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Video: Stroke Prevention in A-Fib and Anticoagulant Therapy
Through interviews and animations explains how atrial fibrillation can cause stroke and why anticoagulation is so important. Discussion of warfarin (brand name Coumadin), the required (weekly or monthly) monitoring, interactions with food, alcohol and other drugs and the newer anticoagulants (NOACs).
Developed in association with Boehringer Ingelheim [one manufacturer of the new NOACs]. (5:36)
YouTube video playback controls: When watching this video, you have several playback options. The following controls are located in the lower right portion of the frame: Turn on closed captions, Settings (speed/quality), Watch on YouTube website, and Enlarge video to full frame. Click an icon to select.
If you find any errors on this page, email us. Y Last updated: Monday, January 15, 2018
New Research on NOACs: Which has More Bleeding Risk―Which is Safer?
Do you take the anticoagulant, Xarelto? Or one of the newer NOACs? Which is safest? Which has the least GI bleeding?
NOACs Research Study Results
A Mayo Clinic study indicated that the risk of gastrointestinal (GI) bleeding is higher for patients taking Xarelto than for other anticoagulants in its class.
The researchers compared the gastrointestinal (GI) safety profile of three rival oral anticoagulants: Xarelto (rivaroxaban), Pradaxa (dabigatran) and Eliquis (apixaban). All of the patients in the study had Atrial Fibrillation.
Bleeding occurrence: GI bleeding occurred more frequently in patients taking Xarelto compared to Pradaxa (approximately 20% increased risk), while Eliquis had the lowest GI bleeding risk.
Age factor: They also found that the risk of GI bleeds increased with age. In particular, patients over the age of 75 were at an increased risk.
Safety: Eliquis had the most favorable GI safety profile, even among very elderly patients, and Xarelto had the least favorable. … Continue reading this report…->
2017 AF Symposium: New Reports on Reversing Fibrosis and Hypercoagulability & NOACs
I've been a busy writer since attending the 2017 AF Symposium in January. Here are two more summary reports.
Report 5: Some Forms of Fibrosis May Be Reversible: Research with Overweight Sheep
In a very hopeful study for Atrial Fibrillation patients, Dr. Stanley Nattel of the University of Montreal, Montreal, Canada concluded that some forms or types of fibrosis are indeed reversible.
He described his experiments with overweight sheep. A 30% weight lost reduced fibrosis as well as inflammation and incidence of A-Fib. Continue reading….
Report 6: Hypercoagulability May Cause A-Fib, NOACs May Prevent It
Novel oral anticoagulants (NOACs) may both prevent and stop A-Fib, according to a thought-provoking hypothesis by Dr. Ulrich Schotten of the University of Maastricht, Maastricht, The Netherlands.
His different, somewhat contrary hypothesis flips the current thinking― that hypercoagulability increases and promotes A-Fib (versus A-Fib increasing hypercoagulability).
Working with specially designed mice with increased thrombin activity (hypercoagulated mice), Dr. Schotten found that these mice had increased atrial fibrosis and A-Fib, and a hypercoagulated state promotes atrial fibrosis…Continue reading….
See the entire list of my reports from the 2017 AF Symposium.
Look for three more reports soon.
2017 AF Symposium: Hypercoagulability May Cause A-Fib, NOACs May Prevent It
AF Symposium 2017
Hypercoagulability May Cause A-Fib, NOACs May Prevent It
Novel oral anticoagulants (NOACs) may both prevent and stop A-Fib, according to a thought-provoking hypothesis by Dr. Ulrich Schotten of the University of Maastricht, Maastricht, The Netherlands.
We know that untreated A-Fib increases the risk of stroke 4-5 times and causes decreased blood flow (ischemia). A-Fib also increases the heart's tendency for blood to coagulate and form clots (hypercoagulability).
Dr. Schotten presented a different, somewhat contrary, and thought-provoking hypothesis that flips current thinking― that hypercoagulability increases and promotes A-Fib (versus A-Fib increasing hypercoagulability).
Research with mice: Working with specially designed mice with increased thrombin activity (hypercoagulated mice), Dr. Schotten found that these mice had increased atrial fibrosis and A-Fib, that a hypercoagulated state promotes atrial fibrosis and A-Fib. Coagulation factors produce profibrotic and proinflammatory responses which can both induce and maintain A-Fib.
The anticoagulant Nadroparin used primarily in surgery (brand name fraxiparine or fraxodi) was used in these mice to reduce their hypercoagulabity. This inhibited the development of A-Fib in these mice.
Dr. Schotten found that Novel Oral Anticoagulants (NOACs), but not warfarin, inhibit collagen synthesis (atrial fibrosis) by reducing the activity of Protease Activated Receptors (PARs).
What Patients Need to Know
Dr. Schotten's preliminary research indicates there may be a special benefit to taking NOACs. Not only do they reduce hypercoagulability and thereby work to prevent A-Fib strokes, but they may both prevent and stop A-Fib. This is a ground-breaking hypothesis which may lead to major advances in A-Fib research and treatments.
More About Dr. Ulrich Schotten
See a short video by Dr. Schotten: Digital tools for personalized therapy of cardiac arrhythmia presentation at the European Health Science Match, October 2016. (3:11 min.)
Return to 2017 AF Symposium reports
If you find any errors on this page, email us. ♥ Last updated: Monday, February 6, 2017
FAQs A-Fib Drug Therapy: Anticoagulant Side Effects and Alternatives to Xarelto (NOACs)
FAQs A-Fib Drug Therapy: Alternatives to Xarelto
24. "I have A-Fib, and my heart doctor wants me to take Xarelto 15 mg. I am concerned about the side effects which can involve death. What else can I do?"
You are right to be concerned about the side effects of Xarelto, one of the new Novel Oral Anticoagulants (NOACs).
All anticoagulants are inherently dangerous. You bruise easily, cuts take a long time to stop bleeding, you can't participate in any contact sports; there is an increased risk of developing a hemorrhagic stroke and gastrointestinal bleeding. "Oral anticoagulants are high-risk medications" (Drs. Witt & Hansen) (Most EPs are well aware of the risks of life-long anticoagulation.)
Primary risk: Uncontrolled bleeding is the primary risk (patients have bled to death in the ER.) Anticoagulants cause or increase bleeding. That's how they work. To decrease your risk of blood clots and stroke, they hinder the clotting ability of your blood. But, they also increase your risk of bleeding.
Normally, clotting is a good thing like when you have a scrape or cut.
Other risks: Do the NOACs have the same long-term problems as warfarin (Coumadin), i.e., microbleeds in the brain, hemorrhagic stroke, early dementia, etc.?
We don't know yet. The NOACs haven't been around long enough to determine their long-term side effects. But intuitively one would expect so. (The recent spate of ads from lawyers seeking clients who have been harmed by NOACs would seem to lead to this conclusion.)
Anticoagulants Protect You and Give Peace of Mind
But in spite of the possible negative effects of anticoagulants, if you have A-Fib and a real risk of stroke, anticoagulants do work. You're no longer 4–5 times more likely to have an A-Fib (ischemic) stroke. Taking an anticoagulant to prevent an A-Fib stroke also may give you peace of mind.
What Else Can You Do? Remove the Reason for an Anticoagulant—Three Options
Be advised: No anticoagulant will absolutely guarantee you will never have a stroke.
The best way to deal with the increased risk of stroke and side effects of anticoagulants is to no longer need them. Here are three options:
#1 Alternative: Get rid of your A-Fib.
As EP and prolific blogger Dr. John Mandrola wrote: "…if there is no A-Fib, there is no benefit from anticoagulation."
Action: Request a catheter ablation procedure. Today, you can have an ablation immediately (called 'first-line therapy'). You don't have to waste a year on failed drug therapies. See Catheter Ablation Reduces Stroke Risk Even for Higher Risk Patients
#2 Alternative: Close off your Left Atrial Appendage (LAA).
The Left Atrial Appendage is where 90%-95% of A-Fib clots originate.
Action: Request a Watchman device. The Watchman device is inserted to close off your LAA and keep clots from entering your blood stream. See Watchman Better Than Lifetime on Warfarin
#3 Alternative: Consider non-prescription blood thinners
Ask your doctor about your CHA2DS2-VASc score (a stroke risk assessor). If your score is a 1 or 2 (out of 10), ask if you could take a non-prescription approach to a blood thinner.
Perhaps you can benefit from an increase in natural blood thinners such as turmeric, ginger and vitamin E or, especially, the supplement Nattokinase. See FAQ: "Are natural blood thinners as good as prescription blood thinners?"
Bottom Line
Whether or not to take anticoagulants (and which one) is one of the most difficult decisions you and your doctor must make. Talk to your doctor about alternatives to anticoagulants: Taking an anticoagulant isn't like taking a daily vitamin. Only take one if you are at a real risk of stroke.
Taking an anticoagulant isn't like taking a daily vitamin. Only take one if you are at a real risk of stroke.
• Catheter ablation
• LAA closure (Watchman device)
• Non-prescription blood thinners
If you decide to stay on a NOAC, ask your doctor about taking Eliquis instead of Xarelto. Eliquis tested better than the other NOACs and is considered safer. See Warfarin vs. Pradaxa and the Other New Anticoagulants and the FAQ: Is Eliquis Safer.
Thanks to Jim Lewis for this question.
Witt, Daniel W. and Hansen, Alisyn L. editorial in New Oral Anticoagulants Can Require Careful Dosing Too. by Scott Baltic. Medscape/Reuters Health Information, December 29, 2016. http://www.medscape.com/viewarticle/873821?src=wnl_edit_tpal
You must be your own best patient advocate.
Don't settle for a lifetime on anticoagulants or blood thinners.
Last updated: Sunday, January 1, 2017 Return to FAQ Drug Therapies
NOACs: Why Isn't There a Way to Measure Their Effectiveness?
Warfarin has one, but the NOACs don't. What am I talking about?
Warfarin (Coumadin) has a way to monitor and measure its effectiveness for a specific patient. But there's no similar way to measure the effectiveness of the new Novel Anticoagulant drugs (NOACs).
Warfarin and Your INR
With warfarin, blood testing for your INR (International Normalized Ratio) will tell your doctor what dosage of warfarin is needed to maintain your ideal INR range between 2.0 and 3.0. (Below 2.0, there's more of a risk of an ischemic [clotting] stroke; above 4.0, there's more of a risk of a hemorrhagic [bleeding] stroke.)
NOACs: No Blood Testing but at What Price?
From the clinical trials we know NOACs work as well as warfarin. In addition, the NOACs don't require periodic blood testing. But the FDA, under pressure for new anticoagulants, approved the NOACs without there being any established or universally recognized method of determining their clot preventing effectiveness.
Without any method of determining their clot preventing effectiveness, how can you determine if your NOAC is working for you? … Continue reading this report…->
New FAQ About Testing of NOACs and Natural Blood Thinners
I've posted a new FAQ in the Complementary & Natural Therapies section:
"Have there been any tests comparing natural blood thinners to the new anticoagulants (NOACs) in terms of efficacy and speed of onset?"
Comparison testing is unlikely. It's highly unlikely that pharmaceutical companies and the FDA will one day pay for unbiased tests comparing their products to natural blood thinners. They have everything to lose and nothing to gain. Clinical trials are expensive, so it's unlikely any others (i.e., the nutritional supplements industry) will have a financial incentive to pursue it either.
Stop Taking Warfarin―Produces Arterial Calcification
Stop Taking Warfarin―Produces Arterial Calcification
The blood thinner, warfarin (Coumadin) is a "vitamin K-antagonist" which works by blocking vitamin K (i.e., K-2, menaquinone), thereby affecting several steps in the anticoagulation pathway and decreasing clotting proteins in the blood.
But vitamin K is also essential for heart and bone health. Vitamin K determines whether we maintain strong bone density and soft pliable tissues. Without enough K-2, osteocalcin, a protein that binds calcium to bone, doesn't function. This vascular calcification produces plaque and reduces aortic and artery elasticity.
"When calcium doesn't stay in bones, it can end up clogging your arteries, causing a heart attack or stroke."
Warfarin Blocks Vitamin K: Deposits Calcium in Arteries
By blocking vitamin K (K-2), warfarin deposits calcium in our arteries and progressively turns them into stone. In the absence of vitamin K, bony structures form in soft tissues. When you hear the term "hardening of the arteries," this means that previously flexible blood vessels are turning into rigid (calcified) bony structures.
In a study of 451 women using mammograms to measure arterial calcification, after just one month of warfarin use, arterial calcification increased by 50% compared to untreated women. After five years, arterial calcification increased almost 3-fold.
Why You Should You Stop Taking Warfarin
If you are taking warfarin (Coumadin), you should talk to your doctor about switching to Eliquis (apixaban) which tested the best of the NOACs and is the safest. (See my article, Warfarin and New Anticoagulants.)
The new oral anticoagulants (NOACs) do not block vitamin K. But the NOACs do have drawbacks. In the case of severe bleeding, there is currently no antidote or reversal agent like there is for warfarin (a reversal agent for the direct factor Xa inhibitors Xarelto and Eliquis is close to FDA approval).
Added 2015: The FDA approved a reversal agent Praxbind for the NOAC Pradaxa Oct. 16, 2015. In clinical trials, 5gs of Praxbind (idarucizumab) administered by IV reversed the anticoagulant effect of Pradaxa within minutes (which is significantly faster than the current antidotes for warfarin).
Whether or not to be on an anticoagulant and which one to take is the most difficult decision you and your doctor have to make (and your initial decision may change over time as your body changes.)
If you aren't happy with your doctor's response, get a second opinion. You need to feel confident and at peace with this decision.
NOACs: Xarelto Best Seller
AF Symposium 2015
The Novel Oral Anticoagulants: Xarelto Best Seller
by Steve S. Ryan, PhD, Updated August 2015
Dr. Daniel Singer of Mass General updated our info about the NOACs (Novel Oral Anticoagulants). Rivoraxaban (Xarelto) is now the most commonly prescribed NOAC. (This is somewhat surprising since dabigatran [Pradaxa] was the first NOAC approved by the FDA and for many months was the only alternative to warfarin. But Pradaxa has lost market share, possibly because of the bad publicity about deaths in the ER from not being able to stop bleeding and its law suit settlements.) (See also: Stop Prescribing or Taking Pradaxa: Suspect in 542 Patient Deaths and Warfarin vs. Pradaxa and the Other New Anticoagulants )
NOACs More Prescribed for New Patients Than Warfarin
After a slow start, NOACs are now prescribed by doctors more commonly than warfarin for new A-Fib patients.
How Do We Know Patients are Actually Taking NOACs and Getting Adequate Levels of Anticoagulation?
The obvious problems with NOACs are they are very costly compared to warfarin, and there currently aren't any reversal agents like there are for warfarin. But Dr. Singer raised another problem. How can we know the patient is taking the NOAC, what anticoagulant level are they reaching? With warfarin we have INR levels and years of experience in monitoring. Dr. Singer thinks that with more time and clinical experience, we may get a better handle on how the NOACs are actually performing.
GI Bleeding Preferable to Brain Bleeds
Some NOACs produce gastrointestinal bleeding and damage. But Dr. Singer pointed out that from his perspective that is acceptable. No one wants to have gastrointestinal bleeding. But compared to intracranial bleeds, GI bleeds are seldom lethal and don't leave people disabled.
Editor's Comments:
Dr. Singer didn't venture to distinguish between the various NOACs because there haven't been any head-to-head trials. But, in this editor's opinion, Eliquis tested better and is safer than the others.
NOTE: Another NOAC Edoxaban (Lixiana) was approved by the FDA in January, 2015.
Update August 15, 2015:
See also: Edoxaban Compared to Other Blood Thinners.
An experimental drug idarucizumad has show positive results as a reversal agent for Pradaxa (dabigatran). In a new study of 90 patients who had uncontrolled bleeding with Pradaxa, idarucizumad stopped this bleeding within minutes. No serious side effects were reported. FDA approval is pending.
We have previously reported on the reversal agent Andexanet Alfa which is on FDA fast track approval as an antidote to the Factor Xa inhibitors Xarelto and Eliquis. FDA approval is pending.
All Anticoagulants Cause Bleeding
AF Symposium 2015
All Anticoagulants Cause Bleeding
Updated August 2015
Dr. Peter Kowey of Lankenau Hospital in Wynnewood, PA discussed the special needs of patients with both A-Fib and Coronary Artery Disease (CAD). Sometimes, for example, these patients have to take both anticoagulant therapy for A-Fib and antiplatelets for stents. Some patients wind up taking a combination of three different drugs like warfarin, clopidogrel and aspirin.
Dr. Kowey pointed out how taking combinations of anticoagulants and antiplatelets multiplies the risk of bleeding. He cited the WOEST study which, though small, indicated that there was no real need for aspirin in addition to warfarin and clopidogrel.
All Anticoagulants Cause Bleeding
His most important point Dr. Kowey made for A-Fib patients is that all anticoagulants cause bleeding. That's how they work. What an EP and an A-Fib patient strive for together is to find the right dose that gives the best protection versus minimizing the chances of bleeding. It's tricky, because there are so many differences among patients. And it changes over time as we do.
NOACs May Be Dose Dependent
Dr. Kowey also discussed how the new anticoagulants (NOACs) were FDA approved on the assumption that one-size-fits-all, that one dosage works for all patients. But we know that warfarin is dose dependent. One would expect intuitively that the NOACs would work in a similar manner.
Dr. Kowey discussed the recent FDA hearings on the new anticoagulant edoxaban (Savaysa), namely that patients who had very good renal function seemed to get less of an anticoagulant effect. Patients taking the previously FDA approved NOACs may have been underdosed, because most of these drugs are renally eliminated. Unlike the INR measure in warfarin, the NOACs don't have any standard, recognized way of measuring the anticoagulant effect as a guide to dosing. The one-size-fits-all NOAC dosage may work for most people, but others may be over- or under-anticoagulated.
Editor's Comments
Though not part of Dr. Kowey's presentation, recent reports on Pradaxa (dabigatran) indicate that Boehringer-Inglehoff may have known that Pradaxa was dose dependent but didn't tell the FDA. (See Claim "Misguided" That Pradaxa Needs No Blood-Level Monitoring.)
Taking anticoagulants is a trade-off. For most people, lowering the risk of an A-Fib stroke is a most welcome benefit compared to an added tendency to bleed.
All Anticoagulants Cause Bleeding and Are Dangerous
Anticoagulants are not like taking vitamins. No one wants to take an anticoagulant. Dr. Kowey's statement that "all anticoagulants cause bleeding" and are inherently dangerous should determine how we look at all anticoagulants. This is in stark contrast with how NOACs are presented in today's TV advertisements. (Just take an anticoagulant and live happily ever after!)
We obviously don't have any data on the long-term effects of taking NOACS for years. Some people on long-term warfarin have been known to develop micro bleeds and dementia. Will this happen with the NOACs? We simply don't know. But intuitively one would expect the same thing to happen, though probably not to the extent of warfarin.
NOACs Dose Dependent?
Dr. Kowey's presentation also highlighted another important point for A-Fib patients—NOACs are probably dose dependent to some extent. One size does not fit all. If you are taking a NOAC, you may be under- or over-dosed.
How serious a problem is this? We simply don't know. With Pradaxa many people have died in the ER from bleeding that doctors couldn't stop. Was this because of over-dosing? It's hard to tell. (See Stop Prescribing or Taking Pradaxa.)
One wonders how the FDA could have approved new anticoagulants with no standard, proven method of determining the anticoagulants' effectiveness? (The NOACs were also approved with no reversal agent or antidote in case of bleeding!) But to be fair to the FDA, there was a great need for new anticoagulants to alleviate the problems with warfarin. And from the clinical trials, few could have anticipated the real world NOAC problems.
Update August 15, 2015: Reversal Agent for Pradaxa (dabigatran)
An experimental drug, idarucizumad, has show positive results as a reversal agent for Pradaxa (dabigatran). In a new study of 90 patients who had uncontrolled bleeding with Pradaxa, idarucizumad stopped this bleeding within minutes. No serious side effects were reported. FDA approval is pending.
We have previously reported on the reversal agent Andexanet Alfa which is on FDA fast track approval as an antidote to the Factor Xa inhibitors Xarelto and Eliquis. FDA approval is pending.
Update October 26, 2015: FDA Approves Reversal Agent Praxbind® for the Anticoagulant Pradaxa
Return to: AF Symposium: Steve's In-Depth Reports Written for Patients
Last updated: Wednesday, January 27, 2016
The Year in Review: Highlights and Achievements
When I think about the field of atrial fibrillation in 2013, several thoughts come to mind. There were technical advancements, some new drug therapies, and additions to our understanding of Atrial Fibrillation (and a few accomplishments for our A-Fib.com website).
Heart Imaging And Mapping Systems
Perhaps the most important technical innovations in 2013 for A-Fib patients were the introduction of two new heart imaging and mapping systems. A third system, the Bioelectronic Catheter, represents a whole new technology with tremendous potential for A-Fib patients.
The ECGI System
The ECGI system, combined with a CT scan, produces a complete 3-D image of your heart along with identifying all the A-Fib-producing spots. Think of it as an ECG with 256 special high resolution electrodes rather than 12. It greatly reduces your ablation time and your radiation exposure.
A day before your ablation, you simply don a special vest with 256 electrodes covering your upper torso, and lay down. The 3-D image created is a road map of your heart with all the focal and rotor areas (A-Fib-producing spots) identified. During your ablation your EP simply ablates the "guilty" areas. Read more of my article…
The FIRM System
The FIRM system uses a different approach to mapping the heart and the A-Fib producing spots. It uses a basket catheter inside the heart to map large areas in a single pass and reveal the location of foci and rotors. Read more of my article…
Why are these two technologies important? ECGI allows your imaging & mapping to be performed the day prior to your ablation, rather than during your ablation. This shortens the length of your ablation procedure. In addition it reduces your radiation exposure and produces remarkably accurate 3D images of your heart and identifies where A-Fib signals are coming from. The FIRM system, though performed during an ablation rather than before it, may be a significant improvement over the Lasso catheter mapping system now in current use. Both systems may mark a new level of imaging/mapping for A-Fib.
Stretchable Electronics Meets the Balloon Catheter
The merging of living systems with electronic systems is called "bioelectronics". Key is a flexible, pliable circuit made from organic materials—the carbon-based building blocks of life. Bioelectronics have entered the EP lab with a prototype of a 'bioelectronic catheter', the marriage of a pliable integrated circuit with a catheter balloon.
In a mapping application, the deflated bioelectronic balloon catheter is slipped into the heart, then pumped up. The inflated integrated circuit conforms to the heart's grooves and makes contact with hard-to-reach tissue. It can map a hundred electrical signals simultaneously, across a wider area and in far greater detail than had been previously possible. And it's being developed to function in reverse. For ablation applications, instead of detecting current, it can apply precise electrical burns. This is a potentially breakthrough technology that may well change the way catheter mapping and ablation are performed. (Thanks to David Holzman for calling our attention to this ground-breaking research article.)
This is a remarkable time in the history of A-Fib treatment. Three very different technologies are poised to radically improve the way A-Fib is detected, mapped and ablated. We'll look back at 2013 as a watershed year for A-Fib patients.
Three New Anticoagulants
In 2013 we saw three new anticoagulants, a welcome development for A-Fib patients. Note: the new anticoagulants are very expensive compared to the proven anticoagulant warfarin.
How do they compare to warfarin?
Warfarin seems to have a slightly higher chance of producing intracranial bleeding.
In general stay away from Pradaxa. There are horrible ER reports of patients bleeding to death from even minor cuts, because there is no antidote or reversal agent. Read more about my Pradaxa warning…
Eliquis, in general, tested better than Xarelto in the clinical trials, but it's so new we don't have a lot of real-world data on it yet. And, as with Pradaxa, neither have antidotes or reversal agents.
In addition, there was what some consider a major problem with the clinical trials comparing the new anticoagulants to warfarin. 'Compliance' rates by warfarin users were poor (many either weren't taking their warfarin or weren't in the proper INR range). Did this skew the results?
And finally, unlike warfarin where effectiveness can be measured with INR levels, we don't have any way to measure how effectively the new blood thinners actually anticoagulate blood. Read more of my article "Warfarin vs. Pradaxa and the Other New Anticoagulants".
Keep in mind: 'New' doesn't necessarily mean 'better' or 'more effective' for You.
High Blood Pressure with Your A-Fib? Is Renal Denervation a solution?
As many as 30% of people with A-Fib also have high blood pressure which can't be lowered by meds, exercise, diet, etc. There was hope that Renal Denervation would help.
With Renal Denervation, an ablation catheter is threaded into the left and right arteries leading to the kidneys, then RF energy is applied to the nerves in the vascular walls of the arteries, hopefully reducing 'Sympathetic Tone', lowering high blood pressure and reducing A-Fib. For many people Renal Denervation seemed the only realistic hope of lowering their high blood pressure. However, the Medtronic Simplicity-3 trial indicated that renal denervation doesn't work. Read more of this article… For 2014 news on this topic, read more…
A Study of Obesity and A-Fib: A-Fib Potentially Reversible
Obesity is a well known cause or trigger of A-Fib, probably because it puts extra pressure and stress on the Pulmonary Vein openings where most A-Fib starts.
In 2013 A research study report focused on obese patients with A-Fib. Those who lost a significant amount of weight also had 2.5 times less A-Fib episodes and reduced their left atrial area and intra-ventricular septal thickness.
Good news! Losing weight can potentially reverse some of the remodeling effects of A-Fib. Related article: Obesity in Young Women Doubles Chances of Developing A-Fib.
Obstructive Sleep Apnea and A-Fib
Obstructive Sleep Apnea (OSA) is another well recognized cause or trigger of A-Fib. Anyone with A-Fib should be tested for sleep apnea.
Earlier studies have shown approximately two-thirds (62%) of patients with paroxysmal or persistent A-Fib suffer from sleep apnea. In 2013, research reports showed that the worse one's sleep apnea is, the worse A-Fib can become. In addition, sleep apnea often predicts A-Fib recurrence after catheter ablation.
Before an ablation, Dr. Sidney Peykar of the Cardiac Arrhythmia Institute in Florida, requires all his A-Fib patients be tested for sleep apnea. If they have sleep apnea, they must use CPAP therapy after their ablation procedure.
A-Fib.com: Our New Website's First Year
The original A-Fib.com web site was created using the phased out software MS FrontPage. Thanks to a "no strings attached" grant from Medtronic, A-Fib.com was reinvented with a more up-to-date but familiar look, and features more functionality (built on an infra-structure using Joomla and WordPress). We can now grow the site and add features and functions as needed.
It involved a tremendous amount of work. A special thanks to Sharion Cox for building the new site and for technical support. My wife, Patti Ryan, designed the look and all graphics. (I can't thank Patti enough; I'm so lucky!)
A-Fib.com Project:
Update the Directory of Doctors & Facilities
Back when I started A-Fib.com in 2002, there were less than a dozen sites performing ablations for A-Fib. Today our Directory of Doctors and Facilities lists well over 1,000 centers in the US, plus many sites worldwide.
Increasingly, doctors were writing me asking why they weren't included, or why their info was incorrect since they had moved, etc. To update our records and our service to A-Fib patients, starting in July 2013, we prepared and mailed letters to over 1,000 doctors/facilities. We asked each to update/verify their listing (and include a contact person for our use).
Note to Doctors! If you haven't updated your listing in our A-Fib.com Directory of Doctors and Facilities, just use our Contact Us form to email me and I'll send you the form to fill in and return.
The response to our bulk mailing was great. The data input started in October and continued for several months (as time allowed). Recently, we cut over to the 'new' Directory menu and pages.
What's Ahead for A-Fib.com in 2014
2014 Boston AFib Symposium Reports: Check out my new reports from the 2014 Boston A-Fib Symposium (BAFS) held January 9-11, 2014 in Orlando FL.
The first two reports are posted. Look for more reports soon. I usually end up with 12-15 reports in total.
Our a-Fib.com Directory of Doctors & Facilities: Work on updating our listings is still underway. We need to contact those who did not respond to our request for verification or updating of their listing. (Shall we write again or maybe make phone calls?)
Amazon Best Sellers list: Our book sales continue to grow. Did you know that our book 'Beat Your A-Fib' has been on Amazon's Best Sellers list continually in two categories (Disorders & Diseases Reference and Heart Disease) since its debut in March 2012? Visit Amazon.com and read over 40 customer reviews.
Help A-Fib.com Become Self-sustaining: We plan to step up our efforts to make A-Fib.com a self-sustaining site. (Since 2002, Steve and Patti Ryan have personally funded A-Fib.com with an occassional reader's donation.)
Bookmark this link!
Visit our shop at Spreadshirt.com.
In our efforts toward sustainabiliy, several years ago we added a PayPal 'Donate' button (you don't need a PayPal account to donate) and invited donations toward our onlline maintenance costs.
Then, a year or so ago, we added a portal link to Amazon.com. When you use our Amazon.com link, A-Fib.com receives a small commission on each sale (at no extra cost to you).
Our newest effort is our 'A-Fib can be Cured! shop with T-shirts and more at Spreadshirt.com. With each shirt purchase $2 goes to support A-Fib.com. (We will roll out new designs every quarter or so).
Posted February 2014
Help A-Fib.com become self-sustaining! Help keep A-Fib.com independent and ad-free.
Will 2014 be the year you help support A-Fib.com?
Last updated: Wednesday, February 11, 2015
AF Symposium 2015 Brief Reports by Steve S. Ryan, PhD
2015 International AF Symposium
by Steve S. Ryan, PhD
This overview should give you a sense of the topics floating through the three days in Orlando and the over sixty presentations by fifty A-Fib experts and researchers. (Most recent brief reports listed first)
AF Symposium: My Brief Reports
The Rhythmia 3-Dimensional Mapping System (Live from Leipzig via Satellite)
(Please be advised that the Symposium organizers go to great lengths not to identify or unfairly publicize one device over another. When writing these reports I often have to do a good deal of research to correctly identify and describe particular devices that are demonstrated, as a service to readers. But this in no way implies or suggests that one device is superior to another.)
Dr. Gerhard Hindricks of the University of Leipzig in Germany gave a dynamic presentation of a catheter ablation of a 46-year-old female with paroxysmal A-Fib using the Rhythmia 3-dimensional multipolar mapping system by Boston Scientific. Along with his colleagues Drs. Andreas Bollmann and Jedrzej Kosiuk, they used the Rhythmia special basket catheter to generate a 3-D map of electrogram voltages and activation times. To me it seemed amazingly fast. The eight-splined bidirectional catheter produced 1,000 data points per minute. In what seemed like only a few passes, they produced a 3-D color reconstruction of the patient's left atrium.
The actual ablation was routine. They terminated the A-Fib into sinus rhythm without having to use Electrocardioversion. But they found that the PV isolation was incomplete. Using the same Rhythmia 3-D mapping catheter, they were easily and quickly able to locate the gap in the Left Superior PV and ablate it.
LAA Occlusion Devices: Is the Watchman Device Dead in the Water?
Dr. Vivek Reddy from Mount Sinai School of Medicine in New York City gave a very well referenced and persuasive presentation on the Watchman device which closes off the Left Atrial Appendage to prevent clots and strokes. The theory behind the Watchman device is that most A-Fib clots originate in the Left Atrial Appendage (LAA). The Watchman closes off the LAA where 90-95% of A-Fib strokes come from. It's a very low risk procedure that takes as little as 20 minutes to install. Afterward, you would usually not need to be on blood thinners. (For more, see my article, The Watchman Device: The Alternative to Blood Thinners).
Dr. Reddy certainly persuaded me that the FDA should approve the Watchman device. Dr. Reddy, earlier in Washington, had made the same persuasive arguments before the FDA.
Dr. Andrew Farb from the FDA took the bull by the horns and gave his perspective on the various LAA Closure (Occlusion) Devices. But as one would expect, he didn't indicate how the FDA would rule on the Watchman device, since deliberations were still ongoing.
After his presentation, I asked him several pointed questions about this, but he was, of course, careful not to comment about current FDA deliberations. My guess? If body language, momentum, mood of the presentations, and more importantly recent research indicate anything, the Watchman device probably will not be approved by the FDA.
There was a palpable sense of sadness at the end of these presentations. The attendees realized that the game may be over for the Watchman device. I hope I am wrong, since the Watchman device would be an important tool to help A-Fib patients. Once the FDA rules and the current clinical trials of the Watchman device end, you will probably have to go to Canada or overseas to get a Watchman device installed.
(Happily I was wrong on this prediction. Update: The U.S. Food and Drug Administration (FDA) approved Boston Scientific's WATCHMAN™ LAA closure technology for use in the U.S. on March 13, 2015. It has been available internationally since 2009. The FDA approval of the WATCHMAN device is based on the clinical program which consists of numerous studies, with more than 2,400 patients and nearly 6,000 patient-years of follow-up. The Watchman device will be available first at U.S. centers where it has been used in clinical studies.)
Watchman May Win FDA Approval
In my earlier brief reports on the Orlando AF Symposium, based on the recent research and the FDA presentation, I said the Watchman device probably won't be approved in the US. I'm happy to say that I am most likely wrong.
At the LAA Symposium 2015 in Marina del Rey, CA, it was suggested that the Watchman device may be approved by the middle of this year. One presenter described how the FDA chairman talked with several people who were going to Canada to have the Watchman device installed. He seemed embarrassed that the Watchman was available everywhere in the world but not in the US and said that it has to be approved.
Other doctors I talked with at the LAA Symposium were of the same opinion. Presenters described how clinical trials for other LAA closure devices were on hold so that they could get approved in comparison to the Watchman (Non-Inferiority Trials). Dr. Dhanunjaya Lakkireddy of the University of Kansas Medical Center said that we are at a "tipping point" for the (A-Fib) industry.
FDA 'Easy Feasibility Study' (EFS)
As everyone, including the FDA, is well aware, A-Fib innovations usually start in Europe where they are more easily approved. Then only later do they move to the US for FDA approval, since the FDA generally requires more data than European regulators.
Drs. Jun Dong and Andrew Farb from the FDA described the FDA's 'Easy Feasibility Study' (EFS) program where medical device innovations could be evaluated in the US without having to go to Europe first. He encouraged researchers and attendees to take advantage of the new EFS program. This is major news and may make the development of A-Fib innovations much easier to accomplish in the US.
For further information, contact: Andrew Farb, Email: firstname.lastname@example.com. 301-796-6317
Reversal Agents for the New Anticoagulants (NOACs)?
Dr. Luigi Di Biase from the Albert Einstein College of Medicine in the Bronx, NY and Dr. Daniel Singer from Massachusetts General Hospital in Boston each described potentially great developments in reversal agents for apixaban (Eliquis) and rivaroxaban (Xarelto).
Dr. Di Biase described studies where leaving people on uninterrupted rivaroxaban and apixaban before, during and after an ablation dramatically reduced the amount of silent thromboembolic lesions and were as safe as warfarin with regards to stroke and TIAs. (This didn't work with dabigatran [Pradaxa].) But if patients develop bleeding or effusion during the ablation, they are in trouble because there is no direct reversal agent as there is for warfarin. He has used Factor IV as an indirect reversal agent. Dr. Singer also described how Factor IV was used as a reversal agent for apixaban.
But there are new reversal agents for apixaban and rivaroxaban which promise to completely reverse the effects of these two drugs in less than four minutes. The FDA is speeding up studies on these reversal agents. But one never knows when or if the FDA will approve them.
Female Gender: Is it a Risk Factor for Stroke?
Dr. John Day of the Intermountain Heart Institute in Murray, UT (and recently elected president of the Heart Rhythm Society) may be the first A-Fib leader to publicly question whether women should be given one point on the stroke risk CHA2DS2-VASc scale just because of their gender. Many doctors have said this in a circumspect way. Dr. Eric Prystowsky in a presentation at last year's AHS meeting thought that most doctors would agree with Dr. Day, "as long as there wasn't a camera focused on them." He gave the example of a 45-year-old woman in good health and a 45-year-old man with hypertension who according to current guidelines should both be given one point on the stroke risk CHA2DS2-VASc score.
Editor's Comments:
As readers of A-Fib.com, you know that's been my opinion ever since the original European guidelines came out. Women in their child-bearing years are much less at risk of stroke because of the blood-thinning effect of losing blood each month. And even after menopause women have less risk of stroke. But eventually they do have more strokes. But not because of an innate inferiority, but because women live longer than men. Stroke is age related. An observational Danish registry study documents this.
For more, see The Denmark Study: Women in A-Fib Not at Greater Risk of Stroke Contrary to CHA2DS2-VASc Guidelines!) (Be advised that the original European guidelines were written by doctors with major conflicts of interest.) These guidelines may be a not so very subtle form of gender bias.
Living in A-Fib More Dangerous Than Having an Ablation
Living in A-Fib is more dangerous than having an ablation, according to Dr. Josef Kautzner from Prague, the Czech Republic. Studies have documented that the adverse effects of living in A-Fib, having to take A-Fib drugs and anticoagulants for life are both pragmatically and statistically worse than having an ablation. Dr. Kautzner discussed how A-Fib can cause or is associated with silent brain lesions and dementia. Any time you go into a hospital is a risk. And no one would say that a catheter ablation is a walk in the park. But an ablation is a low risk procedure, though not risk free. The risk is similar to having your tubes tied. The possible adverse effects of an ablation procedure (like bleeding at the groin) are generally temporary, unlike the lasting, permanent damage you can do to your heart, body and brain by living in A-Fib for years.
Rotors! Rotors! Rotors! Sizzling Topic but No Consensus
The most hotly discussed topic at this year's symposium was rotors. The opinions expressed about rotors were at times very heated, more than I had ever seen at an AF Symposium. Dr. Shih-Ann Chen of Taipei, Taiwan disagreed with Dr. Sanjiv Narayan of Stanford, CA about the basic concepts of rotors and how they should be defined. Dr. Ravi Mandapati of UCLA and Loma Linda University disagreed with Dr. Narayan which was all the more striking in that he had worked with Dr. Narayan when he was at UCLA. Dr. Pierre Jais of Bordeaux, France said that the FIRM mapping system misses 40% of the atrium area.
Drs. Haissaguerre and Jais from Bordeaux and Dr. Sebastien Knecht of Brussels, Belgium gave presentations on how they were using the CardioInsight body surface mapping vest to perform ablations of "drivers" at many different centers, while Dr. Karl-Heinz Kuck from Hamburg, Germany using a different body surface mapping system said that he couldn't ablate rotors. Dr. Narayan says the FIRM system finds a maximum of 2-3 rotors in the atria, while other systems find as many as seven. The FIRM system says rotors are usually relatively stable and can last as long as 30 seconds while others say they rotate in one fixed spot for only one or two rotations, that they tend to migrate within a certain area.
The presenters obviously didn't share a consensus of basic concepts of what rotors are, how they work, their importance in A-Fib, how they should be correctly identified, used, and ablated. (It seems to me the Bordeaux group has the best understanding and pragmatic use of rotors. They refer to "rotors" and focal sources as "drivers.") But the CardioInsight system Bordeaux uses isn't currently available or isn't being tested in the US.
Holistic Approach to Health: Great Results Dealing with Obesity
Obesity was one of the most often discussed topics. There is a growing consensus among EPs that it isn't enough to just give obese patients a catheter ablation while not dealing with their obesity. If the obesity isn't dealt with, their A-Fib is very likely to re-occur. A-Fib will develop in other spots that haven't been ablated. The condition (obesity) that triggered or caused the A-Fib will trigger or cause it again, if it isn't taken care of.
Dr. Prashanthan Sanders of Adelaide, Australia described the great results he is getting in his clinic which includes a weight loss program and counseling. He convinces his overweight patients to buy into the program, lose weight, and keep it off. The program works so well that just by losing weight patients become A-Fib free. This program is a holistic approach to health and also is developed to work for diabetes, sleep apnea, hypertension, binge drinking and smoking.
Dr. Sanders foresees a world where some patients become A-Fib free simply by changing their life style, where they don't have to have a catheter ablation to become A-Fib free.
Many other doctors commented that A-Fib treatment at many centers today includes or should include much more than A-Fib ablation and drugs. A-Fib centers should have nutritionists, exercise therapists, sleep apnea specialists, etc. as part of their A-Fib program.
Atrial Esophageal Fistula: A Case Study
Dr. John Day of the Intermountain Heart Institute in the Challenging Cases Discussion described his experience with the dreaded Atrial Esophageal Fistula. Though very rare, this is one of the few possible complications of a catheter ablation that can kill you. An ablation, if not done with caution, can irritate and damage the esophagus which often lies right next to the heart. Over 2-3 weeks stomach acid can eat through this damaged area to produce a hole or fistula from the esophagus into the heart.
As soon as Dr. Day saw this patient, he knew it was a fistula and immediately called surgeons and a GI doctor. All the surgeons were doing operations and didn't want to do the surgery in the EP lab. Dr. Day described how he and his colleagues ran down the hospital hallway to the operating room while giving the patient a transfusion and at the same time pumping out the blood escaping from his heart.
The GI doctor got there first and put in a stent in the esophagus to plug the hole. There was lots of discussion as to whether this was the best approach, but it worked. The patient survived but had to spend a month in the hospital.
This cautionary and very dramatic tale certainly got the attention of all the attendees. No matter how rare a fistula is, every EP and A-Fib center must have an established protocol in place to deal with it. I remember Dr. Hugh Calkins in a previous Symposium advising, "There are only two kinds of EPs—those who have not had an Atrial Esophageal Fistula and those who have!" (Dr. Calkins' patient with fistula also survived.)
Anticoagulation Case Study: Dilemma for 92-year-old With Paroxysmal A-Fib
Dr. Peter Kowey of Lankenau Hospital in Winnewood, PA described a case that illustrates the kind of dilemma both doctors and patients often have to face. A 92-year-old woman with paroxysmal A-Fib who had been treated for many years with warfarin had some bruising and nuisance bleeding, but never anything major.
Dr. Kowey thought that ethically he should tell her about the different new anticoagulants which may be superior to warfarin, then see if she wanted to change. She went with apixaban (Eliquis), then six months later had a stroke even though she was taking apixaban properly and conscientiously. Happily, she made an almost full recovery. She returned to warfarin which had worked for her in the past and which she was comfortable using.
Editor's Comments:
One of the reasons Dr. Kowey discussed the new anticoagulants with his 92-year-old patient was because warfarin is considered more apt to cause bleeding in older patients. The newer anticoagulants in clinical trials caused less bleeding. But we don't have much data from the clinical trials on people over 90 years old.
Can we say that apixaban didn't work or was ineffective? No. Anticoagulants reduce but do not totally eliminate the risk of an A-Fib stroke. Just because she had a stroke doesn't mean apixaban didn't work.
Dr. Jeremy Ruskin pointed out that there has never been and probably never will be a head-to-head comparison of the three new anticoagulants. But in my opinion apixaban (Eliquis) appears to have tested better and is safer than the others
For more, see my 2013 BAFS articles, The New Anticoagulants (NOACs) and Warfarin vs. Pradaxa and the Other New Anticoagulants.
Ablation Without X-Ray or Fluoroscopy (Live via Satellite)
In the satellite case live presentations, Drs. Rodney Horton and Amin Al-Ahmad from the Texas Cardiac Arrhythmia Institute in Austin, TX surprised us by doing an ablation without wearing the standard lead aprons to prevent fluoroscopy exposure. Even more surprising was one of the lab assistants who was pregnant. She could work on the ablation because no fluoroscopy was used. The doctors did the whole ablation using ICE (Intracardiac Echo) and 3D mapping. They showed for example how ICE can be used to thread the catheter up into the heart and into the left atrium. Dr. Horton said that not having to wear those heavy lead aprons would probably add 5-10 years to his ablation career.
(They didn't wear surgical masks during the ablation which was surprising to me. I will write them for an explanation.)
From Beijing: Strange Chinese Case (Live via Satellite)
The live satellite case from Beijing, China was technically flawless and probably a first of its kind. But it wasn't much of a learning experience for the attendees. The Chinese EPs only used one catheter and had to frequently pull out the mapping catheter and replace it with the ablation catheter, etc. When the expert panel asked them questions, the Chinese EPs either didn't understand or simply didn't answer them. They seemed very uncomfortable. It seemed like a throwback to ablation techniques of 20 years ago.
Ablation and Closing Off the Left Atrial Appendage in the Same Procedure (Live via Satellite)
Drs. Claudio Tondo, Gaetano Fassini, Massimo Moltrasio, and Antonio Dello Russo from Milan, Italy showed how they do a catheter ablation for A-Fib and install the Watchman device in the same procedure, when it's needed. They do the ablation procedure first. Then when the patient is in sinus rhythm, they install the Watchman device. (This can't be done in the US, because the Watchman device hasn't received FDA approval. In later discussions including representatives of the FDA, there was an all too real possibility that the Watchman will never receive FDA approval.)
Contact Force Sensing and Jet Ventilation (Live Satellite Presentation)
Drs. Kevin Heist and Moussa Mansour from Massachusetts General in Boston showed in a live case how they used a Contact Force Sensing catheter combined with Jet Ventilation. (There are two Contact Force Sensing catheters approved by the FDA—the ThermoCool Smart Touch device by Biosense Webster (approved Feb. 24, 2014) and the TactiCath Quartz Contact Force Ablation Catheter by St. Jude Medical (approved Oct. 27, 2014). This live case used the TactiCath catheter but didn't imply or suggest it is superior to the ThermoCool catheter. For a description of each, see my 2014 AF Symposium report The New Era of Catheter Ablation Technology: Force Sensing Catheters.
This combination of Force Sensing Catheter with Jet Ventilation for RF ablation probably represents the most advanced RF ablation strategy available today. Jet Ventilation doesn't stop the heart from beating as in bypass surgery. But to this observer it seemed to put the heart in a type of slow motion with a lot less movement than when the heart is beating in normal sinus rhythm. You could really see a difference when they turned the Jet Ventilation off and on. Slowing down the heart like this helps the ablation doctor make lesions in hard-to-access areas and makes it easier to hold the catheter steady and apply the right contact pressure.
Non-Invasive Electrocardiographic Imaging—ECGI—CardioInsight
Drs. Michel Haissaguerre and Pierre Jais from Bordeaux/LYRIC gave presentations on the ECGI system. The day before their ablation, the patient lies down on his/her back and a technician places a vest-like device with 256 electrodes over his/her chest and stomach. These electrodes combine with rapid CT (Computed Tomography) scans to produce a very detailed 3D color map of the heart. (For a detailed description and discussion of the ECGI system, see 2013 BAFS: Non-Invasive Electrocardiographic Imaging [ECG]) The system automatically detects rotors and foci and computes them into a "Cumulative Map" or movie. These driver regions are ranked, based on statistical prevalence.
Then, Dr. Sebastien Knecht from CHU Brugmann, Brussels, Belgium, described the AFACART trial design and preliminary results using the CardioInsight ECGI system. Many centers in Europe including four in Germany are now using the CardioInsight. Requiring very little training, technicians and EPs using the CardioInsight system are getting similar great results like the Bordeaux group. Though these studies just started, it looks like the CardioInsight ECGI mapping and ablation system is poised to revolutionize the way EPs map and perform ablations.
Fibrosis and A-Fib: Continuing Research on Sheep
Dr. Jose Jalife of the University of Michigan in Ann Arbor, MI, continued his exciting research on fibrosis and A-Fib. In previous Symposiums Dr. Jalife demonstrated how A-Fib produces fibrosis. When he paced sheep into A-Fib, their hearts became fibrotic within a very short time. The markers of fibrosis (collagen and scarring) increased progressively as the sheep went from paroxysmal to persistent A-Fib. (See A-Fib Produces Fibrosis—Experimental and Real-World Data.)
Fibrosis is tissue that has fiber-like characteristics which develop in place of the normal smooth walls of the heart. Fibrotic tissue is scarred, immobile, basically dead tissue with reduced or no blood flow and no transport function. It results in a loss of atrial muscle mass. Over time it makes the heart stiff, less flexible and weak, overworks the heart, reduces pumping efficiency and leads to other heart problems. Fibrosis, up to now, was considered permanent and irreversible. But Dr. Jalife gave his sheep a Gal-3 inhibitor GM-CT-01 that actually prevented and reduced fibrosis! (For his previous presentations, see 2014 BAFS: The Holy Grail: Preventing A-Fib by a GAL-3 Inhibitor.)
In his continuing studies of sheep, Dr. Jalife found that fibrosis predicts recurrence, and that fibrosis can not be reversed if it is well established, even with GAL-3 Inhibitors.
Return to AF Symposiums by Year
Return to: AF Symposium: Steve's In-Depth Reports Written for Patients
Last updated: Wednesday, January 18, 2017


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Hours by appointment
Group Acupressure Sessions
Expert bodywork therapy at an affordable price
To bring the benefits of Asian Bodywork Therapy to the most people, we now offer group acupressure sessions. A group session lasts approximately an hour, has three to five attendees, and includes:
- Placement of acupressure pellets on ear and body points as appropriate for each individual. These pellets, made of stainless steel or from the seeds of the vaccaria flower, do not puncture the skin; they are held to it with adhesive tape and can be left in place for several days to gently stimulate acu-points.
- Seated shiatsu and acupressure treatment. This will usually address the neck and shoulder areas for relief of stress and tension, as well as any problem areas each client may be experiencing.
- Lifestyle and health habits consultation, including instructions for acupressure self-treatment.
If you would like to participate in a group acupressure session, please sign up for our mailing list (or e-mail firstname.lastname@example.com) to receive schedule information.

subset: commoncrawl


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Mary J blige!!!!!
Printable View
Mary J blige!!!!!
You didn't start a new one, so I will:
Title: Step in the Name of Love
R Kelly
Song: I Don't Wanna Cry
Artist: ?
Mariah Carey :barf
Title: Stroke You Up
Changing Faces
Song: I'm Coming Back
Artist: ?
The Good Girls
Song:The Young Crazed Peeling
Song:The Young Crazed Peeling
Artist: The Distillers (yes I cheated, it's been almost a month :laugh)
Song: Pitseleh
Elliott Smith
Song: Waking to the dream of you
Lori Carson
Song: Sara Smile
Hall and Oates
Song: Barely Breathing


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Habitat ReStore Customer Service Volunteer
Cause Areas
WhenIt's flexible! We'll work with your schedule.
Where210 South MurrayAnderson, SC 29624
The ReStore is in need of volunteers who are able to commit to 1 day a week (2 to 6 hours) to assist with customer service at the front of the store. Volunteers will help greet customers, assist the cashier with transactions, assist customers with finding merchandise, and help organize the furniture and housewares sections of the ReStore. Also, this individual will assist with contacting donors to express our appreciation, so a friendly personality is a must! This is a great position for a "people person" and for anyone who has a passion for hospitality, decorating, and organization. The ReStore in Anderson SC is a thrift store associated with Habitat for Humanity. The majority of our merchandise is donated, and the revenue from store sales goes to fund Habitat's housing mission here in Anderson County. Read more online at www.habitatanderson.com.
- Customer Service
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Good Match For
Teens People 55+
Requirements & Commitment
- Must be at least 16
- 2 to 6 hours per week - Tuesday through Saturday


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What does RYCEY mean in NASDAQ Symbols?
This page is about the meanings of the acronym/abbreviation/shorthand RYCEY in the Business field in general and in the NASDAQ Symbols terminology in particular.
Rolls Royce P L C
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According to a recent survey of over 13,000 general counsel and corporate directors, cybersecurity and data protection now rank as top-of-mind concerns. All types of business must contend with physical and digital security threats to their operations, assets, and reputation—as well as an increasingly complex and active legislative, regulatory, and standards landscape. What can and should in-house counsel do?
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Join Hogan Lovells and a panel of highly-experienced practitioners for practical and cutting-edge insights that you can immediately apply to your practice.
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What does line code mean?
Definitions for line code
Here are all the possible meanings and translations of the word line code.
line code(Noun)
A code chosen for use within a communications system for transmission purposes.
Line code
In telecommunication, a line code is a code chosen for use within a communications system for baseband transmission purposes. Line coding is often used for digital data transport.
Chaldean Numerology
The numerical value of line code in Chaldean Numerology is: 6
Pythagorean Numerology
The numerical value of line code in Pythagorean Numerology is: 4
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24 Feb
Jim Clark
You guys are wonderful. I am 64 and was a Unix engineer the last 15 years of my employment. As you realize, you blink twice in this business and you are out of the game. I have now been a customer since 2000 for no reason. Thank you so much for carrying the water for me. Well worth it!


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It's Sunday, time to recap the pictures that I post on My Sports Obsession Tumblr page. It is a variety of sports pictures and videos from vintage to current.
I get a little Hall of Fame heavy this week but there are a few classic MLB, NFL and NBA mixed in there as well.
Welcome to Cooperstown
Frank Thomas (1994)
Greg Maddux (1988)
Tom Glavine (1992)
Cooperstown – 2014
Chicago Tribune, January 9th, 2014
Bart Starr
Frank Thomas homers in all-star game
Frank Thomas – first career hit (August 3rd, 1990)
Deion Sanders trying to score of Mike McFarlane (1990)
Michael Jordan & Patrick Ewing
Dwight Clark – the Catch
If there is too many gif images above they may not all show up, if this is the case, then check out all the photographs and gifs above on My Sports Obsession Tumblr or like us on Facebook so you can share with your friends.


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The Green Bronze Mirror
by Lynne Ellison
In BriefA modern girl finds a bronze mirror, green with age, almost buried in the sand. Looking into it, she is transported back in time to the Roman Empire where she encounters all kinds of adventures.
Why you should read itWritten with style and imagination by a 14-year-old, The Green Bronze Mirror is a fun and adventurous read for anyone interested in the history of Ancient Rome.
Contributor :Christopher


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More: Quantico breakdown: Who we do and don't trust so far
Holy bomb threats! Tonight's episode of Quantico was pretty explosive — and now that suspicions are falling on an outside terrorist cell, it's looking like Parrish is actually getting closer to clearing her name... if she can just survive long enough to bring the real terrorist to justice.
Last week, Quantico left Parrish and Haas thinking that Nimah and Raina might be at the center of the attack, but we quickly learned this week that the twins have been undercover in a terrorist cell on American soil.
#Quantico's @jazmasri on the twins' big reveals and what's next https://t.co/TcLtBakV2k @QuanticoTV pic.twitter.com/HeYbs7YKjd— TV Guide (@TVGuide) November 9, 2015
This new twist was particularly exciting, since we got to watch the recruits all work together to disarm a faux bomb tonight — with that much togetherness, it's heartbreaking to imagine one of the people in that room betraying everyone.
All season long we've been scratching our heads over which one of Parrish's Quantico peers could be responsible for blowing up Grand Central Station — but we were just following Agent O'Connor's suspiciously pointed finger. What if, in his desire to skewer Parrish, O'Connor has just sent all of us on a wild goose chase (and wasted the FBI's valuable time)?
More: Supergirl: Why Kara's horrible boss is actually the perfect ally
Of course, that doesn't mean we're clearing O'Connor, because he is most definitely still guilty of some major shady business... I mean, why does he have it out for Parrish in the first place? And why did he let Booth take the fall for whatever happened under his watch in Chicago? Tonight's episode brought us a little bit closer to finding out, but not close enough.
But the truth isn't the only thing getting closer... Parrish and Booth shared more than a few steamy moments, giving us hope that they'll wind up rekindling the romance. A possibility that seems more and more likely, with Parrish's confession tonight that Booth should get away from her because everyone she cares about winds up getting hurt.
More: Gabourey Sidibe disgustingly shamed over Empire sex scene
But what's going to happen now that Booth's been shot? Agent Vasquez, who turned everyone in, decided to let Parrish run off with the bleeding hottie, but to what end? And will the twins be safe now that their cover has been blown?
Basically, we can't believe we have to wait a whole week to see what happens next.
What do you think? Is the terrorist cell responsible for the bomb, or is it just a red herring? Tell us in the comments below.
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Snow, ice and sub-zero temperatures led to a 'huge spike' in emergency calls last weekend.
East Midlands Ambulance Service received 900 more calls between Thursday and Sunday than it did during the same period last year.
With less than a third of calls relating to immediately life-threatening situations, EMAS has urged people to assist them during its busy period by only dialing 999 for emergencies and the most serious illnesses.
Deputy director of operations Paul StClair said: "We are receiving a huge volume of calls though our control centres in Nottingham and Lincoln.
"This includes dealing with road traffic accidents across the patch and the impact of the cold weather on the elderly and those with existing medical conditions.
"I'm proud of the fantastic job our staff are doing in assisting patients despite difficult weather conditions.
"To ensure we can continue to help those in the most need we need the public's support - please only dial 999 in genuine emergencies such as severe loss of blood, loss of consciousness, chest pains and fitting."
EMAS has reported that more than 1,000 of the 6,335 calls received during the four days could have been dealt with more appropriately through other NHS services.
The service has also expressed its thanks to the volunteers of LIVES First REsponders, fire services who attended many of the call-outs.
To find out about NHS services available to you visit NHS


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|Monday October 29th, 2012
...slash private debt by 100pc of GDP, boost growth, stabilize prices, and dethrone bankers all at the same time. It could be done cleanly and painlessly, by legislative command, far more quickly than anybody imagined.What is this miraculous resolution?Ā A contemporary Chicago Plan as first laid out by Henry Simmons and Irving Fisher in 1936.Ā What is proposes is that various states eliminate fractional reserve banking and flood the market with fiat currency to make up for the elimination of private money.Ā The state would then take full control over the money supply and take the privilege of creating credit out of thin air away from private banks.Ā As Evans-Pritchard puts it
The conjuring trick is to replace our system of private bank-created money Ś roughly 97pc of the money supply Ś with state-created money.In other words, the proposal is the enforcement of what is known as greenbackerism where the state remains the only entity legally able to create money.
The nation regains sovereign control over the money supply. There are no more banks runs, and fewer boom-bust credit cycles.
There is no tenable economic, legal, moral, or spiritual rationale that could be adduced in justification of paper money and fractional-reserve banking. The prevailing ways of money production, relying as they do on a panoply of legal privileges, are alien elements in the capitalist [i.e., true free market] economy. They provide illicit incomes, encourage irresponsibility and dependence, stimulate the artificial centralization of political and economic decision-making, and constantly create fundamental disequilibria that threaten the life and welfare of millions of people. In short, paper money and fractional-reserve banking go a long way toward accounting for the excesses for which the capitalist economy is widely chided.The fractional reserve banking system by definition is unstable and insolvent because of the pyramiding of credit which takes place.Ā Forcing banks to hold 100% reserves would be a good step toward having a legitimate banking sector which doesn't pose a risk to the greater economy.Ā But the greenbacker scheme is a terrible channel to do so as the state would proceed to devalue the currency at an extraordinary rate.Ā The only economical and moral solution is for the enforcement of 100% reserve banking while leaving money to the marketplace.Ā Evans-Pritchard should consider that possibility before giving credence to a ploy that is a backdoor to socialism.


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Sugar Me
Well with Eurovision fever upon us, it's time to remember some past entrants and where better to start than with glam era babe Lynsey De Paul who came second with "Rock Bottom" in the seventies. Though I'm not posting that particular track because...well her other stuff was better and I thought I'd start with her first single, the briliant "Sugar Me".
Lynsey De Paul - Sugar Me


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It is our mission to positvely impact at least 13,800 area businesses by December 31, 2017.
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- We create, execute, and acheive a customized strategic plan for growth
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In order to have something different than you have right now, then something must change. We guide you through that process and get you even further than you thought possible...


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Members of the House Natural Resources Committee introduced two bills to protect and expand U.S. onshore energy production on federal lands. The bills would remove government roadblocks and hurdles that delay American energy production, promote production of our oil shale resources, and ensure that oil and natural gas resources in the National Petroleum Reserve-Alaska (NPR-A) are developed and transported in a timely, efficient manner.
"Our onshore federal lands contain incredible potential for energy production, job creation, and economic growth. Yet federal red-tape and regulations imposed by the Obama Administration are keeping these resources under tight lock-and-key," said House Natural Resources Committee Chairman Doc Hastings (WA-04). "These bills will help protect our oil and natural gas resources from onerous, duplicative federal regulatory hurdles and streamline the process so that energy production on federal lands can be as successful on private and state lands."
A legislative hearing on the bills will be held on Tuesday, May 21, 2013. The hearing will also include H.R. 555, the BLM Live Internet Auctions Act by Rep. Bill Johnson (OH-06) and H.R. 1394, Planning for American Energy Act by Rep. Scott Tipton (CO-03).
The Federal Lands Jobs and Energy Security Act (H.R. 1965), introduced by Subcommittee on Energy and Mineral Resources Chairman Doug Lamborn (CO-05), would streamline government hurdles that block and delay development of our onshore oil and natural gas and renewable energy resources. The bill would reform the leasing process for onshore oil and natural gas projects on federal lands to eliminate unnecessary delays; reform the process for energy permitting, once a lease is in hand, to encourage the timely development of our federal resources; ensure funds are available for efficient wind and solar permitting; and set clear rules for the development of U.S. oil shale resources.
"America has vast untapped energy resources but the Obama Administration has repeatedly blocked and delayed the development of energy on federal lands. By allowing us to responsibly develop our vast energy reserves, these bills will not only create jobs, but will lower energy costs and reduce our dependence on foreign oil," said Subcommittee Chairman Lamborn.
The National Petroleum Reserve Alaska Access Act (H.R. 1964), introduced by Chairman Hastings and Rep. Don Young (AK-at large) would cut through bureaucratic red tape to unlock the full potential of energy resources in the NPR-A by ensuring that oil and natural gas are developed and transported in a timely and efficient manner. The NPR-A was specifically set aside for energy production and according to the U.S. Geological Survey could contain over 2.7 billion barrels of oil and 114.36 trillion cubic feet of natural gas. In February, the Obama Administration announced final plans to close over half of the NPR-A to energy production.
The bill would require annual lease sales to be held in the NPR-A, streamline the permitting process to ensure timely development of resources, and set firm timelines for infrastructure permits to be approved. It would also nullify the plan released by the Obama Administration in February 2013 and require the Interior Department to issue a new integrated activity plan.
"Continually, the Obama Administration boasts that oil and natural gas production in the United States has increased, but everyone knows that those increases are a result of drilling taking place on state and private land. Today's legislation would add some truth to their misleading statement by furthering responsible resource development in promising areas of the NPR-A," said Rep. Young. "Most importantly, this legislation nullifies the Obama Administration's flawed recent NPRA management plan, and requires that it be replaced with a plan that supports, rather than hinders, resource development. If producers can't drill in the NPRA, then where can they drill?"
Similar legislation was introduced last Congress and passed by the House with bipartisan support.
Source: http://naturalresources.house.gov/news/documentsingle.aspx?DocumentID=333908


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About Conference
Conference Series LLC heartily welcomes you to attend the "2nd International Conference on Quantum Physics and Nuclear Energy" during May 15-17, 2017 at Munich, Germany.
The main theme of the conference is "Augmenting the Classic Quantum Theories by fostering the contemporary Nuclear Power".
We cordially invite all the participants who are interested in sharing their knowledge and research in the arena of Quantum Physics and Nuclear Engineering. Quantum Physics 2017 anticipates more than 300 participants around the globe with thought provoking Keynote lectures, Oral and Poster presentations.
Opportunity to attend the presentations delivered by eminent scientists, researchers, experts from all over the world. Participation in sessions on specific topics on which the conference is expected to achieve progress. Global networking in transferring and exchanging Ideas. Share your excitement in promoting new ideas, developments and innovations in Quantum Physics 2017.
Why to Attend?
In the light of this theme, the conference series aims at providing the links between Quantum Physics and Nuclear Engineering by creating a platform for active participation, exchange of expertise and lateral thinking from researchers, scientists, and educators through invited plenary lectures, symposia, workshops, invited sessions and oral and poster sessions of unsolicited contributions.
Conference Series LLC look forward to welcoming you to an inspiring, educational and enjoyable program in Munich, Germany with the intent of emphasizing the applications of Quantum Physics and Nuclear Engineering research to the improvement of the global strength.
Target Audience:
- Directors of companies
- Researchers
- Professors
- Lecturers
- Scientists
- Students
- Managers & Business Intelligence Experts
- Research students and Research Institutes
- Advertising and Promotion Agency Executives
Conference Highlights
- Quantum Science
- Quantum States
- Quantum Field Theory
- Theory of Everything: String Theory
- Flow of Time
- Quantum Physics and the Universe
- Quantum Computing
- In Depth Quantum Mechanics
- Quantum Mechanics Interpretations
- Quantum Transport and Dissipation
- Physical Mathematics
- Nuclear Science
- Nuclear Engineering
- Nuclear Reactors
- Materials and Fuels for Nuclear Technology
- Interactions and Maintenance in Nuclear Technology
- Latest Technologies, Innovations and Applications
Special Issues
All accepted abstracts will be published in respective Journals.
- Journal of Lasers, Optics & Photonics
- Journal of Pure and Applied Physics
- Journal of Physical Mathematics
- Journal of Nuclear Energy Science & Power Generation Technology.
- Journal of Nuclear Medicine & Radiation Therapy.
Abstracts will be provided with Digital Object Identifier by Cross Ref.
See more at: http://quantumphysics.conferenceseries.com/
See more at: http://quantumphysics.conferenceseries.com/


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Ad Focus, Inc. offers a wide variety of dynamic and innovative indoor and outdoor advertising products.
Our high profile large format out of home media products include static and digital billboards,
indoor kiosks, outdoor kiosks, taxi, pedicab, tuk tuk advertising, bike bars and party bikes.
Our products are available in highly sought-after high traffic areas.


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Owner FAQs
What will my vacancy rent for?
The preferred method for renting a property takes a little common sense and a diligent effort to follow the formula to its conclusion. The steps are as follows:
- Using an objective Rent Market Survey of properties currently on the market, determine the high and low rent in the neighborhood and the average. Place the property on the market at any price within that range. The higher the price selected over the average, the more likely the process will take longer to obtain a tenant. Putting the rent below the average and closer to the lowest rent, the quicker a suitable tenant will be located on average. If you would like a no obligation rent quote click here.
- Place ads in several Internet listing websites, and on any other vacancy list that you can. Put a sign up and have your vacancy list available at your office 24/7.
- Be available to either take calls live or provide a recording to provide complete information to prospects. Try to eliminate "phone tag" as prospects are often not available to call back.
- If you are not obtaining calls, appointments to show, or suitable qualified applications you will have to lower your price by approximately 5% after two to three weeks. Change all advertising and follow the same strategy. Lower the rent an additional 5% every two to three weeks until the property is obtaining qualified applications.
Continue this process until the property is at the bottom of high/low asking rent for the neighborhood. Recheck the high/low to make sure someone else has not further lowered their rent. If so, lower your rent to match or make it slightly lower than the lowest rent. It is a fact that neither the owner or the property manager determine the rental rate. The rental rate is determined by market demand. If you think your property is "different" or "better" than competing properties and you price it higher than those competing vacancies, you will soon find out if you are truly able to get more rent. If the market answers yes, that is great. If your property does not rent quickly, better follow our strategy.
How long will it take to rent my vacancy?Our goal is to rent your property within 30 days. By following our pricing strategy (see the preceeding question) that should be achievable. An overpriced property may never rent. Your property manager is the best person to talk to about how to get the job done in 30 days. Talking your property manager into a higher rent to better cover your costs will probably result in a longer vacancy.
How do you screen for good residents?We require a detailed application from each adult and photo identification. All applications are carefully screened for credit, rental and ownership references, and income. A credit check will reveal hidden addresses and pay history. If the credit history passes our requirements we will verify all addresses lived at and talk to the owner about those previous tenancies. Our access to tax records will allow us to verify ownership. We will also verify employment and income levels. No applicant will be approved until all questions are answered to our satisfaction. In some cases we may lower the standards on a particular property in order to be realistic about getting the property rented in a reasonable time frame.
How is advertising handled?
We start the marketing process at the time we receive a 30-Day Notice from your resident or at the time we sign you up for management. Your property will appear on our vacancy list that is posted at all of our offices as well as on our website. We also put a sign on your property giving drive by rental prospects access to our 24 Hour Hotline Recording. Approximately 1 out of 4 prospects come to us from signage at the property. We will also advertise your property online through multiple rental databases. The cost for internet databases is much less than you would pay if you did it yourself as we pass much of the discounts we receive for annual contracts on to you. Most owners can budget to pay approximately $99.00 per month.
What should I do to my property to prepare it for a new resident?After price, the most important controllable factor in renting a property is condition. The walls should be freshly painted (or appear freshly painted), carpets clean with no tears or loose areas, clean appliances, clean kitchen and bathrooms, and clean or new blinds. Finally, the yard should be in good condition in both front and back. We are happy to inspect the property for you to help get the most out of your renovation dollars. Our company is full service and can provide all vendors needed to get your property "rent ready" quickly and for a great price.
What lenght of lease do you recommend?We normally recommend a one year lease to start. Understand that a lease benefits the resident more than it benefits the owner of the property. If the resident causes you problems or you want to move them out it is very difficult to get them out before the expiration of the lease. For this reason, it is not unreasonable to use a six month lease on some properties.
How is maintenance handled?
Residents are instructed to call, email, log into our website, or write to us with their repair requests. We will then compare the request to our history of maintenance on your property. We also keep on file your dollar limits for repairs as well as your contact information. Most callers need routine assistance and we are able to help them either by walking them through a simple procedure or by scheduling one of our technicians or vendors. Our company has made the extra effort to obtain a California General Contractors License (#773021) which operates as RAM Property Services. Both of these complimentary services allow us to quickly address most of your property's needs without having to make a phone call to a 3rd party vendor. We are more efficient and we know that the proper licensing and insurance (worker's compensation and liability) are in place at all times.
Who handles problems during the night, on weekends, and holidays?We have a 24/7 response to all maintenance calls. We will talk with the resident to determine how to proceed. Many times we solve a problem over the phone or by simply calling one of our plumbers that we have access to 24 hours a day.
What are habitability requirements?They are requirements that all owners of residential rental property must adhere to. They are enforceable by the local city or county building department. Failure to maintain your property to these standards may subject you to fines, lawsuits, or the shutting down of your rental. Here is the law: Civil Code §1941.1 A dwelling shall be deemed untenantable for purposes of Section 1941 if it substantially lacks any of the following affirmative standard characteristics: (a) Effective waterproofing and weather protection of roof and exterior walls, including unbroken windows and doors. (b) Plumbing or gas facilities which conformed to applicable law in effect at the time of installation, maintained in good working order. (c) A water supply approved under applicable law, which is under the control of the tenant, capable of producing hot and cold running water, or a system which is under the control of the landlord, which produces hot and cold running water, furnished to appropriate fixtures, and connected to a sewage disposal system approved under applicable law. (d) Heating facilities which conformed with applicable law at the time of installation, maintained in good working order. (e) Electrical lighting, with wiring and electrical equipment which conformed with applicable law at the time of installation, maintained in good working order. (f) Building, grounds and appurtenances at the time of the commencement of the lease or rental agreement in every part clean, sanitary, and free from all accumulations of debris, filth, rubbish, garbage, rodents and vermin, and all areas under control of the landlord kept in every part clean, sanitary, and free from all accumulations of debris, filth, rubbish, garbage, rodents, and vermin. (g) An adequate number of appropriate receptacles for garbage and rubbish, in clean condition and good repair at the time of the commencement of the lease or rental agreement, with the landlord providing appropriate serviceable receptacles thereafter, and being responsible for the clean condition and good repair of such receptacles under his control. (h) Floors, stairways, and railings maintained in good repair.
What happens if the resident does not pay the rent?If your resident does not pay rent as agreed we will make contact with them soon after the rent due date. Our due date is normally the 3rd of the month, but an existing lease may be later. If we cannot get a satisfactory answer we will make arrangements to serve a 3-Day Notice To Pay Rent or Quit. Once the three days pass we will submit the notice along with the existing rental agreement to a local attorney. This will start a process known as an unlawful detainer. It may include a court trail, but normally does not. The resident may move at any time, we may obtain a court order to move the tenant with the assistance of the local law enforcement, or we may obtain a stipulated judgment where the resident is ordered to pay back all monies owed, including future rents, or face an eviction without another judgment. You are responsible to pay for all legal costs.
What happens if the tenant bounces their rent check?As soon as we determine a rent check has bounced we will process it and notify the resident that the rent is now owed along with a processing fee and a late fee. If necessary we will serve the tenants a Three Day Notice to Pay Rent or Quit. Most residents end up clearing the check but it may delay your statement and funds.
Can you help me if I already have a resident?Yes. We may have to continue using your lease until it concludes, or we may be able to sign your current resident onto our lease. In cases where the resident is behind in their rent we can take the necessary steps to either get them to pay or evict if we cannot obtain payment. Many residents will suddenly find a way to pay the rent or move as soon as they hear that we are in place to follow through with all collection issues.
Who pays for repairs after a resident moves out?
After the move-out inspection, we will determine who is responsible to pay the bills to bring the property back to the condition it was in prior the resident moving in. You are allowed by law to charge the resident's deposit for rent, damages above normal wear and tear, and cleaning. We will charge the resident for everything that they should be charged for. We will compare the move in condition (we do a written move in condition report and include digital photos) to the current condition (we take digital photos to verify our written report upon move out). We want you to know that we consider this an important time in the management cycle, and we will protect your interests. We can use the resident's security deposit to pay for all or part of the bills. If the resident's deposit does not cover the costs, then you will have to pay the balance. In that event, we will bill the resident and turn them over to collection if the amount due is not paid promptly.
What bills can you pay and when?We can pay bills associated with your property including maintenance bills, utilities, taxes, insurance, and mortgages. We charge a small additional fee to pay mortgages. After the rents come in we pay mortgages and utilities first. Then we pay any other bills and begin sending owner proceeds checks.
Do you hold funds in reserve?All accounts are required to maintain a reserve amount. This is to cover any charges or maintenance bills that might be incurred when we do not have rents to cover those costs. The amount is determined by mutual agreement and is normally $300.00 or more.
How can I get my statements online?In addition to your emailed owner statements you can access your statements online at your convenience. You may view your monthly statements and reports through our owner portal. You can access the owner portal by clicking on this link: https://homepointe.appfolio.com/portal.
Who holds the residents security deposit?We hold the resident's security deposit in our trust account until it is paid back to the resident or used for rent, cleaning, or repairs upon their move out.
When do I get reports and when do you send me money each month?All rents are due on the first and considered late if received after the 3rd of the month. Most owner checks are mailed on the 20th, but you can choose to have an early check and report sent to you for a small extra charge. In that case, we can send your check and report by the 10th. Since rent checks must clear the bank, it is not practical to send funds earlier than the 10th. We do offer the ability for you to obtain your statements with copies of available invoices paid online at our website. If you choose this method you will get a discounted management fee. We encourage all owners to receive their funds via ACH. This allows us to electronically send your funds directly to your bank from our bank. There is no extra charge for this service. If your funds are sent via ACH, we post your report to our website the same day. Note: Weekends and holidays can delay owner proceeds checks to the next business day.
What liabilities do I have and how can I protect myself?As the owner of the property you could be held liable for known and some unknown conditions at the property. In most cases your fire/liability insurance policy will cover you adequately. You should discuss with your insurance company the amount of recommended limits for your situation. Our management agreement with you, which is the same as most other management companies, has an indemnity clause that places basic liability for all acts on the owner. Insurance companies know this and most will willingly name the property manager as either additional insured or name the manager as an interested party to the policy at no extra cost. This is important to do as you want the insurance company to protect us both in the unlikely event of a lawsuit. In most cases, just acting with common sense and acting quickly will lessen the likelihood of a lawsuit.
Who actually handles my property and how do we communicate?You will be assigned to an available property manager that knows the area that your property is located in. You may meet with them to sign up your account or by appointment at any time. You will get a letter from our office giving you the managers contact information including phone number and extension and email address. Email is the preferred method of contact with our office.
How often do you check on my property?During a vacancy we normally show your property 2-3 times per week. While rented, we schedule your property for an annual inspection. This inspection is sometimes called a "leak check", since we check for roof leaks, pipe leaks, and tub/shower leaks. We also photograph the property and we do provide you with a written report. This inspection normally takes 1-2 hours which includes setting up the appointment, the inspection, writing up the report, and sending it to you. We bill this inspection at our normal rate for maintenance. If you want additional inspections they can be arranged. We also suggest you have a "termite inspection" performed at least every two years to check for dryrot, leaks under the house or in the attic, and for infestations.
Why should I use your company vs. another?Hopefully you can see that HomePointe is a great value for you and your property. From three offices we have more selection for renters that are easier to access, we are an industry leader in technology making us convenient for renters and owners alike. We are also totally dedicated to property management and maintenance so we are not distracted by the sales market.
How long do we sign an agreement for?Our property management agreements start with a six month or twelve month term and then become month to month. In some cases a longer term can be used by mutual agreement. Once the initial term is completed the agreement can be cancelled with 30 days notice.
Do you have any references?We are happy to provide two references upon request. Once we receive your request we will contact two active clients to get their permission to have you contact them.
What does all this cost?Costs vary depending upon the type of property you have. Contact us here and complete our contact form and select Property Management Services. We will email you our current rates. All rates are subject to negotiation based on location and number of properties in your portfolio. Our rates are competitive within the industry.
How do I get started?
If you currently have a property manager that needs to be terminated:
- Check your current property management contract to see what type of notice is required. It is typical that you will be required to give a 30 day notice. If possible, call the manager to see if they will accept a shorter notice. Many will, especially if they know that you are unhappy. If you do not have a written contract, assume 30 days is required.
- Compose a brief letter as follows: "Please terminate your services on ______________ (property address), effective __________ (date). A representative of HomePointe Property Management will be in touch with you prior to the termination date to pick up keys and any pertinent files. Please send remaining funds in my account directly to me including tenant security deposits.
- Mail or email the letter and send a copy to HomePointe.
Everyone must do this:
- Sign and deliver a HomePointe Property Management Agreement and a HomePointe Owner Information Sheet to HomePointe at 5896 South Land Park Dr., Sacramento, CA 95822. You can also mail those documents to P.O. Box 221660, Sacramento, CA 95822 or fax them to 916-429-0389. Both of these documents are available in our Owner Services Section within this website.
- If you have a current resident please provide us the current rental agreement. If none is available let us know if you would like one to be completed and signed for the current resident.
- We need to know the current rent rate, deposit amount, and any amounts the resident owes.
- Provide us with keys if available.
A HomePointe Property Management Manager will call you as soon as we receive the signed forms. Thank you for choosing HomePointe.


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Body and Soul now increases the target's movement speed by 12/25%, down from 30/60%.
This change is now on the PTR for 4.1, what are you thoughts on this?
Was it OP or was it against "bring the player not the class"?
I thought it was an very fun mechanic which was really usefull in fights like atramedes and any situation were you need to escape fast.
Due the fact that the power of the spell comes forward trough the priest reaction speed in some situations i find it a not needed nerv.
I dont do pvp on my priest so i have no idea if it was OP in pvp.
Greetings Dezi