Welcome to the Oct/Nov issue of The AFIB Report in which we return to our more traditional format, taking a summary look at some of the more relevant AFIB-related studies published in recent months addressing topics of interest for both the lay ‘afibber’ and health professional alike, and offering practical real-world guidelines.

Our prime focus in this issue is a collection of subjects garnering increasing investigative effort in the last few years, centered on life-style issues that can negatively impact the course of AFIB, and modification of which can make a positive long-term contribution toward minimizing our total AFIB burden over time. Indeed, the very same core focus of the past 14 years here at the heart of this newsletter and associated website: http://www.afibbers.org .

First at bat, we look at one of the top avoidable triggers for many afibbers – excessive alcohol consumption. We all are well aware of the association, but now we have some hard data on a dose/response relationship to help guide a reasonable approach to alcohol intake, such as when alcohol might be used in moderation and when best to leave it alone. Also, key insights into types of alcoholic drinks and their relative influence as triggers are discussed.

Next we review two very informative large Scandinavian studies on the role of endurance exercise and it’s association with AFIB. Again, a topic we have visited in the recent past, but with new insights here into a long-term dose/response relationship between low to moderate and moderate to intensive endurance exercise and AFIB over time, including the influence of age.

Exciting news as well from the NOAC (novel oral anticoagulant) arena, with a just off the press trial using Xarelto (rivaroxaban) in place of warfarin for elective cardioversion that offers the prospect of greatly shortening the time to early cardioversion, while improving both outcome and safety.

Another breaking NOAC-related news item reveals positive results from a phase-3 study on the new NOAC Factor Xa inhibitor antidote, Andexanet Alfa, by Portola Pharmaceuticals that is very much worth hearing about.

Back at the dawn of The AFIB Report, and long before the majority of cardiologists and EPs were aware of the problem, founder Hans Larsen alerted us all to the dangers of digoxin use as a rate control drug for treating AFIB. Now we see full confirmation and vindication of Hans’ pioneering insights on this key issue from the TREAT-AF study, showing that digoxin use is significantly associated with increased risk of death, even in patients with newly diagnosed AFIB.

Finally, a new study out of the respected EP group at Intermountain Heart Institute in Utah gives compelling evidence of a significantly lower long-term stroke risk in AFIB ablation patients compared to AFIB patients who do not undergo ablation across all age strata, and independent of baseline CHADS2 risk score. In fact, stroke risks for those completing a successful ablation process are on par with that for the same age group population who has never had AFIB. Reassuring findings, indeed!

Wishing you all good health and lots of NSR!

Shannon