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


Conflicts of Interest—Influencing Doctors for the Price of a Meal

In a 2016 JAMA Internal Medicine report, the authors compared meal payments to doctors with the drugs they prescribed to Medicare patients.

Even doctors who accepted only one free meal were more likely to prescribe the brand name drug.

Not surprisingly, they found that physicians who accept free meals from a drug company are more likely to prescribe that company’s brand name drugs rather than cheaper (and usually more proven) generic drugs. This study only focused on physicians who received meals.

Even doctors who accepted only one free meal were more likely to prescribe the brand name drug. Doctors who accepted four or more meals were far more likely to prescribe brand name drugs than doctors who accepted no meals. Furthermore, doctors who accepted more expensive meals prescribed more brand name drugs.

Steer Clear of Conflicts of Interest

Studies have found that when there is a conflict of interest, it is almost impossible for even well-meaning people to see things objectively.

Dr. Dan Ariely of Duke University described how, if a doctor must choose between two procedures, they are likely to pick the one that has the better outcome for their bottom line (i.e. financial benefit).

“That doesn’t mean the doctor is unethical…it just means he is human. We truly seem to not realize how corrosive conflicts of interest are to honesty and objectivity.”

He advocates that we steer clear of people and organizations with conflicts of interest “because it does not appear to be possible to overcome conflicts of interest.”

When to be Suspicious of Doctors

Doctors are only human. They may not realize a conflict of interest is affecting their recommendations. So be suspicious if your doctor tells you:

In today’s world, you have to do your own due diligence…get a second (or third) opinion.

• to take an expensive new drug
• to just “live with your A-Fib”
• insists that catheter ablation is too dangerous or unproven
• that A-Fib can’t be cured
• that you have to take drugs for the rest of your life

If this happens to you, RUN, DON’T WALK and get a second opinion (and even a third opinion).

In today’s world, you have to do your own due diligence. You know what makes sense and what doesn’t.

For more, see my article: EP’s Million Dollar Club—Are Payments to Doctors Buying Influence?\

References for this article
Husten, Larry. CardioBrief: The Hidden Cost of Free Lunch. Medpage Today. June 21, 2016. http://cardiobrief.org/2016/06/20/the-hidden-cost-of-free-lunch/

DeJong, C. et al. Pharmaceutical Industry-Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries. JAMA Intern Med. Published online June 20, 2016. http://archinte.jamanetwork.com/article.aspx?articleid=2520680 doi:10.1001/jamainternmed.2016.2765

Yeh, JS et al. Association of Industry Payments to Physicians With the Prescribing of Brand-name Statins in Massachusetts. JAMA Intern Med. 2016;176(6):763-768. http://archinte.jamanetwork.com/article.aspx?articleid=2520680 doi:10.1001/jamainternmed.2016.1709. Ariely, Dan. Why Everybody Is Lying. Bottom Line Personal. Volume 37, Number 14, July 15, 2016. P. 14.

Husten, L. Dollars for Heart Docs: Analysis of CMS database shows some docs pocketed millions from drug and device makers. CardioBrief, June 23, 2015.  http://www.medpagetoday.com/publichealthpolicy/ethics/52731

Medpage Today Staff. Hospital-Based Medicine: How Do Policies on Detailing Affect Branded Drug RX?—F. Perry Wilson, MD, digs int recent study. Medpage Today, May 04, 2017. https://www.medpagetoday.com/hospitalbasedmedicine/generalhospitalpractice/65017

 

Our Patient-to-Patient Resources: Help from Others with Atrial Fibrillation

To help you cope with your Atrial Fibrillation, we offer you the resources to educate yourself about A-Fib and your treatment options, and to arm yourself with the skills to navigate a path to a life without Atrial Fibrillation.

Our Personal A-Fib stories of Hope and Courage and our A-Fib Support Volunteers are two resources to help answer your questions and bolster your resolve to Seek Your A-Fib Cure (or best outcome for you).

A-Fib Patient Stories of Hope, Courage and Lessons Learned

Your first experiences with Atrial Fibrillation have changed your life in a number of ways: dealing with your A-Fib symptoms, the emotional toll as well, and the impact on your family.

It’s encouraging to read how someone else has dealt with their A-Fib. In our 99+ Personal A-Fib Stories of Hope, A-Fib patients tell their stories to encourage and offer you hope. (The first story is Steve Ryan’s in 1998). Many writers have included their email address if you want to contact them directly. To browse our patient experiences, go to Personal A-Fib Stories of Hope and Courage.

Offering Hope: Our A-Fib Support Volunteers

Having someone you can turn to for advice, emotional support, and a sense of hope that you can be cured, may bring you peace of mind. Our A-Fib Support Volunteers have gone through a lot while seeking their A-Fib cure. They have been helped along the way and want to return the favor. They answer questions and offer you encouragement through exchanging emails and sharing their stories.

Our volunteer listings are organized by geographic locations, within the U. S. and internationally by country and/or region.  Learn how to contact our A-Fib Support Volunteers.

Readers post their stories and volunteer to help you to
Seek your Cure. 

Update: My Post-Abaltion 2-Month Checkup

It’s been almost two months since my catheter ablation August 1, 2019 at St. John’s Hospital in Santa Monica, CA. And I’m feeling fine.

Just had a check-up with my EP, Dr. Shephal Doshi, on Wednesday. I haven’t had an A-Fib episode for a month.

My ECG looks perfect (see below). Notice how good the P-wave looks which often disappears when you have A-Fib. (Want to learn how read an ECG? See my article, Understanding the EKG Signal.)

Steve Ryan, A-Fib.com. ECG on Sept 25, 2019 by Dr Doshi. Verdict: all is normal!

My ECG on Sept 25, 2019 by Dr Doshi. Verdict: all is normal!

My Reveal LINQ Loop Heart rate Monitor Report

When you look at the report from my Reveal LINQ inplanted monitor, you can see I have had some tachycardia (marked in blue). But I think that may have come from the intense 100 meters sprints I do at the track. (Tachycardia is anything over 100 beats/minute.) Not to worry. Tachycardias do sometimes occur after an ablation. But one’s heartbeat usually returns to normal, as did mine.

Steve Ryan, A-Fib.com: My implanted LINQ heart monitor report 9-25-19. Note: Tachy and Pause.

My implanted LINQ heart monitor report 9-25-19. Note: Tachy and Pause.

As I reported before, during my first month post-op, I had one three-second pause at 2:00 am which isn’t of concern to me (marked in red).

Though my EP suggests putting in a pacemaker, I’d rather wait till after my blanking period is over. And even then, I’m against having a pacemaker unless I’m dizzy and feeling faint. Who wants to be burdened with a pacemaker for the rest of one’s life if it isn’t really necessary?

The Best News of All

And perhaps my best news is I don’t have to take my anticoagulant (Xarelto) any more. Yea!

Now it’s just one month to go in my 3-month post-ablation blanking/healing period. If it’s smooth sailing this next month, I’ll report again then.

For all my reports about the return of my Atrial Fibrillation after 21 years, see the following posts:

Sept 2018: Has My A-Fib Returned? I Get an Insertable Wireless Monitor
Oct 2018: Part 2: My Medtronic Reveal LINQ loop recorder21-Day results
Nov 2018: Part 3: PVCs/PACs but No A-Fib; False positives from my LINQ Monitor
July 2019: My 20-year Warranty Ran Out! My A-Fib is Back!
Aug 2, 2019: My Catheter Ablation was a Success—I was Home the Same Day
Aug 5, 2019: My A-Fib RF Catheter Ablations: 1998 vs 2019

Triggering A-Fib at the Dentist: My Post-Ablation Experience

A while back we published a warning by Dr. Sam about how your dentist’s use of local anesthesia containing epinephrine can trigger your A-Fib. I have another warning to add.

My Dental Cleaning After Catheter Ablation

I was reminded of Dr. Sam’s post when I visited my own dentist three days after having my recent catheter ablation (my Atrial Fibrillation returned after 21 years of being A-Fib free).

No-no-no-ultrasonic dental cleaning for me

Upon hearing of my medical procedure, my long-time dentist, Dr. Dave Famili, didn’t want to use the typical ultrasonic type of dental cleaning because it could distrupt my heart rhythm. So, they didn’t use anything electronic. Instead, they did a manual cleaning only, and all was good.

For my chart, he also requested the name and contact information for my EP, Dr. Shepal Doshi, in case he needed to be contacted.

Update Your Medical Records

From my first-hand experience, I remind you to be sure to inform your dentist and other healthcare providers when you have a procedure for your Atrial Fibrillation.

Use of Epinephrine Could Trigger Your A-Fib 

Another concern at the dentist is the use of Epinephrine (Epi or Adrenalin). It 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 any local anesthesia with Epinephrine (Epi) potentially can trigger A-Fib.

Local anesthesia (with Epi or Adrenalin) is used by dentists, dermatologists, emergency room personnel and others.

At the Dentist: A retired MD wrote to caution A-Fib patients that local anesthesia containing epinephrine can trigger your A-Fib.

Dr. Sam writes: “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. 

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.

I found very little info online about this, and no studies had been done about dental anesthesia with Epi & A-Fib.”

Tell Your Doctors: Epinephrine Containing Products Can Trigger Your A-Fib

At the Opthamologist: The drops that the eye doctor uses to dilate your eyes are similar to Adrenalin. Ask for an alternative.

At the Dermatologist: Local anesthesia containing epinephrine is used by your doctor to numb skin and reduce bleeding when they remove cysts, limpomas, moles, skin cancer spots, etc. and to close lacerations. Tell them your concern about triggering your A-Fib.

Your GP and at the Emergency Room: Doctors use local anesthesia with Epinephrine to sew up wounds and/or to do small surgical procedures requiring local anesthesia, because it reduces bleeding locally and lasts longer. Remind your GP and discuss your A-Fib with emergency room caregivers. Express your concern about the use of Epinephrine. Ask for an alternative.

Are You Allergic to Medications? As a Caution Include Epinephrine

Allergic to any medications?

Medical staff routinely ask if you are allergic to any medications.

Tell your doctors you have Atrial Fibrillation and discuss your concern that the use of local anesthesia with Epinephrine may trigger your Atrial Fibrillation.

You might want to add Epinephrine as a medication you are allergic to in your medical records along with an explanation.

A-Fib Pause: To Pace or Not to Pace…That is the Question

I’ve posted about my A-Fib retuning last Fall and subsequently having a Medtronic Reveal LINQ Insertable Cardiac Monitor (ICM)—one of the world’s smallest cardiac monitors—inserted just under the skin near my heart. Each night my Reveal Linq wireless monitor transmits that day’s data by wireless connection to my EP, Dr. Shephal Doshi.

Surprise—I Didn’t Feel a Thing

One morning in the week following my successful RF catheter ablation, at 6:27 am unbeknownst to me, my Linq recorder captured this episode—a seven-second pause:

The ECG signal strip is a graphic tracing of the electrical activity of your heart.

The next morning Dr. Doshi was on the phone telling me to come into the office immediately. He showed me the printout, and I was amazed.

In this second graphic, called a scatter plot, you can clearly see the dots representing the pause (outlined by a red box). The differences between consecutive R-wave intervals reveal patterns in the rhythm.

Scatter plots use horizontal and vertical axes to plot data points. Here the differences between consecutive R-wave intervals are plotted in order to reveal patterns in the rhythm.

Wow, 7-seconds—that’s a huge pause! It’s no wonder Dr. Doshi and his office called me the next day. He wanted to install a pacemaker right away and scheduled it for a week later. He also told me not to drive a car.

Remember: Your Best Patient Advocate is You

Unlike when I had A-Fib back in 1997, this time I wasn’t feeling any dizziness during the day.

At A-Fib.com, we always encourage you to be your own best patient advocate (which can include your spouse or partner. too.) And to not blindly follow your doctor’s advice. Always educate yourself. So I read up on pacemakers.

What is a Pacemaker?

In this instance, pacemakers are used to treat a slow heartbeat in people with A-Fib. It’s a small device that monitors your heartbeat and sends out a signal to stimulate your heart if it’s beating too slowly. The device is made up of a small box called a generator. It holds a battery and tiny computer.

Source: Pacemaker illustration from solarstorms.org

Source: Pacemaker illustration from solarstorms.org

Very thin wires called leads connect the pacemaker to your heart. Impulses flow through the leads to keep the organ in rhythm. There are also “leadless” pacemakers which are entirely installed inside your heart.

Installing a Pacemaker: The doctor programs and customizes the pacemaker for each patient to help keep their heart in rhythm. The surgery to put in the device is safe, but there are some risks, such as bleeding or bruising in the area where your doctor places the pacemaker, infection, damaged blood vessel or collapsed lung. You may need another surgery to fix it.

Life with a Pacemaker: Sometimes the impulses from a pacemaker cause discomfort. You may be dizzy, or feel a throbbing in your neck.

Once you have one put in, you might have to keep your distance from objects that give off a strong magnetic field, because they could affect the electrical signals from your pacemaker like metal detectors, cell phones and MP3 players and some medical machines, such as an MRI

In general, it is a permanent installation—you’ll have it for the rest of your life.

VIDEO: Traditional and Leadless Pacemakers Explained. Peter Santucci, MD, is a cardiologist with Loyola University Medical Center; he describes the traditional pacemaker and it’s installation using graphic animations.Then compares with the miniaturized leadless version. 2:30 min. Posted by Loyola Medical. Go to video.

Considering a Pacemaker: Pros and Cons

Patti and I discussed the pros and cons of a pacemaker.  In this instance, my heart was beating too slowly. But that’s normal for me. Because of years of running and exercise, my resting heart rate is in the high 50s, which is very low compared to others with A-Fib.

The three-month “blanking” period following my ablation is when my heart is healing and learning to once again beat in normal sinus rhythm. That’s why it’s common for A-Fib to recur during this time.

Illustration showing placement of the Medtronic Mica leadless pacemaker

Illustration showing placement of the Medtronic Mica leadless pacemaker

It doesn’t mean your ablation was a failure—think of it like planting a fruit tree. The tree might not produce fruit right way, but give it time to acclimate, absorb the nutrients in the soil, to grow stronger and bask in the sun. So I’m giving my heart some time, too.

Hitting the Pause Button on a Pacemaker for Now

In the meantime, I haven’t had another pause and have remained A-Fib free. I am hoping that this 7-second pause was a one-time thing and that my heart will stay in normal sinus rhythm in the months to come.

Dr. Doshi wants to install a “leadless” pacemaker which would be entirely installed inside my heart. Having that installed is a big step for me, one that I’ll have to live with for the rest of my life.

So, I decided to wait on having it installed. I’ll reconsider a pacemaker after my 3-month blanking period is behind me.

I’ll keep you posted on the status of my A-Fib post-ablation.

A-Fib Patients: How Does Your Doctor Talk to You?

I recall an email sent to me by a woman from England who described her horrendous A-Fib symptoms—palpitations, extreme fluttering, breathlessness, “absolute extreme fatigue.” She recalled how the doctor said her symptoms had nothing to do with A-Fib, that the symptoms were all in her head, and that she was exaggerating her breathlessness and exhaustion.

Wow! First, I reassured her that her symptoms are very real for many A-Fib patients. I then suggested she change doctors. (I also recommended she contact our A-Fib Support Volunteers.)

How’s the Rapport With Your Doctor?

There’s an insightful article in the Journal of Cardiovascular Electrophysiology (I’d like to send a copy to her doctor) “How doctors can provide better treatment by understanding the hearts―and minds―of AF patients.

In brief, it’s a Top 10 list: 5 things A-Fib patients do not want to hear from their doctors and 5 things they do want to hear. (Go to the journal article.)

Five Things A-Fib Patients Do Not Want To Hear

Several research studies tell us that some doctors underestimate the impact Atrial Fibrillation has on a patient’s quality of life. Many doctors treat A-Fib as a benign heart ailment. But patients report how A-Fib can wreak havoc in their lives.

Responding to a survey, A-Fib patients said they do not want their healthcare providers to say:


1. “A-Fib won’t kill you.”
2. “Just get on with your life and stop thinking about your A-Fib.”
3. “Stay off the Internet and only listen to me.”
4. “I’ll choose your treatment, not you.”
5. “You’re just a hysterical female.”


Did anything on this list sound (or feel) familiar to you?

If your doctor is condescending or dismisses your concerns, you’re getting poor care. If a doctor is too busy to talk with you and answer your concerns, he’s probably too busy to take care of you properly.

Like the patient from England, it may be time for you to change doctors.

Five Things A-Fib Patients Do Want To Hear

Those doctors who recognize the serious effects atrial fibrillation can have on patients will foster meaningful and productive partnerships with their patients. From the same survey, here are five things A-Fib patients do want their healthcare providers to say:


1. “I respect you and will listen.”
2. “I want to be sure you understand.”
3. “Let’s customize a treatment that works with your lifestyle.”
4. “I understand your values and preferences.”
5. “Here are some resources about A-Fib.”


Do the comments on this second list sound like your doctor?

When your doctor respects you and listens to you, you’re more likely to collaborate on a treatment plan tailored to you and your treatment goals.

If you don’t have this kind of rapport with your current doctor(s), it’s worth looking elsewhere for a new doctor (even if they’re considered “the best” in their field).

Changing Doctors Can Be Scary: We Can Help

As a researcher in doctor-patient communication, Robin DiMatteo, of U. of Calif.- Riverside, says of changing doctors: ”I really think it’s a fear of the unknown. But if the doctor isn’t supporting your healing or health, you should go.”A-Fib.com Directory of Doctors and Medical Centers Treating A-Fib Patients at A-Fib.com

At A-Fib.com, we can help you. First, learn more about how to Find The Right Doctor For You and Your Treatment Goals.

Then check our Directory of Doctors and Facilities. We list US & international physicians and medical centers treating Atrial Fibrillation patients. This evolving list is offered as a service and convenience to A-Fib patients. (Important: Unlike other directories, we accept no fee to be included.) 

Resources for this article
Mellanie True Hills presentation, 2017 American Heart Association Scientific Sessions in Anaheim, California, November 11-15, 2017.

Recognize AFib Patient Values by Mellanie True Hills. PowerPoint Presentation. From Improving Outcomes for Patients with AFib. American Heart Assoc. Non-CME Webinar. May 3, 2018. https://www.heart.org/-/media/files/health-topics/atrial-fibrillation/improving-outcomes-for-patients-with-afib-ucm_500972.pdf?la=en&hash=CDE25CF86D94CE01B9D5662E45E86619F20FF809

Hills, M T.  The transformative power of understanding and trust in AF care: How doctors can provide better treatment by understanding the hearts―and minds―of AF patients. Journal of Cardiovascular Electrophysiology. Point of View. Volume 29, Issue 4, April 2018. Pages: 641-642. https://doi.org/10.1111/jce.13443

Be Suspicious of A-Fib Info on the Internet―Here’s Why

by Steve S. Ryan

When I attend talks at most A-Fib conferences, the first slide a presenter shows is often a list of their Conflicts of Interest. It’s required of all speakers.

But this is not required of websites! Health/Heart-related websites are not required to be transparent and reveal their conflicts of interest.

Drug Industry Owns or Influences Most Heart/Health Web sites

The drug and device industry owns, operates or influences almost every health/heart-related web site on the Internet!

The fact is most health/heart web sites are supported by drug companies who donate most of their funding.

For example, did you know that the drug company Ely Lilly partially owns and operates WebMD, the Heart.org, Medscape.com, eMedicine.com and many other health web sites?

The fact is that most health/heart-related web sites are supported by drug companies who donate most of their funding. Consider how that may affect the information they put on their web sites―they’re not going to bite the hand that feeds them.

VIDEO: Video: Buyer Beware of Misleading A-Fib Information on the Web and in the Media

Beware of misleading and incorrect A-Fib information published by reputable sources on the internet and in print media. Steve S. Ryan, PhD, gives three specific examples of why you need to be on the lookout for inaccurate statements about Atrial Fibrillation. 3:59 min. Go to video.

Be Suspicious of A-Fib Info on the Internet

Steve Ryan video at A-Fib.com

VIDEO: Buyer Beware of Misleading or Inaccurate A-Fib Information.

In our crazy world, you can’t afford to trust anything you read on the Internet.

At one time I tried to keep track of all the mis-information found on various A-Fib web sites. When we’d find something wrong, we would write the site. I don’t think we’ve ever received a reply. Finally, we gave up.

(See my video: Buyer Beware of Misleading or Inaccurate A-Fib Information.)

In today’s world, you have to do your own due diligence.

Many web sites put out biased or mis-information often for financial gains, but sometimes it’s just out-of-date. Be skeptical.

You can tell if someone is trying to pull the wool over your eyes. Truth will out. If you feel uncomfortable or that something is wrong with a site, it probably is. When you find a good site, the truth will jump out at you.

Whenever you visit a heart health-related website, ask yourself: “Who owns this site?” and “What is their agenda?” (Hint: Check their list of “sponsors” and follow the money!)

How Does A-Fib.com Measure Up?

A-Fib Inc. has earned GuideStar’s highest rating, the GuideStar Exchange Platinum Seal, a leading symbol of transparency and accountability in the non-profit world.

Transparency means that anyone can find out what we have been doing, what we have achieved, and how we are doing in achieving our ultimate goals. You can check the A-Fib.com public listing at GuideStar.org.

A-Fib.com has also earned the Health On the Net Foundation (HON) Certification for quality and trustworthiness of medical and health online information.

For more, you can also read the A-Fib.com Disclosures page.  

Caution - when searching A-Fib websites always ask: who is paying for this site and what is their agenda?

Hint: Check their list of “sponsors” and follow the money!

My A-Fib RF Catheter Ablations: 1998 vs 2019

When I developed paroxysmal Atrial Fibrillation in 1997, I was very symptomatic. This time, in 2019, I didn’t have any symptoms—instead my A-Fib was detected by my tiny, inserted Medtronic Reveal LINQ loop monitor/recorder.

More Differences Between 1998 and 2019

Since 1998, the treatment of A-Fib by catheter ablation has advanced by light years including 3D Mapping and ablation systems and catheter technologies.

My last ablation 21 years ago in Bordeaux, France lasted eight+ hours. This one at St. John’s Hospital in Santa Monica, CA took only 2-3 hours.

In Bordeaux, I was in the hospital for 9 days (mostly for observation, and a “touch up” second EP lab visit). In 2019, I was in and out in 12 hours.

Second Time Around: My A-Fib Catheter Ablation Prep

Steve Ryan pre-op A-Fib ablation

Pre-op: Steve with nurse inserting IV

On Thursday, August 1st, my wife, Patti, and I arrived at St. John’s around 5:30 am.

The nurses did the usual insertion of an IV port. They had trouble getting into my left arm and used the right. Then they shaved not just my groin but my chest and back too so that they could more easily attach the electrode pads for the mapping system (those pads were cold).

Then they wheeled me into the EP lab where it seemed like an army of people were waiting on me (probably around 8 people.) They were very friendly and super-efficient in their gowns and face masks.

Dr. Shephal Doshi of Pacific Heart Institute did my RF catheter ablation. (Both he and the anesthesiologist visited me in pre-op before the ablation.) Dr. Doshi has an excellent rapport with the staff and has a great sense of humor.

Out Like a Light

Before I knew it, they had a mask over my face, and I was out like a light. (Dr. Doshi said I was a “cheap date.”)

Mapping of my A-Fib heart - Steve Ryan August 2019

Mapping screen showing my A-Fib heart – the dots are the ablation lesions – notice the tight arrangement; Steve Ryan August 2019

Thanks to Dr. Doshi, we have loads of photos of my RF catheter ablation taken from the EP lab control room and some from inside the EP lab. (I intend to get an explanation of each screen from him to share with you later.)

Post-Ablation Recovery

I didn’t wake up until in the recovery room. Dr. Doshi said everything went very well. I will give you more technical details as I learn them (I don’t remember much of what he said at the time.)

He told Patti that indeed he could see the ablation lesions from my first ablation in 1998, which were around just two of my pulmonary veins (and some other areas). So, no wonder I needed a “touch-up”.

I don’t know too many details from 1998—I didn’t know to ask for the Operating Room (OR) report back then.

Post op: Dr Doshi and nurse Jamie removing Steve’s groin stitch.

To close the one catheter incision point in my right femoral vein, he used some kind of sliding figure-eight stitch that could be loosened or tightened as needed. That stitch was painful and hurt for a while. It was removed before I left the hospital.

In the recovery room I remember them bringing me a vegetable soup which tasted delicious. Patti fed me bits of a lunch of chicken salad and raw vegetables, low-fat milk and pineapple chunks.

I was discharged about 4:30pm. After a stop at the pharmacy, we were home by 6pm. Amazing compared to my first catheter ablation in 1998. In and out in under 12 hours!

Meds: Pantoprazole and Xarelto

Dr. Doshi said I have a large esophagus so he was concerned about acid reflux damage. To prevent the very rare complication Atrial Esophageal Fistula, I was given a prescription for the Proton Pump Inhibitor Pantoprazole SOD 40 mg to be taken once a day. I did have some acid reflux the first day, but none since I started taking the Pantoprazole. (For more about Atrial Esophageal Fistula , see Dr. David Keane’s AF Symposium 2014 presentation, “Complications Associated with Catheter Ablation for AF”.)

And I’m continuing to take Xarelto 20 mg (rivaroxaban) at night with a meal (I was also on it two weeks prior to my ablation).

Recovering at Home

Dr. Shephal Doshi and Steve Ryan before his A-Fib catheter ablation Aug 1 2019

My wife, Patti, drove me home that evening. I felt terrific. But that wasn’t to last.

No problems with my heart, but the next night (Friday), I developed a low-grade fever and felt very weak and unbalanced the next day. I slept a lot Saturday and felt better.

Sunday I was scheduled to be a lector at our local Catholic church. ­(I tried to get someone to sub for me but couldn’t find anyone.) I did read the scriptures for our congregation and felt fine. But went straight home after (I wouldn’t recommend this for everyone). One needs rest after an ablation.

As I write this Sunday night, I feel fine, just a bit tired. I’ll write more when I talk with Dr Doshi about my fever and after my two-week checkup.

My Catheter Ablation was a Success—I was Home the Same Day

My A-Fib catheter ablation “touch up” went off without a hitch. Dr. Shephal Doshi had me in the cath lab by 8am, out by 11am, discharged by 5pm. I feel great! (but no heavy lifting or workouts for two weeks.)

Thanks to all who emailed with good wishes, positive thoughts and prayers for a safe and successful ablation.

Look for my post with the details on Monday.

Steve Ryan in the cath lab St John Hospital before ablation on Aug 1, 2019

Steve Ryan, prepped in the cath lab at St John Hospital, Santa Monica, CA, before a catheter ablation for his asymptomatic, paroxysmal atrial fibrillation.

 

Share Your Insights! A-Fib.com Guest Contributors Welcome

There are many ways you can participate at A-Fib.com. You can join our Support Volunteers who offer others hope and encouragement; Join our Positive Thoughts/Prayer group to help those who believe in the healing power of hope, belief and prayer; Share your Personal A-Fib story to inspire others…

Or, be a contributor and write about a topic you’re passionate about.

A-Fib.com Guest Contributors Welcome

A-Fib.com welcomes guest contributors

You don’t have to be an experienced or published writer. Just informed and passionate about a specific A-Fib topic or issue. Why not share your insights with our A-Fib.com readers? Get your byline and photo on our website. We welcome guest contributors!

All opinions are welcome. You don’t have to agree with the publisher’s point-of-view. For example, see the editorial by Ken Close, Editorial: A-Fib.com Bias in Coverage of Mini-Maze?

You can see examples of articles by other guest writers. Check out an article by Lyn Haye, Obesity in Young Women Doubles Chances of Developing A-Fib and a patient review by Frances Koepnick’s “Patient Review: AliveCor Heart Monitor for SmartPhones“.

Is This Your Time to Contribute to A-Fib.com?

Whatever you choose to write about, long or short, the length and style is up to you. We’ll support you all the way (and even supply graphics if needed.)

If you’re interested in being an A-Fib.com guest contributor or just have questions about it, send us an email. I encourage you to do it TODAY!

My 20-year Warranty Ran Out! My A-Fib is Back!

I had my catheter ablation twenty years ago and was blessedly A-Fib free till age 78. This past autumn my A-Fib reared its devilish head once again.

During a medical exam in August 2018, one of my doctors (not a cardiologist) detected an irregular heart beat. When my EP took my ECG, he didn’t detect A-Fib (thank goodness) and I didn’t have any symptoms.

Medtronic Reveal LINQ insertable heart monitor

Medtronic Reveal LINQ

But, just to be sure, he implanted a tiny wireless heart monitor so he could review my heart activity over time.

A few months ago, the Medtronic Reveal LINQ loop monitor/recorder showed I had one asymptomatic A-Fib episode up to 15 hours long and one 5-second pause during my sleep at 3:00 am.

Read my earlier posts about the return of my A-Fib:

• Sept 2018: Has My A-Fib Returned? I Get an Insertable Wireless Monitor
• Oct 2018: Part 2: My Medtronic Reveal LINQ loop recorder—21-Day results
• Nov 2018: Part 3: PVCs/PACs but No A-Fib; False positives from my LINQ Monitor

You can also read my full A-Fib story (the first A-Fib.com story).

My A-Fib Recurrence Not Surprising

My A-Fib recurrence didn’t come as much of a surprise. My catheter ablation back in 1998 was primitive compared to what EPs are doing today. I had what was called at that time a “focal point catheter ablation”.

Steve Ryan - A-Fib free since 1998 - active lifestyle

Steve Ryan, A-Fib free since 1998, doing the high jump.

Back in 1998, they actually ablated inside just one of my pulmonary veins (PVs) to eliminate the A-Fib signal source. (Today they don’t ablate inside a PV anymore because of the possible danger of causing stenosis/swelling of the PV. Instead, they ablate/isolate at the openings of the PVs to block A-Fib signals from entering the left atrium from the PVs where most A-Fib signals come from.)

Also back then along with my A-Fib, I also had a lot of pauses. But they disappeared after my catheter ablation in 1998. A successful catheter ablation often eliminates these pauses, which is one of the reasons I chose to have a catheter ablation.

Strenuous Lifestyle: 20 Years is Not Enough

Steve Ryan - sprint training

Steve Ryan sprint training

What’s surprising is not that my A-Fib re-occurred, but how long my relatively primitive ablation lasted. In effect, none of the openings to my PVs back in 1998 were electrically isolated from the rest of my heart (just inside one PV).

But nevertheless, I remained A-Fib free for 20 years while participating in very demanding, strenuous training and activities such as Masters Track meets.

I want another 20 years!

Choosing Ablation Rather Than A-Fib Drugs

I was offered the treatment option of just taking A-Fib drugs (I was asymptomatic). I chose instead to have a modern catheter ablation which will be performed Thursday, August 1st by Dr. Shephal Doshi at St. John’s hospital in Santa Monica, CA.

Also, I don’t want to be on today’s A-Fib drugs if I can avoid them.

Today’s Advanced Mapping Techniques

Dr. Doshi will identify and isolate the openings to my pulmonary veins so A-Fib signals from the PVs can’t get to the rest of your heart.

Dr Fishel RF catheter ablation video

Ablation 3-D modeling screen

But that’s not the only possible source of A-Fib signals. A-Fib can develop from other areas of the heart such as the right atrium, left atrial appendage (LAA), transeptal wall, coronary sinus, etc.

So, Dr. Doshi will use advanced mapping technologies not avaliable in 1998 to look for, then isolate, any other areas of the heart which produce A-Fib signals. His goal is to identify and isolate all A-Fib signals no matter the source.

In the final step of the ablation, he will use a drug or a electrical stimulation (passing) to try and stimulate my heart back into A-Fib—hopefully with no success.

Your Positive Thoughts and Prayers Please!

That Demon on Your Shoulder Called ‘A-Fib-Zebub’

Ridding myself of that demon ‘A-Fib Zebub’

Like so many of our A-Fib.com readers having an ablation, I ask you to please keep me in your thoughts/prayers, especially August 1st.

I have every confidence that this ablation will be a “touch-up” job, and I will once again be A-Fib free.

I expect only a one-night stay in the hospital. Patti and I will report in ASAP afterward to give you an update.

Visit our Pinterest Board with Over 50 Celebs with A-Fib

Atrial Fibrillation doesn’t discriminate. It hits performers and musicians, politicians and public officials, sport professionals (from the NBA, NFL, MLB, NHL), track & field competitors and Olympic champions.

Browse our Pinterest board of over 50 celebs who have dealt with A-Fib. You’ll be amazed at the many personalities and celebrities with A-Fib. For example:

Kevin Nealon

KEVIN NEALON, comedian-actor-writer and Saturday Night Live alumni; Had his first A-Fib episode while on vacation in Mexico. He ended up in an emergency room thinking it was a heart attack. Back home he was diagnosed with A-Fib. Today as a spokesman for Janssen pharmaceuticals, he promotes stroke and clot prevention.

Lynne Cox

LYNNE COX, Champion long-distance open-water swimmer, swam the English Channel at age 15; became the first woman to swim across the Bering Strait from the United States to the Soviet Union. Diagnosed in 2012 with A-Fib. From her 2016 memoir Swimming in the Sink: An Episode of the Heart.

Billie Jean King

BILLIE JEAN KING, Tennis legend (Wimbledon champ 20 times) and advocate for gender equality. Her A-Fib diagnosis came after playing tennis with a friend. “My heart was beating, I thought it was going to come out of my chest.” 

Ellen Degeneres

Ellen Degeneres

ELLEN DEGENERES, Talk show host, comedian. Ellen acknowledged her A-Fib in an episode of her show with Canadian comedian, actor and television host Howie Mandel (who also has A-Fib).

Rich Peverley

RICH PEVERLEY, Dallas Stars forward. A “blip” on his EKG during the physical prior to 2013 training camp was A-Fib. With a procedure to shock his heart back into rhythm and with medication he returned to the ice three weeks later.

Browse our Pinterest board of over 50 celebrities, personalities, athletes and public servants who have dealt with A-Fib. Go to “Celebs With A-Fib“.

Or visit all our A-Fib-related Pinterest boards.

A-Fib.com is Your Independent Source of Unbiased Information

Who can you trust? Did you know…the drug and medical device industries operate or influence almost every health/heart related web site on the Internet?

For example, the drug company Eli Lilly is a “partner” with WebMD (WebMD Health Corp.) which includes the websites, Medscape.com, MedicineNeteMedicine.com, eMedicineHealth, RxListtheHeart.org, and Drugs.com.

Consider for a moment how that may affect the information you read on their websites. Can you trust these sites to be impartial?

Beholden to No One Except Our Readers

Reader Paul O.

Former A-Fib patient, Paul V. O’Connell of Baltimore, MD, wrote about A-Fib.com publisher, Steve Ryan:

“Steve’s probably the world’s best informed patient advocate when it comes to understanding atrial fibrillation and its treatment. 

Most important, Steve is not owned by the AMA or Big Pharma—so he is not beholden to anyone except his readers.”

Health On the Net and GuideStar Certified

A-Fib.com has earned and maintained the Health On the Net Foundation (HON) Certification for quality and trustworthiness of medical and health online information. The Health On the Net Foundation (HON) Code of Conduct helps protect citizens from misleading health information. 

A-Fib Inc. has earned GuideStar’s highest rating, the GuideStar Exchange Platinum Seal, a leading symbol of transparency and accountability in the non-profit world.

A-Fib.com is Independent and Unbiased with No Affiliations

From our start in 2002, Steve has maintained an independent and unbiased viewpoint. To assure our integrity, A-Fib.com is deliberately not affiliated with any medical school, device manufacturer, pharmaceutical company, HMO, or medical practice.

At A-Fib.com, Steve accepts no third-party advertising, does not charge for inclusion in our Directory of Doctors & Facilities and accepts no fee (cash or other kind) for a listing in Steve’s Lists of Doctors by Specialty. Not many healthcare websites or patient education sites can make these same claims.

A-Fib.com is your independent source of unbiased information
about Atrial Fibrillation and its resources and treatments.

Join our Mission. Support A-Fib.com.

Every donation helps. Even $1.00.

Resource for this article
Rosenberg. Grassley Investigates Lilly/WebMD link Reported by Washington Post. Opednews.com 2/24/2010 http://www.opednews.com/articles/Grassley-Investigates-Lill-by-Martha-Rosenberg-100224-629.html

At A-Fib.com, What Do We Stand For?

To maintain our independence, integrity and our unbiased viewpoint, A-Fib.com is deliberately not affiliated with any medical school, device manufacturer, pharmaceutical company, HMO, or medical practice.

We accept no third-party advertising, do not charge for inclusion in our Directory of Doctors & Facilities and accept no fee (cash or other kind) for a listing in Steve’s Lists of Doctors by Specialty.

Not many healthcare websites or patient education sites can make these claims.

The A-Fib.com Mission

If you visit our “About Us” page, you can read about how Steve Ryan started A-Fib.com after researching and finding his own cure.

Among other things, you will also find the A-Fib.com mission statement. It summarizes what we do and why.

Our Mission: A-Fib.com offers hope and guidance to empower patients to find their A-Fib cure or best outcome. A-Fib.com is the patient’s unbiased source of well-researched information on current and emerging Atrial Fibrillation treatments.

Join Us! Support the A-Fib.com Mission

If you would like to support our mission, you can refer others to our website, you can bookmark and use the A-Fib.com Amazon.com portal link to shop online. Or make a donation through PayPal towards our monthly publishing expenses.

A-Fib.com is your independent source of unbiased information
about Atrial Fibrillation and its resources and treatments.

Join our Mission. Support A-Fib.com.

Updated: What is the Annual ‘AF Symposium’ and Why it’s Important to Patients

I’ve updated my page about the What is the Annual ‘AF Symposium’ and Why it’s Important to Patients. If you are new to reading my reports and summaries from this annual presentation and learning event, you’ll want to take a look.

The most important point I make is that this conference provides me with a unique opportunity to learn about advances in research and therapeutics directly from many of the most eminent investigators in the field.

I use this newly gained insight to share those findings that are relevant to A-Fib patients and their families. And I do it in plain language, filtering out as much medical jargon as possible.

In 2002 I started Atrial Fibrillation: Resources for Patients, A-Fib.com, to spare others the frustration, depression and anxiety I went through to find my cure. (Read Steve’s storyPersonal A-Fib story #1). I continue this mission through my reports from the AF Symposium.

My goal is to provide you with the most up-to-date research and developments in the treatment of Atrial Fibrillation that may affect your choices of medical care.

Go to: What is the Annual ‘AF Symposium’ and Why it’s Important to Patients.

Remember: You must educate yourself to find
your A-Fib cure or best outcome for you!

Our A-Fib.com Video Library and My Top 5 Picks for the Newly Diagnosed

We have screened hundreds of A-Fib-related videos over the years and have carefully selected a short list for you. Our A-Fib library of videos and animations are for the reader who learns visually through motion graphics, audio, and personal interviews. These short videos are organized loosely into three levels:

Browse our curated A-Fib Video Library

♥ Introductory/Basic Level is for the newly diagnosed patient. Fundamentals of the heart’s electrical system, stroke risk and anticoagulation therapy, ECG/EKG, and catheter/surgical treatments. Helpful for the family and friends of an A-Fib patient, too.

♥ Intermediate Level is for the more informed patient. Videos offer details of the heart’s functions, types of heart monitoring devices, specifics of catheter ablation, maze and hybrid surgeries, and closure of the Left Atrial Appendage.

♥ Advanced Level videos offer a more extensive look at cardioversion, ECGs/EKGs, ejection fraction, catheter ablations/EP lab and maze/mini-maze surgeries. (May requires basic understanding of cardiac anatomy and A-Fib physiology.)

We invite you to browse our A-Fib library of videos and animations and try out a few of our titles.

Top 5 Videos for the Newly Diagnosed Patient

The newly diagnosed A-Fib patient has lots of questions. What is A-Fib? How do I deal with my symptoms? What are my treatment options? How does it impact my family? For answers, start with these videos.

1. Introduction to How a Normal Heart Pumps Blood

Heart Pumps

A short video about the path of a red blood cell through the heart’s four chambers to deliver oxygen to the body and then return to be re-oxygenated. Animation with narration. (Don’t worry about remembering the terminology, just follow the flow of the red blood cell). By The Children’s Hospital of Philadelphia.  (1:00 min.) Go to video.

2. Stroke Prevention in A-Fib and Anticoagulant Therapy

Treatment for stroke prevention in AFThrough interviews and animations explains how atrial fibrillation can cause stroke and why anticoagulation is so important; Discussion of: warfarin (Coumadin), the required monitoring, interactions with food, alcohol and other drugs: newer anticoagulants (NOACs) that do not require regular testing, aren’t affected by foods [but are expensive]. On-camera interviews with AF Association CEO, Trudie Lobban MBE and other experts (5:36)  Developed in association with the drug maker, Boehringer Ingelheim. Go to video.

3. The EKG Signal and Conduction System of the Heart

A-Fib EKG Signal video at A-Fib.com

The EKG signal

Excellent illustration of the heart and a fully labeled graphic of theConduction System of the Heart’. Descriptive text accompanies each step in the animation. First a normally beating heart, the electrical signal path and corresponding EKG tracing. Then the same heart in Atrial Fibrillation with EKG tracing of the heart in A-Fib. Go to video on the American Heart Association website.

4. About Magnesium Deficiency with Dr. Carolyn Dean

C. Dean, MD

C. Dean, MD

Most A-Fib patients are deficient in Magnesium.The Best Way to Supplement Magnesium with Dr. Carolyn Dean, the author of The Magnesium Miracle. Getting nutrients through food is not always possible; discusses side effects of too much and how you can tell if you have a deficiency. (3:39). Go to video. See also: Importance of Balancing Calcium & Magnesium“ (1:00)

5. When Drug Therapy Fails: Why Patients Consider Catheter Ablation

InsiderMedicine.com-When Drug Therapy Fails-Catheter Ablation

Why Ablation?

Dr. Susan M. Sharma discusses why patients with atrial fibrillation turn to ablation when drug therapy doesn’t work. Presenting research findings by David J. Wilber MD; Carlo Pappone, MD, Dr. Sharma discusses the success rates of drug therapy versus catheter ablation. Transcript of the narration is provided. (3:00 min.) From Insidermedicine.com. Go to video.

Disclaimer: Videos provided for your convenience only; we make no endorsement of a specific treatment, physician or medical facility.

For more videos,
visit our A-Fib.com Video Library

Steve Ryan Videos

We’ve edited Steve’s most interesting radio and TV interviews to create several short (3-5 min.) videos. Check out Videos Featuring Steve S. Ryan, PhD, publisher of A-Fib.com.

Do I Have a Legal Right to My Medical Records? Can I See Them? Get Copies?

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

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

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

Make an Inventory of Your Medical Records

When it comes time to see a new doctor or specialist, you’ll want to supply them with a copy of all your relevant A-Fib related medical records.

You may already have many of these records on file and just need to identify those you are missing. (You may be fortunate and have online access to your information, depending on your health provider.)

How to Request Copies of Missing Records

If you are missing copies of some of your files, you may need to request files from current and former physicians and medical centers. So, how do you do that? For all the details, see my article: 3 Ways to Request Copies of your Medical Records

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

Once you have a complete set of your medical records, store your originals in a binder or file folder. Store CDs in binder sleeves or copy to your PC. Make backup copies of any digital records.

Where Do You Organize Your A-Fib Records?

Keep your medical records in a binder or folder. at A-Fib.comWe strongly encourage you to get in the habit of storing all your A-Fib-related research and documents in one place. Don’t leave your doctor’s office, medical center or hospital without a copy of every test or procedure they perform. If the test result isn’t immediately available, have them mail it to you.

Patient Online Services: If your healthcare provider offers a secure online portal to your patient records, be sure to sign up for it. It is a convenient way to access your health information and medical records. Services include email communication with your doctors (no phone tag), your doctor’s instructions during office visits, a calendar of all upcoming and past office visits, all tests results, a list of prescribed medications and patient education resources.

Store your A-Fib Research: As you search for your Atrial Fibrillation cure, organize the information you are collecting. Start with a notebook and a three-ring binder or a file folder. To learn more, see my article, Why You Need an A-Fib Notebook and 3-Ring Binder.

Make Medical Record-Keeping a Habit: Don’t leave your doctor’s office or medical canter without a copy of every test they performed. Store in your A-Fib three-ring binder or file folder.

Never see a doctor alone - 350 wide at 300 res

A Look at the A-Fib.com Glossary of A-Fib Medical Terms

As part of your education about Atrial Fibrillation, you’re bound to run across terms that you do not understand. Bookmark our Glossary of Medical Terms page (or click on “Glossary of Terms” in the left menu) and refer to it when reading and studying about A-Fib.

Our A-Fib.com Glossary of Medical Terms and Phrases is the most complete online source devoted exclusively to Atrial Fibrillation. Each definition is written in everyday language—a great resource for patients and their families.

A Sampling of Glossary Terms

To give you an idea of what you’ll find, we’ve selected a few Atrial Fibrillation terms and phrases related to drug therapy:

If you don’t find the term you are looking for—email us and we’ll add it to the Glossary.

Beta Blocker: A medication that slows down conduction through the heart and makes the AV Node less sensitive to A-Fib impulses.

Calcium Channel Blocker: A medication that prevents or slows the flow of calcium ions into smooth muscle cells such as the heart. This impedes muscle cell contraction, thereby allowing blood vessels to expand and carry more blood and oxygen to tissues.

NOAC: NOAC stands for Novel Oral AntiCoagulants. NOACs are alternatives for vitamin K antagonists (e.g., Warfarin) for stroke prevention in patients with atrial fibrillation.

“Pill-in-the-Pocket” Treatment: For Paroxysmal A-Fib patients. When an A-Fib attack occurs, the patient takes an antiarrhythmic med (flecainide, propafenone, etc.) to return to normal sinus rhythm.

Rate Control Medications: Drug therapy that attempts to control your heart rate (ventricular beats), but leave the upper chambers (atria) of your heart in A-Fib.

Rhythm Control Medications: Drug therapy that uses rhythm control drugs, called antiarrhythmics, to try to stop A-Fib and make the heart beat normally.

Browse Our Glossary of A-Fib Terms

Go ahead and take a leisurely stroll through our Glossary of Medical Terms and Phrases. Bookmark the page and refer to if any time you’re learning about Atrial Fibrillation and your treatment options.

By the way: If you don’t find the term you are looking for—email us and we’ll add it.

Go to our Glossary
Bookmark it! Refer to it often!

Click image to go to A-Fib.com Glossary of Terms

Considering a LAA Occlusion Closure? Watch Out for Nickel Allergy

Approximately 8% of us have a nickel allergy. If you’ve had your ears pierced (or some other body part) and had to use “hypoallergenic” jewelry, you most likely have a nickel allergy. (Patti says gold earrings also work for her nickel allergy but are more costly.) It is one of the most common causes of metal sensitivities in people.

For more info on Nickel allergy, go to Two Cents About Nickel from American Academy of Allergy, Asthma & Immunology.

If you’re one of the many A-Fib patients looking to close off their Left Atrial Appendage, be aware if you have a nickel allergy, you have limited choices of an occlusion device.

Thanks to Frances Koepnick for alerting us to this problem. She had to cancel having a Watchman implanted because of her nickel allergy.

Nickel in Occlusion Devices

Heart illustration showing the Left Atrial Appendage at A-Fib.com

Heart illustration showing the Left Atrial Appendage

Watchman occlusion device (Boston Scientific): The Watchman contains Nitinol, a metal that is approximately 50% nickel and 50% titanium. The manufacturer states that individuals with a nickel allergy are ineligible for a Watchman implant.

Amplatzer Amulet occlusion device (St. Jude Medical-Abbott): The Amulet also contains nitinol and, therefore, has the same implications for nickel allergy.

Hyper-sensitivity Diagnostic Test Results

Standard skin/patch testing is considered unreliable for metal allergy testing. “Metal-LLT (Lymphocyte Transformation Testing)” is a diagnostic test used by allergists to measure hypersensitivity responses.

Below is a sample of test results showing nickel sensitivity:

Metal Challenge Stimulation Index  Range (percentile based)
Aluminum 0.9 Normal (Non-Reactive)
Nickel 4.2 Reactive
Iron 0.7 Normal

For LAA Closure: What To Do About a Nickel Allergy?

Right now Frances’ only option seems to be the Lariat II device (SentraHEART Inc).

The Lariat II does contain Nitinol, but it is gold plated. The gold plating acts as a barrier to nitinol/nickel exposure. Though formerly approved by the FDA, the Lariat II device is currently in a second (extended) “Amaze”clinical trial which is due to be completed in December 2019.

For more about the SentraHeart, see my article, Lariat II Suture Delivery Device.

Additional warning: today’s pacemaker leads may also contain nickel.

Steve’s A-Fib Alerts: April 2019 Issue—Ready for You!

The April 2019 issue of Steve’s A-FibAlerts is out and includes lists of the best absorbed forms of Magnesium supplements, an updated review of medic alert ID products and services, Dr. Kowey’s insights, “Eleven Things I Know About A-Fib Drug Therapy” and more. Read it now.

Our A-Fib Alerts is presented in a condensed, easy-to-scan format. Read the latest issue here. Even better—have our A-Fib Alerts sent directly to you via email. Click to Subscribe. (There’s no risk, you can unsubscribe at any time.) Join readers around the world getting their A-Fib news from Steve’s A-Fib Alerts.

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