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From: (Steven B. Harris )
Subject: Re: Deadly Medicine (pub.1994)
Date: 14 Sep 1995

In <> Margaret Harris
<> writes:

>The book "Deadly Medicine" discusses the use of "Flecanaide" and other
>arrythmic drugs experimented with around 1985. The effects of these drugs
>were controversial. Today flecainide and other arrythmic drugs are used
>by millions of people for atrial fibrillation as well as ventricular
>fibrillation. According to the above text these drugs were promoted by
>the drug company in part because of the huge revenues it would generate.
>Does anyone have opinions about the use of these drugs and the drug
>companies research in this area? ARE THEY SAFE?

   Well, the problem is that they used the wrong endpoint in the
studies-- not less dysrythmia is what you want, but less death.

   Yes the newer agents like flecanide look pretty dismal.  Don't know
why they are still on the market.  Perhaps a cardiologist will comment.
Perhaps they have one small subgroup of people they are still hoping
these things help.

                                       Steve Harris, M.D.

From: B. Harris)
Subject: Re: atrial fib
Date: 18 May 1997

In <> peter nelson
<> writes:

>SPOFF10 wrote:
>> does anyone have any information about the use of
>> calan sr in the treatment of atrial fib.  how about
>> diet and other restrictions if any.
>Dietary restrictions for atrila fib, as with
>most arrhythmia's are to avoid alcohol and caffeine.
>Atrial fib is a very serious condition that
>used to be regarded as somewhat benign.  It
>is associated with a significant increase in the
>risk of strokes.
>More recent research suggests that it's worse
>than previously thought:  long-term studies of
>atrial fibrillation sufferers who don't have
>strokes find that they nonetheless suffer
>significant cognitive and memory deficits
>compared to non-atrial-fib patients.  The theory
>is that A/F is thrwoing off lots of TINY clots
>which lodge in small blood vessels in the brain
>and gradually degrade its function.

   Yes.  I think that people with chronic, unfixable A-fib should be
on aspirin.  The role of coumadin is controversial, but most
cardiologists now stay away from it.

   Calan (verapamil) is to control heart rate with A-fib, not to keep
you out of it.  Digoxin does much the same kind of thing.  Alcohol and
caffeine restrictions are useful only for those you go in and out of
the rhythm, not those who are stuck in it.

                                        Steve Harris, M.D.

From: Neal Lippman <>
Subject: Re: Use of Catheter Ablation as a cure of Chronic Lone Atrial
Date: Thu, 28 Jan 1999 02:04:30 GMT

Because of the amount of information being posted here related to atrial
fibrillation, ablation, and other forms of treatment, I decided to take a
few minutes and jot down what I think is a reasonable way to summarize
the options and their pros and cons. THis is similar to the explanation I
give my own patients with atrial fibrillation. In the interest of space,
I will eliminate the explanation of what AF is that I also include in my

1. AF can cause symptoms or morbidity for 4 reasons:
    i. The rapid ventricular response leading to symptoms of tachycardia and
inefficient heart function;
    ii. The irregular ventricular response (even when not rapid) can
cause symptoms and may also lead to inefficient heart function
(preliminary data supports this idea);
    iii. The lack of atrial mechanical function leads to symptoms related to
inefficient heart function (loss of atrial filling of the ventricle; "pacemaker
    iv. The risk of thromboemolism (stroke, etc).

2. There are two ways to treat AF:
    i. Restore/maintain sinus rhythm, which treats all 4 problems;
    ii. Control the ventricular response without restoring sinus rhythm.
This treats i only. With the addition of Coumadin/Aspirin/Heparin, iv. is
reduced but not completely eliminated. With AV node ablation/pacemaker
implantion (see below), ii is also fixed. Nothing in this approach deals
with iii.

3. Options to maintain sinus rhythm:
    i. Antiarrythmic drugs. THey work, it's relatively easy to do, but
there are risks of proarrhythmia, drug side effects, drug failure (50%
or more of patients), you have to take drugs all the time, expense of
the prescriptions, drug interactions, etc.
    ii. The surgical Maze procedure. Technically, this is not
experimental, but has not received widespread use in the US (in contrast
to Japan, where they have done at least 10x as many as Cox, who developed
the procedure, has done himself). It needs to be done CORRECTLY, so you
should have it done by someone who knows how to do it right. While is is
very effective, obviously it involves open heart surgery, there is a risk
of fluid retention post operatively (? related to ANF from the atrial
incisions), 20% need a pacer post-op.
    iii. The catheter Maze procedure. This IS experimental, and is only
being done in a few spots in the US and in more spots in Europe. It is
unclear, at present in what form this will, if it ever does, make it to
general availability / application to patients with AF. There is a form
of AF, however, which appears to initiate via a focal atrial tachycardia
arising from the left atrium around the pulmonary veins, and ablation of
that tachycardia may prevent AF from occurring. In that setting, AF
ablation is a more reasonable options, but is not technically a atrial
Maze procedure; rather it is an ablation of a focal atrial tachycardia.
Most EPS doing ablation could offer this form of the procedure.
    iv. The implantable atrial defibrillator. Not a mechanism really to
prevent AF; rather, the ACD can pace/shock the atrium in response to the
development of an atrial arrhythmia. The form of AF beginning around the
pulmonary veins described above may response to pacing in the atrium;
other forms of AF require shocks.  Experimental in the US; no
commercially available ACDs have been approved for release by the FDA at
this point in time.

4. Controlling the ventricular response:
    i. Pharmacologic: AV Nodal blocking drugs, such as beta blockers,
calcium channel blockers, digoxin, amiodarone (also used to maintain
sinus rhythm as well)
    ii. Mechanical: AV node ablation, resulting in complete AV block,
followed by permanent pacemaker implantation. Note that this procedure
DOES NOT cure the AF; it just prevents the electrical impulses from
propagating to the ventricle. Note also that this technique, in addition
to controlling the ventricular rate, also regularizes the rate which is
now fully controlled by the pacemaker.

I hope this is helpful.

Neal wrote:

> You might have seen my earlier posting on this article and afib.  My husband
> has chronic afib (I'm not familiar with the term long afib).  I did LOTS of
> research and so did his cardiologist.  He spoke to a top electrophysiologist
> at Massachusetts General Hospital, and their opinion was that my husband was
> not a candidate for this procedure.  Something about where the fibrillation
> is occuring in his heart.  I guess you need to see someone who is familiar
> with this procedure and with the newer methods that have been recently used.
> I have to tell you that we were very disappointed.  He did talk about the
> Maze surgery, but said it was still too experimental for him to recommend.
> If you go back on this newsgroup you will see an article posted by Henk.
> It does say that the ablation can cure atrial fibrillation so if I were
> you I'd look for an experienced electrophysiologist.
> In article <78hnht$euk$>,
> wrote:
> > I have read an Article on a study for use of Non Surgical Treatment (i.e.
> > Catheter Ablation) for arrhythmia (refer to a copy from Jhon Hopkins Article
> > on this study below).
> >
> > Does any body know about the status of the FDA approval of such method in
> > treating Chronic Lone Atrial Fibrillation?
> > _________________________________________________________________________
> > Johns Hopkins Medical Institutions
> > 19-Jan-99
> >
> > Study Affirms Value of Non-Surgical Treatment for Arrhythmia
> > Library: MED
> > Description: A widely used nonsurgical treatment for rapid heart rhythms is
> > safe and beneficial for both children and adults, according to results of a
> > national study led by Johns Hopkins physicians.
> > 1/19/99
> >
> > January 14, 1999
> >
> > Johns Hopkins Medical Institutions' news releases are available on a
> > PRE- EMBARGOED basis on Newswise at and from
> > the Office of Communications and Public Affairs' direct e-mail news
> > release service. To enroll, call 410-955-4288 or send e-mail to
> >
> > 
> > 
> > 
> > A widely used nonsurgical treatment for rapid heart rhythms is safe
> > and beneficial for both children and adults, according to results of a
> > national study led by Johns Hopkins physicians.
> > 
> > "This is the first large multicenter study to suggest that
> > radiofrequency catheter ablation is safe and effective therapy, and
> > that it can now be considered as an alternative to drug therapy in the
> > treatment of certain cardiac arrhythmias," says Hugh Calkins, M.D.,
> > lead author of the study and director of electrophysiology at Hopkins.
> > "Before this procedure was developed in the early 1990s, arrhythmia
> > patients were treated with medication, underwent open heart surgery or
> > suffered. The technology has now advanced to the point at which we can
> > do the procedure on an outpatient basis, curing patients within a
> > matter of hours and sending them home the same day."
> > 
> > Radiofrequency catheter ablation destroys parts of the electrical
> > pathways in the heart that cause rapid heart rhythms, or arrhythmias.
> > A physician guides a catheter with an electrode at the tip to the
> > focal point of the abnormal pathway in the heart muscle. Then a mild,
> > painless burst of energy -- similar to microwave heat -- is
> > transmitted to destroy the small area of heart tissue containing the
> > pathway, ending the electrical misfirings that caused the arrhythmia.
> > 
> > Calkins estimates that more than 15,000 catheter ablations are
> > performed nationwide each year. About one in every 100 people has some
> > type of arrhythmia.
> > 
> > Results of the study were published in the Jan. 19 issue of
> > Circulation, an American Heart Association journal.
> > 
> > Researchers followed 1,050 patients who underwent three types of
> > catheter ablations between 1992 and 1995. The patient population
> > consisted of 439 males and 561 females ranging in age from eight
> > months to 90 years. Among the group, 133 (13 percent) were younger
> > than 13 and 193 (18 percent) were between 13 and 20 years old.
> > Underlying heart disease was present in 270 patients.
> > 
> > Results showed that catheter ablation could be performed with a high
> > level of success (95 percent), a low recurrence rate (6 percent) and a
> > relatively low incidence of major complications (3 percent). The
> > one-year survival rate after catheter ablation was 98 percent.
> > 
> > In addition, the researchers noted that the probability for success
> > was highest among medical centers that performed the greatest number
> > of procedures on an annual basis.
> > 
> > Other institutions involved in the study were: Children's Hospital,
> > Boston; Duke University Medical Center, Durham, N.C.; Good Samaritan
> > Hospital, Los Angles; Krannert Institute, Indianapolis; Loyola
> > University Medical Center, Maywood, Ill.; Mayo Clinic, Rochester,
> > Minn.; Medical University of South Carolina, Charleston; Northside
> > Cardiology, Indianapolis; St. Francis Hospital, Tulsa, Okla.; Sentara
> > Norfolk General Hospital, Norfolk, Va.; Stanford University Medical
> > Center, Stanford, Calif.; Sutter Memorial Hospital, Sacramento,
> > Calif.; Temple University Medical Center, Philadelphia; University of
> > Alabama at Birmingham; University Hospital of Cleveland; University of
> > Massachusetts Medical Center, Worcester, Mass.; and Vanderbilt
> > University Medical Center, Nashville, Tenn.
> >
> > --JHMI--
> > Media Contact: Brian Vastag (410)955-8665
> > <>
> > Karen Infeld (410)955-1534 (after 1/25/99)
> > <>
> >
> > SciNews-MedNews Menu <> | LifeNews Menu
> > <> | BizNews Menu
> > <>
> > Search Any Library <> | Newswise Home
> > <>
> > Use your browser's "Back" button to return to the article

From: Neal Lippman <>
Subject: Re: Atrial Fibrillation Cause and Cure
Date: Wed, 03 Feb 1999 04:01:36 GMT

In response to the several recent postings on this topic:

1. Atrial fibrillation (AF) is treated as a nuisance, rather than a life
threatening problem, because for the fast majority of AF sufferers, this
is exactly the case. Note, however, that I said "sufferers." I don't
discount the extreme symptoms and negative impact of life and well-being
that AF can have. On the other hand, it is important to ensure that the
cure is not worse than the disease; in this regard, it is important to
ensure that in using a potentially toxic antiarrhythmic drug or surgical
procedure such as the Maze procedure, that the risk of said therapy be
justified in terms of the potential benefit to the patient. When one of
my patients says to me "I would rather take on any risk to be rid of my
symptoms" then agressive drug or non-drug therapy is in order. If he/she
says "this doesn't bother me too much, I can live with it" then my level
of comfort with prescribing antiarrhythmic drugs is obviously much lower.

2. One reason that your doctors may not be helping you all that much with
your AF is that AF is actually an extremely difficult rhythm to treat,
despite the fact that it is so common. Unfortunately, achieving /
maintaining sinus rhythm is not as easy or as long-lasting as we would
like. You are, in part, seeing the limitation of medical knowledge and
capability as much as your individual doctors' limitations.

3. There is some emerging evidence linking some arrhythmias (AF, SVT,
PACs) with GI causes, most commonly esophageal dysmotility and GE reflux.
The details aren't really sorted out; there is more on this in the GI
literature than the cardiologic literature at present.


"Jerry D." wrote:

> One of my E.P.'s secretaries said it best.
> "If there was ever any cure for Afib we would go out of business."
> It seems many doctors appreciate the fact that AF is a "relatively" non
> life threatening arrythmia.  They can make countless errors in drug
> therapy and yet the patient will survive.  The quality of the patient's
> life does not seem to matter much to these doctors.  They view AF as a
> nusance and perhaps their patients as well.  V-Tach seems to be a
> priority at the expense of AF patients. From my experience I have found
> that many do not understand the quality of life issue with AF.
> My continuing battle with AF has caused me to lose faith in the American
> medical system.  However, I think any other disease would have brought
> me to the same conclusion.
> IMHO, the only person that can improve the quality of your life is
> yourself.
> Best of health to all,
> Jerry
> David Olson wrote:
> > My cardiologist flat out said there is nothing he
> > can do.  When it comes to the heart, the medical philosophy seems to be, if
> > it won't kill you or you don't pass out, we don't treat it.  A broken broken
> > arm won't kill you either but it sure causes a hell of a problem with
> > quality of life.
> >
> > Dave

From: Neal Lippman <>
Subject: Re: Atrial Fibrillation Cause and Cure
Date: Wed, 03 Feb 1999 04:09:04 GMT

There are several approaches to ablation for atrial fibrillation.

1. For some patients, most notably those with structurally normal or near
normal hearts and paroxysmal atrial fibrillation, ablation within the
right atrium may be effective in preventing AF recurrences. The success
rates (this data is all preliminary and unpublished) are around 40-60%;
there is no long term follow-up.  However, ablation confined to the right
atrium is relatively safe, and this may be an appropriate approach for
some patients with highly symptomatic PAF adverse to taking, or
unresponsive to, antiarrhythmia drugs. Another approach in this
population might be single site or dual site atrial pacing.

2. In some patients, AF appears to be initiated by a focal atrial
tachycardia that arises from around the pulmonary veins. In these
patients, ablation of that tachycardia appears to prevent AF recurrences.
While the procedural success rate is high, there is no longer term
follow-up. In addition, there are reports of ablation within the
pulmonary veins resulting in stenosis of the vein and pulmonary
hypertension, a very serious and lifethreatening condition. There is a
suggestion that stenosis of even one (of the four) PV's can cause
pulmonary hypertension, and more work is needed in this area.

3. For patients without the above two situations, the catheter Maze
procedure is an attempt, via catheters, to recreate the lines of
conduction block created surgically with the conventional Maze procedure.
In my opinion, the procedure types in the first 130 or so patients done
in the US were quite long, and the complication rate for serious
complications (death, stroke, pulmonary embolus, radiation burns to the
chest from the large amount of fluoro used) were unacceptibly high for
this procedure to be of general application. Again, more work is needed
and eventually, I hope, this procedure will become a more generally
applicable one.


Dick LeCompte wrote:

> You mention The Catheter maze procedure. mY cardiologist thinks it is a great
> advancement in teh treatment af specific A-fibs such as sick sinus syndrome .
> What have you heard about it . There has not been much chatter here about it and
> the little that I have seen has not been very positive. Comments?????Thanks.
> wrote:
> > Thanks for Dr. Neal "Excellant Summary on Atrial Fibrillation and the
> > available methods of controlling it". From the smmary, I gather there is
> > no cure. As an Electrical Engineer, this conclusion make sence.
> >
> > Since I have been diagnozed with" Chronic Lone Atrial Fibrillation"
> > 2 1/2 years ago, I have been reading about the AF. I am amazed about
> > the Medical Profession approal to proble solving. It is quite different
> > from my engineering profession. It seems the Medical Approach to AF is
> > to concentate on treating the symptom and not the cause. Why?
> >
> > I guess because this approach is a lot simpler than tackling the unknown
> > cause. In my case "Lone AF", exceclude mechanical heart functions and it
> > simply means unknown cause.
> >
> > The use of the maze procedure or catheter ablation cannot be consider a
> > mean to cure AF, simply because if the cause is unknown, there is no
> > gurantee that the problem would not return again.
> >
> > If the problem in the AF is the extra electrical signal(s) should it be
> > logical to find the source out side tha Atria and to fix it? For any Dr. who
> > can read my message: Is there any research in this area (to find the
> > cause out side the atria)? Is it possible that the problem comes from
> > an over load condition due to many electric signals arriving at the
> > sinus node (which resulted in sinus node damage)?  Should this oveload
> > condition exeplain the corrolation between excessive stess and heat
> > desease, between drinking cafeen and fast heart rate,...etc? Any comments?

From: B. Harris)
Subject: Re: CQ10 and Atrial Fibrillation
Date: 21 May 1999 00:47:37 GMT

In <>
(ACOFTIL) writes:

>I am an occasional lurker on this group. My father has an electrical
>atrial fibrillation (IOW-his brain sometimes does not send the proper
>electrical signals to his heart--causing fibrillation).
>I ran across several web sites and articles about using CQ10 for heart
>disease, but can't find any specifics about if it might help his
>situation--which is NOT actually heart disease.
>I have written the dr on the CQ10 web site, but no answer.
>I use CQ10 to help increase O2 in my brain (I have fibromyalgia). So, it
>only makes sense that if Dad could help his brain work better it might
>reduce the number of fibrillations he has. Right?

   Well, no.  Atrial fibrillation is not caused by bad signals from the
brain.  It's due usually to enlarged atria, in turn usually due to
ventricular stiffness from aging or high blood pressure, or to primary
lung or valvular disease.  It can also be caused by alcohol or thyroid
disease.   Workup requires an ultrasound exam and some hormone tests.
People who stay in atrial fibrillation, or who go in and out, are at
HUGE risk for embolic stroke (increases stroke risk by at least a
factor of 5), and need to be on coumadin, the major "blood thinner."
There are a number of effective ways of keeping some people out of
A-fib, starting with potassium and magnesium supplementation, and
progressing to various antiarrhymic drugs.  Coenzyme Q10, while benign
and perhaps helpful for blood pressure and possibly for some kinds of
heart failure, is not useful for atrial fibrillation.  If it is used in
place of coumadin and antiarrhymics it can be very dangerous-- in the
sense of wasting your time when you should be doing something to
prevent the stroke that is coming.

   Let me be blunt. One of the more common kinds of stroke from A-fib
is the left middle cerebral artery embolism.  That's the one that
leaves you paralyzed on your right side, not able to speak, and with
poor ability to read and even comprehend speech.  If you futz around
too long with alternative treatments for A-fib, you may eventually find
yourself looking into alternative treatments for people who drool in
wheelchairs and say "nuh, nuh, nuh, NUUUH!"

From: "Steve Harris" <>
Subject: Re: coumadin ?
Date: Fri, 9 May 2003 16:34:15 -0700
Message-ID: <b9hdtk$obk$>

Your risk of stoke rises by a factor of 7 without Coumadin
in A-fib. It's one of the few places where there aren't yet
any other good choices. I know of at least one alternative
drug in the pipeline, but it's still in trials. A few years

With newer ways of testing effect (INR) coumadin's a much
safer drug than it was 10 or 20 years ago. Bite the bullet
and do it.


"tools" <> wrote in message
> "Mick Williams, Jr." <> wrote in
> > Hi
> >
> > My father has just been informed by his Dr. that he will need to start
> > taking this drug for atrial fibrillation.  He is 64 and deathly afraid
> > of taking coumadin.  Several people he knew (including his brother,
> > whom I believe died of complications while on coumadin) have not had
> > much luck on this medication.
> > 
> > I have been looking online for alternatives, and the information I
> > have found seems to be both dated and conflicting.
> > 
> > My question:  What, if anything, can my father do to avoid taking
> > this?  He is not in the best of health, and his diet leaves something
> > to be desired.  Is a lifestyle change enough to stagger the necessity
> > of taking blood-thinning medication?
> > 
> > I am quite sure there exists no magic answer to my questions; however,
> > even precautions against certain alternatives would be greatly
> > appreciated.
> >
> > Thanks in advance,
> >
> > Mick Williams, Jr.
> Mick, you might find more help in one of the Herbal Medicine groups.
> That said, I think you might want to talk with a Doctor of Chinese
> Medicine.

From: "Steve Harris" <>
Subject: Re: coumadin ?
Date: Fri, 9 May 2003 17:01:47 -0700
Message-ID: <b9hfh9$4fp$>

"Beth Gottschalk" <> wrote in message
> In article
> (Mick Williams, Jr.) wrote:
> There are a number of natural blood-thinning supplements. You might want
> to look up garlic, valerian, red clover etc., etc. If you are lucky
> enough to find a doctor who is also familiar with alternative medicine
> (look for the letters "DO" along with "MD") and/or read up on everything
> you can find in Google (including side effects for each thing you find!)
> your father may not have to take the coumadin.

No such luck. D.O.'s are slightly differently trained but
they are not incompetent. Any D.O. will tell him just the
same as any M.D. "Get yourself on coumadin".

> For what it's worth, CoQ10 has been credited with modifying the
> arrhythmia or in some cases, I think, overcoming it.

No good evidence. There are antiarrhythmic meds, also, but
they fail once the atria are larger than a certain size. And
nothing helps this rhythm after you've been in it for more
than a year, since your atrial walls become fibrosed. If you
don't move any of your other muscles for a year, something
similar would happen to them also.

> Also, there are procedures (some less drastic than others) that I
> understand can restore natural heart rhythm.  I've also read that,
> according to one opinion, the rhythm is less important than the heart
> rate.

We're talking about stroke.

> I ran into the same problem and was afraid of the coumadin and other
> prescriptions.  Currently I'm using supplements and so far, apparently,
> so good.

Great. But when you stroke out with a big clot to your left
MCA, we won't be hearing from you here, will we?  Or perhaps
maybe "9slknwjcbkjwbrkjba" from your address if your
physical therapist manages to log you on.

Don't give advice on life and death matters, if you're
completely clueless about the subject you're talking about.


From: "Steve Harris" <>
Subject: Re: coumadin ?
Date: Sun, 11 May 2003 11:58:19 -0700
Message-ID: <b9m6ii$c64$>

"Mike & Heather Collins"
<> wrote in message
> Stev
> Not all herbalists are charlatans. I had a colleague who worked part
> time in the lab doing legitimate medical research and also ran his own
> herbal medicine practice.

Fine, but if he treated A-fib with herbs he was a charlatan.

Herbal effects on clotting tend to be mild, and where they
occur, tend to be platelet-related. Antiplatelet agents
don't work for preventing A-fib stroke, so you're pretty
much out of the game there.

In order to prevent stroke with A-fib you need to
anticoagulate to a quite significant extent-- a place you
don't dare stay without frequent monitoring of your clotting
system. Even if there WAS an herb that could put you there
(I will bet dinner there is none-- my own knowledge of real
and scientifically studied effects of herbs is not small),
what herbalist would run the PT INR tests to make sure you
stayed there?

This whole conversation is surreal.


From: Steve Harris <>
Subject: Re: Difference Between SVT and Afib
Date: 16 Feb 2005 12:04:00 -0800
Message-ID: <>

>>Better would be to read the OP, Steve, so you would understand the
question that was actually asked. <<

COMMENT: Here is the what the original poster (OP) asked:

>>Surely there is somebody out htere who can give a good explanation of
the difference between a SVT and AFIb.  We all know that anything above
the ventricle is by definition an SVT but Cardio definately do
distinguish between these two terms.  Surely it cannot be that difficult
to get an eductation explanation.<<

COMMENT: The answer I gave is correct, and consistent with the
reference. Here it is.

>>Yes. Though A-fib is a subset of SVT's (ie, one of many SVTs), in
practice the term "SVT" is somes lazily and incorrectly used for any old
narrow-complex tachycardia that is NOT A-fib. This is a bastardization,
and is be discouraged.  An SVT is any rapid heart rate which originates
in the atria or AV node (ie, not in the ventricle). There are half a
dozen common SVTs. <<

After this, YOUR answer to the OP was that "SVTs is not associated with
increased risk of cardioembolic strokes". To which I objected that this
explanation incorrectly differentiates the two entities. A fib is an
SVT which predisposes to stroke. To which you said essentially have if
a cardiologist defines them in terms of their embolic stroke risk, then
that's how they're being defined, QED. To which I reply bullshit. It's
not up to you to privately define the terms. They already have
Then the next howler: you say:

>>If you were to refer a patient to me (or any other cardiologist for
that matter) stating that the reason for the consultation was to evaluate
and treat an SVT and I (or any other cardiologist) were to find out that
your patient has Afib, my impression about you would be that you are
unable to discern an irregularly irregular rhythm. <<

My comment is that we weren't talking about me or any other doctor
referring a patient to you or any other cardiologist. YOU need to read
the OP question again.

As a matter of fact, I can think of cases where "SVT" is all you can
say about a rhythm which presents as a short run of narrow complex
rapid tachycardia on a single lead (say in an ICU), and that's all the
record of it you have. If it's not perfectly regular you can't rule out
A fib from that because a fast A fib can be surprisingly regular. All
you know is it's a short run of narrow complex tachycardia. This is why
the terms PSVT and SVT were invented in the first place. They are
narrow complex tachycardias, paroxysmal or not.


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