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

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

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

Surprise—I Didn’t Feel a Thing

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

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

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

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

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

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

Remember: Your Best Patient Advocate is You

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

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

What is a Pacemaker?

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

Source: Pacemaker illustration from solarstorms.org

Source: Pacemaker illustration from solarstorms.org

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

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

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

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

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

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

Considering a Pacemaker: Pros and Cons

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

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

Illustration showing placement of the Medtronic Mica leadless pacemaker

Illustration showing placement of the Medtronic Mica leadless pacemaker

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

Hitting the Pause Button on a Pacemaker for Now

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

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

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

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

VIDEO: Pacemakers—Traditional and Leadless Explained

Dr.Peter Santucci, is a cardiologist with Loyola University Medical Center; He describes the traditional pacemaker and it’s installation using graphic animations. Then compares with the miniaturized leadless version. 2:30 min. Posted by Loyola Medical.

YouTube video playback controls: When watching this video, you have several playback options. The following controls are located in the lower right portion of the frame: Turn on closed captions, Settings (speed/quality), Watch on YouTube website, and Enlarge video to full frame. Click on arrow  icon to select.

If you find any errors on this page, email us. Y Last updated: Friday, August 16, 2019

Return to Instructional A-Fib Videos and Animations

My A-Fib RF Catheter Ablations: 1998 vs 2019

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

More Differences Between 1998 and 2019

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

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

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

Second Time Around: My A-Fib Catheter Ablation Prep

Steve Ryan pre-op A-Fib ablation

Pre-op: Steve with nurse inserting IV

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

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

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

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

Out Like a Light

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

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

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

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

Post-Ablation Recovery

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

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

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

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

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

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

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

Meds: Pantoprazole and Xarelto

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

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

Recovering at Home

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

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

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

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

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

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

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

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

Look for my post with the details on Monday.

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

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

 

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

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

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

Medtronic Reveal LINQ insertable heart monitor

Medtronic Reveal LINQ

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

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

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

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

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

My A-Fib Recurrence Not Surprising

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

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

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

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

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

Strenuous Lifestyle: 20 Years is Not Enough

Steve Ryan - sprint training

Steve Ryan sprint training

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

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

I want another 20 years!

Choosing Ablation Rather Than A-Fib Drugs

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

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

Today’s Advanced Mapping Techniques

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

Dr Fishel RF catheter ablation video

Ablation 3-D modeling screen

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

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

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

Your Positive Thoughts and Prayers Please!

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

Ridding myself of that demon ‘A-Fib Zebub’

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

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

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

Considering a LAA Occlusion Closure? Watch Out for Nickel Allergy

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

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

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

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

Nickel in Occlusion Devices

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

Heart illustration showing the Left Atrial Appendage

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

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

Hyper-sensitivity Diagnostic Test Results

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

Below is a sample of test results showing nickel sensitivity:

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

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

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

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

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

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

Can One Have a Stroke If A-Fib Free? Years After Successful Ablation, He has TIAs

Steve from Minnesota had a successful catheter ablation in 2016 at the Mayo Clinic. He remained in normal sinus rhythm (NSR), off all medications and felt very good. He walked every day and felt well.

TIA symptoms are the same as a stroke, and usually begin suddenly. The difference is the symptoms only last for a few minutes or hours as the blockage is temporary.

Recently he wrote to me that in the fall of 2018, he had a TIA (Transient Ischemic Attack, a temporary stroke) where his left arm went limp for about 30-60 seconds. Then in March 2019, another TIA caused him to lose complete vision in his left eye for 2-3 minutes.

In response, his electrophysiologist (EP) put him on the anticoagulant Eliquis. He wore a loop monitor which showed he was in normal sinus rhythm with only a single “5-beat atrial tachycardia” (only one irregular beat). All the usual tests came back showing no heart problems.

How can Steve have TIAs if he doesn’t have any A-Fib?

Unfortunately for A-Fib patients, clots and stroke can also be non-A-Fib related, such as vascular strokes or hypertensive lacunar stroke. (Vascular and cerebrovascular disease can produce a heart attack or coronary event as well as a clot or stroke.)

With A-Fib patients, clots more often come the Left Atrium and Left Atrial Appendage (LAA). But stroke can originate from other areas. For example, plaque deposits in the arteries can break loose and form clots.

Also, if Minnesota Steve developed some fibrosis while he was in A-Fib, his left atrium may not be contracting properly making clot formation more possible. And sometimes if the LAA is electrically isolated during the ablation, it may not be contracting properly and can develop clots.

(Doctors may want to check Minnesota Steve for Patent Foramen Ovale and Atrial Septal Defect where a hole in the septum can permit clots to pass to the brain. Though, normally, this problem would have been found when performing Steve’s original ablation.

A transient ischemic attack (TIA) occurs when part of the brain experiences a temporary lack of blood flow. This causes stroke-like symptoms that resolve within 24 hours. Unlike a stroke, a ministroke on its own doesn’t cause permanent disabilities.

Would a Watchman device to close off the LAA prevent these TIAs?

Not necessarily. For patients with A-Fib, clots tend to form in the Left Atrial Appendage (LAA) because blood tends to stagnate there. But if blood is being pumped properly in the left atrium, it’s harder for clots to form in the LAA. (And other areas of clot formation can occur in the left atrium besides the LAA.)

What should Steve do now? What can he do to guarantee that he will never have a stroke?

Having TIAs is a warning sign. Often, but not always, TIAs precede a major stroke. To help guard against clots and stroke, Minnesota Steve will likely have to be on an anticoagulant, such as Eliquis, for life.

What’s Next for Steve?

Minnesota Steve and his doctor should concentrate on treating vascular risk factors such as blood pressure, diabetes, cholesterol control, (CHADs2-VASc) and if needed, stop smoking. And, of course, continue monitoring for A-Fib.

Fibrosis makes the heart stiff, less flexible and weak, overworks the heart and reduces pumping efficiency.

Minnesota Steve probably should have an MRI done to measure for fibrosis in his heart. In addition, his Left Atrial Appendage (LAA) should be checked with a echocardiograph (TEE) to see if it is emptying properly.

His doctor may also want to determine how much plaque Minnesota Steve has in his arteries. How likely is it to break off and form clots? (Some doctors may suggest antiplatelet therapy in addition to the anticoagulant Eliquis, but usually the two are not combined effectively.)

I’ll continue to track Minnesota Steve’s progress and write an update if I get more information on his health status.

No Absolute Guarantee Against Stroke

While anticoagulants significantly lower the risk of an A-Fib stroke, they but do not totally eliminate it.

While anticoagulants significantly lower the risk of an A-Fib stroke, but they do not totally eliminate the risk.

A close friend of ours with A-Fib was on Coumadin at the ideal INR range (2.5) and still had a major stroke.

After a successful catheter ablation such as Minnesota Steve had, one’s stroke risk generally drops down to that of a normal person. But normal people have strokes and TIAs, too.

There is no therapy that will absolutely guarantee one will never have a stroke.

Share Your Views at A-Fib.comMinnesota Steve is blessed to have no permanent damage from those TIAs. But they are warning signs which must be heeded, probably by life-long anticoagulation. No one wants to be on anticoagulants for life. But he may not have any other choice.

Share your insights: Without a lot of current definitive research, this is a difficult subject to discuss. If anyone has any suggestions, criticisms, or comments to share on this most important topic, please email me.

A special thanks to Steve from Minnesota for asking this question and sharing his TIA experiences.

Your Nearest ‘Certified Stroke Center’ Could Save Your Life

or avert the debilitating effects of an A-Fib stroke.
But only if you get there within four hours.

Use my article to find your nearest certified or ‘Advanced Comprehensive Stroke Center’. Read my article.

My Top 5 Picks: Steve’s A-Fib Survival Kit for the Newly Diagnosed

By Steve S. Ryan, PhD. This post was originally published July 15, 2016.Steve's A-Fib Survival Kit at A-Fib.com

Your first experiences with Atrial Fibrillation have changed your life in a number of ways. As a former A-Fib patient (cured since 1998) I highly recommend these items when first diagnosed with this beast called ‘Atrial Fibrillation’.

My Top 5 Recommendations for the Newly Diagnosed

These are the products I recommend (and use) along with a Bonus: a good medical dictionary. These items are available from many online sources, but I’ve made them easy to order the entire list by making a ‘Wish List’ on Amazon.com: Steve Ryan’s A-Fib Survival Kit for the Newly Diagnosed,(Note: Use our Amazon portal link, and your purchases help support A-Fib.com.)

Magnesium Mg Drs Best1. Doctor’s Best High Absorption Magnesium (200 Mg Elemental), 240-Count

Most A-Fib patients are deficient in Magnesium (Mg). While Magnesium (Mg) is one of the main components of heart cell functioning, it seems to be chronically lacking in most diets.

One form of easily absorbed magnesium is Magnesium glycinate, a chelated amino acid. Look for the label ‘Albion Minerals’ designed to limit bowel sensitivity. Dosage: 600-800 mg daily in divided dosages (meals and bedtime). Read more about Magnesium.

Potassium NOW bottle2. Now Foods Potassium Gluconate Pure Powder, 1-pound

Just like magnesium deficiency, A-Fib patients are usually deficient in Potassium as well. We recommend the powder in order to take the recommended dose of 1600-2400 mg per day.

Be cautious of potassium tablets. For example those listed as 540 mg ONLY contain 99 mg of Potassium. Read more about Potassium.

BYA cover3. Beat Your A-Fib: The Essential Guide to Finding Your Cure: Written in everyday language for patients with Atrial Fibrillation

A-Fib can be cured! That’s the theme of this book written by a former A-Fib patient and publisher of the patient education website, A-Fib.com. Empowers patients to seek their cure. Written in plain language for A-Fib patients and their families.

Polar FT2 Heart Rate Monitor at A-Fib.com4. Polar FT2 Heart Rate Monitor, Black or Blue

Many A-Fib patients want to monitor their heart rate when exercising or doing strenuous tasks (mowing the lawn, moving equipment, etc.) This is a basic DIY model with a clear, LARGE number display of your heart rate (as a number). Requires wearing the included T31 coded transmitter chest strap.

One-button start. Includes a FT2 Getting Started Guide.

Also look at other Polar models: FT1 & RS3000X. I wore a Polar monitor when I had A-Fib, so it’s my brand of choice, but there are many other good brands.

Oximeter image5. Zacurate 500BL Fingertip Pulse Oximeter Blood Oxygen Saturation Monitor 

Many A-Fib patients also suffer with undiagnosed sleep apnea. A finger Oximeter is an easy way to check your oxygen level. A reading of 90% or lower means you should talk to your doctor as you may need a sleep study.

Oxford Med DictionaryBONUS: Concise Medical Dictionary (Oxford Quick Reference)

An excellent medical dictionary, the best I’ve found for patients with Atrial Fibrillation who are conducting research into their best treatment options. Includes occasional illustrations (for fun check p. 276 for the types of fingerprint patterns).

More of My Amazon.com Lists

Besides Steve Ryan’s A-Fib Survival Kit for the Newly Diagnosed, see my other Amazon.com lists for supplements, recommended books and DIY heart rate monitors:

By a Former A-Fib Patient: My Recommended ProductsAmazon.com link using A-Fib.com account ID afiin-20
For A-Fib Patients: 7 Supplements for a Healthy Heart
For A-Fib Patients: A-Fib Reference Books and Guides
For A-Fib Patients: Recommended Magnesium and Potassium Supplements
Steve’s Top Picks: DIY Heart Rate Monitors for A-Fib Patients

Note: Use the A-Fib.com Amazon portal link and your purchases help support A-Fib.com (http://tinyurl.com/Shop-Amazon-for-A-Fib). Learn more at: Use our Portal Link When you Shop at Amazon.com.

Click image to read Steve Ryan's personal experience story. at A-Fib.com

Click image to read Steve Ryan’s personal experience story.

A-Fib Drug Therapy: If We’re Sick, Just Take a Pill, Right?

In the US, we’ve been conditioned to think, “if we’re sick, just take a pill”.

When you have Atrial Fibrillation, anti-arrhythmic drug (AAD) therapy is certainly better than living a life in A-Fib. It can be useful for many patients.

And according to Dr. Peter Kowey, Lankenau Heart Institute (Philadelphia, PA), while anti-arrhythmic therapy is not perfect, it can improve quality of life and functionality for a significant percentage of A-Fib patients.

Peter R. Kowey MD

P. Kowey MD

Dr Kowey is an internationally respected expert in heart rhythm disorders. His research has led to the development of dozens of new drugs and devices for treating a wide range of cardiac diseases.

He cautions, though, that A-Fib anti-arrhythmic drugs are just a stopgap measure. The problem is they don’t deal with the underlying cause. And are seldom a lasting cure for A-Fib.

The Trade-Offs of Anti-Arrhythmic Drugs

In our article, Eleven Things I Know About A-Fib Drug TherapyDr. Kowey writes:

“An anti-arrhythmic drug is a poison administered in a therapeutic concentration. Like most meds, anti-arrhythmic drugs, (AADs), are a trade-off between the unnatural and possible toxicity with the power to alleviate our A-Fib symptoms.”

Did  “an anti-arrhythmic drug is a poison” set off alarm bells for you?

In general, anti-arrhythmic drugs are toxic substances which aren’t meant to be in our bodies―so our bodies tend to reject them.

For more, see our full article with Dr. Kowey’s insights, Eleven Things I Know About A-Fib Drug Therapy. It’s based on his 2014 American Heart Association (AHA) Scientific Session presentation.

Look Beyond the Typical AAD Therapy

Today’s anti-arrhythmic drugs have mediocre success rates (often under 50%).

Beyond AAD Therapy

Many patients often experience unacceptable side effects. Many just stop taking them. And when they do work, they tend to lose their effectiveness over time.

According to Drs. Irina Savelieva and John Camm of St. George’s University of London:

“The plethora of antiarrhythmic drugs currently available for the treatment of A-Fib is a reflection that none is wholly satisfactory, each having limited efficacy combined with poor safety and tolerability.”

These drugs don’t cure A-Fib but merely keep it at bay. Most Atrial Fibrillation patients should look beyond the typical antiarrhythmic drug therapy.

See our Treatments page to learn more about Medicines or ‘Drug Therapies’ for A-Fib.

Answering Your Questions About A-Fib Drug Therapies

Since the beginning of A-Fib.com, we have answered thousands of patient’s questions—many times the same questions. Perhaps the same questions you may have right now.

For unbiased information and guidance about medicines and drug therapy treatments, see our page of questions and answers. You’ll find explanations, resources and advice for the most frequently asked questions by patients and their families. Go to FAQ A-Fib Treatments: Medicines and Drug Therapies.

Super-Loading: How A-Fib Patients can Correct a Severe Magnesium Deficiency

The mineral Magnesium (Mg) is needed for proper muscle (including the heart), nerve, and enzyme function. A deficiency in Magnesium (along with potassium) can cause palpitations and force the heart into fatal arrhythmias including Atrial Fibrillation.

Magnesium (Mg) is one of the main components of heart cell functioning, but is chronically lacking in most diets. Magnesium deficiencies in general populations range from 65% to 80%, creating a substantial cumulative deficiency over months and years.

A deficiency in magnesium (along with potassium) can force the heart into fatal arrhythmias including Atrial Fibrillation.

Magnesium used to be plentiful in fruits, vegetable and grains, but decades of industrial-scale farming have stripped the soil of minerals like magnesium. One study found that the nutrient content of crops has declined by as much as 40% since the 1950s.

In addition, we no longer absorb magnesium by bathing in or drinking natural mineral-rich water that is high in magnesium—instead, we’re drinking and bathing in tap water that’s devoid of magnesium.

So it’s now almost impossible for A-Fib patients to get adequate amounts of Magnesium from a healthy diet.

To correct a severe Magnesium deficiency and restore levels, it’s often necessary to take a Magnesium supplement over several months.

Not All Magnesium Supplements are Created Equal

Magnesium: Element #12 on the Periodic Table

Confused by the various forms of Magnesium supplements? There are so many different types. Sadly, many of the available magnesium supplements aren’t even absorbable by your digestive tract and will not do anything beneficial for your health. And a low-quality magnesium supplement can cause diarrhea.

Fortunately for A-Fib patients, there are many magnesium forms that are absorbed well by your body.

OrAL Magnesium (Tablets)

• Magnesium Glycinate: (such as Doctor’s Best High Absorption Magnesium Glycinate Lysinate 100% Chelated). One of the most commonly used form of magnesium is both highly absorbed, inexpensive, and easy to use. Magnesium glycinate is absorbed in a different part of the gut compared to other magnesium types, so it’s a good option if other supplements give you digestive stress.

• Magnesium Gluconate: Has very good absorption rate; a good alternative if you have had digestive trouble with other types of magnesium supplements.

• Magnesium Threonate: (such as Life Extension Neuro-Mag Magnesium L-Threonate). Magnesium threonate is a newer form of Magnesium supplement that can penetrate the blood-brain barrier with potentially neuroprotective effects against Alzheimer’s disease. Pricier but doesn’t have the laxative effect. Contains very low elemental magnesium per dose which suggests it would not be a good choice for correcting a magnesium deficiency.

Topical/Liquid forms

• Sublingual Angstrom Magnesium: (such as Mother Earth Minerals Angstrom Minerals, Magnesium-8 ozs.A quickly absorbed liquid that’s 99% pure Magnesium, it’s applied under the tongue, then after one minute, swallowed. Angstrom Magnesium has the best magnesium absorption and generally the fewest digestive side effects. It’s especially good for those who are severely magnesium deficient and need a lot of magnesium in order to replenish their levels.

Magnesium chloride bath salts.

• Magnesium Chloride flakes: (such as Ancient Minerals Magnesium Bath Flakes of Pure Chloride). Similar to Epsom salts (Magnesium sulfate), the molecular structure of Magnesium Chloride is different and is much more easily absorbed into the body. Add Magnesium Chloride flakes to a weekly soaking bath or a foot bath. Can be used in conjunction with magnesium tablets.

• Magnesium Oil: (such as Ancient Minerals Magnesium Oil Spray – Magnesium Chloride). Apply Magnesium oil once a day to arms or legs; after 20-30 minutes, wash off. Can be used in conjunction with magnesium tablets.

Inferior Forms of Magnesium

Some oral forms of magnesium (often cheap) offer relatively low bioavailability (the degree and rate at which it enters the body’s circulatory system). These forms of magnesium do not absorb well and tend to offer little benefit beyond laxative or antacid properties.

When super-loading to replenish your Magnesium, it’s best to avoid Magnesium oxide, Magnesium dihydroxide (milk of magnesia), Magnesium sulfate, Magnesium aspartate, and Magnesium carbonate.

In particular, be sure to avoid any supplement containing magnesium stearate, a common but potentially hazardous additive.

Before You Buy: Seek Brand Quality and Consistency

There are many forms and brands of magnesium supplements. Before you buy, be sure to check the label to ensure they only contain the one type of magnesium and no fillers.

Proper levels of Magnesium can improve by 34% your chances of living a long, healthy life!

It’s critically important to purchase from a source that tests every batch to ensure you are getting what is on the label and nothing else, like unwanted toxins, allergens, and heavy metals.

Look for brands of magnesium that are pharmaceutical grade and adhere to Good Manufacturing Practice (GMP), a system for ensuring that products are consistently produced and controlled according to quality standards. This means they are produced in strictly monitored facilities which also send batches of their product to third parties for analysis before selling to consumers (such as Nature Made).

(To learn about independent organizations that test branded supplements, see: Which Brands of Vitamins and Minerals Can I Trust?)

Bottom Line for Super-Loading Magnesium

As an A-Fib patient, you may have a severe Magnesium deficiency. To restore your level, it is often necessary to take a Magnesium supplement over several months. We recommend the following when you are “super-loading Magnesium”.

Magnesium supplements should always be taken daily with a meal or just after eating.

• Oral: Magnesium glycinate is thought to be the best type of oral supplement when correcting a severe magnesium deficiency.

• Sublingual: Angstrom Magnesium is 99% pure Magnesium that’s applied under the tongue. Especially good for those who are severely magnesium deficient.

• Topical: Magnesium oil and Magnesium chloride salts (flakes). These are absorbed directly through the skin and by-pass the gastrointestinal (GI) tract, so they can be used in conjunction with magnesium tablets. If sensitive to bowel problems, they can be used as an alternative to Magnesium tablets.

Keep in Mind: Everyone’s body reacts differently to supplements. Just because a form of Magnesium is best for one person, doesn’t mean it’s the best for YOU.

To learn more about Magnesium, see Cardiovascular Benefits of Magnesium: Insights for Atrial Fibrillation Patients.

References for this article
• Rethinking Magnesium: Why You’re Deficient And Need To Supplement (Quick Fix). Nature Builds Health. Jun 09, 2018. URL: https://www.naturebuildshealth.com/blog/magnesium_deficiency_benefits#6

• Leech, J. What Is The Best Magnesium Supplement in 2018? A Comprehensive Review. DietvsDisease.org. Last updated 2nd January, 2018. URL: https://www.dietvsdisease.org/best-magnesium-supplement/

• Magnesium Chloride: Is It Really the “Master Magnesium Compound”? Dr J. Mercola. Last accessed Jan 28, 2019. URL: https://articles.mercola.com/vitamins-supplements/magnesium-chloride.aspx

• What Is The Best Magnesium Supplement? Dr. David Jockers. Last accessed January 28, 2019. URL: https://drjockers.com/best-magnesium-supplement/

• Magnesium: An Invisible Deficiency That Could Be Harming Your Health. Dr. J. Mercola. January 19, 2015. URL:  https://articles.mercola.com/sites/articles/archive/2015/01/19/magnesium-deficiency.aspx

Tony Rejects Drug Therapy: Says to Ask Questions, None are Stupid

Tony Hall, Evansville, IN, was 54 years old when he develped Atrial Fibrillation in January 2014. After confirming his diagnosis at the hospital, he wrote:

“I sit in the passenger seat feeling like a pet heading to a kennel. Suddenly things are different. I no longer have that “healthy as a horse” attitude.”

He started drug therapy. Then came a cardioconversion, but that didn’t keep him in normal sinus rhythm for long. He was in and out of A-Fib, and by August was in persistent A-Fib.

Learning His Treatment Options

Tony didn’t passively accept everything he was hearing from doctors and others.

He and his wife, Jill, read as much as they could and critically waded through the information they found. (I’m continually amazed at how much mis-information there is about A-Fib on the internet and in the media.)

5-months post-ablation, Tony and Jill after 10K race.

After doing his research, educating himself about treatment options and learning what his health insurance would cover, he chose to have a catheter ablation at the Mayo Clinic in December 2014.

During his three month blanking period, he had some sporadic fluttering and early on a couple of brief A-Fib episodes.

Off all medication and A-Fib-free, in March 2015 he completed a 10K race beating his time from the previous year by a fraction.

Becoming his Own Best Patient Advocate

Tony and Jill are great examples for all A-Fibbers of how to become your own best patient advocate. He rejected endless trials of various drug therapies. Instead he opted for a catheter ablation just shy of a year after his initial A-Fib diagnosis.

In his A-Fib story, he shares this advice to others considering a catheter ablation:

“Make sure, if you desire to have an ablation, that your reasoning is sound and that you have a good argument as to why drug therapy is not the way you want to go.
Having an ablation as front line treatment for A-Fib is not embraced by every EP, and many are reluctant to ablate until drug therapy has failed.
Be persistent and move on [to another doctor] if you are met with resistance.”

For Tony Hall’s personal experience story, see: Very Active 54-Year Old Became His Own Patient Advocate; Chose Ablation as First Line Treatment.

The Dangers of Magnesium Deficiency, Especially for Patients with Atrial Fibrillation

Magnesium is a mineral involved in many processes in the body including normal muscle contraction (including the heart), nerve signaling and the building of healthy bones. About 350 enzymes are known to depend on magnesium.

Magnesium is needed for proper muscle, nerve, and enzyme function. 

At least 80% of Americans are deficient in Magnesium (Mg). Other Western countries today exhibit similar deficiencies.

Most US adults ingest only about 270 mg of magnesium a day, well below the modest magnesium Recommended Daily Allowance (RDA) of 420 mg for adult males and 320 mg for adult females. (RDA is the minimum amount for a healthy person.)

This creates a substantial cumulative deficiency over months and years.

Magnesium Deficiency and Atrial Fibrillation

A deficiency in magnesium can force the heart into fatal arrhythmias and is central to creating conditions in the heart that cause Atrial Fibrillation.

A-Fib patients, in particular, are often significantly deficient in magnesium. A normal healthy diet rarely meets your need for magnesium.

Therefore, it’s often necessary to take a magnesium supplement over several months to restore levels.

Causes of Today’s Magnesium Deficiency

Why are so many of us deficient in Magnesium?

Magnesium used to be plentiful in fruits, vegetable and grains, but decades of industrial-scale farming have stripped the soil of minerals like magnesium. One study found that the nutrient content of crops has declined by as much as 40% since the 1950s. It’s now almost impossible to get adequate amounts of magnesium from food.

We’re not drinking spring or mineral water that’s high in magnesium—instead, we’re drinking tap water that’s devoid of magnesium. As a result, we ingest even less magnesium. Add to that, we’re no longer bathing in natural water that is high in magnesium. Our skin can absorb magnesium from our bathing water—which is now missing.

Prescription drugs can lower our magnesium levels, as can the stress of our modern lifestyles.

Over the years, this has caused a magnesium deficient population, especially critical for those with Atrial Fibrillation or other heart ailments.

Magnesium Deficiency and How to Restore Your Levels

What’s to do about it? Everyone with A-Fib should understand the role of magnesium in the body and its effects on the heart, and know how to detect if they are magnesium deficient, and how to increase their magnesium levels if they are. Start with these articles:

• Treatments: Mineral Deficiencies
Cardiovascular Benefits of Magnesium: Insights for Atrial Fibrillation Patients.

Then, take a look at this video with Dr. Carolyn Dean, author of The Magnesium Miracle.

VIDEO: The Best Way to Supplement Magnesium with Dr. Carolyn Dean

For those with magnesium deficient diets, getting nutrients through food is not always possible. Dr. Carolyn Dean, author of The Magnesium Miracle, talks about the external use of magnesium oil and Epson salts and the various powder and tablets to supplement magnesium.

She covers the side effects of too much Mg, and how you can tell if you have a Mg deficiency. (3:39 min.) From iHealthTube.com. Go to video.

Reference for this article
• Goodman, Dennis. This Mineral Prevents Headaches, Heart Disease, More. Bottom Line Personal. Volume 35, Number 2, January 15, 2014.

• Galan P. Dietary magnesium intake in French adult population. In: Theophile T, Anastassopoulou J. Magnesium: current status and new developments: theoretical, biological, and medical aspects. Dordrecht: Kluwer Academic; 1997.

I Couldn’t Believe the Drugs He Was On; How to Ask Questions About Your A-Fib Prescriptions

03/15/2019 5 pm: Corrected a missing link below to the Free Worksheet, Ask These Questions Before Starting a Prescription Drug.

I received a very distressing email from a reader, Kenny, who was worried about his prescribed medications. He wrote that he just had a cardioversion a week ago and is back in A-Fib (unfortunately that’s not uncommon). Alarm bells went off in my head when I read:

“My doctor just prescribed me amiodarone 200mg, 4x a day…I’m a little concerned about the amiodarone and all the side effects!”

“I’m also on Digoxin…Xarelto and aspirin… .”

“I can’t get my doctor’s office or doctor to call me back! Reluctant to start amiodarone until I can talk to someone!” 

Drugs Therapies Concerns - capsule of heart molecules at A-Fib.com

Drugs Therapies Concerns

Ding, Ding, Ding! I am deeply concerned for him. The doctor prescribing these drugs is in internal medicine, not a cardiac electrophysiologist. While Kenny and I continue to exchange emails, here’s some highlights from my first reply:

Amiodarone is an extremely toxic drug, and this dosage is 4x the normal dose.
You must get a second opinion ASAP! (consult a cardiac electrophysiologist)
Digoxin is also a dangerous drug not normally prescribed for A-Fib patients.
It’s very unusual to prescribe both Xarelto and aspirin.

Time to Change Doctors? And lastly, I wrote him that if your doctor or his office isn’t calling you back, that’s a sign you should look for a new doctor (don’t be afraid to fire your doctor). You need good communication when you’re in A-Fib and trying to find a cure.

I’m glad Kenny reached out to me so we can get him on the right A-Fib treatment plan for him and his treatment goals.

Ask These Questions Before Starting a Prescription Drug

Download the Free Worksheet

Before starting any prescription drug for your Atrial Fibrillation, you should ask what it’s for and why you should take it.

Download our free worksheet, 10 Questions to Ask Before Taking Any Medication’ and use as a guide to ask these questions of your doctor or healthcare provider, and note their responses:

1. Why am I being prescribed this medication?
2. What are the alternatives to taking this medication?
3. What are the side effects of this drug?
4. Are there any precautions or special dietary instructions I should follow?
5. Can it interfere with my other medications?.
6. How long before I know if this drug is working?
7. How will I be monitored on this drug? How often?
8. What happens if this drug doesn’t work?
9. What if my A-Fib symptoms become worse?
10. If I don’t respond to medications, will you consider non-pharmaceutical treatments (such as a catheter ablation)?

Research and Learn About Any Prescription Drug 

You can do your own research about a specific medication and if it’s the right one for you.

An excellent prescription database is the U.S. National Library of Medicine Drug Information Portal. (For an example, see the page on Warfarin [Coumadin].)

Decision Making Time

Download our free worksheet: ’10 Questions to Ask Before Taking Any Medication’. Take a copy to your office visits.

Your research and the answers to these 10 questions should help you decide about taking a new prescription drug. Remember, it’s your heart, your health. Taking medications is a decision you should make in partnership with your doctor.

Note: File your completed worksheets in your A-Fib binder or file folder to use for future reference and follow-up.)

AF Symposium New Report: Live! Convergent Hybrid Ablation for Atrial Fibrillation

Background: The Convergent Hybrid Ablation is currently used for patients with persistent and longstanding persistent atrial fibrillation.
The Hybrid is performed under general anesthesia. First the surgeon accesses the outside (epicardial) of the heart and creates lesions on the posterior left atrial wall and around the pulmonary veins (PVs). Next, the EP performs a standard PV catheter ablation from inside (endocardial) the heart, uses mapping systems to detect any gaps in the surgical ablation lines, and completes the surgeon’s lesion set, if needed.

Via live streaming video, AF Symposium attendees got to watch a Convergent Hybrid operation/procedure performed from Emory Heart and Vascular Center at Saint Joseph’s Hospital, Atlanta, GA.

PATIENT DESCRIPTION: A DIFFICULT CASE

The patient was a 62-year-old man who had been in A-Fib for 21 years, 10 years of those in persistent A-Fib. He was also very tall. He also complained of being very fatigued.

They didn’t know the amount of fibrosis the patient had developed. They mentioned that they hoped the fibrosis was localized rather than diffuse and that the patient did not have a Utah 4 or a Strawberry-type of large fibrosis area. (About Utah and fibrosis, see High Fibrosis at Greater Risk of Stroke and Precludes Catheter Ablation)

The patient had been on rate control drugs and the antiarrhythmic Sotalol. It was not mentioned if anyone had ever tried a normal catheter ablation on this patient before going to the Convergent operation/procedure.

Phase I: SURGERY ON OUTSIDE OF HEART

In this version of the hybrid, the cardiothoracic surgeon accesses the outside posterior of the heart through the subxiphoid process cutting through the central tendon of the soft tissue of the diaphragm making a 2-3 cm incision.

Important: Read my extensive Editor’s Comments at the end of this report.

The surgeon achieves direct vision of the posterior cardiac structure with a miniature camera (from EnSight by AtriCure). (The xiphoid process is a cartilaginous section at the lower end of the sternum.)… Continue reading my new report from the 2019 AF Symposium->

2019 AF Symposium: Live! Convergent Hybrid Ablation for Atrial Fibrillation

by Steve S. Ryan

Convergent surgical lesions pattern

Background: The Convergent Hybrid Ablation is currently used for patients with persistent and longstanding persistent atrial fibrillation.
The Hybrid is performed under general anesthesia. First the surgeon accesses the outside (epicardial) of the heart and creates lesions on the posterior left atrial wall and around the pulmonary veins (PVs).
Next, the EP performs a standard PV catheter ablation from inside (endocardial) the heart, uses mapping systems to detect any gaps in the surgical ablation lines, and completes the surgeon’s lesion set, if needed.

Live Case from Atlanta: Sequential Endocardial and Epicardial Operation/Procedure

Symposium attendees got to watch a Convergent Hybrid operation/procedure performed Live from Emory Heart and Vascular Center at Saint Joseph’s Hospital, Atlanta, GA. Presenting doctors were cardiothoracic surgeon Dr. Michael Halkos and cardiac electrophysiologists (EPs) Dr. David DeLurgio and Dr. Kevin Makati.

Patient Description: a Difficult Case

The patient was a 62-year-old man who had been in A-Fib for 21 years, 10 years of which were in persistent A-Fib. He was also very tall. He also complained of being very fatigued.

They didn’t know the amount of fibrosis the patient had developed. (One would think someone in A-Fib for such a long time would have developed a significant amount of fibrosis.) They did not measure the patient’s amount or type of fibrosis. They mentioned that they hoped the fibrosis was localized rather than diffuse and that the patient did not have a Utah 4 or a Strawberry-type large fibrosis area. (About Utah and fibrosis, see High Fibrosis at Greater Risk of Stroke and Precludes Catheter Ablation)

The patient had been on rate control drugs and the antiarrhythmic Sotalol. It was not mentioned if anyone had ever tried a normal catheter ablation on this patient before going to the Convergent operation/procedure.

Surgery on Outside of Heart

In this version of the hybrid, the cardiothoracic surgeon accesses the outside posterior of the heart through the subxiphoid process cutting through the central tendon of the soft tissue of the diaphragm making a 2-3 cm incision. The surgeon achieves direct vision of the posterior cardiac structure with a miniature camera (from EnSight by AtriCure). (The xiphoid process is a cartilaginous section at the lower end of the sternum.)

Size comparison: Atricure EPI-Sense device size vs. ablation catheter

Convergent Catheter vs. PVI Ablation Catheter: The catheter used to make the burns in the Convergent operation is unlike a standard point-by-point RF catheter with force sensing.

The Atricure EPi-Sense Guided Coagulation System with VisiTrax® technology: How it works.

Instead it is a long linear catheter with multiple RF coils on its side which is placed horizontally to make long, large burns on the heart.(AtriCure EPi Sense Coagulation Device).

The burns are normally 90 seconds long at 30 watts. This catheter can also be used for pacing, sensing, and to produce electrograms. Impedance drops (10%) are used to verify lesion effectiveness. The catheter has a notch on the top which can be used to orient the catheter.

Phase I: Live Surgical Operation

When starting, the Symposium audience watched as the surgeon, Dr. Michael Halkos, accessed the outside of the heart through the diaphram. Then he identified the left inferior and right inferior PVs.

Illustration of surgical lesions to outside of heart

Using these benchmark structures, he then started to ablate the whole of the posterior left atrium including any other areas of the posterior left atrium he could access.

The burns can overlap and can be repeated. (We only saw them make 2 burns, but usually 20 to 40 burns are made.)

We also saw the surgeon use a suction catheter to remove any blood and liquid from the area being worked on. Note: The pericardium sac is filled with saline to help prevent damage to the esophagus.

Phase II: EP Procedure

Because of time constraints, we didn’t get to see Dr. David DeLurgio, the cardiac electrophysiologist (EP) work on this patient after he was wheeled into the EP lab.

Dr. DeLurgio was scheduled after the surgery phase to later perform a PVI ablation and ablate the right atrium Cavo-tricuspid Isthmus (CTI) to prevent Flutter.

His tasks would also include using mapping technology to check the surgeon’s lesions and fill in any gaps.

Editor’s Comments
Who should consider a Hybrid Ablation for Atrial Fibrillation? Patients with persistent and/or longstanding persistent atrial fibrillation. Specifically, the Hybrid Surgery/Ablation might be an effective option for:
  • highly symptomatic patients with persistent atrial fibrillation and longstanding persistent atrial fibrillation who have failed one or two catheter ablations,
  • for someone with a significantly enlarged left atrium, or
  • for someone who is morbidly obese (making it difficult to create imaging maps necessary for catheter ablations).
This 62-year-old Patient:  It was not mentioned if anyone had ever tried a normal catheter ablation on this patient before going to the Convergent operation/procedure.
I hope for this 62-year-old male patient that he was treated first with a less invasive PV catheter ablation (or two). If the ablation(s) failed, only then would his doctors recommende the much more invasive and riskier convergent surgery.
This was a “sequential” Hybrid approach. There is also a “non-synchronous” or two-staged version where the surgeon and the EP work on the same patient but at different times and/or places.
“Minimally invasive”: Though called “minimally invasive,” the Convergent operation is still major heart surgery. It’s invasive, traumatic, complicated, requires considerable surgical skills and experience, and is potentially risky.
My Bias: Please be advised that I am personally biased against the Convergent Hybrid operation/procedure. Whenever I see it, I get nauseous and sick to my stomach watching them burn the whole of the posterior left atrium wall. To me this is overkill.
The outside posterior left atrium is turned into dead, fibrotic tissue. There is no more blood flow, transport and contraction function no longer work, nerve transmission is destroyed, normal heart muscle fibers turn into non-contracting scar tissue. The ability of the left atrium to contract risks being hindered.
The surgeon does tremendous damage to the outside posterior left atrium which can never be restored. This may weaken the heart and contribute later to heart problems like congestive heart failure.
I can’t imagine having my outside posterior left atrium wall destroyed like that. All too many patients today suffer from weak hearts due to heart muscle damage.
Difference between Surgeons and EPs: Cardiac Electrophysiologists (EPs) do often ablate in the inside posterior left atrium such as by creating a box lesion set. But they try to do as little permanent damage to the heart as possible.
Similar ablation techniques are called ‘hybrid ablation technique’, ‘convergence process’, ‘Convergent Maze Procedure’ and ‘Convergent Ablation”’
.
Whereas surgeons in the Convergent operation try to do as much damage as possible. Their goal is durable posterior wall isolation.
My concern: Is it really necessary to completely obliterate the outside left atrium posterior wall to make a patient A-Fib free? Perhaps. In some patients this may indeed be necessary. But is this necessary in every patient having a convergent operation?

For more about the Hybrid approach, see my article: Advantages of the Convergent Procedure and the VIDEO: The Hybrid Maze/Ablation for Atrial Fibrillation for Persistent A-Fib Includes animation and on-camera interviews. Published by Tenet Heart & Vascular Network. Length 4:30

If you find any errors on this page, email us. Y Last updated: Monday, March 11, 2019

Return to 2019 AF Symposium Reports

Updated Article: Treating Mineral Deficiencies in A-Fib Patients

When you have A-Fib, a sensible starting point may be to check for chemical imbalances or deficiencies. A deficiency in minerals like magnesium or potassium can force the heart into fatal arrhythmias.

If you haven’t recently read our Mineral Deficiencies page under Treatments, you might want to review it. We’ve updated and added some new content.

The Top Four Minerals/Vitamins

vitamins and minerals for A-Fib patients - A-Fib.com

We cover the four main minerals/vitamins of special concern to patients with Atrial Fibrillation:

Magnesium
Calcium
Potassium
Vitamin D

For each we describe the mineral’s role and function in our body. Then, we cover how to test for deficiency (or overload). We describe the food or natural sources, then the various forms and choices of each supplement and recommended dosages.

You’ll find the topics to discuss with your doctors including recommended tests and alternative choices. All backed up with our usual well researched citations. Go to our Mineral Deficiencies page.

Reliable, Unbiased Information on Vitamins and Minerals

In our search for unbiased information sources about vitamins and mineral supplements, we looked at many, many informational directories.

Three searchable databases rose to the top of our list. See Our Top 3 Sources for Reliable, Unbiased Info on Vitamins and Supplements.

AF Symposium Two New Reports: Ablation Without Touching Heart and New RF Balloon Catheter

I’ve posted two of my reports from the 2019 AF Symposium.

Automated Robotic Ultrasound Ablation

From the Czech Republic via streaming video, a catheter ablation using an incredible new technology―Ultrasound Mapping and Ablation (Low-Intensity Collimated Ultrasound, LICU) from Vytronus, Inc. The catheter never touches the tissue!

From Vytronus VIDEO: Ultrasound Mapping and Ablation

The EP created a robotic lesion path for the ultrasound catheter to follow. Using electromagnetic navigation, the catheter automatically went to the spots and path the operator drew.

We watched as the catheter hovered over the heart surface while the highly directional ultrasound energy beam created the lesion lines—never touching the tissue. It was amazing to watch!

To learn more...go to my full report: Ablation Without touching the Heart Surface Using Ultrasound―Live Case from Prague.

Multi-Electrode Radio-Frequency (RF) Balloon Catheter

Multi-Electrode Radio-Frequency (RF) Balloon Catheter from Biosense Webster

The new irrigated Multi-Electrode RF Balloon Catheter from Biosense Webster is a “one-shot” delivery of RF energy and can burn lesions to isolate the Pulmonary Veins in minutes. And because the electrodes can be programmed to deliver less energy levels (for example near the esophagus), the RF Balloon Catheter can be safer and more effective than traditional RF point-by-point ablation.

It has 10 gold surface electrodes or heating bars which can be turned on and off or set to deliver different energy levels simultaneously. Each electrode is powered by its own generator.

While the AF Symposium audience watched the RF ablation live, the EP took just 7 seconds to isolate a particular vein―quite remarkable compared to the time involved for traditional RF.

To read my full report, go to: Multi-Electrode RF Balloon Catheter―Live Case from Boston Mass. General

“Do Not Use This Product” Warnings on Decongestants: Which are Safe for A-Fib Patients

by Steve Ryan
First published Dec. 2017. Last updated: March 14, 2019

It’s cough and cold season, and millions of cold sufferers are reaching for an over-the-counter (OTC) decongestant capsule or nasal spray to clear a stuffy nose.

As an A-Fib patient, did you notice these over-the-counter decongestants often contain a warning such as:

“Do not use this product if you have heart disease, high blood pressure, thyroid disease, diabetes, or difficulty in urination due to enlargement of the prostate gland, unless directed by a doctor.”

What does this warning mean for patients with Atrial Fibrillation?

Decongestants, Heart Disease and A-Fib

When you have a stuffed up nose from a cold or allergies, a decongestant can cut down on the fluid in the lining of your nose. That relieves swollen nasal passages and congestion. (In general, an antihistamine doesn’t help with this symptom.)

The Problem: When taking a decongestant, heart rate and blood pressure go up, the heart beats stronger, blood vessels constrict in nasal passages reducing fluid build-up. In general that’s okay for most patients.

But not for patients with high blood pressure, heart disease or, specifically, Atrial Fibrillation. Decongestants cause the blood vessels to shrink and blood pressure to rise. Perfect conditions that can trigger or induce an episode of their A-Fib.

Another concern for A-Fib patients is that some over-the-counter (OTC) medications can interact with the anti-arrhythmic medication they’re taking.

Check your Cold Medicine: The main active ingredient in many decongestants is pseudoephedrine, a stimulant. It is well known for shrinking swollen nasal mucous membranes.

To find out if your cold medicine contains a decongestant, start by reading the label. You can lookup the ingredients of any OTC medication at Drugs.com. Just search by product name or active ingredient.

In addition, you can consult your pharmacist who can check the label of a medicine and let you know if it’s safe for someone with atrial fibrillation and/or high blood pressure.

Drugs.com makes it easy to check the ingredients of any OTC medication, just search by product name or active ingredient.

OTC Decongestants to Avoid: Some OTC decongestants tablets, capsules and nasal sprays to avoid if you have atrial fibrillation include:

• AccuHist DM® (containing Brompheniramine, Dextromethorphan, Guaifenesin, Pseudoephedrine)
• Advil Allergy Sinus® (containing Chlorpheniramine, Ibuprofen, Pseudoephedrine)
• Advil Cold and Sinus® (containing Ibuprofen, Pseudoephedrine)
• Sudafed (pseudoephedrine)
• Afrin and other decongestant nasal sprays and pumps (oxymetazoline)

Phenylephrine: a Safe Substitute? Maybe. A substitute for pseudoephedrine is phenylephrine. In general, phenylephrine is milder than pseudoephedrine but also less effective in treating nasal congestion. As with other decongestants, it causes the constriction of blood vessels and increases blood pressure.

There is anecdotal evidence that products with the substitute phenylephrine might be less of a trigger for A-Fib than products with pseudoephedrine. Products with phenylephrine:

Sudafed PE Congestion tablets
Dimetapp Nasal Decongestant capsules
Mucinex Sinus-Max Pressure and Pain caplets (Sue Greene writes that she has used Guaifenesin (Mucinex) for years which has never put her into A-Fib, 2/15/19. Lompocsue(at)yahoo.com.)

Decongestant-Free Products: These tablets, capsules and nasal sprays are decongestant-free and safe for patients with Atrial Fibrillation (They are marketed for those with High Blood Pressure):

Coricidin HBP line of products (Chlorpheniramine)
DayQuil HBP Cold & Flu (dextromethorphan hydrobromide)
NyQuil HBP Cold & Flu (dextromethorphan hydrobromide)
• non-medicated inhalers such as Vicks VapoInhalers (Levmetamfetamine)

What About Antihistamines?

Antihistamines reduce the effects of histamine in the body which can produce sneezing, runny nose, etc. Though they can lessen your symptoms, some can aggravate a heart condition, or be dangerous when mixed with blood pressure drugs and certain heart medicines.

Antihistamines can be dangerous when mixed with blood pressure drugs and certain heart medicines.

Heart-safe Antihistamines: Compared to decongestants, antihistamines are often better tolerated by people with A-Fib. Some heart-safe antihistamines that can help with a stuffy nose from a cold include:

Claritin tablets (loratadine)
Zyrtec tablets (cetirizine)
Allegra tablets (fexofenadine)
• Chlor-Trimeton (chlorpheniramine)

Non-Drug Alternatives for Cold Relief

If you want to avoid medications altogether, you can try a variety of things to clear your head.

Breathe Right nasal strips may help you breathe better at night. Use saline nasal spray (like Ocean or Basic Care) to help flush your sinuses, relieve nasal congestion and curb inflammation of mucous membranes.

A steamy shower or a hot towel wrapped around the face can also relieve congestion. Drinking plenty of fluids, especially hot beverages (like chicken soup), keeps mucus moist and flowing.

Recommendations for A-Fib Patients

Antihistamines and decongestants can give much-needed relief for a runny or congested nose. But A-Fib patients should pay attention to the warnings for heart patients. Here’s some products and procedures to consider:

Decongestant-free: Look for decongestant-free products (e.g. Coricidin HBP, DayQuil HBP Cold & Flu, NyQuil HBP Cold & Flu and Vicks VapoInhalers).

One possible exception are those decongestant products with the active ingredient phenylephrine (e.g. Sudafed PE, Dimetapp and Mucinex Sinus).

Heart-safe antihistamines: You can try one of the heart-safe antihistamines (e.g. Claritin, Zyrtec and Allegra).

Drug-free alternatives: Try drug-free substitutes (e.g. Breath Right nasal strips, saline nasal spray and a steamy shower).

The best advice for you and your A-Fib: Always consult your cardiologist or EP. Ask what’s the best option for your stuffy nose or allergies. And ask about interactions with your other heart medications (especially if you have high blood pressure).

References for this article
• Don’t let decongestants squeeze your heart. Harvard Health Publishing, Harvard Medical School. March, 2014. https://www.health.harvard.edu/newsletter_article/dont-let-decongestants-squeeze-your-heart

• Atrial fibrillation: Frequently asked questions. University of Iowa Health Care. Last reviewed: December 2015. https://uihc.org/health-topics/atrial-fibrillation-frequently-asked-questions

• Wieneke, H. Induction of Atrial Fibrillation by Topical Use of Nasal Decongestants. Mayo Clinic Proceedings , July 2016, Volume 91, Issue 7, Page 977. https://doi.org/10.1016/j.mayocp.2016.04.011

• Terrie, YC. Decongestants and Hypertension: Making Wise Choices When Selecting OTC Medications. Pharmacy Times, December 20, 2017. https://www.pharmacytimes.com/publications/issue/2017/december2017/decongestants-and-hypertension-making-wise-choices-when-selecting-otc-medications

2019 AF Symposium: Common Fluoroscopy Technology Converted to Real-Time 3D Images

Fluoroscopy is a type of medical imaging that shows a continuous 2D X-ray image on a monitor, (like an X-ray movie).

by Steve S. Ryan

Another medical breakthrough at this year’s AF Symposium featured an innovative mapping technology which turns normal fluoroscopy into real-time 3D imagery.

During a live CryoBalloon ablation from Milwaukee, WI, the system was used by Drs. Sabir Jra and Dr. Mohamed Hani of Aurora Health Care.

The Navik 3D Cardiac Mapping System from APN Health was FDA approved in 2016 and was first clinically used in March 2018. Dr. Jra is also the developer.

Real-Time Converting 2D to 3D: How the System Works

Commonly found in most every Electrophysiology lab is equipment for fluoroscopy. It’s a type of medical imaging that shows a continuous 2D X-ray image on a monitor (like an X-ray movie).

Monitor images Navik 3D system

The genius of Dr. Jra’s system is converting the familiar fluoroscopy into 3D real-time images.

The Navik 3D Cardiac Mapping System uses a complex mathematical formula and fast processor calculations to locate any opaque object (such as a catheter or a pulmonary vein opening) within regular X-ray fluoroscopy and turn it into a 3D image.

The Navik system uses real-time 2D, single-plane fluoroscopy images along with body surface ECG data and intracardiac echo signals to create a synchronized, real-time 3D visual map.

Real-Time 3D Images

As AF Symposium attendees watched the live CryoBalloon ablation, the mapping seemed to be very fast. It created and displayed real-time 3D maps of the cardiac chambers during the ablation, though the images appeared somewhat different from images from other 3D mapping systems.

Dr. Jra’s system can be integrated into a normal electrophysiology lab using typical procedure equipment. During the live procedure, his lab looked like other EP labs I’ve seen.

Editor’s Comments
3D Huge Improvement over Fluoroscopy: Dr. Jra’s work is innovative and a true medical breakthrough. It’s incredible—being able to convert, in real-time, fluoroscopic images into 3D images. Any electrophysiologist (EP) using fluoroscopy could, in theory, use Dr. Jra’s system.
Instead of X-ray images which are 2D and not all that clear, 3D images are a potentially huge improvement and would make the EP’s work more easily and clearly viewed.
Easy to Install and Use: The Navik 3D Cardiac Mapping System seems relatively easy and cost-effective to install. It doesn’t require major changes to an existing EP lab. But does require one addition piece of equipment, a body surface ECG system under the patient exam table.
Will 3D Fluoroscopy Become Widely Accepted and Used? Considering how many different excellent mapping and ablation systems are now being used, one wonders if Dr. Jra’s 3D fluoroscopy system will become accepted in today’s A-Fib marketplace, I’ll watch the rollout of the Navik 3D Cardiac Mapping System and report on its progress.
References for this article
Djelmami-Hani, M. Novel Approach to Cardiac 3-D Mapping. EP Lab Digest, Vol 18. Issue 9, Sept. 2018. URL: https://www.eplabdigest.com/novel-approach-cardiac-3d-mapping.

APN Health Receives FDA Clearance for Navik 3D Cardiac Mapping System. Diagnostic and Interventional Cardiology, February 29, 2016. URL: https://www.dicardiology.com/product/apn-health-receives-fda-clearance-navik-3d-cardiac-mapping-system

If you find any errors on this page, email us. Y Last updated: Friday, February 8, 2019

Return to 2019 AF Symposium Reports

AF Symposium: New Product Vascular Closure Device for Catheter Ablations

I just got off the phone with Andy who was telling me about his RF Ablation and his post-op experience. He had to lie on his back for 15 hours before his groin incision stopped bleeding and he was safe to go home. He said it was quite painful to be immobile that long.

Delivery disc of the  ASCADE MVP implants the collegan plug

My first report from the 2019 AF Symposium is about a new product used during catheter ablations and is designed to help patients like Andy go home sooner after their ablation.

The problem? Post-op bleeding from the catheter insertion point in the groin. Typically, the patient lies on their back for about 6 hours while the insertion point heals and stops bleeding enough so they can be discharged. (For guys, especially, it’s no fun having to use a Foley catheter to pee.)

Cardiva Medical has solved this problem. A simple, ingenious device closes off the insertion point(s) in the groin with a “collagen plug”.

Collagen plug like a cork in a bottle

How it’s used: After completing the ablation, the EP withdraws the ablation catheter, then replaces it with the VASCADE MVP which has a expandable/collapsible delivery disc to implant a collagen plug. This plug acts like a cork in a bottle and stops all bleeding leakage. (The FDA was so impressed with the VASCADE that it approved it within weeks.)

I give it a try: In the Exhibitors Hall, Michael Gebauer of Cardiva Medical demonstrated it to me. It takes a whole 5 seconds to insert the VASCADE MVP.

Continue reading (for how to get the cork out of the bottle, and more)go to my full report: Cardiva Medical ASCADE MVP Vascular Closure Device.

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