Doctors & patients are saying about 'A-Fib.com'...
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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
A-Fib Patients: Know Your Risk During Non-Cardiac Surgeries
For patients with Atrial Fibrillation, any surgery is riskier than for patients without A-Fib. That’s the finding of a 2022 study.
In a study from the Cleveland Clinic, patients with A-Fib undergoing non-cardiac surgery were associated with higher risks of mortality, heart failure, and stroke.
Study Parameters: Non-cardiac surgery was classified as vascular, thoracic, general, genitourinary, gynecological, orthopedics and neurosurgery, breast, head and neck, and transplant. (Basically any major surgery not involving the heart.)
Participants included 8,635,758 Medicare patients admitted from 2015 to 2019 for various surgeries not involving the heart (non-cardiac surgery). Out of this number of patients, 16.4% of patients had A-Fib at the time of their surgery.
Focus of the Study: Did post-surgery adverse events differ for A-Fib patients compared to the other participants?
Findings: The study found that pre-existing A-Fib is independently associated with postoperative adverse outcomes after surgery. These include increased risk of stroke, heart failure and other heart-related complications.
Editor’s Comments
Established Protocols: There are well established and known protocols to prevent, diminish or neutralize A-Fib when undergoing noncardiac surgery. The researchers, Waterford and Ad, state that preoperative oral amiodarone is the single most powerful intervention to dramatically reduce rates of POAF.
They recommend 400 mg oral amiodarone per day for 3 days prior to surgery, followed by 200 mg per day for 10 days through and following the operation regardless of whether or not POAF developed. It’s recommended that a patient be on a beta-blocker or a statin whenever possible.
Ideally, Become A-Fib Free Before the Surgery: If you have A-Fib and have to undergo non-cardiac surgery, try to become A-Fib free before the surgery. (This is even more important if undergoing cardiac surgery such as bypass).
Medication Adjustment: Even if you can’t have a catheter ablation, your EP can often adjust your meds so that you are A-Fib free at the time of the noncardiac surgery.
Proper Pre-Op Treatment: If it isn’t possible to be A-Fib free before the your surgery, make sure your surgeon knows about and uses protocols to prevent and diminish the effects of A-Fib on non-cardiac surgery. See Having Surgery? Post-Operative A-Fib & Protocols to Prevent it.
Be Insistent! Be Assertive! Be aware that many surgeons (and their staff) don’t know about or use these protocols.
If you’re told by the surgeon’s office staff to “Don’t worry about that.” or “The surgeon is very experienced,” don’t settle for platitudes.
You may have to be very assertive with your surgeon to make sure they understand your concerns and treat you properly before the surgery.
It’s Okay to Fire Your Surgeon: If your surgeon won’t work with you, there are many surgeons who will. It’s okay to fire your surgeon, and find another one who will address these concerns.
Magnesium Works in ERs to Reduce Risk of A-Fib or Return to Normal Sinus Rhythm
In the United Kingdom, it is common practice in critical care (E.R.) to administer serum magnesium to prevent A-Fib or to return patients to normal sinus rhythm.
This isn’t commonly done in the U.S.
UK ER Study: Magnesium Used in the ER to Prevent A-Fib
Research published in 2022 describes a study done of an adult critical care unit/emergency department (casualty) at the University College London Hospital between January 2016 and December 2017.
This single center observational study examined the preferences of critical nurses using Mg in patients who had undergone non-cardiac surgery.
Of 9,114 opportunities to administer intravenous Magnesium (Mg), there were significant variation practices depending on the individual nurses.
But still, intravenous Mg was associated with a 3% decrease in the relative risk of getting A-Fib after non-cardiac surgery.
Austrian ER Study: IV Magnesium Returns Normal Sinus Rhythm
A study from Vienna, Austria, looked at 2,546 episodes of non-permanent A-Fib in the emergency room (ER). Admission of Intravenous Magnesium (145.8 mg) and Potassium (24 mEq) were compared to no administration of either supplement.
Researchers found that Intravenous Magnesium and Potassium was associated with increased odds of returning patients to normal sinus rhythm (19.2% vs 10.4%) (but didn’t affect A-Flutter.)
Editor’s Comments
Though the above studies differ, they both show that administering Intravenous Magnesium in the ER is an effective tool in avoiding A-Fib or in returning A-Fib patients to normal sinus rhythm.
Some ERs in the U.S. do use Magnesium to return patients to normal sinus rhythm. (But many doctors still consider Magnesium [and most supplements] as little more than snake oil.)
This research is encouraging and indicates that Magnesium can be a useful tool with critical care patients. More research is needed.
What This Means for A-Fib Patients: If you wind up in the emergency room or urgent care for your Atrial Fibrillation, ask if they intend to administer an IV of Magnesium. (If not, why?)
For more about Magnesium, see my article, Cardiovascular Benefits of Magnesium: Insights for Atrial Fibrillation Patients.
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!
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 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.
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.
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
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.
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.
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.
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.
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.
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.
