|
![]() |
![]() |
EDITORIAL
Hans |
ABSTRACTS
Quantification of PVI efficacyLINZ, AUSTRIA. Pulmonary vein isolation is the most common therapy for atrial fibrillation patients whose symptoms cannot be controlled with drugs. The procedure has an estimated success rate of 75-80% for a first procedure and close to 90% if a second, touch-up procedure is performed. The measure of success is, however, often somewhat ambiguous since it is not practical to continue Holter monitoring for months after the procedure. Recording the frequency and duration of afib episodes, both symptomatic and asymptomatic, for several months prior to and following the PVI would clearly be the optimum way to determine the success of a procedure and to gauge the merits of different approaches to PVI. Austrian researchers now report the first attempt to quantify the efficacy and benefits of PVI. Their study included 6 male and 6 female afibbers with an average age of 57 years and no underlying heart disease. The participants had all been unable to achieve relief with antiarrhythmic drugs and had had an ICD (implantable cardiovascular defibrillator) implanted. The ICD (Medtronic AT500) has extensive recording and data storage capabilities, so that long-term evaluation of daily AF frequency and duration is imminently feasible. At an average 21 months after implantation, the 12 patients underwent PVI since the ICD was not controlling their symptoms adequately. The researchers were then able to compare the AF severity prior to PVI with that observed after PVI. The pre-ablation monitoring period ranged from 11 to 29 months, while the post-ablation period varied from 2 to 20 months. Among the highlights of the study are:
Editor's comment: To my knowledge, this is the first quantitative study of the efficacy of pulmonary vein isolation. The results are encouraging and certainly support the idea that PVI is an effective solution to intractable AF. Of particular interest to newly ablated afibbers is the observation that improvement is not often instantaneous, but rather a gradual process over a 3-month period. The finding that one's quality of life is poor prior to ablation but improves markedly after, will not come as a great surprise to successful ablatees, but does give the rest of us some hope.
Survey of AF patients confirms our findingsLUND, SWEDEN. Researchers at Lund University Hospital report the results of a survey conducted among 100 afibbers who had presented at the hospital during an afib episode. The group consisted of 72 men and 28 women with a median age of 60 years (range of 22 to 79 years). None of the members of the group had underlying heart disease and all had earlier been diagnosed as having idiopathic, paroxysmal atrial fibrillation; thus, this group was very similar to the group surveyed in our 1st LAF Survey in February 2001. The findings were also very similar with the highlights being:
Hansson, A, et al. Arrhythmia-provoking factors and symptoms at the onset of paroxysmal atrial fibrillation: a study based on interviews with 100 patients seeking hospital assistance. BMC Cardiovascular Disorders, Vol. 4, No. 1, August 3, 2004, pp.13-22 Editor's comment: Apart from our own LAF surveys, this is the first detailed survey of afib patients that I have seen in the medical literature. It is very encouraging and, hopefully, a first step towards an era of greater cooperation between patients and physicians in determining the causes of LAF.
Lifetime risk of developing afibBOSTON, MASSACHUSETTS. More and more researchers in the field of atrial fibrillation are beginning to use the term "epidemic". There are now about 2.3 million people in the US suffering from the disorder and this number will probably double in the next decade or so. Researchers involved with the Framingham Heart Study now report that a 40-year-old man or woman has a 25% lifetime risk of developing afib. The lifetime risk does not change substantially with age because as the number of years of exposure decreases the risk increases.
Congestive heart failure or a prior heart attack both increase the risk of afib; however, even excluding these
causes, the lifetime risk of developing AF is still 16% which means that 1 in 6 men and women will experience it
at some point in their lives. The 25%, or 1 in 4, lifetime risk is put in perspective by comparing it to the lifetime
risk for a 40-year-old of developing congestive heart failure (1 in 5) and for a 40-year-old woman of developing
breast cancer (1 in 8). It is interesting that, although the incidence of hypertension increased markedly with age,
especially among women, there was no indication that the lifetime risk of AF increased with the degree of
hypertension. The Framingham researchers conclude that, "These substantial lifetime risks underscore the
major public health burden posed by AF and the need for further investigation into predisposing conditions,
preventive strategies, and more effective therapies." Editor's comment: Hopefully, this will be the "wake-up call" we have all been anxiously awaiting.
Frequent afib and electrical remodelingNAGASAKI, JAPAN. One question that preys on the minds of afibbers experiencing frequent episodes is will afib eventually damage my heart? There is no clear answer to this question, but Japanese researchers now report that afibbers with frequent episodes do experience more extensive electrical remodeling than do afibbers with less frequent episodes. Their study included 108 afibbers (71 men and 37 women) with symptomatic, paroxysmal, idiopathic (of no known cause) atrial fibrillation with no underlying heart disease. The group was divided into two subgroups. The first consisted of 57 afibbers with episodes more than once a month and the second involved 51 afibbers with episode frequency of less than once a month. The researchers performed an electrophysiological study using endocardial mapping of 12 locations in the right atrium during sinus rhythm. They measured the duration of each atrial electrogram (the time from the beginning of the earliest electrical activity that deviated from the stable baseline value to the last point of the electrogram at which the baseline value was crossed) and the number of fragmented deflections (the number of downward deflections in the electrogram) a measure related to premature beats. They also counted the number of abnormal electrograms, that is, the number of electrograms where the duration exceeded 100 milliseconds (ms) or where the number of fragmented deflections exceeded 8.
The researchers found that the average duration of the electrogram was 98 ms in the group of frequent afibbers
versus 88 ms in the group of infrequent afibbers. The maximal numbers of fragmented deflections were 8.7 and
7.5 respectively. Overall, the frequency of abnormal electrograms (middle right atrium) was 38.6% in the
frequent episode group versus 19.6% in the group having less than one episode a month. Previous research
has shown that non-afibbers, on average, have a mean electrogram duration of only 74 ms and only 3.9
fragmented deflections. The researchers also found that the more years the study participants had suffered from
AF the more likely they were to have long duration electrograms, more fragmented deflections, and abnormal
electrograms. They conclude that paroxysmal atrial fibrillation (PAF) results in the gradual electrical remodeling
of the atrial muscle. Based on previous research, they also conclude that the higher the frequency and the more
prolonged the duration of AF history, the greater the likelihood that PAF will develop into permanent AF. Editor's comment: This is clearly a complex subject, but it seems clear that having frequent episodes for a good number of years will eventually cause change (damage?) to the heart and may ultimately lead to permanent afib. This is the bad news. The good news is that increasing attention is being paid to quantifying afib (episode frequency, duration, and years of history) and linking it to measurable heart parameters. This can only help in advancing our knowledge. Some afibbers, of course, have been able to halt the progression of their afib through dietary or other means. This is likely to have slowed the progression of atrial remodeling as well.
|
|
|
||
---|---|---|
Paroxysmal | ||
Adrenergic | ||
Mixed | ||
Vagal | ||
Unknown | ||
Persistent | ||
Adrenergic | ||
Mixed | ||
Vagal | ||
Unknown | ||
Permanent | ||
Unknown | ||
TOTAL |
Twenty-one (42%) had experienced side effects from their protocol with the most common being:
Other side effects experienced by one respondent each included dry mouth, exercise intolerance, decrease in urinary stream, acid reflux, chest and joint pain, eye floaters, headaches, and gas and belching.
The frequency of side effects was thus slightly less than for the drugs only group (56%), but higher than that experienced by the alternative protocol group (15%).
Thirty-four (68%) had noticed additional benefits from their regimen. Five respondents reported reduction in their stress level and greater peace of mind. Four of these were taking flecainide (2 with supplements), while one was taking valsartan (Diovan), an angiotensin II blocker. Two had undertaken a program of meditation or stress management. Three respondents reported disappearance of their gastroesophageal reflux disorder (GERD). One of these was taking omeprazole (Losec).
Three respondents reported a greater energy level. All were taking numerous supplements as well as the drugs flecainide, propafenone (on demand) or dofetilide (Tikosyn).
Other reported benefits were better exercise tolerance, normalized blood pressure, weight loss, fewer ectopic beats, better sleep, and less cramping when running.
Eleven respondents (22%) no longer needed to avoid their previous triggers such as exercise, alcohol, caffeine, MSG, cold drinks, large meals, etc. Sixteen (32%) still needed to avoid their known triggers, 20 (40%) still needed to avoid some triggers, but not as many as before they began their protocol, and the remaining 3 (6%) were not sure whether they still had to avoid triggers.
The majority (86%) would recommend their program to other afibbers, but 24% were still contemplating an ablation, while 32% were uncertain whether they would have one or not. The majority (44%) was quite sure they would not undergo an ablation.
The percentage of afibbers in this group who would not contemplate an ablation (44%) compares to 29% in the drugs only group and 66% in the alternative protocol only group.
The sources of information used in arriving at the successful protocol were as follows:
Primary physician | |
Naturopath | |
Cardiologist | |
Electrophysiologist | |
Other health care practitioner | |
Lone Atrial Fibrillation: Towards A Cure | |
The AFIB Report | |
Afibbers.org bulletin board | |
Other bulletin boards | |
Personal research on the Internet | |
Other sources |
The afibbers who had used a combined drug and alternative protocol to manage their afib had clearly combined information obtained from their cardiologist with that learned from various sources related to www.afibbers.org (the bulletin board, the LAF book, and The AFIB Report).
Methods Used in Management
All afibbers included in this group used one or more pharmaceutical drugs to manage their afib. In addition, they used one or more of the following modalities:
Pharmaceutical Drugs
Forty-six of the 50 respondents were using antiarrhythmics, beta-blockers or calcium channel blockers as part of
their afib management program. One had achieved control through the use of omeprazole (Losec) to manage
GERD, one was using valsartan (Diovan), an angiotensin II receptor blocker, and two respondents were
managing their afib with tranquilizers or antidepressants.
|
||||
---|---|---|---|---|
Flecainide | Tambocor | |||
Propafenone | Rythmol | |||
Disopyramide | Norpace | |||
Sotalol | Betapace | |||
Digoxin | Lanoxin | |||
Amiodarone | Cordarone | |||
Dofetilide | Tikosyn | |||
Metoprolol | Toprol | |||
Atenolol | Tenormin | |||
Nadolol | Corgard |
It is clear that flecainide is, by far, the most prescribed antiarrhythmic and that monotherapy (using just one drug) is still the most widely used treatment.
Supplements
Thirty-eight out of 50 (76%) respondents were using one or more supplements in their afib management
protocol.
|
||
---|---|---|
Magnesium | 100-1000 mg | |
Potassium | 100-1200 mg | |
Fish oil | 500-6000 mg | |
Coenzyme Q10 | 10-300 mg | |
Vitamin C | 250-2000 mg | |
Vitamin E | 250-800 IU | |
B vitamins | - | |
l-carnitine | 500-1000 mg | |
Calcium | 300-1000 mg | |
Multivitamin | - | Taurine | 500 mg | Zinc | 20-25 mg | Selenium | 100 mcg |
Other supplements used by just one respondent each were vitamin D, iodine, thyrosine, ginkgo biloba, thyrosol, policosanol, amino acids, enzymes, and ambrostose (Mannatech).
Magnesium is clearly the most popular supplement followed by potassium, fish oil and coenzyme Q10. Most of the 38 supplement users (55%) used just 1 or 2 daily supplements, but 22% used 7 or 8 and 5% used 9 or more daily supplements.
Trigger Avoidance
Nine out of the 50 (18%) respondents had used conscious trigger avoidance as an important component in their
afib management program. The majority (67%) had found it beneficial to strictly avoid caffeine in all its forms.
Others (56%) had found that avoiding alcohol was important. Three afibbers (33%) had found relief from
avoiding glutamates, MSG, and aspartame (NutraSweet), while one had noted benefits from sharply reducing
sugar consumption. It is interesting that one afibber had found relief from cutting out salt, while another had
found that a low-salt diet resulted in more episodes.
Dietary Changes
Eight out of 50 (16%) respondents had found dietary changes to be effective. The most popular measure was to
discover a suitable diet program and stick with it. The Paleo, Atkins, Zone, and Dean Ornish diets had been
used successfully by at least one respondent. Avoidance of grains and gluten was cited as beneficial by 50% of
the afibbers who reported dietary changes with avoiding dairy products and eating lots of bananas and nuts
being other reported measures.
Stress management
Ten respondents (20%) reported that they had found stress management highly beneficial in controlling their
afib. Several respondents used more than one method with the following being the most popular:
Acupuncture, yoga, Tai Chi, brisk exercise, and forgiveness were other stress management techniques practiced by one respondent each.
GERD Elimination
One respondent had used omeprazole (Losec) to control GERD, and 2 had been able to eliminate it by cutting
out grains, especially wheat in their diet.
Other Methods
One respondent had found relief by having all dental amalgam fillings and dissimilar metals in the mouth
removed. One had found psychoanalysis useful, and 3 had found weight loss beneficial. One afibber who had
been in permanent afib eliminated episodes through an estrogen/testosterone balancing program.
Effectiveness of Protocols
A total of 36 afibbers in the group had sufficient data for detailed analysis and fulfilled the criteria of having spent at least 50% less time in afib (number of episodes x average duration) in the 3 months after their program became effective as compared to the 3 months prior to embarking on their program.
The 36 afibbers had been on their program for an average of 19 months (2-60 months) and the time before it became effective varied from 1 day to 36 months with a median of 1 month. The 36 afibbers had been afib-free or at least vastly improved for anywhere from 3 months to 5 years with an average (median) of 13 months. Afib severity parameters for a 3-month period before and for a 3-month period after the program became effective are presented below:
|
||
---|---|---|
Mean | ||
Median | ||
Minimum | ||
Maximum | ||
Episode Duration, hrs. | ||
Mean | ||
Median | ||
Minimum | ||
Maximum | ||
Total Time Spent in Afib, hrs. | ||
Mean | ||
Median | ||
Minimum | ||
Maximum |
The average (mean) reduction in time spent in afib by the group of 36 was 93%.
Among the group of 36 there was an "elite" group of 10 afibbers who had observed at least a 99% improvement (average of 99.9%) who had effectively managed their afib for at least 6 months and who had, during the time their protocol had been effective, experienced, on average, less than one episode per six months. Taking a closer look at the particulars of this group compared to the total group of 50 might be constructive.
|
||
---|---|---|
Current age (mean) | ||
Age at diagnosis | ||
Years of afib | ||
% male | ||
Underlying heart disease | ||
Mitral valve prolapse | ||
Paroxysmal afib | ||
3 months prior to protocol | ||
Median number of episodes | ||
Median duration of episodes, hrs. | Time spent in afib, hrs. |
|
||
---|---|---|
Use of flecainide | ||
Use of beta-blockers * | ||
Use of supplements | ||
Use of trigger avoidance | ||
Use of dietary changes | ||
Use of stress management | ||
Use of GERD elimination | ||
Use of other methods | ||
Supplementation with magnesium | ||
Supplementation with potassium | Supplementation with fish oil | Supplementation with CoQ10 |
There were no major differences in demographics except a higher incidence of mitral valve prolapse in the elite group. The differences in afib severity observed prior to protocol between the elite group and the group of 36 were not statistically significant.
Members of the elite group were more likely to use flecainide, and more likely to focus on conscious trigger avoidance and dietary changes. They were less likely to use supplements, and none of them supplemented with potassium.
All in all, there were no startling differences that could explain the elite group's success. However, combining the results with those reported in part 2 of the survey (October 2004), there is a trend for dietary changes to be the most successful strategy.
The detailed profiles of the 10 members of the "elite" group are presented below:
Male afibber
48 years of age with mixed AF of 7 years standing Time on successful protocol 16 months
Episodes in 3-month period prior to protocol 1
Drugs - omeprazole (Losec) 20 mg/day
Dietary changes Cut out all sugar
Additional benefits of protocol More energy, no depression Comments - Eliminating GERD eliminated afib |
Male afibber
58 years of age with mixed AF of 5 years standing Time on successful protocol 36 months
Episodes in 3-month period prior to protocol 7
Drugs - flecainide 2 x 100 mg/day
Dietary changes None reported
Additional benefits of protocol None reported Comments - Flecainide use resulted in my improvement |
Male afibber
62 years of age with vagal AF of 4 years standing Time on successful protocol 23 months
Episodes in 3-month period prior to protocol 12
Drugs - disopyramide (Norpace)
Dietary changes Cut out cereals
Additional benefits of protocol GERD and indigestion gone Comments - Would recommend this protocol to vagal afibbers |
Male afibber
55 years of age with vagal AF of 3 years standing Time on successful protocol 30 months
Episodes in 3-month period prior to protocol 2
Drugs - flecainide
Dietary changes lost 25 pounds
Additional benefits of protocol Happier, less worry, better overall health
|
Male afibber
66 years of age with vagal AF of 26 years standing Time on successful protocol 6 months
Episodes in 3-month period prior to protocol 3
Drugs - flecainide 2 x 100 mg/day
Dietary changes Trigger avoidance only
Additional benefits of protocol None reported Comments - Took 2 months before flecainide worked |
Male afibber
68 years of age with vagal AF of 18 years standing Time on successful protocol 40 months
Episodes in 3-month period prior to protocol 6
Drugs - flecainide (150 mg slow-release)
Dietary changes Changed to Zone diet
Additional benefits of protocol Better overall health Comments - Eliminating amalgams had an immediate beneficial effect on my afib |
Male afibber
57 years of age with paroxysmal AF of 3 years standing Time on successful protocol 30 months
Episodes in 3-month period prior to protocol 12
Drugs - flecainide (3 x 100 mg), metoprolol (25 mg)
Dietary changes Peppermint tea at meals
Additional benefits of protocol None reported Comments - I still experience a few PACs after a big meal |
Male afibber
71 years of age with mixed AF of 15 years standing Time on successful protocol 28 months
Episodes in 3-month period prior to protocol 2
Drugs - amiodarone (150 mg), Irbesartan (150 mg)
Dietary changes Eliminated trigger foods and eat everything in moderation
Additional benefits of protocol Peace of mind Comments - * A few, very minor, transient afib episodes during initial medication adjustment |
Female afibber
55 years of age with mixed AF of 2 years standing Time on successful protocol 20 months
Episodes in 3-month period prior to protocol 3
Drugs - nadolol (40 mg/day)
Dietary changes Reduced sugar intake
Additional benefits of protocol Reduction in anxiety
|
Female afibber
64 years of age with vagal AF of 3 years standing Time on successful protocol 20 months
Episodes in 3-month period prior to protocol 22
Drugs - flecainide (2 x 100 mg) + atenolol (25 mg)
Dietary changes None reported
Additional benefits of protocol None reported Comments - Flecainide is what eliminated my afib |
Defining success as having totally eliminated afib episodes for a minimum of 6 months after establishing an effective protocol yields the following success rates for the three groups:
These numbers clearly show that it is possible to eliminate, or vastly reduce, afib episodes with drugs, alternative means or combinations thereof. However, considering that participation in the LAF-7 survey was limited to afibbers who felt they had control of their afib, the overall proportion of afibbers who have completely eliminated their afib with drugs, alternative means or both is likely to still be disappointingly small.
A summary of the findings from the group of 80 afibbers who have undergone ablation will be presented in the December issue.
Atrial Fibrillation & the Boiled Frog Syndrome
My odyssey with atrial fibrillation (AF) began in 1982 when I experienced my first episode. Rather than present a detailed chronology of the progression of the disease over the following 22 years, I think that it would be more illustrative to use an analogy. You have all probably heard of the Boiled Frog Syndrome. In 1982 the pot of room temperature water was on the stove and I jumped in. As the years progressed there was very little heat turned on until the early 1990s when my episodes of AF increased from one or two a year to eight or ten. Up to this point I would always return to sinus rhythm (SR) within 12 to 24 hours with no intervention. I did visit the local emergency room once or twice when the onset seemed particularly uncomfortable and scary. My doctor recommended a complete heart evaluation to determine if there was any underlying heart disease. Luckily, all the heart tests were normal. However, like the frog I began to feel the heat being turned up and the water began to warm, but I still did not fully grasp the insidious nature of this progressing disease. Cardiac health and fitness have always been an important part of my life. Ever since I was in high school, I have been an active runner, hiker, cyclist and physically a very hard worker. With the increasing frequency, intensity and duration of my AF episodes, I began to realize that my daily workouts were being interrupted and my conditioning was suffering. I decided to try more aggressively to find some answers. Living near Stanford University made it easy for me to be evaluated by some of the most respected cardiologists in the country. By the mid-1990s the heat on the AF pot was being turned up more and more, but I was totally unable to jump out. The doctors tried me on the entire array of Antiarrhythmic drugs. None worked particularly well and most had fairly debilitating side effects. I hated taking drugs but I had reached the point where I was becoming desperate to find a solution. At this point my diagnosis was pretty well confirmed. I had vagally induced paroxysmal AF. My primary cardiologist described my condition as "idiopathic" AF. That is a fancy word for AF of unknown origin. Visits to the emergency room resulted in the standard protocol of confirming AF via an EKG (they certainly did not need to do this because I knew only too well when I was in AF), analyzing blood to see if I had a heart attack, a little nitro and digoxin (described in the AF Report to be contraindicated) to demonstrate that they were taking action, the initiation of a blood thinning protocol and a suggestion to see my Cardiologist as soon as possible. So, I would go back to the Cardiologist and by then I would have converted back to SR. By the late 1990s I was having four to six episodes per month. They would last 12 to 36 hours and the only drug that seemed to help was Propafenone (Rythmol), but the side effects of blurred vision, dizziness, and an overall general malaise were almost intolerable. Again, my doctor tried me on different drugs and I remember particularly well one incident when I switched to Betapace AF (sotalol). I was in Hawaii on vacation with some friends and went into AF, so I started on the Betapace. This drug exacerbated the symptoms and prolonged the episode for 8 days. I finally got off the drug and converted to SR two days later. Disgusted and discouraged I sought out more help. I went to the "top" cardio electrophysiologist at Stanford. He did a complete workup. His conclusion and I quote him exactly: "Yes, you have Afib. It is going to get worse and there is NOTHING you can do about it". If murder were legal, there would have been one less electrophysiologist on the Stanford faculty. I was devastated, discouraged and very pissed off. I simply would not accept that answer and meanwhile the heat in the stove was being further increased and the water temperature in the pot was rising significantly. I scoured the country for answers. A friend had some connections at the Texas Heart Institute. They did a complete workup, but in the end they had no solution. Then, I went to the Scripps Institute in La Jolla to one of the leading researchers on the electrophysiology of the heart. Another complete workup showed once again that I had no underlying heart disease or functional problem Their advice was to keep my heart as healthy as possible via a low fat diet, antioxidant supplementation, and avoid possible triggers such as alcohol, caffeine etc. and to take the Rythmol on demand as needed. The trouble was that I had been doing this already. Like many of you, I devoured the literature looking for answers. I subscribed to the Cleveland Clinic and Harvard Heart Letters. I spent hours searching the web. I tried supplements and avoided any and all triggers that I could find in the literature. By 2001 I was having two to three episodes per week. Each episode would last anywhere from six to eighteen hours and I would have the usual post episode fatigue and I would barely recover before the next onset. My biggest fear was that I had the sense that my heart might be remodeling to the point where AF was the going to be the norm and SR the exception. About this time two things changed my outlook. I began seeing a Doctor C who believed that my AF might be partially the result of a Post Viral Syndrome which, via a low level, persistent inflammation, was affecting the electrical conduction cells in my heart. He started me on a protocol of very high doses of Vitamin C in a liposomal form and the injection of growth factors to help stimulate the regeneration of the damaged cells in my heart. While this protocol did not stop my AF, it did keep me from going into persistent or permanent AF and helped me cope much more effectively with the episodes. Doctor C's caring, diligence and willingness to think outside the box gave me great hope and regained for me the will to not give into this insidious disease. The second thing that changed my outlook was my introduction to The AFIB Report. I am very indebted to Hans Larsen for showing me that I was not alone, that there is hope, that there are numerous paths to explore and more coming along everyday and, most important, that I must take charge of my own health care. The traditional medical community knows very little about AF other than being able to diagnose it. Since in most cases it is not immediately life threatening, there does not seem to be any sense of urgency to find a solution even though it is well known that the risk of stroke increases for people in Afib. However, for those of us who have experienced years of Afib, I think it would be safe to say that we feel a tremendous sense of urgency. In my particular case the quality of my physical life was diminishing rapidly. My social life was affected because I knew that every 2 or 3 days I would go into Afib and in Afib I preferred reclusion to social interaction. The same could be said for my family life. And, of course, work is always more difficult when in Afib. In late 2003 I felt like a parboiled frog and yet I could not jump out of the pot. I had tolerated the increase in the temperature of the AF pot, but could not really see a way out. Then a scientist friend of my sent me a research paper describing some clinical results using Cryoablation (versus RF Ablation) for the treatment of Afib (the full citation, along with others, is listed at the end of this article). The etiology of my AF seemed to fit that of those patients who had been successfully treated by the Cryoablation. The company, CryoCor, Inc. that created the technology used in the procedure is located in San Diego, CA. (Please note that I have no personal affiliation with the Company, nor am I related to anyone at the Company or have any financial involvement). In November 2003 Doctor C and I visited the company to learn more about their technology and to evaluate the possibility for this procedure to help me. We came away very encouraged by the personnel, the technology and the results that were being obtained by the clinical team in Maastricht in The Netherlands. Doctor C and I did a considerable amount of additional research and concluded that it would be worthwhile to have my particular case evaluated by the team in Holland and CryoCor to see if I might possibly be a viable candidate for the procedure. All my previous medical records were sent to CryoCor and they requested some additional tests. Their conclusion was that my etiology was typical of the patients who had been successfully treated. So, on March 17, 2004 I was in Maastricht for a Pulmonary Vein Isolation procedure using Cryoablation. The ablation is delivered from a 10Fr catheter that achieves tip temperatures as low as -95C. Liquid nitrous oxide is boiled in the tip of the catheter to achieve this level of cooling. The cooling causes the heart cells to break open and loose their function; hence they are unable to conduct electrical impulses that started my episodes of AF. The catheter is delivered to the heart similar to RF ablation catheters, namely inserted through the groin and advanced across the intraatrial septum to the orifice of the pulmonary veins, where they drain from the lungs into the left atrium. My procedure was performed with what is known as a "lasso" guided segmental isolation where the doctors looked for electrical activation in my pulmonary veins with the lasso and then froze around the circumference of the vein orifice until there was no activity in these veins. I was put on Coumadin for three weeks prior to going to Maastricht and went off it two days before the actual procedure. While it is well known that RF ablation of the pulmonary veins can cause serious stenosis or narrowing, Cryoabaltion leaves intact the matrix that surrounds the heart cells and this is believed to minimize the risk of narrowing. Over 100 patients with AF that were treated with Cryoablation received CAT scans before and one year after their Cryoablations. None of these patients showed any narrowing at all. Therefore, in Medical Centers outside the US where Cryoablations are being performed, there is no post procedure monitoring of the pulmonary veins because it is widely accepted that the risk of narrowing is low or absent. I chose to go to Maastricht because the procedure is commercial in Europe (in the U.S. it is undergoing an IDE Multicenter Clinical Trial) and the doctors there had performed more of this particular procedure than anyone in the world and they helped develop the technique. The procedure lasted about 5 hours during which time I was awake listening and talking to the doctors. All the work was done with catheters inserted in the groin. About 60 sites in my pulmonary veins were evaluated and around 20 sites were actually ablated. After the procedure I spent the night in the hospital and then saw the doctors before being released. The following day I returned to California. The post procedure requirements included being on Coumadin for three months, continued use of Rythmol at 150 mgs 2x/day for two months and no strenuous physical workouts for three weeks. In the first month after the procedure I had two relatively minor episodes of 4-6 hours duration. Since April 21st I have had NO Atrial Fib. In fact, I have not even had a single PAC. As I am writing this I have been Afib free for over 5 months. That is the longest consecutive Afib free period in over 12 years. I am off of all drugs. I can work out everyday and feel like I did 15 years ago. I am told that, based upon clinical experience, once a patient goes 5 to 6 months Afib free, it is very unlikely that I will have any further episodes. Whether I do or not, these past five months alone have been worth the journey. My hope is that others may find similar good fortune. I do not know if I am totally cured, nor what the future may hold, but every Afib free day is a blessing and I'll take them one at a time. Unlike the sad ending for the Boiling Frog, with the help of Cryoablation, some luck and The Almighty, this is one Frog who jumped out of the boiling water and is now back down to room temperature. References:
Contacts:
|
BOOK REVIEWS
The Inflammation Syndrome
The Inflammation Cure
Stop Inflammation Now! There is currently considerable interest in the subject of inflammation both among medical researchers and clinicians and as well, the general public. The February 23, 2004 issue of Time magazine featured "Inflammation, The Secret Killer" as the cover story, and recent issues of several health oriented magazines have had inflammation as the feature topic. While inflammation is an essential and integral part of the normal immune reaction and the response to injury, chronic inflammation may be asymptomatic and present serious health risks which can be much more dangerous and extensive than one might expect. Chronic inflammation, which is involved in diseases such as rheumatoid arthritis, inflammatory bowel syndrome and Crohn's disease, is now implicated in diseases where the connection is far less obvious, such as atherosclerosis, cancer, and Alzheimer's disease. Thus from the layman's point of view, the obvious questions are:
These are questions that might reasonably be put to one's physician, but the complexity of the subject does not lend itself to the fifteen minute office visit setting, and some, perhaps even many individuals are interested in acquiring a fairly detailed knowledge of what is now considered a serious health issue. The three books address the above questions, although the approach, depth of treatment, and emphasis differ considerably. The principal authors of two of the books are MDs. Jack Challem is a leading health and medical writer and coauthor of the popular and widely-read book Syndrome X. Challem's book introduces the reader to what he calls the Inflammation Syndrome, which he describes as the cumulative effect of low-grade inflammation that grows into chronic, debilitating disease. He discusses six general categories of inflammatory triggers: (1) age-related wear and tear; (2) physical injuries; (3) infections; (4) environmental stresses including tobacco smoke, air pollution etc.; (5) allergies and food sensitivities; and (6) dietary imbalances and deficiencies. He carefully distinguishes between the triggers of inflammation and what causes the normal response to go out of control. There is a very strong emphasis on the dietary aspects of inflammation and his "anti-inflammation" approach is primarily through diet modification involving both the elimination of foods that trigger inflammation and adding and emphasizing foods he considers beneficial in this context. Challem also provides a simple questionnaire that readers can use to evaluate their level of inflammation. Part II of the book outlines fifteen steps to fight the Inflammatory Syndrome, and both diet plans and recipes are presented. While anti-inflammatory drugs are discussed, Challem's attitude is somewhere between negative and highly cautious. Part III is titled "The Anti-inflammatory Supplement Plan" and includes a detailed discussion of omega-3 fatty acids, vitamin E, glucosamine, the B vitamins, etc. Finally, in Part IV there is an informative discussion of about twenty diseases and specific conditions that have a connection with chronic inflammation. This final section should leave little doubt in the reader's mind as to the importance of avoiding or dealing with chronic inflammation. In The Inflammation Cure, Meggs and Svec, after a brief introduction to the nature of the inflammatory process, provide a lengthy and informative discussion of the connections, both proven and suspected, between inflammation and heart disease, stroke, diabetes, cancer, fatigue, obesity, depression, autoimmune diseases, allergies, asthma, arthritis and Alzheimer's disease. They then deal with the question "what does one do" by offering a game plan involving dietary and lifestyle solutions, as well as suggestions regarding the modification of triggers at home and in the workplace. Considerable emphasis is placed on so-called mind-body solutions which reflect the connection between psychological stress and inflammation. The book also contains a quiz readers can take to estimate their level of susceptibility to inflammation-related disorders by measuring exposure to the most common sources and causes of inflammation. There is also a short discussion of laboratory inflammation tests, supplements and anti-inflammatory drugs. One of the merits of this book is the comprehensive approach to the problem of dealing with chronic inflammation and its risks. Stop Inflammation Now! This book is sub-titled "A step-by-Step Plan to Prevent, Treat, and Reverse Inflammationthe Leading Cause of Heart Disease and Related Conditions." The principal author, Richard Fleming, is a nuclear cardiologist. The main emphasis of this book is on heart disease, and the depth of the discussion of this topic is one of the book's strengths. But aside from the title, it would seem appropriate to classify it as a diet book rather than a book on inflammation. It promotes a two-step, very low-fat (15% of energy intake in the phase 2 diet) and low-protein diet plan coupled with exercise. Inflammation is discussed here and there in the book, but the level of treatment of the subject is minimal compared to the books by Challem and by Meggs and Svec. It in fact differs from these two books in many respects. For example, Fleming considers fish to be an inflammatory food (page 20), and fish is a very minor part of his Phase II diet (page 163), whereas fish is a significant part of the anti-inflammatory diet plans of both Challem and Meggs. Fleming is also against fish oil supplements. But while Meggs recommends eating fish three to five times a week and imitating the Mediterranean diet by the liberal use of olive oil, he is close to Fleming in suggesting very little meat, poultry, cheese, butter, milk, and other animal products. Challem deals with the meat issue by recommending meat from free-range or grass fed animals and eggs from free-range chickens or eggs enriched with omega-3 fatty acids. Challem is also enthusiastic about olive oil and eating lots of fish. In the opinion of this reviewer, Fleming's book should be viewed in the context of the high-carb vs. low-carb controversy and the debate as to the connection between fat and heart disease. The book, by and large, promotes one view favored by the very low-fat school. The philosophy is similar to that of Dean Ornish before he started recommending fish oil and fish in his diet (see www.Ornish.com). Also, there are some, perhaps many, who would find the Phase II diet consisting of 17 servings of fruits and vegetables per day to be a bit difficult to manage. At issue is the balance of macronutrients and the emphasis on very low fat consumption that puts him at odds with other interpretations of the modern nutritional literature. This is a highly complex and controversial subject. Fleming's book should be read along with such books as Walter Willett's Eat, Drink and be Healthy, the Harvard Medical School Guide to Healthy Eating, Arthur Agatston's The South Beach Diet (Agatston is also a cardiologist) and Stephen Sinatra's Heart Sense for Women (Sinatra is also a cardiologist) to obtain a balanced picture (see also the IHN research reports "The Diet Zoo" and "Dietary Fat and Coronary Heart Disease: Is There a Connection?"). Readers desiring a broad background on the subject of inflammation should be well served by either The Inflammation Syndrome or The Inflammation Cure or better, by both.
Reviewed by William R. Ware
|
The AFIB Report is published 10 times a year by Hans R. Larsen MSc ChE 1320 Point Street, Victoria, BC, Canada V8S 1A5 Phone: (250) 384-2524 E-mail: [email protected] URL: http://www.afibbers.org Copyright © 2004 by Hans R. Larsen The AFIB Report does not provide medical advice. Do not attempt self- diagnosis or self-medication based on our reports. Please consult your health-care provider if you wish to follow up on the information presented. |