I have not been reading or posting lately so I hope another person has not posted this. If they have, sorry. Dr. John Mandrola writes some interesting articles and should you decide to read the entire article, it can be found on this site. medscape.com/viewarticle/86... You will need to log in to read the entire article.
I've ablated AF many hundreds of times over the past 12 years. I do fewer AF ablations now. I go slower. Patients and I have long chats about AF; we discuss their symptoms, the reasons for these symptoms, the vast uncertainty of AF and its treatment, and, mostly, the expectations of ablation or no ablation. Could a nurturing, respectful, and optimistic doctor-patient interaction deliver antiarrhythmic effects?
Something clicked when I read the Turkish authors call for a sham-control trial. Their words reminded me how little we know about AF. The truth is we lack a true scientific understanding of what causes the arrhythmia, and we have little basic scientific insights into what is fibrillation itself.
It was a big step we made going from Haïssaguerre and colleagues first description of focal tachycardia in the pulmonary veins to extensive left atrial ablation.
It is time to rethink our strategy. Better late than never.
And a few more excerpts:
But AF ablation is not just unproven, it's inelegant. This month, almost 2 decades after the first report of AF ablation, German authors called the 2-year results after cryoballoon ablation in patients with persistent AF "promising." How promising? The procedure failed in 22 of the 50 patients (44%).
Not only are the results poor, but the procedure is big—ablation lesions in the left atrium, often millimeters away from the esophagus or phrenic nerve, general anesthesia, transseptal puncture, multiple vascular entries, and hours of bed rest put patients at significant risk. Creating scar to treat a disease that is often caused by scar hardly seems elegant.