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


Post Surgery―Develops A-Fib, Drug Therapy & Supplements Restore Sinus Rhythm

My name is Richard, male, and born in 1945. I am 5′ 9’’, weigh 167 lbs., and am a non-smoker. My exercise is walking about 1.5 miles a day, and I have a healthy diet.

Complications from an Appendectomy Surgery―Develops A-Fib

In April 2018 I was in the hospital for three weeks. I had two surgeries, first an appendectomy and 10 days later correction of a problem caused by the first surgery.

After the second surgery I developed A-Fib, with no prior history of it.

Surgery is a form of trauma, and this shock depletes magnesium and can lead to heart arrhythmias.

The only drug to bring me back to sinus rhythm was Amiodarone. I left the hospital with prescriptions for Amiodarone 100 mg a day and Metoprolol Tartrate 25 mg twice a day.

Amiodarone Damages Thyroid

Everything was under control for several months. Until I had blood work that revealed my Thyroid was not functioning. Amiodarone was removed, and… continue reading Richard’s personal A-Fib story.

Our A-Fib Positive Thought/Prayer Group: Coordinator Needed

At A-Fib.com we believe in healing through hope, belief, prayer—and in the power of positive thoughts. To support our A-Fib.com readers in seeking their cure (or best outcome), we offer the assistance of our dedicated A-Fib Positive Thought/Prayer Group. This support group is just an email away.

Once we receive your request for prayer or positive thoughts, we ask our group of volunteers to support you as requested.

I consider this work a call from God and a special vocation.

My First-Hand Experience with our Positive Thoughts/Prayer Group

Instead of just writing about this phenomenon, I experienced it myself when I asked the group for positive thoughts & prayers for the success of my upcoming intestinal surgery on March 28, 2018.

So may people emailed me such heartfelt support it brought tears to my eyes. It was very encouraging to know I wasn’t alone, that so many cared about me. Can’t thank you all enough! (BTW: My surgery was successful.)

Many Thanks to Our Coordinator

For years, Barbara Cogburn has coordinated our A-Fib Positive Thought/Prayer Group, but has recently stepped down. We can’t thank her enough for this service to others with A-Fib.

Think of how many people Barbara has helped over the years, who have benefited from her warm, understanding emails and encouragement.

We Need a New Coordinator

Could you take on the coordinator role of our Positive Thought/Prayer Group?

You can have a direct impact in the lives of other A-Fib patients and their families.

How it Works: A-Fib patients would email you with their requests. You would respond with encouragement and assurance of the group’s support. Then you’d email their request to our group of volunteers.

For the details of what’s involved, with questions, etc., contact me at ssryan@a-fib.com.

ADVENT Trial of Pulsed Field Ablation (PFA) for Paroxysmal A-Fib! PFA a True Game Changer

Fundamentally different from traditional methods for cardiac ablation, I expect the FARAPULSE Pulsed Field Ablation (PFA) will change the way catheter ablations are done and will become an innovative and most effective treatment option for Atrial Fibrillation.

U.S. Trial of Pulsed Field Ablation (PFA)

The U.S. trial of the FARAPULSE Pulsed Field Ablation (PFA) system is underway. The first patients in the ADVENT Trial were treated at New York’s Mount Sinai Hospital by Vivek Reddy, M.D., Director of Cardiac Arrhythmia Services.

” I believe PFA will define a new era in the ablation of AF and possibly other arrhythmias.” – Dr. Pierre Jais, French Bordeaux LIRYC

The ADVENT Trial is a prospective randomized pivotal trial of the FARAPULSE Pulsed Field Ablation System compared with standard of care ablation in patients with paroxysmal atrial fibrillation.

“…We look forward to how our study can move adoption of this procedure forward,” said Dr. Vivek Y. Reddy.

ADVENT Trial is Recruiting: You May Quality

There are 37 study locations participating in the ADVENT Trial (see the list). Recruiting is underway and you may qualify.

Key inclusion criteria: Patients are required to meet all the following inclusion criteria to participate in this study (there are also exclusion criteria):

• Age 18-75
• Paroxysmal atrial fibrillation
• Anti-arrhythmic drug failed for efficacy or intolerance

Learn more about the ADVENT Trial on the FARAPULSE website. Prospective patients of The ADVENT Trial should contact their physician.

How PFA Works

As an emerging technology, there are many concepts and treatment strategies that will be brand new to you (they were for me).

Pulsed Field Ablation (PFA) is fundamentally different from traditional methods for cardiac ablation. PFA is very tissue selective.

PFA is Tissue Selective; Green labels are Preserved tissue; Red label is Ablated tissue

Through a process called irreversible electroporation, cardiac tissue targeted for ablation is rendered electrically inactive while collateral tissues are spared.

Unlike traditional thermal methods, PFA works on the selected cell types while leaving others alone.

Based on European clinical trials, these electric fields have proven very effective in durably “silencing” abnormal heart signals, while reducing the risk of damage to other nearby tissues.

For more on how PFA works, see my report: 2020 AF Symposium Pulsed Field Ablation—Emerging Tech for Atrial Fibrillation.

First Approved in Europe

In March 2021, Pulsed Field Ablation (PFA) from FARAPULSE, Inc. received CE Mark approval and can now market in the Europeans Union and other CE Mark countries. FARAPULSE plans to launch by first partnering with a select number of physicians, then move to a broader rollout.

Boston Scientific has expanded investment in FARAPULSE, Inc. and secured an exclusive option to acquire it.

Resources for this article
• Reddy VY, et ak. Pulsed Field Ablation of Paroxysmal Atrial Fibrillation: 1-Year Outcomes of IMPULSE, PEFCAT, and PEFCAT II. JACC Clin Electrophysiol. 2021 May;7(5):614-627. doi: 10.1016/j.jacep.2021.02.014. Epub 2021 Apr 28. PMID: 33933412.

• First AF Patients Treated With Farapulse Pulsed Field Ablation System. DAIC.com  MARCH 03, 2021. May-June 2021 Issue. https://www.dicardiology.com/content/first-af-patients-treated-farapulse-pulsed-field-ablation-system

• The FARAPULSE ADVENT PIVOTAL Trial (ADVENT). ClinicalTrial.gov https://www.clinicaltrials.gov/ct2/show/NCT04612244?term=NCT04612244&draw=2&rank=1

Editorial: Elderly With A-Fib and Dementia Still Given Blood Thinners

In a disturbing article about our elderly living in nursing homes, a third of older patients with A-Fib and severe dementia were still given anticoagulants during the last 6 months of their lives. This is according to analysis of patients Medicare data.

According to study authors, Dr. Gregory Ouellet of Yale University and his colleagues, “We were surprised that patients with markers of very high short-term mortality—for example, difficulty swallowing and weight loss—were more likely to be receiving anticoagulants…This is counterintuitive since the potential benefits of these medications are the lowest in this group.”

“These findings underscore the fact that, while practice guidelines contain a well-defined threshold for starting anticoagulation for AF, there is no clear standard for stopping it,” Dr. Ouellet and colleagues wrote in their article.

Dr. Ouellet unexpectedly found that greater bleeding risk (their ATRIA score) was also associated with greater odds of anticoagulant use. The greater their risk of bleeding, the more likely these elderly A-Fib patients were to be on anticoagulants.

Improper use of anticoagulants can cause intracranial hemorrhage, bruising and excessive bleeding.

Nursing home length of stay was more strongly associated with anticoagulant use instead of the patients’ stroke risk (CHA2DS2-VASc score).

In their study, Ouellet and co-authors used Medicare data to evaluate 15,217 nursing home residents with atrial fibrillation and advanced dementia who had at least moderate stroke risk (CHA2DS2-VASc score of 2 or more) and who died from 2014 through 2017.

That Makes No Sense! Is This the Way We Treat Our Elderly?

I was astounded to read this analysis found the greater their risk of bleeding, the more likely these elderly A-Fib patients were to be on anticoagulants. This improper use of anticoagulants can cause intracranial hemorrhage, bruising and excessive bleeding.

Nursing home patients with greater risk of bleeding should not be prescribed anticoagulants, but they were.

What this finding says is that many the nursing homes weren’t all that concerned about actual stroke risk when prescribing anticoagulants.

The most important treatment for elderly patients with severe dementia and limited life expectance is, as much as possible, to help their quality of life, to let them die in peace and as much comfort as possible. … Continue reading this book review..->

Comparing the Effectiveness and Safety of the Direct Oral Anticoagulants (DOACs) in Patients With A-Fib

Anticoagulants are used with high-risk Atrial Fibrillation patients for the prevention of clots and stroke. FDA approved in 2010, Direct Oral Anticoagulant (DOACs) quickly became attractive alternatives to warfarin, the long‐standing standard of care in anticoagulation.

DOACs include dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis). (Edoxaban [Savaysa] approval came later.)

The use of the term “Direct Oral Anticoagulants” (DOACs) has replaced the term NOACs (Novel Oral Anticoagulants), but it means the same.

When the FDA approved DOACs (Direct Oral Anticoagulants), they relied on 3 different clinical trials. But these trials only compared a DOAC, like Eliquis, to warfarin, not to the other DOACs.

Someone like myself had to dig deep into the research to find evidence of which DOAC actually tested better/safer of the three. (I found that Eliquis tested better and was safer.)

For more about the DOACs, see my articles: Warfarin and the New Anticoagulants, and my report from the AF Symposium: The New Anticoagulants.

DOACs: Finally a Head-to-Head Comparison

Today there is clinical data comparing the DOACs against each other. (And support my original reports.)

A comprehensive review of 36 randomized control trials and observational studies included over 1 ¼ million patients. The DOACs compared were apixaban, dabigatran, rivaroxaban, and edoxaban. The reviewers found:

▪ For major bleeding: Eliquis (apixaban) “tended to be safer” than Xarelto (rivaroxaban) and Pradaxa (dabigatran) based on both direct and indirect comparisons;

▪ For best treatment: Eliquis had a higher probability of being the best treatment of decreased risk of stroke/systemic embolism;

▪ Highest benefit: Eliquis had the highest net clinical benefit and smallest NNTnet (Number Needed to Treat for net effect, i.e., how many people were helped by it, how many were harmed.)

Reviewers Conclusions

The researchers wrote: “Apixaban (Eliquis) appeared to have a favorable effectiveness-safety profile compared with the other DOACs (NOACs) in AF for stroke prevention, based on evidence from both direct and indirect comparisons.” (Translation: Eliquis was found to be more effective and safer than the other DOACs).

Editor’s Comments:

Editor's Comments about Cecelia's A-Fib storyIn the world of scientific statistics and cautious conclusions, this is about as big an endorsement as you will find: Eliquis is superior to the other anticoagulants.
If you’re on a different DOAC, talk to your doctor about switching to Eliquis.
Know the Risks of Taking Anticoagulants (Blood Thinners): Taking almost any prescription medication has trade-offs. In the case of anticoagulants, on one hand you get protection from having an A-Fib stroke (which often leads to death or severe disability), but on the other hand you have an increased risk of bleeding and other problems.
Is an Anticoagulant Necessary for Me? Be certain you should be on an anticoagulant in the first place. Doctors assess an A-Fib patient’s risk of stroke using a rating scale (called CHA2DS2-VASc). Ask your doctor what’s your risk-of-stroke score. If your score is a 1 or 2 (out of 10), ask if you could take a non-prescription approach to a blood thinner.
Remember Anticoagulants Are High Risk Drugs: Be aware that all anticoagulants are considered high risk drugs.

They aren’t like taking vitamins, though they are certainly better than having an A-Fib (ischemic) stroke. To learn more see: Anticoagulants Increase Risk of Hemorrhagic-Type Strokes.

Resource for this article
Zhang, J., et al. Comparative effectiveness and safety of direct acting oral anticoagulants in nonvalvular atrial fibrillation for stroke prevention: a systematic review and meta-analysis. Eur J Epidemiol (2021). https://doi.org/10.1007/s10654-021-00751-7

More Reports from the 2021 AF Symposium

Each year you’ll find me at the annual AF Symposium. It’s a unique experience. I attend presentations by the most eminent medical researchers, scientists, cardiologists and cardiac electrophysiologists working in A-Fib today.

I’ve published two more summary reports from the 2021 AF Symposium:

Spotlight Session: Javelin VINE Filter to Prevent Stroke

The idea behind the Javelin Medical VINE filter is to catch and stop clots (emboli) trying to travel up into the brain. This is done by inserting the VINE filter into both carotid arteries.(Of all the 5-minute Spotlight Session talks, this is my personal favorite.)

That’s incredibly good news for many A-Fib patients! It’s simple, ingenious, and very effective. Javelin Medical is an Israeli company located in Yokne’am Illit, Israel. Read more.

Live Case: Vein of Marshall Alcohol Ablation2021 AF Symposium Live Streaming Video

The AF Symposium audience watched live streaming video from Houston as Dr. Miguel Valderrabano demonstrated an innovative treatment for A-Fib using Alcohol Ablation of the Vein of Marshall.

In difficult A-Fib cases (persistent, long-term persistent), the Vein of Marshall can contain A-Fib signals (potentials, triggers) which are hard to reach and ablate. Adding ablation of the Vein of Marshall using Ethanol has been proven effective.

Using a 3 mm balloon catheter containing ethanol, he distributed ethanol into the Vein of Marshall starting distally (at the far end of the vein). Read more.

To browse through my other reports, go to 2021 AF Symposium Reports. For reports from other years go to Archive of AF Symposiums Summaries by Year

 

Catheter Ablation for A-Fib Lowers Dementia Risk

In an important study from South Korea, researchers found that patients undergoing a successful catheter ablation for A-Fib had a reduced risk of dementia.

Previous research had shown a link between patients with Atrial Fibrillation and an increased risk of dementia.

Normal Sinus Rhythm Reduces Dementia Risk

Successful ablation for A-Fib linked with reduced risk of dementia.

Using data from South Korea’s National Health Insurance Service, researchers identified 9,119 patients with Atrial Fibrillation who had a catheter ablation and 17,978 who received medical therapies.

During the follow-up period (6-12 years) dementia was found in 164 cases in the ablation group and 308 cases in the medical therapy group. Ablation was linked to a 23% lower incidence of Alzheimer’s disease and a 50% decrease in vascular dementia compared to medical therapies.

Intuitively one would think that going from A-Fib to normal sinus rhythm would increase and improve blood flow to the brain, thereby improving brain function.

And indeed, in this retrospective study, catheter ablation reduced the incidence of dementia by nearly a third (27%) compared to those who tried to control their A-Fib with medication alone.

Ablation Reduced Dementia by 44%!

According to one of the lead researchers, Dr. Gregory Lip of the University of Liverpool (UK), “…successful ablation was significantly associated with a 44% reduced risk of dementia compared to medical therapy…” (But not if the ablation failed.)

Editor’s Comments
Editor's Comments about Cecelia's A-Fib storyImproved blood flow reduces Alzheimer’s. What’s perhaps most important about this study is the reduced risk or incidence of Alzheimer’s disease after a successful catheter ablation for A-Fib.
When people develop Alzheimer’s, it’s considered the end, that there’s very little that can be done to help these patients. But restoring blood flow to their brains seems to prevent or reduce Alzheimer’s.

Can we prevent or reduce Alzheimer’s by improving blood flow to the brain? Could these researchers have discovered a way to cure or improve Alzheimer’s? This could be ground-breaking research!

Resources for this article
Catheter ablation linked to lower incidence of dementia in AF patients. Cardiac Rhythm News. October 7, 2020. https://tinyurl.com/86mnkas2

Hospitalized Pot Users with Arrhythmias at Higher Risk of Death

Marijuana or cannabis is the most commonly used psychoactive substance worldwide. However, there is limited knowledge about the safety of the drug in people with cardiac arrhythmias (i.e., Atrial Fibrillation and abnormally slow or fast heart rate).

Pot Users with Arrhythmias More Likely to Die in Hospital

An observational study of 2.4 million cannabis users hospitalized from 2016-2018 was conducted using the National Inpatient Sample database, which covers 97% of the US population.

Medicinal Marijuana and A-Fib

Marijuana and A-Fib

Examined was the burden of arrhythmias in drug users admitted to hospital. The study also compared length of hospital stay and deaths in hospital between those with and without an arrhythmia.

The study found that cannabis users with an arrhythmia were 4.5 times more likely to die while in hospital than those without an arrhythmia, according to Dr. Sittinum Thangjui of Basset Healthcare Network, Cooperstown, NY.

Patients with an arrhythmia accounted for 7.6% (187,825) of the 2,457,544 adult cannabis users. Atrial fibrillation was the most common arrhythmia, followed by abnormally slow heart rate and abnormally fast heart rate.

“People should …be careful when using cannabis if they have a concomitant heart problem. -Dr. Sittinum Thangjui

The arrhythmia group were older: the average age was 50.5 years compared to 38.3 years for those without an arrhythmia. Those with arrhythmias also had more co-existing health conditions.

“People should be aware of this devastating outcome and be careful when using cannabis if they have a concomitant heart problem” says Dr. Sittinum Thangjui. He didn’t indicate or speculate how or why cannabis use caused or was associated more hospital deaths in patients with arrhythmias.

This research was presented at the EHRA 2021, an online scientific congress of the European Society of Cardiology (ESC).

Editor’s Comments:

Editor's Comments about Cecelia's A-Fib storyAtrial Fibrillation patents who use cannabis be aware. Especially if you are older (50+) and have concomitant health problems such as diabetes, heart failure, chronic kidney disease or obesity.

However, common sense would indicate that these older arrhythmia patients would be more likely to die in the hospital, whether or not they used cannabis. (Only a brief abstract is currently available and not the complete study.)

Resources for this article

• Abstract title: Burden of arrhythmia in hospitalized patients with cannabis use related disorders: analysis of 2016-2018 national inpatient sample.

• People with heart rhythm disorders warned over cannabis use. European Society of Cardiology Press Release, April 23, 2021.

• European Society of Cardiology 2021 Online Congress. https://www.escardio.org/Congresses-&-Events/EHRA-Congress/Scientific-sessions

Doctors Paid for Use of a Manufacturer’s Brand of Implantable Cardioverter-Defibrillator (ICD)

Another study of how Medical device manufacturers manage to pay doctors to prescribe their product, in this case, brands of ICDs. A JAMA study documented that “physicians were most likely to use the ICD brand from the manufacturer who gave them the most money.”

(But it should be noted that there was no association between the amount physicians received and postprocedural complications and/or death.)

Study of Payments to Doctors

In this study patients received a first-time implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) from any of the 4 major manufacturers.

A normal chest X-ray after placement of an ICD

A normal chest X-ray after placement of an ICD

Data came from the National Cardiovascular Data ICD Registry linked with the Open Payments Program’s payment data.

Over a 3-year period (2016-2018), 145,900 patients received these devices. They were implanted by 4,435 physicians at 1,763 facilities. 94% of these physicians received payments from these device manufacturers.

Between 38.5% and 54.7% of patients received devices from the manufacturers who had provided the physicians with the largest payments.

For example, doctors who received the highest payments from “manufacturer A” were about 6-fold more likely to use its product versus an ICD from a  company that didn’t pay them. This is according to Jeptha P. Curtis, MD, and colleagues at Yale School of Medicine in New haven, CT.

“Manufacturer D” did even better at rewarding doctors who used its ICDs. Those receiving the highest payments were 17-fold more likely to use its devices.

Is “Buying Off” Physicians Unethical and/or Illegal?

To this question Dr. Curtis replied:

“Instead I think it represents a softer type of influence. If I have a choice of devices from different manufacturers, and I have financial entanglements with one of them, it stands to reason that I will be more likely, consciously or not, to select that manufacturer, particularly if I do not think there is a difference in device performance.”

Current laws, such as the Anti-Kickback Statute and The Stark Law can be circumvented by saying the payments are for such things as speakers’ fees or travel costs. The Curtis study didn’t examine differences in types of payments such as consulting fees versus food and beverage payments (a definite limitation).

Editor’s Comments
Editor's Comments about Cecelia's A-Fib storyPayments to doctors by device manufacturers (and pharmaceutical companies), however they are justified, undermine the reputation and trust we ought to have in our doctors.
As consumers, we must do all we can to make sure that laws are written or revised to address these payments.

To quote Dr. Curtis, “Patients need to know that decisions regarding their care have been made on the basis of fact and science, not on how much money their physician received from a device company.”

Resources for this article

• Annapureddy, A, et al. Association between industry payments to physicians and device selection in ICD implantation. JAMA, 2020; 324(17):1755-1764. https://jamanetwork.com/journals/jama/article-abstract/2772494 doi:10.1001/jama.2020.17436

• Hlavinka, Elizabeth. Sunshine Act Brings Some Transparency but Little Change—Industry largess to physicians unaffected; strong link between payments and choice of ICD. Medpage Today, November 3, 2020.

• The National Cardiovascular Data Registry (NCDR®): The American College of Cardiology’s (ACC) suite of cardiovascular data registries helping hospitals and private practices measure and improve the quality of care they provide. https://cvquality.acc.org/NCDR-Home/about-ncdr

Book Review: The AFib Cure by John D. Day and T. Jared Bunch

Review by Steve S. Ryan, PhD

Book cover of The AFib Cure by Drs. Day and Bunch

The AFib Cure by Drs Day and Bunch

The AFib Cure: Get off Your Medications, Take Control of your health, and Add Years to Your Life was written by Drs. Day and Bunch for patients with Atrial Fibrillation. The center theme of The AFib Cure is “Food is the best medicine.”

The AFib Cure Focused on Diet

Their list of food prohibitions is more extensive than even by the most fanatical diet gurus. Though the authors acknowledge that this diet doesn’t work well enough. They admit that “about half of our patients can’t reach a drug-free goal (i.e., being A-Fib free) with lifestyle and biomarker optimization (diet) strategies alone.”

An only 50% success rate isn’t acceptable for most Atrial Fibrillation patients, particularly when it comes at such a cost. The authors require superhuman efforts and absolute dedication to their diet.

Food Prohibitions: The AFib Cure diet prohibits a lot. The list includes:

• Alcohol
• Sugar
• Flour, Bread, White Rice
• Coffee/Caffeine
• Stimulants
• Marijuana/THC
• Packaged Processed Food
• Fast Food
• Meat (wild meat OK)
• Fish (limited [5] exceptions)
• Supplements

Is Food a Medicine?

How does the AFib Cure diet work to cure A-Fib? The authors fail to show how physically and/or chemically their diet can cure Atrial Fibrillation. As doctors know, food is not a medicine.

… Continue reading this book review..->

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