#142 Is Caffeine Safe for the Heart?

January 31st, 2016 by

Is Caffeine Safe for the Heart?

New research reports that caffeine does not cause an irregular heart beat, palpitations, or heart arrhythmias.  Can we really believe the results of this new study?  Read on to see my answer to the question, is caffeine safe for the heart?

Mark’s Experience

Mark was a 46 year old man who came to see me for palpitations and a rapid heart beat.  Mark was tired all of the time.  The only thing that could get him through the long work day was Red Bull and Monster energy drinks.

He typically started off the day with a Red Bull.  In the afternoon, when energy levels were at the lowest, he would switch to Monster.  Sometimes, if he was really tired, he might add in a third energy drink or even a cup of coffee.

To identify the cause of his palpitations and rapid heart beat, I had him wear a heart monitor.  After just a few days it was obvious what was going on.

His palpitations clearly correlated with premature heart beats arising from his ventricles or PVCs.  The rapid heart beat coincided to short episodes of a heart arrhythmia called atrial fibrillation.

Fortunately, Mark’s stress echocardiogram and other tests were completely normal.

Knowing about the reported possible heart dangers of energy drinks, I asked him to stop the energy drinks.  I also encouraged him to eat healthier, exercise every day, and make sleep a priority.

When he came back to see me a month later, he reported that his energy levels were much better.  His symptoms were also completely gone.

Initially, I suspected it was the eliminating the caffeine from the energy drinks that did the trick.  I was surprised to find out that while he no longer drank energy drinks, he was now eating dark chocolate on most days.  With this new information, it became clear to me that perhaps caffeine was not the cause of his heart troubles.

Latest Study on Caffeine and Abnormal Heart Rhythms

This past week, a new study was published by my colleagues at the University of California, San Francisco  (UCSF) on the effects of caffeine to the heart’s rhythm.  As might be expected, as soon as this study was published, headlines around the world reported “Caffeine May Not Cause Palpitations.”

In this study, UCSF cardiologists recruited 1,388 participants in this study.  As part of this study, participants reported their coffee, tea, and chocolate intake.

To measure the effect of coffee, tea, and chocolate on the heart, participants also wore heart monitors to record every heart beat.  When UCSF cardiologists reviewed their heart monitors, they found no correlation between the number of irregular heart beats and caffeine intake.  In other words, regardless of their caffeine intake, it did not seem to affect how many premature atrial contractions (PACs) or premature ventricular contractions (PVCs) study participants had.

Limitations of this Caffeine Arrhythmia Study

Does this study mean that people who suffer from heart arrhythmias can have all the caffeine they want?  Not so fast.  This study leaves many questions unasnwered.  In my opinion, there are three big limitations of this study.

1. This was an observational study.

As an observational study we can’t conclusively say that caffeine from coffee, tea, or chocolate doesn’t cause heart arrhythmias.  All we can say is that, for whatever reason, the amount of caffeine consumed from coffee, tea, and chocolate in this study, did not seem to affect the number of irregular heart beats.

There could be other reasons why these study participants were not affected by caffeine.  Perhaps these people practiced mindfulness techniques, like meditation or yoga, to control stress and keep irregular heart beats at bay with increasing doses of caffeine.

2. This study did not include caffeine from other sources.

Study participants were only asked about coffee, tea, and chocolate consumption.  They were not asked about caffeine from other sources.  For example, researchers had no idea if study participants were also drinking Diet Coke or Red Bull.

3. This study did not compare fast versus slow caffeine metabolizers.

It is possible that most of the study participants were fast caffeine metabolizers.  For fast caffeine metabolizers, caffeine consumption has little affect on the heart.

Fast vs. Slow Caffeine Metabolizers

Does caffeine make it hard for you to sleep at night?  If so, then chances are that you are part of the 50% of people who have a genetic variant to your CYP1A2 gene.

Variations in the CYPA12 gene can cause you to metabolize caffeine more slowly.  Indeed, based on your genetics, there can be up to a 40-fold difference in how fast caffeine is metabolized in your body.

These genetic differences may explain why some studies report that caffeine may be dangerous to your heart and other studies, like the one discussed in this artice, report that caffeine is safe.  Indeed, other studies report that caffeine slow metabolizers can have up to a 64% increased risk of a heart attack depending on their caffeine dose.

Fortunately, less than 100 mg/day appears to be safe, even for caffeine slow metabolizers.  How much is 100 mg of caffeine?  A 100 mg dose of caffeine is approximately the equivalent of one cup of coffee, two cups of tea, three 12-ounce cans of soda pop, or four ounces of dark chocolate.

Why does medical science seem to be “flip flopping” on issues like coffee and caffeine?  This is likely because we have not taken into account genetic differences.  Just as everyone responds differently to medications, everyone responds differently to caffeine.

When it comes to caffeine metabolism, I am a slow metabolizer.  Fortunately, dark chocolate does not cause palpitations or arrhythmias for me.  While I love my dark chocolate, as a slow caffeine metabolizer, I must eat it first thing in the morning or I will have troubles sleeping at night.

The Big Picture

In the big picture of things, if you suffer from palpitations, arrhythmias, or heart problems should you or shouldn’t you consume caffeine?  Fortunately, this study suggests that if your caffeine source is coffee, tea, or chocolate you may be just fine.

One important thing to remember is that this study was just an average of 1,388 people.  I’m sure that of these 1,388 people, there were some whose heart’s were very sensitive to caffeine.  Perhaps these were the caffeine slow metabolizers?

While you could certainly have your genes tested to find out, as I described in a previous blog, perhaps an easier solution would be to just monitor how caffeine affects your body.  If caffeine causes palpitations or heart arrhythmias it would be best to avoid caffeine.  In contrast, if it doesn’t seem to bother you then it is probably OK unless your doctor tells you otherwise.

If you have heart problems or insomnia, try cutting out caffeine, or even setting a caffeine curfew of say 12 pm in the afternoon, to see if it makes a difference.  Perhaps you are like me in that caffeine is fine first thing in the morning.

How does caffeine affect you?  Please leave your comments below.  Also, if you have any questions about this article, please leave your questions below.  I will try to answer every question.

#101 Why Do More Women Die From Atrial Fibrillation Than Men?

May 10th, 2015 by

Why Do More Women Die From Atrial Fibrillation Than Men?

In this podcast, I interview Dr. Jared Bunch about the recent article he wrote for Everyday Health on this subject.  Given that 1 in 4 adults in the U.S. will experience atrial fibrillation at some point in their lives, this is an especially important topic.

How Do I Listen To This Podcast?

To listen to this podcast you can click on the sound icon above.  Alternatively, you can subscribe to my podcast on iTunes or Stitcher Radio so that you never miss an episode.

What is Atrial Fibrillation?

Atrial fibrillation is the most common heart rhythm abnormality.  In atrial fibrillation, the two upper chambers of the heart are in complete electrical chaos.  This typically results in a very fast and irregular pulse.  Patients often experience palpitations, shortness of breath, chest discomfort, and fatigue.  Surprisingly, in the inactive and elderly, people may not have any symptoms at all.

Is Atrial Fibrillation Dangerous?

Even if you have no symptoms at all, atrial fibrillation is still a very dangerous heart condition.  Patients suffering from atrial fibrillation are much more likely to have a stroke, develop dementia, or experience heart failure or a heart attack.

What is the #1 Risk for Women?

Contrary to conventional wisdom, the number one cause of death for women is not breast cancer.  In fact, it’s not even all of the cancers combined.  Rather, the number one cause of death for women is still heart disease.

Why Do Women Die More From Atrial Fibrillation Than Men?

Many studies have shown that women are more at risk from dying from atrial fibrillation than men.  We still don’t know exactly why women are more at risk than men.  There are many possible theories.

1. Women tend to be 4 years older at the time of being diagnosed with atrial fibrillation.

2. Women are less likely to be prescribed blood thinners with atrial fibrillation.

3. Women may respond differently to blood thinners than men.

4. Women with atrial fibrillation have a higher heart attack risk than men.

Two Types of Heart Attacks

In general, there are two different kinds of heart attacks.  The first is the classic form of a heart attack where a plaque in one of the arteries of the heart ruptures and blocks off blood flow in that artery.  All of the heart muscle downstream of that clot is at risk of dying.  Physicians call this kind of a heart attack a “ST elevation” myocardial infarction (STEMI) because the ST segment of the ECG is elevated.

The other form of a heart attack is where the demands of the heart exceed blood flow available.  This would be the same concept as “red lining” your car’s engine.  If you run your heart too hard for too long this can also cause heart muscle to die or a heart attack.  Physicians call this kind of a heart attack a “Non ST elevation” myocardial infarction (NSTEMI) because the ST segment of the ECG is not elevated.

Why Do Women Have More Heart Attacks With Atrial Fibrillation?

In a recently published medical study of 14,462 people that were followed for 21.6 years, researchers observed 1,374 heart attacks.  Overall, people suffering from atrial fibrillation were 63% more likely to suffer a heart attack.

These atrial fibrillation induced heart attacks appeared to be primarily the NSTEMI form where heart demands exceed blood flow to the heart rather than the classic blood clot.  Even more surprising is that most of these atrial fibrillation heart attacks occurred in women.

Just to clarify, atrial fibrillation is an electrical problem with the heart whereas a heart attack is a plumbing problem with the heart.  However, if the electrical problem (atrial fibrillation) drives the heart rate too fast for too long it can trigger a heart attack or a plumbing problem with the heart.

While a 63% increased risk of a heart attack from atrial fibrillation sounds frightening, the numbers were even more frightening if you break them down by gender.  For example, men were just 21% more likely to suffer a heart attack from their atrial fibrillation whereas women were 172% more likely to suffer a heart attack from atrial fibrillation.  Approximately 10% of people suffering from this type of a heart attack never make it out of the hospital alive.

The question then naturally arises, why were women so much more likely to suffer heart attacks from their atrial fibrillation?  Researchers were unsure exactly why women were so much more at risk.  Some theories include poor control of atrial fibrillation, untreated other medical problems, or lack of blood thinners.

What Can Women Do?

1. If you have atrial fibrillation get it treated so that you can avoid a heart attack.

2. Breathe clean air. This means no smoking or exposure to second hand smoking.

3. Reverse or control the other risk factors.  The common cardiac risk factors include high blood pressure, cholesterol, and diabetes.

4. Maintain a healthy weight.

5. Exercise every day.

6. Eat a healthy diet.

7. Manage stress, stay socially connected, and get restorative sleep at night.

#AF-008 Does Sleep Apnea Cause Atrial Fibrillation?

January 8th, 2014 by

Does Sleep Apnea Cause Atrial Fibrillation?

Kathy never seemed to get a good night of sleep.  Her husband, John, told me “she snores like a train and then stops breathing.  After a pause, she gasps for air, and then goes back to sleep.”

Does this sound like someone you know?  If so, they likely have a condition called sleep apnea.  Not only does sleep apnea make people feel tired all of the time but it also puts them at high risk for high blood pressure, heart failure, sudden cardiac arrest, and atrial fibrillation.

In this article, I will discuss why sleep apnea is so dangerous and treatment options to avoid this risk.

What is Sleep Apnea?

Sleep apnea is a condition where people stop breathing while they are sleeping.  When this happens, not only is sleep disrupted leaving the person tired the next day, but this drop in oxygen levels can cause many different heart problems.

The most feared complication from sleep apnea is premature death.  For example, the risk of sudden cardiac arrest is increased up to three times in patients with sleep apnea.

How Do I Know if I Have Sleep Apnea?

I have found that the sleeping partner can usually make this diagnosis.  They will tell you that you snore and will often stop breathing throughout the night.

Another good way to tell if you have sleep apnea is to look at your neck size.  If it is 17 or larger for a man or 16 or larger for a woman, then there is a good chance you have sleep apnea.

For people at risk for sleep apnea, we typically order an overnight pulse oximetry test.  In this test, people sleep with a pulse oximetry meter on their finger during the night.  If they have frequent episodes of their oxygen levels dropping below 90%, then they likely have sleep apnea.  Patients with an abnormal overnight sleep oximetry test are then referred for an overnight sleep study to confirm the diagnosis.

What Causes Sleep Apnea?

Most cases of sleep apnea are from being overweight.  The extra tissue in the neck or the back of the tongue collapses the airway during sleep.  The key then, in treating sleep apnea, is to keep this extra body tissue from collapsing the airway at night.

What is the Risk of Atrial Fibrillation with Sleep Apnea?

The stress of going periods of time during the night without breathing takes a significant toll on the heart.  Sleep apnea has been shown to cause enlargement of the left atrium of the heart which is the usual source of atrial fibrillation.  This left atrial enlargement then causes disruption of electrical pathways leading to a four-fold increased risk of atrial fibrillation!

How is Sleep Apnea Treated?

For most people suffering from sleep apnea, it is initially treated with CPAP, or continuous positive airway pressure, to keep the airways from collapsing during sleep.  Some cases may require alternating pressures, BiPAP, to treat sleep apnea.  Your sleep doctor can help you to select the right treatment option for you.

What If I Can’t Tolerate CPAP?

While some people have no problems tolerating CPAP therapy, others cannot.  Particularly, for those with claustrophobia this can be very difficult.

I know that I could never tolerate this therapy.  I have enough difficulties sleeping as it is and CPAP would only further complicate things for me.

If you cannot tolerate CPAP, your physician may elect to just give you oxygen at night.  While this does not solve the problem of the airway collapsing, at least the extra oxygen will help to keep your blood oxygen levels higher while sleeping.

Other patients have considered surgical options to treat sleep apnea.  These surgeries often focus on surgically removing the extra tissue that collapses the airways while sleeping.  Unfortunately, the long-term success rates for these surgeries are either lacking or are unimpressive–not to mention the surgical risks of these procedures.

Natural Ways to Treat Sleep Apnea

Another approach, which is seldom discussed, is a natural approach to treating sleep apnea.  For most people who suffer from this condition, it is much more likely to occur when they are sleeping on their backs.

A simple approach that many of my patients have tried is to sew a tennis ball into the back of a shirt.  These patients then wear this “tennis ball shirt” each night while sleeping.  Every time they roll onto their backs the tennis ball awakens them.  Over time, they subconsciously learn to sleep on their stomach or sides.

Probably the most effective natural treatment approach to sleep apnea is to just lose weight.  As the primary cause of sleep apnea is too much fat deposition in the neck and back of the tongue, weight loss can solve the underlying problem.  I have seen countless patients who have completely reversed their sleep apnea with weight loss alone.

Will Sleep Apnea Treatment Reverse A-Fib?

As sleep apnea and atrial fibrillation go hand-in-hand, many patients ask me if their atrial fibrillation will go into remission with sleep apnea treatment.

A recent study showed that treating sleep apnea decreased the risk of atrial fibrillation by 42%.  Even if sleep apnea treatment does not make your A-Fib go away, at least it will make your A-fib much easier to treat.

For example, if you and your physician ultimately decide on a catheter ablation procedure to treat your A-Fib, having your sleep apnea under control doubles your chances of a successful procedure.  In this study, if you had sleep apnea, and refused treatment for the sleep apnea, your chances of a successful ablation procedure was only 37%.

Clearly, if you want to successfully treat your A-Fib, you cannot ignore underlying sleep apnea!

Action Steps

What should you do if you have been diagnosed with A-Fib and are at risk for sleep apnea?  Below are my three action steps:

1. Get Tested

The screening test for sleep apnea is so simple.  You just sleep at home with a pulse oximetry device on your finger.  If you have not yet been tested then call your physician today to schedule this test.

2. Get Treated

If you have sleep apnea, get treated.  Many patients cannot tolerate CPAP on their first try.  Don’t give up.  Work with your sleep physician to find the right equipment for you.

3. Reverse Sleep Apnea

Even if you tolerate CPAP just fine, wouldn’t it be even better if you could just reverse this condition?  I have found that most patients can reverse sleep apnea naturally with weight loss and by not sleeping on their backs (the tennis ball in the back of the shirt trick works really well for this).

The important thing to remember is you cannot stop using CPAP until you are sure you have completely reversed the sleep apnea.  Work with your physician and, after sufficient weight loss, repeat the overnight sleep oximetry test to make sure your oxygen levels never drop at night.

Do you have sleep apnea and atrial fibrillation?  What has worked for you?

#AF-004 When Should I Consider an Ablation for A-Fib?

January 4th, 2014 by

When Should I Consider an Ablation for A-Fib?

John had been struggling with atrial fibrillation (A-Fib) for years.  He had tried the medications but they all made him feel tired.  He just did not like the way he felt when his heart was out of rhythm.  Should he consider a catheter ablation procedure to manage his A-Fib?

In this article we will discuss when an ablation procedure should be considered for the treatment of A-Fib.

What is a catheter ablation procedure?

A catheter ablation procedure is a minimally invasive procedure where a cardiologist inserts thin catheters through your veins and advances them to the heart.  Once these catheters are in your heart, a 3D map is often created to see where these abnormal heart rhythms are originating from.  Once the rogue spots that are causing A-Fib are identified, these areas are then cauterized or frozen to keep the heart beating normally.

Patients may go home the same day or they may be observed overnight.  Typically just a band-aid is used for the puncture sites as stitches are not even required for this procedure.  To see video footage of an ablation you can watch this TV segment.

Do I have to take a medicine first?

Many patients who come to see me are disheartened to learn that I generally encourage them to try an antiarrhythmic medication first.  The reason is that this is the approach recommended by the A-Fib Treatment Guidelines and the fact that many insurance companies will not pay for the procedure unless an antiarrhythmic has been tried first.

On average, I find these anti-arrhythmic medications generally only work for a year or two.  For some patients they do not work at all.  For other patients I have found that they may effectively control A-Fib for more than 20 years!

One potential advantage to trying a medication first is that our technology for catheter ablation procedures just gets better with time.  Thus, if you can control your A-Fib for 3-5 years, we may have an even better treatment option for A-Fib at that time.

One thing to remember is that antiarrhythmics are not without risk.  Most of the antiarrhythmics studied have been shown to increase the risk of premature death.

Should I wait to have my ablation procedure?

Patients often ask me, “can I wait to have my ablation?”  My answer generally is that as long as you can maintain normal rhythm it is a reasonable option to wait for an ablation procedure.

There is a common saying that “A-Fib begets A-Fib.”  The reason is that episodes of A-Fib may lead to scarring of the heart.  This heart scarring then leads to even more episodes of A-Fib.

For patients who have been continuously out of rhythm for more than 1 year, the chances of a successful ablation procedure decrease significantly.  Indeed, we have published a study which showed that the longer an ablation is delayed the lower the chances of success.

What are the benefits of a catheter ablation?

In countless studies, the two clearly proven benefits of catheter ablation for A-Fib include the following:

1. To control A-Fib symptoms

2. To increase your chances of holding normal rhythm

While no one questions the role of a catheter ablation to control symptoms and increase your chances of holding normal rhythm, the question many have sought to know is will it prolong life, prevent strokes, and prevent dementia.

In our study of 37,908 patients at Intermountain Healthcare we asked this very question.  Our study showed that those patients who elected to have a catheter ablation procedure lived much longer and were much less likely to suffer from a stroke or dementia.

It should be pointed out that our study did not randomize patients to the two different treatments strategies, namely ablation versus drugs.  As it was not a randomized study, catheter ablation cannot yet be considered as a proven way to prevent premature death, strokes, and dementia.

To fully answer this question, there is an ongoing large multi-center study, called the CABANA Study, which will answer this question.  This study is funded, in part, by the National Institutes of Health.

Who is the ideal ablation candidate?

Another question I am frequently asked is “am I a good candidate for an ablation?”  After personally performing more than 4,000 catheter ablation procedures for A-Fib, these are the patients that I have found who are most likely to be “cured” from A-Fib.

1. They have paroxysmal A-Fib (A-Fib stops on its own)

2. Their left atrium is normal in size

3. They don’t have any other cardiac or medical problems

4. They have an ideal body weight

5. They are young

What are the risks of a catheter ablation procedure?

Unfortunately, catheter ablation procedures are not risk free.  Many complications can occur.  For example, patients could suffer the following complications: bleeding, infection, heart attack, stroke, tear in the heart, damage to the pulmonary veins, esophageal perforation, nerve damage, emergent open-heart cardiac surgery, or even death.

When it comes to the risk of a complication, experience does matter.  Like everything in life, the more you do something the better you get at doing it.

When it comes to catheter ablation, studies show that if your procedure is done by an inexperienced physician or hospital, you have a 1 in 200 chance of never leaving the hospital alive.  In this study, an inexperienced physician was defined as a cardiologist (an electrophysiologist or cardiologist specializing in heart rhythm disorders) who did less than 25 of these procedures each year.  An inexperienced hospital was defined as a hospital that did less than 50 of these procedures each year.

If your electrophysiologist has recommended a catheter ablation procedure for A-Fib, find out how experienced they are, how experienced the hospital is, and ask them to show you their complication rate data.  If they cannot show you these numbers you may want to consider looking elsewhere for a procedure which could have significant complications.

Should I have a radiofrequency or cryoballoon ablation procedure?

There are two general ablation approaches for atrial fibrillation, radiofrequency (heat energy) or cryo (cold energy).  Either approach can effectively eliminate the areas of the heart which are misfiring.  As there are no data showing which approach is best, the best approach for you is the technique your electrophysiologist is most comfortable with.

Is a surgical ablation procedure better?

In addition to the catheter approaches, there is also a surgical approach to treating atrial fibrillation.  If you need open-heart surgery bypass surgery or valve surgery, your surgeon could easily perform a MAZE surgery for atrial fibrillation while your chest is open.

Surgeons have now started doing less invasive surgeries for atrial fibrillation which involve much smaller incisions in your chest.  For many patients, these “Mini-MAZE” surgeries can be very effective in controlling A-Fib.

Certainly, the more invasive the procedure is the higher the risks.  Studies have not shown whether the surgical approach is more effective than catheter approaches in treating A-Fib.

The surgical approach for A-Fib could be a good option if you live in a region where you have an experienced surgeon and your electrophysiologist is inexperienced in performing catheter ablation procedures.

Should John consider an ablation procedure?

In John’s case, his atrial fibrillation has caused him significant symptoms.  When he is out of rhythm he feels very tired and short of breath with any activity.

John had also tried an antiarrhythmic medication to control his A-Fib.  Initially he tried flecainide.  When flecainide was no longer effective he tried sotalol.  Both of these medicines not only failed to control his symptoms but also caused him to feel very tired.  To be honest, John also did not like having to take medications for the rest of his life.

As he had symptoms from A-Fib and medications were ineffective, he clearly met the established criteria for a catheter ablation procedure.  Fortunately, his procedure went well and he is now drug-free and doesn’t have any more A-Fib.

Should I consider an ablation procedure?

At the end of the day, should you consider a catheter ablation procedure?  Regardless of whether you are an ideal candidate or not, the following are the people who should at least consider this procedure:

1. Your A-Fib causes you symptoms

2. Antiarrhythmics either don’t work or cause significant side effects

3. You have been in normal rhythm within the last year

Has your doctor recommended a catheter ablation procedure?


#AF-001 The Most Important Factor to Cure A-Fib

January 1st, 2014 by

The Most Important Factor to Cure A-Fib

Do you or a loved one suffer from A-Fib?  A-Fib, which is also known as atrial fibrillation or “AF,” is the most common heart arrhythmia and affects 1 in 4 adults.  In A-Fib the heart typically beats very fast and irregularly leading to strokes, heart failure, dementia, and even premature death.

Just what exactly is the most important factor to cure A-Fib?  In this article we will explore the most important factor to cure A-Fib.

A-Fib 20 Years Ago

I can hardly believe it but 20 years have now passed since I graduated from Johns Hopkins Medical School.  I remember seeing my first case of A-Fib as a fresh young intern at Stanford University Medical Center in 1995.

John was an overweight 52 year old man who suddenly developed severe chest pain and palpitations while staying late at work one night to meet a stressful deadline.  Panicked he dialed 911 and was brought to the Stanford Hospital emergency room.  As I was the intern on call for the ER that night my pager went off and I was called to see John.

Seeing how severe his condition was we quickly shocked his heart back into normal rhythm.  It was just like what you might see on TV except his body did not jump off the table when we shocked his heart.

While this temporarily corrected his arrhythmia it was just a matter of time before I would see him again for more episodes of A-Fib.  In those days we really did not understand what caused A-Fib and all we had available to treat A-Fib were medications.

A-Fib Treatment in the Last 10 Years

Fast forward to the last 10 years.  Now, if you or a loved one has suffered from A-Fib then you have undoubtably heard about the very popular catheter ablation procedure.

As a cardiologist specializing in the treatment of heart rhythm disorders I personally have done more than 4,000 of these catheter ablation procedures for patients suffering from atrial fibrillation.  A catheter ablation procedure is where we go into the heart with catheters through a vein in the leg.

This procedure is so minimally invasive that all it requires is an IV.  No cutting or stitches are needed.  Once catheters are in the heart we can 3-dimensionally map out the source of A-Fib and then either cauterize or freeze those areas of the heart.

While this treatment approach has been very successful in treating A-Fib, unfortunately the arrhythmia often comes back a few years later.  When A-Fib recurs the ablation procedure is done again.  Some patients may even have three or more of these catheter ablation procedures performed.

Is there a better way to treat A-Fib?

As I have been involved in helping to develop the catheter ablation procedure for A-Fib since it was first developed in 1998, it has always troubled me that so many of these “successfully” treated patients have had their A-Fib come back.  Why is this the case?

Fortunately, we now have a much better understanding of the various causes of A-Fib.  For example, the obesity epidemic in the U.S. has made the U.S. the A-Fib capital of the world!  In fact, A-Fib is nearly 10 times more common in the U.S. than in Asian countries.

It is not just the obesity epidemic but also high blood pressure, a poor diet, stress, lack of exercise, and sleep apnea, among other conditions, which is driving the A-Fib epidemic.  Based on our new understanding of the causes of A-Fib we now know that while a catheter ablation procedure can be very effective in treating today’s A-Fib, if aggressive lifestyle changes are not made then it is just a matter of time before new A-Fib areas develop.

This new understanding of A-Fib led my good friends and fellow colleagues in Australia to perform a landmark study in the cardiology world to see if aggressive lifestyle modification changes can improve the long-term success of catheter ablation.


In the ARREST-AF Study, my good friends in Australia recruited 149 overweight A-Fib patients who had recently undergone an A-Fib ablation procedure.  Of these 149 patients, 61 volunteered to participate in an aggressive lifestyle modification program.  The 88 patients that were unwilling to “change their ways” after this heart procedure served as the control group.

This aggressive lifestyle modification program consisted of the following:

1. Weight loss

2. Aggressive control of blood pressure, lipids, and diabetes

3. Treatment of sleep apnea

4. Smoking cessation

5. Decreasing alcohol intake

The group of patients who signed up for lifestyle modification did very well in “changing their ways.”  They were able to lose 29 pounds (13.2 kg), stop smoking, limit alcohol intake, and get their blood pressure, lipid, diabetes, and sleep apnea under control.  Many of these conditions were even reversed.

With these changes, the group that participated in lifestyle changes were 3 times more likely to have their procedure work long-term.  Unfortunately, for the group unwilling to make changes, most had their A-Fib come back within two years of their heart procedure.

Take Home Message of this Study

The big picture or take home message of this study is that modern medicine is not a “fix” for poor lifestyle choices.  We simply cannot undo years of damage with a pill or a procedure.

If you want to beat A-Fib, or for that matter any heart condition, the most important factor is to adopt a healthy lifestyle.  Indeed, studies show that 80% of all heart conditions are completely preventable or reversible with a healthy lifestyle.

It is not just heart disease either.  A healthy lifestyle can prevent cancer, Alzheimer’s Disease, diabetes, and most other medical conditions.

We are not victims of the genes we inherited from our parents.  Whether or not we will suffer from long-term medical conditions in this life, to a large extent, is based on the daily decisions we make.

Even if you have abused your body in the past it is never too late to change.  The body has a remarkable ability to heal itself if we will just give it a chance.  Make the commitment today to make healthy decisions!

Do you want to learn more about how to prevent atrial fibrillation naturally?  Here is a recent presentation I delivered at the most recent Stop Afib symposium in Dallas, Texas.

What positive changes have you made in your life?  Please share with me your comments below.


Please do not self diagnose or treat based on anything you have read in this article.  Please work with your individual physician in deciding what treatment strategy is best for you.