PDF Summary:The AFib Cure, by John D. Day and T. Jared Bunch

Atrial fibrillation (AFib) causes your heart to beat irregularly, which can lead to serious health complications like heart failure, stroke, and increased infection risk. While AFib itself is typically not fatal, the conditions it triggers or worsens can be deadly. In The AFib Cure, cardiologists John D. Day and T. Jared Bunch explain that AFib is a systemic disease with multiple underlying causes—from genetic predisposition and lifestyle factors to stress and inflammation.

Day and Bunch offer a path to managing and potentially reversing AFib through lifestyle optimization, careful monitoring of biomarkers, and strategic use of medical interventions like ablation and medications. You'll learn how various triggers provoke AFib episodes, which common medications can worsen the condition, and how tracking your biomarkers helps you determine the right treatment approach for your situation.

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(Shortform note: While researchers have found that psychological stress can trigger AFib in both men and women, they haven’t found that it’s more likely to do so in women. For example, medical researchers conducted a study of 6,000 men and women over a 10-year period. They found that both men and women who experienced psychological stress were more likely to develop AFib than those who didn’t. However, they didn’t find that women were more likely to develop AFib than men. Similarly, cardiovascular researchers conducted a review of 10 studies on the relationship between psychological stress and AFib. They found that psychological stress can trigger AFib in both men and women, but they didn’t find that it’s more likely to do so in women.)

Emotions like being sad, angry, stressed, impatient, and anxious can raise the odds of an AFib event by as much as fivefold within a 24-hour period. However, happiness has a protective effect. Being happy reduces the chance of heart rhythm irregularities that day by 85%. Having depression raises the odds of AFib by as much as 700%. However, treating your depression can significantly lower your risk. Physical strains, such as surgery, illnesses, and auto crashes, can also bring on AFib. For uncommon, one-time occurrences like these, it's possible that once the stressor is gone, the AFib will subside. However, it probably foreshadows future events. If a significant stressful event triggered your AFib, something else has probably been driving you in that direction for quite a while.

(Shortform note: The numbers in this section may be inaccurate. For example, medical researchers have found that depression increases the risk of AFib by 25% to 38%, not 700%. Similarly, a meta-analysis of 10 studies found that emotional distress increases the risk of AFib by 19% to 24%, not fivefold. An academic paper on the relationship between happiness and heart health found that happiness reduces the risk of heart disease by 22%, not 85%. While these numbers are still significant, they’re much lower than the numbers in this section.)

AFib Management and the Pursuit of "Recovery"

Day and Bunch offer a path to managing AFib and perhaps curing it. Their health optimization strategies can assist in preventing and reducing dangerous arrhythmias, supporting a life that’s longer, healthier, and happier. The book is for those dedicated to immediate life improvement, who think it’s crucial to exhaust all possibilities to remit AFib with an emphasis on natural treatments, and who think age isn't required to determine health.

Is AFib Reversible?

The idea that AFib can be reversed is supported by research on “reverse atrial remodeling.” Stanley Nattel and Masahide Harada explain that when AFib is successfully suppressed for extended periods, the atria can partially return to a more normal state, both structurally and electrically. This means the changes that make AFib self-perpetuating aren’t always permanent. The heart’s electrical system can regain some of its normal function, and the atria can shrink back toward their original size. This reversibility is most pronounced when AFib is treated early, before extensive structural changes have occurred.

Let’s explore some interventions for managing AFib, including lifestyle changes and monitoring your biomarkers.

AFib Interventions: Procedures, Medications, and Devices

Certain medications can trigger or worsen AFib, Day and Bunch explain. These include thiazide diuretics, which can lower potassium and magnesium levels; nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, which can heighten the likelihood of cardiac and renal failure and, for individuals on blood thinners, the risk of gastrointestinal bleeding; and proton-pump inhibitors, which reduce gastric acid and can block magnesium absorption or change the gut microbiome.

Other medications that can trigger or worsen AFib include steroids, which can raise blood glucose levels and blood pressure; cardiac stimulant medications; over-the-counter decongestants; medications for attention-deficit/hyperactivity disorder; digoxin and calcium channel blockers, which address abnormal heart rhythms; asthma and emphysema medications; cytostatics, which treat cancer, certain skin conditions, and infections; central nervous system drugs, including some antidepressants, antimigraine drugs, anticholinergics, and dopamine agonists; and osteoporosis-preventing drugs.

The Benefits of Proton-Pump Inhibitors

While proton-pump inhibitors (PPIs) can block magnesium absorption and change the gut microbiome, they’re often prescribed to AFib patients who are at risk of gastrointestinal bleeding. According to Deepak L. Bhatt et al., patients who require long-term antithrombotic therapy (such as those with AFib) are at risk of gastrointestinal bleeding, which can be fatal. PPIs can reduce the risk of gastrointestinal bleeding by suppressing gastric acid production, which helps protect the stomach lining from damage caused by antithrombotic drugs. The authors argue that the benefits of PPIs in preventing gastrointestinal bleeding outweigh the potential risks associated with their use, such as changes to the gut microbiome.

Next, we’ll look at two main interventions for AFib: medication and ablation.

AFib Interventions: Ablation and Pharmacological Approaches

Day and Bunch explain that ablation and medications are the primary interventions for AFib. Ablation serves as a treatment that eliminates AFib by destroying the heart tissue that causes the condition. Medications for AFib include antiarrhythmics, which maintain normal heart rhythm, and anticoagulants, which prevent blood clots.

Ablation surpasses medications in maintaining heart rhythm, improving life satisfaction, and lowering the likelihood of hospitalization. It decreases the likelihood of early death, stroke, and dementia. However, ablation results in AFib reoccurrence in as many as 40% of patients. Medications can cause adverse effects and require careful monitoring. They work for a limited duration and don't lengthen life span.

Medications for AFib Can Lengthen Life Span

Contrary to the authors’ claim, medical researchers have found that medications for AFib can lengthen life span. In a meta-analysis, clinical researchers found that oral anticoagulants, which prevent blood clots, reduce the risk of death in patients with AFib. The researchers analyzed 29 randomized controlled trials involving 28,044 participants. They found that oral anticoagulants reduced the risk of death by 10% compared to no medication. The researchers concluded that oral anticoagulants are effective in reducing the risk of death in patients with AFib. This finding is significant because AFib is associated with an increased risk of stroke and death.

AFib Interventions: Rate/Rhythm Control and Preventing Strokes

Day and Bunch note that antiarrhythmic drugs and those that regulate heart rate are common medications for AFib. Rate controllers reduce how fast your heart beats, whereas antiarrhythmics affect your heart’s electrical channels to maintain its rhythm. Rate controllers are the most popular drugs given to AFib patients. They slow your heart down, which can be helpful if you're experiencing a rapid heartbeat. However, they decrease your heart rate even when AFib isn't actively occurring, which can lead to bradycardia—a state where the heart beats too slowly and doesn't circulate sufficient oxygenated blood throughout the body.

Antiarrhythmics generally don't offer lasting results for many. They should serve as temporary measures to allow additional methods to take effect. If you're using a rate controller, use a heart rate monitor like a smartwatch.

(Shortform note: If you’re taking a rate-controlling drug, ask your clinician to define a safe range for your heart rate. Then, set your smartwatch to alert you if your heart rate falls outside of this range. This way, you can take immediate action if your heart rate becomes dangerously low or high. For example, if your heart rate drops below the safe range, you might need to stop taking the medication and contact your doctor. If it rises above the safe range, you may need to rest or seek medical attention.)

Day and Bunch also explain that closing or removing the appendage in the left atrium can help prevent strokes. The left atrial appendage is a tiny pouch located in the muscular wall of the left atrium. About 90% of all AFib strokes result from coagulations that form in this sac. Closing off the left atrial appendage can prevent clots from traveling to the brain and causing a stroke.

(Shortform note: The authors of the 2020 European Society of Cardiology guidelines for atrial fibrillation disagree with Day and Bunch’s recommendation that most people with AFib should have their left atrial appendage closed off. They argue that this procedure should only be considered for people who can’t take anticoagulant drugs. They explain that there’s not enough evidence to recommend closing off the left atrial appendage in people who can safely take anticoagulant drugs. They also note that closing off the left atrial appendage is a complex procedure that can have serious complications, such as bleeding, infection, and damage to the heart.)

This can be done by securing, clipping, or removing the appendage, or by inserting a device that blocks the sac's opening. Research indicates that a closure device paired with daily aspirin results in survival rates comparable to those with warfarin, an anticoagulant that has a significant bleeding risk.

(Shortform note: In a pooled analysis of two randomized trials, Vivek Y. Reddy, David R. Holmes Jr., and colleagues found that patients who received a left atrial appendage closure device and transitioned from short-term anticoagulation to antiplatelet therapy had lower all-cause mortality compared to those on warfarin, without an increase in stroke or systemic embolism. This suggests that the device plus aspirin may offer a safer alternative to long-term warfarin therapy for stroke prevention in atrial fibrillation patients.)

However, there is a possibility that a clot could form on the closure device. In rare cases, a leak may occur in the left atrial appendage, meaning blood can still enter and exit, or a stump may form, which is a "dead-end pouch" in the heart's left atrium that can develop blood clots. A leakage or remnant could elevate your chance of a stroke by up to 22 times. However, as the technology has advanced through the years, the likelihood of these issues has decreased. If you opt for closing or excising the left atrial appendage, it's crucial to undergo a transesophageal echocardiogram post-procedure to confirm the absence of clots, leaks, or stumps. Continuing with anticoagulants or undergoing further procedures may help resolve these issues.

Risks of Transesophageal Echocardiogram

While the authors recommend a transesophageal echocardiogram after the procedure, it's important to note that this test carries its own risks. According to one medical research article, the procedure is generally safe, but complications can occur in about 0.2% to 0.5% of cases. These complications can include damage to the esophagus, bleeding, or reactions to the sedatives used during the test. The risk of complications is higher in older adults, people with certain health conditions, and those who are frail. The procedure involves inserting a probe down the throat, which can be uncomfortable and may cause gagging or throat irritation. While the information gained from a transesophageal echocardiogram can be valuable, it's important to weigh these risks against the potential benefits, especially for patients who may be more vulnerable to complications.

The All-Encompassing Approach to AFib Remission: Lifestyle, Biomarkers, and Continuous Care

Lifestyle Interventions to Remit AFib

Day and Bunch suggest that adjusting your lifestyle can aid in achieving AFib remission. However, it takes a long-term commitment to maintain it. You must track your health and make adjustments as needed. You can use a smartwatch or smartphone to monitor your heart rate variability, physical activity, rest, diet, and stress.

(Shortform note: While smartwatches can help you track your health, they can also cause anxiety. For example, if you’re constantly checking your sleep metrics, you may become anxious about not getting enough sleep, which can actually disrupt your sleep. This can create a vicious cycle where you’re so worried about your sleep that you can’t sleep.)

Monitoring and the BLAST Care Framework

Day and Bunch explain that tracking your biomarkers is crucial for managing AFib. Biomarkers are bodily substances that indicate your likelihood of developing AFib. Tracking these biomarkers helps you determine which lifestyle changes you need to make, whether you need an ablation, and which medications you need to take.

(Shortform note: Day and Bunch don’t explain how tracking these bodily substances helps you determine which lifestyle changes, ablation, and medications you need. In practice, clinicians use mathematical tools to determine the likelihood of a patient developing AFib based on their biomarkers. For example, the authors of one study developed a tool that uses a patient’s troponin and NT-proBNP levels to determine their risk of stroke. The higher the risk, the more aggressively the patient should pursue lifestyle changes, ablation, and medication.)

Smartwatches and other technology can also help track AFib occurrences. They can reliably detect AFib and document an EKG. They can additionally collect daily reports on your cardiac rhythm, which you can download and save. This data may assist you in seeing how your behaviors affect your heartbeat. Other devices that can aid in monitoring AFib include Bluetooth-enabled electrodes, oximeters, listening devices, and monitors that check your blood pressure and heart rhythm.

(Shortform note: While smartwatches and other devices can help you track your AFib, they may not be as reliable as the authors suggest. In a study of over 400,000 participants, researchers Marco V. Perez, Kenneth W. Mahaffey, and Heidi Hedlin found that only 0.52% of participants received an irregular pulse notification from their smartwatch. Of those who received a notification, only about one-third had AFib confirmed by an ambulatory ECG patch.)