Doctors & patients are saying about 'A-Fib.com'...
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Dr. Douglas L. Packer, MD, FHRS, Mayo Clinic, Rochester, MN
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Jill and Steve Douglas, East Troy, WI
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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
The Threat to Patients with “Silent A-Fib” How to Reach Them?
‘Silent A-Fib’ is a serious public health problem. Anywhere from 30%-50% of those with A-Fib aren’t aware they suffer from A-Fib and that their heart health is deteriorating.
In his A-Fib story, Kevin Sullivan, age 46, wrote about his diagnosis of Silent A-Fib.
“I was healthy, played basketball three times per week, and lifted weights. I started to notice on some days playing basketball, I was having some strange sensations in my chest. And sometimes, difficultly catching my breath. But the next day I would feel fine. I assumed this was just what it felt like to get old.”
He writes, that at the time, he happened to see a cardiologist about medication for high cholesterol:
“I went to see a cardiologist. They looked at my heart with ultrasound and asked if I could feel “that.” I asked them what they were talking about, and they told me that I was having atrial fibrillation. That was the first time I had ever heard of the phrase.”
‘Silent A-Fib’ vs. ‘Symptomatic A-Fib’
Silent (asymptomatic) A-Fib can have similar long-term effects as A-Fib with symptoms. Silent A-Fib may progress and get worse just like symptomatic A-Fib. Increased fibrosis may develop, the atrium may become stretched and dilated, the frequency and duration of the unnoticed A-Fib attacks may increase over time (electrical remodeling).
Is “Silent A-Fib” Really Silent? Some people question whether “silent” A-Fib is really silent (from a clinical aspect). Even with Silent A-Fib, one loses 15%-30% of normal blood flow to the brain and other organs which certainly has an effect. (For Kevin Sullivan, he experienced occasional pain in his chest and shortness of breath while playing basketball.)
Those with Silent A-Fib may get used to their symptoms, or they write off the tiredness, dizziness or mental slowness like Kevin Sullivan did. Nonetheless, almost everyone in Silent A-Fib is affected and changed by their A-Fib to some extent.
‘Silent A-Fib’ More Dangerous: Increased Risk of A-Fib Stroke
When left untreated, A Fib patients have a 5X higher chance of stroke, and a greater risk of heart failure. Often, an A-Fib patient is hospitalized or dies from an A-Fib-related stroke without anyone ever knowing the patient had A-Fib.
And if the patient with A-Fib survives, they have about a 50% higher risk of remaining disabled or handicapped (compared to stoke patients without A Fib).
Tactics to Find Undiagnosed ‘Silent A-Fib’
Today, during a routine physical exam, general practitioners (GPs) will listen to your heart with a stethoscope and would notice if your heart beat was irregular. After a certain age, your exam may also include an ECG (EKG), and the tracing would show if you are in Atrial Fibrillation, even if your not aware of it. Cardiologists routinely perform an ECG and catch Silent A-Fib (like Kevin Sullivan’s cardiologist did).
But, to be detected, A-Fib must be present at the time of the ECG, and we know that A-Fib is often intermittent. If intermittent A-Fib is suspected, your EP has an array of A-Fib wearable event monitoring devices (like the band-aid-size ‘Zio patch’ monitor).
What if A-Fib isn’t even on the patient’s radar? What’s the remedy? More frequent and regular screenings! But how? First, by healthcare personnel teaching ‘at-risk age groups’ how to use pulse-taking palpation (which can be readily taught). See also the VIDEO: “Know Your Pulse” Awareness Campaign.)
Second, through community-sponsored health screening events when patients who are interacting with their healthcare provider for another reason, such as an annual flu vaccination.
Think of the lives and permanent disabilities that would be saved by inexpensive screening and easily administered monitoring for Silent A-Fib.
The Future of Screening for Silent A-Fib: Heart-monitoring apps and devices are growing in popularity. Two FDA-approved devices are the iPhone app called Cardio Rhythm, and the AliveCor Kardia device that connects to a app-equipped smartphone.
What Patients Need to Know
If you have A-Fib, discuss it with your family and friends. Answer their questions. Because A-Fib runs in families, urge your immediate family members to discuss A-Fib with their doctors.
Encourage your friends over 60 years old to do the same. Support community-sponsored health screening events.
The Effect of Diet & Nutrition on Your A-Fib: My Top 5 Articles
Many patients wonder if eating or avoiding the right foods might lessen or improve their A-Fib symptoms. While we don’t know of any diet to “cure” your A-Fib, you might consider the “DASH” eating plan recommended by U.S. National Heart, Lung and Blood Institute which reduces the risk of developing cardiovascular disease.
The following articles may answer some of your A-Fib-related questions involving diet and nutrition:
1. Caffeine: “Is drinking coffee (tea, colas, other products with caffeine) going to make my A-Fib worse or trigger an A-Fib attack?”
2. Diet: “Is a whole food or organic diet helpful for patients with Atrial Fibrillation? Is there any research recommending one or the other?”
3. Personal A-Fib story: “No Way Am I Having an Ablation! But Diet and Meds Disappoint—A-Fib Free After Ablation” by Saul Lisauskas
4. Nutrition: “Why are doctors so opposed to nutrition as a way of helping A-Fib. I tried to talk with my doctor about magnesium and other nutritional supplements. ‘There’s no proof that they work,’ was his response.”
5. Holistic Approach: “I want nutritional counseling and a more integrated approach to my A-Fib treatment plan. How do I find a doctor with a more “holistic” approach?”
Be a Sleuth: Keep an Episode Diary
Keep a diary of your A-Fib episodes
To determine if certain foods or beverages may be triggering the number and duration of your A-Fib attacks, start by keeping a log or diary. When an episode occurs, note the day & time, duration and what you were doing, eating or drinking.
As you collect data, scrutinize your log entries for patterns and specific triggers. This may lead you to lessen or eliminate certain foods or beverages or even activities that appear to trigger your A-Fib. You may want to share your log with your doctor.
Updated Article on Sleep Apnea Home Testing
Philips’ Alice NightOne
We’ve updated our article: Sleep Apnea: Home Testing with WatchPAT Device and the Philips Respironics.
There are several FDA-approved sleep study devices you can use in the comfort of your own bedroom to determine if you have sleep apnea. And it’s convenient (especially if being away from home overnight is problematic).
Everyone with A-Fib should be tested for sleep apnea. It’s now available at a fraction of the cost of an in-lab sleep study ($250-$300 vs. $1100-$2,000).
We’ve added the Philips Alice™ NightOne home test. Continue to the updated article…
Sleep Apnea: When Snoring Can Be Lethal
Obstructive Sleep Apnea (OSA) is so common that at least 43% of patients with Atrial Fibrillation also suffer from it. For that reason alone, you should be tested for sleep apnea.
Aside from causing or triggering A-Fib, untreated sleep apnea can cause many other serious health threats. Patients with sleep apnea have a higher mortality rate, a longer duration of hospitalization, and greater medical coists. (Gill & Wu)
Got Sleep Apnea? Your Life-Threatening Risks
Researchers at the U. of Wisconsin examined 22-years of mortality data on the study’s participants and found the following:
The Wisconsin Sleep Cohort Study
Beginning in 1989, the U. of Wisconsin study used a random sample of 1,522 Wisconsin state employees. The participants underwent overnight sleep apnea studies and many other tests at four-year intervals. They were not selected because they had known sleep problems. (After the testing, researchers contacted participants with severe sleep apnea and explained the health risks.)
The study reveals the numerous life-altering and life-threatening health issues associated with sleep apnea.
Sleep Apnea: a condition in which one or more pauses in breathing occur while sleeping, pauses can last a few seconds to minutes and can occur 30 times or more an hour.
More EPs are Sending Patients for Sleep Studies
So many A-Fib patients also suffer from sleep apnea that many Electrophysiologists (EPs) routinely send their patients for a sleep apnea study. Some A-Fib centers have their own sleep study program. (The patient just walks down the hall to an A-Fib sleep study area.)
For some lucky patients, normal sinus rhythm (NSR) can be restored just by controlling their sleep apnea and getting a good night’s sleep.
Take Action: Sleep Apnea Can be Lethal
The Wisconsin Sleep Study findings demonstrate just how lethal sleep apnea can be. Sleep apnea isn’t a minor health problem, and it’s a condition you can do something about. (Just like A-Fib, you don’t have to just live with it).
If your significant other tells you that you pause breathing when you sleep or that you snore, do something about it! (Not everyone with sleep apnea snores, but snoring may indicate sleep apnea.)
Talk with your doctors about testing for sleep apnea. You may need an in-lab sleep study (or the newer option of a home sleep test).
Learn More About Sleep Studies
Read about in-lab and in-home sleep studies in our article, Sleep Apnea: Home Testing with WatchPAT Device and the Philips Respironics
On a Personal Note: My wife has sleep apnea (but not A-Fib). While sleeping, she would actually stop breathing for what seemed like a long time, then suddenly gasp for air. It was very scary! But now she uses a CPAP machine, sleeps soundly and wakes up rested.
Sleep apnea may run in families. Her brother has sleep apnea also.
Gill, Jashan & Chunyi Wu. In-hospital Outcomes and Arrhythmia Burden in Patients with Obstructive Sleep Apnea and Heart Failure with Preserved Ejection Fraction. The Journal of Innovations in Cardiac Rhythm Management, June 2022, Volume 12/Number 6. p. 5033.
Infographic: A-Fib & Sleep Apnea—The Life-Threatening Risks
Sleep Apnea is common amount Atrial Fibrillation
At least 43% of patients with Atrial Fibrillation suffer from Obstructive Sleep Apnea (OSA) as well.
Sleep Apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.
It is now established that there’s a correlation between Sleep Apnea and A-Fib.
AliveCor Kardia May be Big Winner in Britain’s NHS Plan
AliveCor, maker of the Kardia ECG smartphone attachment to detect Atrial Fibrillation, may be a big winner in a plan by the British National Health Service (NHS).
AliveCor Kardia attached to a smartphone
Dr. David Albert, AliveCor founder, said the British plan opens the door to the NHS buying AliveCor devices for all 2 million atrial fibrillation patients in England.
The NHS has announced plans to give millions of patients free health apps & connected health devices in a bid to promote self-management of chronic diseases.
The plan is expected to “save money and lives by preventing strokes.” About 20 percent of British A-Fib patients have strokes. The program will start in April 2017.
The AliveCor Kardia, cleared for use in the US by the FDA, attaches to Android and Apple Devices and by pressing the sensors with your fingers (or thumbs), capture single-lead, medical-grade EKGs in just 30-seconds. Instantly you know if your heart rhythm is normal or if atrial fibrillation (A-Fib) is detected in your EKG. Data can be captured and sent to your doctor.
Request to Our Readers
Is anyone using the latest AliveCor® version, ‘Kardia™ Mobile’? (Model 1141, out since Feb. 2016) I want to update our Feb. 2015 review.
How do you typically use it? Are you satisfied with the performance? Do you transfer the data to your doctor?
Will you share your product experiences with me? Just shoot me an Email with your impressions.
My Top 5 Picks: DIY Heart Rate & Handheld ECG Monitors
By Steve S. Ryan, PhD, Updated Dec 10, 2016
Many A-Fib patients want to monitor their heart rate when exercising or when performing physically demanding activities, i.e., mowing the lawn, loading equipment, etc. (I wore one when I had A-Fib.) A consumer ‘DIY” monitor or Handheld ECG monitor may meet this need.
My Top 5 Picks for DIY Heart Rate & Handheld ECG Monitors
To get you started, here are my Top 5 Picks. These products are available from many online sources, but to make it easy for you and to read my other recommendations, see my ‘Wish List’ on Amazon.com. (Note: Use our Amazon portal link, and your purchases help support A-Fib.com.)
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Learn More About DIY Heart Rate Monitors
For more information about these monitors, see my Guide to DIY Heart Rate Monitors & Handheld ECG Monitors (Part I).
To learn how they work, see DIY Heart Rate Monitors: How They Work For A-Fib Patients (Part II).
2016 AF Report: 2 Challenging, Difficult Catheter Ablation Cases with LAA Closure
AF Symposium 2016
Steve Ryan at 2016 AF Symposium
Two Challenging, Difficult Catheter Ablation Cases with LAA Closure
by Steve S. Ryan, PhD
One of the most interesting and practical sessions was “Challenging Cases in Catheter Ablation and LAA Closure for AF”. Featured were a panel with some of the world’s ‘master’ Electrophysiologists (EPs). Each presented one or two cases of their most challenging and difficult cases from the past year. The panelists were:
• Dr. David Keane, St. Vincent’s University Hospital, Dublin, Ireland (Moderator).
• Dr. Moussa Mansour, Massachusetts General Hospital, Boston, MA.
• Dr. Andrea Natale, Texas Cardiac Arrhythmia Institute, Austin, TX
• Dr. Douglas Packer, Mayo Clinic, Rochester, MN
• Dr. Vivek Reddy, Mount Sinai Hospital, New York, NY
• Dr. Miguel Valderrabano, Houston Methodist Hospital, Houston, TX
• Dr. David Wilber, Loyola University Medical Center, Chicago, IL
Two cases of Persistent A-Fib stood out as significant for readers of A-Fib.com. To learn why, see my ‘Take Away’ comments that follow each case description.
Electrically Dead Left Atrium
Dr. Miguel Valderrabano
Dr. Valderrabano presented the case of a 48-year-old female patient with symptomatic Persistent A-Fib. She had been cardioverted several times and had tried several antiarrhythmic drugs including amiodarone. She had had Pulmonary Vein Isolations (PVI) by other EPs before being referred to Dr. Valderrabano.
Her left atrium was enlarged. Dr. Valderrabano ablated her again but couldn’t isolate her Left Atrial Appendage (LAA) where A-Fib signals were still coming from. He used the Lariat (SentreHeart, Inc.), a noose-like suture delivery device, to close off and electrically remove her LAA.
After these steps, she had a leak from her closed-off LAA which had to be plugged. She was A-Fib free but developed Atrial Flutter which had to be ablated.
After all these ablations, she was finally in sinus rhythm. But at what cost? All the extensive ablations and scarring had made her Left Atrium electrically dead and unable to contract normally (“Stiff Left Atrium”).
The patient knew she might lose contraction of her left atrium, but was most happy to be in sinus rhythm after years of symptomatic A-Fib.
TAKE-AWAYS FOR PATIENTS
Lariat to Prevent A-Fib Signals from the LAA: The Lariat is an occlusion device, and like the Watchman, is normally used for closing off the Left Atrial Appendage (LAA) to prevent A-Fib clots breaking loose and causing a stroke. It’s particularly useful for people who can’t or don’t want to take anticoagulants.
In this case, the LAA was the source of non-Pulmonary Vein (PV) signals (and often is). By removing it, patients can often be restored to sinus rhythm. (Master EPs now consider the LAA the most important source of non-PV triggers. Unfortunately, many EPs are unaware of the LAA’s importance and don’t check it for non-PV triggers during an ablation.)
Stiff Left Atrium: No one wants to lose their Left Atrium’s ability to contract and pump. But in extreme cases, this may happen.
I talked to one of the most experienced EPS in the world who has had to do several ablations which restored a patient to sinus but also rendered their left atrium electrically dead and unable to contract normally. [Note: the Left Ventricle does most of the heavy-duty pumping work.]
His patients, even though they knew the risks, were overjoyed to finally be in normal sinus rhythm. After years of symptomatic A-Fib, they had their life back again.
FIRM Advantages and Problems
Dr Vivek Reddy, Mt Siani Hospital
Dr. Vivek Reddy presented the case of a 63-year-old male in Persistent A-Fib who had had several ablations before being referred to him. After wearing a Holter monitor for one-week, the data showed an A-Fib burden of 27%, i.e. his A-Fib was very symptomatic and burdensome.
Dr. Reddy did a FIRM-guided ablation, but the patient was still in A-Fib.
Upon closer examination and manual mapping, the ‘renegade’ A-Fib signal source was found and ablated, which restored the patient to sinus rhythm.
Dr. Reddy had discovered the A-Fib signal in the area where the FIRM basket catheter didn’t map. As mentioned in other Symposium presentations, due to design problems, the FIRM basket catheter maps only slightly more than ½ of the left atrium. (New basket catheters to correct this problem are being developed by the manufacturer, Abbott/Topera.)
TAKE-AWAYS FOR PATIENTS
Limited but Extensive Data with Fast Results: Even though the FIRM mapping and ablation system seems to currently have built-in limitations, master EPs still use the FIRM basket mapping catheter because it provides a great deal of important information very quickly. It is especially useful in cases of Persistent A-Fib where it identifies non-PV triggers such as rotors and focal drivers. As Dr. Reddy stated earlier, this is the future of A-Fib ablation.
Choose an EP Who Can Compensate for FIRM Limitations: When choosing an EP to do your ablation, it isn’t enough to select someone who uses the FIRM system. You need an EP who knows the limitations of the FIRM system and how to find and ablate non-PV triggers the FIRM system may miss. The fact that an EP uses the FIRM system is not a guarantee you will have a successful ablation.
Wrap Up
The two cases I chose to write about were the most informative for those A-Fib patients seeking to understand the most current treatment options. This Saturday afternoon session was the last of the 2016 AF Symposium.
For more about the Lariat occlusion device, see my brief article: Lariat II Suture Delivery Device.
For more about the FIRM mapping system, see my brief article: FIRM Mapping System—Should Ablation Patients Avoid It?
Return to 2016 AF Symposium Reports reby Steve Ryan, PhD
If you find any errors on this page, email us. Y Last updated: Saturday, February 16, 2019
Bordeaux New ECGI Ablation Protocol—Re-Mapping during Ablation
AF Symposium 2016
Bordeaux New ECGI Ablation Protocol—Re-Mapping During Ablation
by Steve S. Ryan, PhD, February 2016
CardioInsight ECGI vest-like device with 256 electrodes for 3-D non-invasive mapping
Updated Feb. 2017: The CardioInsight system was approved by the US FDA Feb. 3, 2017 and is being made available to A-Fib centers in the U.S. Dr. Vivek Reddy at Mount Sinai Medical Center in New York City was the first to use the system commercially in the U.S.
Why ECGI/ECVUE is Important
ECGI/ECVUE is probably the most significant, game changing improvement in treating A-Fib (along with Contact Force sensing catheters), particularly for people with persistent A-Fib.
ECGI will not only change the ways mapping and ablations are done, but possibly how you and I are examined and diagnosed in our doctor’s office.
Image a Future Physical Without an EKG
Imagine when you go in for a physical that, instead of getting an EKG, you simply put on an ECGI vest which tells the doctor where and how many A-Fib producing potentials you have in your heart, all without you having to be in A-Fib. Admittedly, this is pie-in-the-sky speculation right now. But the ECGI vest has tremendous potential to change the way A-Fib is diagnosed and treated.
Dr. Michel Haissaguerre & New Uses of ECGI/ECVUE
Dr Michele Haissaguerre, The Bordeaux Group
Dr. Michel Haissaguerre of Central Hospital, Bordeaux, France presented new developments in how the Bordeaux group now uses ECGI/ECVUE Cardio Insight body surface mapping for persistent A-Fib. His talk was entitled “Monitoring of AF Drivers During Catheter Ablation for Persistent AF.” (For a detailed description and discussion of the ECGI system, see 2013 BAFS: Non-Invasive Electrocardiographic Imaging [ECG]). See also How ECGI Works.)
Patient Prep with the ECGI Vest
Typically, the day before an ablation, a technician (it doesn’t have to be the EP ablationist) uses a ECGI vest to map and identify sites in the heart producing A-Fib signals (rotors and focal sources). The next day, using this map combined with a CT scan which produces a very detailed 3D color map of the heart, the EP ablates and isolates these sites.
What’s New: Bordeaux Group Also Re-Maps Using the ECGI Vest
What’s brand new about how the Bordeaux group is using ECGI is that, if a patient’s A-Fib has not been terminated after the ablation, they then re-map using the ECGI vest. This often reveals missed, changed or new A-Fib drivers. They then ablate/isolate these regions.
The ideal or goal is for A-Fib to terminate into sinus rhythm or Atrial Tachycardia (AT). Atrial Tachycardia (a heartbeat that is in sinus rhythm but faster than normal) can then also be mapped and ablated into Normal Sinus Rhythm (NSR). (Atrial Tachycardia, for the average persistent patient, feels a lot better than being in A-Fib.)
If after re-mapping and ablation, the patient is still in A-Fib, they use Electrocardioversion to try to shock the patient back into sinus.
See the AF Symposium Live Case Presentations: Dr. Mélèze Hocini of the Bordeaux group ablated a 40-year-old male with persistent A-Fib. She found four areas of rotor/focal activity in his heart. After ablating the third area, the patient’s persistent A-Fib terminated. Dr. Hocini did not have to re-map or ablate the fourth area.)
Slides of Before and After ECGI Ablation
Dr, Haissaguerre showed slides of before and after an ablation using ECGI. Ablation at a driver region transformed rapid, complex signals into slower, organized signals.
In the AFACART study in which eight different centers used the ECGI system, ablations in driver regions varied from 38 to 98 minutes of cumulative RF energy delivery time per center despite similar patients and targets (indicating the current lack of standardized ablation techniques). (For more on the AFACART study, see AF Symposium 2015: AFACART Clinical Trial.)
Persistent A-Fib Case: In the case of a 48-year-old female in Persistent A-Fib for four months, four target areas were identified: the inferior Left Atrium (LA), the LA Septum, the anterior of the LPV (Left Pulmonary Vein) to the LAA, and the posterior area of the RPV (Right Pulmonary Vein). (They divide the left and right atria into seven general physical areas.) A-Fib continued after these driver areas were ablated. On re-mapping, the septum area was found to be still active. After 2 more minutes of RF delivery to that septum area, A-Fib terminated into normal sinus rhythm.
Ablation Failure From Thicker Atrial Tissue?
Dr. Haissaguerre pointed out that ablation failure happens particularly in the right and left atrial appendages because of thicker atrial tissue. He showed a slide where he ablated one driver area, then six months later ECGI showed a new driver region at the LAA ridge.
Right Atrium Drivers Reduced After Left Atrium Ablation
Next, he showed slides where the ECGI mapping system initially showed driver activity in the Right Atrium (RA). But after Left Atrium (LA) ablation, this driver activity was greatly reduced. He suggested that RA drivers might mirror or be a projection of LA drivers.
(This is a new research finding that may be very important and may change the way the right atrium is ablated in persistent A-Fib cases.)
ECGI After Prior Extensive PVIs
Dr. Haissaguerre showed slides of patients who had had two or three prior PVIs. ECGI clearly showed where there were still driver regions. Each patient’s persistent A-Fib was terminated into normal sinus rhythm.
Mapping of Atrial Tachycardias (ATs)
The ECGI system can also map Atrial Tachycardias (AT). Dr. Haissaguerre found that half the ATs found were focal ATs, “mostly localized reentry”; 68% were from driver regions previously ablated; 32% were from new sites.
The other half of the ATs were “Macroreentries” and required linear ablations to terminate.
Limitations of ECGI NonInvasive Driver Mapping
According to Dr. Haissaguerre:
• Body filtering (ECGI) may miss small local AF Signals, while showing the main propagating waves in a panoramic scope
• Extensive ablation may affect egm (electrogram) quality and analysis
• Besides ‘drivers’, other mechanisms of AF perpetuation may coexist, particularly in longer lasting (>1 year) AF
Dr. Haissaguerre’s Conclusions
• Remapping can confirm elimination or persistence of drivers or show new drivers (requiring further ablation)
• This dynamic information will probably increase the rate of AF termination
• Further improvement expected with rapid mapping of Atrial Tachycardias
What Patients Need to Know
The ECGI/ECVUE Cardio Insight body surface mapping seems like a major improvement and development, particularly for patients in persistent A-Fib, usually the hardest to cure.
This ECGI system is being carefully developed in eight centers in Europe (AFACART clinical trial). It was recently purchased by Medtronic and is headquarted in Dublin, Ireland.
(No one at the Medtronic booth at the AF Symposium exhibit hall could tell me when the ECGI system will be available for examination and use in the US and worldwide. I’ll update this report when I know.)
Re-Mapping a Major Improvement in ECGI: We’re grateful to Dr. Haissaguerre and the Bordeaux group for developing the technique of re-mapping during an ablation. It’s certainly a major improvement in what was already a very good mapping and ablation system.
Mapping and Ablating Atrial Tachycardias (ATs): From a patient’s perspective, it’s great to know that ECGI can be used to identify and ablate atrial tachycardias (fast heart rates).
A-Fib termination can result in normal sinus or ATs which are a form of sinus rhythm. For most people, ATs are certainly better than being in A-Fib. But they can be annoying and disruptive. It’s good to know they can be mapped and ablated just like A-Fib signals.
ECGI May Miss Small Local ATs and A-Fib Signals: ECGI isn’t perfected yet. Dr. Haissaguerre showed that many of the local ATs found came from driver regions previously ablated.
DR. MICHEL HAÏSSAGUERRE
Dr. (Prof.) Michel Haïssaguerre, Central Hospital, Bordeaux, France, and his colleagues invented pulmonary vein catheter ablation for A-Fib (PVA/I). The Bordeaux Group is considered one of the top A-Fib centers in the world and noted for their cutting edge research in the treatment of Atrial Fibrillation. Interesting fact: I (Steve Ryan) was their first US patient in 1998.
Return to 2016 AF Symposium Reports by Steve Ryan, PhD
If you find any errors on this page, email us. Y Last updated: Saturday, May 6, 2017
DIY Heart Rate Monitors: How They Work For A-Fib Patients (Part II)
A-Fib patients sometimes use consumer ‘DIY” Heart Rate Monitors (HRM) when exercising or performing physically demanding activities (For specific models and options, see our article, DIY Heart Rate Monitors & Handheld ECG Monitors Part I.)
How Do DIY Heart Rate Monitors Work?
Basic HRMs use a chest strap to pick up the electrical signals from the heart. However, due to the inherent design of the chest strap, the accuracy is somewhat limited and is no replacement for the signals recorded by a Holter or Event Monitor.
A HRM keeps track of your heart’s R-R interval or the time between R peaks. Without getting too technical, the R peak on a generic ECG waveform (see the diagram) corresponds to the ventricle beat (depolarization) and has the largest amplitude (height) of the complete waveform.
When the amplitude (picked up as a voltage differential) exceeds a certain threshold, a “beat” is picked up by the chest strap and transmitted wirelessly to the HRM. It is the time between these R peak “beats” that is used by the HRM to determine instantaneous heart rate. It is only going to pick up episodes of arrhythmia as are manifested in ventricle beats (the R on the waveform).
This is one of the fundamental differences in how data is recorded by HRMs (R-R interval) versus Holter/Event Monitors (actual waveform).
In fact, this is what Polar has to say:
“Polar products are not designed to detect arrhythmia or irregular rhythms and will interpret them as noise or interference. The computer in the wrist unit will make error corrections, so that arrhythmia beats are not included in the averaged beats per minute. The blinking heart symbol in the face of the unit, however, will continue to show all heart beats received.
In most cases the Polar products will work fine for persons with arrhythmia.”
HRM Recording Capability
Most HRMs provide some internal storage recording capability. While lower cost HRMs simply record low, high and average heart rate, upper end models allow you to download heart rate data to your PC.
App-enabled smartphones are changing how this data is viewed, collected and saved for future review.
How To Setup and Use an HRM
On most of the HRMs, you can set a heart rate zone, and the watch monitor (or app-enabled smartphone) will record how long you stayed in that zone.
You could then program a high heart rate zone which you might only enter if you were in A-Fib. That way you could record how long you stayed in A-Fib and what your max heart rate was. This data could be reviewed on the watch monitor (or app-enabled smartphone) without having to download it to a PC.
On HRMs with PC interface capability, you can view data in a graphic form (on some watches/smartphones you can view the graphic data but with lower resolution.) This analyses could tell you when you were at a higher heart rate—A-Fib—and how long you stayed there. Of course these kinds of features require some PC skills, but typically the programs are pretty user friendly. (See the above graphic example of a Polar PC program).
For more, see our article, DIY Heart Rate Monitors & Handheld ECG Monitors.
Shop Amazon.com for Steve’s Top Picks: DIY Heart Rate Monitors for A-Fib Patients.
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If you find any errors on this page, email us. Y Last updated: Monday, August 27, 2018
