Doctors & patients are saying about ''...

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

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

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

Jill and Steve Douglas, East Troy, WI 

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

Faye Spencer, Boise, ID, April 2017

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

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

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

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

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

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

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

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

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

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

Ira David Levin, heart patient, 
Rome, Italy

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

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

Parlay an Ablation to Keep Dementia Away

I have written about studies documenting that A-Fib leads to or causes dementia. How A-Fib doubles the risk of dementia. And that there’s a direct cause and effect relationship, independently relating A-Fib to cognitive decline and dementia.

Good news! A recent research study tells us there’s a way to break that link.

Observational Study: Ablation Reduces Dementia

In a fascinating observational study from Turin, Italy, catheter ablation for A-Fib was associated with a nearly 50% reduction in dementia during a 4.5-year follow-up.

The researchers looked at four observational studies from 2020-2021 that included 40,146 patients of whom 11,312 had catheter ablation for A-Fib.

Compared to patients who developed dementia, they found having a catheter ablation for A-Fib reduced the risk of developing dementia by 50%!

Researchers concluded: ”Correct management of the arrhythmia holds the potential to delay or avoid cognitive decline occurrence.”

Important Research Findings for Patients with A-Fib!

We know that going from A-Fib to normal sinus rhythm increases and improves blood flow to the brain. So it’s intuitive to suppose that improving brain function would reduce the risk of dementia.

A-Fib patients who have a catheter ablation may now add another benefit to becoming A-Fib free, they may also significantly reduce the risk of developing dementia!

Seek Your Cure and a Two-For-One

If you have A-Fib, don’t settle for a life on meds. Don’t just “manage” your A-Fib. Seek your Cure.

A two-for-one! If your path to a cure includes a catheter ablation, you may also be reducing your risk of developing dementia. That’s a double whammy!

Saglietto A, et al. Association of Catheter Ablation and Reduced Incidence of Dementia among Patients with Atrial Fibrillation during Long-Term Follow-Up: A Systematic Review and Meta-Analysis of Observational Studies. J Cardiovasc Dev Dis. 2022 Apr 30;9(5):140. doi: 10.3390/jcdd9050140. PMID: 35621851; PMCID: PMC9143892.

COVID-19 Increases Odds of Developing A-Fib

It’s unfortunate but we have to add developing A-Fib to the list of effects of having COVID-19.

A retrospective study from the Mass General Brigham hospital system in Boston studied the risk of hospitalized COVID patients to develop onset of atrial fibrillation. The study used data from between March 1, 2020 and February 28, 2021 and matched 11,004 COVID-19 negative patients to 2,283 COVID-19 positive patients.

They found that COVID-19 positive patients had 19% higher odds of developing Atrial Fibrillation compared to COVID-19 negative patients. And 57% higher odds of developing A-Fib compared to pre-pandemic patients.

Sad to say, during this world-wide pandemic, a greater risk of developing Atrial Fibrillation is yet another fallout of COVID-19 disease.

Treatment for Familial A-Fib: We know that Atrial Fibrillation runs in families. Recent data suggests that up to 30% of atrial fibrillation patients may have a family history of the condition. This includes offspring too.

For more about Familial A-Fib, see: Inherited (Familial) A-Fib: My Top 5 Articles

If you have A-Fib and a blood relative develops COVID-19, there is treatment to reduce their chance of developing A-Fib.  An antiarrhythmic medication can be prescribed on a temporary basis to prevent or better control early on-set A-Fib. Talk with them and their doctor about this treatment.

A-Fib Patients: When you have A-Fib, the risk for complications is elevated. Get vaccinated against COVID-19 and keep up with your booster shots. To avoid making your A-Fib worse, do everything you can to avoid catching COVID-19.

Wollborn, J, et al. COVID-19 increases the risk for the onset of atrial fibrillation in hospitalized patients. Scientific Reports 12, Article number: 12014 (2022).

Go to Free Report; download PDF.

Pulsed Field Ablation Proves Safe Without Cerebral Complications

We have written many articles on Pulsed Field Ablation (PFA), a new and very effective treatment option for the ablation of A-Fib. (For a background on PFA, see my post: Pulsed Field Ablation—Emerging Tech for Atrial Fibrillation.)

PFA continues in clinical trials, is awaiting FDA approval in the U.S. (expected in 2024), and is already in daily use in some countries.

Previous studies have shown that PFA performs catheter ablation effectively with no adverse effects, such as coronary artery stenosis, persistent phrenic nerve palsy, or esophageal damage. PFA doesn’t damage surrounding non-cardiac tissue.

But what about cerebral damage?

Thermal (RF) Ablation: Silent Cerebral Lesions

When using thermal ablation (Radio Frequency), procedure-associated stroke, while rare, can be among the most severe disabling complications of RF ablation.

Recent studies using magnetic resonance imaging (MRI) have shown the occurrence of silent cerebral lesions and/or events with possible cerebral complications using RF ablation.

Are there cerebral complications with Pulsed Field Ablation as the energy source?

Pulsed Field Ablation: No Neurological Problems

In a small (though probably definitive) study from Germany, 30 patients with symptomatic paroxysmal A-Fib received a Pulmonary Vein Isolation using Pulsed Field Ablation energy. Stroke scores, using the National Institutes of Health Stroke Scale, were assessed before the ablation and afterwards at 2 days and 30 days.

One day after receiving their Pulsed Field Ablation, patients underwent a cerebral MRI. Of patients, 97% showed no silent cerebral lesions or events. One patient did have a single, newly visible, asymptomatic, transient brain lesion. But forty days after the procedure, a follow-up MRI scan showed complete regression of the lesion.

None of the patients receiving the Pulsed Field Ablation had any neurological deficits.

Editor's CommentsEditor’s Comments:

Yet another study demonstrating the neurological safety of Pulsed Field Ablation (PFA). This study from Germany, used MRI to detect possible brain damage and found that PFA produced no neurological problems.
In practical terms, PFA is safer than current ablation energy sources.

Pulsed Field Ablation is a true game changer! I repeat my previous prediction that Pulsed Field Ablation will supersede all other types of catheter ablation for A-Fib.

Reinsch, N. et al. Cerebral safety after pulsed field ablation for paroxysmal atrial fibrillation. Science Direct, Heart Rhythm, Available online 17 June 2022.


Post-Operative A-Fib Happens Too Often and is Dangerous

A friend of ours had to undergo heart bypass surgery. Though I forewarned him, he did go into A-Fib after surgery. It’s called Post-operative A-Fib (POAF).

Why did this happen? The surgeon didn’t pretreat him before the surgery so that he wouldn’t get A-Fib.

Fortunately, after the surgery, the surgeon did put him on a protocol (amiodarone for a short time) that did bring him back into normal sinus rhythm. Luckily, he has remained free of A-Fib. Not all surgery patients are so lucky. 

Post-operative atrial fibrillation (POAF) is a well-recognized consequence of surgery.

Post-operative atrial fibrillation (POAF) is a well-recognized consequence of surgery.

Nonetheless, doctors tend to view Post-Operative A-Fib as a benign event, triggered by the stress of the surgery.

Observational Study: How Often Does POAF Occur?

In an observational retrospective study of nearly 3 million patients, researchers collected data on health claims from 2016 to 2018 for discharges from acute care hospitals across 11 states in the USA.

Patients were followed up for an average (median) of 1.7 years. The researchers adjusted their analyses to account for factors that could affect the results such as age, sex, race, insurance status, medical history and body mass index.

Study Findings: Among 76,536 patients who underwent heart surgery, 14,365 (18.8%) developed A-Fib.

Patients who underwent heart surgery, 18.8% developed A-Fib.

Among 2,929,854 patients without a history of heart disease who had surgery for non-heart-related conditions, 23,763 (0.8%) developed A-Fib.

The risk of hospitalization for heart failure for both groups of patients increased regardless of whether or not the surgery was for a heart condition. (Increased by a third and doubled, respectively.)

Risks of Post-Operative A-Fib

Occurrence rates of POAF are difficult to generalize as they vary by the type of surgery. It’s been estimated that Post-Operative A-Fib (POAF) occurs in as high as 64% of patients undergoing heart surgery (and from a low of 0.4% to a high of 26% of patients undergoing non-cardiac surgery.

Evidence is emerging that Post-Operative A-Fib is linked to longer term problems such as stroke and death from any cause and increased risk of hospitalization for heart failure. And may require more aggressive treatments for other risk factors such as high blood pressure, diabetes and narrowing of the arteries.

Editor's CommentsEditor’s Comments

These findings add to a growing body of literature suggesting that POAF is not just a transient response to surgery.
Post-Operative A-Fib and Heart Failure: The most disturbing point of this study is that post-operative A-Fib is linked to an increased risk of hospitalization for heart failure.
Insist on Use of Protocols: Anyone having surgery should make sure their surgeon knows about and uses protocols to prevent A-Fib after their surgery. They should insist on pre-op treatment.
It’s a shame that most surgeons don’t know about or use these protocols, it’s so simple to do.
To learn about pre-op treatments, go to my post, Having Surgery? Post-Operative A-Fib & Protocols to Prevent it.


• Goyal, P., et al. Post-operative atrial fibrillation and risk of heart failure hospitalization, European Heart Journal, Volume 43, Issue 31, 14 August 2022, Pages 2971–2980,

• Middeldorp, M. et al. Post-operative AF and heart failure hospitalizations: what remains hidden in patients undergoing surgery, European Heart Journal, Volume 43, Issue 31, 14 August 2022, Pages 2981–2983,

• Goyal, P. et al. AF after surgery is linked to an increased risk of heart failure hospitalization. Cardiac Rhythm News, June 29, 2022.

• Lopes LA, Agrawal DK. Post-Operative Atrial Fibrillation: Current Treatments and Etiologies for a Persistent Surgical Complication. J Surg Res (Houst). 2022;5(1):159-172. doi: 10.26502/jsr.10020209. Epub 2022 Mar 28. PMID: 35445200; PMCID: PMC9017863.

• Joshi KK, et al. Postoperative atrial fibrillation in patients undergoing non-cardiac non-thoracic surgery: A practical approach for the hospitalist. Hosp Pract (1995). 2015;43(4):235-44. doi: 10.1080/21548331.2015.1096181. PMID: 26414594; PMCID: PMC4724415

• Welker, C. C. et al. Postoperative Atrial Fibrillation: Guidelines Revisited. Editorial, Journal of Cardiothoracic and Vascular Anesthesia. August 1, 2023. DOI:  

New Anticoagulant with less Bleeding Risk―Asundexian Factor XI (Bayer)

Today’s anticoagulants (DOACs-Direct Oral Anticoagulants) have a residual risk of major bleeding of 1.5-3.6%/year. That means that after stopping a DOAC anticoagulant, the effects can continue to affect you for 1½ to 3½ years afterward.

The result is you continue to be at a higher risk of major bleeding even though you are no longer taking the anticoagulant.

Alarming, bleeding events remain a high risk for you.

These bleeding events are associated with increased mortality, high costs, and compromised adherence to treatment. Especially for patients 65 and older, anticoagulants increase the risk of hemorrhagic-type strokes. (For more about anticoagulants, see my post: Anticoagulants Increase Risk of Hemorrhagic-Type Strokes.)

Pacific-AF clinical trials

Drug to Reduce Bleeding Event in Clinical Trial

Currently the PACIFIC-AF clinical trials is studying Asundexian, a new anticoagulant. Asundexian is an oral factor XI (FXIa inhibitor). Early clinical results indicate that FXIa inhibition works to prevent stroke with reduced bleeding risk. Clinical trials and phases are continuing.

If FXIa inhibition proves to be safer and as effective as existing DOACs, it would be a major advance in stroke-prevention therapy.

• Sandro Ninni, Stanley Nattel. Factor xia inhibition in atrial Fibrillation: insights and knowledge gaps emerging from the PACIFIC-AF trial. Cardiovascular Research, cvac196. January 25, 2023,

• Piccini JP, et al. PACIFIC-AF Investigators. Safety of the oral factor XIa inhibitor asundexian compared with apixaban in patients with atrial fibrillation (PACIFIC-AF): a multicentre, randomised, double-blind, double-dummy, dose-finding phase 2 study. Lancet. 2022 Apr 9;399(10333):1383-1390. doi: 10.1016/S0140-6736(22)00456-1. Epub 2022 Apr 3. PMID: 35385695.

• Rhoads, Allison T. Clinical Overview: Asundexian for Secondary Prevention in Patients With Non-Cardioembolic Ischemic Stroke Pharmacy Times. May 16, 2022.

My A-Fib Update: Touch-Up Ablation and Closure of My Left Atrial Appendage

Background: I received my first catheter ablation back in 1998 at Bordeaux, France where they invented the procedure. (I was their first US patient.) After this ablation, I was A-Fib free for over 21 years. This is an update to my own A-Fib story (Story #1 under Personal A-Fib Stories of Hope.)

In 2018 my GP detected an irregular heartbeat, though I was unaware of it and had no symptoms. I had a Medtronic Reveal LINQ Insertable wireless loop recorder/monitor installed. (See Has My A-Fib Returned?)

Steve Ryan with Dr. Natale and his nurse before his ablation.

It eventually showed that my A-Fib had reoccurred−at age 80. This wasn’t surprising to me since my ablation procedure back in 1998 was primitive compared to what’s being done today. At that time, none of my Pulmonary Veins (PVs) were completely isolated.

I had a “modern” ablation in 2019 and was much improved. But my loop recorder showed Very Late Recurrence of A-Fib—I still had paroxysmal A-Fib.

Very Late Reoccurrence and the Left Atrial Appendage (LAA)

Recent research shows that the Left Atrial Appendage (LAA) is responsible for a great deal of A-Fib recurrence, (See LAA Under-Recognized Trigger).

Dr. Andrea Natale performed my re-do, touch-up  ablation on August 19, 2021 at Los Robles Hospital in Thousand Oaks, CA. He isolated both my LAA and coronary sinus and other areas of my heart which had developed non-PV triggers. (See A-Fib Free Again.)

Need to Close Off My LAA

Unfortunately, the ablation work done on my LAA reduced its ability to contract properly. I was aware of this potential problem and discussed it with Dr. Natale. Because my LAA wasn’t contracting properly, there was a greater danger of forming an A-Fib clot there. But instead of going on heavy-duty anticoagulants for life, I opted fer a Watchman occlusion device to close off the LAA. So, a few weeks later I had the Watchman installed.

A-Fib Free, Once Again!

After my LAA was closed off I was on ½ dose Eliquis for a while. They also did a CT scan June 27, 2022 to make sure the Watchman was seated properly and didn’t have any leaks.

I’m now once again, A-Fib free! All is well.

My Battery Died!

LUX-Dx implantable loop monitor

My doctor continues to monitor my heart through my LINQ loop recorder (a tiny cardiac monitor implanted just under the skin near my heart). In June, the battery on my 3 year old Reveal LINQ loop recorder died. I now have a newer version (Boston Scientific LUX-Dx). It was installed by Dr. Shephal Doshi at St. John’s in Santa Monica, CA on July 7, 2022. This one should last 4½ years.

Technology marches on! My old loop record used a recording/transmitting device at my bedside. This new one seamlessly sends the daily data to my cell phone, then to Dr. Doshi for review. All has been quiet since.

Editor’s Comments

Editor's Comments

A-Fib Recurrence is Discouraging, But it Happens. It’s certainly discouraging to have A-Fib reoccur after 21 years. But on the positive side, I had 21 years of being A-Fib free! I was able to lead a normal, very active life (running, sprinting, high jumping, lifting weights, swimming, participating in track meets, etc.) I didn’t worry about A-Fib reoccurring and was surprised when it did at age 80. (In cancer research, anyone who is in remission for 5 years is considered cured. The same should hold for A-Fib.)
Why Does A-Fib Reoccur? We don’t know why A-Fib reoccurs in a small number of patients. It’s probably related to aging. But the good news is that EPs today know how to fix it and restore people to normal sinus rhythm.
Running on All Cylinders! I’m back to normal, running with no A-Fib. I may have lost some heart pumping ability when my Watchman was installed to close off my LAA. But it doesn’t seem to have much of or any effect. Curing my A-Fib was much more important.  My speed isn’t what it used to be. But I am 81 years old and also had to have my left hip replaced two years ago which by itself made me seconds slower.
The bottom line is that, even though at age 81 I’m well past “my expiration date”, I’m in great health and am very active. I can’t thank enough all the EPs and researchers who made this possible.
Select an EP Who Maps and Ablates the LAA.  No matter what kind of A-Fib you have, if closing off your LAA, make sure your EP knows how, is experienced at, and routinely maps and ablates the LAA. This may produce a more successful ablation and save you from a recurrence of A-Fib.
Concurrent Installation? Today, there is a trend toward closing off the LAA at the same time as your catheter ablation. If you are considering a catheter ablation, I urge you to discuss this issue with your EP.
To learn more about the Left Atrial Appendage, see my article, The Role of the Left Atrial Appendage (LAA) & Removal Issues.

Click on photo to browse the over 100 patient stories of Personal A-Fib Stories of Hope.

2023 AF Symposium Spotlight: Ground-Breaking LAA Elimination Device

For A-Fib patients, perhaps the most innovative and potentially ground-breaking presentation at this year’s AF Symposium was by Dr. Saibal Kar of Cardiovascular Associates at Los Robles Hospital in Thousand Oaks, CA.

Laminar LAA closure device

In a Spotlight Session on Friday, he described a new device for closing off (“eliminating”) the Left Atrial Appendage (LAA). The LAA is where 90%-95% of Atrial Fibrillation clots and strokes come from.

The Laminar LAA elimination device is a potential medical breakthrough innovation! It takes little time to insert, it could be positioned at the same time as a catheter ablation. This could revolutionize the way LAAs are closed off today.. Learn all about it in my report: Spotlight Session: Laminar LAA Closure/Elimination Device.


Study of Dementia Risk: Catheter Ablation for A­-Fib Versus Drug Therapy Alone

Historically, dementia in patients with A-Fib was attributed to strokes.

Recently it has become clear that A-Fib is associated with multiple forms of dementia even in the absence of stroke.

… A-Fib is associated with multiple forms of dementia even in the absence of stroke.
According to research, dementia may be attributable to alterations in neurological hemodynamics and brain activity that are associated with both dementia and depression.

As anyone with an aging loved one suffering from dementia can tell you, dementia is a major health problem. In the U.S., dementia is predicted to affect more than 10.5 million Americans by 2050.

Research: Risks of Ablation vs. Drug Therapy

In an observational study, researchers compared A-Fib patients who had a catheter ablation to those treated with drug therapy alone.

They used the 2010 to 2021 data from a large, nationally representative claims database (Optum Clinformatics Data) to identify 19,088 A-Fib patients. They then divided these patients into two groups: those receiving a catheter ablation vs those receiving anti-arrhythmic drug (AAD) therapy alone.

Findings: Risks of Dementia and Mortality

Dementia Risk: They found that catheter ablation for A-Fib was associated with a 41% lower risk of dementia compared to patients treated only with anti-arrhythmic drug therapy. This dementia risk reduction held across both males and females.

A lower Mortality Risk means you are less likely to die prematurely from one cause versus any other cause of death.

Mortality Risk: Though not studied as a primary outcome, researchers found patients treated with catheter ablation also had a 49% lower rick of mortality compared with anti-arrhythmic drug therapy only.

What This Means to Patients

Catheter Ablation, by reducing the risk of dementia by 41%, is a major advance in our knowledge about health care for A-Fib patients.

This is yet another reason to get a catheter ablation ASAP in order to be A-Fib free.

Zeitler, E. et al. Comparative risk of dementia among patients with atrial fibrillation threated with catheter ablation versus anti-arrhythmic drugs. Science Direct, American Heart Journal, Available online 20 September 2022.

A-Fib and Dementia: Neither is a normal part of growing older.

2023 AF Symposium: Live Case from Dublin using Pulsed Field Ablation and Multispline Catheter

LIVE live from Dublin, Ireland—it was like we were in the EP lab with Drs. Joseph Galvin and Gabor Szeplaki from Mater Private Hospital in Ireland.

They perform 800-900 ablations/year and have done 268 cases of Pulsed Field Ablation (PFA) using the Boston Scientific Farapulse system. Amazingly, these ablation average 40 minutes in length—a very short time to perform an ablation (and no complications).

The patient was a 66-year-old woman who had developed symptomatic paroxysmal A-Fib three years ago, medications were poorly tolerated.

The first thing we noticed was, instead of the typical Lead apron shields to protect against Fluoroscopy radiation, they were wearing what looked like plastic vests which were leadless (but did provide radiation protection).

As we watched from Boston… . Read my full blow-by-blow report, see Live Case Presentation from Dublin, Ireland. Pulsed Field Ablation for AF Using a Multispline Catheter.

A-Fib Patients with Sleep Apnea: Philips Respironics Recall of CPAP Devices

Background: A-Fib patients often have obstructive sleep apnea as well. Many use a Continuous Positive Airway Pressure (CPAP) device when sleeping to keep their air way open and unobstructed.

The FDA Safety Commission and NST Attorneys-at-Law report that Philips has recalled their CPAP devices because of “identified potential health risks related to the polyester-based polyurethane sound abatement foam component of these devices.” The foam in the machine can break down and then be swallowed or inhaled by the user.

According to Philips’ lab results, degraded polyurethane foam produced potentially harmful chemicals. These chemicals may then enter one’s body, reach the bloodstream, and travel to any body tissue and organ. Most of these harmful chemicals from the degraded foam can cause cancer.

All CPAP Users

If you use a different brand of CPAP device, check the tubing. Or talk to your supplier about how safe your device is in light of the Phillips recall.

If You Have a Philips CPAP Device

For detailed information about this recall, go the NST Attorneys-at-Law web site or Philips Voluntary Recall Information to:

  • Determine if your product is listed in the Philips recall notification
  • Learn how to Register Your Device For Recall and What To Expect Next

Talk to Your Doctor: The U.S. Food and Drug Administration (FDA) advises consumers to talk to their doctor to weigh the risks of continued use and decide on a suitable way to move forward.

A-Fib, Sleep Apnea and CPAP: What You Need to Know

If you have a Phillips CPAP device, learn if you have a model that has been recalled. If so, stop using it and talk with your doctor on how to proceed.

If you model has been officially recalled, Philips should give you a new one. But you may be safer switching to another CPAP manufacturer.

Visit the Philips Voluntary Recall Information website to stay current on your claim.

• UPDATE: Certain Philips Respironics Ventilators, BiPAP Machines, and CPAP Machines Recalled Due to Potential Health Risks: FDA Safety Communication.

• Voluntary Recall Information: Philips Respironics Sleep and Respiratory Care devices.

• CPAP and Cancer. NST Attorneys-at-Law.

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