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


Drug Therapies

2021 AF Symposium Spotlight Session: Drug in Development from Acesion Pharma

2021 AF Symposium

Spotlight Session: Drug in Development from Acesion Pharma

At this year’s AF Symposium, there were 22 Spotlight Session talks 5 minutes long spread out over 3 days. Normally I don’t report on them in detail, since they usually aren’t currently available (and may never make it through development and regulatory hurdles into the marketplace). But here’d one that may be of interest to patients.
Dr. John Camm - A-Fib.com

Dr. John Camm

Dr. John Camm of St. George’s Hospital in Oxford, UK discussed a drug in development from Acesion Pharma, a Danish biotech company.

This new drug (AP30663) is highly atrial specific and works as an SK channel inhibitor [to suppress A-Fib]. SK channel inhibitors are ion channels present in the heart which regulate the cardiac rhythm.

Acesion’s new drug is designed for IV cardioversion of A-Fib to normal sinus rhythm.

Editor’s Comments:

Just the fact that Acesion is working on a new antiarrhythmic drug is news in itself. It’s been years since any new antiarrhythmic drugs have come on the market. And the antiarrhythmic drugs currently available to patients leave a lot to be desired.

Plus, the Acesion drug being developed is highly atrial specific which is an important advantage over most other antiarrhythmics.

If you find any errors on this page, email us. Y Last updated: Monday, April 19, 2021

Return to 2021 AF Symposium Reports

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

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

Delaying A-Fib Progression: Ablation vs Antiarrhythmic Drugs

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

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

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

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

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

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

Consider Working Aggressively to Stop Your A-Fib

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

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

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

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

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

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

New Research: Rhythm vs Rate Control Drugs for Atrial Fibrillation

Background: Back in the early days of A-Fib research, the 2002 AFFIRM study found no mortality difference between Rate Control and Rhythm Control. Though largely discredited today, many Cardiologists still use the AFFIRM study to justify keeping patients on rate control drugs (and anticoagulants), while leaving them in A-Fib. (If your Cardiologist tells you that, it’s time to get a second opinion.)

Results 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:

Remember: A-Fib is a progressive disease. 

• 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.

AFFIRM (2002) Study: Not Really an Endorsement of Rate Control Drugs

Dr Andrea Natale

Dr Andrea Natale

In the AFFIRM study, most of the rhythm control patients took antiarrhythmic drugs (AADs) to try to stay in sinus. Very few had catheter ablations. But AADs are known to have many toxicities which caused their own set of health problems and negatively influenced the results.

Dr. Andrea Natale of the Texas Cardiac Arrhythmia Institute/St. David’s Medical Center in Austin, TX pointed out that the AFFIRM study was not really an endorsement of Rate Control drugs.

Success of Antiarrhythmic Medications Borderline: According to Dr. Natale, the 2002 AFFIRM study illustrates how ineffective and dangerous current antiarrhythmic drugs can be.

“…data from several trials have demonstrated that the success of antiarrhythmic medications (AADs) in maintaining sinus rhythm is borderline, at best, with increasing failure rates over time… AADs clearly do not cure A-Fib; at best, they are a palliative treatment used to reduce the burden of A-Fib as opposed to eliminating it altogether. …in our experience rhythm control is not only ineffective and poorly tolerated, but only delays an inevitable ablation.”

“…In our experience rhythm control is not only ineffective and poorly tolerated, but only delays an inevitable ablation.”

The AFFIRM study didn’t compare patients in Rate Controlled A-Fib with patients in Normal Sinus Rhythm (the goal of catheter ablation).

Study Conclusion: In fact, the AFFIRM investigators concluded, “the presence of sinus rhythm was one of the most powerful independent predictors of survival, along with the use of warfarin…Patients in sinus rhythm were almost half as likely to die compared with those with A-Fib.”

New Study Confirms Rhythm Better Than Rate Control

EAST-AFNET 4 stands for The Early Treatment of Atrial Fibrillation for Stroke Prevention Triall;  It started in 2011.

The EAST-AFNET 4 trial studied 2,789 patients with early A-Fib (and other cardiovascular conditions). They were randomized to either early rhythm control or rate control (“usual care”).

“Early rhythm control” included treatment with antiarrhythmic drugs or atrial fibrillation catherter ablation (relatively few had ablations). Patients were included if they were diagnosed less than a year before enrollment (median time since diagnosis was 36 days).

Duration of Study: Patients were followed for about five years. The primary outcomes examined were death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome (first primary outcome).

Study Results: The early rhythm-control strategy proved superior to rate control and was associated with a lower risk of adverse cardiovascular outcomes than usual care. The study was stopped early, because the rythm control group did so much better than the usual-care group (3.9 negative events vs 5.0). As one would expect, sinus rhythm was more common in the rhythm control group (82% vs 61% at two years)

Editor’s Comments:

We should not be surprised that rhythm control proved better for patients than rate control.
Let’s bury the 2002 AFFIRM study once and for all!

Remember: A-Fib is a progressive disease. Leaving people in A-Fib while just trying to control their rate (symptoms) is imprudent and over time can be very harmful to A-Fib patients.

Resources for this article
Wyse DG, et al; Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002 Dec 5;347(23):1825-33. doi: 10.1056/NEJMoa021328. PMID: 12466506. https://pubmed.ncbi.nlm.nih.gov/12466506/

Kirchhof, P. et al. Early rhythm-control therapy in patients with atrial fibrillation. (EAST-AFNET 4 trial). N Engl J Med., 2020 August 29. https://www.nejm.org/doi/full/10.1056/NEJMoa2019422

Debate “Catheter Ablation should be first line therapy in selected patients with A-Fib” Boston AF Symposium, January 13-14, 2006. https://a-fib.com/boston-af-symposium-2006-summaries/#debate

“Your A-Fib is Just Nerves”…”Try Not to Think About It”; At 72 Finally A-Fib & PVCs-Free After 2 Ablations, But Then a Setback

By Cecelia Hender, July 2020

Cecelia Hender and granddaughter

I have been asked to write my story about my journey with A-Fib. I have had arrhythmias since I was a young woman. I was about 20 years old when I first experienced irregular heartbeats. I had gone to my doctor back then and was told it was “nerves” and to relax. This was how most women were treated by doctors back then. Everything was “nerves”.

Time passed, and the irregular heartbeats seemed to get worse at times.

In my 30’s, I remember going to another doctor and told him that when my heart would take off like a race horse, I could not breathe. And when it stopped, I felt I could climb a mountain again. He said, “try not to think about it.”  What ????

I fought with these irregular heartbeats for many years. I was on different blood pressure meds that also helped with heartbeats, but I was never told to see a cardiologist or have a doctor investigate just what was going on.

Once or twice, when I was younger, a doctor had me wear a heart monitor. It was a 24-hour monitor. And when it showed nothing for that period of time, he said I was fine.

Sent to a Cardiologist Almost By Accident―Hard to Document the Arrhythmia

I worked for a medical facility, and one day about 15 years ago a young doctor came in for an interview. He sat in my office for a good amount of time while they were preparing for the interview. During this time, I got to talk to him a lot.

When he said he was an electrophysiologist [cardiac specialist], I asked about my irregular heartbeats. He was so kind and intelligent and gave me a lot of information to think about.

It was this young doctor who told me that I should see a cardiologist. So, I did. And I was treated with medications and had many heart monitors.

But it was always hard to catch the arrhythmias on an ECG or heart monitor.

“You are in A-Fib”―Two Weeks of A-Fib Hell…

Finally, in 2017 I had another [heart] monitor, and it showed a series of irregular heartbeats.

But on this one particular day, I had a very irritating rhythm. It was very fast, then irregularly fast, and I could barely breathe. I went to my PCP [Primary Care Physician] office where they did an EKG and said, “You are in A-Fib”.

They sent me immediately to my cardiologist who confirmed this. I was put on a different kind of med (Metoprolol at first and also Coumadin). And “fingers crossed” I would convert on my own. 

I remember like it was yesterday, the moment my heart decided to go back into normal sinus rhythm. I was so happy and felt so strong…

…Then Blessed ‘Normal Sinus Rhythm!’

It took almost two weeks, but I remember like it was yesterday, the moment my heart decided to go back into normal sinus rhythm.

The feeling was like a major blessing had just descended on me. I was so happy and felt so strong in that very moment. I cried.

Dr. Seth McClennen―Successful Ablation! But PVCs Major Issue

I met with Dr. Seth McClennen, an Electrophysiologist, who decided I was a good candidate for ablation. I was so thrilled.

Finally, someone was going to help me be normal!

My whole life was spent afraid and never going anywhere alone for fear that my heart would act up and I’d be stranded someplace unable to breathe – unable to move. Finally, I found some help.

Dr. Seth McClennen is a well-known and most beloved Electrophysiologist here in the Boston area. He is the best in my book.

He told me all that I needed to know about ablation, and off I went for my very first A-Fib ablation in June 2017.

Although PVC’s don’t carry the risk of stroke as A-Fib but are just as debilitating.

It was successful! I went almost two years without an episode of A-Fib at all whatsoever.

However, my PVC’s were a major issue.  They still kept me house-bound for the most part. Afraid to go anywhere alone. Although PVC’s don’t carry the risk of stroke that A-Fib has, they were just as debilitating.

A Second Ablation for PVCs―Without General Anesthesia―No Big Deal

Dr. McClennen suggested a second ablation for the PVC’s in January 2019.  He said that it would be best if I could go through this without anesthesia, because with sedation, the PVC’s would “hide,” and the ablation would be difficult.

So, I did it … my trust in Dr. McClennen and his wonderful team outweighed any fear or apprehension on my part.

For another patient’s story about treating PVCs, see PVC-Free After Successful Ablation at Mayo Clinic by Dr. Mulpuru

My second ablation was in April 2019. The ablation without sedation was no big deal at all. Now I am talking about a PVC ablation. Seth McClennen was right there working, and I could talk to him any time. He kept me informed as to what was going on.

At one point he said, “Think of something that irritates you so we can get these to come out, and I can follow the path.”  So something that irritates me or causes stress will bring these out …. Well, it worked, and he was able to ablate these PVC’s.

Successful PVCs Ablation―Living Without Fear

For the first time in my whole life, I was able to move about without fear.

I could go to the store and feel normal—I was not worried that my heart would go crazy and I would be left in a puddle somewhere with no one to help me.

(Being a widow, it is very hard to continue life alone especially where your health is concerned. My husband died eight years ago when he was only 60 years old. I have never recovered.)

A Setback: Respiratory Infection Triggers A-Fib

Life was good as far as my heart was concerned. For three months I had no A-Fib or PVC’s. Then suddenly in April 2019, I got an upper respiratory infection which kicked off an episode of A-Fib. Oh no!!!…This familiar awful feeling was something I remembered.

It woke me up, and I immediately took my heart rate. It was 198. No one to take me to the hospital. And with my nerves, I did not want to call an ambulance. That was a BIG MISTAKE. I won’t do that again….

Anyway, a few hours later, my cousin came and took me to the Emergency Room.

They tried Cardioversion TWICE, but it did not work; so, I was put on the antiarrhythmic Tikosyn (dofetilide).

Tikosyn Works, But “Can I Have Another Ablation?”

I had to stay in the hospital for a week to level out and make sure this antiarrhythmic would be okay for me. It got my heart in perfect order, but I don’t want to stay on this forever.

So, my next question for my wonderful Dr. McClennen was “Can I have another ablation”? He answered, “Yes, we will discuss it in the Fall.”

Is Another Ablation on the Horizon?

So, I am waiting eagerly for Fall 2020 when we can discuss another A-Fib ablation. In the mean time, let me share what I’ve learned so far about treating Atrial Fibrillation.

Lessons Learned

Lessons learned about life with A-FibAblation is a Blessing and Low Risk―Better Than Living in Fear

Why do I feel excited about ablation? I truly feel that having an ablation is a blessing. And this is why I am writing this story for you.

I know there are risks and I know people are afraid of ablations, but the risks are nothing compared to living each moment of your life afraid to live.

Find a Great Doctor!

The trick is finding a great doctor. Not just a good doctor, but a great doctor.  What makes a great doctor?  Well, to ME … it’s someone who listened to me. Dr. Seth McClennen listened. He cared.  He even wants me to email him when I have a concern or question. He always answers me. Always.

Kardia Device a Great Help

AliveCor with tablet at A-Fib.com

Using Kardia with tablet; under $100.

I have a Kardia machine – it’s that little EKG tag that you can email to your doctor.  I have sent Dr. McClennen my EKG when I’ve had a question. More so now, with this antiarrhythmic drug, I am always tempted to take an EKG and send it to say “How am I doing?”  Some days I just need to know my heart is in good order.

Find a Great Pharmacist As Well

It helps greatly to have a wonderful pharmacist too. Someone you can confide in and who will help you. The particular drug I am on interacts with so many things that I have to check everything with the pharmacist. Lisa Cohen Szumita is a wonderful pharmacist who is there to answer all my questions.

So, my advice is to have a great doctor – and a wonderful Pharmacist who has that rare quality these days of “Caring” for their patients.

Your Attitude is Your Greatest Weapon

As far as ablations go…your attitude is your greatest weapon.

If you are told you need an ablation, be blessed. Be thankful and blessed.

It’s what we AFIBBERS have to help us live a normal life. Thanks be to God!  When you are going to have your ablation, go into that hospital thanking God and asking Him and His angels to surround you.

Are you in need of prayer? Positive thoughts? Read about our A-Fib Positive Thoughts/Prayer Group and how to send us your request.

Ask all of us here on the A-Fib.com website to hold you in prayer and good thoughts. That is what we are called to do.

Leave fear behind you – don’t bring fear into your procedure. Bring FAITH and JOY and PEACE. I went into that A-Fib ablation with such excitement—to finally live a life where I was not afraid to be in the store alone. A simple thing … but I was unable to do it. After ablation, my life was restored.

I was so very upset that an upper respiratory infection brought me down. But I am on the right track again. So for the time being, I will take this antiarrhythmic.  (Please don’t send me any scary emails about what I take.)  I’ve heard it all. I did all the reports at work that had any and all of these drugs listed. I know all about it. But for now, it’s what I have to do

When the Fall comes, if my cardiologist says I’m good for another ablation …. Well, thanks be to God !! …. And so it is.

P.S. I’ll update my story when I have something to share. If you want to write me, send an email to Steve and he will forward it.

Cecelia Hender
Abington, Massachusetts

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

Editor’s Comments

I can’t help but get angry reading Cecelia’s story. After repeated heart rhythm complaints to her doctors, I can’t believe she wasn’t referred to a cardiologist.

She’s not alone with doctors dismissing women’s symptoms.

Other female patients have reported being told: “You’re experiencing a type of panic disorder.” “You’re exaggerating.” “A-Fib is no big deal.” “Take a Valium.” “Just take your meds and get used to being in A-Fib.”

Consequences of Gender Bias: If you are female, be prepared to experience gender bias in the medical field (but less so among Electrophysiologists [EPs]).

Beware of condescending behavior. You don’t have to accept or put up with that kind of attitude. Anticipate gender bias! Don’t let it deter you! (For more see: Women with A-Fib: Mother Nature and Gender Bias—Or—Get Thee to an EP ASAP.) 

Don’t Just Live with A-Fib: Educate Yourself! Cecelia had irregular heartbeats for decades before she learned she should consult a specialist, a Cardiologist (an electrophysiologist to be exact). 

Don’t be afraid to get a second opinion. Don’t be afraid to fire your doctor.

Thankfully Cecelia finally got her Atrial Fibrillation diagnosed. She then found one of the best electrophysiologists (EP) in her area. She learned about A-Fib. She got the best and most up-to-date advice and treatment. She had lived in fear of her A-Fib but found her cure in spite of her fears.

Catching the Arrhythmias: Cecelia describes very well her frustration when doctors tried and failed to document her A-Fib. All too often when you have occasional (paroxysmal) A-Fib, you’ll be in the doctor’s office and your heart is in normal sinus rhythm (NSR). If you’re not in A-Fib, they can’t document it with an ECG. Frustrating!

(I remember spending all morning in a doctor’s office waiting for an A-Fib attack so that an EKG can document it. But no luck. Then when I went downstairs for lunch, that‘s when I had an A-Fib episode.)

iRhythm Zio patch

Advancements in Heart Monitoring. Today doctors have any number of monitoring and data recording devices to “catch” A-Fib episodes.There are patches such as a Zio Patch which looks like a big Band Aid and which you wear for 1 or 2 weeks.

Medtronic Reveal LINQ insertable heart monitor

Medtronic Reveal LINQ

Another is an implantable loop recorder like the Medtronic Reveal LINQ which is inserted under your skin in a very simple, fast procedure. (I’ve had one for the last 1 1/2 years). It lasts for three years and tells doctors (and you) what’s going on in your heart 24/7.

Today your doctors are much more likely to “catch” and document your irregular heartbeats.

Dealing with PVCs: We’re most grateful to Cecelia for describing how Dr. McClennen fixed her PVCs which are a major issue for some people with A-Fib.

Maybe the key to ablating PVCs is no sedation or conscious sedation rather than general anesthesia. (I’ll try to get more info on Dr. McClennen’s methods of ablating PVCs.)

Learn about sharing your A-Fib story

Return to: Personal A-Fib Stories

If you find any errors on this page, email us. Y Last updated: Friday, October 16, 2020

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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

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.

Any pause over 5 seconds can cause dizziness, fainting and falls and is usually an indication that a pacemaker is necessary.

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.

To learn about the heart’s QRS, see my article Understanding the EKG Signal.

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.

Peter R. Kowey MD

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 TherapyDr. 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.

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.

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 - capsule of heart molecules at A-Fib.com

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

Download the Free Worksheet

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

Download our free worksheet: ’10 Questions to Ask Before Taking Any Medication’. Take a copy to your office visits.

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

Medical Marijuana: A-Fib Patients Offer Personal Experiences

Due to the increased use of medical marijuana in California and other states, we should soon be getting more data on marijuana’s effects on Atrial Fibrillation.

Several readers with A-Fib have emailed me to share their experiences and observations with marijuana. There seems to be a lot of interest every time I write about this topic.

How about you? I’d love to get more first-hand feedback from A-Fib users. Please email me.

First-Hand Experiences: A-Fib and Medical Marijuana

Jim, an A-Fib patient, has kindly shared his personal use of marijuana and how it helps him. He has tried various meds, cardioversion, and had a failed ablation. He owns his own business in California and is under a lot of stress.

♥ JIM: “Because of all of this, I was having trouble sleeping and was getting very stressed out. But instead of taking something pharmaceutical, I turned to medical marijuana. It changed my life. I come home at night, have some marijuana edibles, and the stress goes away. I sleep wonderfully at night, waking up fresh and ready for another day.

I told my doctor who understands. He says that marijuana edibles shouldn’t have anything to do with A-Fib, and that I can continue to take them.”

On the other hand, John writes that:

♥ JOHN: “99% of his A-Fib attacks occurred while under the influence of marijuana.”

And others add their experiences:

♥ JONATHAN: “I tried a tiny bit of brownie for the first time since being diagnosed with A-Fib (occasional episodes). It was OK until about two hours later. I went into A-Fib and, a bit later, came the closest I ever have to blacking out. I don’t think it’s for me anymore.”

You can join the discussion, too. If you have used marijuana to help with your A-Fib symptoms, email me and share your experience.

♥ WILLIAM: “The A-Fib ablation has been very successful, except the two times that I went into A-Fib after smoking marijuana. I’m a lifelong recreational marijuana smoker, also smoke to relieve the pain from six surgeries on my right arm. Both times that I’ve gone into A-Fib since my last ablation have been after smoking marijuana. After the latest episode I’ve quite smoking marijuana because of the evidence that it can lead to A-Fib.”

♥ SCOTT: “I am currently 55 years old and have been through 15 cardioversions due to A-Fib. I smoked marijuana pretty much daily and noticed that, when I smoked, my heart rate went up. So, I stopped smoking altogether. Since quitting smoking marijuana 7 years ago, I have not had a single case of going into A-Fib. I’m positive that the two are related.”

Scott added that he also stopped drinking which helped. He used to drink a six pack daily.


PODCAST: Marijuana—Good, Bad or Ugly for Patients with A-Fib?

For my most recent report about A-Fib and Marijuana, listen to my Podcast with Travis Van Slooten, publisher of LivingWithAtrialFibrillation.com. (About 18 min. in length.) Includes transcript.

PODCAST

Marijuana—Good, Bad or Ugly for Patients with A-Fib?

With Steve Ryan and Travis Van Slooten (18 min.)

Go to Podcast

References for this article
Korantzopoulos, P. et al. Atrial Fibrillation and Marijuana Smoking. International Journal of Clinical Practice. 2008;62(2):308-313.

Petronis KR, Anthony JC. An epidemiologic investigation of marijuana- and cocaine-related palpitations. Drug Alcohol Depend 1989; 23: 219-26.

Rettner, R. Marijuana Use May Raise Stroke Risk in Young Adults. LiveScience.com, MyHealthNewsDaily February 08, 2013. Last accessed Nov 5, 2014. URL: http://www.livescience.com/26965-marijuana-smoking-stroke-risk.html

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