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
AVNRT Diagnosed, 2nd Ablation—Finally A-Fib Free
Prior to 2015, I was an active 67-year old male who had taken up running in my late 30’s…I had never experienced any heart issues. Late in September 2015, my heart was racing and a local Spokane hospital ER informed I was experiencing atrial fibrillation. Approximately 12 hours later, with meds, I was back in normal sinus rhythm.
Bob Thompson, Spokane, WA
Over Three Years A-Fib, Bouts Become More Frequent
Over the next few years, I went into A-Fib over 50 times with each bout lasting on the average 10 to 12 hours.Taking metoprolol while in A-Fib, got me back in normal sinus rhythm. I never needed to have a cardioversion.
After dealing with A-Fib for over three years and with the occurrences becoming more frequent, I opted to have a heart catheter ablation in September 2018. Result: the ablation was a complete failure. The EP was only able to ablate three of the four pulmonary veins.
Ablation Fails—Exploring Mini-Maze Procedure
After my failed ablation, my occurrences of A-Fib rapidly increased. I began to explore another option, a mini-maze procedure.
I met with a cardiac surgeon in Spokane who suggested I try one more catheter ablation before I opted for the mini-maze procedure. The surgeon informed me that the best EP in Spokane was Dr. Mark Harwood whom he would be seeing later in the day.
Best EP in Spokane Calls Me the Next Day!
One day after meeting with the cardiac surgeon, I received a call from Dr. Harwood’s office. Upon meeting with Dr. Harwood, he informed me that he was confident of his ability to ablate all four of my pulmonary veins.
Scheduled for Ablation But Stress Test Reveals AVNRT
I was scheduled to have my second ablation in March 2019, but it was contingent on the results of a stress test.
A few days later, at the end of the stress test, I went into A-Fib. An irregularity (tachycardia) was detected requiring an AVNRT Ablation as well. Continue reading Bob’s story…->
A Failed Ablation, then AVNRT Diagnosed and 2nd Ablation—Now Finally A-Fib Free
Bob Thompson, Spokane, WA
By Bob Thompson, Spokane, WA, August 3, 2020
Prior to 2015, I was an active 67-year old male who had taken up running in my late 30’s. I had been diagnosed with Essential Tremor [involuntary shaking or trembling] early in my life but otherwise was considered to be very healthy. I had never experienced any heart issues. Little did I know how much my life was about to change.
Late in the evening of July 11, 2015, I began to feel like my heart was racing and immediately went to a local Spokane hospital ER. After a short period of time, I was informed that my heart was experiencing atrial fibrillation.
Since I was already taking the beta blocker metoprolol for my Essential Tremor, the ER staff intravenously gave me some additional metoprolol. Approximately 12 hours later, I was back in normal sinus rhythm.
Surprised by A-Fib―Researching on the Internet
But what was atrial fibrillation? I had never heard of this diagnosis before the summer of 2015. As is my custom when I am unfamiliar with something, I went to the internet and began to research A-Fib.
I discovered Steve Ryan’s website, A-Fib.com and almost immediately ordered a copy of his book, Beat Your A-Fib. Both Steve’s website and book have been invaluable resources in my quest to deal with my A-Fib.
A-Fib Attacks Continue Lasting 10-12 Hours―Tries Drug Therapy
Over the next few years, I went into A-Fib over 50 times with each bout lasting on the average 10 to 12 hours. Increasing my dosage of metoprolol while in A-Fib, resulted in being able to get back into normal sinus rhythm, and I never needed to have a cardioversion.
My first electrophysiologist (EP) recommended that I take flecainide whenever I went into A-Fib (the so-called Pill-in-the-Pocket treatment), but I found that particular drug did nothing but cause extreme stomach discomfort.
The EP also recommended I try some additional drugs such as sotalol and amiodarone, but I resisted because of the likely side effects that would result. I did, however, agree to take the blood thinner Eliquis.
After Three Years, Time for a Catheter Ablation―Disappointing Failure
After dealing with A-Fib for over three years and with the occurrences becoming more frequent, I opted to have a heart catheter ablation on September 15, 2018.
Result: the ablation was a complete failure. The EP was only able to ablate three of the four pulmonary veins.
A-Fib Occurrences Increase, Exploring Mini-Maze Procedure
Subsequent to the ablation, my occurrences of A-Fib rapidly increased. I began to explore another option, a mini-maze procedure. I met with a cardiac surgeon in Spokane who suggested I try one more catheter ablation before I opted for the mini-maze procedure.
The surgeon informed me that the best EP in Spokane was Dr. Mark Harwood whom he would be seeing later in the day. I informed the surgeon I was aware of Dr. Harwood’s reputation, but I was never able to see him because the EP who had performed the first ablation was part of the same practice of EPs.
Dr. Harwood’s Office Calls Me the Next Day!
One day after meeting with the cardiac surgeon, I received a call from Dr. Harwood’s office informing me that Dr. Harwood could see me the next day. Upon meeting with Dr. Harwood, he informed me that he was confident of his ability to ablate all four of my pulmonary veins.
However at the completion of the stress test, I went into A-Fib. Dr. Harwood detected an irregularity (Tachycardia) that lead him to also perform an AVNRT Ablation.
Another Ablation in March 2019
As scheduled, I had an atrial fibrillation ablation on March 15, 2019. Unlike my first ablation, Dr. Harwood was able to successfully ablate all four pulmonary veins.
In addition, at the same time, Dr. Harwood also performed an AVNRT (Atrioventricular Node Reentrant Tachycardia) ablation which he felt was needed after detecting an irregularity in the EKG during the earlier stress test. [For more about AVNRT, see my Editor’s Comments below.]
Success! A-Fib Free Since March 2019
Subsequent to my 2019 ablation procedures, I have had no recurrences of A-Fib. I no longer need to take the blood thinner Eliquis.
In other words, after almost four years, I am A-Fib free, and I and my wife now have our lives back.
Lessons Learned: My Advice
Here is my advice to others who are battling A-Fib:
1. Never give up in trying to find a cure for this insidious disease. Do not accept the words “Learn to Live with It”.
2. Do not settle for seeing the first available EP which is a mistake I made. Talk to other physicians and medical professionals and ask them for recommendations.
3. It is normal to have anxiety when dealing with A-Fib. My digestive system was a complete mess until I was finally convinced to take some anxiety medication.
4. Try to avoid being tired. Looking back at the chart I kept for my A-Fib incidences shows a definite pattern of going into A-Fib after excessive exercise or work.
5. If you have doubts as to whether or not you are experiencing A-Fib, go to a local fire station that has a paramedic on site. You will be able to have an EKG at no cost.
In Gratitude
In conclusion, I will be forever grateful to Dr. Mark Harwood of Providence Spokane Cardiology-North, for going beyond the parameters of a normal ablation of the pulmonary veins and performing the AVNRT ablation which likely resulted in my cure.
In addition, I am so thankful for the input I have received from Steve Ryan from his website and book as well as one-on-one correspondence.
You can contact me at easychatt@aol.com.
Bob Thompson
Spokane, WA
Editor’s Comments
All EPs Are Not Equal: It’s a shame that Bob’s first EP wasn’t able to isolate all of his PVs. Unfortunately, all EPs are not equal. One of the hardest tasks A-Fib patients face is finding the right EP.
Don’t be afraid to get a second (or third) opinion. Don’t just go with an EP who happens to work near you. Be prepared to travel. Go to the best, most experienced EP you can find, afford, and to where you can reasonably travel.
Search Out the Best EP You Can Find: One of the best ways to find a good EP is what Bob did: talk to doctors, nurses, or support staff who work in the field. They can often tell you who is the best and whom to avoid. But getting this kind of inside info isn’t easy and isn’t possible in many cases.
How Do You Find the Right EP for You? To learn how electrophysiologists differ and how to find the right EP for you, see two of my articles:
• A Tale of Two Ablations and Why All EPs Are Not Equal
• Considering a Catheter Ablation? Know Complication Rates When Choosing Your Doctor.
Bob’s Persistence: What’s inspiring about Bob’s story is his persistence in getting to the best EP in Spokane. God bless the wonderful surgeon who recommended that Bob see Dr. Harwood, even though that surgeon might lose a patient for his own Mini-Maze surgery.
Heart in AVNRT: Instead of a single path, an extra (re-entry]) circuit is shown from the Sinus node and within the AV node.
Technical Description of Bob’s Ablation
Kudos to Dr. Harwood for discovering that Bob had AVNRT and an extra circuit (from the Sinus node and within the AV Node).The ablation for ANVRT is a somewhat unusual procedure.
AVNRT stands for Atrioventricular Node Reentrant Tachycardia.
Normally, the AV Node electrically connects the atria and ventricles and is normally a single electrical road. But in AVNRT, there is a re-entry [extra] circuit within or adjacent to the AV Node.
Catheter Ablation of Pulmonary Veins
Bob’s Left Superior Pulmonary Vein [RSVP] needed to be ablated at the roof, and the Left Inferior Pulmonary Vein [LIPV] needed to be ablated at the ridge.
After isolating Bob’s PVs, Dr. Harwood administered adenosine to confirm entrance and exit block. He then waited 30 minutes to re-confirm that all PVs remained blocked/isolated.
AVNRT illustration: The extra path creates cardiac conduction with both a Fast signal and a Slow signal that disrupts normal sinus rhythm.
Ablation for AVNRT
Next Dr. Harwood used atrial pacing on isoproterenol to induce Supraventricular Tachycardia [SVT].
Then he ablated this extra pathway or circuit which eliminated Bob’s re-entrant tachycardia without damaging Bob’s normal AV Node circuit/pathway.
In effect, he found and engaged Bob’s “Slow Pathway” circuit which was adjacent to his normal AV Node circuit.
My Top 5 Articles: Surgical Treatment Options for Atrial Fibrillation
When drug therapies fail or if not a candidate for catheter ablation, patients look to surgical treatments to reduce the risk of stroke, to ease symptoms or to cure their Atrial Fibrillation.
Here are my top 5 articles about the Maze & Mini-maze surgeries and role of the left atrial appendage:
- The Cox-Maze & Mini-Maze Surgeries and the Hybrid Surgery/Ablation
- Advantages of the Convergent (Hybrid) Procedure
- Considering a Mini-Maze? Don’t Destroy the Ganglionic Plexus
- The Role of the Left Atrial Appendage (LAA) & Removal Issues
- The Watchman™ Device: The Alternative to Blood Thinners
BONUS VIDEO
Mini-Maze Surgery with Cardiac Surgeon Dr. Dipin Gupta
Cardiothoracic surgeon Dipin Gupta, MD, discusses this surgical treatment for persistent atrial fibrillation. The Mini-Maze is done without open-heart surgery and using a small incision on the side of the chest. Published by MedStar and Cleveland Clinic. March, 2015 (4:35) Go to video->
Now A-Fib Free: A 23-Year Atrial Fibrillation Ordeal, Trial, Tribulations and Recovery
By Charn Deol, Richmond, British Columbia, Canada, May 2017
Charn Deol, B.C., Canada
My medical issues with atrial fibrillation started when I was 43 in August of 1993 when I was aware of having a few skipped heartbeats. I had just returned to Canada having been working extensively for the last few years in Southeast Asia. About a week later, the irregular heart beating got worse in duration.
At the same time, a dull aching pain started in the left chest region the size of a 50-cent piece.
A-Fib Drugs Don’t Work, Chest Pain Condition Worse
Upon being sent to a heart specialist in September 1993, numerous drugs were prescribed to keep my heart in rhythm (digoxin, flecainide, sotalol). They did not work, some had serious side effects, and every few days I would go into atrial fibrillation.
The atrial fibrillation happened once or twice per week and lasted from a few hours to 24 hours. Then it would stop on its own, and the heart would go into normal sinus rhythm.
Second medical condition: At the same time, the very centered pain in the upper left chest area kept getting worse and added to the debilitation of daily life. These medical conditions started my long journey to find relief (cure) from two medical conditions that were not being controlled or cured by conventional medical treatments.
Alternative Healthcare Practitioners―India & China, Too
In my search for a cure(s), I met a family practitioner and other medical and alternative specialists who used treatment protocols that could be labeled ‘experimental’ or ‘out of the box’, as they say.
While discovering alternative medical treatments in 1994, I also went to India for Ayurvedic treatment [one of the world’s oldest holistic healing systems] and even to China for treatment. Most alternative (non-allopathic) medical practitioners look at the body as an interconnected processing unit and believed in my case that the pain in the left chest and the atrial fibrillation were connected. This was not the thinking of the allopathic doctors, so I was all mixed up as to what was going on in my body. This can be psychologically very distressing if you do not have a strong family/friend support network.
Having been to a multitude of healthcare practitioners, numerous chiropractors, massage therapists and other more esoteric healthcare practitioners (100s over the 23 years), there was no resolution to my medical condition.
Encainide Drug Therapy: Up and Out
The heart specialist that gave me sotalol [an antiarrhythmic drug] in 1995 gave me a dose that dropped the heartbeat to 30 beats per minute putting me into the emergency room, but the drug had no effect on my atrial fibrillation.
In 1996 seeing my third cardiologist, I was put on a drug called encainide [also an antiarrhythmic drug], to be used on an as needed basis [pill-in-the-pocket]. It worked and would stop my atrial fibrillation in approximately 20 minutes.
But it had no effect on the chest pain which was getting worse now with a pain spot in the left shoulder blade area also the size of a 50-cent piece having started out of nowhere.
About 6 months after starting on the encainide, one of my friend’s son with a heart condition since childhood passed away. And I was told he had just been started on a new drug for him called “encainide” along with “sotalol”. The same cardiologist had been providing this drug free of charge to me, so I was pleased that it worked for me and cost me nothing.
The problem I found out was that it was illegal for the cardiologist to prescribe this drug because it had killed too many people. When he got caught, then encainide was no longer available. (Encainide is a class 1C antiarrhythmic drug no longer used because of its frequent proarrhythmic effects.)
Chelation for Very High Levels of Mercury
While all the above was going on, I was tested for heavy metals through urine analysis. It was discovered that I had the highest level of mercury ever seen by the lab in any of their patients (7400 nmol/dl). So I started protocols to take the mercury out of my body using chelation treatments with EDTA and then DMPS and DMSA (metal chelators).
At the same time, my other medical practitioners had me on oral and IV multivitamins and mineral protocols.
Mercury Cleared, Atrial Fibrillation Stops!
By 2000, the mercury was finally out of my system and my atrial fibrillation stopped! It is known mercury can concentrate in nerve tissue. While only a correlative relationship―mercury out of system―my atrial fibrillation did stop.
Chest Pain Condition Worse than Ever
From 2000 to 2010 I had no atrial fibrillation. But the chest pain condition did not stop, and it got worse extending into my gut region. All medical protocols tried could not alleviate this pain, nor was any etiology discovered as to what was the underlying cause of the pain condition.
Thanks to my resiliency, I was still able to go hiking, skiing, travel and work part-time on my own schedule. But it took great perseverance.
After 10 Years A-Fib Returns―and Heavy Levels of Lead (This Time)!
In 2010, while starting a hike, the atrial fibrillation began again. The A-Fib would last 6-8 hours and occur an average of 2 times per week.
I was immediately tested for heavy metals again, and this time I had high levels of lead, not mercury. Even with thorough investigations of potential sources for this lead contamination in my body, no source was discovered. We worked (and continue to work) on getting these lead levels down (I had no high lead levels back in the 1990’s when tested―only mercury).
Amiodarone Bad Side Effects
I again began doing alternative treatments to deal with the atrial fibrillation and the pain condition, nothing worked. I went to China again for treatments, IV EDTA infusions again, etc., but the pain persisted at high levels and the atrial fibrillation kept getting worse.
In 2012, I saw a new cardiologist who put me on flecainide again. And when it did not work, he provided me with a new drug called amiodarone. This drug lead to paranoia and left me with an epididymitis in my right testicle which I suffer from to this day. (Epididymitis is inflammation of the tube at the back of the testicle that stores and carries sperm.) He had no compassion for my dilemma. This is another cardiologist I dropped.
Ablation in Vancouver, B.C. Fails―A-Fib Worse and More Chest Pain
By late 2014, the atrial fibrillation was occurring on average every second day and lasting 24-38 hours. My next cardiologist sent me to the Atrial Fibrillation clinic in Vancouver where I was evaluated by an electrophysiologist. The A-Fib was very debilitating, so I was ready for surgery.
I asked for the most experienced electrophysiologist at the clinic to do the surgery. I waited an extra 3 months for the surgery because this highly qualified electrophysiologist was in so much demand.
Finally, in November 2015 I had the ablation therapy (it took approximately 2.5 hours). I came out of the surgery worse than ever. The atrial fibrillation did not stop, and the pain was worse than ever in my left chest, left shoulder-blade and gut regions.
AV Node Ablation & Pacemaker?―No! No! No!
The electrophysiologist wanted to wait for the 6 month recuperation period after the ablation therapy to see if I would go into regular sinus rhythm. By September 2016 (9 months later), I was worse than ever. In November, I saw my electrophysiologist under the impression that he would do another ablation treatment, since I was told and with my own research had confirmed that ablation treatments may be required for up to four times for the treatment to work.
This “top” electrophysiologist recommended I have a pacemaker put in and the AV node be ablated instead, so that the pacemaker could take over the regular beating of the heart. I asked the electrophysiologist why not do further ablation treatments as per the standard practice. He said if that is what I wanted, he would do another ablation. This was quite disconcerting―I am relying on his extensive knowledge to help me in a field where I am no expert. We agreed to set up a surgical date for a second ablation on December 12, 2016.
Upon leaving the office and arriving home, I informed my wife of the unpleasant appointment I had with the electrophysiologist, especially his lackadaisical attitude towards my serious heart condition. As a patient, the relationship is somewhat like that of a child with a parent. The patient is naïve, scared, distraught and looking for a path of reassurance from the medical profession. This was not the case in this situation.
This is when “gut instincts” come into play. My gut said to ‘no longer trust’ this supposed best electrophysiologist at the hospital and search for an alternative path. (And I canceled my December 12, 2016 scheduled ablation.)
Counseling with Steve Ryan
Having been a reader of Steve Ryan’s website, I reached out to him and agreed for him to become my advocate and provide me with advice on how to deal with my current concerns over either going along with having a pacemaker placed in my chest along with ablation of the AV node OR to try a second ablation. Steve recommended a second ablation and the Bordeaux Clinic―it was too early to place a pacemaker/ablate the AV node at this stage.
Following this detailed discussion with Steve, I spoke with my wife and got a hold of the Bordeaux Clinic in France on December 2, 2016. With some back and forth email communication, ablation therapy was arranged for December 12, 2016. Somehow with luck and quick action, my wife and I were on an airplane to France and arrived in Bordeaux on December 10.
Second Ablation in Bordeaux and Use of CardioInsight Vest
The surgery on December 12 was done by Prof. Mélèze Hocini. Instead of taking the standard time of 2.5 to 3 hours for the surgery, it took well over 6 hours until approximately 4 pm. Dr Hocini was on her feet and exhausted.
I was informed the next day that my surgery was much more complicated than envisioned, and there were many areas that had to be ablated not only for the atrial fibrillation but also for atrial flutter. It appeared the “top” specialist I had used in Vancouver had not done his job properly. (Remember that I had been worse for the year after my first ablation).
Dr. Hocini was able to see the numerous sites leading to the atrial fibrillation/flutter in my heart due to an advanced computer assisted mapping vest (CardioInsight) which helps the electrophysiologist see in more detail cells in the heart that are acting erratically. This system is just starting to be used in the U.S. by a few doctors. (See Bordeaux ECGI CardioInsight)
Successful Ablation—No A-Fib, But Chest Pain Condition Continues
I felt great the day after the surgery, no atrial fibrillation or flutter. Pain syndrome still there. I remained in the hospital for 4 more days and all went well, and then stayed in France for 7 more days sightseeing. No problems. I was to continue on Xarelto to keep the blood thin [for risk of stroke].
At Home A-Fib Returns with Persistent A-Flutter
Upon arriving back in Canada, the atrial fibrillation and flutter returned. Dr Hocini recommended cardioversion which I did twice but I still ended up in persistent atrial flutter with a heartbeat in the 130 range but no longer irregular.
Beta Blockers were tried to lower the heartbeat for a few weeks which did not work. Dr. Hocini recommended another cardioversion with sotalol prescribed for after the cardioversion. This was done on February 17, 2017. The heartbeat converted to sinus rhythm (65 heartbeat and was regular).
Normal Sinus Rhythm―4+ Months So Far
I have now remained in rhythm since February 17, 2017 with a quick flutter occurring once in a while. Since I am sensitive to prescription medications, I was placed on a low dose of 40 mg sotalol 2 times per day.
Minerals, Vitamin IVs for Inflammation of the Heart
With my other medical practitioners, I also had mineral and vitamin IVs during this time to help alleviate the inflammation in my heart from the surgery. I also took (and continue to take) vitamins and supplements as recommended by the other medical professionals treating me to keep the inflammation in the heart down.
Dr. Hocini had stated that since my ablation surgery was so complicated, I might have to go back to Bordeaux for another ablation. I have to get through the recommended 6 month recuperation time frame to see if the surgery has been successful. The last 3 months have me heading in the right direction of recovery.
Lessons Learned: After 23 Years with A-Fib
From this experience I’ve learned to obtain as much knowledge as possible of your condition. Trust your gut feelings if you feel uncomfortable with your surgeon. Increase your intake of nutritious foods and supplements prior to and after the surgery. Steve Ryan’s website provided me with the knowledge to make educated decisions.
If you have the funds and/or a complicated atrial fibrillation situation, please find the best surgeon you can and then still question him/her. Get a second [or third] opinion if your gut tells you to.
Doctors are just human beings with positive and negative traits like the rest of us. My first surgeon did not do his job properly in my first ablation and was flippant in his attitude in recommending a second surgical treatment.
With luck, trusting my gut instinct, educating myself, and a great family support system, I was able to find the best clinic in the world to treat me for this very debilitating medical condition.
I welcome your email if I can be of help to you.
Charn Deol, May 2017
charnee@gmail.com
P.S. FYI: My chest pain problem persists and goes undiagnosed, but that’s a story for another website!
Editor’s Comments:
Three month ‘blanking’ period: Charn’s A-Fib returned after his successful second ablation. This is quite common in more difficult cases. Your heart is ‘learning’ to beat normally again. That’s why doctors wait for at least three months before declaring your ablation a success. In Charn’s case, during the first two months, a couple rounds of cardioversions were followed by a third with sotalol prescribed after the cardioversion. This worked to get his heart back into and stay in normal sinus rhythm (NSR).
Be a proactive patient: Charn’s story is truly inspiring and an example of being proactive and not giving up. Do research yourself, get advice, and check out alternatives! We’ve been conditioned to trust doctors. Sometimes we just have to say “NO! That doesn’t make sense to me”. It’s okay to fire your doctor!
I told Charn an AV Node ablation is a treatment of last resort; it destroys the AV Node, the heart’s natural pacemaker. There’s no going back and you are forever pacemaker dependent.
Instead, I advised Charn to seek a second ablation and supplied him a list of Master EPs who routinely treat difficult, complex cases. Kudos to him for deciding to go to the Bordeaux group, considered the best in the world. [For more about Bordeaux, see my article, ‘2016 Cost of Ablation by Bordeaux Group (It’s Less Than You Might Think)’].
Chelation therapy: Chelation is FDA approved for lead removal and is the preferred medical treatment for metal poisoning. But few doctors perform chelation therapy or provide heavy metal testing. To find a doctor for these therapies, go to: http://www.acam.org. (They also do IV therapy for vitamin C and other vitamins and minerals which seems to have helped Charn.)
Amiodarone drug therapy: Amiodarone is considered the most effective of the antiarrhythmic drugs, but it’s also the most toxic and is notorious for bad side effects, including death. It’s generally prescribed only for short periods of time such as for a few months after a catheter ablation and under very close supervision. (For more about Amiodarone, see my article, ‘Amiodarone: Most Effective and Most Toxic‘.
Charn’s second ablation Operating Report: Charn’s ablation was more difficult than most. He had been in A-Fib off and on for 23 years. In addition to having to work around a previous failed ablation, Dr. Hocini had to track down and ablate many non-PV triggers. Using the CardioInsight system, Dr. Hocini found A-Fib sources in the septum and in the anterior Left Atrium (LA) region, and his left and right inferior PVs had to be re-isolated.
But Dr. Hocini didn’t stop there. Using pacing again, Dr. Hocini found peri-mitral flutter in Charn’s left atrium which terminated by completing an anterior mitral line and required high energy because of the thickness of his heart tissue. Dr. Hocini had to work on Charn for six hours to the point of exhaustion.
Charn’s chest pain continues: Charn’s debilitating chest pain seemed to start when he first developed A-Fib. I’m disappointed that being A-Fib-free didn’t get rid of the pain he still experiences. I’ve never heard of pain like this coming from A-Fib. Charn has seen many doctors and tried alternative strategies to no avail.
If anyone has any ideas, strategies, or insights to help Charn’s pain, please email me.
Return to Patient A-Fib Stories
If you find any errors on this page, email us. Y Last updated: Sunday, June 4, 2017
Ablation of the AV Node and Implanting of a Pacemaker for Atrial Fibrillation
Location of the AV Node
From a patient’s point of view, this is a procedure of last resort.
Each heartbeat normally starts in the right atrium where a specialized group of cells called the sinus node generates an electrical signal that travels down a single electrical road (the Atrioventricular [AV] Node) that connects the atria to the ventricles below.
By ablating or eliminating this AV Node, your Atrial Fibrillation signals can’t get to the ventricles which does stop your heart from racing.
But for your heart to beat at all or at the proper rate, you must have a permanent pacemaker implanted in your heart for the rest of your life. (Leadless pacemakers can be used since they only need to detect signals and pace the right ventricle.)
Advantages of AV Node ablation
Your heart rhythm will be regular and will no longer race rapidly but will be controlled by the pacemaker.
You may no longer require many of your medications to control your heart rhythm.
After an AV Node Ablation with Pacemaker procedure, patients report feeling better with an improved quality of life (being able to golf 18 holes, for example) than when A-Fib made their heart race.
Note: If you suffer from Sick Sinus Syndrome (a bad Sinus Node) and would need a pacemaker anyway, an AV Node ablation procedure may be appropriate.
Disadvantages of AV Node ablation
The procedure does not cure your A-Fib. It only treats the symptoms. This procedure will control the heart rhythm but the multiple short circuits in the atria will still be present. You will simply no longer be aware of them.
Because you still have A-Fib: you continue to be at increased risk of stroke, and have to forever take anticoagulants. Over time, A-Fib may decrease mental abilities and lead to dementia. Also, after an AV Node Ablation, patients with Paroxysmal (occasional) A-Fib often develop Persistent A-Fib.
In addition, when you eliminate the AV Node, there is a risk of sudden death because of the ventricles beating too fast. (Biventricular pacing is generally preferred over uni-ventricular pacing which potentially can worsen or even cause heart failure by one ventricle beating out of sync with the other.)
An AV Node ablation is irreversible. You will be dependent on the pacemaker for the rest of your life.
If you find any errors on this page, email us. Y Last updated: Wednesday, August 26, 2020
Return to Treatments for Atrial Fibrillation
Treatments for Atrial Fibrillation
Treatments for Atrial Fibrillation include both short-term and long-term approaches aimed at controlling or eliminating the abnormal heart rhythm associated with A-Fib.
Diagnostic Testing
Doctors have several technologies and diagnostic tests to aid them in evaluating your A-Fib. Go to Diagnostic Testing ->
Additional resources:
• VIDEO: An Introduction to Your Heart’s Electrical System & How Clots Form
• VIDEO: The Zio® XT Patch (iRhythm): Single-Use Ambulatory Cardiac Monitor
• Sleep Apnea: Home Testing Now Available
• A Primer: Ambulatory Heart Rhythm Monitors
• Guide to DIY Heart Rate Monitors & Handheld ECG Monitors (Part I)
• Understanding the EKG Signal
• The CHADS2 Stroke-Risk Grading System
Mineral Deficiencies
A deficiency in minerals like magnesium or potassium can force the heart into fatal arrhythmias. When you have A-Fib, a sensible starting point is to check for chemical imbalances or deficiencies. Go to Mineral Deficiencies ->
Additional resources:
• VIDEO: The Best Way to Supplement Magnesium
• Frequently Asked Questions:Mineral Deficiencies & Supplements
• ‘Natural’ Supplements for a Healthy Heart
• Alternative Remedies and Tips
Homeopathic Remedies
Iron Overload or Lack of Iron
Acupuncture/Acupressure
Chiropractic Adjustment
Hypnosis
Patient Tips for Temporary Relief
• Acupuncture Helps A-Fib—Specific Acupuncture Sites Identified
• Low Serum Magnesium Linked with A-Fib
Drug Therapies
Medications (drug therapies) for A-Fib patients are designed to regain and maintain normal heart rhythm, control the heart rate (pulse), and prevent stroke. Go to Drug Therapies ->
Additional resources:
• Frequently Asked Questions:Drug Therapies and Medicines
• Warfarin vs. Pradaxa and the Other New Anticoagulants
• Amiodarone: Most Effective and Most Toxic
• My Top 5 Articles About Warfarin Therapy, Associated Risks and Alternatives
• Watchman: the Alternative to Blood Thinners
• VIDEO: The Watchman Device: Closure of the Left Atrial Appendage Technique
Cardioversion
The goal of cardioversion is to restore your heart to normal rhythm. There are two types of cardioversion: chemical and electrical. Cardioversion through the use of drugs is called chemical cardioversion. Electrical cardioversion uses a timed electrical shock to restore normal rhythm. Go to Cardiversion ->
Additional resources:
• VIDEO: Dr. Bruce Janiak’s Cardioversion from Atrial Fibrillation
• VIDEO: Step-by-Step: Cardioversion Demonstration by ER Staff
Catheter Ablation
RF and CryoBalloon catheter ablation are minimally invasive procedures that block electrical signals which trigger erratic heart rhythms like Atrial Fibrillation. Go to Catheter Ablation ->
Additional resources:
• VIDEO: When Drug Therapy Fails: Why Patients Consider Catheter Ablation
• Frequently Asked Questions: Catheter Ablation, Pulmonary Vein Isolation, CyroBalloon Ablation
• Considering a Catheter Ablation? Know Complication Rates When Choosing Your Doctor
• Recurrence of A-Fib After Successful Catheter Ablation
• A Cryo Ablation Primer
• Bordeaux Procedures & Costs
Cox Maze & Mini-Maze Surgeries & Hybrid Surgery/Ablation
The traditional open-heart Cox-Maze is usually performed concurrent with other heart disease treatments. More common are the various Mini-Maze surgeries which are stand-alone surgeries performed through small port-size incisions in the chest. Go to the Maze, Mini-Maze & Hybrid ->
Additional resources:
• VIDEO: The Maze Open-Heart Surgery (Concurrent Heart Surgery)
• VIDEO: Mini-Maze Ablation for Persistent A-Fib: With Cardiac Surgeon Dr. Dipin Gupta
• Advantages of the Convergent Procedure by Dr. James Edgerton
• Advances in Surgical Therapy for A-Fib by Dr. David Kess
• Role of the LAA & Removal Issues
Ablation of the AV Node and Implanting a Pacemaker
From a patient’s point of view, this is a procedure of last resort. By ablating or eliminating the AV Node, your Atrial Fibrillation signals can’t get to the ventricles which does stop your heart from racing and improves your Quality of Life. But you must have a permanent pacemaker implanted in your heart for the rest of your life to replace your AV Node functions. And what’s worse, you still have Atrial Fibrillation. Go to Ablation of the AV Node->
Pacemakers & ICDs
Pacemakers may be implanted for pacing support, or in conjunction with Ablation of the AV Node (see above). Implanting a pacemaker seems to be most helpful if you have a slow heart rate or pauses as a result of taking A-Fib medications. But be advised that pacemakers tend to have bad effects over the long term.
ICDs which shock the heart to return it to normal rhythm are not usually used in A-Fib. Some people describe an ICD shock as like a horse kicking you in the chest. Because A-Fib attacks can occur relatively frequently, repeated ICD shocks can be very painful and disruptive. Patients with ICDs often live in fear of the next shock. Most patients would rather have A-Fib than risk being shocked throughout the day and night. Go to Pacemakers & ICDs ->
Decisions About Treatment Options
When considering treatments for atrial fibrillation, you may ask,“Which is the best A-Fib treatment option for me?” This is a decision only you and your doctor can make. Here are some guidelines to help you. I’ve listed A-Fib conditions as patients might describe them. Select one (or more) that best describes your A-Fib and read your possible options. Go to Decision About Treatment Options ->
Remember…A-Fib is a progressive disease…
Don’t wait – Seek a CURE as soon as practical.
I Beat my A-Fib—So can You!– Steve Ryan, former A-Fib patient
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If you find any errors on this page, email us. Y Last updated: Wednesday, April 28, 2021
