Any feedback on this doctor who is all over tube? I listened to him about ablation and he seemed pretty negative about the procedure.
Dr. Sanjay Gupta???: Any feedback on... - Atrial Fibrillati...
Dr. Sanjay Gupta???
I follow the guy on Facebook and Twitter and enjoy his YouTube channel. I use his wisdom as I do most of the stuff I read on the Internet, as reference. However, he isn't my EP in fact I don't think he is an Electrophysiologist and any decisions I have to make around my condition/ treatment would go through my own specialist. Still I think Dr Gupta doing what he does is so informative.
It seems to me there was another thread based on this discussion - and a lot of people were critical of his arguments - perhaps someone can repost the link to that earlier thread?
He is based in York but not on AFA electro physiologist list.
NYC is not the top place for heart problems.
There is a great variety of skill and knowledge and lack of skill and knowledge in cardiologists in NYC and NJ and other areas of NY State and all over the USA. My husband and I have been through afew cardiologists and have actually "fired" afew. Also, we have great freedom in which doctor or hospital we use.
In the USA the top hospitals for a heart procedure are: 1st Mayo Clinic in rochester Minnesota; 2nd: is the Cleveland Clinic, inCleveland, Ohio; 3rd is Strong Memorial Hospital (part of the university of rochester medical center) inRochester New York (where I had my ablation); and 4th is a hospital in Boston, the name of which I do not recall.
ALSO, you need and electrophysiologist; an extremely expert one, with an expert support staff, in an excellent hospital, in which the problems of afib procedure have never happened.(ex. the heat causes a hole between the left atrium and the adjacent esophagus)
The successful recovery from afib and ablation takes months and requires the patient's participation, to a very high degree, to keep himself very healthy as per avoiding triggers, figuring out what suppplements and foods to consume, how to take , with what other things, and how long before a particular drug ; how much and what type of exercise to use and how to increase slowly and so many other things. It all can work out very successfully. if not correctly.
I do not think Sanjay Gupta knows about ablations. He also probably does not have afib. Electrophysiology is an extemely complex esoteric field.
The doctor I saw for this procedure has done thousands of them --it is all he and his staff do--he has written hudnreds of research articles and electrophysiology and other medical text books and teaches in the medical school about this. Here is a person who is expert and who is thinking about how to deal with this problem.
As far as cardiologists go, and medical insuirance, most cardiologists do not seem to know that a magnesium deficiency can cause afib,; they do not test for red blood cell magnesium but use plasma magnesium if anything at all and have told me at our consult that if my plasma magnesium is within range even if very low it means that the insides of my cells have enough magnesium. It turns out that this is actually not true. I know this but that doctor does not. scary!!';
the red blood cell magnesium test range has an upper limit. If your result is at that upper limit this means your cells have a good amoutn of magnesium inside them. Then we have different kinds of magnesium-Magnesium L-threonate passes the blood brain barrier going to the hypothalamus which controls heart rate' magnesium glycinate is more relaxing' also magnesium taurate is good. and of course you can't take too much magnesium or take it within 3 hours of sotalol--so the whole thing is very complicated.
The doctors in general seem to ignore the fact that inflammation can cause afib. Ex. bio markers of inflammation should be tested at an annual checkup and especially if have hypertension or any cardio symptoms. Please look at Cleveland Clinic Heart Lab list of blood tests fpor thoise with any hear tissues. In fact their Dr. Nisson has said that these 10 tests should be gieven as part of a PREVENTIVE test checkup. Note that the operative word here is PREVENTIVE. (see cleveland clinic)
Such markers may be: c-reactive protein (hsCRP) ; homocysteine; fibrinogen; isoprostanes;MT-Pro BNT- shows that the heart is irritated or under stress-this is an enzyme produce dby the left ventricle when the hear tis under stress; matrix metalloproteinase; and there are others. Also recommended is an ekg, an echocardiogram, and a base line heart scan--the scan at princceton longevity in prineton nj, with cardiologist/engineer Dr. Rhumberger has the correct soft ware to show any plaque including on valves. You can have a cardio artery plaque score of 900 without having any symptoms although this score guarantees you may have a 90% cahnce os a sever cardio vascular advers event within the next few months.
The cardiologists in general ignore the fact that "diseases of aging" are caused , in large part, by inflammation and mitochondrial decay. Inflammation is in fact one of the afib triggers--so if you have an ablation, but later you expose yoursefl to all the triggers, it may appear that the ablation failed--how about before getting another ablation a patient removed all the triggers?
Doctors do not prescribe all the bio marker tests and insurance does not always pay for them . My pre medicare insurance paid for these but I had to insist the doctor prescribed these tests; Medicare does not pay for them. I buy the tests from a company called Life Extension (LEF.org)-their doctor writes the prescription'; the cost is verylow compared to what the labs charge the insurance compahny and would bill you for if the insurance does not pay--ex. I got a bunch of tests for $350 that the lab would charge an insurance company $3500 for at least. However the Life Extension foundation has a contract with a laboratory in the neighboring state to where I live and we drive 80 miles each way to do the blood draw. The results are then e mailed to me, and a hard copy can be sent as well if I request it. The labs can also be e mailed by the Lab Corp comapany to my doctor. I use a hormone and thyroid doctor who has opted out of insurance so he can easily give his patients appropriate care. He charges me $300 once a year for an in person consult after I have obtained the blood test (cbc, comprehensive metabolic panel, all hormones, thyroids etc)--so all this excellent checkup costs me $650 a year. All these things are necessary for heart health--and of course the tests have an add on I include for red blood cell magnesium. If I want to pay another $100 I can get a blood test for oxidized LDL and matrix metalloproteinase (bad stuff that consumes collagen--holds heart cells and all body;s cells together--also collagen is the primary component of your heart valves and all your ligaments and tendons)---so you can see why someone might think ablations don't work.
I seee my electrophysiologist every 6 months for an ekg to check I am in normal sinus rythm and to check my QT interval ( which can be mnmade to long by sotalol) and my metabolic panel to check that none of the meds I take are harming me.
But the rest is really up to me. So you cAn see why there is more to a successful recovery than simply getting an ablation.
I realize this is too much info and every aspect may not apply to you-and maybe ablation is not right for you- but it covers whether sanjay gupta is right.
I think he makes huge sense and I like his approach. However everyone's condition is unique.
I thought he was an EP ??
No ...cardiologist not EP.
I see now that I've been confusing Dr Sanjay Gupta with Dr Dhiraj Gupta at the Liverpool Heart & Chest hospital who is an EP
@Yatsura
Cardiologists do NOT know about afib like an electrophysiologist does. Not only that you have to get a very very excellent electrophysiologist. ex. Mayo clinic, Cliveland clinic, Strong memorial hospital (all in USA)
I think it is great to have his videos to use as we wish to, remembering that some of what he says is opinion not fact. I do think he should be a little bit careful about what he says as his videos are so available to people and not everyone has access to other opinions. I have listened to a lot of them and take on board some of what he says and use some of his more challenging statements to form questions for my own E.P. x
dedeottie try looking at LEF.org-also of the 80 or so references following each article, you can click on some of them or look them up elsewhere; also look at biofoundations.org--you can also click on most of their reference research papers. you can say you want info about cardiovascular health and also specifically about afib and about inflammation etc. These are sources of direct research info. so you can read them and reach your own conclusion and see if you agree with the organizations conclusions. Also when you get the abstract of a scientific research article on pub med and want the whole article without buying the journal or paying for the article if you e mail the corresponding author whose e mail is at the top of the article-regardless of his country he or she will be more than happy to thank you for your interest in his research and e mail you the complete research article. I hope this will give you more information so that you can make an informed choice.
Dedottie, I do so agree with what you have just posted. I don't think that everyone agrees with what are often just his opinions.
here is another article which I posted on another thread which gives a good overview
For the majority of those with paroxysmal AF the decision about ablation is really a simple one. Either heed the largely unwarranted scare stories and watch your AF and the attendant suffering get worse over the months and years to the point where it becomes too late to go down that route. Or have an ablation (perhaps you'll need more than one) and like the thousands before you, dump this awful condition once and for all. Dr Gupta has produced some very informative videos but I agree his piece on ablations was very negative. From my 'limited' experience, this hesitancy around ablation therapy is not unique among non-EP cardios. (Odd, I know - perhaps it's worth investigating this further.)
However his input has probably left another thousand souls fearing their own shadows and putting off what is the nearest thing available to a long term cure. Not a good situation.
Hes not gonna scare me from my ablation I can't wait to get it done!!! X
Me too, just hope I am suitable, I'm in NSR after a CV in January, but worried that my left ventricle is knackered after being in fast AF for 6 weeks and uncontrolled high blood pressure for I don't know how long
This is the earlier thread
healthunlocked.com/afassoci...
I wasn't convinced by his arguments at all I am afraid.
And look how his video clip was brilliantly and so clearly discredited by Robert E Lee in the post below it. The days when one took what a doctor said as gospel simply because he was a doctor have, thankfully, long gone.
@MikeCol research research research--there is a lot of info.LEF.org bIofoundations .org cleveland clinic heart lab--jus t aBOUT HEART HEALTH, WHAT BLOOD TESTS AND PREVENTIVE TEST TO DO BEFORE YOU HAVE A PROBLEM SO THEN AFTER SEEING THE TESTS YOUCAN FIND IDEAS ABOUT HOW TO CHANGE THE DIRECTION THINGS ARE GOING BEFORE YOU GET DNAGEROUS SYMPTOMS. DOCTORS WANT YOU TO WAIT TIL YOU HAVE SYMPTOMS BEFORE DOING ANY TESTS. uSUALLY this is due to an insurance company not paying for such tezts because it has decided they are not medically necessary. In other words if you are not severly ill theinsurance does not want ot do tests. Medicine is currently not preventive enough--not geared enough to increasing health longevity--why I read LEF.org info (stands for life extension-gee what a concept)_ Medical life extension as per insurance sometimes just means keeping you alive while treating multiple illnesses. I'd rather prevent the conditions and be alive and healthy at the same time. THIS IS BACKWARDS. IT IS THEN DISEASE CARE INSTEAD OF PREVENTIVE HEALTH CARE. read AND THEN YOUCAN EXTEND YOUR HEALTH LONGEVITY.
Haven't watched this one will try to do so. It's so confusing to have an ablation or not. Three years for me with Paf last 18 months no a and e return to normality on flec etc. Cardiologist said we have other options "before we stick wires into you ". I have read on here that people have been taking flec or like minded meds to stop rythym for years. Is this an option .....keep taking the pills.......naively obeying my consultant. ....don't know what the future brings but I get the feeling that a number of authors on this site think that ablation is key and Paf will only progress into something unmanageable. I will be interested in seeing what Dr Gupta has to say is there a link please. Chris
I think it's important to understand that while there may well be other drug related options to try before ablation, only an ablation (perhaps more than one) can make AF go away. Meds can only make the symptoms more bearable in the short to medium term. But the clock is always ticking; it's likely that the frequency and duration of episodes will increase, symptoms will become more resistant to drug treatment and, the key point, the ablation option is slipping away from you.
Where's the other side of this coin? Where are all these scary ablations that leave patients either dead or permanently worse off than they were before they submitted themselves to this terrifying procedure? We know that ablations don't always achieve what they set out to achieve. Staying AF free is certainly not guaranteed at the end of your day and a half in hospital. But if that's the case, then 'disappointment' is probably the worse thing you will experience. But what have you lost, other than a bit of time making arrangements for the next one?
One thing is certain. Rejecting the ablation option if it's available to you means AF, and all the baggage it carries now and in the future, will stay with you for the rest of your life. Now that prospect scares me far more than a second ablation, should it ever become necessary.
But you must make up your own minds, of course.
I think its worth taking a chance. But there can be problems believe me.
I have had 3 ablations now. Have had af for about 16 years. Pacemaker for 14 years. Struggled with most meds. First ablation didnt work and i was back in hospital twice with a bleed from groin. Second one worked for 3 years. Had third one couple of weeks ago. . Prof Schilling found much to do then problems after. Toe caused an oesophageal haematoma and pericardium and pleural efusions. Very painful. In hospital for 5 nights and still got af at mo. Just hope it has worked as couldnt go through it again. I think I am an awkward customer. they do their best. i am 64.
If you are still young and working its perhaps worth a try. But if you do you must rest properly after to let the groin heal.
Dr Sanjay Gupta is a consultant Cardiologist I'm not sure he has ever claimed to be an EP....I find his opinions and knowledge very helpful along with all the other advice that is widely available....I find this gives us all the opportunity to make informed choices rather than just accept blindly what our own consultant cardiologist/GPs say and we all accept as fact...who quite frankly in my own experience have been worse than poor I think we are lucky to have experts Like Dr Gupta putting himself out there helping many understand a little more what is AF is all about although each and every one of us has a very different experience with how AF affects our lives........
If you would like unbiased information from guys who specialise in AF I Would highly recommend the AFA Patients day in October. I have attended a few now and each time I have taken so much from it. Getting to speak with EPs close up about everything AF is the best thing we as sufferers could hope for. There are different opinions and ablation is always a hot topic.
Cheers, Jason
He's not an EP, he doesn't have AF, he's never performed or received an ablation - how is he an expert Steve?
As I said in my original comment he is an Consultant Cardiologist so I presume he has just a little more expertise in this field than many who claim to have all the answers......my own experience with so called experts has been nothing short of borderline incompetence so I prefer to read listen and learn then hopefully make a considered choice in which direction to take .....
Unwise to presume Steve. The video says it all. He clearly lacks the specialised knowledge of AF that is acquired by an EP. Just watch it again then read Robert E Lee's critique.
Electrophysiologists are the experts in arrythmias - would you ask a plumber to fix your electrics?
100% agree and I have never said cardiologist are experts in arrhythmia if you care to read my previous comments not just the bit that suits your twisted argument....unfortunately both my GP and consultant cardiologist refuse point blank to refer me to see an EP so I have no option than to listen to the advice of others who put themselves out there for us all to make our choices...
A lot of EPs have made videos including Professor Richard Schilling. I think it can only be a good thing as it gives us more information and then we can make our own choices. I would like to see a video on the different medications used to treat AF and their long term use.
it is indeed a good thing - it would appear that information given even post ablation can be very poor judging by the number of posts that we say a few weeks after the procedure saying "had a few blips" is this normal - that would not suggest information is great - also few appear to have had explained the complication rate (4/5%) which again we see queries about on here . In the end the decision to go for the ablation will probably depend on how bad the AF is and how its affecting your quality of life that makes any risk worth taking , but, the decision should be taken based on full information which clearly is not the case for many.
A man stood on a river bank in Africa with a cardiologist and an EP. The river was full of crocodiles and coming towards the river was a large lion. "Get in my boat and I will take you across the river" said the cardiologist. " Don't worry "said the EP "I have a rifle and can shoot the lion". at which point the cardiologist chimes in "Oh don't trust him.--- sometimes he misses".
Ah Bob, so did you get in the boat or trust the shot??!!
I am somewhat familiar with Dr Gupta in the US. He is a neurosurgeon, not an EP or ablation expert that I am aware of. Not sure if he has ever performed or even been present during an Ablation procedure. More importantly, I think he spends more time in front of the TV these days than in surgery. He had been CNN's medical reporter for many years. While his reporting can be interesting at times (albeit controversial) he is a TV medical generalist and certainly not an ablation expert to my knowledge. I saw the video that was posted a few weeks ago and I had the same negative reaction as some of those who also watched it. Basically, I would rely on an EP, who does this stuff day in and day out and not a TV medical reporter.
Jeff
I think that there is another sanjay Gupta in the US, not the one we are referring to here who practices in York.
Looks like I'm mistaken. I reviewed the video again and he sounds and looks remarkably similar to the CNN reporter. I stand corrected, but my point still stands- rely on the EP who does ablations for a living
Old York! The original....
The Dr Gupta you are referring to is not the same guy..but none the less I agree with your opinions on seeing an EP.....
My GP mentioned that knowledge about health care doubles every four years so it is very difficult for even doctors to be on top of their game unless they continually take new training which is probably difficult for them to do, especially if it is very specialized. This is likely a big reason why there are so many different opinions by health care professionals.
i am impressed with his recommendations. and have taken his suggestions to heart. my motto is and always has been that if it is not completely broken, do not fix it. everyone is always in a hurry to alleviate discomfort. no one is going to feel good all the time. your body has an amazing ability to cope and adapt with the changes. leave well enough alone. more is not always better. i suffer from many health issues. pills and intervention are not always the answer. knowing your body and what triggers the problems and learning how to deal with it is a great plus. it takes patience and research and the ability to be able to say no, today is not a good day, i will rest and regroup and focus on feeling better when i am rested. i think the dr gupta is trying to get the word out that ablation is not the fix all answer. and when all else fails maybe it can help, but most likely not. and keep taking those baby aspirins daily in the meantime. my 2 cents.
I respect your 2 cents lessuey but I would suggest that your 'lay back and accept it' attitude is not one that would find favour everywhere.
"My motto is and always has been that if it is not completely broken, do not fix it."
I bet you have a lovely home....and car..... and.......
Sorry lessuey, but it's not a great position to spout words of wisdom from.
Before my diagnosis I took baby aspirin - I considered lots of reports about the benefits of aspirin on various cancers and a multitude of other things. I have stopped now I am on warfarin. But I am worried - are you taking aspirin instead of warfarin?
Lessuey may be in the USA where they still prescribe aspirin even though in the UK it was stopped 2 years ago for AF. Also most of Europe does not prescribe aspirin.
i refuse to take any prescribed drugs if i can prevent stroke and thin my blood the old fashioned way. the aspirin way. it is an anti inflammatory with little to none side effects. it has been shown to assist health beyond just blood thinning. but then again, there are no huge profits for drug companies on aspirin.
I hear what you say about the multiple beneficial effects of aspirin (I used to take it too) but please, google aspirin v. warfarin for AFib patients - all the recent research shows warfarin or the NOACs are far superior in reducing stroke risk.
Hi Lessuey, if you have AF and are taking aspirin then this certainly goes against all current medical advice. But I am sure you have read about that. Just a quick point about drug company profits, aspirin is of course a cheap drug, but so is warfarin, which has been out of "license" for more than 50 years and is one of the cheapest drugs you can buy and certainly does not add to the profits of any multinational drug company.
Be well
Ian
Lessuey...my sister in law is confined to a bed in a nursing home due to a debilitating stroke because she went against her docs advice and refused a blood thinner in favor of an aspirin.
Sorry to hear that.
From you post am I correct in thinking you are in the US.
As this is an old post from 5 months ago (I only picked it up because of subscribing and having an email alert of a new reply) I was wondering if you would make this a brand new post because that will then draw attention to the risks.
Thanks. PeterWh.
yes, way less warnings and side effects. way less likely to suffer an uncontrollable "bleed"
Depends where the bleed is - far more gastric tract bleeds with asprin. My grandmother used to take asprin daily for arthritis 60+ years ago - it was thought to be 'safe' treatment back in the day - unfortunately for her it was not.
She survived the bleed but never took another as long as she lived. And her son was a doctor and it was only because he noticed she was having symptoms, recognized them and got her to hospital that she survived. Do not delude yourself that asprin is 'safe' - it is no safer than any other drug.
Less likely to have a cranial bleed though, (is that what you call 'uncontrollable'?) according to studies.
ALL 'medicines' have side effects - it is always a personal decision as to what to take but it is a good idea to thoroughly research your subject before making that choice.
An occassional asprin is not going to do you harm and there are some occasions such as after open heart surgery or insertion of stents or after a TIA or stroke when it is the best choice. But remember it is an anti-platelet not an anti-coagulant and therefore not affective for helping to prevent strokes in AF patients.
Sorry but that concept is well out of date. In many areas preventative maintenance is done because the affects and issues and inconvenience is significantly reduced. Medicine has catching up to do in that respect!!!! With AF there is strong evidence that doing it whilst in paroxysmal is so much more successful than waiting for the AF to become persistent.
I know that EPs always say that one should consider an ablation only to address symptoms and quality of life issues, not stroke risk or longevity. My EP says the same thing and Dr. Gupta informs us that having AF in the past has already done some damage to the heart, so stroke risk will still be elevated after an ablation.
However, it just makes common sense that if having a number of AF episodes increases one's risk of having a stroke, then a process (ablation) that reduces or eliminates AF episodes should also reduce one's risk of having a stroke; probably not reduced to the level of non AF patients, but at least reduced.
I think of it this way (my percentages are probably not correct but illustrative): If I was a non AF person, my annual stroke risk might be .5% and as an AF person my stroke risk might be 4%. If having an ablation reduces my annual stroke risk down to 2 or 3%, then, relative to the non AF population, I am still at risk of stroke (and should remain on anticoagulants), but my overall stroke risk would go down.
I know that the ablation procedure itself increases risk of stroke during and immediately after the procedure so I don't know how to factor that in.
Here's a 2013 study that seems support my theory that ablations reduce stroke risk:
heartrhythmjournal.com/arti...
However, here's a 2015 study that shows ablations have no impact on stroke risk:
ncbi.nlm.nih.gov/pmc/articl...
I am curious if any of you have had conversations with your EP about this topic or have ideas where to get more information.
It doesn't really matter Jeffer. If you are on anti-coags and remain on them after the ablation - your stroke risk is as low as you are ever going to get it. It really isn't something to worry about. The number of people having a stroke during ablation is so small as to be something else not to worry about. Mind you, it's probably the best place in the world to have a stroke, if you think about.
Thanks for the reply Mike. I will stay on anticoagulants but I was just considering pros and cons for a 2nd ablation. I have had improvement after my 1st ablation but still have some occasional quality of life issues with shorter AF episodes.
Maybe I'm just overly concerned about a stroke since my father had AF, had a severe stroke and eventually died from it (after a year of a non-existent life in a facility). Now I see Mark's reply below about potentially reduced Alzheimers risk too (another big worry of mine - lol) and the pro arguments for a 2nd ablation are beginning to win.
My mum had AF she took Warfarin but over time the AF led to heart failure and after seven years she passed away after having a cardiac arrest. but that was fifteen years ago and things have changed. my dad had Alzheimer's and it was the most awful time but the point is neither of my parents had a stroke. so while I do know there are percentages you can't live your life by them there are a lot of things you can do to help your self but after that as my mum used to say (Que sera sera)
One aspect that must NOT be overlooked is that practices change which can render statistics and issues meaningless.
One of these is in relation to strokes having an ablation. Up to recently many EPs stopped the patient's anticoagulant (usually warfarin) for 5 days or so before the ablation and sometimes for a few days afterwards. I suspect that some EPs still do this. However a FEW patients suffered a stroke as a result but NOT because of the ablation per se but because Anticoagulation was stopped. However many now do not stop Anticoagulation AT ALL (even the night before). The rationale is to reduce the risk of a stroke. I suspect that if the study was rerun now then the "official" risk of a stroke at the time of the ablation is now REDUCED.
Peter,when I had my ablation,they stopped my anticoagulants three days prior to the procedure. They gave me a different type the day of the procedure. I had a cryoablation done. They had to have my clotting factor up to a certain level to remove the insertion sheaths. Once they were removed I started on warafin. Supposedly, this was to reduce the chance of developing a clot and related consequences.
When I had my ablation last year my EP wanted my INR to be in the range 2.5 to 3.5. I was instructed take the warfarin the night before at 7.30pm as usual. The next morning (Monday) my INR was only 2.1 but still went ahead with ablation with a top up. That evening warfarin was taken as usual (though a bit later as I was not back on the ward until latter 6pm and was in lying flat mode. The next morning (Tuesday) INR was 2.7. However by Saturday am when I took INR with my coaguchek INR dropped to 1.9 and warfarin dose increased from 4mg to 5mg. By Sunday morning INR dropped further to 1.7. Monday 2.0 then Wednesday back in range at 2.9. This dip after ablation is apparently normal. During the ablation and in the few days afterwards the body is repairing and hence clotting takes place. One of reasons for increased risks.
They wanted mine to be 2.0. The first reading was 2.9. Had a looooong wait to get it down to that level. My back still aches when I think about it :-)))
I had a conversation with Richard Schilling as to whether a successful ablation reduced stroke risk. He thinks it does however until the link is proven (there's a large ongoing trial) he suggests remaining on warfarin.
Related to this, I was reading an article today which indicates that dementia, particularly Alzheimers, is reduced with a successful ablation. Also those with more than 75% TTR on warfarin have a far lower risk of dementia than those with TTR less than 75%.
Responding generally about risks because various responses are missing the point except jeffer.
Yes the risk is reduced by an ablation BUT it will NOT return you to the "normal" risk that the majority of people have. Ergo it is important to continue with Anticoagulation.
Also remember that statistics are, contrary to popular belief, are not exactly accurate and in essence is a sample that is manipulated, extrapolated, etc. In particular for medical trials the overall numbers involved are relatively small though I suspect (hopefully) well selected. However once release the numbers can be refined. Also issues and side effects that were not identified in the trials can become apparent, particularly because people are on different medications and as we all know AF and medicines affect each off us quite differently.
For example it could mean that if there are 100 people in a room and they are checked out then 5 or 10 or more of them have AF even though the accepted number is 1% of the population so it should only be 1 who had AF. Similarly you could have 10,000 people in a stadium and none of them have AF.