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


Treatments

7 Key Points of the new “2023 Guideline for the Diagnosis & Management of Atrial Fibrillation”

This is my second report on the new “2023 Guideline for the Diagnosis & Management of Atrial Fibrillation” published in January 2024. The updated recommendations was a collaborated effort by cardiologists, electrophysiologists, surgeons, pharmacists, patient representatives and other stakeholders. The Guideline was last updated in 2014 and supplemented in 2019.
In my first report, I wrote why the new Guideline is important to all A-Fib patients and covered a few of the important updates. It includes new evidence to guide your cardiologist and electrophysiologist in the treatment of your Atrial Fibrillation.

7 Key Points For Patients to Know

After writing my first report, I continued to study the Guideline (it’s 171 pages after all).

This second report contains several important key points that may influence how you interact with your electrophysiologist and cardiologist. And can affect your choice of which A-Fib treatment(s) is right for you.

To be an informed patient, the main points you should know are:

1. As before, catheter ablation is recognized as first-line therapy for most A-Fib patients.

What that means is that you no longer have to undergo months or a year on antiarrhythmic (drug) therapy before you can have a catheter ablation. Even if you’ve just been diagnosed with A-Fib, you can choose to have a catheter ablation as your first treatment option.

From the Guideline: “Catheter ablation is useful as first-line therapy to improve symptoms and reduce progression to persistent AF.”

“Early rhythm control is associated with a greater likelihood of maintaining sinus rhythm in the long term and minimizing AF burden and reducing the progression of the disease.” And it reduces the likelihood of dementia onset.

2. The Guideline emphasizes the use of catheter ablation (CA) early in the treatment of A-Fib. Studies show an early catheter ablation is beneficial particularly in patients with heart failure.

3. Warfarin is no longer a recommended anticoagulant. Direct oral anticoagulants (DOAC) are preferred over warfarin (with the exception of certain patients with, for example, a mechanical heart valve).

4. Aspirin is no longer recommended as an anticoagulant. “Aspirin…alone as an alternative to anticoagulation is not recommended to reduce stroke risk.”

5. The guideline recognizes that clots take time to form (e.g. “lasting ≥24 hours”). Before, it was thought that even a short A-Fib episode (less than 5 minutes) could cause a clot and stroke.

Under the new guideline, for most patients whose A-Fib episodes last less than 5 minutes should not receive Oral Anticoagulant.

6. Important recognition: The benefits of Left Atrial Appendage Occlusion devices (i.e., Watchman, Amplatzer, etc.) may be a reasonable alternative to an Oral Anticoagulant.

7. The Guideline recognizes that “A-Fib burden” (how severe your A-Fib is and how it affects you) is an important factor in the treatment of your A-Fib.

Read it Yourself

If you haven’t already read it, I recommend you read my first report.

Also, if you want to review the Guideline yourself, the entire document is on the The Journal American College of Cardiology website. It includes a Table of Contents so you can jump to and read a particular section. Footnotes are included and linked to a 32-page Reference section as well as Appendices.

You can also download a copy of the 171 page Guideline as in a .PDF document and review it at your leisure.

Research
• Crawford, Thomas E. et al. 2023 Guidelines for Diagnosis and Management of Atrial Fibrillation: Key Perspectives. American College of Cardiology, Nov. 30, 2023. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2023/11/27/19/46/2023-acc-guideline-for-af-gl-af

• Joglar, Jose A. et al. 2023 ACC/AHA/ACCP/HRS Guidelines for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines Circulation Vol. 149, No.1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193

First-Time Catheter Ablation for Atrial Fibrillation Safer Than Ever

For patients with symptomatic A-Fib, catheter ablation is a commonly performed procedure. However, it does have potential complications. As with any procedure, the informed patient needs to know the risk factors.

To determine the most recent complication rates, researchers did a systematic review and pooled analysis of 89 studies from the past 10 years. Their results were published in May 2023.

Research Methods 

EDLINE and EMBASE databases were searched from January 2013 to September 2022 for randomized control trials that included patients undergoing a first ablation procedure using either radiofrequency or cryoballoon.

A total of 89 studies met inclusion criteria. A total of 15,701 patients were included in the current analysis.

By comparison, the complication rate for the common appendectomy is around 18%.

Survey Findings

Vascular complications (i.e., bleeding and clotting) were the most frequent type of complication (1.31%).

The next most common complications were pericardial effusion/tamponade (i.e., fluid buildup around the heart) (0.78%) and stroke/transient ischemic attack (blood clot to the brain) (0.17%).

During the 10-year period of the analysis, procedure-related complication rates were:
• Overall 4.51%
Severe  2.44%

Comparing the earlier 5-year period to the most recent 5-year period, complication rates were:
• Earlier period: 5.31%
• Most recent period: 3.77%.

Over the 2 time periods, mortality rates were stable.

There was no significant difference as to pattern of A-Fib, ablation technique, or ablation strategies beyond the pulmonary vein isolation.

Researchers Conclusions

When you see the term “catheter ablation” it’s shorthand for pulmonary veins ablation (PVA).
Procedure-related complications and mortality rates associated with A-Fib catheter ablation are low.

Complication rates have declined in the past decade (2013-2022).

A significant improvement in the safety of the procedure was observed over the last 5 years (2018-2022).

Neither the type of energy used for ablation nor the creation of additional lesions in addition to the pulmonary veins significantly influenced the procedural complication rate.

Editor's CommentsWhat This Means for A-Fib Patients

One of the drawbacks of these findings from a patient’s perspective it that it doesn’t differentiate between major and minor complications.

All Complications Are Not Equal: For example, vascular complications (such as bruising or bleeding at the catheter insertion points) are usually minor and easily taken care of with no lasting consequences.

More serious complications are:

Tamponade: Blood can bleed into the pericardium sac that surrounds the heart compressing it. Most centers and Electrophysiologists (EPs) are well aware of this and can move swiftly to drain off the extra blood.

Atrioesophageal Fistula: This is a very rare complication (less than 1 in 1000) but one which can kill you. When a catheter makes an RF burn (lesion) near the esophagus, the heat may damage the esophagus wall which can later be eroded by gastric acids allowing blood to leak into the esophagus. Most centers and EPs now take extensive precautions to prevent this. (The new technology, Pulse Field Ablation, virtually eliminates this complication, see Pulsed Field Ablation—Emerging Tech for Atrial Fibrillation)

Stroke: During a catheter ablation you are on heavy-duty anticoagulants so strokes are rare (0.17%). But as with anyone with A-Fib, strokes can occur.

In this analysis of 89 studies the overall major complication rate was very small.

First-Time Catheter Ablation: The bottom line for us patients is that first-time catheter ablation (PVA) is one of the safest procedures you can have in a hospital. (FYI: By comparison, the complication rate for the common appendectomy is around 18%.)

In practice, for most A-Fib patients, the actual risks are so small that it’s safer getting a PVA than not getting one.

A PVA is safe and afterwards certainly feels a lot better than a life in A-Fib and/or a life on antiarrhythmic drugs and anticoagulants. One reason people get a PVA is so that they don’t have to live the rest of their lives on these drugs.

When choosing to have a catheter ablation, make the effort to find high volume operators and experienced hospitals.

Catheter Ablation is Considered a Low-Risk Procedure: Over 1 million catheter ablations are performed annually in the U.S.

The complication rate has continued to decrease.  In this analysis a significant improvement in safety was observed over the last 5 years.

But Beware of Low-Volume Operators: As patients we need to be aware that complications come mostly from low volume operators (those who perform less than 25 ablations a year), and that 81% of all ablations are performed by low volume operators.

This is important! When choosing to have a catheter ablation, make the effort to find high volume operators and experienced hospitals.

Research
Benali K, Khairy P, Hammache N, et al. Procedure-Related Complications of Catheter Ablation for Atrial Fibrillation. J Am Coll Cardiol. 2023 May, 81 (21) 2089–2099. https://doi.org/10.1016/j.jacc.2023.03.418

New “2023 Guideline for the Diagnosis & Management of Atrial Fibrillation”

Links updated: 12-21-23

Important for all A-Fib patients: The newly issued 2023 Guideline for the Diagnosis and Management of Atrial Fibrillation. The guideline includes new evidence to guide your cardiologist and electrophysiologist in the treatment of your Atrial Fibrillation. It was last updated in 2014 and supplemented in 2019.

Cardiologists, electrophysiologists, surgeons, pharmacists, patient representatives and other stakeholders all collaborated on the updated recommendations.

First issued in 1980, the American College of Cardiology (ACC) and the American Heart Association (AHA) develop and publish these guidelines without commercial support, and members volunteer their time to the writing and review efforts.

ACC/AHA develop and publish these guidelines without commercial support, and members volunteer to write and review them.

ACC/AHA/ACCP/HRS: The 2023 Guideline is endorsed by four medical organizations: American College of Cardiology (ACC), American Heart Association (AHA), American College of Clinical Pharmacy (ACCP), and Heart Rhythm Society (HRS).

A Few of the Important Updates for Patients: I am still reading/studying this document—it’s 171 pages long. Here are a few updates that reflect important shifts in the treatment of A-Fib patients:

• Stages of atrial fibrillation: recognizes A-Fib as a disease continuum that requires a variety of strategies at the different stages;
• A-Fib risk factor: recognizes lifestyle and risk factor modification as a pillar of A-Fib management to prevent onset and progression;
• Catheter ablation of A-Fib: can be first-line therapy; Recognizes the superiority of catheter ablation over drug therapy for rhythm control;
• Left atrial appendage occlusion devices: recognized for safety and efficacy.

Steve Ryan at the 2023 AF Symposium

If you read A-Fib.com regularly, you know these topics have filled my posts for years. I write about these topics after reading the newest research, evidence and findings, querying the experts and learn the latest innovations at the annual AF Symposiums from presentations by leading electrophysiologists, cardiologists, scientists and researchers (read my 2023 AF Symposium posts).

I’ll write more about these changes.

You Can Read it Yourself. It’s available on the websites of the American College of Cardiology (JACC.org) and the American Heart Association (ahajournal.org).

Newly released: 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines; Issued by American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines; See www.jacc.org or www.aha.org.

 

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.

“Non-cardiac Surgery” means any surgery that doesn’t involve the heart.

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.

For patients with Atrial Fibrillation, any surgery is riskier than for patients without A-Fib.

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 CommentsEditor’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.

References
• Prasadam S. et al. Preoperative Atrial Fibrillation and Cardiovascular Outcomes After Noncardiac Surgery. JACC Journals, Vol. 79 No. 25. https://www.jacc.org/doi/10.1016/j.jacc.2022.04.021

• Waterford and Ad. 7 Pillars of Postoperative Atrial Prevention. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. Editorial. November 25, 2021. https://pubmed.ncbi.nlm.nih.gov/34823388/ doi: 10.1177/15569845211043485.

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 CommentsEditor’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.

References
• Cacioppo, F. et at., Association of Intravenous Potassium and Magnesium Administration With Spontaneous Conversion of Atrial Fibrillation and Atrial Flutter in the Emergency Department. JAMA Network Open. 2022;5(10):e2237234.

• Wilson, M.G. et al. Clinical preference instrumental variable analysis of the effectiveness of magnesium supplementation for atrial fibrillation prophylaxis in critical care. www.nature.com/scientificreports. (2022) 12:17433. https://doi.org/10.1038/s41598-022-21286-1.

 

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!

Research
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.

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.

Reference
Reinsch, N. et al. Cerebral safety after pulsed field ablation for paroxysmal atrial fibrillation. Science Direct, Heart Rhythm, Available online 17 June 2022. https://www.heartrhythmjournal.com/article/S1547-5271(22)02090-2/fulltext. https://doi.org/10.1016/j.hrthm.2022.06.018

 

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.

References
• 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, https://academic.oup.com/cardiovascres/advance-article/doi/10.1093/cvr/cvac196/7005367. https://doi.org/10.1093/cvr/cvac196

• 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. https://www.pharmacytimes.com/view/clinical-overview-asundexian-for-secondary-prevention-in-patients-with-non-cardioembolic-ischemic-stroke

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.

 

Follow Us
facebook - A-Fib.comtwitter - A-Fib.comlinkedin - A-Fib.compinterest - A-Fib.comYouTube: A-Fib Can be Cured! - A-Fib.com

We Need You Help A-Fib.com be self-supporting-Use our link to Amazon  

A-Fib.com is a
501(c)(3) Nonprofit



Your support is needed. Every donation helps, even just $1.00.



A-Fib.com top rated by Healthline.com since 2014 

Home | The A-Fib Coach | Help Support A-Fib.com | A-Fib News Archive | Tell Us What You think | Press Room | GuideStar Seal | HON certification | Disclosures | Terms of Use | Privacy Policy