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

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.

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.

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.

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.

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

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.

2019 AF Symposium: Multi-Electrode RF Balloon Catheter―Live Case from Mass. General

by Steve S. Ryan

Live streaming video-2019 AF Sympoium; A-Fib.comMassachusetts General Hospital in Boston, MA was the origination site for an ablation using a new irrigated Multi-Electrode Radiofrequency (RF) balloon catheter from Biosense Webster. Live via streaming video, were Drs. Moussa Mansour, Andrea Natale and Kevin Heist.

Multi-Electrode RF Balloon Catheter from Biosense Webster

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 a traditional RF point-by-point ablation.

Multi-Electrode RF balloon catheter from Biosense Webster; A-Fib.com

Multi-Electrode RF balloon catheter from Biosense Webster

Catheter design: This new irrigated Multi-Electrode RF balloon catheter 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.

In addition, rather than a fixed size, the 28 mm balloon is “compliant” and can fit into different-sized and shaped pulmonary vein openings.

Balloon catheters: This is the first RF balloon catheter in use for pulmonary vein (PV) ablation. Up to now balloon catheter technology has been used mainly with Cryoablation of the PV veins and the Laser Balloon catheter.

Approvals: In Europe, 200 patients have been treated with the Multi-Electrode RF balloon catheter. It is in trials in the U.S. and hasn’t yet been approved by the FDA.

Balloon Catheter also Creates 3-D Mapping

The 10 electrodes in the balloon also function as a circular mapping catheter to produce a 3-D map of the atrium and can pace the heart as well.

The liquid used to cool the RF burns flows at 35 nl/min. The RF is unipolar and heats at a maximum of 15 watts. RF lesions are made for 60 seconds, but the time can be reduced to 20 seconds when working on areas such as the posterior wall near the esophagus.

 RADIANCE stands for “PV Isolation with a Novel Multi-electrode Radiofrequency Balloon Catheter that Allows Directionally-Tailored Energy Delivery”

RADIANCE multicenter study: The RADIANCE study was a multicenter study conducted between Dec. 2, 2016 and March 8, 2017 in Europe. A total of 39 patients with paroxysmal atrial fibrillation were treated with the Biosense Webster multi-electrode radio frequency (RF) balloon catheter at four centers with nine different operators from both the U.S. and Europe.

In the RADIANCE study, 100 percent of the treated pulmonary veins were electrically isolated without the need for “touch-up” lesions with a RF focal catheter (referred to as “one-shot” delivery).  The study showed the RF balloon catheter could deliver directionally-tailored energy using multiple electrodes for efficient acute PVI in patients with paroxysmal A-Fib. For more about the RADIANCE Study see Multi-Electrode RF Balloon Efficient for Acute Pulmonary Vein Isolation Study.

Editor’s Comments
Advantages of the new RF Balloon Catheter:
It is difficult with an RF point-by-point catheter to produce a solid circular lesion around the PVs in a beating heart. It can take hours.
By comparison, this new irrigated RF Balloon Catheter is a “one-shot” delivery of energy and can isolate (burn lesions) in the PVs 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 point-by-point ablation.
Compared to CryoBalloon Ablation: The question from a patient’s perspective is which is better or more effective? The newer RF Balloon catheter ablation (when FDA approved in the U.S.), or the current, already proven CryoBalloon ablation? Right now, there isn’t enough data to answer this question.
The RF Balloon ablation does have an advantage over traditional CryoBalloon ablation. It can deliver different energy levels to prevent deeper ablation damage. (Currently, potential damage to the esophagus is handled with displacement tools which move the esophagus away from ablation sites. For more on this, see Esophageal Displacement Tool.)
Bottom Line for Patients: Promising! I’m excited about the Multi-Electrode Radiofrequency (RF) balloon catheter from Biosense Webster. I’ll report on it again, hopefully when it receives FDA approval for use in the U.S.
Reference for this article
Fornell, D. Multi-Electrode RF Balloon Efficient for Acute Pulmonary Vein Isolation. Study presented at the Heart Rhythm Society’s 2017 Late-Breaking Clinical Trials Section. DAIC, May 17, 2017. https://www.dicardiology.com/article/multi-electrode-rf-balloon-efficient-acute-pulmonary-vein-isolation

If you find any errors on this page, email us. Y Last updated: Thursday, March 14, 2019

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AF Symposium 2019: Live from Prague—Ablation Without touching the Heart Surface Using Ultrasound

By Steve S. Ryan

On the second day of the AF Symposium attendees viewed, live from the Czech Republic, a catheter ablation using an incredible new technology―Ultrasound Mapping and Ablation (Low-Intensity Collimated Ultrasound, LICU) from Vytronus, Inc.

“Collimated” refers to focusing ultrasound rays so that they are parallel and spread out minimally with minimum divergence.

The procedure was via live streaming video from Na Homolce Hospital in Prague. The doctors performing the A-Fib ablation were cardiac electrophysiologists Jan Petru, Moritoshi Funasako, and Petr Neuzil.

Near-Real Time Ultrasonic Imaging of the Heart

The system first robotically scanned the left atrium and Pulmonary Veins (PVs) to create a 3-D global image of the heart anatomy in near-real time using the same dual-purpose transducer tip that makes the ablation lesions. (Later the same process was used to verify ablation lesions and the effectiveness of the ablation.)

Automated Robotic Ultrasound Ablation

In this automated robotic ablation, the LICU ultrasound catheter with a dual-purpose transducer tip didn’t touch the heart surface to make ablation lines.

The EP created a robotic 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.

It was amazing to watch!

If the heart surface was thicker, the ultrasound catheter slowed down thereby increasing the ultrasound dose and energy delivered. This made the continuous lesions deep enough and transmural. The catheter didn’t touch or make contact with the heart surface.

Flowing Blood in the Heart Doesn’t Affect the Ultrasound Beam

The choice of ultrasound frequency (approximately 10 MHz) means that the ultrasound beam is affected very little by blood in the heart. Blood is “transparent” to the ultrasound beam.

This also means that the distance from the catheter tip to the targeted tissue isn’t critical and can vary. Also, the ultrasound catheter tip is irrigated to cool the tissue and prevent the formation of char or thrombus.

Color-Coded Range Map

The system uses a color-coded ultrasound-generated range map which displays how far the tip of the catheter is from the tissue to be ablated in order to create good lesions.

If the operator sees purple, blue or green, the catheter is within therapeutic ablation range. Yellow, orange and red indicate the catheter is beyond therapeutic range. The therapeutic range can vary from 5 mm to 50 mm.

During the live ablation, the EP said that dark blue is the best, while purple may be too close.

VIDEO: Product Animation. Ultrasound Mapping and Ablation (Low-Intensity Collimated Ultrasound, LICU) from Vytronus, Inc. (2:22 min.)

Video playback controls: Controls are located in the lower right portion of the frame: Click on arrow icon to select.

Editor’s Comments:
Background: In the past, high-intensity focused ultrasound (HIFU) caused esophageal injury and was withdrawn from clinical use. But Low-Intensity Collimated Ultrasound (LICU) operates at a lower acoustic intensity than the previous HIFU. Lesion formation occurs at a more gradual fashion.
Though not yet approved for use in the U.S., development of an ultrasound LICU ablation catheter and mapping system is a most important innovation for A-Fib patients.
Near-Real-Time Mapping: The ability of the ultrasound catheter to create 3-D images of the atrium and PVs at almost the same time as the ablation is a major advantage over other mapping systems. It creates more accurate rendering of the targeted heart features. In other systems there can be map drifts/shifts, inaccuracies from heart motion, respiratory motion, and volume-related chamber enlargement.
Non-Contact Ablation: In an ultrasound LICU ablation the catheter doesn’t touch the heart tissue. The EP doesn’t have to worry about “contact force” measurement, i.e., whether they are applying enough or too much force to make good transmural lesions.
Robotically Controlled Ablation Process: To me the robotic ultrasound LICU system seems easier to use. The ultrasound lesions were created automatically. As compared to standard point-by-point RF ablation or even CryoBalloon ablation, it’s remarkably simple and requires much less EP involvement and skill.
From a patient’s perspective, you aren’t as dependent on the skill and manual dexterity of the EP (or whether they are on top of their game that day).
A Breakthrough but Not Yet Available: It was obvious to everyone in the AF Symposium audience that we were witnessing the dawn of a potential new age in catheter ablation.
Though still investigational and not yet approved in the U.S., robotic low-intensity ultrasound mapping and ablation seems like a radical breakthrough in ablation treatment.
More Studies Needed: Many studies of its safety and efficacy need to be made before ultrasound ablation becomes available to patients. But low-intensity robotic ultrasound ablation looks really promising.
References for this article
Koruth, J.S. et al. Pre-Clinical Investigation of a Low-Intensity Collimated Ultrasound System for Pulmonary Vein Isolation in a Porcine Model. JACC: Clinical Electrophysiology, Vol. 1, No. 4, August 2015 http://electrophysiology.onlinejacc.org/content/1/4/306. DOI: 10.1016/j.jacep.2015.04.011

Vytronus, Inc. Ultrasound Mapping and Ablation (Low-Intensity Collimated Ultrasound, LICU),  the Vytronus LICU® system. URL: https://www.vytronus.com/technology/

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5-Year CABANA Trial: Compares Catheter Ablation with Antiarrhythmic Drug Therapy

The catheter ablation procedure for Atrial Fibrillation has been around for 20+ years.

In a randomized controlled trial, the 5-year CABANA study is the largest to compare the A-Fib treatments of catheter ablation (PVI) and antiarrhythmic drug therapy (AAD).

CABANA stands for Catheter Ablation versus Antiarrhythmic Drug Therapy.

CABANA Trial Design

Worldwide, 2,204 patients with new onset or undertreated Atrial Fibrillation were randomized between two treatments: catheter ablation (PVI) or antiarrhythmic drug (AAD) therapy. Patient participants were followed for nearly 5 years.

Patients details: Many patients had concurrent illnesses with Atrial Fibrillation: cardiomyopathy (9%), chronic heart failure (15%), prior cerebrovascular accidents or TIAs (mini-strokes) (10%).

Over half of participants (57%) had persistent or long-standing persistent A-Fib [i.e. harder types of A-Fib to cure].

Drug details: Antiarrhythmic drug (AAD) therapy was mostly rhythm control (87.2%), some received rate control drug therapy.

Anticoagulation drug therapy was used in both groups.

CABANA Trial Results

Crossover a Major Problem: Many in the AAD therapy arm decided to have a catheter ablation instead (27.5%). And some in the ablation arm decided not to have an ablation (9.2%). [One can not blame patients or their doctors for making these life-impacting choices.] 

The CABANA results showed catheter ablation was significantly better than drug therapy for the primary endpoint (a composite of all-cause mortality, disabling stroke, serious bleeding or cardiac arrest). [See Additional Research Findings below.] Mortality and death rate were also significantly better for catheter ablation.

CABANA Findings: Ablation vs AAD Therapy

▪ Catheter Ablation significantly reduced the recurrence of A-Fib versus AAD therapy.

▪ Catheter Ablation improved ‘quality of life’ (QofL) more than AAD therapy, though both groups showed substantial improvement.

▪ Catheter Ablation patients had incremental, clinically meaningful and significant improvements in A-Fib-related symptoms. This benefit was sustained over 5 years of follow-up.

▪ Catheter Ablation was found to be a safe and effective therapy for A-Fib and had low adverse event rates.

Take-Aways for A-Fib Patients

Ablation Works Better than Antiarrhythmic Drugs: Rather than a life on antiarrhythmic drug therapy, the CABANA trial and other studies show that a catheter ablation is the better choice over antiarrhythmic drug therapy.

For related studies, see CASTLE AF: Live Longer-Have a Catheter Ablation and AATAC AF: Catheter Ablation Compared to Amiodarone Drug Therapy.

In an editorial in the Journal of Innovations in Cardiac Rhythm Management, Dr. Moussa Mansour, Massachusetts General Hospital, wrote about the CABANA trial:

“It confirmed our belief that catheter ablation is a superior treatment to the use of pharmacological agents, and corroborates the findings of many other radomized clinical trials.” 

Lower Recurrence: What’s also important for patients is the lower risk of recurrence of A-Fib versus AAD therapy.

Reduced Ablation Safety Concerns: Ablation significantly improved overall mortality and major heart problems.

Immeasurable Improvement in Quality of Life! Perhaps even more important for patients on a daily basis, catheter ablation significantly improved quality of life.

Don’t Settle for a Lifetime on Drugs

Over the years, catheter ablation for A-Fib has become an increasingly low risk procedure with reduced safety concerns. (Ablation isn’t surgery. There’s no cutting involved. Complication risk is similar to tubal ligation or vasectomy.)

An ablation can reduce or entirely rid you of your A-Fib symptoms, make you feel better, and let you live a healthier and longer life (for people who are older, too). A catheter ablation significantly improves your quality of life (even if you need a second “re-do ablation” down the road).

For many, many patients, A-Fib is definitely curable. Getting back into normal sinus rhythm and staying in sinus rhythm is a life-changing experience, as anyone who’s free from the burden of A-Fib can tell you.

See also:  Does a Successful Catheter Ablation Have Side Benefits? How About a Failed Ablation?

Additional Study Findings
Primary endpoints: Results of the primary endpoints were not significant. This is probably due to the crossovers and the lower than expected adverse event rates (5.2% for ablation versus 6.1% for AAD therapy).

Deeper Analysis of Data: The researchers performed sensitivity analyses on the primary results using “treatment received” and “per protocol” rather than “intent to treat”.

Research Terms: Primary endpoint—specific event the study is designed to assess. Intent to treat—all assigned to the AAD group compared to the assigned ablation group (even though 1/4 crossed over to the ablation group). Treatment received—compared all who received an ablation to all who received AAD therapy.
References for this article
• Packer, Douglas. CABANA trial provides important new data on clinical and quality of life effects of ablation for atrial fibrillation. Cardiac Rhythm News: October 18, 2018, Issue 42. P. 1.

• Mansour, Moussa. Letter from the Editor in Chief. The Journal of Innovations in Cardiac Rhythm Management, June 2018. DOI: 10.19102/icrm.2018.090609.

After 18 years in A-Fib, Triathlete Mike Jones Asked, “Could I Be so Fortunate?”

In his A-Fib story, Mike Jones writes that he’d been a very physically active middle age man who competed in running, triathlons and handball. It was difficult for him to accept that “something was wrong”.

In fact, he had paroxysmal A-Fib episodes for at least three years before his official diagnosis. Over the many years, he had been on various drug therapies, but nonetheless, his A-Fib episodes become very debilitating. He shares:

Mike Jones

“For many years, surgical intervention was out of reach, and financially out of the question for me. And, in those days, there was only the “Maze”. Along the way, I read a little bit about the Mini Maze, which did not inspire me much either.
It wasn’t until I found “A-Fib Resources for Patients” [A-Fib.com] that I began to take a real interest in researching PVI/PVA [Pulmonary Vein Isolation/Ablation] .”

Mike recalls the day after his life-changing catheter ablation:

“On the drive home the following afternoon, I thought about all those years that I had spent….with all of the drugs, and all of the depressing hours, with all of the sacrifices, and all of the fear…nearly 15 years of it.
Then, my long-awaited PVI procedure. In a 2 day period of time, with little discomfort (and within my budget!) all of that might now be behind me.
Could I be so fortunate?
I feel a little foolish now, a little sheepish, that I had made such a big thing out of getting this procedure done.”

Life After His Ablation

In the ten months following his ablation, Mike writes that he only had two episodes early on and that he continues to take soaks in Epson salts once a week to keep his magnesium levels up.

He writes about his life now that it is free of A-Fib:

 “I do not take any blood thinners, and no heart medication whatsoever. In my 70’s now, I won’t be running any endurance races, and my conditioning level is too low for any serious handball (yet).
But my energy level is high enough that I live a very normal life. I am a hobby woodworker, and I typically spend anywhere from 4 to 6 hours a day in my shop. I walk, swim, cut wood, and, when nobody is looking…I dance.
“I walk, swim, cut wood, and, when nobody is looking…I dance.”
I understand that the A-Fibs might one day return, but I would have no hesitation in returning for a tune up if, or when, that day should ever arrive.”

―Mike Jones, Redding, CA, Now A-Fib free after an ablation using both CryoBalloon and RF methods 

A-Fib is a Progressive Disease

It’s really remarkable that Mike could live in paroxysmal A-Fib for 18 years and not progress to Persistent or Longstanding Persistent A-Fib. In one study over half the people who developed paroxysmal A-Fib turned Persistent after only one year. Perhaps Mike’s athleticism and fitness kept his A-Fib from getting worse.

In most people, A-Fib is a progressive disease that remodels the heart and gets worse over time. To avoid this happening to you, aim to be A-Fib free as soon as you can.

For more about Mike, read his A-Fib story, Triathlete 18 years in A-Fib, on Amiodarone for eight years―then A-Fib free after ablation by Dr. Padraig O’Neill.

For more A-Fib stories to encourage and inspire you, go to Personal A-Fib Stories of Hope.

“Normal” Has a New Meaning for Jim After His Ablation

Before you developed Atrial Fibrillation, did you lead an active lifestyle? Has A-Fib robbed you of your energy and replaced it with fatigue? That’s what happened to Jim. After years of drug therapy that didn’t work, read how Jim recovered his active lifestyle post-ablation.

Three years after his ablation, Jim McGauley of Macclenny, FL, shared his personal A-Fib story with our A-Fib.com readers. His atrial fibrillation had been detected several years earlier but was not controlled effectively with drug therapy.

Jim underwent a catheter ablation in the summer of 2009. His procedure was performed without complications by Dr. Saumil Oza and his team at St. Vincent’s Medical Center, Bridgeport, CT.

He writes that, after a brief period of recuperation, he resumed normal activity.  In his story, After Years in A-Fib, New Energy and Improved Life, Jim shares: 

“Within a matter of days [of my ablation], I realized that “normal” had a new meaning.
I had lived with the atrial fibrillation for years, and it took the ablation and resulting corrected heart rhythm to bring about a marked surge in my energy level with less fatigue and an overall sense of “fitness”.
I have always maintained an active lifestyle, but post-ablation I was able to increase significantly my exercise regimen. I now run 2-3 miles three times a week and include modest weight training to keep my upper body toned.”
Jim McGauley, Publisher, The Baker County Press, Macclenny, FL. After failed drug therapy, now A-Fib free via catheter ablation.

Catheter Ablation Can Have Life-Altering Effects

Atrial Fibrillation patients seeking a cure and relief from their symptoms often have many questions about catheter ablation procedures. To learn more, see:

• VIDEO: When Drug Therapy Fails: Why Patients Consider Catheter Ablation (3:00 min., includes transcript)
• Treatments/Catheter Ablation
• Frequently Asked Questions: Catheter Ablation, Pulmonary Vein Isolation, CyroBalloon Ablation

About the ablation experience itself, Jim went on to share:

“The ablation itself is minimally invasive considering that it is correcting an abnormality inside the heart itself, and the recovery period was brief and generally comfortable.

I would readily recommend it… to anyone qualifying as a candidate to correct atrial fibrillation.”

―Jim McGauley, now A-Fib free after catheter ablation 

Diet and Nutrition: ‘The China Study’ and Other Diet Plans With Dr. Joseph Mercola

After Saul Lisauskas of Encinitas, CA was diagnosed with Atrial Fibrillation, he was disappointed by doctors who offered only drug therapy with no advice about improving his symptoms through diet and nutrition. He decided to educated himself on the topic: In his A-Fib story Saul wrote:

Saul Lisauskas

“I read a few books on the subject of food and the interaction with our body. The best book was The China Study. It will give you an education about food, its sources and dangers.”

The China Study Book and its Critics

The China Study by T. Colin Campbell & Thomas M. Campbell II was first published in 2004. The book’s title comes from the China-Cornell-Oxford Project, a 20-year study that began in 1983 and was conducted jointly by the Chinese Academy of Preventive Medicine, Cornell University, and the University of Oxford.

By Campbell & Campbell II

Conflicting opinions: There has been criticism of some of the conclusions drawn in The China Study (mostly focused on data collection, collection bias and data analysis).

Publisher of Cholesterol-and-Health.com Christopher Masterjohn, PhD has written: “Only 39 of 350 pages are actually devoted to the China study…[The China Study] would be more aptly titled, A Comprehensive Case for the Vegan Diet, and the reader should be cautioned that the evidence is selected, presented, and interpreted with the goal of making that case in mind.”

The Cornell-Oxford-China Study: A Critique (Jesse and Julie Racsh Foundation) states: “After performing regression analyses, the data does not justify the indictment of all animal foods as risk factors for chronic degenerative disease.” Read the report online or download the PDF.

A Critical Look at ‘The China Study’ and Other Diet Plans: Dr. Mercola Interviews Denise Minger

Dr J. Mercola

A jam-packed, up-to-date article for those interested in improving current health problems and long-term health through diet and nutrition.

Denise Minger

Published in July 2018, natural health expert and Mercola.com founder Dr. Joseph Mercola interviewed Denise Minger, most noted for her comprehensive rebuttal of “The China Study” (The China Study: Fact or Fallacy?) some eight years ago. She’s heavily vested in the vegan versus omnivore battle, having cycled through vegetarianism and raw veganism, finally coming full circle to being an omnivore.

Topics covered in a Critical Look at ‘The China Study’ and Other Diet Plans:

• Raw Veganism Took a Toll on Health
• Debunking ‘The China Study’
• The Case for Lowering Protein Intake
• Protein Cycling
• Macronutrient Cycling — An Overlooked Component of Optimal Health
• Cyclical Ketogenic Diet Is Ideally Combined With Cyclical Fasting
• Focus on Nutrient Density
• How Minger’s Diet Has Changed Over the Years
• Critiquing the Blood Type Diet
• Awesome Omnivore
• Plant-Based Paleo
• Lifelong Learning Is Key to Staying Ahead

Go to A Critical Look at ‘The China Study’ and Other Diet Plans.

VIDEO: Highlights from Dr. Joseph Mercola’s interview with Denise Minger (2:28)


YouTube video playback controls are located in the lower right portion of the frame: closed captions,
speed/quality, watch on YouTube website and enlarge video to full frame.

Additional Resources About Diet and Nutrition

Download the full transcript of Dr. Mercola’s interview with Denise Minger. Read Debra Minger’s The China Study: Fact or Fallacy?.

Read The China Study for Free: The 2006 edition is available to read online or download.

The 2017 edition of The China Study is available at Amazon.com and other bookstores.

See my article: The Effect of Diet & Nutrition on Your A-Fib: My Top 5 Articles.

Resources for this article

• The China Project: Studying the Link Between Diet and Disease. Study room provides a general overview and introduction to the Cornell-China-Oxford project. Accessed August 7, 2018 URL: http://www.cornell.edu/video/playlist/the-china-project-studying-the-link-between-diet-and-disease

• Cornell-Oxford-China Study: A Critique. Jesse and Julie Racsh Foundation. Accessed August 7, 2018 URL: http://www.raschfoundation.org/wp-content/uploads/Cornell_Oxford_China-Study-Critique.pdf

• Masterjohn, C. The Truth About the China Study. Cholesterol and Health.com Accessed August 7, 2018 URL: http://www.cholesterol-and-health.com/China-Study.html

• Mercola, J. A Critical Look at ‘The China Study’ and Other Diet Plans. Mercola.com, July 08, 2018. URL: https://articles.mercola.com/sites/articles/archive/2018/07/08/the-china-study-and-other-nutrition-plans.aspx

• Minger, D. The China Study: Fact or Fallacy? July 7, 2010. DeniseMinger.com. https://deniseminger.com/2010/07/07/the-china-study-fact-or-fallac/

No Way Am I Having an Ablation! Seeks Alternative Treatments

Saul Lisauskas of Encinitas, CA, was 62 years old when he first detected something wrong with his heart. After his A-Fib was diagnosed, he started to note his episodes were associated with stress and getting angry, along with dehydration, too much caffeinated coffee and foods containing MSG.

Saul Lisauskas

He was disappointed by doctors who offered only drug therapy with no advice about nutrition and the benefts of an improved, healthy diet. He decided to educated himself on the topic: Saul wrote:

“I read a few books on the subject of food and the interaction with our body. The best book was The China Study. It will give you an education about food, its sources and dangers.”

Looking for Alternative Treatments: A Vegetarian Diet

While avoiding his A-Fib ‘triggers’, he decided to go vegetarian but eating fish (a pescetarian) to reduce exposures to foods laced with unhealthy chemicals. (As a bonus, he lost 20 pounds in 3 months.) He was feeling better, but his A-Fib was still active. In his A-Fib story, Saul shares:

“The cardiologist explained to me that the real solution lay in having an Ablation procedure. I was willing to do anything to avoid that surgery.
“I was willing to do anything to avoid that surgery [catheter ablation].”
But with time, my A-Fib episodes increased along with longer periods of activity and stronger symptoms.”
During my ordeal leading up to my Ablation procedure, I was taking various meds in order to control my A-Fib.
However, the meds would make me dizzy and slow down my heart rate to dangerous levels to the point that such levels in fact were counterproductive. My system would compensate by sudden increases of adrenaline and consequently place me in A-Fib mode.
Consequently, I had a pacemaker installed to prevent low levels of heart rate.”

After nearly 8 years since his A-Fib diagnosis, Saul writes about his decision to have a catheter ablation:

“I was getting tired of and frustrated with all these meds.
After too many episodes of A-Fib forcing me to go to the ER, I capitulated against the Ablation surgery and had it done.
Today I am feeling well and doing my daily activities. …I feel that I may be cured well enough not to have to have another ablation.”

― Saul Lisauskas, Encinitas, CA, A-Fib free with pacemaker and catheter ablation

Since his ablation, Saul writes that he remains cautious not to run the risk of stress, dehydration, too much caffeinated coffee or getting angry.

To read more about Saul’s story, see No Way Am I Having an Ablation! But Diet and Meds Disappoint—A-Fib Free After Ablation.

Lessons Learned

When asked if he had any ‘Lessons Learned’ to share, Saul offers these insights:

”Doctors do not have a solution for everybody with A-Fib…We need to carefully educate ourselves as we follow the doctor’s recommendations and observe how our body reacts. Do not follow blindly the doctor’s recommendations.”

Saul certainly did everything he could to avoid having an ablation—identifying what triggered his A-Fib, a vegan diet with fish and all kinds of meds.

Saul certainly did everything he could to avoid having an ablation.

His experience with meds was unfortunate. The meds Saul was taking slowed his heart rate to the point where his doctor had to insert a pacemaker to keep his heart rate normal. It’s crazy to think about it. If this happens to you, talk to your doctor about changing meds (or change doctors).

Unfortunately, once the heart starts to produce A-Fib signals, it’s hard to turn them off. Saul faced the decision that many people have to make. He bit the bullet and had a catheter ablation―with successful results. He’s now A-Fib free!

What’s the Best Treatment Options For You?

A-Fib is not a one-size-fits-all disease. Your Atrial Fibrillation is unique to you. Along with various treatments, you may need to address concurrent medical conditions (i.e, hypertension, diabetes, obesity, sleep apnea). Likewise, you may need to make lifestyle changes (e.g., diet, exercise, caffeine, alcohol, smoking).

In addition, your heart is a resilient muscle that tends to heal itself, so you may need a repeat procedure.

To learn about options for Atrial Fibrillation patients, see our pages under Treatments for A-Fib. Then go to: Decisions About Treatment Options. And remember…

Always Aim for a Cure!

NEW VIDEO: What Should I Expect After my A-Fib Catheter Ablation Procedure?

What to expect post-ablation

We have posted a new video that features Cardiac Electrophysiologist Dr. Darryl Wells.

He talks about judging the success of your ablation, why it’s difficult to predict which patients will be completely cured after one ablation procedure and why some require two procedures.

He discusses safety of the procedure and the appropriate age range for patients to receive the ablation procedure. (3:17)

Published by Swedish Heart and Vascular Institute. Go to video->

PVCs Aren’t Always Benign, and He Didn’t Want to Live with Them

Do NOT listen when doctors say PVCs are harmless, writes John Thorton from Sioux Falls, SD. Besides A-Fib and A-Flutter, his PVCs were destroying his life and driving him crazy.

Premature Ventricular Contractions (PVCs) are premature beats that occur in the ventricles, i.e., the heart’s lower chambers. (Premature beats that occur in the atria, the heart’s upper chambers, are called premature atrial contractions, or PACs.) In his A-Fib story, John writes:

John & Marcia T.

“The local MDs (about a half dozen different ones), cardiologists, EPs, and other local specialists, all told me stuff like: “Everyone has PVCs” and “PVCs are benign,” and “It is just anxiety,” and “You just need to learn to live with it”.
Which was completely WRONG.
Being his Own Patient Advocate

In his A-Fib story, PVC-Free After Successful Ablation at Mayo Clinic, John advises: Be assertive, even aggressive.

“I had to set up my own appointment at Mayo Clinic to get evaluated there. It was a lot of work, by me alone, to get in to see the doctors at Mayo, but it was worth it.
I honestly believe that had I not gone to Mayo, I would have suffered some major heart event, or possibly death.”

PVCs Aren’t Always Benign

Especially for people with A-Fib, PVCs should be taken seriously. Often they precede or predict who will develop A-Fib. They can increase chances of a fatal heart attack or sudden death. The good news: sites in the heart that produce PVCs can be mapped and ablated just like A-Fib signals.

To learn more about PVCs, see my article: FAQs Coping with A-Fib: PVCs & PACs

Don’t be Afraid to Fire Your Doctor!

Kudos to John for being his own best patient advocate, for taking the bull by the horns and dealing with his PVCs. In spite of what he heard from everyone else, he persevered and went to probably the best center in the US for treating PVCs—the Mayo Clinic. Now John’s A-Fib free and only has occasional PVCs.

Like John, don’t be afraid to fire your doctor! To learn how to interview doctors, see our page: Finding the Right Doctor for You and Your A-Fib.

VIDEO: What Should I Expect After an Atrial Fibrillation Ablation Procedure?

Atrial Fibrillation videos at A-Fib.comCardiac electrophysiologist Dr. Darryl Wells talks about judging success of your ablation, why it’s difficult to predict which patients will be completely cured after one ablation procedure and why some require two procedures, safety and the appropriate age range for patients to receive the ablation procedure. (3:17)

Published by Swedish Heart and Vascular Institute.

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 an icon to select.

If you find any errors on this page, email us. Y Last updated: Wednesday, February 6, 2019
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VIDEO: The Hybrid Maze/Ablation for Atrial Fibrillation for Persistent A-Fib

For persistent or long-standing persistent atrial fibrillation, the Hybrid Maze/Ablation (also called the Hybrid Convergent Procedure) combines the complementary efforts of both the cardiothoracic surgeon and the cardiac electrophysiologist. The surgeon works on the outside the heart and the EP on the inside of the heart to eliminate the Atrial Fibrillation signals.

In this video, two cardiac EPs and a cardiothoracic surgeon describe the advantages, safety and effectiveness of the Hybrid approach and who is a good candidate. Includes animation and on-camera interviews.

Published by Tenet Heart & Vascular Network. Length 4:30. 

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 an icon to select.

If you find any errors on this page, email us. Y Last updated: Tuesday, July 17, 2018

Return to Instructional A-Fib Videos and Animations

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