2020 AF Symposium Challenging Case: 75-Year-Old, A-Fib Increases, Develops Bradycardia, 12-sec Heart Pause
2020 AF Symposium: AF Management
Challenging Case: 75-Year-Old, A-Fib Increases, Develops Bradycardia, 12-sec Heart Pause
by Steve S. Ryan
One of the most interesting sessions at the AF Symposium is the “Challenging Cases in AF Management: Anticoagulation, Arrhythmic Drugs and Catheter Ablation for AF” where leading doctors discuss very frankly their most difficult cases that year.
While several cases were discussed, here I summarize just one case.

Dr Eric Prystowsky
Patient History: 75-Year-Old Female
Case presented by Dr. Eric Prystowsky, St. Vincent Hospital, Indianapolis, IN
Dr. Prystowsky described the case of a 75-year-old female with A-Fib of at least three years duration. Before she came to Dr. Prystowsky, she was on Sotalol 40 mg 2/d and aspirin.
She was doing fine until a few months before when her A-Fib attacks became more frequent and with a more rapid rate. She also developed bradycardia and had a 12-second pause in heart beat.
Pacemaker and Pericardial Effusion: She had a pacemaker installed (but not by Dr. Prystowsky). During the implanting of the pacemaker, she developed a pericardial effusion (bleeding from the heart into the pericardium sac). She was not on anticoagulants.
Two weeks after implanting the pacemaker, she felt lousy with recurring palpitations.
Treatment by Dr. Prystowsky
Flecainide added: Dr. Prystowsky put her on flecainide 100 mg 2/day. She had slightly elevated blood pressure. She was also on aspirin, metoprolol, and Atorvastatin (to lower blood pressure by treating high cholesterol and triglyceride levels).
The patient had repeatedly been offered a catheter ablation, but she declined each time.
Reset Pacemaker: The pacemaker was controlling her atrium 93% of the time. Her Ejection Fraction was 55%-60% (a good range).
Dr. Prystowsky reprogrammed her pacemaker to change her AV interval. He stopped the aspirin, and put her on apixaban (Eliquis) 5 mg 2/d. He ordered a stress echo test to check her heart.
She felt better for 5 days.
Moderate Pericardial Effusion; Medications Adjusted
The patient then developed a moderate (“significant”) pericardial effusion.
Dr. Prystowsky stopped the apixaban (probably the cause of the pericardial effusion). Because she still had some symptomatic episodes of A-Fib (although much better), he then increased the flecainide to 150 mg.
Contributing Role: Referring to the cause of the patient’s pericardial effusion, Dr. Prystowsky faced the fact that “I did it.”
She experienced bad side effects with the increased dosage of flecainide. He put her on 100 mg 3/day to reduce the side effects.
The patient had repeatedly been offered a catheter ablation, but she declined each time.
Minimizing Pacing; Medication Adjusted
The patient’s ventricular pacing produced a wide QRS which Dr. Prystowsky said “worried the hell out of me.” He tried to minimize the pacing she received.
A CT scan revealed that her pacemaker incisions were fine, and that she had no more pericardial effusion. He re-started apixaban. She felt great.
He wound up putting her on amiodarone 200 mg which she tolerated well (previously she didn’t react well to Sotalol).
Dr. Prystowsky’s Lament
He described what he called his “shpilkes” index (Yiddish for anxiousness). When he talks to his fellows, “If you go home and worry about your patient at midnight, you ought to re-think everything.”
One Year Later and Lesson Learned
A year later she came in complaining of palpitations. Her pacemaker revealed that she only had 2 minutes of A-Fib in six months. Dr. Prystowsky told her, “I can’t do better than that.”
Dr. Prystowsky told the attendees that he would never again put a woman of her age on flecainide 150 mg.
He wrote me that it’s been over a year, and the patient is doing great.
If you find any errors on this page, email us. Y Last updated: Monday, February 22, 2021
Return to 2020 AF Symposium Reports
A-Fib Drug Therapy: If We’re Sick, Just Take a Pill, Right?
In the US, we’ve been conditioned to think, “if we’re sick, just take a pill”.
When you have Atrial Fibrillation, anti-arrhythmic drug (AAD) therapy is certainly better than living a life in A-Fib. It can be useful for many patients.
And according to Dr. Peter Kowey, Lankenau Heart Institute (Philadelphia, PA), while anti-arrhythmic therapy is not perfect, it can improve quality of life and functionality for a significant percentage of A-Fib patients.

P. Kowey MD
Dr Kowey is an internationally respected expert in heart rhythm disorders. His research has led to the development of dozens of new drugs and devices for treating a wide range of cardiac diseases.
He cautions, though, that A-Fib anti-arrhythmic drugs are just a stopgap measure. The problem is they don’t deal with the underlying cause. And are seldom a lasting cure for A-Fib.
The Trade-Offs of Anti-Arrhythmic Drugs
In our article, Eleven Things I Know About A-Fib Drug Therapy, Dr. Kowey writes:
“An anti-arrhythmic drug is a poison administered in a therapeutic concentration. Like most meds, anti-arrhythmic drugs, (AADs), are a trade-off between the unnatural and possible toxicity with the power to alleviate our A-Fib symptoms.”
Did “an anti-arrhythmic drug is a poison” set off alarm bells for you?
In general, anti-arrhythmic drugs are toxic substances which aren’t meant to be in our bodies―so our bodies tend to reject them.
For more, see our full article with Dr. Kowey’s insights, Eleven Things I Know About A-Fib Drug Therapy. It’s based on his 2014 American Heart Association (AHA) Scientific Session presentation.
Look Beyond the Typical AAD Therapy
Today’s anti-arrhythmic drugs have mediocre success rates (often under 50%).

Beyond AAD Therapy
Many patients often experience unacceptable side effects. Many just stop taking them. And when they do work, they tend to lose their effectiveness over time.
According to Drs. Irina Savelieva and John Camm of St. George’s University of London:
“The plethora of antiarrhythmic drugs currently available for the treatment of A-Fib is a reflection that none is wholly satisfactory, each having limited efficacy combined with poor safety and tolerability.”
These drugs don’t cure A-Fib but merely keep it at bay. Most Atrial Fibrillation patients should look beyond the typical antiarrhythmic drug therapy.
See our Treatments page to learn more about Medicines or ‘Drug Therapies’ for A-Fib.
Answering Your Questions About A-Fib Drug Therapies
Since the beginning of A-Fib.com, we have answered thousands of patient’s questions—many times the same questions. Perhaps the same questions you may have right now.
For unbiased information and guidance about medicines and drug therapy treatments, see our page of questions and answers. You’ll find explanations, resources and advice for the most frequently asked questions by patients and their families. Go to FAQ A-Fib Treatments: Medicines and Drug Therapies.
I Couldn’t Believe the Drugs He Was On; How to Ask Questions About Your A-Fib Prescriptions
03/15/2019 5 pm: Corrected a missing link below to the Free Worksheet, Ask These Questions Before Starting a Prescription Drug.
I received a very distressing email from a reader, Kenny, who was worried about his prescribed medications. He wrote that he just had a cardioversion a week ago and is back in A-Fib (unfortunately that’s not uncommon). Alarm bells went off in my head when I read:
“My doctor just prescribed me amiodarone 200mg, 4x a day…I’m a little concerned about the amiodarone and all the side effects!”
“I’m also on Digoxin…Xarelto and aspirin… .”
“I can’t get my doctor’s office or doctor to call me back! Reluctant to start amiodarone until I can talk to someone!”

Drugs Therapies Concerns
Ding, Ding, Ding! I am deeply concerned for him. The doctor prescribing these drugs is in internal medicine, not a cardiac electrophysiologist. While Kenny and I continue to exchange emails, here’s some highlights from my first reply:
• Amiodarone is an extremely toxic drug, and this dosage is 4x the normal dose.
• You must get a second opinion ASAP! (consult a cardiac electrophysiologist)
• Digoxin is also a dangerous drug not normally prescribed for A-Fib patients.
• It’s very unusual to prescribe both Xarelto and aspirin.
Time to Change Doctors? And lastly, I wrote him that if your doctor or his office isn’t calling you back, that’s a sign you should look for a new doctor (don’t be afraid to fire your doctor). You need good communication when you’re in A-Fib and trying to find a cure.
I’m glad Kenny reached out to me so we can get him on the right A-Fib treatment plan for him and his treatment goals.
Ask These Questions Before Starting a Prescription Drug
Before starting any prescription drug for your Atrial Fibrillation, you should ask what it’s for and why you should take it.
Download our free worksheet, ‘10 Questions to Ask Before Taking Any Medication’ and use as a guide to ask these questions of your doctor or healthcare provider, and note their responses:
1. Why am I being prescribed this medication?
2. What are the alternatives to taking this medication?
3. What are the side effects of this drug?
4. Are there any precautions or special dietary instructions I should follow?
5. Can it interfere with my other medications?.
6. How long before I know if this drug is working?
7. How will I be monitored on this drug? How often?
8. What happens if this drug doesn’t work?
9. What if my A-Fib symptoms become worse?
10. If I don’t respond to medications, will you consider non-pharmaceutical treatments (such as a catheter ablation)?
Research and Learn About Any Prescription Drug 
You can do your own research about a specific medication and if it’s the right one for you.
An excellent prescription database is the U.S. National Library of Medicine Drug Information Portal. (For an example, see the page on Warfarin [Coumadin].)
Decision Making Time
Your research and the answers to these 10 questions should help you decide about taking a new prescription drug. Remember, it’s your heart, your health. Taking medications is a decision you should make in partnership with your doctor.
Note: File your completed worksheets in your A-Fib binder or file folder to use for future reference and follow-up.)
“Do Not Use This Product” Warnings on Decongestants: Which are Safe for A-Fib Patients
by Steve Ryan
First published Dec. 2017. Last updated: August 19, 2020
It’s cough and cold season, and millions of cold sufferers are reaching for an over-the-counter (OTC) decongestant capsule or nasal spray to clear a stuffy nose.
As an A-Fib patient, did you notice these over-the-counter decongestants often contain a warning such as:
“Do not use this product if you have heart disease, high blood pressure, thyroid disease, diabetes, or difficulty in urination due to enlargement of the prostate gland, unless directed by a doctor.”
What does this warning mean for patients with Atrial Fibrillation?
Decongestants, Heart Disease and A-Fib
When you have a stuffed up nose from a cold or allergies, a decongestant can cut down on the fluid in the lining of your nose. That relieves swollen nasal passages and congestion. (In general, an antihistamine doesn’t help with this symptom.)
The Problem: When taking a decongestant, heart rate and blood pressure go up, the heart beats stronger, blood vessels constrict in nasal passages reducing fluid build-up. In general that’s okay for most patients.
But not for patients with high blood pressure, heart disease or, specifically, Atrial Fibrillation. Decongestants cause the blood vessels to shrink and blood pressure to rise. Perfect conditions that can trigger or induce an episode of their A-Fib.
Another concern for A-Fib patients is that some over-the-counter (OTC) medications can interact with the anti-arrhythmic medication they’re taking.
Check your Cold Medicine: The main active ingredient in many decongestants is pseudoephedrine, a stimulant. It is well known for shrinking swollen nasal mucous membranes.
To find out if your cold medicine contains a decongestant, start by reading the label. You can lookup the ingredients of any OTC medication at Drugs.com. Just search by product name or active ingredient.
In addition, you can consult your pharmacist who can check the label of a medicine and let you know if it’s safe for someone with atrial fibrillation and/or high blood pressure.
Drugs.com makes it easy to check the ingredients of any OTC medication, just search by product name or active ingredient.
OTC Decongestants to Avoid: Some OTC decongestants tablets, capsules and nasal sprays to avoid if you have atrial fibrillation include:
• AccuHist DM® (containing Brompheniramine, Dextromethorphan, Guaifenesin, Pseudoephedrine)
• Advil Allergy Sinus® (containing Chlorpheniramine, Ibuprofen, Pseudoephedrine)
• Advil Cold and Sinus® (containing Ibuprofen, Pseudoephedrine)
• Sudafed (pseudoephedrine)
• Afrin and other decongestant nasal sprays and pumps (oxymetazoline)
Phenylephrine: a Safe Substitute? Maybe. A substitute for pseudoephedrine is phenylephrine. In general, phenylephrine is milder than pseudoephedrine but also less effective in treating nasal congestion. As with other decongestants, it causes the constriction of blood vessels and increases blood pressure.
There is anecdotal evidence that products with the substitute phenylephrine might be less of a trigger for A-Fib than products with pseudoephedrine. Products with phenylephrine:
• Sudafed PE Congestion tablets
• Dimetapp Nasal Decongestant capsules
• Mucinex Sinus-Max Pressure and Pain caplets (Sue Greene writes that she has used Guaifenesin (Mucinex) for years which has never put her into A-Fib, 2/15/19. Lompocsue(at)yahoo.com.)
Decongestant-Free Products: These tablets, capsules and nasal sprays are decongestant-free and safe for patients with Atrial Fibrillation (They are marketed for those with High Blood Pressure):
• Coricidin HBP line of products (Chlorpheniramine)
• DayQuil HBP Cold & Flu (dextromethorphan hydrobromide)
• NyQuil HBP Cold & Flu (dextromethorphan hydrobromide)
• non-medicated inhalers such as Vicks VapoInhalers (Levmetamfetamine)
What About Antihistamines?
Antihistamines reduce the effects of histamine in the body which can produce sneezing, runny nose, etc. Though they can lessen your symptoms, some can aggravate a heart condition, or be dangerous when mixed with blood pressure drugs and certain heart medicines.
Antihistamines can be dangerous when mixed with blood pressure drugs and certain heart medicines.
Heart-safe Antihistamines: Compared to decongestants, antihistamines are often better tolerated by people with A-Fib. Some heart-safe antihistamines that can help with a stuffy nose from a cold include:
• Claritin tablets (loratadine)
• Zyrtec tablets (cetirizine)
• Allegra tablets (fexofenadine)
• Chlor-Trimeton (chlorpheniramine)
Non-Drug Alternatives for Cold Relief
If you want to avoid medications altogether, you can try a variety of things to clear your head.
Breathe Right nasal strips may help you breathe better at night. Use saline nasal spray (like Ocean or Basic Care) to help flush your sinuses, relieve nasal congestion and curb inflammation of mucous membranes.
A steamy shower or a hot towel wrapped around the face can also relieve congestion. Drinking plenty of fluids, especially hot beverages (like chicken soup), keeps mucus moist and flowing.
Recommendations for A-Fib Patients
Antihistamines and decongestants can give much-needed relief for a runny or congested nose. But A-Fib patients should pay attention to the warnings for heart patients. Here’s some products and procedures to consider:
Decongestant-free: Look for decongestant-free products (e.g. Coricidin HBP, DayQuil HBP Cold & Flu, NyQuil HBP Cold & Flu and Vicks VapoInhalers).
One possible exception are those decongestant products with the active ingredient phenylephrine (e.g. Sudafed PE, Dimetapp and Mucinex Sinus).
Heart-safe antihistamines: You can try one of the heart-safe antihistamines (e.g. Claritin, Zyrtec and Allegra).
Drug-free alternatives: Try drug-free substitutes (e.g. Breath Right nasal strips, saline nasal spray and a steamy shower).
The best advice for you and your A-Fib: Always consult your cardiologist or EP. Ask what’s the best option for your stuffy nose or allergies. And ask about interactions with your other heart medications (especially if you have high blood pressure).
References
• Don’t let decongestants squeeze your heart. Harvard Health Publishing, Harvard Medical School. March, 2014. https://www.health.harvard.edu/newsletter_article/dont-let-decongestants-squeeze-your-heart
• Atrial fibrillation: Frequently asked questions. University of Iowa Health Care. Last reviewed: December 2015. https://uihc.org/health-topics/atrial-fibrillation-frequently-asked-questions
• Wieneke, H. Induction of Atrial Fibrillation by Topical Use of Nasal Decongestants. Mayo Clinic Proceedings , July 2016, Volume 91, Issue 7, Page 977. https://doi.org/10.1016/j.mayocp.2016.04.011
• Terrie, YC. Decongestants and Hypertension: Making Wise Choices When Selecting OTC Medications. Pharmacy Times, December 20, 2017. https://www.pharmacytimes.com/publications/issue/2017/december2017/decongestants-and-hypertension-making-wise-choices-when-selecting-otc-medications
Why am I Angry at Some Doctors Treating Atrial Fibrillation Patients?
I can’t tell you how angry I am at cardiologists who want to leave their patients in Atrial Fibrillation.
It doesn’t matter even if a patient has no apparent symptoms. Just putting a patient on rate control meds and leaving them in A-Fib can have disastrous consequences.
Silent A-Fib Discovered During a Routine Physical

Discovered during routine exam
I corresponded with a fellow who had just found out he was in “silent” Atrial Fibrillation (no symptoms).
I told him he was very lucky (and should buy his doctor a present in gratitude). His doctor discovered his A-Fib during a routine physical exam. If his silent A-Fib had continued untreated, he might easily have been one of the 35% who suffer a debilitating A-Fib-related clot and stroke.
I would normally commend his cardiologist, but his doctor just put him on the rate control drug, diltiazem, and left him in A-Fib.
That is so wrong for so many reasons!
Rate Control Drugs Don’t Really “Treat” A-Fib
Rate control drugs aren’t really a “treatment” for A-Fib. Though they slow the rate of the ventricles, they leave you in A-Fib.
They may alleviate some A-Fib symptoms, but do not address the primary risks of stroke and death associated with A-Fib.
Effects of Leaving Someone in A-Fib
A-Fib is a progressive disease. Just putting patients on rate control meds (even if they have no apparent symptoms) and leaving them in A-Fib can have disastrous consequences. Atrial Fibrillation can:
• Enlarge and weaken your heart often leading to other heart problems and heart failure.
• Remodel your heart, producing more and more fibrous tissue which is irreversible.
• Dilate and stretch your left atrium to the point where its function is compromised.
• Progress to Chronic (continuous) A-Fib often within a year; Or longer and more frequent A-Fib episodes.
• Increase your risk of dementia and decrease your mental abilities because 15%-30% of your blood isn’t being pumped properly to your brain and other organs.
What Patients Need to Know
For many, many patients, A-Fib is definitely curable. You don’t have to settle for a lifetime of “controlling” your Atrial Fibrillation.
Normal Sinus Rhythm: The goal of today’s AHA/ACC/HRS A-Fib Treatment Guidelines is to get Atrial Fibrillation patients back into normal sinus rhythm (NSR) and stay in sinus rhythm.
Unless too feeble, there’s no good reason to just leave someone in A-Fib (see note below).
Don’t let your doctor leave you in A-Fib. Educate yourself. Learn your treatment options.
Always Aim High! No matter how long you’ve had A-Fib, you should aim for a complete and permanent cure. Shoot for the moon, as they say, and you’ll find the best outcome for you and your type of A-Fib.
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
There was no significant difference between the two arms in the primary endpoint of the trial (the composite of all-cause mortality, disabling stroke, serious bleeding, or cardiac arrest), which occurred in 9.2% of patients in the drug group and 8% of patients in the ablation group (hazard ratio 0.86, CI 0.65-1.15, p =0.303).
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 problem arises when so many of the AAD therapy arm cross over. In the primary endpoint “intent to treat” group, those who wound up having an ablation were still included in the ADD arm. Whereas when researchers looked at actual “treatment received”, 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.
Additional 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.
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?
Blood Thinner Myths Debunked by Healthcare Monitor Guide to AFIB
Every Atrial Fibrillation patient has to deal with the increased risk of clots and stroke and that often includes taking a blood thinner or anticoagulant.
At my doctor’s office I came across one of those “free take home copy” publications about Atrial Fibrillation. Healthcare Monitor Guide to Living with AFib 2018 had an interesting sidebar with a few myths and truths about blood thinners. I’d like to share a few misconceptions they list:

Guide to Living with AFib 2018
• “I’m afraid of shaving because I hear it’ll take forever to stop bleeding.”
• “Blood thinners will make me feel tired.”
• “It seems I bruise much more easily now-and that can’t be good.”
Do any of these ring a bell with you? Are you concerned with the same issues? Healthcare Monitor debunks these as myths and explains way.
Blood Thinner Myths Debunked
“I’m afraid of shaving because I heart it’ll take forever to stop bleeding…If bleeding while shaving is a problem, consider using an electric shaver. And remember: Even if you seem to bleed more easily now, suffering a stroke could cost you your life.
Blood thinners will make me feel tired. There’s no evidence that blood thinners cause or worsen fatigue. In fact, fatigue has not been identified as a problem in numerous studies done in thousands of patients. Of course, several things can effect your energy levels, including other medications you’re taking and lack of sleep. If you’re feeling more exhausted than usual, bring it up with your doctor.
It seems I bruise much more easily now-and that can’t be good. It’s true that bruising may be somewhat increased while you’re on a blood thinner. Although this can be a nuisance, it is important to remember that you are taking this medication to lower the risk of stroke. So the trade-off—accepting a slight increase in bruising—is worth the protection from dangerous clots.”
An Alternative to Blood Thinners

Catheter placing Watchman in LAA
But blood thinners are not like taking vitamins. They have their own set of risks and side effects. However, preventing a stroke is for most people a welcome trade-off for any bad effects of anticoagulants.
If you can’t or don’t want to take blood thinners, an option is to have a device installed to close off the Left Atrial Appendage. The LAA is a small pocket of heart tissue located above the left atrium where 90%-95% of A-fib strokes originate.
To learn more see my articles: Watchman: the Alternative to Blood Thinners or LAA Occlusion for A-Fib Patients: The Lariat II Versus the Watchman Device.
Or watch the 3:28 min. video: The Watchman Device: Closure of the Left Atrial Appendage.