Sanjay Gupta on Ablation

Most will have seen this. This guys communication skills are astonishing

Some of what he says is controversial. And the evidence base is missing here.

The thread is worth a read too

healthunlocked.com/afassoci...

[jeanjeannie50]

Sanjay Gupta is a saint. He's one doctor in a million who really cares about people and wants to help them with their AF. I'm a friend of his on Facebook and get to have direct access to open talks he frequently gives on that site where you can ask questions and he answers them immediately. He has also recently posted some smaller videos which are only on Facebook.

We have lots of YouTube videos of his put on the this forum frequently. Every talk he gives is full of the information members here really need to hear.

Jean

[jeanjeannie50]

Here's a statement Sanjay Gupta issued two months ago:

Having spent almost 28 years in Medicine, I have come to the following conclusions: I believe that the healthcare industry rarely ever provides healthcare. Instead it provides disease management by using expensive and potentially harmful pills to mask symptoms.

Secondly I believe people come to see doctors to be engaged, educated and empowered rather than being given a set of pills before being shown the door. I think lifestyle management is perhaps the single most effective therapy in medicine and yet largely ignored because it is boring and not as profitable as promoting the newest and often most expensive tablets.

I do believe that high quality reliable jargon-free information about health should be available at no cost to everyone in the world. Unfortunately many people rely on google to answer their questions and are often left confused and anxious because of the unreliability and variability of the quality of information

I think the media, the pharmaceutical industry and often the healthcare industry profit by promoting fear rather than providing reassurance and empathy. I want to do things differently. I want to use the power of the internet to provide everyone with a high quality reliable and evidence based resource for medical information. I want to impart knowledge in an empathic and reassuring manner. I want to empower patients to take control of their health by addressing their lifestyles and preventing disease from happening in the first instance. Most of all, I want people to stop being fearful and anxious about their health by getting them to focus on improving their quality of lives and living fearlessly.

Sanjay Gupta

[Hidden in reply to jeanjeannie50]

Jeanjeannie50 thank you

Powerful heartfelt message

Is he well thought of at Heart Rhythm Alliance?

[BobD Volunteer in reply to Hidden]

He has presented at Patients Day a few years ago.

[Hidden in reply to BobD]

......but he’s still a naughty boy.....he said blood thinners twice!!!😳.....you need to have a word in his 👂👂.....where would we be without him....👍

[CaroleF in reply to BobD]

I wish they'd ask him again and I doubt I'm the only one who would like that.

[secondtry in reply to jeanjeannie50]

Hi Jean, I know you are good at your homework so you may be interested in drhyman.com He has covered diet but now is doing a series of talks on-line on the 'Broken Brain' - just heard the first last night, essentially he is addressing what he calls 'Functional Medicine' and seeking to show that the myriad of ASD,ADD, ADHD, alzheimers dementia etc etc are not just bad luck and inevitable.

[jeanjeannie50 in reply to secondtry]

Thank you for thinking of me Secondtry. I haven't looked at your link yet, but will certainly do so.

Yes, I'm aware of Dr Hyman and am watching his Broken Brain videos for the second time. I watched the first episode yesterday too. He did release these for limited access viewing a few months ago, but I thought they were so informative that I would watch them a second time.

I was only diagnosed hypothyroid about 6 months ago, so am keen to find out all I can about it. I had been putting all my extreme tiredness down to my AF. Poor old heart was being blamed for everything.

Jean

[secondtry in reply to jeanjeannie50]

I should have known you would be onto him!

[Globe-J]

Could anyone comment please.

SG seems to say that a successful ablation, i.e. cessation of AF will not improve the stroke risk. That seems illogical.

Thank you

J

[BobD Volunteer in reply to Globe-J]

Not at all. It is not AF that causes the risk but the company it keeps. ALSO the work done inside the heart produces scarring which in turn can promote localised pooling of blood and clot formation. Most of us old hands would rather chew off an appendage that stop anticoagulants.. I know that this is counter intuitive but true.

[AnneTS in reply to BobD]

Totally agree Bob. Warfarin costs the NHS pennies and well-managed is a useful protection.

[LouBrig in reply to BobD]

After having an Ablation recently at the age of 51 I was aware that scarring can promote pooling. My AF appears to have been encouraged by high levels of stress prior to my mums death/bereavement. AF for me doesn't keep company with anything other health issues and so am deemed low risk. Should I be concerned that my EP only prescribed AG prior to and post Ablation. Also he has suggested stopping the 2.5mg of Bisopropol.

[LouBrig in reply to LouBrig]

I meant 'wasnt' aware it can promote pooling.

[BobD Volunteer in reply to LouBrig]

Calcium deposits in water pipes can cause noise for similar reasons. The surface is no longer smooth so flow is disturbed.

Stress may well have contributed but you need a pre-disposition before you can have AF.

This can be genetic or acquired for example by over exercise. If the stress caused valvular problems and high blood pressure then maybe this may have contributed to enlargement of the left atrium, the stretching of which sometimes causes the natural circuitry to break down.

In your case with a low CHADSVASC then you would only have been put on AC for the period of the ablation and recovery so what you do now is up to you. I have my own views but always say the only right answer is what is right for you.

[LouBrig in reply to BobD]

I am not aware it is genetic and I certainly don't exercise too much, if at all. My BP was a touch high during stressful period but my EP suggests my heart structure is very healthy.

I guess you mean 'up to you' is lifestyle changes. I am so fearful of it coming back I'll do anything to help.

[BobD Volunteer in reply to LouBrig]

I meant that there is no compelling data related reason as yet to continue AC but yes life style changes are beneficial. I think we all feel as you do. I am more worried about AF coming back than my past cancer.

[Hidden in reply to Globe-J]

Yup illogical but he would not stake his reputation on that unless there is definite proof out there somewhere. Wonder where?

[fnurd in reply to Globe-J]

I agree, and I think (guardedly) so does my EP, Prof Schilling.

In my notes I found these studies which although not RCTs still seem pretty compelling:

This pure substrate-based ablation strategy has resulted in remarkable success, including mortality benefit, even in high-risk patients with very long standing persistent AF.

sciencedirect.com/science/a...

As shown in Fig. 5, maintaining sinus rhythm was associated with a much better survival rate compared to those whose AF ablation failed to restore sinus rhythm (p < 0.0001). There were 20 deaths; 11 of the 445 patients (2.5%; 3 cardiac and 8 noncardiac deaths) who remained in NSR died compared to 9 of the 69 patients (13%; most were cardiac deaths) whose ablation failed to restore sinus rhythm during the follow-up period.

sciencedirect.com/science/a...

[Globe-J in reply to fnurd]

Hi again,

While it certainly is not my wish to offend anyone here. In my view, Dr Gupta is not particularly controversial, more likely misleading and potentially very harmful to anyone seeking sound, evidence based, medical advice.

Presenting unsupported personal opinions as facts may gain attention, create a guru like image, gurus are not questioned, are they? Have Dr Guptas’ controversial suggestions been peer reviewed in a medical journal? It seems doubtful, but I will stand corrected, if wrong.

Best wishes to all

J (-:

[doodle68 in reply to Globe-J]

Hi Globe you say ..

''Presenting unsupported personal opinions'' ...

....I haven't watched the video above for some time but I do recall on most of the Dr Gupta videos I have watched (and that is pretty much all of them ) he mentions various studies and pieces of research some dating back a number of years which support his pronouncements.

For me experience counts for a lot too and I think Dr Gupta has plenty of that.

[Globe-J in reply to doodle68]

Hi,

Does he, In a video a few weeks ago? I did make a comment, on the forum at, the time regarding a blank statement, along the line ‘stopping AF does not diminish the chance of a stroke’. Did he provide any references then? In the recent video, defending his dubious claim he reasserts the position with the insertion of many ‘possibly, may be’, etc. What is he really saying? The cherry-picked studies, some very old, are ‘the proof’. Yet he mentions not a single study suggesting the opposite. A paramount duty of a scientist, or a doctor is to be objective and balanced.

I wanted to voice my opinion, if even one person will listen to Dr Gupta, or any other ‘expert’ with an open, critical (in an academic sense) mind, then I succeeded

J (-:

[Hidden in reply to Globe-J]

GlobeJ

My understanding is that there is no evidence right now that successful ablation reduces stroke risk, but that decent RCT s will likely confirm that in the medium term.

I imagine fear of litigation must impact such studies.

[Globe-J in reply to Hidden]

Thanks Oyster,

It seems the jury is out on this one.

Do you think that there may be other health benefits associated with stopping AF?

J (-:

[Hidden in reply to Globe-J]

Globe-J

I will only believe my answer to your question when I have been in permanent AFlutter for 12 months, another 9 to go, and can then tell you if and why things are worse. So far not so bad apart from uncomfortable ectopics.

The obsession with minimising paroxysmal AF can be debilitating.

[Globe-J in reply to Hidden]

Sure, although I may disagree on points, we are all different and I'd never dispute your position regarding yourself.

All I am trying to do is to access evidence based, objective information, and hearing members’ personal experiences. This forum has helped me to make informed choices. Now I am pleased, having been free of the pest for some months. However, my answer to a question ‘would you recommend the Maze Procedure has been: “Do not rush, it is a highly invasive surgery with its own consequences, think carefully.”

Please do be sure that I look forward to hearing your experience too

J

[Hidden in reply to Globe-J]

Globe-J

Sorry, I could have put that better.

Now that I am persistent AFL I don't stress about avoiding paroxysmal AF

I think we are on the same page. btw, fnurd is a medical statistician and our go to person to assess studies, RCTs etc

[Globe-J in reply to Hidden]

(-:

[BobD Volunteer]

I was first told this about ten years ago by Dr.Matt Fey one of AF A's medical advisers. It made me very sad to start with but I soon realised that it is better to know that not. There is no statistical data to show that Ablation reduces stroke risk BUT if your Chadsvasc was low before and you only took anticoagulants for the purpose of the ablation you may perhaps choose to stop once things had settled down (maybe six months). I did this after my second ablation but had to re-start when the AF came back. After my third I was that much older anyway and choose to remain on warfarin for life now.

In fact there are plenty of us who believe that any diagnosis of AF should mean anticoagulation but this is not currently NICE quidelines.

[RobertELee]

Yes, let's be honest a cash strapped NHS wouldn't be prescribing expensive anti-coagulants if they didn't serve a valuable purpose even after successful ablation. Give up everything else before you stop taking the ACs....

[Globe-J]

Good, you voiced your opinion, I have mine

J (-: