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


Catheter Ablation

Q&A: Can Catheter Ablation Be a First-Choice Option?

Q: “I was told that I can’t have a catheter ablation to fix my A-Fib until after at least a year of trying different medications. Is that right? I don’t want to live in A-Fib for a year. I’m very symptomatic. I hate being in A-Fib.”

A: Catheter Ablation Can Be a First-Choice Option. Current Guideline for the Management of Patients with Atrial Fibrillation say you don’t have to wait before getting a catheter ablation. You can have a catheter ablation right away as a first-choice option.

Here is the actual wording of the guidelines:

“The role of catheter ablation as first-line therapy, prior to a trial of a Class I or III antiarrhythmic agent, is an appropriate indication for catheter ablation of AF in patients with symptomatic paroxysmal or persistent AF.”

Guidelines Level of Confidence: Catheter Ablation has a Class IIa Level of Evidence (LOE) indication. This means the “weight of evidence” is in favor of this treatment as useful and effective. (To read more, see Catheter Ablation of AF as First-Line Therapy (p. e307.), in the 2017 HRS/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation.)

Drugs First? Your doctor will usually talk about first trying antiarrhythmic meds. This can waste valuable time as most “antiarrhythmic” drug therapies are only effective about 40% of the time cause, can have bad side effect, and often become less effective over time. And, you will most likely still have A-Fib.

Catheter Ablation as a First Choice? If you want to skip the drug therapies, ask your doctor about catheter ablation. If your electrophysiologist won’t talk to you about catheter ablation, seek a second opinion (or change doctors).

As an A-Fib patient, know your rights and be assertive.

2021 AF Symposium: ATTEST Trial—Catheter Ablation to Modify Progression of AF

2021 AF Symposium

ATTEST Trial: Catheter Ablation to Modify Progression of AF

Dr. Karl-Heinz Kuck

Dr. Karl-Heinz Kuck of the Asklepios Klinik St. Georg in Hamburg, Germany, gave a presentation on the findings from the ATTEST Trial. (He also spoke on this topic at the 2020 AF Symposium).

Patient Risk: Progressing from Paroxysmal to Persistent A-Fib

Dr. Kuck pointed out that within one year, 4% to 15% of paroxysmal A-Fib patients become persistent.

In addition: they are at a higher risk of dying, they have more risk of stroke, and it’s more difficult to restore them to normal sinus rhythm. (In the Rocket AF trial, the mortality rate of persistent A-Fib was triple that of paroxysmal patients.)

The ATTEST Trial: RF Ablation vs Antiarrhythmic Drugs

The ATTEST clinical trial included 255 paroxysmal patients in 36 different study locations. They were older than 60 years and had to have been in A-Fib for at least 2 years (mean age 68). They had failed up to 2 antiarrhythmic drugs (either rate or rhythm control).

Patients were randomized to two groups: radiofrequency ablation (RF) (128) or antiarrhythmic drugs (127). They were followed for 3 years (ending in 2018).

ATTEST Findings

Significant data about the progression of A-Fib was learned from this trial.

• At 3 years, the rate of persistent A-Fib or atrial tachycardia was lower (2.4% ) in the RF group vs the antiarrhythmic drug group (17.5%).

• The RF group was approximately 10 times less likely to develop persistent A-Fib compared to the antiarrhythmic drug group.

• For patients in the antiarrhythmic drug group, 20.6% progressed to persistent A-Fib or atrial tachycardia compared to only 2.2% in the RF group.

• Recurrences occurred in 49% of the ablation group vs. 84% in the drug group. Repeat ablations were done on 17.1% of the ablation group.

Dr. Kuck’s advice: “Ablate as early as possible.”

Dr. Kuck’s Conclusions

Early radiofrequency ablation was superior to antiarrhythmic drugs to delay the progression to persistent atrial fibrillation among patients with paroxysmal A-Fib.

Dr. Kuck’s advice: “Ablate as early as possible.”

Editor’s Comments

The EAST-AFNET 4 Trial: The ATTEST Trial findings dovetailed with results from the EAST-AFNET 4 Trial.

Dr Paulus Kirchhof

In another ’21 AF Symposium presentation, Dr. Paulus Kirchoff (Institute of Cardiovascular Sciences, U. of Birmingham, UK) reported that EAST-AFNET 4 trial findings supported early initiation of rhythm therapy in cases of recent onset A-Fib. (See 2021 AF Symposium: EAST-AFNET 4 Trial—Early Rhythm Control Therapy in AF)
Research by both Dr. Kuck and Dr. Kirchhof came to the same conclusion: “ablate as early as possible” and the need for “early initiation of rhythm therapy.”
Why Risk Progressing into Persistent A-Fib? There are so many bad things that can happen to you when left in A-Fib. As Dr. Kuck points out, you’re at a higher risk of dying, there’s more risk of stroke, it’s more difficult to restore you to normal sinus rhythm.
And we haven’t even talked about heart damage from fibrosis, the risk of electrical remodeling of the heart, and the all-too-real dangers of taking antiarrhythmic drugs over time.
And what about quality of life? Who wants to live in A-Fib? There are few medical procedures so transformative and life changing as going from A-Fib to normal sinus rhythm.
Don’t Leave Someone in A-Fib―Ablate as Early as Possible: Dr. Kuck’s (and Dr. Kirchhof’s)  research answers once and for all whether or not A-Fib patients should be left in A-Fib, whether seriously symptomatic or not (e.g., leaving A-Fib patients on rate control drugs but still in A-Fib.)
These patients are 10 times more likely to progress to persistent A-Fib. That’s why today’s Management of A-Fib Treatment Guidelines lists catheter ablation as a first-line choice. That is, A-Fib patients have the option of going directly to a catheter ablation.
Research supports the same conclusion: “ablate as early as possible” and the need for “early initiation of rhythm therapy.”
Time for a Second Opinion? I occasionally hear of Cardiologists who refuse to refer patients for a catheter ablation, who tell patients a catheter ablation is unproven and dangerous. Not true!
When you hear something like that, it’s time to get a second opinion and/or change doctors.
Know Your Rights—Be Assertive: Your doctor may try to talk you into first trying antiarrhythmic meds before offering you the option of a catheter ablation.

As an A-Fib patient, know your rights and be assertive. According to the Management of Atrial Fibrillation Treatment guidelines, you have a right to choose catheter ablation as your first choice.

If you find any errors on this page, email us. Y Last updated: Friday, April 16, 2021

Return to 2021 AF Symposium Reports

2021 AF Symposium: Another Study Finds Ablation Better First-Line Treatment Than Medication

2021 AF Symposium

Another Study Finds Ablation Better First-Line Treatment Than Medication

To date there have been many research studies demonstrating the superiority of ablation versus drug therapy for A-Fib.

Dr. Jason Andrade

This is a Canadian study of CyroBalloon ablation by lead author Dr. Jason Andrade of University of British Columbia Faculty of Medicine. According to study researchers, CryoBalloon ablation “is a more effective first-line treatment for (A-Fib) patients than medication.”

It was better at preventing symptoms of A-Fib from recurring at all, and reduced the amount of time some patients experienced A-Fib.

The Study: CryoBalloon Ablation Halved Rate of Recurrence vs. Drugs

All 303 patients were treated for A-Fib for the first time in their lives. Half were randomized to receive CryoBalloon ablation, while the other half were treated with antiarrhythmic drugs (AADs).

Of the Cryo-Balloon group, 57.1% didn’t have a recurrence of some form of an irregular heartbeat by the one-year mark [not as high a success rate compared to other studies]. While the success rate of the AAD group was only 32.2%.

CryoBalloon ablation halved the rate of recurrence compared to usual drug therapy.

Additional Benefit: CryoBalloon Ablation Improved Quality-Of-Life

Ablation outperformed the drug group in terms of quality-of-life improvement. Eighty-nine per cent of CryoBalloon patients were free of symptomatic arrhythmia episodes.

According to Dr. Andrade, “Patients who received cryoballoon ablation were more likely to be symptom-free and not require hospitalization for their atrial fibrillation.”

Editor’s Comments

Choose Ablation Over Drugs: Dr. Andrade states explicitly that A-Fib patients should think of catheter ablation as first-line therapy, not something you do after trying multiple antiarrhythmic drugs (AADs).
This is in accordance with current best practices i.e., Guidelines for the Management of Patients with Atrial Fibrillation. AADs don’t work half as well as catheter ablation. In the real world, AADs are ineffective, cause bad side effect, or lose what effectiveness they had over time. And while you’re wasting a year or two trying various AADs, you’re usually still miserable in A-Fib.
Catheter Ablation Transforms Your Life: An A-Fib attack can totally incapacitate you. Even mild to moderate A-Fib can make you feel unwell, produces shortness of breath, brain fog, etc. You may be unable or reluctant to pursue normal activities like traveling and exercise. And you often live in fear of the next A-Fib attack. Or you’re angry and frustrated at your out-of-control heart.
A catheter ablation can change all that.

There are few medical procedures so transformative and life changing as a successful catheter ablation. Ask any former A-Fib patient who is now A-Fib free.

Resources for this article

• A procedure, not medication, may be a more effective first-line of treatment for common heart rhythm problem. UBC Faculty of Medicine, November 24, 2020. https://www.med.ubc.ca/news/a-procedure-not-medication-may-be-a-more-effective-first-line-of-treatment-for-common-heart-rhythm-problem/

• Minimally invasive procedure beats meds for atrial fibrillation. Bottom Line Personal, Volume 42, Number 8, April 15, 2021.

f you find any errors on this page, email us. Y Last updated: Friday, April 16, 2021

Return to 2021 AF Symposium Reports

2021 AF Symposium Live Case: Pulsed Field Ablation for Atrial Fibrillation Using a Lattice-Tip Focal Catheter

2021 AF Symposium

Live Case: Pulsed Field Ablation for Atrial Fibrillation Using a Lattice-Tip Focal Catheter

2021 AF Symposium Live Streaming Video

In a live ablation case titled “Pulsed Field Ablation for Atrial Fibrillation Using a Lattice-Tip Focal Catheter”, Drs. Vivek Reddy and Petr Neuzil demonstrated a new, innovate strategy of using Pulsed Field Ablation (PFA) combined with RF ablation developed by the private company AFFERA, Inc. (Watertown, MA).

Dr. Vivek Reddy is with Mount Sinai Medical Center in New York City and Dr. Petr Neuzil is with Homolka Hospital, Prague, Czech Republic.

The AFFERA System

The AFFERA system

The AFFERA system uses a single lattice-tip catheter but two different energy generators, one for PFA and another for RF ablations.

One of the great advantages of Pulsed Field Ablation (PFA) is that the PF energy doesn’t damage adjacent tissue or structures such as the Phrenic nerve or the esophagus.

A simple foot pedal is used to switch between the two energy generators. A PF ablation appeared as a green dot on the mapping screen. An RF ablation appears as a red dot.

[For more about PFA, see 2020 AF Symposium: Pulsed Field Ablation—Emerging Tech for Atrial Fibrillation.]

Live Via Streaming Video

The Patient’s History: Dr. Reddy’ patient had been in persistent A-Fib, was cardioverted, but went into typical Flutter.

Live from Prague, Czech Republic: When the Symposium audience joined the live video feed from Prague, the doctors and their team had already started the procedure.

The Pulmonary Veins (PVs) were already isolated. They had created a Flutter map.

Posterior Wall Ablation Using PFA: The Symposium audience watched as Dr. Reddy used the system to make PF ablations in areas of the heart. Although near other structures the PF ablation energy only affected the heart tissue, not any of the nearby tissue or organs located just behind the heart.

Dr. Reddy had started working on ablating the posterior wall using 4-second PFA lesions. A bullseye symbol would first appear on the monitoring screen where the lesion was aimed. We were amazed at how fast Dr. Reddy could make a roof line on the posterior wall using PFA.

Dr. Reddy pointed out that there was no significant temperature change when applying PFA lesions. When asked about using a temperature probe in the esophagus, he explained that at first, they did use a temperature probe. After 70-80 cases, they didn’t see any significant temperature changes. Today they no longer use temperature probes in the esophagus.

PFA Faster Than RF Ablations

When switching to PFA, Dr. Reddy only had to apply PFA for 3-5 seconds which is much faster than typical point-by-point RF ablation. The entire lattice-tip delivered a series of micro-second PFA pulses. Saline irrigation was still used as in RF delivery [but one wonders why this is necessary]. There was no need for temperature feedback when using PFA.

In one instance, when a mitral line block was not achieved with the lattice tip, Dr. Reddy switched to RF to make a coronary sinus (CS) ablation. (Although, in most situations, PFA worked well to isolate the CS without having to use RF.)

Spacing Between Ablation Dots

Red dots are RF ablations; Green dots are PFA.

He explained that they are now using a 4 mm spacing PFA distance between ablation spots, but this may change with more experience and data. Spacing of 6 mm may be enough for isolation.

As Dr. Reddy moved away from near the esophagus, he double clicked on the pedal to switch to RF to make ablations in areas of the heart not adjacent to areas that could be damaged by RF energy, such as isolating/ablating around some of the Pulmonary Veins (PVs). When using RF, he increased his spacing between lesions to 6-7 mm. “With RF we think we get a much wider lesion.”

He showed how the AFFERA software showed a gap in blue which indicated too wide spacing. He had preset the software to show blue with any gap larger than 8 mm.

After finishing the mitral isthmus roof line, the Symposium moderator switched away from Dr. Reddy to another live streaming video presentation.

Why Use Both PFA and RF?

Dr. David Keane from St. Vincent’s hospital in Dublin, Ireland asked the question we all wanted to know. “Why? Why even bother with RF in these cases?” If PFA works so well, why use RF at all?

The Lattice catheter

Dr. Reddy stated, “I’m not saying we will never go to pure PFA.” But he also acknowledged that 60 to 70 percent of his ablations using the AFFERA system were made with PFA. In this study itself, they ablated 60-70 patients using only pure PFA.

Dr. Reddy indicated that being able to use RF at times during an ablation may give operators more flexibility to go after more elusive signals such as Atypical Flutter. “This approach may wind up being preferred in many patients. We will see.”

Technical Achievement: The Lattice-Tip Catheter

The Lattice-tip catheter is probably worth a report on its own. It looks like a sphere which can be changed and compressed to different shapes. It’s mounted on a deflectable catheter with an expandable 9-mm diameter nitinol lattice electrode which contains 9 mini-electrodes on the spherical surface.

It also has embedded thermocouples for temperature control and an irrigation pump for saline during RF ablation along with an integrated mapping system.

During this live procedure, Dr. Reddy demonstrated how the Lattice-tip catheter can be changed to shapes like a football or to function like a point-by-point RF catheter.

It can make lesions very rapidly because of its wide footprint and improved catheter stability. It can make wide ablation lines. And the compressibility of the lattice mesh and its spring-like interaction with tissue, make for better and wider lesions.

Being able to both map and create lesions using the same catheter is a technical achievement that will make EPs job much easier and more efficient.

Editor's Comments about Cecelia's A-Fib storyEditor’s Comments

Some have said that, since almost all EPs are experienced in using RF, a combination system using both RF and PFA might be more easily used by EPs. EPs know from experience how well RF works and the durability of RF lesions. But to me the AFFERA system is at best a transitional treatment and can’t compare to pure PFA.
What was confusing, at least for me, was that at last year’s AF Symposium Dr. Reddy presented ground-breaking research on Pulsed Field Ablation using the Farapulse system. I only found out later that Dr. Reddy’s presentation this year about the AFFERA system was actually in competition with Farapulse.
Despite the technological innovation of the AFFERA, Inc. PFA and RF combination system, it’s unlikely that it will be adapted by the EP community in the long run. “Pure” PFA seems to work so well that there doesn’t seem to be a need for a combination system. But I could be proven wrong. Maybe there are difficult signal areas that PFA may not be able to adequately address with the same effectiveness as RF ablations.

The LIRYC Bordeaux group is starting a 5-year study to compare RF ablations  with PFA which should answer most of these questions. (Also see ’21 Symp: Pulsed Field Ablation Using Multielectrode Catheters and PFA Compared to RF Study)

Resource for this article

• Reddy, V.Y. et al. Lattice-Tip Focal Ablation Catheter That Toggles Between Radiofrequency and Pulsed Field Energy to Treat Atrial Fibrillation. Circulation: Arrhythmia and Electrophysiology, Vol. 13, No. 6. https://www.ahajournals.org/doi/10.1161/CIRCEP.120.008718

• Atrial Esophageal Fistula: The esophagus often lies right behind the left atrium posterior wall or behind a particular Pulmonary Vein. RF heat applied to nearby tissue can damage the esophagus often with deadly complications.

Ablation Patients 10 Times Less Likely to Develop Persistent A-Fib Than Those on Drugs

Atrial Fibrillation is a progressive disease. For some that progress can happen quickly. For one in five patients, the path from Paroxysmal A-Fib (occasional) to Persistent A-Fib occurs within one year. (But there are people who’ve had Paroxysmal A-Fib for years.)

Delaying A-Fib Progression: Ablation vs Antiarrhythmic Drugs

The ATTEST study (The Atrial Fibrillation Progressions Trial) compared the treatments of radiofrequency (RF) catheter ablation versus standard antiarrhythmic drugs (AADs) in delaying A-Fib progression.

Patients were followed for three years. Of patients from the standard antiarrhythmic drugs group, 17.5% developed persistent A-Fib. While only 2.4% from the RF catheter ablation group experienced progression.

A-Fib Progression Delayed: The results at three years after study initiation show that patients treated with catheter ablation (aged 67.8±4.8 years) were almost 10 times less likely to develop persistent AF than patients on antiarrhythmic drugs.

“These results…suggest that early use of catheter ablation can significantly delay or prevent the progression of AF more effectively than drug therapy.”Prof. Karl-Heinz Kuck,” ATTEST lead author

The results of the ATTEST clinical trial aren’t at all surprising. It’s intuitive isn’t it? Someone free of A-Fib after a catheter ablation obviously wouldn’t progress to Persistent A-Fib—since they no longer have even occasional (paroxysmal) A-Fib.

The ATTEST study provides us additional clinical proof that catheter ablation may be a better treatment choice for most A-Fib patients compared to a lifetime on antiarrhythmic drugs (AADs).

Consider Working Aggressively to Stop Your A-Fib

Keep in mind there are people who’ve had Paroxysmal A-Fib for years and never progress to Persistent or Long-standing Persistent. But the odds are against you. The longer you have Atrial Fibrillation, the harder it can be to cure it.

Think About Your Treatment Goals: Is managing your A-Fib and increased stroke risk with meds okay with you? Or do you prefer to aim for a cure?

Discuss the options with your doctor. Take action as soon as practical.

For more about the ATTEST clinical trial, see AF Symposium ‘20 After Diagnosis, How Soon Should an A-Fib Patient Get an Ablation?

Resource for this article
ESC 2019: Catheter ablation may be up to 10 times more effective than drug therapy alone at delaying AF progression. Cardiac Rhythm News. September 2, 2019. https://cardiacrhythmnews.com/catheter-ablation-may-be-up-to-10-times-more-effective-than-drug-therapy-alone-at-delaying-af-progression/

A-Fib is Progressive infographic at A-Fib.com

Pre-Ablation Fitness Prevents Recurrence of Atrial Fibrillation

If you are physically fit before your catheter ablation for atrial fibrillation, you have a “much higher chance” of benefiting from the procedure and remaining in normal sinus rhythm (NSR). That’s the findings of a study from the Cleveland Clinic.

Less fit patients have more recurrence, are hospitalized more often, have to continue taking antiarrhythmic drugs longer, and have higher death rates.

Cleveland Clinic Physiology Fitness Study of A-Fib Patients (2012-2018)

In this study from the Cleveland Clinic, the participants were 591 patients scheduled to have their first catheter ablation for A-Fib.

Cardiorespiratory Fitness (CRF) relates to the ability of the circulatory and respiratory systems to supply oxygen during sustained physical activity.

In the 12 months prior to their ablation, all were tested for fitness on a treadmill. Patients’ fitness was ranked as low, adequate, or high according to their Cardiorespiratory Fitness (CRF).

Astonishing Results: The Impact of Fitness

At 32+ months after ablation, findings among the three groups include:

Recurrence rate of:

• 79% of the low fitness group
• 54% of the adequate fitness group
• 5% in the high fitness group

Antiarrhythmic Drugs Use Discontinued in:

• 56% of the high fitness group
• 11% of the low fitness group

Mortality rate of:

• 11% of low fitness group
• 5% of high fitness group
• 4% of adequate fitness group

Comorbidities

Other diseases such as hypertension, diabetes, and obstructive sleep apnea were similar across all three groups.

Study Implications

According to lead investigator Wael A. Jaber:

“Being fit is a great antiarrhythmic… . High physical fitness can keep you in rhythm after A-Fib ablation… . Being physically fit acted almost like a medication…”

Previous Studies about Exercise

Previous studies have shown that exercise, weight loss, and similar lifestyle modifications not only improve A-Fib symptoms, but in some cases even result in freedom from A-Fib.

Lack of fitness has been shown to predict A-Fib and arrhythmia recurrence.

Exercise, weight loss, and similar lifestyle modifications can improve A-Fib symptoms, and in some cases lead to freedom from A-Fib.

Dr. Prashanthan Sanders of Adelaide, Australia has described the great results he is getting in his clinic which includes a weight loss program and counseling. He convinces his overweight patients to buy into the program, lose weight, and keep it off.

The program works so well that just by losing weight patients become A-Fib free.

This program is a holistic approach to health and also is developed to work for diabetes, sleep apnea, hypertension, binge drinking and smoking.

Requiring or Recommending Fitness Program for A-Fib?

The Cleveland Clinic study is probably the first study to look at the effect fitness has on patient outcomes after ablation.

Physical fitness improves your A-Fib symptoms and ablation outcomes.

The results are so convincing we need to look at whether a fitness program before an ablation may alter and improve the chances of a successful A-Fib ablation. i. e., “survival of the fittest.”

For example, many A-Fib centers now routinely require patients with sleep apnea to get treatment before they can get an ablation.

Could this be done for patients with poor fitness as well? (Unfortunately, poor fitness is often a result of being in A-Fib with lower ability to exercise adequately.)

Managing Comorbidities: Many A-Fib centers now target the monitoring and improvement in blood pressure, glycemic control and weight loss in patients with A-Fib. Perhaps, better fitness and exercise capacity should probably be added to this target list, especially before an ablation.

More Study Data Needed: An important follow-up clinical study would be to determine whether modifying fitness prior to ablation improves outcomes.

Bottom Line for A-Fib Patients Considering Catheter Ablation

All A-Fib patients should work to be as fit as they can be. It’s especially important before a catheter ablation.

Exercise and manage any comorbidities. Address your sleep apnea. Lose weight and/or maintain a healthy weight. Eat a healthy diet and limit alcohol consumption. These life choices can reduce or help manage high blood pressure and diabetes.

Resources for this article

• Donnellan E, et all. Higher baseline cardiorespiratory fitness is associated with lower arrhythmia recurrence and death after atrial fibrillation ablation. Heart Rhythm. 2020 Oct;17(10):1687-1693. doi: 10.1016/j.hrthm.2020.05.013. Epub 2020 Aug 3. PMID: 32762978

• Fitness linked to lower arrhythmia recurrence after AF ablation. Cardiac Rhythm News. August 7, 2010. https://tinyurl.com/AFIBFitnessAblationRecurrence

Catheter Ablation for Atrial Fibrillation Prevents Recurrence Compared to Drugs

Several recent research trials and studies have demonstrated that up to 94% of patients with Atrial Fibrillation treated with catheter ablation are free from arrhythmia recurrence at one year.

And, with nearly one-half the chance of death, stroke, cardiac arrest, and cardiovascular hospitalization when compared to patients on antiarrhythmic drugs (AADs).

In addition, these studies show that catheter ablation could significantly improve patient quality-of-life versus a treatment strategy of drug therapy. (Also, ablation is a more cost-effective option over the long term.)

Recurrences Attributable to Comorbidities (Other Illnesses)

With so many catheter ablations for A-Fib being performed worldwide (some estimate over one million preformed last year), it’s inevitable that anecdotally you’ll hear of people having recurrences.

Comorbidities raise risk of A-Fib recurrence

Comorbidities raise risk of A-Fib recurrence

But recurrences are often attributable to comorbidities such as diabetes, sleep apnea, high blood pressure, obesity, etc.

For example, if you come in with sleep apnea, some centers won’t allow you to have a catheter ablation till you get the sleep apnea problem under control, because of the threat of recurrence.

To lower your risk of recurrence after a successful ablation, aim to avoid other health problems. Address your sleep apnea. Lose weight and/or maintain a healthy weight. Stay fit, eat a healthy diet and limit alcohol consumption. These life choices can reduce the risk of developing high blood pressure and diabetes.

Staying in generally good health (and avoiding comorbidities) will lower your risk of recurrence of your A-Fib.

Why Not to Fear Recurrence: Consider a Worst-Case Scenario

For a moment, let’s discuss a worst-case scenario. At age 60 you are diagnosed with Lone A-Fib (no comorbidities) and have a catheter ablation which makes you A-Fib free.

It lasts 10 years. But think. For all those 10 years, you’ve know what a blessing it is being in normal sinus rhythm (NSR).

If your A-Fib recurs it’s not the end of the world. You and your doctor will deal with it.

Then, at age 70, your A-Fib returns. After a short touch-up ablation (which probably filled in some gaps that appeared in the ablation lines), you’re once again A-Fib free. And, you will probably live in normal sinus for the rest of your life.

(This scenario worked out pretty well, don’t you think.) If your A-Fib recurs it’s not the end of the world. You and your doctor will deal with it.

For A-Fib Patients Reluctant About Catheter Ablation

The track record for successful catheter ablation to treat Atrial Fibrillation is impressive. And continues to outperform treatment with antiarrhythmic drugs (AADs).

While recurrence does happen, it’s mostly after years of living A-Fib free in normal sinus rhythm. If that happens, often it only requires a “touch-up” ablation to get back once again in normal sinus rhythm.

It makes no sense to not have a catheter ablation because of some remote possibility you might have a recurrence!

On a Personal Note

My 21-year Catheter Ablation ‘Warranty’ Ran Out! 

My A-Fib returned in Sept. 2018. Recurrence didn’t come as much of a surprise. Back in 1998 my ablation was primitive compared to what EPs are doing today. They actually ablated inside just one of my pulmonary veins (PVs) to eliminate the A-Fib signal source. -> Read how Steve Ryan’s became A-Fib-free again.

Resource for this article

• Biosense Webster, Inc. Announces Catheter Ablation May Be up to 10 Times More Effective Than Standard Drug Therapy Alone at Delaying Progression of Atrial Fibrillation. October 3, 2019. ESC Congress

• ESC 2019: Catheter ablation may be up to 10 times more effective than drug therapy alone at delaying AF progression. Cardiac Rhythm News. 2nd September 2019. https://tinyurl.com/25xykh3k

• Philips, T. et al. Improving procedural and one-year outcome after contact force-guided pulmonary vein isolation: the role of interlesion distance, ablation index, and contact force variability in the ‘CLOSE’-protocol. https://pubmed.ncbi.nlm.nih.gov/29315411/ doi: 10.1093/europace/eux376

• Johnson &Johnson, October 3, 2019. Biosense Webster, Inc. Announces Catheter Ablation May Be up to 10 Times More Effective Than Standard Drug Therapy Alone at Delaying Progression of Atrial Fibrillation. https://tinyurl.com/4n7xdsh5

Additional Sources:

• Hussein A, et al. Prospective use of Ablation Index targets improves clinical outcomes following ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2017. 28 (9): 1037-1047.

• Taghji P, et al. Evaluation of a Strategy Aiming to Enclose the Pulmonary Veins With Contiguous and Optimized Radiofrequency Lesions in Paroxysmal Atrial Fibrillation: A Pilot Study. JACC Clin Electrophysiol 2018. 4 (1): 99-108.

• Phlips T, et al. Improving procedural and one-year outcome after contact force-guided pulmonary vein isolation: the role of interlesion distance, ablation index, and contact force variability in the ‘CLOSE’-protocol. Europace 2018. 20. (FI_3): f419-f427.

• Solimene F, et al. (2019) Safety and efficacy of atrial fibrillation ablation guided by Ablation Index module. J Interv Card Electrophysiol 2019. 54 (1): 9-15.

• Di Giovanni G, et al. One-year follow-up after single procedure Cryoballoon ablation: a comparison between the first and second generation balloon. J Cardiovasc Electrophysiol 2014. 25 (8): 834-839.

• Jourda F, et al. Contact-force guided radiofrequency vs. second-generation balloon cryotherapy for pulmonary vein isolation in patients with paroxysmal atrial fibrillation-a prospective evaluation. Europace 17 2015. (2): 225-231.

• Lemes C, et al. One-year clinical outcome after pulmonary vein isolation in persistent atrial fibrillation using the second-generation 28 mm cryoballoon: a retrospective analysis. 2016. Europace 18 (2): 201-205.

• Guhl EN, et al. Efficacy of Cryoballoon Pulmonary Vein Isolation in Patients With Persistent Atrial Fibrillation. J Cardiovasc Electrophysiol 2016. 27 (4): 423-427.

• Irfan G,  et al. One-year follow-up after second-generation cryoballoon ablation for atrial fibrillation in a large cohort of patients: a single-centre experience. 2016 Europace 18 (7): 987-993.

• Boveda S, et al. Single-Procedure Outcomes and Quality-of-Life Improvement 12 Months Post-Cryoballoon Ablation in Persistent Atrial Fibrillation: Results From the Multicenter CRYO4PERSISTENT AF Trial. JACC Clin Electrophysiol 2018.  4 (11): 1440-1447

Research: Catheter Ablation for Atrial Fibrillation Lowers Risk of Dementia

In an important study from South Korea, researchers found that patients undergoing a successful catheter ablation for A-Fib had a reduced risk of dementia. Previous research had shown that A-Fib was linked to an increased risk of dementia.

Sinus Rhythm Reduces Dementia

Intuitively one would think that going from A-Fib to normal sinus rhythm would increase and improve blood flow to the brain, thereby improving brain function. And indeed, in this retrospective study, catheter ablation reduced the incidence of dementia by nearly a third (27%) compared to those who tried to control their A-Fib with medication alone.

Alzheimer’s disease is one type of dementia.

Using data from South Korea’s National Health Insurance Service, they identified 9,119 patients who had ablation and 17,978 who received medical therapies. During the follow-up period (6-12 years) there were 164 cases of dementia in the ablation group and 308 cases in the medical therapy group. Ablation was linked to a 23% lower incidence of Alzheimer’s disease and a 50% decrease in vascular dementia compared to medical therapies.

Ablation was linked to a 23% lower incidence of Alzheimer’s disease and a 50% decrease in vascular dementia compared to medical therapies.

Ablation Reduced Dementia by 44%!

According to one of the lead researchers, Dr. Gregory Lip of the University of Liverpool (UK), “…successful ablation was significantly associated with a 44% reduced risk of dementia compared to medical therapy…”

Improved Blood Flow Reduces Alzheimer’s

What’s perhaps most important about this study is the reduced risk or incidence of Alzheimer’s disease after a successful catheter ablation for A-Fib. When people develop Alzheimer’s, it’s considered the end, that there’s very little that can be done to help these patients. But restoring blood flow to their brains seems to prevent or reduce Alzheimer’s.

Can we prevent or reduce Alzheimer’s by improving blood flow to the brain? Could these researchers have discovered a way to cure or improve Alzheimer’s? This could be ground-breaking research!

Resource for this article
Catheter ablation linked to lower incidence of dementia in AF patients, Cardiac Rhythm News. October 7, 2020. https://tinyurl.com/LowerDementia

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.

The cardiac surgeon in Spokane suggested I try one more catheter ablation before I opted for the 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.

I found the drug fecainide (the so-called Pill-in-the-Pocket treatment) did nothing but cause extreme stomach discomfort.

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.

Rather than a Mini-Maze, the surgeon suggested another ablation and referred me to the best EP in town.

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.

AVNRT stands for Atrioventricular Node Reentrant Tachycardia.
I was scheduled to have my second ablation with Dr. Harwood on March 15, 2019, but it was contingent on the results of a stress test. A few days later, the stress test was performed and was a success.

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.]

After almost four years, I am A-Fib free; I and my wife now have our lives back.

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

Lessons learned about life with A-Fib

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.

VIDEO: Learn how your heart works, see  Your Heart’s Electrical System:An Introduction.

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

Editor's Comments about Cecelia's A-Fib story

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.

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