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FAQs Understanding A-Fib: Which Procedure Has the Best Cure Rates
FAQs Understanding A-Fib: Best Cure Rate
15. "I have paroxysmal A-Fib and would like to know your opinion on which procedure has the best cure rate."
The best cure rate isn't the only criteria you should consider when seeking your Atrial Fibrillation cure.
Let me first review your top three procedure options: cardioversion, catheter ablation, and surgical Maze/Mini-Maze.
Electrocardioversion: When first diagnosed with Atrial Fibrillation, doctors often recommend an Electrocardioversion to get you back into normal sinus rhythm. But for most patients, their A-Fib returns within a week to a month. (However, you might be lucky like the A-Fib patient who wrote us that he was A-Fib free for 7 years after a successful cardioversion.)
Catheter Ablations: Radio-frequency and CryoBalloon catheter ablations have similar success rates 70%-85% for the first ablation, around 90% is you need a second ablation. Currently, CryoBalloon ablation has a slightly better cure rate with the least recurrence.
How to achieve these high success rates? It's crucial you choose the right electrophysiologist (EP), one with a high success rate and the best you can afford (considering cost and any travel expense). What counts is the EP's skill and experience.
You want an EP who not only ablates your pulmonary veins, but will also look for, map and ablate non-pulmonary vein (PV) triggers. That may require advanced techniques like withdrawing the CryoBalloon catheter and replacing it with an RF catheter to ablate the non-PV triggers. (See our Choosing the Right Doctor: 7 Questions You've Got to Ask [And What the Answers Mean].)
Cox Maze and Mini-Maze surgeries: Success rates are similar to catheter ablation, 75%–90%. But surgery isn't recommended as a first choice or option by current A-Fib treatment guidelines. Compared to catheter ablations, the maze surgeries are more invasive, traumatic, risky and with longer (in hospital) recovery times
When should you consider the Maze/Mini-Maze? The primary reasons to consider a Maze surgery is because you can't have a catheter ablation (ex: can't take blood thinners), you've had several failed ablations, or if you are morbidly obese.
You should also consider that Mini-Maze surgeries have built in limitations. For example, unlike catheter ablations, mini-maze surgery can't reach the right atrium, or other areas of the heart where A-Fib signals may originate (non-PV locations). The more extensive surgeries create a great deal of lesions burns on the heart which may impact heart function.
So How Do You Choose the Best Treatment For You?
Atrial Fibrillation is not a one-size fits all type of disease.
Your first step is to see a heart rhythm specialist, a cardiac electrophysiologist (EP), who specializes in the electrical function of the heart.
An EP will work with you to consider the best treatment options for you. If your best treatment option is surgical, your EP will refer you to a surgeon and continue to manage your care after your surgery.
To help you find the right EP for you, see Finding the Right Doctor for You and Your A-Fib.
If you find any errors on this page, email us. ♥ Last updated: Wednesday, August 24, 2016
New Story: Cardiologists Offer Little A-Fib Advice to Fellow Doctor
John Bennett, MD, practices emergency medicine in Miami, Florida. Dr. Bennett is known for his series of Google Hangouts live videos featuring experts in a variety of medical fields. To learn more, visit his website, Internetmedicine.com, "Where the Internet Meet Medicine." His Atrial Fibrillation started at age 57.
"As a physician, I had the usual knowledge most physicians have about A Fib—which is not much. Especially the care of chronic Atrial Fibrillation. Like most people, I trusted my cardiologist to do the best thing for me.
First Cardiologist No Options But Drugs—I Hated Coumadin
My first cardiologist did the usual workup, and prescribed Coumadin. I hated that medicine. Made me feel tired, no energy, but I accepted it.
Finally, I got tired of being tired, so I started to do some online research.
I found out that you could elect to be cardioverted, which my first cardiologist did not even mention (since, of course, he would lose me as a patient, if I returned to normal sinus rhythm).
Electrocardioversion Works for 7 Years
I then went straight to an Electrophysiologist (EP), who converted me, and it lasted 7 years. Then last year…" Continue reading Dr. John Bennett's story->
Cardiologists Offer Little A-Fib Advice, Even to a Fellow Doctor!
By John Bennett, MD, July 2016
John Bennett, MD, is known for his series of Google Hangouts live videos featuring experts in a variety of medical fields. To learn more, visit his website, Internetmedicine.com, "Where the Internet Meets Medicine." Previously Dr. Bennett worked in Emergency Medicine in Miami, Florida.
I had the good fortune to run into Steve Ryan, find his website, and get his book. Ultimately I got fine care and returned to having a healthy heart. My story being at age 57 when I suddenly went into Atrial Fibrillation.
I Trusted My Cardiologist
As a physician, I had the usual knowledge most physicians have about A Fib—which is not much, especially the care of chronic Atrial Fibrillation. Like most people, I trusted my cardiologist to do the best thing for me.
My first cardiologist did not even mention cardioversion to get me back in sinus rhythm.
First Cardiologist No Options But Drugs—I Hated Coumadin
My first cardiologist did the usual workup, and prescribed Coumadin. I hated that medicine. Made me feel tired, no energy, but I accepted it.
Finally, I got tired of being tired, so I started to do some online research.
I found out that you could elect to be cardioverted, which my first cardiologist did not even mention (since, of course, he would lose me as a patient, if I returned to normal sinus rhythm).
Electrocardioversion Works for 7 Years
Well, he did. I then went straight to an Electrophysiologist (EP), who converted me, and it lasted 7 years. I was cardioverted again but this time it only lasted 5 months.
Still, no talk of catheter ablation. I had to chase my doctor down the hall to say, "What's the plan?"
Research and reading 'Beat Your A-Fib', I found I might be a candidate for catheter ablation.
Ablation and A-Fib Free—"Beat Your A-Fib" Book
Next, I went back to the internet where I ran across Steve's book, 'Beat Your A-Fib' and found I might be a candidate for catheter ablation.
July 2015 I had an ablation by Dr. Todd Florin at Mount Sinai Medical Center in Miami Beach (highly recommended, good listener, super team) and returned to normal sinus rhythm. It's been one year and I am still in normal sinus rhythm. If you've had A-Fib, I don't have to tell you the difference between A-Fib and sinus rhythm.
I am truly appreciative about Steve's work [A-Fib.com] and his book. I feel like a real human being again, with normal energy levels.
Lessons Learned
Like Steve says, catheter ablation may not be the answer for every patient with A Fib.
But you need to be aware of it! Read. Be aggressive with your cardiologist. Ask about catheter ablation [and other options]. Take an active role in the care of your pump!
Steve's book, "Beat Your A-Fib," motivated me to get active and investigate my treatment options.
Isn't it sad that TWO of my Cardiologists did not care enough to even mention ablation to me? And I am a friggin' doctor―and they treated me that way!
John Bennet, MD
Miami, Florida
Editor's comments
Electrocardioversion best for recent-onset A-Fib: Dr. Bennett was very fortunate to have a cardioversion keep him in sinus rhythm for seven years.
Unfortunately for most patients, a cardioversion seldom lasts that long. It works best in cases of recent onset A-Fib. It's a very safe procedure and is certainly worth a try, but cardioversion is seldom a permanent cure for A-Fib. Don't be surprised if you're back in A-Fib within a week to a month.
Amazing! Dr. Bennett's fellow physicians didn't tell him about options like electrocardioversion and catheter ablation.
Amazing! Dr. Bennett's fellow physicians didn't tell him about options like electrocardioversion and catheter ablation.
You can't always trust cardiologists (or the media): What's most amazing about Dr. Bennett's story is that his fellow physicians and colleagues (whom he trusted) didn't tell him about options like Electrocardioversion and catheter ablation.
Today's media and web sites talk about "Living with A-Fib". But living in A-Fib is detrimental to your long-term health.
In contrast, the message at A-Fib.com is: You don't have to live in A-Fib. Seek your Cure.
Staying in A-Fib Reduces Brain Volume & Cognitive Function
A study of brain atrophy from Iceland found that A-Fib in the elderly caused accelerated loses of brain volume and cognitive function.
This is yet another study driving a stake into the heart of the notion that you can just leave patients in A-Fib with anticoagulants and rate control drugs, and they will live happily ever after.
"It's better for the brain to remain in sinus rhythm than to pursue rate control of A-Fib" stated Dr. David O. Arnar, speaking of the AGES-Reykjavik Study results at the 2015 Euro Society of Cardiology Annual Congress.
The AGES-Reykjavik Study
Over two thousand elderly subjects without dementia (mean age 67 years old) were tested and followed for over 5 years. Participants had brain MRIs and structured cognitive function testing during the duration of the study.
The 2,472 elderly patients fell into three groups: those who remained A-Fib-free throughout the study, those with confirmed A-Fib at the start (121), and those who developed new-onset A-Fib (132) by the end of the study.
AGES Findings: Brain Matter
At the end of the follow-up period, all participants had a reduction in brain grey matter. The amount of reduction varied significantly by group:
• A-Fib-free: 1.8% decrease
• Ongoing A-Fib: 2.79% decrease
• New-onset A-Fib: 6.5% decrease
Joe Mirretti A-Fib Story
A-Fib Patient Story #81
Two Months After A-Fib Diagnosis, 62-Year Old Cyclist Has CyroBalloon Ablation; Difficult Three-Month Blanking Period
By Joe Mirretti, Gurnee, IL, May 2015
I just turned 62 and have been an active cyclist all my life. I also run and lift weights. My resting heart rate is 47.
December 2014: First A-Fib Attack
On December 11, I got on the stationary bike, and my pulse was 100 without doing anything. When I started pedaling, it went up to 140. I thought something was wrong with my heart rate monitor. When I drove home, my heart rate was all over the place.
My wife, Wendi, took me to the Emergency Room (ER). One nurse came in and thought I had gone back into sinus rhythm since my pulse was in the 70s, but that was double my normal heart rate. When I stood up, the ER staff became more alarmed—my pulse jumped up to 170-180. They confirmed that I had Atrial Fibrillation (A-Fib).
Electrocardioversions Don't Last, Drugs Have Bad Side Effects
The A-Fib felt terrible. I was out of breath, had palpitations, I couldn't exercise, my heart was thumping in my chest.
The A-Fib felt terrible. I was out of breath, had palpitations, I couldn't exercise, my heart was thumping in my chest….Even with drugs, the A-Fib would wake me up in the middle of the night.
They Electrocardioverted me December 12, 2014. That worked for about a week. But December 17 while lying in bed I sneezed and went right back into A-Fib. I had another Electrocardioversion December 19 which this time only lasted 4-5 days.
For a while I was on Diltiazem 160 mg/d and later flecainide 150 mg/2Xday. They also put me on the blood thinner Eliquis. But I had terrible side effects from these drugs, such as vertigo. When I'd take flecainide, hours after dinner my pulse would even out before going to sleep. But 3-4 hours later the A-Fib would wake me up in the middle of the night.
In early January I had a chiropractic adjustment to my back which seemed to put me back into sinus rhythm for 12 days.
With Active Life Style, Learns About Catheter Ablation
Because of my active life style, my cardiologist at Northwestern in Lake Forest (North of Chicago), Dr. Ian D. Cohen, thought I would probably need a catheter ablation.
He helped me schedule an appointment on January 9 with Dr. Albert C. Lin of the Northwestern Un. Feinberg School of Medicine/Bluhm Cardiovascular Institute which has a branch in Lake Forest. I was very impressed by Dr. Lin. He was very interested in hearing everything we had to say and was confident. I asked him if the chiropractic adjustment was responsible for getting me back into Sinus. He couldn't say for sure, but he predicted I'd go back into A-Fib. Needless to say, he was right.
Extremely Symptomatic, Decides "I Can't Live in A-Fib"
My wife, Wendi, and I both agreed that I should have a CryoBalloon ablation as soon as possible. I was so symptomatic I couldn't live in A-Fib, the drugs caused me terrible side effects, and the cardioversions didn't work.
I had read that the faster you correct or get A-Fib cured, the better.
I had read that the faster you correct or get A-Fib cured, the better you are. And we liked Dr. Lin. He was very encouraging, but wasn't telling us we need to do this. He said, "Don't make a decision now. Go home and discuss it."
We decided to go with the ablation. Dr. Lin was able to schedule us for a CryoBalloon ablation February 12, 2015.
A-Fib Research Online: Encouraged By Stories on A-Fib.com
I Googled everything on A-Fib as much as I could. The stories and information you gave on A-Fib.com really helped me move forward.
I just think it's so wonderful they are developing these ablations so quickly and improving them. I read your story how back in 1998 you were in the hospital for nearly two weeks when you had your ablation. (See Steve Ryan's A-Fib story.) I was only in the hospital overnight.
I've always had skipped heart beats. The doctors have seen it on my EKGs and stress tests but were never concerned about it.
I don't understand how some people don't feel anything when in A-Fib. I always wore a heart rate monitor when I worked out. I've been keeping records of my workouts daily going back 25 years. I noticed a couple of years ago I may have had some brief episodes of A-Fib, but they corrected themselves. However, I didn't know anything about A-Fib at that time.
I've always had skipped heart beats. The doctors have seen it on my EKGs and stress tests but were never concerned about it.
February 2015: My CryoBalloon Ablation Day Arrives
I remember counting the days until the scheduled ablation. That's how bad the A-Fib symptoms were, and they were getting worse. I had an MRI on February 10, 2015 at Northwestern in Chicago.
The morning of February 12, ablation day, we got up at 4:00 am since I was the first patient of the day. My wife, Wendi, did a great job getting me there, as she does not like to drive in the city, and rush hour in Chicago is crazy. (I had not driven in three weeks because of the vertigo.)
The ablation took about four hours. I woke up in perfect sinus rhythm! Dr. Lin said he CryoAblated all four pulmonary veins, and that everything went as well as possible. He sent me home the next morning on no meds except Eliquis.
Difficult Recovery—Dealing With Weird Sensations and Worry
The recovery was difficult. The next day, out of the hospital I felt pretty rough, like I had been hit by a truck. I had no A-Fib the first 8 days, just occasional rapid heartbeats.
I was encouraged to exercise. The eighth day I got on the stationary bike for an hour. Later I had a short A-Fib attack. Dr. Lin put me back on a ½ dose of flecainide for a while.
Like everyone has said in their stories, A-Fib does such a job on your head. Every time you feel something, it scares you like you're going back into A-Fib.
That's been a mental battle. That's why reading those stories helps, what other people went through those first three months. You're going to get a number of strange things happening to you during the 3-month blanking period after an ablation. Mine have been very short.
Dr. Lin and his office were terrific during this time. I could call any time, and his assistant or Dr. Lin would call me right back.
I'm not having any A-Fib, my skipped beats and palpitations are getting shorter and shorter.
But it's a mental battle. What I've read is your heart is trying to go back into A-Fib and the beat is now blocked. Your heart is adjusting and getting used to beating normally again.
On and Off Meds During 3–Month Blanking Period
The day I left the hospital Dr. Lin took me off of all meds except Eliquis. But after I got the short bout of A-Fib, he put me back on ½ dose of flecainide, 75 mg 2X/d for one month. Then he put me on a little bit of metoprolol 25 mg because Diltiazem caused me such bad side effects. He said he did that because there is a possibility that the flecainide in rare cases could cause rapid heartbeat.
About a month after my ablation, he took me off of flecainide. Since then I've only been on 25 mg of metoprolol and Eliquis. I have given up my morning expresso and only have one glass of wine with dinner.
Lessons Learned: Three Months Post-Ablation
I am very pleased I went ahead with the ablation. I've passed my 3 month blanking period (I was 30 days on a Holter monitor) with no A-Fib. I'm biking for an hour 3 days a week. I hope to encourage others with A-Fib to seek help. There are solutions out there.
If you have A-Fib, I would definitely explore ablation options as soon as possible for many reasons (i.e., avoid side-effects or reactions to meds, increase your chance of success with just one procedure, reduced anxiety and stress, etc.).
It's helpful to read stories of other A-Fib patients. (Go to A-Fib.com/Personal A-Fib Stories of Hope.) It helps to hear what other people are going through.
After ablation, don't push too soon. I advice you to get back to exercise slowly to give your heart a chance to heal.
In writing my story, I hope to encourage others with A-Fib to seek help. There are solutions out there. I was very healthy to begin with which probably helped the odds of the ablation being successful.
Joe Mirretti
Email: mirritaly(at)aol.com
Editor's Comments:
Ablation as First Choice Treatment: From the date Joe had his first A-Fib attack to his CryoBalloon ablation was barely two months!
I want to commend Dr. Ian D. Cohen, Joe's cardiologist at Northwestern in Lake Forest. He understood that A-Fib patients don't have to suffer through months or years while trying different drugs. Current guidelines allow you to get an ablation right away. Based on Joe's active lifestyle he referred Joe for an ablation.
More doctors today understand how A-Fib drugs are often ineffective and have intolerable side effects, and how terrible it can be to live in symptomatic A-Fib.
You can have a catheter ablation right away if you want. A catheter ablation is a low risk procedure (it isn't surgery—there's no cutting involved). It's one of the safest cardiac procedures you can have.
Coping with the Blanking Period: We're grateful to Joe for calling our attention particularly to the mental aspects of dealing with the blanking period after an ablation. We certainly need to develop more help and instruction so that patients can cope better during this time.
The Genetics of A-Fib: Joe's son developed A-Fib, too. Although the exact incidence of the familial form of atrial fibrillation is unknown, recent studies suggest that up to 30 percent of people with atrial fibrillation may have a relative with the condition.
If you have a family member who has A-Fib, your chances of developing A-Fib are much greater than the average person's. You need to be more attentive and you ought to see an Electrophysiologist (EP) to get tested for silent A-Fib. (Some people say that all A-Fib is genetic. But we don't have the research and studies to confirm this hypothesis.)
Join the Genetics Research Studies Underway: Several A-Fib research centers around the US are doing ground-breaking research on genetic A-Fib. If you have 3 or 4 family members with A-Fib, you can join these studies at no cost (except travel). You and your family would be involved in cutting-edge research that is changing the way we identify and treat A-Fib. For further info, contact Dr. Patrick Ellinor at Mass General:
Dr. Patrick T. Ellinor, MD, PhD Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit St., GRB 109, Boston, MA 02114. 617-726-5067 Fax: 617-726-2155 E-mail: pellinor(at)partners.org
Return to Patient A-Fib Stories
If you find any errors on this page, email us. Y Last updated: Sunday, July 17, 2016
Subject Index to A-Fib.com Articles for Additional Reading
Subject Index to A-Fib.com Articles
This index is a growing list of articles found throughout the A-Fib.com site that augment or supplement the major topics (each subject title is a link). If you have a keyword or topic, you can also use the 'Search' feature in the upper right corner of every page. New posts are flagged in Red.
Select a subject to browse articles:
♥ Dealing with Atrial Fibrillation
♥ Minerals Deficiencies & Supplements
♥ Drug Therapies & Medications
♥ Catheter Ablation, CyroBalloon and Pulmonary Veins Isolation
♥ Surgeries: Maze/Mini-Maze, Convergent, LAA Closure
♥ AF Symposium Articles by Year: Steve's Summary Reports
Didn't find what you're looking for?
Try the 'Search our Site' feature (top right of every page)
Return to A-Fib.com home page
Last updated: Monday, March 2, 2015
Can Anyone in A-Fib Really Be Asymptomatic?
AF Symposium 2015
Can Anyone in A-Fib Really Be Asymptomatic?
Dr. Jeremy Ruskin of Massachusetts General made a statement during the 'Challenging Cases' discussions which changed my thinking about the true nature of asymptomatic or 'silent' A-Fib.
Not everyone may "feel" their A-Fib symptoms…but losing that amount of blood flow must affect your body and brain in some way
In the case being discussed, Dr. Ruskin recommended an Electrocardioversion to get the asymptomatic patient back in Normal Sinus Rhythm (NSR). Many times patients who are used to living with their A-Fib will indeed notice a difference when returned to NSR—they often feel much better.
Editor's Comments:
In A-Fib, you lose 15%-30% of your normal pumping blood volume because the atria fibrillate instead of pumping blood down into the ventricles. Not everyone may "feel" A-Fib symptoms like chest pains, palpitation or shortness of breath. But losing that amount of blood flow must affect your body and brain in some way. Patients with persistent A-Fib may adjust their life-style to this loss of blood flow or just get used to it. Or they may compensate with strenuous exercise (making the ventricles suck blood down from the non-functioning atria like a turkey baster). But A-Fib is affecting them, consciously or not.
I have a friend who is in persistent A-Fib and is "asymptomatic." He is a swimmer and exercises a lot. He does take a blood thinner to prevent an A-Fib stroke (which he doesn't like. He wants to get a Watchman device installed to close off his Left Atrial Appendage [LAA] so that he doesn't have to take anticoagulants).
I will now recommend to my friend that he get an cardioversion to see if he notices a difference when he is in Normal Sinus Rhythm (NSR) compared to being in persistent A-Fib. A cardioversion is non-invasive and pretty safe. The only problem is that the result often doesn't last. But even if it lasts for just a few days, my friend would still be able to compare being in NSR versus living in persistent A-Fib. (I'll also remind him that the best way to get off of anticoagulants is to cure your A-Fib.)
And returning to NSR after a cardioversion even for a few days is generally a good sign that a successful catheter ablation may fix his A-Fib, that his A-Fib hasn't progressed so far that he can't be shocked out of it.
Return to AF Symposium 2015: Brief Reports
Last updated: Friday, February 27, 2015
FAQs A-Fib Ablations: Is 82 Too Old for a PVA?
FAQs A-Fib Ablations: Is 82 Too Old for a PVA?
10. I am 82 years old. Am I too old to have a successful Pulmonary Vein Ablation? What doctors or medical centers perform PVAs on patients my age?"
This is a very important question since so many people in their 80s are getting A-Fib. 8-10% of people in their 80s have A-Fib. Recent studies indicate you are certainly not too old to have a successful Pulmonary Vein Ablation.
1. "Age should not preclude patients from A-Fib ablation," according to the authors of a study comparing catheter ablation to antiarrhythmic drugs (AADs) in the elderly. 412 patients aged 70 years or older with symptomatic persistent A-Fib refractory to at least one AAD choose either ablation or AAD treatment. Pulmonary Vein Isolation (PVI) and right atrium cavotricuspid isthmus (Flutter) ablation were performed in the entire ablation group. 60% also received left atrium linear lesions at the roof and left isthmus.
The AAD group underwent electrical cardioversion (ECV) after four weeks of AAD and continued the AAD thereafter. Catheter ablation in the elderly was more effective in maintaining sinus rhythm (SR) than AAD (76% vs, 46%). And due to the higher rate of SR maintenance, the ablation group was more likely to discontinue AADs (67% vs. 28%) and oral anticoagulants (74% vs. 43%), "with a consequent greater reduction of long-term adverse events (7.7% vs. 23.9%) and greater improvement in quality of life." (Elderly patients with a previous history of TIA/stroke had more cerebral thromboembolisms (strokes) during the ablation procedure.)
2. In a study of 103 octogenarians (with four over 90 years old) who had an A-Fib ablation and were followed for 18 months, 69% of the octogenarians were A-Fib free without AAD after a single procedure compared to 71% of those younger than 80 (no significant difference). The success rate increased to 87% after two procedures.
3. Another study looked at A-Fib ablation in patients over 80 years old vs. younger patients. The hospital stay was longer in the older patients, but there was no increased risk of complications. One-year survival free of A-Fib or Flutter was 78% in those older than 80 and 75% in those younger (no significant difference).
4. A multicenter study looked at 175 patients older than 75 who underwent catheter ablation for symptomatic A-Fib with a mean follow-up of 20 months. The ablation procedure consisted of pulmonary vein antrum isolation and isolation of the superior vena cava. 73% maintained sinus rhythm (SR) after a single ablation procedure, and the complication rate was 1%. After a second ablation, 82% maintained SR without AADs. An additional 22 patients were able to maintain SR with AADs. Thus 94% of patients older than 75 remained in SR at almost 2 years of follow-up with a very low rate of major procedure-related complications.
Editor's comments:
The above studies demonstrate conclusively that for people over 80, not only can you have an A-Fib ablation, you probably should—especially compared to living the rest of your life on antiarrhythmic (AADs) and anticoagulant drugs. AADs produce much more long-term adverse events than an A-Fib ablation. But more importantly, a successful A-Fib ablation produces a dramatic improvement in one's quality of life that is indeed life-changing. Ask anyone who's had A-Fib what it's like to have a heart that beats normally again.
If you're over 80, many cardiologists will put you on antiarrhythmic (AADs) and anticoagulant drugs rather than refer you to an EP for an A-Fib ablation. But, all things considered, this may not be in your best interest. If this happens to you, don't hesitate about getting a second opinion.
Some say that people over 80 years old shouldn't have an A-Fib ablation because they are often sicker or more frail than younger people. But that isn't always the case. People who live into their 80s often have more healthy life habits such as not smoking, good diet, aren't overweight, low cholesterol, don't binge drink, are more often female, take better care of themselves, and are more likely to seek good medical care if problems arise. In one study the most elderly (over 85) had a much lower complication rate (2.5%) than younger patients.
If you do have other illnesses besides A-Fib and are over 80 years old, obviously you need to take care of the more life-threatening illnesses first. But an A-Fib ablation may improve your overall health and your other illnesses, because of the improvement in your circulation and blood flow from being in normal sinus rhythm. EPs should do a thorough examination of you before designating you for an A-Fib ablation. They are unlikely to perform an ablation on someone very ill or near death's door.
Ultimately whether or not to have an A-Fib ablation is a question only you and your doctor can answer based on your individual needs, health, medical history, how your A-Fib affects you, etc.
Centers that perform ablations on 80-year-olds
¤ Dr. Andrea Natale and his colleagues around the US are known for their success in ablating older patients. See:
• Texas Cardiac Arrhythmia Institute/St. David's Medical Center/ Univ. of Texas in Austin
• California Pacific Medical Center in San Francisco, CA
• Scripps Clinic in La Jolla, CA
¤ Intermountain Heart Rhythm Specialists in Murray, UT (near Salt Lake City)
¤ Go, "Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention." JAMA, 2001:285:2370-2375. Last accessed 9/25/2014. http://www.ncbi.nlm.nih.gov/pubmed/11343485
¤ Blandino et al. Long-term efficacy and safety of two different rhythm control strategies in elderly patients with symptomatic persistent atrial fibrillation. J Cardiovasc Electrophysiol. 2013;July 24(7):731-8. Last accessed 9/25/2014. http://www.ncbi.nlm.nih.gov/pubmed/23551460. doi: 10.1111/jce.12126. Epub 2013 Apr 1
¤ Santangeli et al. Catheter ablation in octogenarians: Safety and outcomes. J. Cardiovasc Electrophysiol 2012;23:687-693. Last accessed 9/25/2014. http://www.ncbi.nlm.nih.gov/pubmed/22494628 doi: 10.1111/j.1540-8167.2012.02293.x. Epub 2012 Apr 11
¤ Bunch, TJ et al. Long-term clinical efficacy and risk of catheter ablation for atrial fibrillation in octogenarians. Pacing Clin Electrophysiol 2010;33:146-152. Last accessed 9/25/2014. http://www.ncbi.nlm.nih.gov/pubmed/19889181. doi: 10.1111/j.1540-8159.2009.02604.x. Epub 2009 Nov 2.
¤ Corrado, A. et al. Efficacy, safety, and outcome of atrial fibrillation ablation in septuagenarians. J. Cardiovasc Electrophysiol 2008;19:812-814. Last accessed 9/25/2014. http://www.ncbi.nlm.nih.gov/pubmed/18363688. doi: 10.1111/j.1540-8167.2008.01124.x. Epub 2008 Mar 21
¤ Ellis, E. et al. Trends in utilization and complications of AF Ablation in Medicare patients. Heart Rhythm 2009;6:1267-1273. Last accessed 9/25/2014. http://www.heartrhythmjournal.com/article/S1547-5271%2809%2900618-3/abstract. DOI: http://dx.doi.org/10.1016/j.hrthm.2009.06.009
Return to FAQ Catheter Ablations
Cardioversion to Restore Normal Sinus Rhythm
Cardioversion for Atrial Fibrillation
Your doctor may recommend a cardioversion to restore your heart to normal sinus rhythm (NSR). There are two types of cardioversion: chemical and electrical. Cardioversion through the use of drugs is called chemical cardioversion. Electrical cardioversion uses a low-voltage, timed electrical shock to restore normal rhythm.
Most cardioversions are planned and scheduled several weeks in advance.
On the other hand, if your A-Fib is so irregular and rapid that it is life threatening, you may be sent to the emergency room, given the intravenous anticoagulant Heparin, and an electrical cardioversion performed.
The goal of chemical cardioversion is to make your heart beat regularly (in normal sinus rhythm). It is usually done in a hospital. Some combination of medications (see Treatment/Drug Therapies) is administered intravenously, such as Cardizem, verapamil, ibutilide, or adenosine (a class V antiarrhythmic agent). Doctors monitor you closely for adverse side effects.
Chemical cardioversion is often done in combination with Electrical Cardioversion described below.
Electrical Cardioversion
Electrical Cardioversion is a medical term for giving your heart a low-voltage electrical shock to synchronize it, that is, to make it beat regularly (in normal sinus rhythm). It is often used in combination with Chemical Cardioversion.
Note: Electrical cardioversion is not the same as Defibrillation. In defibrillation, doctors use high-voltage shocks to treat life-threatening arrhythmias or a heart that has stopped.
During Electrical Cardioversion you are anesthetized and are unconscious when you receive the shock. The shock causes the signal producing areas of your heart to discharge all at once. This stops all electrical activity in your heart momentarily, hopefully allowing your normal heart rhythm to take over. Usually only one shock is required to restore NSR.
VIDEO 1: Patient video, short animation (:60) explaining the steps in performing an electrical cardioversion for patients in Atrial Fibrillation; By eMedTV 1
Low Risk Treatment But High Risk of Clots Forming
Electrical Cardioversion is considered a low risk procedure. But it is a 'shock' to the body and requires general anesthesia. (It's like a mini electrocution. The metal paddles or patches, for example, can potentially leave burn marks on the chest.)
Cardioversion does carry a high risk of forming clots and causing stroke.2
Why? An Electrical cardioversion "stuns" your heart along with your Left Arial Appendage (LAA). Clots may form in the LAA while your heart is stunned and not beating. The clot can break away and enter the blood stream with the potential of causing a stroke. (The LAA is where most A-Fib clots originate.)
To dissolve potential clots, your doctor will have you take an anticoagulant like warfarin (Coumadin) before the treatment and in the three to four weeks following treatment.
While on warfarin (Coumadin), your blood will be tested for how long it takes to clot (a prothrombin time test, PT). The goal is to keep your INR (International Normalized Ratio) score between 2.0 and 3.0. Your dosage will be adjusted if necessary. You may have to have your blood tested weekly until your doctor determines you are in the proper INR range.
Success Rate of Cardioversion
Electrical Cardioversion (often combined with Chemical Cardioversion) is considered a standard, routine, low risk treatment option, particularly for recent onset A-Fib patients. If your A-Fib has just started, it may be a momentary aberration; and an Electrical Cardioversion may correct it.
Cardioversion has a very high initial success rate, returning up to 95% of A-Fib patients to NSR.
While the conversion rate is high, recurrence of A-Fib is high too. As few as 23% of patients remain in normal sinus rhythm for more than one year post-procedure. For most, their A-Fib returns within the first five days.4
Are Repeated Electrical Conversions Dangerous?
People with A-Fib often ask, "How often can I be Electrical Cardioverted? Does it ever become counterproductive or dangerous?" Right now we just don't know the answer to this question.
Former Senator and NBA basketball player Bill Bradley had three successful Electrical Cardioversions from 1996-1998 without any apparent ill effects.5 I've heard of an A-Fib patient who received an Electrical Cardioversion once a month for a year without any apparent problems.
VIDEO 2: Watch an actual Electrical Cardioversion recorded at the patient's request: "Me Being Cardioverted" posted by reddy321.6But be advised: the patient in this video is partially awake (this is not the norm). This video is a bit unsettling to watch (but not dangerous or painful for the patient).
Don't Be Frightened
Don't let this type of video frighten you. It may look and sound traumatic, but Electrical Cardioversion is in fact non-invasive and is one of the easiest and safest short term treatments available for A-Fib.
And don't let TV shows with emergency room scenes frighten you either. In fact, those scenes are usually depicting defibrillation, not cardioversion (defibrillators use high-voltage shocks to treat a heart that has stopped beating).
In her Personal Experiences story, Kris tells of accidentally being awake during an electrical cardioversion (see Personal Experiences story #37). According to Kris, the shock is relatively mild compared to what you often see portrayed in medical dramas on TV.
Last updated: Wednesday, April 6, 2016
Back to the Top
Return to Treatments for Atrial Fibrillation
- VIDEO 1: Short animation explaining electrical cardioversion when in Atrial Fibrillation. YouTube video posted by eMedTV; Last accessed Oct 12, 2014; URL: http://www.youtube.com/watch?v=-jkhQ5Tl2fs↵
- Haines, D. "Atrial Fibrillation: New Approaches in Management." Un. of Virginia multi-media presentation, 1999, p.2. http://www.a-fib.com/HainesUnOfVirginiaAtrialFibrillation.htm↵
- Boos C , More RS, Carlsson J. Persistent atrial fibrillation: rate control or rhythm control. BMJ 2003;326:1411–2.↵
- Gorman, Christine, "A Candidate's Racing Heart," TIME, Sunday, Dec. 12, 1999. http://www.time.com/time/printout/0,8816,35831,99.html↵
- VIDEO 2: Me Being Cardioverted YouTube video; Last accessed February 22, 2013; URL: http://www.youtube.com/watch?v=2nsN0vdXZuY&feature=fvw.↵
Treatments for Atrial Fibrillation
Treatments for Atrial Fibrillation include both short-term and long-term approaches aimed at controlling or eliminating the abnormal heart rhythm associated with A-Fib.
Diagnostic Testing
Doctors have several technologies and diagnostic tests to aid them in evaluating your A-Fib. Go to Diagnostic Testing ->
Additional readings:
• Sleep Apnea: Home Testing Now Available
• A Primer: Ambulatory Heart Rhythm Monitors
• Guide to DIY Heart Rate Monitors & Handheld ECG Monitors (Part I)
• Guide to Heart Rate Monitors: How They Work For A-Fib Patients (Part II)
• Understanding the EKG Signal
• The CHADS2 Stroke-Risk Grading System
Mineral Deficiencies
A deficiency in minerals like magnesium or potassium can force the heart into fatal arrhythmias. When you have A-Fib, a sensible starting point is to check for chemical imbalances or deficiencies. Go to Mineral Deficiencies ->
Additional readings:
• Frequently Asked Questions: Mineral Deficiencies & Supplements
• 'Natural' Supplements for a Healthy Heart
• Alternative Remedies and Tips
• Acupuncture Helps A-Fib—Specific Acupuncture Sites Identified
• Low Serum Magnesium Linked with A-Fib
Drug Therapies
Medications (drug therapies) for A-Fib patients are designed to regain and maintain normal heart rhythm, control the heart rate (pulse), and prevent stroke. Go to Drug Therapies ->
Additional readings:
• Frequently Asked Questions: Drug Therapies and Medicines
• Anticoagulant Therapy after Successful A-Fib Catheter Ablation: Is it Right for Me?
• Warfarin vs. Pradaxa and the Other New Anticoagulants
• Amiodarone: Most Effective and Most Toxic
• Research Findings: Anticoagulants for Stroke Prevention
• Watchman: the Alternative to Blood Thinners
The goal of cardioversion is to restore your heart to normal rhythm. There are two types of cardioversion: chemical and electrical. Cardioversion through the use of drugs is called chemical cardioversion. Electrical cardioversion uses a timed electrical shock to restore normal rhythm. Go to Cardiversion ->
Catheter Ablation
RF Catheter Ablation and CryoAblation are minimally invasive catheter procedures that block electrical signals which trigger erratic heart rhythms. Go to Catheter Ablation ->
Additional readings:
• New Ablation Technique by Dr. Andrea Natale
• Frequently Asked Questions: Catheter Ablation, Pulmonary Vein Isolation, CyroBalloon Ablation
• Considering a Catheter Ablation? Know Complication Rates When Choosing Your Doctor
• Ablation Success Rate Much Better With Weight Control
• A-Fib Research: Live Longer―Have a Catheter Ablation
• Recurrence of A-Fib After Successful Catheter Ablation
• A Cryo Ablation Primer
• Radiation Exposure During an Ablation Procedure: How to Protect Yourself from Damage
• Risks Associated with Pulmonary Vein Procedure
• The Evolving Terminology of Catheter Ablation
• Bordeaux Five-Step Ablation Protocol for Chronic A-Fib
• Bordeaux Procedures & Costs
Cox Maze & Mini-Maze Surgeries & Hybrid Surgery/Ablation
The traditional open-heart Cox-Maze is usually performed concurrent with other heart disease treatments. More common are the various Mini-Maze surgeries which are stand-alone surgeries performed through small port-size incisions in the chest. Go to Maze, Mini-Maze & Hybrid ->
Additional readings:
• Advantages of the Convergent Procedure by Dr. James Edgerton
• FAST Trial: Surgical Versus Catheter Ablation―Flawed Study, But Important Results for Patients
• Advances in Surgical Therapy for A-Fib by Dr. David Kess
• Role of the LAA & Removal Issues
Ablation of the AV Node and Implanting a Pacemaker
From a patient's point of view, this is a procedure of last resort. By ablating or eliminating this AV Node, your Atrial Fibrillation signals can't get to the ventricles which does stop your heart from racing. But you must have a permanent pacemaker implanted in your heart for the rest of your life. Go to Ablation of the AV Node->
Pacemakers & ICDs
Pacemakers may be implanted for pacing support, or in conjunction with Ablation of the AV Node (see above). Implanting a pacemaker seems to be most helpful if you have a slow heart rate or pauses as a result of taking A-Fib medications. But be advised that pacemakers tend to have bad effects over the long term. Go to Pacemakers & ICDs ->
Decisions About Treatment Options
When considering treatments for atrial fibrillation, you may ask,"Which is the best A-Fib treatment option for me?" This is a decision only you and your doctor can make. Here are some guidelines to help you. I've listed A-Fib conditions as patients might describe them. Select one (or more) that best describes your A-Fib and read your possible options. Go to Decision About Treatment Options ->
A-Fib is a progressive disease – Don't wait – Seek a CURE as soon as practical.
I Beat my A-Fib—So can YOU!
Last updated: Sunday, January 3, 2016


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Mega founder Kim Dotcom has been scoring one victory after another over his would-be prosecutors over the past year and now he's poised to land his biggest triumph yet. BBC News reports that Dotcom "has won access to evidence seized during raids on the file storage service" after New Zealand's high court ruled that the warrants used to seize the evidence were unlawful. Dotcom wasted no time crowing about his latest win on Twitter and made a "victory" checklist in which he checked off the goal of getting his data back from law enforcement officials. The only item left unchecked on Dotcom's list is getting former Megaupload users' data back, which Dotcom has repeatedly said is one of his most important goals.
[More from BGR: Google's creepiest idea yet: Password pills]
This article was originally published on BGR.com

subset: commoncrawl


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With numerous companies and organizations – from Sony to the MLB – falling victim to high-profile breaches, 2014 certainly generated lot of cyber security buzz. Now, as 2015 approaches, many organizations are taking a lesson from 2014 and aggressively driving their firms toward stronger cyber security solutions. If your company plans to improve its cyber security position in the coming ...Read More »
Tag Archives: SOC
Lunarline Opens New Facility in Ohio to Meet Increasing Cyber Security Demand
Without a doubt, cyber security is a challenging — sometimes even panic-inducing — undertaking for businesses. With a constant stream of news articles announcing catastrophic breaches and warnings about the specter of advanced persistent threats, it's increasingly apparent that fully realized security solutions and all-inclusive privacy training programs are must-haves for companies. Today, most firms depend on sensitive data, stored ...Read More »
Do You Have a Hackable Office?
For many companies, cyber crime has taken a prime spot on their list of concerns. According to ESG research published in June 2014, 62 percent of organizations surveyed have plans to increase their funding for cyber security initiatives in the near future, and 32 percent said that cyber security is one of their top budgeting priorities. Yet with so much ...Read More »
The Third-Party Challenge: Keeping Hackers Out of Remote Access Systems
Giving third-party vendors remote network access opens up new possibilities for organizations. It can streamline operations, enhance service and support functions, and ultimately help a business become more competitive. Unfortunately, for all the benefits it offers, third-party remote access also raises critical cyber security concerns. Many recent network breach incidents involve third-party remote access tools as an entry point. For ...Read More »


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Designs by ghennah
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I love designing stuff. Strange doodles & children's designs mostly. Thanks for stopping by!
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Change Location
ACE Fit Share
Fit Life Articles
Keeping your restaurant encounters to a minimum is one surefire way to ensure that when you go out, you make the most of your meals.
Exercising in the heat can be challenging. Your body starts to sweat to cool down. But if you're working out and your body stops sweating you may have a more serious problem: heat related illnesses (heat exhaustion or heat stroke).
Do you feel like you can't lose weight because you have a slow metabolism? Metabolism is a complex process that's affected by more than just what you eat and how much you exercise. There are a number of factors that might be sabotaging your metabolism, and you might not...


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Sleep Inn Accommodation & Rooms
- Free buffet breakfast, free WiFi, and free parking
Main amenities
- 71 smoke-free guestrooms
- Restaurant
- Indoor pool
- Fitness center
- 24-hour business center
- 24-hour front desk
- Air conditioning
- Daily housekeeping
- Front desk safe
- Laundry service
- Free newspapers in the lobby
For families
- Free cribs/infant beds
- Microwave
- Refrigerator
- Connecting/adjoining rooms available
- Premium TV channels
- Free toiletries
What's around
- St. Claire Square Mall (2.8 mi / 4.5 km)
- Far Oaks Golf Course (3.6 mi / 5.9 km)
- Stonewolf Golf Course (4.1 mi / 6.6 km)
- Pleasant Ridge Park (5.4 mi / 8.7 km)
- Southwestern Illinois College (5.9 mi / 9.6 km)
Sleep Inn Accommodation & Roomsfrom ZAR 1,140
- Standard Room, 2 Queen Beds, Non Smoking
- Standard Room, 1 King Bed, Non Smoking
- Standard Room, 1 King Bed, Non Smoking, Hot Tub
- Room, 1 Queen Bed, Accessible, Non Smoking
More great choices
At a glance
Key facts
Hotel size
- This hotel has 71 rooms
- This hotel is arranged over 3 floors
- Check-in time 4 PM-6 AM
- Check-out time is noon
Required at check in
- Credit card or cash deposit required
- Government-issued photo ID required
- Minimum check-in age is 21
Travelling with others
- Up to 4 children (18 years old and younger) stay free when occupying the parent or guardian's room, using existing bedding
- Pets not allowed
- Pets allowed *
- Specific rooms only *
- 2 per room (up to 50 lb)
- Free WiFi in public areas
- Free WiFi in rooms
- Free self parking
- RV/bus/truck parking
Other information
- Smoke-free property
Nearby Two Star O'Fallon hotels
In the hotel
- Free buffet breakfast
- Restaurant
- Indoor pool
- Fitness facilities
- 24-hour business center
- 24-hour front desk
- Dry cleaning/laundry service
- Laundry facilities
- Free newspapers in lobby
- Number of buildings/towers - 1
- Elevator/lift
- Safe-deposit box at front desk
- Accessible bathroom
- In-room accessibility
- Roll-in shower
In the room
- In-room climate control (air conditioning)
- Air conditioning
- Coffee/tea maker
- Iron/ironing board
- Free toiletries
- Hair dryer
- Premium TV channels
- Desk
- Free weekday newspaper
- Free WiFi
- Free local calls
- Refrigerator
- Microwave
- Daily housekeeping
- Connecting/adjoining rooms available
Top O'Fallon hotels
Recently reviewed hotels in O'Fallon
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"The hotel is in a great location - quiet and close to really good upmarket restaurants, also convenient for the meetings I attended. The hotel decor is a little old (lot's of dark…"Apr 12, 2016
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"We found everything to our satisfaction. We had hired a car so had no problems with the location. There were plenty of convenience stores nearby. The breakfast was generous. The…"Oct 30, 2013
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Sleep Inn Accommodation & Rooms's small print
Also known as
- Sleep Inn Hotel O'Fallon
- Sleep Inn O'Fallon
The property has connecting/adjoining rooms, which are subject to availability and can be requested by contacting the property using the number on the booking confirmation.
Pet-friendly rooms can be requested by contacting the property at the number on the booking confirmation.
The name on the credit card used at check-in to pay for incidentals must be the primary name on the guestroom reservation.
Optional extras
Pets are allowed for an extra charge of USD 10 per pet, per night
We have included all charges provided to us by this hotel. However, charges can vary, for example, based on length of stay or the room you book.
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"Myles was great. Our poodle was very well looked after and would recommend and use his services..."
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"Kathy is delightful and Trix thinks she's pretty hot hanging around Kathys pups. She's been..."
"Briar was so helpful at REALLY short notice (a few hours - I almost had to cancel my trip), &..."
"Howard enjoyed his time with Hettie & her teeny tiny little puppy."
Pet sitting in Oxenford Queensland . Pet boarding alternative to kennels in Oxenford Queensland . Find a trusted pet sitter in Oxenford Queensland . We verify our pet sitters and the stay of your dog or cat is insured.


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DBRL Programs
Harry Potter Party
Columbia Public Library, Children's Program Room
Join us as we celebrate J.K. Rowling's Harry Potter, just in time for the new movie "Fantastic Beasts and Where to Find Them." Come make wands and magical goop, answer trivia about your favorite wizards and much more! Ages 7 and older. Parents welcome. Registration begins Tuesday, October 25.


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Stare Jablonki Vacation Packages
Stare Jablonki is situated 75 miles (121 kilometers) southeast of Gdansk and about 110 miles (177 kilometers) north of Warsaw, the capital of Poland.
It's little wonder Stare Jablonki is such a hotspot for vacationers from across the globe; the surrounding region is dotted with great cities, attractions and landscapes. If you are keen to experience more of the region, head 17 miles (27 kilometers) where you'll find Olsztyn. Here you can spend an hour or two visiting the James Shopping Centre and St. James Cathedral.
To learn about the local culture, visit Poland's history museums, art museums and theaters. Explore Stare Jablonki's spiritual side by paying your respects at the area's monasteries and other sites of spiritual significance.
If you are looking for a completely different activity to enjoy in Poland, have a go at parasailing. The wider region offer some fun outdoor options for active travelers with an affinity for water. Swimming and kite surfing are both popular pastimes here.
Sometimes, the most cherished vacation moments are waiting in local cafés and restaurants. Beef and sometimes cabbage are often used in this region. Two of the local favorites to order are kotlet schabowy (breaded cutlet) are gołąbki (soft boiled cabbage leaves wrapped around minced meat). Piernik (gingerbread) is a great choice to end any Poland food experience.
And at the end of your stay, pack your traveling bag and bid Stare Jablonki a fond Narazie (farewell).
Accommodation in Stare Jablonki
If you can't readily find a place to stay near Stare Jablonki, there are some other options nearby. The Hotel Platinum Aqua Fun & Events in Ostroda, for example, is just 1 mile (2 kilometers) from Stare Jablonki. Alternatively, book a room at the Hotel Platinum Aqua Fun & Events, which are also within driving distance.


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Published On: December 23, 2012 | Duration: 5 min, 43 sec
The evergreen sweet corn soup with corn, chicken and mild seasoning.
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mortar fire
Hamas Arrests Those Responsible for Mortar FireSenior defense officials say that Hamas has arrested the terrorists responsible for a mortar attack on the Eshkol region.
Syrian Mortar Shell Strikes Israeli Golan HeightsMore spillover from the Syrian civil war, as battles continue to rage between regime, rebel forces.
Foreign Worker Killed in Mortar AttackForeign worker becomes third civilian killed by Gaza terrorists.
Elbit Unveils Vehicle-Mounted MortarSpear, a new low-recoil mortar, can be mounted on a variety of light vehicles, including Hummers.
Clash in Gaza: Rockets Lead to Airstrike ResponseGazan terrorists open rocket and mortar fire on Israel leading to an IAF airstrike in response; takes out two concealed missile launchers.
Mortar Fire from Syria Hits GolanNo one hurt, no damage caused in apparently stray fire from fighting between Syrian government forces and rebels.
IDF Fires Back at SyriaAfter several warnings were ignored, IDF troops finally returned fire Sunday after Syrian Army regulars shelled the Golan Heights.


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Stayed 1 night and was good. Room clean and property maintained well. Easy access from I35 and close to many restaurants. Staff friendly and helpfull. For a night this is fine! Will stay again
Breakfast was ok, average for a LQ
- Reservation Options:
- TripAdvisor is proud to partner with Hotels.com, Booking.com, Expedia, Priceline, Hotwire, LaQuinta, Odigeo, Cheap Tickets, Travelocity and TripOnline SA so you can book your La Quinta Inn & Suites Round Rock South reservations with confidence. We help millions of travelers each month to find the perfect hotel for both vacation and business trips, always with the best discounts and special offers.
- Also Known As:
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Night Sky Quotes
and the softness became starlight and filled me full to the bone..Yeats'
Lessons Learned in Life | Look at the stars each night.
Me and my kiddo too! "Mom, can we listen to this before we get out?" You got it, son!
Victoria Erickson (instagram: Victoria1031) (facebook: Victoria Erickson, writer)
she stared at the stars like they were pillows for her mind and in their light, she could rest her heavy head. - christopher poindexter
I've always loved the stars.....Night time is just so peaceful <3
black and white, moon, quote, sky, star - image #129602 on Favim.com
I hope I never get tired of the night sky, of thunderstorms, of watching cream make galaxies in my coffee. I hope I never grow to be someone who can no longer see the small beautiful things.
Wednesday Words of Wisdom – April 17, 2013 | thesassylife
"It is silent music, the night sky" -Donald Miller, Through Painted Deserts


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Hotels in Sioux Falls, South Dakota
Search & Compare Sioux Falls Hotels
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Trending now in Sioux Falls
- Most bookedHoliday Inn Sioux Falls-City Centre
138 people looked at this hotel in the last hour
Most recent review
"It was clean, comfy, and in a nice spot in town to walk to breakfast the next morning and the front desk was great. We got in late and also accidentally booked the wrong night for our stay. They cleared it up without any problem and we're very friendly. If we are ever in town again we will certai..."
A Traveller, Sep 2016, US
124 people looked at this hotel in the last hour
Most recent review
"Pleasant overnight stay after driving 900 km. Stayed on mail level and could here the folks walking around in the room directly above. "
A Traveller, Sep 2016, CA
123 people looked at this hotel in the last hour
Most recent review
"Easy access to shopping areas; easy access to I-29 and I-229; great breakfast ; very clean, friendly helpful staff"
J, Sep 2016, US
109 people looked at this hotel in the last hour
Most recent review
"We had a great stay!! Right by the airport, but out of the way enough where you aren't hearing traffic all night. Really cool sports bar next door. We stayed in a suite & it was clean & luxurious. Recommend for you & your sweetie for a weekend get away!!"
A Traveller, Oct 2016, US
89 people looked at this hotel in the last hour
Most recent review
"My room was clean the staff was nice in the room was just the right size for one person. I frequent Sioux Falls about once a month. I will stay here from now on."
A Traveller, Oct 2016, US
37 people looked at this hotel in the last hour
Most recent review
"We have stayed before while on Blackhills trip . Booked two rooms only had one booked per hotel from Expidia . But was able to get 2nd room required with hotel staff . Pool good, good parking good breakfast. Dennys and Burgerking in walking distance at large truckstop even has a small bar"
A Traveller, Sep 2016, US
33 people looked at this hotel in the last hour
Most recent review
"This hotel was awesome! The staff in the restaurant (especially) Stacy were very friendly and helpful. They served breakfast very quickly which is a plus when you are trying to get on the road. "
A Traveller, Oct 2016, US
31 people looked at this hotel in the last hour
Most recent review
"I had checked into the Microtel down the road and it was disgusting I had to leave. The Candlewood was like an oasis after that."
A Traveller, Sep 2016, US
29 people looked at this hotel in the last hour
Most recent review
"Good service. Close enough to the airport to be convenient. Kind of hard to get into their parking lot, but we had no complaints about our stay. The bed was comfy. Not bad, as long as your expectations aren't too high. The lady in the breakfast room was super friendly, and we would stay there ag..."
A Traveller, Oct 2016, US
15 people looked at this hotel in the last hour
Most recent review
"The gal who checked us in was so nice and helpful. We had our arms full and there wasn't an elevator, so she offered to carry one of our suitcases upstairs! At breakfast one of the maintenance men, explained to my mom where the breakfast items were. The service was awesome."
A Traveller, Sep 2016, US
Map of Sioux Falls hotels
- Empire Mall
- Falls Park
- Sioux Falls Arena
- Augustana College
- Sanford Pentagon
- Great Plains Zoo
- University of Sioux Falls
- Washington Pavilion of Arts and Science
- Blue Mounds State Park
- USS South Dakota Battleship Memorial
- Great Bear Recreation Park
- Delbridge Museum of Natural History
- Old Courthouse Museum
- Thunder Road Family Fun Park
- Fawick Park
- Newton Hills State Park
Best hotels in Sioux Falls
If you are looking for Sioux Falls hotels in a particular area, you can use the search feature at the top of the page to search by neighborhood, landmark, address or zip code, or you can search by using the built-in map feature. You can also browse hotels in Sioux Falls by type, amenities, and star-rating so that you can find the best hotel. Currently, top rated hotels in Sioux Falls are:
- Fairfield Inn & Suites Sioux Falls Airport
- Home2 Suites By Hilton Sioux Falls/Sanford Medical Center
- La Quinta Inn & Suites Sioux Falls
- Comfort Inn & Suites
- Grandstay Hotel And Suites Luverne
The location of your Sioux Falls hotel is important. If you are traveling to Sioux Falls, &StateorCountry for business, you may want to consider getting a hotel close to the airport or near your meeting venue. By doing so, you can really cut down on transportation costs and time. You may also want to book a hotel that offers free wifi just in case you need to get some work done.
If you are traveling for vacation, figure out which attractions or landmarks you want to see and book a hotel that is within close proximity. Although hotels near attractions might cost a little more, you may find that spending those extra few dollars is worth the convenience. You can even find hotels that align with your interests. For example, if you are looking for a relaxing vacation, a spa hotel may be the perfect choice for you.
You'll also want to determine which type of accommodations will suit your needs before booking a hotel in Sioux Falls. If you're traveling with the kiddos, a family friendly hotel will offer larger rooms and more sleeping arrangements. For those traveling for an extended period of time, booking a hotel suite with a kitchenette is a smart move and will feel a little more like home. If you are budget conscience and just need a place to rest your head, a hostel or motel may be all you need.
If you are looking to score the best discounts and deals, use the filter to sort by price from low to high. You can book a hotel in Sioux Falls for as low as $56 per night. If you are looking to cut down on expenses, look for hotels that include free breakfast and parking. Some hotels even offer free shuttle service to and from nearby places. You can also sort by star rating, proximity, and guest rating.
Before you book, check out user reviews. Hotels.com has 8660 reviews in Sioux Falls. We show reviews from Expedia and TripAdvisor so you know that you are reading genuine, reliable reviews. Be sure to download the Hotels.com app so you can book your reservations on the go, view amenities, and save the hotels you want to view and compare later.


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I was highly impressed by the large space each room had. The beds were comfortable and the furniture was well maintained. Front desk staff is friendly and welcoming. However, I did have one complaint. My friends and I stayed at this location for a small get together. Around check-out time, we started loading up our cars and needed to leave some items in the room. When we returned to grab the rest of the stuff, the cleaning service was already turning over our room. We hadn't even checked out yet. I appreciate the promptness of their service, but I thought it was extremely rude since we still had many things in the room.
overall, this experience was great, minus the service incident.
- Official Description (provided by the hotel):
- SpringHill Suites Sioux falls is new as of June 2008. With a modern new design, this hotel's guest rooms are 25% larger than a regular hotel room. Complimentary Breakfast, complimentary internet and 37 inch flat panel HDTV's in all rooms are a few of the amenities. With a fitness center, pool and a location adjacent to the Empire Mall, the SpringHill Suites is perfect for your families weekend getaway. Complimentary airport shuttle is also provided during certain hours. ... more less
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- Also Known As:
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Cuisines and Dishes at Clucker's Charcoal Chicken:
- Barbecue
- Wings
Sep 07 2016
Aaron A. via Yelp
One of the best spots on the north shore for a hungry family. The chicken enchiladas are outstanding.read more
Apr 08 2016
Zoe Z. via Yelp
Clucker's is one of the few places that deliver to Lake Bluff. I personally love it, but it's not a hit for the entire family. The chicken, obviously, is...read more
Sep 05 2016
michael w. via Yelp
What a great find, stopped in on a Saturday for lunch and was pleasantly surprised. Very helpful staff, reasonable prices, and good food options. If you...read more
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Intrusive Testing
Definition - What does Intrusive Testing mean?
Intrusive testing is a kind of testing that involves adding or introducing unexpected external variables into a system. The test records the timing and processing information when the program is performed and executed and external elements are introduced, which might make certain changes in terms of how the program will behave in a real-time environment. This testing usually requires additional codes embedded in the software or has some other processes that run simultaneously with the program to be tested.
Techopedia explains Intrusive Testing
Intrusive testing can be considered a type of interrupt testing, which is used to test how well a system reacts to intrusions and interrupts to its normal workflow. This might be as simple as unplugging a network connection or cutting power to see how the system reacts or recovers from such interrupts. Manual intrusion or hacking may also be done, especially if the system is being tested for network security and vulnerability. In some testing environments, the system being tested is run concurrently with other systems, ensuring that there is a scarcity of resources. This is a way to find out if the system can cope with such problems.
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A grand jury indicted Baltimore Ravens running back Ray Rice on Thursday on a charge of third-degree aggravated assault for allegedly knocking his fiancée unconscious last month during an altercation at a casino in Atlantic City, N.J.
According to ESPN, conviction on a third-degree charge in New Jersey carries a potential prison sentence of three to five years and a fine of up to $15,000.
On Feb. 15, police were called to the Revel Casino and Hotel after an altercation turned violent between Rice and his fiancée, Janay Palmer. Rice was arrested and charged with simple assault-domestic violence. Palmer was charged with simple assault.
A video posted online by TMZ may have damaged Rice in the court of public opinion as the it showed the running back lifting an unconscious Palmer by her arms out of an elevator and laying her on the floor.
Rice's attorney, Michael Diamondstein, told ESPN that while the footage is authentic it is also incomplete.
"I have been advised by the prosecutor's office that an indictment has been returned," Diamondstein told ESPN. "And again, we deny that he committed an aggravated assault. We don't think the law would support that [he did]. And we just ask the public to reserve judgment until all of the facts are out."
The Ravens released a statement Thursday that read: "This is part of the due process for Ray. We know there is more to Ray Rice than this one incident."
Ravens owner Steve Bisciotti told ESPN that despite Rice's arrest, he has a future with the team.
Earlier Thursday, Diamondstein told The Press of Atlantic City that neither Rice nor Palmer wants to move forward with the case.


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Ligament & Tendon Injuries
Using Bursography to Diagnose Palmar Foot Pain
March 08, 2014
Navicular bursography is an effective diagnostic option for palmar foot pain when MRI is not in the cards.... Read More
Diagnosing Lower Limb Lameness in Sport Horses
March 06, 2014
The lower limb is the most common site of lameness in English-discipline sport horses, one veterinarian says.... Read More
Grayson-Jockey Club to Provide Research Funding in 2014
February 27, 2014
The Grayson-Jockey Club Research Foundation will fund 19 research projects worth $1,003,580 in 2014. ... Read More
Assessing Proximal Metatarsal Lameness in Sport Horses
February 15, 2014
Injuries to the top of the rear cannon bone are some of the most difficult to diagnose.... Read More
Equine Lameness: Clinical Judgment Meets Diagnostic Imaging
February 11, 2014
Veterinarians have tools to help them make educated judgments about lamenesses, their causes, and prognoses.... Read More
Nerve Blocks for Suspensory Ligament Diagnosis Done Right
February 09, 2014
A low-volume injection produces less upward diffusion than a high-volume injection, researchers concluded.... Read More
Equine Lameness 101
February 07, 2014
There are ways of preventing and treating equine lameness to help your horse be as healthy as possible.... Read More
Suspensory Injury's Effect on Future Racing Performance
February 02, 2014
How does a suspensory injury impact a racehorse's performance? It depends on the severity of the injury.... Read More
A Review of Fatal Fetlock Injuries in California Racehorses
January 29, 2014
One of the most common sites of catastrophic injuries in Thoroughbred racehorses is the fetlock.... Read More
Treating Soft Tissue Injuries in Racehorses
January 05, 2014
Achieving a sustainable racing career following tendon or ligament injuries remains a challenge, one vet says.... Read More
AAEP Veterinarians Discuss Suspensory Ligament Injuries
January 01, 2014
Attendees discussed diagnostic and treatment options, among other topics.... Read More
Researchers Receive 2013 EQUUS Foundation Research Fellows
December 09, 2013
Each received a $5,000 fellow to support their endeavors in equine research and a $500 travel stipend.... Read More
Christmas Comes Early for Thoroughbred Rescue
November 29, 2013
CANTER California became a beneficiary as Ice Horse transitions to a new product line.... Read More
Doppler Ultrasonography for Monitoring Tendonitis in Horses
October 08, 2013
Colors displayed by Doppler ultrasonography could help vets better follow tendonitis' healing processes. ... Read More
2012 Breeders' Cup Juvenile Winner Shanghai Bobby Retired
September 30, 2013
Shanghai Bobby sustained a suspensory ligament injury and was subsequently retired.... Read More
Soft Tissue Struggles in Senior Horses
July 17, 2013
Soft tissue injuries--specifically tendon and ligament injuries--aren't uncommon in old horses.... Read More
Safeguarding Show Horses: Impossible?
June 26, 2013
No matter the facilities or level of care, we can't ever fully protect horses from themselves.... Read More
Lingering Lameness
June 04, 2013
Is a two-year-old injury a candidate for adipose-derived regenerative stem cell treatment?... Read More
Of Horses and Health Problems
May 21, 2013
I'd like to learn more about your equine seniors and the health challenges they face.... Read More
Hind-Limb Collateral Ligament Injuries Examined
May 18, 2013
Study results indicate affected horses have a guarded prognosis to return to athletic soundness.... Read More
Therapeutic Ultrasound Settings for Horses Identified
April 23, 2013
Researchers identified what ultrasound settings achieve adequate temperature increases to be therapeutic.... Read More
MRI to Evaluate Suspensory, Sesamoid Injuries (AAEP 2012)
March 27, 2013
Researchers say MRI is invaluable for identifying suspensory ligament lesions and sesamoid bone damage.... Read More
Grayson-Jockey Club to Fund 12 New Projects in 2013
March 15, 2013
The Grayson-Jockey Club Research Foundation approved funding of 12 new projects in 2013. ... Read More
Stem Cell Approach Ineffective for SDFT Injuries (AAEP 2012)
March 15, 2013
Researchers found no significant improvement in SDFT injuries treated with mesenchymal stem cells.... Read More
Using MRI and Scintigraphy to Diagnose Suspensory Injuries (AAEP 2012)
February 22, 2013
Using both MRI and scintigraphy could be beneficial when diagnosing suspensory-ligament-related injuries... Read More
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Mesmerized, I pause on a hillside to admire the breathtaking oasis that surrounds the spring-fed pool at Rainbow Springs State Park. It's one of the most eye-catching settings of any of the springs.
Once privately owned, the 1,400-acre park features gardens and tumbling waterfalls. A 500-million-gallon spring feeds the Rainbow River, a popular place for tubing, kayaking in clear-bottom boats, snorkeling, and guided nature trips. "For the locals, this is our beach," says park ranger Nicky Aiken.
Tip: Try to visit on a weekday. This park―like most of the springs―gets its biggest crowds on weekends. www.floridastateparks.org/rainbowsprings or (352) 465-8555.
Jump in and enjoy some of The Sunshine State's refreshing fountains of youth.


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Microsoft Video: Live Tile Experiment
Microsoft Windows 8 and advertising agency McCann from Oslo have pulled off this incredible web video.
The commercial depicts a real situation, which was set up by the creatives for passengers. See how casual walk home can turn into an unexpected party, that goes out into a street. The video features music band from Norway Datarock.
Watch the video and share your impressions about it.
Agency: McCann, Oslo, Norway
Creatives: Jørgen Gjærum, Frank Undheim, Christian Aune, Pål Dobloug
Account Director: Marius Zachariasen
Account Managers: Mari Lund, Merete Hildonen
Agency Producer: Beril Holte Rasmussen
Account Director Media: Simen Kjær
Production: Motion Blur
Director: Hallvar Witzø
Producer: Bruno Kvae
Photo: Karl Erik Brøndbo


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A couple cuts from A$AP Mob's anticipated joint project are liberated
'DPG 4 Life' seeks to pick up where 'Straight Outta Compton' left off
Storytelling mixed in with some mood music. Stir, don't shake
We all love to push the limit when we hit the half pipe – that's what makes extreme sports remarkable. But don't think that it doesn't come with consequences.


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Menzerna | SKU: H0811 | Model: M-113GZW
Brown - Tripoli Prepolish Compound
Price: $24.50
Menzerna M-113GZW - Brown - Tripoli Prepolish Compound
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Coarse prepolishing Tripoli bar compound used to remove 600 grit sanding marks on all wood coatings, preparing the surface for high gloss polishing. Can be used alone to achieve a smooth, even semi gloss finish. Excellent as a prepolish for brass when followed by H0823 for a beautiful high gloss polished surface. Use with a cotton buffing wheel. 2.31 lb. bar.
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About This Activity
Instructors: Jonathan and Jocelyn Kasper. The essence of this camp is teaching kids how to JAM together. Itâs fun! Kids get an introduction to fundamental skills on guitar and piano, and we facilitate both group activities and one-on-one instruction. Children play by ear and learn how to create music on the spot. This camp enables students to do what comes naturally: PLAY music, not work it. Musical instruments are provided. If sold out, check morning session, or Songwriting Camp July 7, or contact www.KasperMusic.com.
Organizer Info
University School of Nashville Summer Camps
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Map & Direction
University School of Nashville 2000 Edgehill Ave. Nashville, TN 37212Get Directions


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What If They Lived? Hollywood's Lost Stars and the Futures They Never Had
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sku: BK 3865
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Book Details
- 421 Pages
- Paperback
- Medium Format
- Released: March 16, 2011
- Publisher: BearManor Media
|Phil Hall & Rory Leighton Aronsky
Description by OLDIES.com:
They were the big screen royalty that left us too soon - the brilliantly talented icons whose premature deaths continue to fill the hearts of movie lovers with rue and pain. From Robert Harron and Rudolph Valentino of the silent era to Heath Ledger and Natasha Richardson of today's cinema, the history of movies is filled with too many legends and rising stars who died before fulfilling their career destinies.
But what would have happened if fate had been kinder? What could have been the careers of Jean Harlow, James Dean, Marilyn Monroe, Dorothy Dandridge, Bruce Lee, John Belushi, River Phoenix, Chris Farley, and many other screen luminaries who died too soon?
What if They Lived? offers a speculative trajectory for the careers that the late, great stars never had. Piecing together pending film projects, industry trends and wider shifts in popular culture, What if They Lived? considers what could have happened to the beloved movie actors who never had a chance to enjoy a long and fruitful professional output.
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Possible Answer
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Max Revive: Sprites: Item Type: Japanese Name: ... Silver: Crystal: ... HeartGold: SoulSilver: A medicine that revives a fainted Pokémon. - read more
Please vote if the answer you were given helped you or not, thats the best way to improve our algorithm. You can also submit an answer or search documents about where to buy max revives in pokemon soul silver.


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Mark first impressed me by not being late for the appointment to see my requirements and I was further impressed with how he freely discussed what could be done with each item, what worked better for my home, than the own idea I had, His method of doing things also saved me som..
We particularly found Alltec Joinery's willingness to work with us in the cabinetry design work of our new house very comforting. High standard of professionalism and no surprises! Very happy with the workmanship and attention to detail.
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Camp Sylvester
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Po Box 3070 Modesto CA 95352 USA
Camp sylvester provides educational and recreational camping facilities to 4-h clubs, ffa chapters, church groups, girl and boy scout troops, non-profit organizations, and families.
Provide camping experience for 4-h. Scouting, and church groups.
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Care-Ousel Therapeutic Riding
elizabeth5 wrote:
My son Jacob has been riding at CARE-ousel for two years. He has muscular dystropy. Jacob has become very fond of (Zip)the horse... more »
- Location:
- Modesto, CA
Junior Golf Association Of Northern California
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Was a former board member a while back when C.O. was the executive director. The problem was that the organization had financial... more »
- Location:
- Modesto, CA


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Richard Nelsen, 75 - March 11, 2011
Richard "Dick" Nelsen, 75, of Cozad passed away Friday, March 11, 2011, at the Cozad Community Hospital.
A private family service took place on Tuesday, March 15, and a private burial was at the Cozad Cemetery.
He was preceded in death by: his parents, Frederick and Thesnelda; a sister-in-law, Karma.
Survivors include: his wife of over 51 years, Mary Jo "Tina" Nelsen of Cozad; two sons—Greg (Mary) Nelsen of Callaway and Eric Nelsen of Arnold; a daughter, Jill (Scott) Breon of Cozad; brother, Bruce Nelsen of Cozad; sister, Liz (Ron) Johnson of Rapid City, SD; a brother-in-law, Tom (Evelyn) Thielen of Ames, IA; 11 grandchildren—Jake (Stephanie), Casey, Dalton, Tara, Nichole, Nathan and Jaiden Nelsen, Ian and Taylor Schmeeckle, and Luke and Nathan Breon; two great-grandchildren; numerous other relatives.
For a complete obituary, see the print edition of the Gothenburg Times or purchase an e-subscription for only $25 per year for the complete paper on-line each Wednesday afternoon.
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Dec 4th
Posted by Mikaespera in Body, Fitness, Health, Sports
Gdy podchodzi do Ciebie osoba, widzisz, że jej skóra jest jakaś inna, sucha, łuszczy się, boisz się. Często nie chcesz podać ręki osobie z takimi dolegliwościami.
Ale ta choroba nie jest zakaźna. Dotykanie chorej osoby nie jest zaraźliwe.
Często reagujemy na takich ludzi z dystansem, zupełnie niepotrzebnie.
Takie osoby jeszcze bardziej dbają o higienę niż ci zdrowi, którzy myją ręce raz dziennie i twierdzą, że to im nic nie zaszkodzi.
Łuszczyca to jedna z chorób skóry, należąca do dermatoz uwarunkowanych genetycznie.
Wywoływana jest przez czynniki środowiskowe lub ustrojowe.
Zmiany chorobowe ujawniają się po przebyciu infekcji lub dużego stresu.
Od momentu pojawienia się pierwszych objawów, choroba może mieć rozmaity przebieg. W zasadzie utrzymuje się przez całe życie. Polega ona na zaburzeniu rogowacenia naskórka oraz pojawieniu się tarczek pokrytych suchymi łuskami. Istotnym problemem jest jednak zaburzenie w funkcjonowaniu bariery ochronnej naskórka.
Łuszczycę dzielimy na dwa podstawowe jej typy:
łuszczycę pospolitą
łuszczycę krostkową
Łuszczyca pospolita zajmuje niekiedy jedynie pojedyncze ogniska na skórze a niekiedy całą skórę.
Skóra łuszczy się, ponieważ dochodzi do nadmiernej ploriferacji, do nadprodukcji krótko żyjących komórek naskórka – keratynocytów oraz procesów zapelenia z kompleksowymi odczynami zapalnymi. Według niektórych badań, skóra objęta łuszczycą traci zdolność do zatrzymywania wody, przez co dochodzi do zwiększonej transepidermalnej ucieczki wody. Powoduje to coraz większą suchość skóry.
W początkowej fazie rozwoju choroby charakterystycznym objawem są okrągłe dosyć ostro odgraniczone ogniska, pokryte layers of white scales.
Zmiany pojawiają się najczęściej na kolanach, okolicy lędźwiowo krzyżowej, łokci i owłosionej skóry głowy.
Jednak ze wszystkim da się żyć. Więc traktujmy siebie na równi i nie bójmy się osób chorych na łuszczycę
Do not be afraid of people with psoriasis
Dec 2nd
Posted by Mikaespera in Body, Fitness, Health, Sports
When a person walks up to you, you see that her skin is some other, dry, flaky, you're afraid. They often do not want to shake hands with a person with such ailments.
But this disease is not contagious. Touching the sick person is not contagious.
Often we react to such people from a distance, completely unnecessarily.
These people care more about health than those in good health who wash their hands once a day and claim that it did not hurt them.
Psoriasis is a disease of the skin, which belongs to the genetically determined dermatoses.
Is caused by environmental factors or systemic.
Lesions show up post-infection, or high stress.
Since the first appearance of symptoms, the disease may have a different course. In principle, persists throughout life. It involves the epidermis, and cornification disorder appears charts covered with dry scales. An important problem is the disruption in the functioning of the protective barrier of the epidermis.
Psoriasis is divided into two basic types of:
psoriasis vulgaris
pustular psoriasis
Psoriasis vulgaris is sometimes only a single outbreak on the skin and sometimes the whole skin.
The skin peels off as it comes to excessive ploriferacji, the overproduction of short-lived cells of the epidermis – keratinocytes and processes with complex odczynami zapelenia inflammatory. According to some studies, the skin covered by psoriasis loses its ability to retain water, which comes to increased transepidermal water escape. This causes more and more dry skin.
In the initial phase of the disease characteristic symptom is quite sharply demarcated round the fire, covered with layers of white scales.
Changes occur most often on the knees, low back cross, elbows and scalp.
However, all can live. Turning themselves so equally and not be afraid of people with psoriasis
Pippa Middleton
Jun 5th
Posted by Mikaespera in Politic
The number of materials with Pippi, which arose in recent dizzy.
Virtually all mainstream media coverage of its place in their pages or air time, trying to explain the phenomenon of 27-year-old British woman. Phillip, because it really is her name, for years lived in the shadow of older sister by one year. There is, however, surprising. Kate was, after Prince William's girlfriend, and it is here that focused attention of paparazzi and fans of the monarchy. "Pippa had no problem with that. Kate is not only her sister, but also the closest friend. Total experienced elation and dilemmas associated with romance with a young Windsor. In addition, the University of Edinburgh, studying there, she met the same aristocrats. I found out that the younger Miss Middleton has found the perfect upper-class world "- described the magazine" Hello ". But one by one …
Carefree student years
Pippa decided not to go to the same school as Kate. Her friends have admitted that, despite the insistence of his sister was a conscious choice. "Pippa is more ambitious and open to new knowledge. She wanted to find out how to cope in their new environment without any protection. She chose a difficult course in English literature "-" Daily Mail quoted a friend of the girl. At the entrance to the elite group of nobles needed only a few weeks. She befriended, among others the best friend of Prince Harry, Guy Pellym Gilkesem or Charlie, the owner of a fashionable club "Maggie's" in London's Fulham Road. She broke a few hearts. For a moment, met with the successor of the Duke of Northumberland, Earl Percym. Later, he was replaced by the son of the Duke of Roxburghe Ted Innes-Ker. Carole Middleton, Pippa's mother, said of him that "he was such a nice boy." Longest, three years spent with Jonathan 'JJ' Jardine Patterson, heir to a banking fortune. They parted in 2007, as a young playboy did not want to settle down. Pippa at the time of study she liked to play. Weekends spent in the rural estates of her friends or at events in London. – She was always the life and soul. Even when sitting on the side, everyone noticed her presence. Well managed to enliven any party – told colleagues further. When she finished college, has used those skills professionally.
He earns a subsistence
British bride William complained that it did not work. Tabloids have reported that Kate spends the whole day in beauty salons and gossip with her friends. Pippa, on the contrary. After graduation in 2008, got time in the company organizing the Table Talk of adoption. I immediately threw himself into new activities. Using the extensive knowledge, she soon became a specialist in the event industry. At the same time the magazine "Tatler", following its presence in the world of English socjety, Pippi awarded the title of "Best Party in Great Britain."
In early 2010 she began working in the family business producing components Party Pieces birthday. Pippa edits the online magazine "Party Times", which is complementary to the tender prepared for the youngest of her parents. It takes her two days a week. The next two devoted to activities in the Table Talk. Every moment of the day is used for business meetings – praised her "the Daily Mail."
The confusion on the point Pippy after the wedding of William and Kate is best summed up Victoria Sykes from American Vogue. "It's a real lucky. Raises the same interest as her sister and can also count on royal treatment, and there are no obligations. You may feel a princess without the side effects of this promotion. " I actually like the current force Pippy story. It is happily in love with a former player of cricket, 30-year-old Alex Loudonie, the stock broker out of the very wealthy and respected family. For this, each counting a colorful magazine is trying to convince her that just appeared on the cover. Pippy good mood did not sour even to discredit her pictures. Especially that the most "shocking" is wrapped in toilet paper. After the British monarchy coped with serious scandals …


text:
Jason Lowe
If you're only going to make one pot pie from scratch in your life, this is the recipe to use.
Leave a Review
This recipe does require a few hours of work but it is so worth it. My family and I loved it and I've been requested to make it again. We didn't nearly finish the portion. But you can freeze the remainder - the crust just won't be the same. It still tastes great after freezing/defrosting though. This is the only chicken pot pie recipe I will use.
I love to cook, but i have to say this one put my patience to the test! As others have said, it is very time consuming. I made it pretty much as described, except that i used only chicken breasts, and simmered the meat a little longer, as they were big pieces . There was enough to make a second 8x8 dish and freeze it while we baked and enjoyed the other one. The next time around, i will make one short-cut - use refrigerated pie crust.
Oh my!! This was outstanding, one of the most flavorful things I have ever made. So often, I am disappointed by highly rated recipes but not this one! As others have said, this is time consuming, even with shortcuts but boy is it worth it! My shortcuts: used a store-bought crust and instead of a whole chicken, I used a pack of organic chicken breasts and thighs. Otherwise, made as written. And I'll definitely make this again!
Can I make this with leftover chicken from last nights roast chicken? Why not. Seems a little too time consuming and the reviews agree. I'll use frozen peas and pearl onions too. Don't tell anybody.
I agree with several reviewers that this takes a long time to make, needs a bit more seasoning, a few more veggies, and there are several short cuts that can be taken, but oh my, with a few adjustments that any experienced cook can make, this is soooo worth it! The crust is especially delicious, as is the sauce - the tomato paste was a bit surprising addition, but adds a nice depth of flavor. If you have a few hours on a weekend, I highly recommend this recipe.
This recipe took 5 hours with two people working nonstop from start to finish in one day. I chose this recipe rather quickly--it looked delicious. I got the ingredients (ended up being $60 in all organic ingredients). I was having a dinner party of sorts and figured it would only take 2 hours given that it says "two hours" from start to finish on the recipe. Well, we got into doing the recipe, the guests arrived, left, and came back and we were still not done. Absolutely delicious, but if you're going to do this recipe, make both of the stocks in the coming days. It served 8 people with leftover filling. The crust was perfect, as was the filling (I added extra salt/pepper/herbs as always). It also just completely discards the veggies it has you use for the stock, so we just threw them into some chicken stock we had lying around and made a soup out of the discarded veggies and leftover filling (also delicious). All in all, the guests were happy, the food was delicious, but I had a terribly sore back and feet by the end of it.
Let's face it, making a chicken pot pie takes time. However, this recipe is unnecessarily laborious. There's no reason to dirty a sheet pan to roast the veggies. Just caramelize them in the pot on the stove before you put the chicken in to simmer. That's what I have always done. And you can skip the ridiculous onion peeling altogether by buying frozen peas WITH pearl onions. Buy fresh mushrooms (any kind) and sauté them instead of rehydrating dried ones.These are just a few examples. Think it through and you can cut out a lot of unnecessary work without compromising a bit of quality.
One question: Can you freeze this, and at what stage? I ned to make it in advance (a week) and then deliver with almost no cooking left. What is the best approach, do you think?
Love the recipe. I used pre-made pie crust and put it in individual small pie servings. I have given it to friends
It was fine but not worth the time. It needed more veggies and more chicken and more seasoning.


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4 out of 5.0, Reviewed Aug 29, 2016
We've encountered only problems about the implementation of a new product, with a new "user experience". But after a reasonable time all works fine.
I like all product features that gives us the possibilities to manage more Contact Center in more locations.
A better installation planning, in more steps instead "one-shot" installation.
The Support portal works fine, with a good response time.
4 out of 5.0, Reviewed Aug 17, 2016
Every stable product with good support
make sure to review complete contact center requirements including all the vendors and location that the solution will be used. especially if you have international call routing and contact centers supported multiple vendors across countries
understand the landscape of current solution before proposing the initial solution
happy with product
thirs party vendor support is not good
4 out of 5.0, Reviewed May 10, 2016
Good experience.
ask about hardware.
business functionality.
Get in writing.
Assure you have covered all parts of the project.


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Freshman point guard Chris De La Rosa has decided to transfer from Siena after helping the Saints men's basketball team enjoy one of its finest seasons ever. A backup to sophomore Ronald Moore, De La Rosa played in all but one of the 34 games this season, averaging 2.5 points and 9.5 minutes per game. He had 51 assists, 30 turnovers and 19 steals. "Chris was a valuable member of our championship season," head coach ...
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