Doctors & patients are saying about ''...

" is a great web site for patients, that is unequaled by anything else out there."

Dr. Douglas L. Packer, MD, FHRS, Mayo Clinic, Rochester, MN

"Jill and I put you and your work in our prayers every night. What you do to help people through this [A-Fib] process is really incredible."

Jill and Steve Douglas, East Troy, WI 

“I really appreciate all the information on your website as it allows me to be a better informed patient and to know what questions to ask my EP. 

Faye Spencer, Boise, ID, April 2017

“I think your site has helped a lot of patients.”

Dr. Hugh G. Calkins, MD  Johns Hopkins,
Baltimore, MD

Doctors & patients are saying about 'Beat Your A-Fib'...

"If I had [your book] 10 years ago, it would have saved me 8 years of hell.”

Roy Salmon, Patient, A-Fib Free,
Adelaide, Australia

"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su,
Cavanaugh Heart Center, 
Phoenix, AZ

"...masterful. You managed to combine an encyclopedic compilation of information with the simplicity of presentation that enhances the delivery of the information to the reader. This is not an easy thing to do, but you have been very, very successful at it."

Ira David Levin, heart patient, 
Rome, Italy

"Within the pages of Beat Your A-Fib, Dr. Steve Ryan, PhD, provides a comprehensive guide for persons seeking to find a cure for their Atrial Fibrillation."

Walter Kerwin, MD, Cedars-Sinai Medical Center, Los Angeles, CA

Warfarin Users: NOACs now First-line Therapy

The use of warfarin (Coumadin, Jantoven) to prevent clots is no longer recommended for most A-Fib patients. With a superior safety profile, NOACs (Novel Oral Anticoagulants) are now recommended as first-line therapy for suitable A-Fib patients. NOACs include dabigatran (Pradaxa), rivaroxaban (Xarelto), Apixaban (Eliquis) and edoxaban (Savaysa).

Be advised: Do not quit taking prescription anticoagulants on your own. Talk to your doctor instead.

A-Fib treatment guidelines were updated in 2019 by the American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS).

The guidelines recommend that Coumadin no longer be used to treat A-Fib except for a limited, specific group of patients. Instead, guidelines strongly recommend using NOACs (DOACs).

“New scientific studies show that NOACs may be safer for patients because there is less risk of bleeding, and they may also be more effective at preventing blood clots than warfarin,” said Craig T. January, MD, PhD, FACC, co-chair of the focused update.

NOAC or DOAC? You may be familiar with “NOAC” (Novel Oral Anticoagulants), but lately the acronym has evolved to “DOAC” (Direct Oral Anticoagulants), since they are no longer “new” or “novel”.

NOACs (or DOACs) Guidelines

The guidelines instead encourage the use of “novel [direct] oral anticoagulants” (NOACs or DOACs) which are better at preventing stroke and have fewer side effects. I’ve written about the NOACs several times:

…Eliquis (apixaban) tested the best and is the safest. But all NOACs are considered high risk drugs and should only be taken if there is a real risk of stroke. (Warfarin vs. Pradaxa and the Other New Anticoagulants)

For example, if you’ve been cured of A-Fib and are A-Fib free by a catheter ablation, you normally don’t have to take NOACs. You aren’t in danger of having an A-Fib stroke if you don’t have A-Fib. NOACs are not like taking vitamins. (Blood Thinners After Ablation

High Cost of NOACs: Co-Pay Card and Patient Assistance Discounts

I know NOACs are much more expensive than Coumadin. And I understand if you and your doctor may choose to continue using Coumadin because of the high cost of a NOACs.

But don’t give up so fast. There are resources to save on prescription cost. For example, here are two resources on Eliquis to check:

• has a very informative page about the NOAC, Eliquis. For example, see Eliquis Prices, Coupons and Patient Assistance Programs

• Eliquis Customer Connect: Bristol-Myers Squibb offers an Eliquis Co-pay card and program which might work to reduce your cost. See ELIQUIS Costs, Savings and Support.

“Eliquis Co-pay Card: Eligible patients may pay no more than $10 per 30-day supply for up to 24 months with an annual savings of $3800; for additional information, contact the program at 855-354-7847.”

Other NOAC drug companies may have similar discount plans. We offer these links to help you get started:

• Pradaxa (dabigatran), see PRADAXA Savings & Support
• Xarelto (rivaroxaban), see Get Savings and Support for XARELTO
• Savaysa (edoxaban), see The SAVAYSA Savings Card

If you are 65 or older, you may qualify for Senior Discounts.

Talk to Your Doctor if You’re on Warfarin

If you’ve on warfarin (Coumadin, Jantoven) to prevent blood clots, you know that this powerful drug can save your life. But warfarin treatment is a careful balance, and certain factors can tip the balance, increasing the risk of bleeding.

If you are taking warfarin, talk to your doctor about the NOACs and whether you should change from warfarin.

Taking an anticoagulants (and which one) is one of the most difficult decisions you and your doctor must make.

Medical ID: If you’re on any blood thinner, it’s a good idea to carry some kind of medical ID. If you have an accident involving bleeding, EMTs can call ahead to the ER and get the staff ready to help you. To print your own I.D. see: Print a free Medical Alert I.D. Wallet Card

Resources for this article
January, C.T., et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Circulation. ACC News Story. Jan 28, 2019.

Updated AFib Guidelines Recommend NOACs to Prevent Stroke in AFib Patients. American College of Cardiology. Jan 28, 2019.

Atrial Fibrillation and PVCs, How Do They Compare?

An 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.

Lorrie’s Catastrophic Mini-Maze Surgery and Its After-Math

Lorrie was an informed Atrial Fibrillation patient. She did everything right.

Lorrie C.

She researched her disease, she studied the choices of surgical treatments. With input from her EP, she thoughtfully decided on a Mini-Maze surgery.

She chose a highly skilled cardiac surgeon with an outstanding reputation. She and a companion interviewed the surgeon and asked loads of questions—twice. And chose one of the top 100 hospitals in the country for her surgery.

It’s a shame she had to endure so many complications.

The first part of Lorrie’s Atrial Fibrillation story was written in 2012 from her hospital room upon re-admission after Mini-Maze surgery. She then jumps to the present and writes about the aftermath. She begins:

“As I sit in my hospital bed on my seventh consecutive day of my second admission, I have finally mustered the strength and clarity of mind to write about my exasperating experience of an elective surgery… .
My A-Fib started when I was in my early 60’s with only a few episodes a year. The story of my Mini-Maze surgery began about four years later when my electrophysiologist felt it was time to put an end to my increasing episodes of Atrial Fibrillation.
Due to having paroxysmal A-Fib (meaning every now and then for unknown reasons) as well as my good health and stamina, at 66 years of age I was the perfect candidate for either a catheter vein ablation or Mini-Maze surgery. Because I was only having about 3 episodes a year and in good health, my EP felt that I would have a success rate of over 95%.
After much research, I decided the Mini-Maze would be the best procedure for me. (My EP felt it would be a better choice than an ablation, for he felt I would have a good outcome, which I did not.)
He also warned me that the Mini-Maze wouldn’t be a “walk in the park.” That was an understatement! …

…Continue reading Lorrie’s story about her mini-maze surgery and learn her advice to others with A-Fib.

Interview with Michele Straube on Results of Survey of A-Fib Patients and Wearable Devices

by Steve S. Ryan

We are happy share the results of Michele Straube’s survey of A-Fib patients on consumer wearable/portable devices/apps which many of you participated in April 2019. She received a great response―315 replies! You can review the actual survey and tabulated results at: Survey Questions and the Results.

You may want to re-read Michele Straube’s 2010 A-Fib story, Cured after 30 years in A-Fib. She recently had a second catheter ablation June 11, 2020  and is doing fine, “Went for a walk in the mountains yesterday with 500’ elevation gain, and felt good.”

Michele Straube

Interpreting the Survey Data

I asked Ms. Straube to share her insights and conclusions about her survey data and how it might or should affect A-Fib treatment strategies.

“What do you think is important in your survey’s responses?”

It’s important how many people responded, and the fact that these AFib patients are very interested in having data about their condition.

It’s clear that AFib patients are interested in being an active part of the team managing their condition. Doctors should welcome this (but see below).

For device and apps developers: there’s a huge market for wearables with apps that help inform AFib patients and gain peace of mind when making treatment decisions. Current devices don’t necessarily give us all the information we’re seeking.

There should be greater collaboration between the device developers and patients in future research and design.

Review the actual survey and tabulated results at: Survey Questions and the Results.
 “What information were you looking for?”

I wanted to know if AFib patients use wearable devices? And if so, why and how they use the data. What device or apps would they like someone to design for them.

 “Were you surprised by any of the results?”

I was surprised how many different devices there are that give some kind of relevant data (over 45 different brands), yet virtually none of the A-Fib respondents were 100% satisfied with their device’s capabilities.

About 10% of the respondents said that their doctors were not interested in seeing the data from wearable devices!!!

Many of the respondents wished for device capabilities that already exist; i.e., the devices are not being marketed to the right audience.

 “What results do you think should be published?”

I wanted to know how AFib patients currently use the data available and what they wish would be developed.

“How do you think your results should influence A-Fib treatment strategies?”

Educate: AFib patients should be educated about the various types of consumer devices and encouraged to use them to help manage their AFib.

Medical providers: doctors should welcome this independently collected additional data (especially for patients who experience AFib episodes when they’re not in the doctor’s office).

Treatment costs: A patient’s use of wearables and apps can reduce the overall expense of AFib treatment.

Michele shared how she used a wearable device:

Using myself as an example, I take an ECG reading on my device, email it to the doctor’s office, and we discuss what to do about a “bad” reading via email or phone. 

The one time my device was not working correctly, I had to go into the office for an official EKG reading, which took up much more of everyone’s time and cost oodles of money … and the end result (modification of my meds) was the exact same had I emailed a reading from my device.

We appreciate Michele’s survey work and sharing the results and her conclusions with readers.

Review the actual survey and tabulated results at: Survey Questions and the Results.

Michele expressed her gratitude to all who participated in this survey, and to and other sites that solicited A-Fib patients to take the survey. Michele Straube can be reached at

AVNRT Diagnosed, 2nd Ablation—Finally A-Fib Free

Prior to 2015, I was an active 67-year old male who had taken up running in my late 30’s…I had never experienced any heart issues. Late in September 2015, my heart was racing and a local Spokane hospital ER informed I was experiencing atrial fibrillation. Approximately 12 hours later, with meds, I was back in normal sinus rhythm.

Bob Thompson, Spokane, WA

Over Three Years A-Fib, Bouts Become More Frequent

Over the next few years, I went into A-Fib over 50 times with each bout lasting on the average 10 to 12 hours.Taking metoprolol while in A-Fib, got me back in normal sinus rhythm. I never needed to have a cardioversion.

After dealing with A-Fib for over three years and with the occurrences becoming more frequent, I opted to have a heart catheter ablation in September 2018. Result: the ablation was a complete failure. The EP was only able to ablate three of the four pulmonary veins.

Ablation Fails—Exploring Mini-Maze Procedure

After my failed ablation, my occurrences of A-Fib rapidly increased. I began to explore another option, a mini-maze procedure.

The cardiac surgeon in Spokane suggested I try one more catheter ablation before I opted for the mini-maze procedure.

I met with a cardiac surgeon in Spokane who suggested I try one more catheter ablation before I opted for the mini-maze procedure. The surgeon informed me that the best EP in Spokane was Dr. Mark Harwood whom he would be seeing later in the day.

Best EP in Spokane Calls Me the Next Day!

One day after meeting with the cardiac surgeon, I received a call from Dr. Harwood’s office. Upon meeting with Dr. Harwood, he informed me that he was confident of his ability to ablate all four of my pulmonary veins.

Scheduled for Ablation But Stress Test Reveals AVNRT

I was scheduled to have my second ablation in March 2019, but it was contingent on the results of a stress test.

A few days later, at the end of the stress test, I went into A-Fib. An irregularity (tachycardia) was detected requiring an AVNRT Ablation as well. Continue reading Bob’s story…->

After 50 years of Irregular Heartbeats and PVCs, Finally an A-Fib Diagnosis and Treatment

Cecelia Hender, 72, shares about her life with Atrial Fibrillation. She writes that heart arrhythmias have been a part of her life since she was a young woman.

I was about 20 years old when I first experienced irregular heartbeats. My doctor back then told me it was “nerves” and to relax.

This was how most women were treated by doctors back then. Everything was “nerves”.

Cecelia Hender from Abington, MA with her granddaughter.

In my 30’s, I told another doctor how my heart would take off like a race horse, I could not breathe. He said, “try not to think about it.”  What????

I fought with these irregular heartbeats for many years. I was never told to see a cardiologist or have a doctor investigate just what was going on.

Sent to a Cardiologist Almost By Accident

About 15 years ago, I worked for a medical facility, and one day a young doctor came in and was waiting for an interview…when he said he was an electrophysiologist [cardiac specialist], I asked about my irregular heartbeats.

He was so kind and intelligent…It was this young doctor who told me that I should see a cardiologist. So, I did. And I was treated with medications and wore many heart monitors.

Hard to Document the Arrhythmia

But it was always hard to catch the arrhythmias on an ECG or heart monitor.

My whole life was spent afraid and never going anywhere alone for fear that my heart would act up and I’d be stranded someplace unable to breathe – unable to move. 

Finally, in 2017 I had another [heart] monitor, and it showed a series of irregular heartbeats.

But on this one particular day, I had a very irritating rhythm. It was very fast, then irregularly fast, and I could barely breathe. I went to my PCP [Primary Care Physician] office where they did an EKG and said, “You are in A-Fib”.

They sent me immediately to my cardiologist who confirmed this. I was put on a different kind of med (Metoprolol at first and also Coumadin). And “fingers crossed” I would convert on my own. It took almost two weeks…Continue to read how two ablations brought Cecelia Hender relief from A-Fib and PVCs, and about a recent setback ->

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).

2020 AF Symposium: 5 Abstracts on Pulsed Field Ablation

The 2020 AF Symposium abstracts are one-page descriptions of A-Fib research, both published or unpublished. The abstracts are supplemental to the Symposium live presentations, panels discussions and spotlight sessions. This year the printed digest contained 55 abstracts. I choose only a few to summarize.

My Summaries of Select PFA Abstracts

Pulsed Field Ablation (PFA) was the single most important topic at this year’s Symposium. I summarized five of the PFA abstracts of most interest to A-Fib patients.

Lesion Durability and Safety Outcomes of Pulsed Field Ablation
The durability of PFA lesions is the focus of Dr. Vivek Reddy’s abstract. His research study followed 113 patients who each received a PFA ablation.

Pulsed Field Ablation with CTI Lesions Terminates Flutter in a Small Study
The use of Pulsed Field Ablation (PFA) may significantly improve CTI ablation lesions to block the Flutter signal. (CTI: Cavo-Tricuspid Isthmus)

Durability of Pulsed Field Ablation Isolation Over Time: Preliminary Study
Pulsed Field Ablation (PFA) is a new treatment. This study asked the question of whether PFA electrical isolation (lesions) regresses over time.

Pulsed Field Ablation vs RF Ablation: A Study in Swine 
PFA is “tissue-specific”. This study tested if surrounding non-heart tissue (the esophagus) would be affected. PFA ablation was compared to RF ablation. Swine (pigs) were used so tissue could be dissected and examined.

Using MRI to Check Pulsed Field Ablations (PFA)
Normally, during a RF or cryo ablation, doctors move the esophagus as far away as possible from where they are ablating. In this study they took no such precautions.

My Summary Reports

For more from the 2020 AF Symposium, go to My Summary Reports Written for A-Fib Patients. Remember, all my reports are written in plain language for A-Fib patients and their families.

COVID-19: White House Pushes Unproven Drugs—Risk of Arrhythmias and Sudden Death

by Steve S. Ryan

Note: I have already written about the risk of COVID-19 for patients with A-Fib (and other cardiovascular diseases). See my post: COVID-19 Virus: Higher Risk for A-Fib Patients.

In recent coronavirus pandemic press conferences, President Donald Trump has repeatedly advocated the use of the drugs hydroxychloroquine (HCQ) and azithromycin (Z-Pak) to treat the COVID-19 virus.

He often says, “What have you got to lose?” About treating patients, he also said these drugs can “help them, but it’s not going to hurt them.” (Really?)

COVID-19 stands for Coronavirus Disease 2019

Hydroxychloroquine & Azithromycin Danger―“What Have You Got to Lose?”

The drugs hydroxychloroquine and azithromycin are currently gaining attention as potential treatments for COVID-19. Hydroxychloroquine sulphate (Plaquenil) is an antimalarial medication. Azithromycin (Z-Pak) is an antibiotic. (Antibiotics in general are ineffective against viruses.)

Each has potential serious implications for people with existing cardiovascular disease.

Contrary to Mr. Trump’s statements, you do have a lot to lose. Medical groups warn that it’s dangerous to be hawking unproven remedies.

Recently, three U.S. heart societies published a joint statement to detail critical cardiovascular considerations in the use of hydroxychloroquine and azithromycin for the treatment of COVID-19.

According to the “Guidance from the American Heart Association, the American College of Cardiology and the Heart Rhythm Society”:

Complications include severe electrical irregularities in the heart such as arrythmia (irregular heartbeat), polymorphic ventricular tachycardia (including Torsade de Pointes) and long QT syndrome, and increased risk of sudden death.

The effect on QT or arrhythmia of these two medications combined has not been studied.

With these increased dangers in mind, we must not take unnecessary (or foolish) risks in the rush to find a treatment or cure for COVID-19.

What We Know So Far About These Drugs and COVID-19

… Continue reading this report…->

COVID-19 Virus: Higher Risk for A-Fib Patients

COVID-19, the disease caused by the new coronavirus SARS-CoV-2, has sickened hundreds of thousands and continues to kill large numbers of people worldwide.

Typically, it’s considered a threat to the lungs, but COVID-19 also presents a significant threat to heart health, according to recently published research.

“But It’s Just the Flu, Right?”

“During most flu epidemics, more people die of heart problems than respiratory issues like pneumonia,” according to Dr. Mohammad Madjid, McGovern Medical School at UTHealth. He expects similar cardiac problems among severe COVID-19 cases.

In addition, COVID-19 can worsen existing cardiovascular disease. For example, Atrial Fibrillation patients may develop myocarditis, an inflammation of the heart muscle. If left untreated, myocarditis may lead to symptoms of heart failure.

And for otherwise healthy people, COVID-19 can cause new heart problems.

“Comorbid” means the simultaneous presence of two chronic diseases or conditions in a patient.

Comorbid Conditions Increase Fatality Rate

Many A-Fib patients also suffer from other chronic conditions such as diabetes and hypertension. With comorbid conditions, COVID-19 can increase the severity and fatality of the virus.

According to research from the Chinese Center for Disease Control and Prevention (CCDC), COVID-19 patients from mainland China who reported no comorbid conditions had a case fatality rate of 0.9%.

While patients with the following comorbid conditions had much higher rates:

+ 10.5% for those with cardiovascular disease
+ 7.3% for diabetes
+ 6.3% for chronic respiratory disease
+ 6.0% for hypertension
+ 5.6% for cancer.

Among critical cases, the case fatality rate is unsurprisingly highest at 49%.

Take Away: A-Fib Patients at Higher Risk for COVID-19 

Patients with underlying cardiovascular disease (i.e., A-Fib) are at higher risk for developing COVID-19 and have a worse outlook.

While Atrial Fibrillation raises your risk for developing COVID-19, its severity and fatality is further increased when combined with chronic diseases like diabetes and hypertension.

Prior heart disease is a risk factor for higher mortality from COVID-19.

Cardiovascular patients are encouraged to take additional, reasonable precautions to avoid contact with the COVID-19 virus. And to stay current with vaccinations, especially for influenza and pneumonia.

A-Fib Patients: Practice Social Distancing and Stay Safe at Home

COVID-19: We Can Do It

Since people can spread the COVID-19 virus before they know they are sick, it is important to stay away from others when possible, even if you or they have no symptoms.

Stay at least 6 feet (2 meters) from other people
Do not gather in groups
Stay out of crowded places and avoid mass gatherings

Social distancing is especially important for people who are at higher risk of getting very sick including older adults and people of any age who have serious underlying medical conditions.

For more information: see the article How to Protect Yourself & Othersfrom the Centers for Disease Control and Prevention (CDC).

Resources for this article
• Citroner, G. Can COVID-19 Damage Your Heart? Here’s What We Know. March 30, 2020.

• Yanping, Z. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19)—China, 2020. Chinese Center for Disease Control and Prevention (China CDC). Online Date: February 17 2020.

• Madjid M, et al. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiol. Published online March 27, 2020. doi:10.1001/jamacardio.2020.1286.

• COVID-19 Clinical Guidance For the Cardiovascular Care Team Bulletin, American College of Cardiology. March 6, 2020.

• Dr. Mohammad Madjid, MS, McGovern Medical School at UTHealth.

• The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020[J]. China CDC Weekly, 2020, 2(8): 113-122

• COVID19-What-You-Can-Do-High-Risk CDC poster.pdf

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