afib“In case I have an A-Fib-related stroke, what does my family need to know to help me? (I’m already on a blood thinner.)  What can I do to improve my odds of surviving it?

Stroke is the most dreaded effect of having A-Fib. And an A-Fib-related stroke is usually worse because the clots tends to be larger. They often result in death or permanent disability.

Here are some basic facts and steps you and your family can take to prepare for and what to do if stroke strikes any member of your family.

Prepare Your Plan: The 4 Steps

For your own and your family’s peace of mind, you need to create a ‘Stroke Action Plan’.

Step 1: Learn the Signs of a Stroke

Make it a family affair. Discuss the most common signs of stroke: sudden weakness of the face, arm or leg, most often on one side of the body.  Stroke may be associated with a headache, or may be completely painless. Each person may have different stroke warning signs.

Step 2―Ask Your Doctor

Discuss with your doctor what actions to take in case of stroke. For example, some doctors recommend aspirin to help avoid a second ischemic stroke (A-Fib). If so, ask what dosage.

Step 3―Locate Your Nearest ‘Certified Stroke Center’

Why a Certified Stroke Center? If a stroke victim gets to a Certified Stroke Center within four hours, there is a good chance specialists can dissolve the clot without any lasting damage.

Only a fraction of the 5,800 acute-care hospitals in the U.S are certified as providing state-of-the-art stroke care.

A certified or ‘Advanced Comprehensive Stroke Center’ is typically the largest and best-equipped hospital in a given geographical area that can treat any kind of stroke or stroke complication.

A Certified Stroke Center will have drugs such as Tissue Plasminogen Activator (tPA) to dissolve the clot. Can use Clopidogrel or acetylsalicylic acid (ASA) to stop platelets from clumping together to form clots. Or use anticoagulants to keep existing blood clots from getting larger.

So do your homework. To find the nearest certified or ‘Advanced Comprehensive Stroke Center’ check these listings:

Find A Certified U.S. Stroke Center Near You/NPR News
Find a Certified Comprehensive Stroke Center

Step 4―Post Your ‘Stroke Action Plan’

Write up the three components of your plan (i.e., the signs of stroke, aspirin dosage and location of the nearest Certified Stroke Center).

What about your workplace? Locate the nearest Certified Stroke Center to your job, too, and post a copy.

Also, print handouts with the name and address of the nearest Certified Stroke Center (Advanced Comprehensive Stroke Center) for EMS responders. Keep a bottle of aspirin nearby.

Store your ‘Stroke Action Plan’ in a special binder or post so that family can easily find the information.

If a Stroke Strikes: Work the Plan

1. Immediately call your emergency medical services (EMS)―even if the person having the stroke doesn’t want you to. (e.g., 911 in US and Canada, 0000 in Australia, 999 in the UK.)

Note: DO NOT try to diagnose the problem by yourself, and DO NOT wait to see if the symptoms go away on their own.

2. While waiting for EMS, administer aspirin in the proper dosage (if advised by your doctor beforehand) to help avoid a second stroke.

Note: The emergency operator might connect you to a hospital that gives you instructions based on symptoms.

3. When EMS arrives, tell them to take the patient to your nearest Certified Stroke Center (give them a handout with the name and address).

Note: If necessary, be firm, insist they go to your choice of Certified Stroke Center. (Realize that some paramedics and ambulance services have side deals with hospitals to take patients to their hospitals, even if it’s not the right hospital for stroke victims.)

The Wrap Up

A ‘Stroke Action Plan’ with specific steps is reassuring during a medical emergency and helps everyone stay calm. Your family will be confident they’re supporting you in taking the right action at the right time.

The only guarantee of not having an A-Fib stroke is to no longer have A-Fib.

Know that quickly going to a certified or ‘Advanced Comprehensive Stroke Center’ may save you from the debilitating effects of an A-Fib stroke, or even death.

For additional reading, see Ablation Reduces Stroke Risk to that of a Normal Person.

References for this article
Chen ZM, et al. Indications for early aspirin use in acute ischemic stroke: A combined analysis of 40,000 randomized patients from the Chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collaborative groups. Stroke. 2000 Jun;31(6):1240-9

Why Choose Comprehensive Stroke Center Certification. The Joint Commission. June 20, 2014. http://tinyurl.com/JC-comprehensive-stroke-ctr

Emergency Telephone Numbers Around the World. ChartBin.com URL: http://chartsbin.com/view/1983

Find A Certified U.S. Stroke Center Near You. NPR News. Updated October 29, 2015. URL: http://tinyurl.com/certified-stroke-center

Find a Certified Comprehensive Stroke Center: Search by US state. The Internet Stroke Center.  URL: http://www.strokecenter.org/trials/centers/

Back to FAQs: Coping with Your A-Fib
Last updated: Wednesday, August 26, 2020

Atrial Fibrillation and PVCs, How Do They Compare?

An A-Fib.com reader sent me an email asking about the difference between Atrial Fibrillation and PVCs. To start, PVC stands for Premature Ventricular Contraction.

What is a PVC?…

A Premature Ventricular Contraction (PVC) is like an extra beat or a missed beat that comes from the lower part of your heart, the ventricles. Not to worry. We all get them occasionally.

EKG showing a PVC spike; (source: Wikipedia)

EKG showing a PVC spike; (source: Wikipedia)

Surprisingly, PVCs can be a forecaster of A-Fib. In fact, PVCs can precede an episode or predict who will develop A-Fib.

…Compared to Atrial Fibrillation?

During A-Fib, the upper part of the heart, the atria, go crazy and start beating out of sync which causes the ventricles (the lower part) to beat irregularly.

(A-Fib is usually much more disturbing than an occasional PVC missed or early beat.)

However, if you have a lot of PVCs, they can be just as disturbing as A-Fib.

When are PVCs Dangerous?

If you experience 5+ PVCs per minute or 10-̵30 per hour, you probably should see your Electrophysiologist (EP).

To read how one patient dealt with his PVCs, see John Thorton’s story, PVC-Free After Successful Ablation at Mayo Clinic.

In particular, PVCs can be dangerous if they amount to over 20% of your heart beats. This can weaken your heart muscle. The Mayo Clinic calls them “high density PVCs”.

Can Life-Threatening PVCs be Treated?

Yes, one treatment for excessive PVCs is a PVC ablation. During this ablation the PVCs are mapped and isolated in much the same way A-Fib signals are isolated during an A-Fib ablation.

If you are looking into an ablation for your PVCs, know that not as many EPs perform PVC ablation compared to A-Fib. (Ask your EP for referrals.)

For more about A-Fib with PVCs see, FAQs Coping with A-Fib: PVCs & PACs.

New FAQ: What is Atypical Flutter?

“I have Atrial Flutter that my EP describes as “atypical”. What does that mean? Is it treated differently than typical Flutter? (I’ve had two ablations, many cardioversions, and a Watchman installed to close off my LAA.)”

Atrial Flutter is similar but different from Atrial Fibrillation. Atrial Flutter is characterized by rapid, organized contractions of individual heart muscle fibers (see graphic below).

In general, there are two types of Atrial Flutter:

• Typical Flutter (from the right atrium)
• Atypical Flutter (can come from anywhere)

Typical Flutter originates in the right atrium (whereas A-Fib usually comes from the left atrium).

Atypical Flutter can come from anywhere and is one of the most difficult arrhythmias to map and ablate.

To learn more, read my full answer, go to: I have Atrial Flutter that my EP describes as “atypical”. What does that mean?”

A-Flutter usually comes from the right atrium (A-Fib usually comes from the left atrium).

FAQ: A-Fib and the Two Types of A-Flutter

FAQs Coping with A-Fib: A-Flutter

“I have Atrial Flutter that my EP describes as “atypical”. What does that mean? Is it treated differently than typical Flutter? (I’ve had two ablations, many cardioversions, and a Watchman installed to close off my LAA.)”

A-Flutter usually comes from the right atrium.

Atrial Flutter is similar but different from Atrial Fibrillation. Atrial Flutter is characterized by rapid, organized contractions of individual heart muscle fibers (see ECG graphic).

In general, there are two types of Atrial Flutter:

Typical Flutter (from the right atrium)
Atypical Flutter (can come from anywhere)

Typical Flutter

Typical Flutter originates in the right atrium (whereas A-Fib usually comes from the left atrium). Typical Flutter is an organized right atrium rhythm which usually travels around the tricuspid valve annulus, either in a counterclockwise or clockwise manner. This is the most common form of atrial Flutter.

The tricuspid valve forms the boundary between the right ventricle and the right atrium. Deoxygenated blood enters the right side of the heart via the inferior and superior vena cava.

An ablation for Typical Flutter is one of the easier and more effective forms of catheter ablation. The electrophysiologist (EP) makes what is called a Cavo-Tricuspid Isthmus line in the right atrium to block Flutter signals.

If combined with an ablation for A-Fib (highly recommended), the EP makes this lesion set or line either before going through the septum to the left atrium or on the way out.

This blocking line can be made in as little as 20 minutes and usually stops Typical Flutter. It’s highly successful (95%) with low risk.

Atypical Flutter

Atypical Flutter can come from anywhere and is one of the most difficult arrhythmias to map and ablate. Atypical Flutter includes any other Flutter circuit (not traveling around the tricuspid valve), from either the left or right atrium.

These Atypical Flutter circuits are often associated with scar tissue from prior A-Fib catheter or surgical procedures, but can arise from spontaneous left and/or right atrial scar. One form can travel around the mitral valve annulus, but many other Atypical Flutter circuits are possible. These can be difficult to map and ablate, and there can be multiple Atypical Flutter circuits in a single patient.

Atypical Flutter often appears, as probably in your case, after a successful ablation for A-Fib. It’s often the last arrhythmia circuit that needs to be ablated to restore a patient to sinus.

Treatment for Your Atypical Flutter

Antiarrhythmic Drugs? Today’s antiarrhythmic drugs leave a lot to be desired. They are effective for only about 40% of patients, tend to lose their effectiveness over time and have bad side effects. While they aren’t considered a “cure” for A-Fib, they can be helpful to improve A-Fib symptoms on a temporary basis.

For more about ablation for Atypical Flutter, see my 2020 AF Symposium report, Live Case of Difficult A-Fib Ablation of Atypical Flutter performed by Dr. Kevin Heist, Mass. General Hospital.

For Atrial Flutter, in particular, antiarrhythmic drugs are even less effective. In fact, they sometimes make Flutter worse by slowing conduction which favors the organization of Flutter circuits.

Master EP for Complex Ablation: Treating your Atypical Flutter is often a complex ablation procedure and isn’t for the faint of heart. You need to find a top “master” EP, a highly skilled EP with a high success rate with difficult A-Fib cases, and Atypical Flutter, in particular.

This complex ablation requires an EP with both the experience and the tenacity to find and ablate these often-elusive Atypical Flutter signals. (Email me, I can suggest several “master” EPs.)

Don’t just go to the EP whose office is near you. Go to the best, most experienced EP you can reasonably find. Be prepared to travel.

I know it’s a lot of effort. But you have to work at finding the right EP for you and your Atrial Flutter.

Learn more about Flutter: Most of the information on A-Fib.com applies to Atrial Flutter too. But I have also written specifically about Atrial Flutter.

So, I offer you a list of my top articles about Atrial Flutter. See My Top 5 Articles About Atrial Flutter.

Reference for this article
Thanks to Embry Rucker for this excellent question.

Update-re-post: FAQs Understanding A-Fib: Local Anesthesia Can Trigger A-Fib

 FAQs Understanding A-Fib: Local Anesthesia

FAQs Understanding Your A-Fib A-Fib.com“I read that the local anesthesia my dentist uses may trigger my A-Fib. Why is that? What can I do about it?”

Dr. Sam, a retired MD, wrote to caution A-Fib patients that local anesthesia containing epinephrine can trigger your A-Fib. Local anesthesia (with Epi or Adrenalin) is used by dentists and emergency room personnel.

Dr. Sam writes:

At the Dentist:This past year 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.

Epinephrine (Epi or Adrenalin) 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 dental local anesthesia with Epinephrine (Epi) potentially can trigger A-Fib. I found very little info online about this and no studies had been done about dental anesthesia with Epi & A-Fib.

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.

Discuss with your dentist if you think you’re sensitive. Tell him/her you have A-Fib.”

At the Opthamologist: “The drops that the eye doctor uses to dilate your eyes are similar to Adrenalin.  Discuss with your eye doctor if you think you’re sensitive. Tell him/her you have A-Fib.”

At the Emergency Room: In the ER doctors use local anesthesia with Epi to sew up lacerations and/or to do small surgical procedures requiring local anesthesia, because it reduces bleeding locally and lasts longer. Tell your doctor you have A-Fib and discuss your concern that the use of local anesthesia with Epi may trigger your Atrial Fibrillation.”

Thanks Dr. Sam for sharing this warning about Epinephrine containing products.

Go back to FAQ Understanding A-Fib
Last updated: April 8, 2020

FAQs A-Fib Effectiveness of Successful Catheter Ablation

 FAQs A-Fib Ablations: Effectiveness 

Catheter Ablation

Catheter Ablation

“How effective is a successful catheter ablation for A-Fib? What should I expect?”

Catheter Ablation Restores Your Life!: There are few medical procedures more transformative than going from A-Fib to Normal Sinus Rhythm (NSR)! Ask any former symptomatic A-Fib patient who is now A-Fib free. It’s like your life has been restored. Few medical advances have been so rapidly and widely adapted as catheter ablation for A-Fib.

Improved Quality of Life: There is an immeasurable improvement in your quality of life. You feel better both physically and mentally. You can exercise normally again. Your general overall health and mental functioning improve, you function better physically, you feel more vital, you can handle physical and mental health stress better. Your blood pressure improves.

You no longer live in fear of the next A-Fib attack. Your Ejection Fraction improves (the ability of your heart to pump blood to your brain and the rest of your body). Your brain works better, you think more clearly, you can handle work and study challenges better. Your A-Fib “brain fog” goes away. You no longer live in fear of developing A-Fib dementia.

Better Than Drugs: You improve much more than people on antiarrhythmic drug therapy. You feel better than a life on A-Fib drugs. “Using quality of life as the primary endpoint of a trial for the first time, we demonstrated that pulmonary vein isolation (PVI) is significantly more effective than antiarrhythmic drug therapy,” according to authors of the CAPTAF clinical trial.

Improved Quantity of Life: Not only is the quality of your life improved, but the quantity as well. You can expect to live longer as well as have a more healthy and fulfilling life. Your long-term risks of death, stroke and dementia are reduced and become similar to people who’ve never had A-Fib.

In one study (CASTLE AF), death rate was reduced by an amazing 47%. Staying in sinus rhythm means you have a 60% reduced rate of cardiovascular mortality (risk of death from stroke and other cardiovascular events).

If you want to live longer (and more fully), have a catheter ablation.

Return to FAQ Catheter Ablations
Last updated: Wednesday, April 8, 2020

Q&A: Natural Therapies & Holistic Treatments For Atrial Fibrillation

You probably have a long list of questions about your Atrial Fibrillation. At A-Fib.com, we have answered thousands of patient questions—perhaps some of the same questions you may have right now. We’ve organized these questions and answers into several topics and treatment groups.

CC use credit - Nikodem_Nijak

Complementary and Natural Therapies

Under FAQ about Living with A-Fib, we discuss Natural Therapies & Holistic Treatments.

Here we focus on topics such as naturopathic doctors, complementary or integrated medicine as well as mind/body practices such as chiropractic, acupuncture, yoga and meditation.

Some of the questions we answer: How do I find a doctor with a more “holistic” approach?,  Is there any evidence on Yoga helping with A-Fib symptoms? and Do A-Fib patients find chiropractic adjustment useful?

We also answer questions about whole food or organic diets, A-Fib and supplements, and the vagal maneuver’.

We invite you to browse through the lists of questions. To read more, just ‘click’ on the question to be taken to the answer page.

Go to Q&A: Natural Therapies & Holistic Treatments

From the U.S. National Institutes of Health (NIH):

“Most people use non-mainstream approaches along with conventional treatments. The boundaries between complementary and conventional medicine overlap and change with time.”  

Hiker Offers Insights About High Altitude and A-Fib

After reading our post, FAQ: How Does High Altitude Affect Atrial Fibrillation?, Michele Straube shared some insightful comments about high altitude and A-Fib. Michele Straube had A-Fib for 30 years until her successful ablation. She is an active hiker including walking the Alps.

“There is “high altitude” and then there is “really high altitude”. Plus, even at “high altitude”, it is possible that anyone who has ever had A-Fib may feel some adverse effects. I offer two stories:

Michele S.

1. I was “cured” of A-Fib in 2009. In December 2015, my family climbed Kilimanjaro taking a longer route up so we had time to acclimate. While the rest of the family summited, I stayed at base camp (15,580′) because my heart was no longer in NSR [normal sinus rhythm]. It returned to NSR as soon as we got down to 12,000′ elevation.
2. We do a lot of hiking in the mountains. Even though I’m not in A-Fib anymore, I feel the elevation (above 8,000′) more than most of my hiking companions. I don’t go into A-Fib (thank goodness), but my heart races and I often get dizzy. It takes me up to 5 days to acclimate, even at that not-so-high elevation.”

I admire Michele’s fearless attitude toward hiking and mountain climbing and her boldness in leading an A-Fib free life. Thanks, Michele, for sharing. To read Michele Straube’s story, go to ‘Cured after 30 years in A-Fib by Dr. Marrouche.

Wondering if you Should Consider a Cox Maze or Mini-Maze for your A-Fib?

What are your options when drugs aren’t working or you can’t tolerate them? When your symptoms are impacting your quality of life? And you want to cure your A-Fib not just manage it? Treatment options to consider include Catheter Ablation or Maze or Mini-Maze surgeries.

We’ve published a new FAQ question and answer about the Maze or Mini-Maze surgeries:

Surgical Maze pattern of series of lesions

“When should A-Fib patients consider a full Cox Maze or a Mini-Maze surgery instead of a Catheter Ablation?”

In general, candidates for Maze or Mini-Maze surgeries are patients with significant, frequent A-Fib symptoms that do not respond to medication or catheter ablation. Patients who are unaware of their A-Fib symptoms are probably not candidates. However, each case is unique, so it’s best to discuss your options with your cardiologist.

There are several specific circumstances in which you might consider a Maze surgery…continue reading our answer…

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