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“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.
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“I think your site has helped a lot of patients.”Dr. Hugh G. Calkins, MD Johns Hopkins,
Baltimore, MD
FAQs A-Fib Effectiveness of Successful Catheter Ablation
FAQs A-Fib Ablations: Effectiveness
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.
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:
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:
“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…
FAQ Update: For stroke prevention—warfarin (Coumadin), an NOAC or aspirin?
We’ve updated our answer to the Frequently-Asked-Question (FAQ):
“For A-Fib patients, which is better to prevent an A-Fib-related stroke—warfarin (Coumadin), a NOAC, or aspirin?”
For decades, people more at risk for A-Fib-related stroke have been on warfarin (Coumadin). In the last few years, many of these patients have switched to the newer NOACs. A-Fib patients with low or no risk factors for stroke are often put on aspirin, or nothing at all.
Differences with the Same Goal
Aspirin is an antiplatelet drug that decreases the stickiness of circulating platelets (small blood cells that start the normal clotting process), so that they adhere to each other less and are less likely to form blood clots. (Cost: dirt cheap.)
Warfarin (brand name Coumadin) is an anticoagulant that works by slowing the production of blood clotting proteins made in the liver. Warfarin is highly effective, reducing the annual risk of stroke by approximately two thirds, but does require periodic lab tests to maintain the proper therapeutic level. (Cost: dirt cheap + lab tests.)
NOACs stands for Novel Oral AntiCoagulants. NOACs are alternatives for vitamin K antagonists (e.g., Warfarin). NOACs don’t require periodic blood testing as with warfarin. The clinical trials indicate NOACs work as well as warfarin. (Cost: Extremely expensive.)
—Continue reading—for the rest of our answer along with a few takeawys.
FAQ: When to Consider the Maze/Mini-Maze Surgery for Atrial Fibrillation
FAQ: Maze Surgeries
“When should A-Fib patients consider a full Cox Maze or a Mini-Maze surgery instead of a Catheter Ablation?”
Surgical Maze pattern of series of lesions
There are several specific circumstances in which you might consider a Maze surgery:
• You are having other heart-related surgery. If you have to undergo open heart surgery for another heart problem, such as a Mitral Valve replacement, the Cox Maze operation can be performed concurrently with your other heart surgery.
• You don’t qualify for a catheter ablation. If you can’t take blood thinners, for example, you can’t have an ablation.
• You’ve already had a stroke. Or you are in danger of having a stroke during a catheter ablation.
• You’re morbidly obese. It’s more difficult to see a clear image of the heart with current imaging systems during a catheter ablation if someone is significantly overweight.
A word of caution—the Maze/Mini-Maze are surgical operations with the potential risks and complications of surgery.
Typical Mini-Maze incisions for surgical ablation of A-Fib
Current Guidelines for the Management of Patients with A-Fib
Surgery isn’t recommended as a first choice by current A-Fib treatment guidelines. The Maze surgeries are more invasive, traumatic, risky and with longer (in hospital) recovery times.
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.
Find the Right Doctor
To find the right electrophysiologist (EP) for you, see Finding the Right Doctor for You and Your A-Fib.
FAQ: I am considering closure of the LAA. What do I need to know?”
FAQ: Closure of the LAA
“I don’t want to be on a blood thinner for years and years. My doctor is talking about closure of the Left Atrial Appendage. What is an occlusion device?”
An occlusion device, like the FDA approved Watchman., is used to close off the Left Atrial Appendage (LAA), the source of most clots (90%-95%) and A-Fib-related strokes.
The Watchman is inserted in a very low risk procedure that takes as little as 20 minutes. Afterward, you would usually not need to be on a blood thinner (anticoagulant).
Closure of the LAA is often included in a Maze/Mini-Maze surgery and sometimes as part of a catheter ablation.
Side Effects: Closure of the LAA may compromise the ability of the Left Atrium to function fully. Serious athletes would probably miss the reduced blood flow from the left atrium. But most A-Fib patients would hardly notice.
Catheter placing Watchman in LAA
Long-Term Effects: What are the long-term effects of leaving a mechanical device like the Watchman inside the heart? We know that, after a few months, heart tissue grows over the Watchman device so that the LAA is permanently closed off from the rest of the heart.
It seems unlikely that complications would develop after a long period of time (compared to long-term use of the blood thinner, warfarin). But we can’t say that for sure until enough time has passed. The first clinical trials installation of the Watchman device in the US was in 2009 and in Europe in 2004. So far, no long-term complications have developed.
Other Occlusion Devices: Besides the Watchman from Boston Scientific, other occlusion devices include the Amplatz Amulet from St. Jude Medical and the LAmbre from LifeTech Scientific.
EPs Installing the Watchman Device: To find EPs installing the Watchman or other occlusion devices, I highly recommend selecting an electrophysiologist (EP) who is certified in “Clinical Cardiac Electrophysiology”. For a list of EPs meeting this criteria, see Steve’s Lists of A-Fib Doctors by Specialty: Doctors Installing the Watchman.
Reference Articles: To learn more about the removal of the LAA, and the Watchman, see my articles, The Role of the Left Atrial Appendage (LAA) & Removal Issues and The Watchman™ Device: The Alternative to Blood Thinners.
FAQs A-Fib Drug Therapy: Natural Blood Thinners
FAQs A-Fib Drug Therapy: Natural Blood Thinners
“Are natural blood thinners for blood clot treatment as good as prescription blood thinners like warfarin?”
There are a number of foods and supplements that are known to thin the blood. These include foods with high amounts of aspirin-like substances called salicylates, omega-3 fatty acids, vitamin E supplements, and foods with natural antibiotic properties.
Healthy adults can greatly reduce the risk of blood clots and cardiovascular disease by modifying their lifestyle and adding nutritional supplements proven to support cardiovascular health. But this site is not recommending or advising that people switch from prescription anticoagulants to natural blood thinners.
No Studies that ‘Natural’ is as Effective as Warfarin
As of yet, there aren’t any double blind studies which demonstrate any natural alternative (or combination) is as effective against stroke as warfarin (Coumadin) or the new NOACs.
Certain foods and supplements may be “natural” and thin the blood, but there’s little research on their effectiveness to prevent clots in those at high-risk for stroke, such as A-Fib patients.
What’s more, there isn’t a way to track their effectiveness in the same way doctors can monitor the action of warfarin through routine blood tests.
Patients with Lone Atrial Fibrillation
Natural blood thinners may be considered for patients with “lone” Atrial Fibrillation, that is, patients who have had A-Fib occur only once or twice, are young, and have an otherwise healthy heart (normal size, no enlarged chambers or leaky valves, not otherwise prone to blood clots or other heart risk factors like diabetes, etc.). These low-risk patients may be candidates for natural alternatives to warfarin (Coumadin). (Historically, these patients may have been put on aspirin.)
If considering a switch to natural blood thinners, do not stop taking your anticoagulation medication. Talk to your doctor first. (But realize that your doctor isn’t likely to tell you to stop taking your warfarin or NOAC prescription.)
Seek Holistic-Minded Practitioners
Instead, you may want to seek out doctors who are holistically-minded and have knowledge of natural medicines; for example, a doctor who practices complementary or integrative medicine or a naturopathic physician. They can partner with you to pursue natural alternatives to prescription medicines. For a listing of such doctors in your area, go to http://www.ACAM.org.
For example, on his website, the Integrative Cardiologist and anti-aging specialist Dr. Stephen Sinatra discusses combating blood clots with this regimen of natural blood thinners:
• Fish oil (2–3 grams daily)
• Garlic (1–2 grams daily in capsule form)
• Nattokinase (100 mg daily)
• Vitamin E as mixed tocopherols (200–300 IU daily)
• Bromelain, an enzyme derived from pineapple (600 mg daily)
For additional advice on natural ways to prevent blood clots, visit www.drsinatra.com.
Talk to Your Doctor: Supplements Can Interfere with Coagulation
Always talk to your doctor before adding any supplements to your treatment plan. Some ‘natural’ supplements may interact with your prescription meds (when taken alone or in combination) or interfere with coagulation and increase your bleeding risk.
Return to FAQ Drug Therapies
Last updated: Wednesday, August 26, 2020
FAQ: “Which is the better to prevent A-Fib-related stroke—warfarin (Coumadin), a NOAC or aspirin?
FAQs A-Fib Drug Therapy: Stroke Prevention
“For A-Fib patients, which is the better to prevent A-Fib-related stroke—warfarin (Coumadin), a NOAC or aspirin?”
Updated: June 2018. For decades, patients more at risk for A-Fib-related stroke have been on warfarin (Coumadin). In the last few years, many of these patients have switched to the newer NOACs. A-Fib patients with low or no risk factors for stroke are often put on aspirin, or nothing at all.
Differences with the Same Goal
Aspirin is an antiplatelet drug that decreases the stickiness of circulating platelets (small blood cells that start the normal clotting process), so that they adhere to each other less and are less likely to form blood clots. (Cost: dirt cheap.)
Warfarin (brand name Coumadin) is an anticoagulant that works by slowing the production of blood clotting proteins made in the liver. Warfarin is highly effective, reducing the annual risk of stroke by approximately two thirds, but does require periodic lab tests to maintain the proper therapeutic level. (Cost: dirt cheap + lab tests.)
NOACs stands for Novel Oral AntiCoagulants. NOACs are alternatives for vitamin K antagonists (e.g., Warfarin). NOACs don’t require periodic blood testing as with warfarin. The clinical trials indicate NOACs work as well as warfarin. (Cost: Very expensive.)
Takeaways
The FDA approved the NOACs without any recognized method of determining their clot preventing effectiveness (as with warfarin, i.e. INR).
Warfarin has been successfully used for stroke prevention in A-Fib patients at high or intermediate risk for stroke. It’s readily available and inexpensive.
Aspirin is no longer recommended as first-line therapy for Atrial Fibrillation patients according to the 2014 AHA/ACC/HRS Treatment Guidelines for Atrial Fibrillation. And has been downgraded to a class 2B drug.
Microbleeds: We obviously don’t have any data on the long-term effects of taking NOACs for years. Some people on long-term warfarin have been known to develop micro bleeds and dementia. Will this happen with the NOACs? We simply don’t know. But intuitively one would expect the same thing to happen, though probably not to the extent of warfarin.
Weighing the various risk/benefit ratios is a decision for you and your doctor. And should be re-evaluated as you grow older.
Return to FAQ Drug Therapies
Last updated: Monday, June 18, 2018
FAQ: Are Anticoagulants and Blood Thinners the Same Thing? How do they Work?
FAQs A-Fib Drug Therapy: Warfarin
“Are Anticoagulants and blood thinners the same thing? How do they thin the blood?”
Since A-Fib increases your risk of clots and stroke, blood thinners are prescribed to prevent or break up blood clots in your heart and blood vessels and thereby reduce your chance of an A-Fib-related stroke.
Although referred to as “blood thinners”, they don’t actually affect the “thickness” or viscosity of your blood.
Anticoagulant Warfarin
There are two main types: anticoagulants and antiplatelet agents. They work differently to accomplish the same end effect.
Anticoagulants work chemically to lengthen the time it takes to form a blood clot.
Common anticoagulants include warfarin (Coumadin), Heparin and the NOACs such as apixaban (Eliquis).
Antiplatelet Aspirin
Antiplatelets prevent blood cells (platelets) from clumping together to form a clot.
Common antiplatelet medications include aspirin, ticlopidine (Ticlid) and clopidogrel (Plavix) .
Final answer: An anticoagulant doesn’t really thin the blood or make it less viscous, but it does help prevent a stroke like blood thinners do.
Note: To read about ‘clot buster’ drugs or treatments that could save you from a debilitating stroke, see my article: Your Nearest ‘Certified Stroke Center’ Could Save Your Life.
Return to FAQ Drug Therapies
Last updated: Tuesday, June 19, 2018
