Doctors & patients are saying about 'A-Fib.com'...


"A-Fib.com 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


September is A-Fib Awareness Month – Get Our Free Report for Families

Top 10 Questions Families Ask About A-Fib - Download Free Report

Top 10 Questions Families Ask About A-Fib – Download Free Report

When a patient is diagnosed with Atrial Fibrillation, family members often struggle to understand what their loved one is going through. With A-Fib, you don’t look sick.

While A-Fib impacts the patient’s health and quality of life, it also affects the lives (and often livelihood) of their loved ones and co-workers. They will have many questions.

September is A-Fib Awareness Month: Celebrate and Help Your Family Understand

Help your family understand how A-Fib make you feel and how it affects you.

During Atrial Fibrillation Awareness Month, we make it easy. We’ve compiled the answers to the most often asked questions from families into a special free report: The Top 10 Questions Families Ask About Atrial Fibrillation.

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

Help Us Promote A-Fib Awareness

Because A-Fib runs in families, urge your immediate family members to discuss A-Fib with their doctors. Encourage your friends over 60 years old to do the same.

Pass this post on to your family, friends and co-workers. Encourage them to download the FREE 5-page PDF report The Top 10 Questions Families Ask About Atrial Fibrillation (and the Answers).

Why not post to Facebook, Twitter or LinkedIn, too? (It’s easy. Use the Share buttons below.)

 Share this post

 

A-Fib Free Again: My 3rd Ablation for “Very Late Recurrence” by Dr Natale

The return of my A-Fib was captured by my Medtronic Reveal LINQ loop recorder. I was asymptomatic, often referred to as Silent A-Fib. (For more about my recurrence, see my earlier post: My A-Fib’s Back: Need a Touch-Up This Week)

A Medtronic Reveal LINQ Insertable Cardiac Monitor (ICM) is one of the world’s smallest cardiac monitors—inserted just under the skin near the heart.

Medtronic Reveal LINQ insertable heart monitor

Medtronic Reveal LINQ IHM

Each night my Reveal Linq wireless monitor transmits that day’s data by wireless connection to my EP, Dr. Shephal Doshi.

I’m 80 years young and a very active runner, high jumper and weightlifter. While many EPs would likely prescribe A-Fib drugs, I chose a third “touch-up” ablation instead.

Very Late Recurrence: This ablation was for the condition called “Very Late Recurrence” where someone who has been A-Fib free for years develops A-Fib again. (Previously these cases were considered very difficult or even impossible to fix.)

Why does A-Fib sometimes recur many years later? We can only speculate. Perhaps the evolution or development of A-Fib silently continues during the years of being A-Fib free. Is it age-related? Does genetics play a role? Obviously more research needs to be done in this area.

Pre-ablation, Steve Ryan with Dr. Natale and his surgical nurse.

But thanks to the excellent research of Dr. Andrea Natale and his colleagues, “Very Late Recurrence” can now be fixed.

To learn more about Very Late Recurrence, see our article: After Two Years A-Fib Free, What Causes ‘Very Late Recurrence’ in Post-Ablation Patients?

My Third Ablation: My re-do catheter ablation was on August 19, 2021 and was performed by Dr. Andrea Natale at Los Robles hospital in Thousand Oaks, CA.

Research has shown that “very late recurrence” of A-Fib is primarily driven by non‐pulmonary vein triggers especially from the left atrial appendage and coronary sinus. Isolation of these triggers results in a high success rate.

Beautiful quilt, Los Robles Hospital Cardiac admittance; Handmade by two staff nurses.

During my ablation, this is exactly what Dr. Natale found. Therefore, he isolated both my left atrial appendage and my coronary sinus to eliminate the locations of these triggers. (My pulmonary veins had remained isolated.) He also made a roof line and an “infero-posterior” line with RF to isolate the posterior wall of the left atrium. He  found non-PV electrograms/potentials in the left atrial septum, the floor of the left atrium, the left atrial lateral wall, and the anterior roof of the left atrium which he eliminated with RF ablation.

I was in the hospital overnight. Everything went fine. The only complication I had was irritation of the throat from being intubated. I had to return to the Los Robles emergency room, but they took care of that with medication.

A-Fib Free (Again): I’m temporarily on Multaq and of course the anticoagulant Eliquis.

I am in the three-month blanking period. This is the period when my heart is learning to beat normally again.

For now, I’m A-Fib free.

 

After Two Years A-Fib Free, What Causes ‘Very Late Recurrence’ in Post-Ablation Patients?

Even though catheter ablation is remarkably successful in restoring most paroxysmal A-Fib patients to normal sinus rhythm, a small number of these patients do have relapses (recurrences) sometimes many years out.

The main objective of this study was to understand why Atrial Fibrillation relapses years after successful electrical isolation of the pulmonary veins (PVs) in paroxysmal patients and whether the presence of comorbidities influence recurrence.

These are the questions Dr Andrea Natale and his colleagues at the Texas Cardiac Arrhythmia Institute were looking to answer.

Study Parameters

In this observational study, researchers at Texas Cardiac Arrhythmia Institute looked at 1,633 of their paroxysmal patients who had been A-Fib free for two years after their first or second catheter ablations, then suffered recurrences years later  (i.e., Very late recurrent).

What does 'Very Late Recurrent' mean?
It’s one of three way to describe the timeframe of A-Fib recurrence after ablation:
• Early recurrence = During the 1-3-month “blanking period”;
• Late recurrence = 3–12 months after ablation;
• Very late recurrent = 12+ months after ablation.

The patients were divided into two groups based on the presence or absence of comorbidities (presence of two or more diseases). The groups were:

Group 1: 692 patients with no comorbidities
Group 2: 941 patients with comorbidities

Comorbidity (co·mor·bid·i·ty) means presence of two or more diseases or medical conditions in a patient.

A-Fib and Common Comorbidities

The Group 2 patients had one or more of the following illnesses/conditions (comorbidities):

• Moderate to severe sleep apnea
• Diabetes mellitus
• Body mass index 30 kg/m² or higher (obese)
• Hypertension treated with multiple anti-hypertensive agents
• Low left ventricular ejection fraction (lower than 45%; normal is 50% to 75%)

Quality of Previous Ablations

The patients who experienced recurrences had been previously well ablated (one or two procedures.) Standard ablation procedures included PVI plus isolation of the left atrial posterior wall and the Superior Vena Cava (SVC):

• Their pulmonary veins were completely isolated of all PV potentials as confirmed by entrance and/or exit block. The electrical isolation was extended to the posterior wall contained between the PVs.
• Posterior wall isolation was performed using multiple ablation points covering the whole posterior wall.
• The SVC was mapped and isolated circumferentially in all patients. The atrial myocardial sleeves extend into the SVC for up to 2 to 5 cm. thus harboring ectopic pacing cells that provide the substrate for atrial arrhythmia. The Superior Vena Cava (SVC) is a known source on non-PV triggers.

Superior Vena Cava (SVC) is a known source of non-PV triggers.

Patient Follow‐up

Follow‐up was performed at 1, 3, 6, and 12 months with office visits, cardiology evaluation, 12‐lead electrocardiogram (ECG) and 7‐day Holter monitoring at 1, 6, and 12 months. After 1 year, patients were followed up annually with a 7‐day Holter and were asked to check their pulse regularly to monitor rate.

Ablation success was defined as absence of arrhythmia off antiarrhythmic drugs.

Ten-Year Recurrence Findings

At 10 years of follow-up, median time to recurrence was 7.4 years. The recurrence rate among the study patients was:

• Group 1 patients: 31.1% experienced recurrence (215 of 692)
• Group 2 patients: 51% experienced recurrence (480 of 941)

Redo Ablations

Patients with recurrence of their A-Fib, underwent a ‘re-do’ ablation:

• 201 in Group 1 patients
• 456 in Group 2 patients

Ablations targets at re-do:

• 561 patients received isolation of the Left Atrial Appendage (LAA) and Coronary Sinus (CS); 96 patients received left atrial lines and flutter ablation; 9 patients received re‐isolation of PVs;
• PV reconnection was not noted in any of the patients with two prior procedures. The SVC was found to be permanently isolated in 642 (97.7%) and no reconnection of posterior wall in 611 (93%) cases.

Top: Representative images showing a patient’s lesion sets during initial ablation. Bottom: 5 years later during the same patient’s re-do ablation.

Two-Year Results After Redo Ablation

At 2 years, 91.1% (134) of Group 1 and 94.4% (391) of Group 2 remained arrhythmia free! These patients received left atrial appendage (LAA) and Coronary Sinus (CS) isolation.

Of those who received left atrial lines and flutter ablation, results were poor with around 7% arrhythmia free.

Study Conclusions

The main objective of this study was to understand why Atrial Fibrillation relapses years after successful PV catheter ablation in paroxysmal patients and whether the presence or absence of comorbidities influence very late recurrences.

Despite permanent pulmonary vein isolation (PVI), very late recurrence was primarily driven by non‐pulmonary vein triggers especially from the left atrial appendage and coronary sinus. Ablation of these triggers resulted in high success rate (regardless of the comorbidity profile.)

The median time to recurrence was significantly shorter in patients with cardiovascular comorbidities.

Editor's Comments about Cecelia's A-Fib storyEditor’s Comments

These study results are remarkable! The study findings reinforce the crucial role of non-PV triggers in the relapse of A-Fib. Knowing how comorbidities shorten the timeline to A-Fib recurrence can motivate patients to improve their overall health.
If You’re Having an Ablation or Re-do Ablation: Besides isolating the Pulmonary Veins, talk with your doctor about mapping and isolating non-PV triggers i.e., from the Left Atrial Appendage (LAA) and Coronary Sinus (CS).
How can You Avoid Recurrence? Get rid of comorbidities. Even after the establishment of sinus rhythm, comorbidities contribute to the progression of A-Fib and its recurrence.
Very late recurrence was primarily driven by non‐pulmonary vein triggers especially from the left atrial appendage and coronary sinus.
While patients in Group 2 (with comorbidities) were able to be cured and restored to sinus rhythm just as well as patients without comorbidities, recurrence occurred sooner (5.6 years versus 7.4 years).
To postpone or avoid recurrence of your A-Fib, do what you can to get healthier. Lose weight if needed, get treatment if you have sleep apnea, address hypertension issues, manage your diabetes, stop smoking, moderate your  consumption of alcohol.
Why Does A-Fib Sometimes Recur Many Years Later? We can only speculate. Perhaps the evolution or development of A-Fib silently continues during the years of being A-Fib free. Is it age-related? Does genetics play a role? Obviously more research needs to be done in this area.
Last Thoughts: Have researchers like Dr. Andrea Natale discovered how to cure even the most difficult A-Fib cases? Isolating the LAA and the CS seems to be the key.

Are we close to a time where even the most difficult cases of A-Fib can be cured by the right EPs using the right ablation techniques at the right time?

Resource for this article
Mohanty, S. et al. Natural History of Arrhythmia After Successful Isolation of Pulmonary Veins, Left Atrial Posterior Wall, and Superior Vena Cava in Patients With Paroxysmal Atrial Fibrillation: A Multi-Center Experience. Journal of the American Heart Association, 2021;10:e020563. https://www.ahajournals.org/doi/10.1161/JAHA.120.020563. https://doi.org/10.1161/JAHA.120.020563

My A-Fib’s Back: Need a Touch-Up This Week

On August 19 I’m scheduled for a touch-up ablation by Dr. Andrea Natale at Los Robles hospital in Thousand Oaks, CA.

Dr. Shephal Doshi and Steve Aug 1 2019

I’m symptom free. But my Medtronic Reveal LINQ loop recorder shows I still have some A-Fib after a catheter ablation by Dr. Shephal Doshi at St. John’s hospital in Santa Monica 24 months ago (August 2019).

Background: My first catheter ablation was in 1998 by Drs. Michel Haïssaguerre, Pierre Jais, and Dipen Shaw in Bordeaux, France. Though it was relatively primitive compared to what EPs are doing today, it kept me A-Fib free for 21+ years.

Steve with Dr Häissaguerre who cured Steve in 1998.

Left Atrial Appendage: During the touch-up ablation, my Left Atrial Appendage (LAA) may have to be electrically isolated. If that’s done, and my LAA doesn’t empty of blood properly, I may have to have a Watchman device inserted to mechanically close off my LAA. As an enthusiastic runner/sprinter, I don’t want to have my LAA closed off as it can reduce blood flow. But at 80 years old, I may have little choice. I’ll post again after my redo ablation.

A “re-do” catheter ablation is nothing to be frightened of. My procedure this week, like last time, will be as an out-patient. For my 2019 touch-up procedure, I arrived at the hospital at 5am and was back home at 5pm. In and Out. Lickety-split!

11 Ways A-Fib Robs You of Your Heart Health

Atrial Fibrillation is a disease of the heart but affects your overall health as well. It is often said, “A-Fib begets A-Fib”. It’s a progressive disease and is self-perpetuating.

Here are the many ways A-Fib can affect you:

1. Risk of stroke. The biggest danger from A-Fib is stroke. Because your heart isn’t pumping out properly, blood can pool in your atria then form clots that travel to the brain causing stroke. Use of anticoagulant drugs reduce, but don’t eliminate, the risk of an A-Fib stroke. Anticoagulants are high risk drugs. They don’t cure or improve your A-Fib.

A-Fib reduces your heart’s pumping ability by 15%–30% decreasing blood flow to the brain….

2. Reduced Blood Circulation. A-Fib reduces your heart’s pumping ability by 15%–30%, decreasing blood flow to the brain and to the rest of the body. This may cause weakness, fatigue, dizziness, brain fog, fainting spells, swelling of the legs, and shortness of breath. Over time, reduced blood circulation contributes to many other health issues.

3. Fibrosis (Structural Remodeling). Over time A-Fib produces fiber-like scar tissue in place of the normal smooth walls of the heart. Fibrosis makes the heart stiff, less flexible and weak with a loss of atrial muscle mass. It overworks the heart, reduces pumping efficiency, and leads to other heart problems. Fibrosis is considered permanent and irreversible.

Over time, the left atrium tends to stretch, weakening the heart muscle.

4. Atrial stretch/expansion (Structural Remodeling). When in A-Fib, your left atrium has to work harder than normal. Over time, the left atrium tends to stretch or dilate thereby weakening the heart muscle. An enlarged left atrium can be diagnosed and measured using an echocardiogram (ECHO). (A normal size is 2.0-4.0 cm; over 5.5 cm is considered chronically enlarged.)

5. Electrical Remodeling. A-Fib causes electrophysiological changes in the heart which are self-perpetuating, make the heart more prone to go into and remain in A-Fib. This Remodeling develops quickly, is progressive, and may be persistent. For instance, an A-Fib episode once a month may escalate to once a week and might become longer than before.

6. Heart Failure. Researchers have found that A-Fib is strongly associated with heart failure which is five times more likely in people with A-Fib. When in A-Fib, your heart isn’t pumping properly. So it’s not surprising that A-Fib leads to heart disease, heart failure, and sudden death. A-Fib affects your whole body. It damages your heart, brain, and other organs.

Most A-Fib patients have at least one comorbidity such as diabetes, hypertension or sleep apnea.

7. Coexisting Conditions (Comorbidities). The symptoms of one illness can predispose a person to another. Most A-Fib patients have at least one comorbidity such as diabetes, hypertension or sleep apnea. A somewhat surprising association with A-Fib is kidney disease and peripheral arterial disease.

8. Dementia. A-Fib has been independently associated with dementia. Leaving patients in A-Fib doubles the risk of developing dementia. Current drugs, even statins, don’t work or have mixed results in preventing dementia. Because your heart is being remodeled electrically, your A-Fib may eventually worsen to Long-standing Persistent A-Fib (which is harder to cure).

“I have never been mentally so incapable…even the simplest work-related problems seemed impossible for me to handle.” — Max Jussila

9. Brain Atrophy, Reduced Brain Volume and Cognitive Function. Research shows A-Fib patients experience loss of both grey and white brain matter, as well as white matter brain lesions. Cognitive function and processing speed decline significantly.

Mental skills and memory are also affected. Max Jussila, a Finnish executive, recalls his challenges. “I have never been mentally so incapable. My memory was gone, my speech was gone (I speak five languages), even the simplest work-related problems seemed impossible for me to handle, let alone solve.”

10. Reduced Quality of Life. For many patients, A-Fib disrupts both work and family life. They are often preoccupied about the next A-Fib attack. When will it hit? How bad will it be? Where will I be at the time? When you travel, you first research the location of the nearest emergency room.

A-Fib can have significant consequences on your social interactions with loved ones, friends and colleagues. The patient’s livelihood may be impacted. Family life may be unsettled. In one study the partners of A-Fib patients reported a significant reduction in their quality of life, to the same degree as the patient.

11. Psychological and Emotional Effects. A-Fib wreaks havoc with your head as well as your heart. Anxiety, fear, frustration, worry, confusion, depression and anger can be as debilitating as the disease itself. Psychological distress worsens A-Fib symptoms’ severity. Physical ailments like colds may be more frequent because of a depressed immune system.


How Much Will You Pay to Stay in A-Fib?

A-Fib costs you in many ways. Beyond the physical, mental and emotional toll, staying in A-Fib is costly to your wallet too. Besides the annual costs of your medications, ER visits, etc., the odds of your being hospitalized increases (each year 750,000 hospitalizations in the U.S. are due to A-Fib).

Don't Settle for a lifetime on medication - Seek your A-Fib Cure

According to the CDC, just in terms of dollars and cents, A-Fib on average costs you an additional $8,700 a year.

When you add up all the costs (physical, emotional and monetary) of living in A-Fib, doesn’t it make sense to ‘Seek you Cure’?

Don’t Settle for a Lifetime on Meds―Seek your A-Fib Cure

Today’s TV advertisements for anticoagulants talk about “living with A-Fib”. They show patients living happy, healthy, care-free lives while still in A-Fib. That’s a Pollyanna fantasyjust take an A-Fib pill and live happily ever after.

Contrary to today’s media, your goal shouldn’t be to just ‘manage’ your A-Fib. For patients with A-Fib, it isn’t enough to simply take an anticoagulant.

Your goal should be to get your A-Fib fixed and have your heart beat again in normal sinus rhythm (NSR). Educate yourself. Learn all your treatment options.

Don’t just settle. Seek your A-Fib cure.

Magnesium IV to Stop A-Fib

We have long advocated the benefits of Magnesium for A-Fib. (See Magnesium Long-Life Insights for A-Fib Patients.)

Intravenous Delivery: A recent randomized controlled double-blind study found that Magnesium delivered directly into the bloodstream (Intravenous, i.e., IV) can produce both rate and rhythm control when used for A-Fib patients in the emergency room (ER).

The Good News: This study from the University of Monastir, Tunisia, found Magnesium IV is the fastest way to improve Magnesium levels and is very effective in restoring A-Fib patients to normal sinus rhythm.

The Bad News: In U.S. emergency rooms, Magnesium IV is not a standard treatment for A-Fib patients (though it may be used prior to cardioversion). (Dr. Julian Whitaker in Newport Beach, CA performs this therapy (www.drwhitaker.com).)

One of our Advisory Board members wrote me about his large facility’s experience with Magnesium IVs, “A few years ago we tried and stopped because of futility.”

Bottom Line: So it’s an interesting research study, but don’t look for a Magnesium IV if you end up in the ER with an A-Fib episode.

Resource for this article
Bouida, W. et al. Low-dose Magnesium Sulfate versus High Dose in the Early Management of Rapid Atrial Fibrillation: randomized controlled double-blind study. (LOMAGHI Study). Acad Emerg Medi. 2019;26(2):183-191. https://www.onlinelibrary.wiley.com/doi/full/10.1111/acem.13522 doi.org/10.1111/acem.13522

Original Medicare or Medicare Advantage Plans? Which is Better If You have A-Fib?

An A-Fib.com reader emailed me that he has A-Fib and is turning 65. He has to decide whether to sign up for Original Medicare or a Medicare Advantage plan. (Open Enrollment is between October and December each year). This decision will affect how much he pays for coverage, what services he gets, what doctors he can use, and his overall quality of care.

Medicare coverage options is a complicated business. I’m not qualified to give you advice. My intent is to point out areas of interest to A-Fib patients. Remember these comments are only my opinion.

Choice of Doctors?

Which is better if you have A-Fib?

With the Medicare Advantage plans, your choice of doctors is limited. Usually you can only use doctors in the plan’s network. This may be fine for a primary care doctor or family doctor.

What if you need a specialist? To see a specialist, you’ll need a referral from your primary care doctor. These referrals are often hard to obtain. You also need prior approval for most services.

Choice of Electrophysiologists (EPs)?

If you have A-Fib, your choice of EPs in Medicare Advantage plans is severely limited. All too often Medicare Advantage plan administrators seem more motivated to reduce your choices.

In one instance, I found only a single EP listed as available for someone I was trying to advise.

Referrals Out of Network. And it’s nearly impossible to get a referral to an industry leader, no matter how good a doctor is or how great a reputation they have. The administrators make it incredibly difficult. And there is usually no appeal.

Not All EPS Are Equal. Most EPs in Medicare Advantage plans would not be considered world beaters (i.e., best in their field). Though most of my experience with Advantage Plans is anecdotal, I’ve never seen an EP industry leader listed in these types of plans.

Not all EPs are equal. Some are low volume operators with high complication rates. You want to avoid these types of EPs at all costs.

When You Need the Best: If your A-Fib is difficult to treat or you have comorbidities (i.e., hypertension, obesity, diabetes) that complicate your treatment, your choice of EP is vital. You need an EP with a track record in successfully treating difficult A-Fib cases.

Shameful: I know of one person who was diagnosed with A-Fib under a Medicare Advantage plan. She was never told about Electrophysiologists who are specialists in arrhythmias, and she was never told about treatments like catheter ablation. This is all despite her facility having well-respected EPs and an active catheter ablation lab. The staff knew but didn’t discuss it with her.

In the end, she had to visit our website to learn about Electrophysiologists and catheter ablation options.

Medicare Gives You Real Choices

Compared to Medicare Advantage plans, with Original Medicare you can use any doctor or hospital that takes Medicare, anywhere in the US.

This is really important if you have A-Fib. You want to be able to go to the best EP you can find.

Fees or Fines for Seeing an EP in Medicare Advantage Plans

Another factor to be considered in Medicare Advantage plans is you pay a fee or fine for every time, for example, when you see an EP. One person told me his fee was $45.00 for one visit to an EP. Those fines or fees can add up pretty fast, especially when you have comorbidities and see multiple doctors for specialized tests.

In contrast, Original Medicare covers routine doctors’ visits. They send payment to the doctor, and the doctor cannot charge the person more than the plan allows. (Check your coverage before making any coverage decision.)

Be Prepared to Fight Advantage Plan Administrators

Having to interact with a Medicare Advantage plan administrator can be a very frustrating experience. Knowing you’re not being taken care of properly can be very depressing.

You often have to be very assertive and fight them ‘tooth and nail’ to get the care and treatment you need. It can take weeks, months, even years until you finally see the right doctors and receive the treatment you need.

Medicare: More Choices and Better for Psychological Health

The bottom line for most A-Fib patients is that Original Medicare not only gives you more choices but is also better for your psychological health. Also, with Original Medicare if you disagree with a coverage or payment decision, you have the right to appeal. (See Your Medicare Benefits booklet.)

Under Original Medicare, it’s tremendously liberating to know you can go to any doctor or facility you want. The last thing you want in your life is some bureaucrat dictating to you what treatments or doctors you can access.

Though obviously many personal and individual factors may influence your choice of Medicare plans, in general, Original Medicare is probably a better choice for many patients with A-Fib.

Medicare coverage options is a complicated business. To learn more, see the downloadable booklet, Your Medicare Benefits.

Are My Comments Too Negative?

Your choice of health coverage is a tricky subject. People tend to email me when they have negative experiences. So, my anecdotally-based comments may be more negative than warranted. There are many different Medicare Advantage plans. Some may be better than others.

If anyone has any clinical studies on this subject or more positive experiences, please let me know.

Cloud graphic - Michele Straube, A-Fib-free after 30 years - A=Fib.com

Side Effects of Flecainide: An A-Fib Patient’s Perspective

Carol, from Salem, Oregon, wrote me to share how taking the antiarrhythmic drug, flecainide, affected her.
Flecainide, an antiarrhythmic medication, works by slowing electrical signals in the heart to stabilize the heart rhythm.

“When I initially started taking flecainide for my A-Fib, I experienced annoying visual disturbances, especially when there was a difference between a light and dark environment such as a stage or when going from a light to a dark room. I would see afterimages, many of them. For example, in a theater I’d see my hands clapping, but I’d see many of them as if in a time lapse still photo. Over time that effect got better.

But other side effects developed.

…Here it goes again. I plan to call the Cardiologist as soon as the office opens. I have the following symptoms:

Irregular heartbeat
stomach discomfort (bloating)
rash and hives
hair loss
anxiety (my shoulders are practically making contact with my ears)
sleep problems
increased sweating
annoying visual disturbances

These are all listed on the package insert as possible side effects. 

Flecainide is pronounced as (flek’ a nide)

However, I am not ready to say they were caused by flecainide as I have had lifelong problems with allergies and digestive issues. Except for the visual disturbances…

I was on flecainide for 12 years―and it mostly worked well―until it didn’t anymore.”

Carol Baumann,
Salem, Oregon

Editor’s Comments

Editor's Comments about Cecelia's A-Fib story
One of the most frequently prescribed antiarrhythmic drugs is flecainide acetate (Tambocor). Flecainide has been around a long time (1985) and is only available as a generic drug.
Instead of a daily dose, fecainide can be used as a “Pill-In-The-Pocket” treatment i.e., taking an antiarrhythmic med at the time of an A-Fib attack.
Flecainide carries an FDA “Black Box Warning” which is the most serious the FDA issues. A Black Box Warning alerts doctors and patients that a drug has potentially dangerous effects.

Lookup fecainide at MedlinePlus.gov

As with almost all antiarrhythmic drugs, flecainide is known for bad side effects.
To read a detailed description of flecainide, its uses and side effects, see fecainide at MedlinePlus/Drugs, Herbs and Supplements (U.S. National Library of Medicine).

Don’t Want to Take Anticoagulants? Three Alternatives for A-Fib Patients

With Atrial Fibrillation, you are 4–5 times more likely to have an A-Fib (ischemic) stroke. Taking an anticoagulant helps prevent an A-Fib stroke and may give you peace of mind.

The negative side is that all anticoagulants are high-risk medications and inherently dangerous. You bruise easily, cuts take a long time to stop bleeding. You can’t participate in any contact sports. There is an increased risk of developing a hemorrhagic stroke and gastrointestinal bleeding. See Risks of Life-Long Anticoagulation.

Be advised that no anticoagulant or blood thinner will absolutely guarantee you will never have a stroke. Even warfarin [Coumadin] only reduces the risk of stroke by 55% to 65%.

(Most EPs are well aware of the risks of life-long anticoagulation.)

Don’t want to take anticoagulants? What’s the alternative? Remove the reason you need an anticoagulant!

Three Alternatives to Taking Anticoagulants

Anticoagulants are used with high-risk Atrial Fibrillation patients for the prevention of clots and stroke.

The best way to deal with the increased risk of stroke and side effects of anticoagulants is to no longer need them. Here are three options:

RF Catheter ablation

#1 Alternative: Get rid of your A-Fib.

As electrophysiologist (EP) and prolific blogger Dr. John Mandrola wrote: “…if there is no A-Fib, there is no benefit from anticoagulation.”

Action: Request a catheter ablation procedure. Today, you can have an ablation immediately (called ‘first-line therapy’). You don’t have to waste a year on failed drug therapies. See Catheter Ablation Reduces Stroke Risk Even for Higher Risk Patients

Placing Watchman in LAA

#2 Alternative: Close off your Left Atrial Appendage (LAA).

The Left Atrial Appendage is where 90%-95% of A-Fib clots originate. Closing off the LAA provides similar protection against having an A-Fib (ischemic) stroke as being on an anticoagulant.

Action: Request a Watchman device. The Watchman device is inserted to close off your LAA and keep clots from entering your blood stream. See Watchman Better Than Lifetime on Warfarin

Natural blood thinners

#3 Alternative: Consider non-prescription blood thinners

Perhaps you can benefit from an increase in natural blood thinners such as turmeric, ginger and vitamin E or, especially, the supplement Nattokinase.

Action: Ask your doctor about your CHA2DS2-VASc score (a stroke risk assessor). If your score is a 1 or 2 (out of 10), ask if you could take a non-prescription approach to a blood thinner. See FAQ: “Are natural blood thinners as good as prescription blood thinners?” 

If you decide to take an DOAC, ask your doctor about taking Eliquis. It tested better than the other DOACs and is considered safer. 

Bottom Line

Whether or not to take anticoagulants (and which one) is one of the most difficult decisions you and your doctor must make. To stop taking an anticoagulant, talk to your doctor about alternatives:

• Catheter ablation
• LAA closure (Watchman device)
• Non-prescription blood thinners

These options may help you to no longer need an anticoagulant. As Dr. John Mandrola wrote: “…if there is no A-Fib, there is no benefit from anticoagulation.”

As an A-Fib patient, don’t settle for a lifetime on anticoagulants or blood thinners. Remember: You must be your own best patient advocate.

Resource for this article
Weng Y, et al. Nattokinase: An Oral Antithrombotic Agent for the Prevention of Cardiovascular Disease. Int J Mol Sci. 2017;18(3):523. Published 2017 Feb 28. doi:10.3390/ijms18030523

Who’s at Higher Risk of a Recurrent A-Fib Stroke?

You’ve had an A-Fib stroke—and you survived—hoorah! Now you wonder…am I more prone to a recurrent stroke? The answer may lie with how often your A-Fib episodes occur (i.e., paroxysmal versus persistent/permanent).

A recent observational research study from Japan posed this question:

In patients with a history of ischemic stroke and atrial fibrillation (A-Fib), is there a difference in the risk of future stroke between those with paroxysmal versus permanent atrial fibrillation?

What’s the Risk of a Recurrent A-Fib Stroke?

The SAMURAI-NVAF study included 1,192 A-Fib patients who had suffered an acute or ischemic stroke (where a clot blocks blood flow to the brain) and followed them for around 1.8 years.

Study patients were hospitalized within 7 days of stroke between April 2011 and March 2014 at 18 Japanese stroke centers. The average age was 77.7 ± 9.9 years, 44% were women, and 63.6% had persistent A-Fib.

Findings: Patients with Persistent A-Fib at Higher Risk of Recurrent Stroke

The researchers found a higher risk of ischemic stroke (or systemic embolism) in those with persistent A-Fib. Persistent patients also had higher rates of both ischemic strokes and transient ischemic attacks (TIAs).

Comorbidities means presence of two or more diseases or medical conditions in a patient.

Patients with persistent A-Fib were in general less healthy. They were more likely to have comorbidities: congestive heart failure, liver problems, higher alcohol use, and more disability after the first stroke.

Patients with paroxysmal A-Fib were associated with increased odds of “functional independence” 3 months after their A-Fib stroke (i.e., less likely to be disabled after the stroke).

Why More Stroke Risk When Persistent? The researchers noted that patients with persistent A-Fib have larger Left Atrial Appendage (LAA) size and more severe blood flow problems (lower LAA ejection fraction). … Continue reading this report…->

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