Eric Bakker N.D.May 15, 2022

Atrial fibrillation (A-fib) is a type of arrhythmia (irregular and typically fast heartbeat) that can cause blood clots in the heart. Stroke, heart failure, and other heart-related problems are all increased by A-fib.


What Is Atrial Fibrillation?

Atrial fibrillation is a condition that appears to strike quite a bit of fear when a person has the diagnosis. It is always the same, it generally appears that as soon as somebody’s heart plays up they appear to fear something very ominous is going to happen. There are many different things which can potentially affect you heart, particularly its beating, pulse rate and the ability to function well as a  pump very well. I wrote this page to explain about atrial fibrillation, one of the more common reasons your heart may “play up” and make you feel that something is not quite right. If you do have arrhythmia, after reading this page I want you to realise that you have nothing to fear, and how fear itself will only contribute to to atrial fibrillation itself.

Atrial fibrillation, or AF, is the most common type of irregular beating of the heart you will experience. It is also called arrhythmia, which is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm and this can cause you to feel that there is “something not right” when your heart beats at times. This may be a bit worse when you lay down or at rest and you could well more notice this when you go to bed or wake up for some, for others it is after they have exerted themselves and it appears to take quite a while or more than usual for the heart to get to a steady slow rhythm again.

Atrial Fibrillation may happen rarely or every now and then, or it may become an ongoing or long-term heart problem that lasts for years and the amazing thing is that some people who have AF may not even feel symptoms. However, even when AF isn’t noticed, it can increase the risk of stroke and in some people, AF can cause chest pain or even heart failure, especially if the heart rhythm is very rapid.

There are no hard or fast rules with this condition, every patient I have seen with AF seems to experience their condition different from others. Their AF may be brief, with symptoms that come and go and end on their own. or the it may be ongoing and require treatment. At rare times, AF is sometimes permanent, and even the doctors drugs and surgery may not be able to restore a normal heart rhythm. For the most part however, people who have AF can live normal, active lives. For some people, natural medicine treatment can successfully restore normal heart rhythms. For others who have a more severe and permanent form of AF, treatment can help control symptoms and prevent complications. An effective treatment may include medicines (prescribed or natural) and lifestyle changes.

Your Resting Pulse

A healthy person with a heart in top shape will have a slow, deep and regular pulse rate which can be anywhere optimally from 40 beats up to 70 beats per minute. When you have arrhythmia, your pulse rate may vary a lot more than usual and it may feel like your heart is racing at times and slow and irregular at other times. With AF, the heart can beat at very fast rates which can be quite scary for some folk. You probably won’t really notice arrhythmia (or you pulse/hear rate for that matter) when when you exert yourself or exercise. It is when you rest that it becomes more noticeable for many.

Atrial Fibrillation Means Electrical Problems of The Heart

I like to think of atrial fibrillation as irregular power surges in a person. Yes, your heart does start up and maintain a steady rhythm because of a tiny electrical discharge. Let’s explain what happens to make your heart beat and to keep it beating:
1. – This tiny regular electrical signal starts in a group of cells called the sino-atrial (SA) node. The SA node is found at the top of the right side of your heart. (the right atrium)
Your SA node is very regular and reliable, and when you are happy and healthy your SA node sends out a steady 50 up to 100 times every single minute.
2 – From the SA node, this tiny electrical spark l travels from the top of the right side of your heart to the left side.  (from the right and left atria). This electrical activity at the top of the hear causes both of these top chambers and this pumps blood into the two bottom chambers of your heart – the ventricles.
3 – The electrical signal then shifts to a group of cells called the atrio-ventricular (AV) node. This tiny node is  located between the top and bottom chambers – the atria and ventricles. From here on, the electrical activity reduces quite a bit, allowing the ventricles time to finish filling with blood.
4 – The electrical signal then leaves the AV node and travels to the ventricles. It causes the ventricles to contract and pump blood to the lungs and the rest of the body.
5 – The ventricles then relax, and the heartbeat process starts all over again in the SA node. When things aren’t all that well and you feel unhappy, stressed, angry and maybe depressed your SA node will become more unreliable and speed up at times and slow right down at others. I have found that stress has a major effect on the heart, especially the heart’s electrical activity.

How Atrial Fibrillation Occurs

Atrial fibrillation is not that difficult to explain, it occurs if rapid, disorganised electrical signals cause the heart’s two upper chambers to “fibrillate”. The term “fibrillate” basically means to contract very fast and irregularly. In AF, blood pools in the atria (the upper chambers) of the heart and isn’t pumped completely into the heart’s two lower chambers, the ventricles. As a result, the heart’s upper and lower chambers don’t work together in a coordinated fashion as they should and this is what causes the problem. In fact, the ventricles may even beat as much as 100 to 175 times a minute, compared to the normal heart rate of between 60 to 100 beats a minute.

Causes Of Atrial Fibrillation

Atrial fibrillation may occur without evidence of underlying heart disease, and what I find interesting in many cases is that AF (just like high blood pressure) has “no known cause” according to the medical profession. This condition appears to be more common in younger people, about half of whom have no other heart problems. As I mentioned earlier, AF occurs if the heart’s electrical signals don’t travel through the heart in a normal way and instead become very rapid and disorganised. It is the damage to the actual heart’s electrical system which causes the AF, and this damage is at times the result of other conditions that affect the health of the heart, such as high blood pressure and coronary heart disease. The risk of AF increases as you age, and inflammation is thought to play a role in causing AF.

Some of the AF causes not involving the heart include:

  • Hyperthyroidism (overactive thyroid)
  • Caffeine may well trigger AF in some people. I have seen this in a few cases, so if you do have AF – STOP all sources of caffeine for a few weeks to see if there is any connection.
  • Alcohol consumption. Drinking alcohol (especially binge drinking), raises your risk. Even modest amounts of alcohol can trigger AF in some people who are particularly susceptible.
  • Sleep apnoea. Research has revealed that some people who have sleep apnoea are at greater risk for AF. Sleep apnoea is a common disorder that causes one or more pauses in breathing or shallow breaths while you sleep.
  • Metabolic syndrome also raises your risk for AF. Metabolic syndrome is the name for a group of risk factors that raises your risk for CHD and other health problems, such as diabetes and stroke.
  • Steroids. Research suggests that those who receive high-dose steroid therapy are at increased risk for AF. This therapy is used for asthma and some inflammatory conditions. Drugs like Predisone may act as a trigger in people who have other AF risk factors.
  • Pulmonary embolism (a blood clot in the lungs)
  • Pneumonia
  • Stress
  • Inflammation and oxidative stress

Some AF Causes Involving The Heart Include:

  • Heart valve disease: This can be something you are born with or be caused by infection or degeneration/calcification of valves with age.
  • Enlargement of the left ventricle walls
  • Coronary heart disease: This results from atherosclerosis, deposits of fatty material inside the arteries that cause blockage or narrowing of the arteries.
  • High blood pressure
  • Cardiomyopathy (disease of the heart muscle) leading to congestive heart failure
  • Sick sinus syndrome (improper production of electrical impulses because of malfunction of the SA node)
  • Pericarditis (inflammation of the sac surrounding the heart)
  • After heart surgery, but then AF resolves within a few days generally.

Case Study: Phil, 63yrs with Atrial Fibrillation

Phil was a most interesting case (not his real name). This man runs a very successful NZ company and is the managing director in charge of several hundred staff in Auckland. His company has amassed literally a fortune over the years but at a huge personal cost, Phil has been married and divorced twice and declared bankrupt only a few years ago but managed to climb back to the top of his game. Phil would have to be one of the most anxious, irritable  and stressed patients I have encountered in over twenty years of practice. He couldn’t even sit down for five minutes during his consultation with me and appeared very impatient and irritable as he paced the floor continually, answering his mobile phone.
Phil began to tell me that he had been to France twice for an operation (over 200K NZ dollars a time) to his heart in order to resolve his atrial fibrillation. Phil mentioned that it was “all a waste of time” because he still suffered from a very irregular heartbeat at times which was literally driving him to despair. This driven man really believed that his AF could be easily resolved with an operation and that he could go back to his regular (and highly stressed) lifestyle as if nothing had ever happened. I only ever say Phil once, he left my room in disbelief and with some urgency and  I’ve wondered at times what ever became of him, and whether he is even still alive. The incredible thing is that if Phil learned to relax properly and developed more of a balance between work and play (and started to understand the connection between mind-body connection more) then there would be no more need for expensive and time-wasting operations. His condition would have resolved all by itself.
Now you will be thinking: “How could Eric know that”, well I can tell you right now, it’s not that difficult to connect a person’s chronic health complaint with the way they think and behave, and the way Phil was behaving I was quite surprised that he even made it to sixty three years of age. You don’t need a medical degree nor a crystal ball to see into the future for patients like Phil, you just need an ounce of common sense to understand that nobody gets away with living like that for too long without some major health problem coming their way. And in Phil’s case it was his heart, making me wonder how happy he really was in life. Some people just throw themselves into their work when they are unhappy, others will eat food and yet others will have addictions such as booze or gambling.

I’m not suggesting that all cases of AF are as a result of living a highly stressed lifestyle, but from the several cases I have seen over the years I could safely say that about half are as a result of a highly strung individual living their life on a razor’s edge. My wife’s girlfriend Shirley (not her real name) is another example of AF induced by stress. Shirley separated from her husband and is undergoing a divorce at present. Her husband left her due to her obsession and extreme competitiveness with her business. She ended up in the emergency ward only a few weeks ago with major arrhythmia after she received a lawyer’s letter outlining the terms of their separation. Her doctor recently diagnosed Shirley as having atrial fibrillation and recommended drugs.

Different Types of Atrial Fibrillation

There are basically 3 different types of AF, some cases last only a short period of time and then resolve. Other AF cases are more persistent in nature and can hang around for awhile whilst other cases are permanent and severe.

  1. Paroxysmal Atrial Fibrillation. Paroxysmal attacks are short, frequent symptoms that can be observed in various clinical conditions such as AF.  In paroxysmal AF, the faulty electrical signals and rapid heart rate begin suddenly and then stop on their own. Symptoms can be mild or severe but they stop within about a week, but usually in less than a day. This is one of the more common forms of AF, and the one to freak a person out because they think they are going to have a heart attack.
  2. Persistent Atrial Fibrillation. This is a condition in which the abnormal heart rhythm continues for more than a week. It may stop on its own, or it can be stopped with treatment.
  3. Permanent Atrial Fibrillation. This is a condition in which a normal heart rhythm can’t be restored with treatment. Both paroxysmal and persistent AF may become more frequent and over time result in a more permanent AF.

Who Is at Risk for Atrial Fibrillation?

Men are more at risk than women, and AF is an uncommon condition in children. This condition affects millions of people worldwide, and the risk of getting AF increases as you age which is is mostly because your risk for heart disease and other conditions that can cause AF also increases as you get older. Nevertheless, about half of the people who have AF are younger than 75.

Major Atrial Fibrillation Risk Factors

Just like any other condition, some people are more at risk than others. Here is a list of the common AF risk factors:

  • High blood pressure
  • Coronary heart disease
  • Heart failure
  • Rheumatic heart disease
  • Heart defects, such as a mitral valve prolapse
  • Pericarditis. This is a condition in which the membrane (the pericardium) around your heart is inflamed
  • Congenital heart defects. This means that you were born with a heart defect of some sort.
  • Sick sinus syndrome (a condition in which the heart’s electrical signals don’t fire properly and the heart rate slows  down; sometimes the heart will switch back and forth between a slow rate and a fast rate)

Oxidative Stress is a Risk Factor for Atrial Fibrillation

Because atrial fibrillation is the most common heart beat irregularity that is usually found in people, it has been widely studied as you can imagine. Researchers from Emory University School of Medicine in Atlanta, USA, made a study and found that the risk of this heart beat irregularity can be predicted by measuring the oxidative stress levels. But what is oxidative stress you ask?  Interestingly, researchers have found a new link between oxidative stress and enlargement of the heart’s left atrium, and this is important news because it is the left atrium which is the main cause of occurrence of atrial fibrillation.

Cardiology Researchers Dr. Nima Ghasemzadeh along with Dr. Arshed Quyyumi, Professor of Medicine and Director of the Emory Cardiovascular Research Institute, Atlanta, Georgia, USA, studied 629 patients on average under the age group of 63, undergoing cardiac catheterisation at Emory for three years and found that the risk of atrial fibrillation increases with age, and approx 3%-5% people over 65 suffer from atrial fibrillation.
Doctors rely on cholesterol as the main driver behind heart disease. Professor Quyyumi speaks about a real underlying vascular abnormality – higher cysteine levels, which is completely ignored by the mainstream.

What Are the Signs and Symptoms of Atrial Fibrillation?

The signs and symptoms of AF can be quite subtle for many years and then pick up in intensity.This can lead to signs and symptoms, such as:

  •     Palpitations (feelings that your heart is skipping a beat, fluttering, or beating too hard or fast)
  •     Shortness of breath
  •     Weakness or problems exercising
  •     Chest pains (can be minimal or quite strong)
  •     Dizziness or fainting (a feeling of light headedness can occur)
  •     Fatigue (tiredness)
  •     Confusion

 Complications Of Atrial Fibrillation

AF has two major complications—stroke and heart failure.

Stroke – During AF, the heart’s upper chambers, the atria, don’t pump all of their blood to the ventricles (the bottom chambers). Some blood pools in the atria. When this happens, a blood clot (called a thrombus) can form. Clots which break off and travel to the brain cause a stroke. (clots that form in one part of the body and travels in the bloodstream to another part of the body are called an embolus.) Blood-thinning drugs that reduce the risk of stroke such as Warfarin are an important part of treatment for people who have AF, although there are natural medicines such as Nattokinase and Omega 3 which also work.
The illustration shows how a stroke can occur during atrial fibrillation. A blood clot can form in the left atrium of the heart and if a piece of the clot breaks off and travels to an artery in the brain, it can block blood flow through the artery causing a stroke to occur. The stroke comes about by way of the lack of blood flow to a specific part of the brain which starves that brain tissue of oxygen, which then dies.
Heart Failure – It is important to remember that your heart is a big mechanical pump, and when this pump fails and it can’t pump enough blood to supply your body’s demands, heart failure occurs. AF may lead to heart failure because the ventricles are beating very fast and can’t completely fill with blood. Thus, they may not be able to pump enough blood through to the lungs and body.
Some of the most common symptoms of heart failure are fatigue and shortness of breath, and these symptoms are primarily caused due to a build-up of fluid in the lungs. Oedema (fluid retention) is also common, fluid also can build up in the feet, ankles, and legs, causing puffiness and weight gain. The main way the heart failure is treated is by way of lifestyle changes, drugs, and procedures or surgery although more rarely, a mechanical heart pump or heart transplant may be used. treatment plan without interference.

How Is Atrial Fibrillation Diagnosed?

Like most other health complaints, your health-care professional will (or should) take a detailed case history. Most medical doctors (and a few naturopaths) will do this by default, but if you are not happy with your consultation you may want a second (or third, etc) opinion. It is YOUR body so don’t be satisfied with an explanation by your practitioner such as “i think you have indigestion” when you know that there is something a lot more serious going on. You would be surprised how many times I have seen a patient who was brushed off with a very simplistic explanation of their signs and symptoms by all types of health-care providers. Some patients have been to dozens of practitioners with little joy as to why they are feeling the way they do. Occasionally they get referred to a specialist, but this certainly not always the case.
Sometimes AF is “a-symptomatic”, which means that it doesn’t cause signs or symptoms. At times AF may even be found during a physical exam or EKG (electrocardiogram) test done for another reason. If you have AF, you will almost certainly want to know the cause, because this will help you plan not only the best way to treat the condition, but hopefully to avoid any further episodes in future.

Atrial fibrillation (AF) Is Diagnosed Based On:

  • Your medical and family history. Does anyone in your family have a history of AF? Has anyone in your family ever had heart disease or high blood pressure? Has anyone had thyroid problems? Does your family have a history of other illnesses or health problems such as diabetes?
  • A physical examination. What signs and symptoms do you have? Have you had palpitations? Are you dizzy or short of breath? Are your feet or ankles swollen (a possible sign of heart failure)? Do you have any chest pain? Your practitioner should do a complete cardiac exam. He or she will listen to the rate and rhythm of your heartbeat and take your pulse and blood pressure reading. Your doctor or cardiologist (heart specialist) will most likely check for any signs of heart muscle or heart valve problems. He or she will listen to your lungs to check for signs of heart failure. Your doctor also will check for swelling in your legs or feet and look for an enlarged thyroid gland or other signs of hyperthyroidism (too much thyroid hormone).
  • Health habits. Do you smoke or use alcohol or caffeine? Are you overweight or have metabolic syndrome?
  • Results from various tests and procedures. Such as an EKG. An EKG is a simple, painless test that records the heart’s electrical activity. It is the most useful test for diagnosing AF. An EKG will show how fast your heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through your heart. A standard EKG only records the heartbeat for a few seconds. It won’t detect AF that doesn’t happen during the test. To diagnose paroxysmal AF, your doctor may ask you to wear a portable EKG monitor at home for a few days that can record your heartbeat for longer periods.


The Heart Stress Test

Some types of heart problems are easier to diagnose when your heart is working hard and beating fast, like during a work-out or when you exercise. During “stress testing”, you exercise on a treadmill generally to make your heart work hard and beat fast while heart tests are being completed. For those who can’t exercise, they are generally given a drug to make their heart work faster an harder.


Echocardiography (echo) uses sound waves to create a moving picture of your heart. The accurate test will show the size and shape of your heart and how well your heart chambers and valves are working together in coordination.
An ECG can also can identify areas around your heart responsible for poor blood flow, various areas of heart muscle that aren’t contracting normally, and any previous injury to your heart muscle caused by poor blood flow.

Chest X Ray

Personally, I’m not a fan of radiation exposure, but a chest x ray is a painless test that creates pictures of the structures in your chest, such as your heart and lungs. This test can show fluid buildup in the lungs and signs of other AF complications.

Blood Tests

Blood tests check the level of thyroid hormone in your body and the balance of your body’s electrolytes such as magnesium, potassium and sodium. Electrolytes are minerals that help maintain fluid levels and the all crucial acid/alkaline balance in the body. These minerals are absolutely essential for normal health and functioning of your body’s cells and organs.

How Is Atrial Fibrillation Treated?

The treatment for atrial fibrillation (AF) depends on how often you have symptoms, how severe they are, and whether or not you already have heart disease. The general treatment of AF includes pharmaceutical drugs, various medical procedures, and lifestyle changes. The goals of treating AF generally include:

  • Preventing blood clots from forming. (thus lowering the risk of stroke)
  • Controlling the rate of ventricle contraction. (called rate control) Rate control is important because it allows the ventricles enough time to completely fill with blood. With this approach, the abnormal heart rhythm continues but you feel better and have fewer symptoms.
  • Restoring a normal heart rhythm. (called rhythm control) Rhythm control allows the top and bottom chambers of the heart to work together to efficiently pump blood to the body.
  • Treating any underlying disorder that’s causing or raising the risk of AF—for example, hyperthyroidism (too much thyroid hormone).

Not Everybody Needs Treatment

People who have AF but don’t have symptoms or related heart problems may not necessarily need treatment. In some cases, AF may even go back to a normal heart rhythm on its own, which can also can occur in people who have AF with symptoms. In some people who have AF for the first time, the treatment may even include the use of a defibrillator (an electrical procedure) to restore a normal heart rhythm. If a person has repeated episodes of AF, it tends to cause changes to the heart’s electrical system leading to persistent or permanent And most all people who have persistent or permanent AF will need treatment to control their heart rate and prevent complications.

Specific Atrial Fibrillation Medical Treatments

  • Blood Clot Prevention. People who have AF are at increased risk for stroke. This is because blood can pool in the heart’s upper chambers (the atria), causing a blood clot to form. If the clot breaks off and travels to the brain, it can cause a stroke. Preventing blood clots from forming is probably the most important part of treating AF. The benefits of this type of treatment have been proven in multiple studies. Doctors prescribe blood-thinning medicines to prevent blood clots. These drugs may well include warfarin, heparin, or aspirin. I’m not a big fan here. People taking blood-thinning medicines need regular blood tests to check how well the medicines are working.
  • Rate Control. Doctors often prescribe certain drugs to slow down the rate at which the ventricles are beating. These medicines help bring the heart rate to a normal level. Many people feel better and function well if their heart rates are well-controlled. Drugs used to control the heart rate include beta blockers (like metoprolol and atenolol), calcium channel blockers (diltiazem and verapamil), and digitalis (digoxin).
  • Rhythm Control. Restoring and maintaining a normal heart rhythm is a treatment approach recommended for people who aren’t doing well with rate control treatment. This treatment also may be used for people who have only recently started having AF. Doctors use drugs or certain procedures to control the heart’s rhythm. Patients often begin rhythm control treatment in a hospital so that their hearts can be closely watched. Restoring a normal rhythm also becomes less likely if the atria are enlarged or if any underlying heart disease worsens. In these cases, the chance that AF will recur is high, even if you’re taking medicine to help convert AF to a normal rhythm. Drugs used to control the heart rhythm include amiodarone, sotalol, flecainide, propafenone, treatmente, and treatment.
  • Catheter ablation may be used to restore a normal heart rhythm if medicines don’t work. For this procedure, a wire is inserted through a vein in the leg or arm and threaded to the heart. Sometimes doctors use catheter ablation to destroy the needdioventricular (AV) node. The AV node is where the heart’s electrical signals pass from the atria to the ventricles (the heart’s lower chambers). This procedure requires your doctor to surgically implant a device called a pacemaker, which helps maintain a normal heart rhythm.

Natural Treatment Of Atrial Fibrillation

You may be told that your only treatment option with AF is drugs or surgery, probably like you will told this when it comes to any condition affecting your heart or circulation. This is not true, there are many different treatment options available to you if you have heart or circulation issues.

  • Magnesium –  Most people who suffer from atrial fibrillation have a magnesium deficiency. Magnesium is a very  important mineral in heart cell function. Magnesium is very easily depleted from your diet and in addition is easily excreted. Be sure to read our comprehensive Magnesium page.  Atrial fibrillation alternative treatment may involve increasing the amount of magnesium in the body. I recommend that you start with taking between 400 – 600 mg of magnesium each day, but better to take 800 mg per day in divided dosages (at least three times daily with foods or meals). You should start you out on low doses and gradually increase your dose over a week or two and see how you feel. It is not uncommon to develop loose bowel movements when first beginning magnesium, especially if you take too much. By slowly increasing the dose over a few weeks you will minimise this effect. I have had very good success with patients taking magnesium, who have AF. It does take time to work our how much magnesium you need to treat your individual case of AF.
  • Epsom salts bath is another atrial fibrillation alternative treatment. A 20 minute soak in water with two cups of Epsom salts can be quite effective. Epsom salts is magnesium sulphate, but in this case you will be soaking in it and it gets absorbed through the skin.
  • Calcium. Are you taking a calcium supplement (on its own, without magnesium) and have AF? Then STOP taking it. If your body is magnesium deficient too much calcium can actually cause atrial fibrillation!  Atrial fibrillation treatment should include equal parts calcium and magnesium in a supplement, or just magnesium on its own. But do not take calcium alone if you have AF, you will only potentially make things worse.
  • Potassium. I invariably find that those who are magnesium deficient are almost certainly potassium deficient. Potassium helps to keep your heart in a proper rhythm, and low potassium levels can lead to atrial fibrillation. You should take 1600 to 2400 mg of potassium daily, start off at a lower dose and gradually increase your dose to reach the 2400 per day.

How Can Atrial Fibrillation Be Prevented?

Following a healthy lifestyle and taking steps to lower your risk for heart disease may help you prevent atrial fibrillation (AF). These steps include:

  •     Following a heart healthy diet that’s low in saturated fat, trans fat, and cholesterol.
  •     A healthy diet includes a variety of whole grains, fruits, and vegetables daily.
  •     Not smoking.
  •     Being physically active.
  •     Maintaining a healthy weight.

If you already have heart disease or other AF risk factors, work with your doctor to manage your condition. In addition to adopting the healthy habits above, which can help control heart disease, your doctor may advise you to:

  •     Follow the DASH eating plan to help lower your blood pressure.
  •     Keep your cholesterol and triglycerides at healthy levels with dietary changes and medicines (if prescribed).
  •     Limit or avoid alcohol.
  •     Control your blood sugar level if you have diabetes.
  •     Get ongoing medical care and take your medicines as prescribed.


Links to Other Information About Atrial Fibrillation

Clinical Trials

  • Clinical Trials (Diseases and Conditions Index)
  • Current Research (Clinical
  • NHLBI Clinical Trials
  • NIH and Clinical Research (National Institutes of Health)
  • Research Match (funded by the National Institutes of Health)

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