It was reported on here a few days ago in a paper produced by an EP that the Cabana trial showed ablation was better than drugs. In a paper released today, Dr John Mandrola begs to differ, "Cabana my initial thoughts":
The conclusion of the trial was "Ablation did not produce a significant reduction in the primary endpoint and all-cause mortality."
Dr JM says "Any electrophysiologist who uses these data to tout ablation as superior to drugs spreads disinformation and demeans our profession. Not only should we not make these false claims, we should vigorously oppose those who do."
The results look quite confusing. No doubt there will be further analysis once the full data has been released. But this is disappointing as it had appeared previously that ablations did reduce stroke risk. In any case I have remained on warfarin since my successful ablation 8 years ago, and I would suggest others consider doing so as well.
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MarkS
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I think this highlights the fact that most heart doctors don't actually appreciate just how bad AF can be. I couldn't care less about having the same 'hard' endpoints of stroke or death for drugs or ablation. The only deciding factor for me was I had no quality of life when in AF. I had the ablation and now have my very active life back. Even if it turns out to be a few years shorter than it might have been on drugs I will still think I made the right decision. What having AF did make me do is once it was gone to get out there and do all the things I'd always said I'd do 'one day' just in case it ever does come back.
A negative opinion indeed from Dr Mandola, but he clearly misses the point that, for many people, the quality of life given back to an AFib sufferer after ablation is what really counts.
It also misses the point that many sufferers, like myself, could not tolerate the currently available medication. In fact it often makes us feel worse.
Last of all, we should be on anti coagulation therapy anyway to reduce our stroke risk, even if we do feel better after ablation(s).
I was not doing well with any of the prescribed drugs for AFib they all failed me and Warfarin made my legs go red and very uncomfortable! I am an Active Gold Panner and when in the mountains (British Columbia Canada) I need all my strength that warfarin took away from me in two week of no warfarin my health was improving quickly I take no meds now my Doctor that did my ablations was every angry they didn't follow orders and another doctor kept me on my meds for two long yrs fighting up and down mountains wondering why I was fatigued, got that fixed up and going strong, this pandemic has put a hold on our lives here and getting worse but when I feel that cool spring wind with the smell of snow from the glaciers I am gone to the claim and get to working digging for that sparkle of gold(shiny) with bears coming around just to say hello! If I go down I will be spread around my mountains from the wild animals! If you've seen where I am talking about, you know my feeling! Life is good, get out and live it if you can, if that is hard sit amongst plants, flowers and trees and see or listen what you are looking at, opens up a whole new world ,the way I look at my world now is totally different but I am not going to hold back Afib took years off my adventures in life, now God willing I will see with new eyes and mindset!
If warfarin's affecting you, you could try one of the new DOACs. Alternatively, a LAA ablation or closure with a device like the amplatzer device.I like BC, I've been there on hols and particularly liked the Yoho and Kootenay NP's. We did a mix of hiking, quad biking, canoeing and rafting. So I can understand your love of the mountains
It is the largest study - I think world wide? - which looks at outcomes for ablation - I think it has run since 2009? They were looking for evidence that eliminating AF via ablation would prolong life - because it would decrease the stroke risk. But as far as I can see - and all seems a bit confused still - they couldn’t find any evidence so the results have caused some discussion and re-thinking.
The cardiologist I saw yesterday told me very firmly that having successful treatment for AF symptoms does not remove stroke risk, anticoagulation is for life.
Interesting comments from Dr Mandrola - I find the way CABANA was conducted rather confusing. Were patients who moved from one cohort to another counted into the results of the original cohort? Surely that and the fact that they transferred in the first place would skew results? Perhaps I have misunderstood.
I wonder how many AF sufferers think about all ‘endpoint’ factors at all when considering ablation. Ablation, for me would be a choice to try to relieve unbearable symptoms of AF and get some degree of quality of life back.
I read Dr Mandrola's article last night, he is someone I admire and I think some of the points he raises give pause for thought not least how the trial was conducted. It will be interesting to see the full details of the trial when they are published
When a thread was posted about the CABANA trial the other day the article sited stated...
[''No one wants to be on drugs for the rest of their life to treat a heart arrhythmia called atrial fibrillation........]
I found that quite misleading the implication being that there was an option available to treat AF namely 'ablation' that could negate the need to take any drugs when for many even with a successful ablation the need for some medication will continue.
There is no 'one size fits all' for the treatment of AF, we patients are all so very different with a range of ages, degree of symptoms and comorbidities. Ablation will be fine for some but not all and I think it is important to tailor the treatment for AF to the circumstances of each patient something advocated by Dr Mandrola.
What I take from this conflict of opinion is that the study could have been better organised. Hindsight is a wonderful tool that helps to organise the next attempt. Our problem is that another five years before another study could give clearer results doesn't help us in making these decisions now.
Another marked factor that doesn't seem to be mentioned in the different views of the outcome is the different kind of experience the AF patients are having individually. We are all different, and this 'mongrel disease' affects us all differently. Some have a really horrible experience of life-changing proportions, whilst others of us have a relatively minor, if scary and uncomfortable, intermittent inconvenience. Some lucky few hardly notice they have it.
I think comments here highlight the difficulty of organising a trial like this. For a new drug it's easy to hide if someone is on the real drug or a placebo, but one can hardly hide whether one has had an ablation or not short of actually putting people under GA and doing nothing to them which I think passes most lines of ethical practice. Thus people having a hard time with drugs are going to consider having an ablation anyway, whilst those for whom the drugs work will remain in this group.
While the full data have not yet been released, I think this is a much more balanced assessment that Dr. John Mandrola's opinion. drjohnday.com/cabana-study/
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