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Could Ablation for AF Be an Elaborate Placebo?
Posted by afhound99
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Re: Could Ablation for AF Be an Elaborate Placebo? June 26, 2016 04:43PM |
Yeah Afhound 99 (and good to hear from you!) ... Dr Mandrola is at it again 
,
He brought up this crazy idea in an ongoing EP-oriented twitter conversation that a good number of top level EPs contribute too, including Drs. Natale, Amin Al Ahmad and Luigi DiBiase from St Davids most of us on this forum are familiar with, and EP Lab Director and elite level ablationist Dr Fermin Garcia and Dr. Pasquale Santangeli of Univ. of Penn as well as a host of other top level elite EPs like Sergio Penski and a quite a few others from around the world.
Even I have joined the group over the last couple of months and offer my two cents from time to time when a patient perspective might help flesh out a given conversation some, in addition to mostly the statistics and doctor's window on this condition.
Every single respected practicing EP ablationist in this twitter conversation responded to Dr John's trying to float this concept (and you could tell he was hoping it would gain some traction) with a resounding rebuke of the idea, offering solid, tangible real world vignettes and evidence from their every day experience ... or at least as much as is possible in a 140 characters/tweet on twitter, which is not much ... but all too the point. Enough, for sure, though to have inspired pause about embracing this projection before the author of this Medscape article might become inspired to actually print such a premise and thus risk confusing a whole bunch of folks.
And yet, here it is in print in Medscape in his column ... I guess it was just too enticing bait. Plus, the theme is in concert with his apparent growing skepticism and uncertainty when it comes to his own mixed feelings about AFIB ablation practice that he discusses on his blog, which is certainly his right. He certainly has had a different experience than I have, and so many others I know here that have also experienced first hand the life-changing relief from completing an expert ablation process by a top volume expert ablationist.
If Dr John is serious about really wanting to understand what is possible in this field, he would serve that desire to expand his perspective by going to spend a month at St Davids and witness first hand the gulf between such concepts he is now floating out to the world, and the reality of what is really possible with a very different perspective and understanding of how to address more complex arrhythmia. He would also be surprised to learn that folks who have undergone such an expert extended ablation process are doing very well in thier lives enjoying real freedom from the beast for the most part, and are not some kind of cardiac cripples that he has immplied in other musings as a rationale and defense from really investigating first hand how these advanced procedures really work that would totally undermine the mistaken concepts he promotes about more advanced ablation.
Alas, Im beginning to think Dr John is moved and motivated as much be wanting to simply take a contrarian view that is controversial ... perhaps to better support his predominant job now as a physician journalist, as much or more than he is concerned about being deliberate in considering the impact on patients and other non-EP medical specialties, by just tossing such concepts out there to get a rise out of the readers. Perhaps he just view his audience as the fellow EPs and doctors he is trying to encourage, and rightly so, to take a more life style risk factor view and stance in their own practices, but he seems to fail to understand how confusing and reticent his statements appear to regular afibbers trying to understand and blend the best of both worlds of learning and adopting better self-health care along with learning how to partner with the most experienced EP when, and if, adding in an expert ablation becomes ones next best choice to really have success in eliminating, or at least dramatically diminishing, the presence of AFIB/Flutter in our lives.
This idea of wondering is maybe the good results from AFIB ablation was all some kind of elaborate placebo was floated in an editorial by a Turkish group ... not exactly the hotbed of ablation research and leadership. It is exactly the kind of thought process that is likely to spring up when that persons first hand or second hand experience with AFIB ablation has been very mixed bag at best.
These folks would be stunned speechless to witness a maestro like Dr Natale render a man who had suffered from 24/7 non-stop symptomatic long standing persistent AFIB for 36 years!!! ... only to see Dr Natale convert this man within 43 minutes of his expert extended ablation protocol including LAA isolation, to pure NSR for the first time in 36 years, as over 250 of us witnessed in real time in the large amphi-theater room at St Davids during the two day EP-Live conference in Austin this past March!
I would just love to see Dr Mandrola try to stand up and posit this myth that what we just witnessed was a case of placebo in action with this fully anesthetized ULTRA-long 36 year duration of LSPAF patient!! He would have been tarred and feathered on the spot by the room full of EPs there.
In any event, Dr John is now promoting we do a double-blinded 'sham' ablation trial. Even though it is impossible to do a true double-blinded RCT with ablations (one can only blind the patients), unless you can figure out a way to blind your ablationist while he is performing the procedure ... and No thank you if he or she is going to do my ablation!! :-).
And brilliant EP Dr Kalyanam Shivkumar Director of the UCLA Arrhythmia program, gave a clear and insightful description to Dr John of why a 'Sham' AFIB ablation is an oxymoron from the outset, since just going inside and doing anything at all in the LA is going to change some EP parameters as it is. Not to mention the ethical hurdles of deciding which AFIB patients are going get the Sham procedure.
We are so far beyond even needing such a concept such as a Sham study, as Natale and quite a few other EPs stated in reply to Dr John on twitter.
In any event, Dr Amin Al-Ahmad, another very bright and skilled ablationist and EP educator, said in response to Dr John posting this new article on this twitter board yesterday: "AF Ablation in the wrong hands is placebo, Cryo for non-PAF (non-paroxysmal AFI
will fail with current technology."
And Dr Natale noted in one of his tweets in response to Dr Al-Ahmads comment, " (that is) Absolutely true ... and 'if you know what you are doing' and actually talk to your patients there is no doubt we're doing good things with ablations"
Dr Fermin Garcia: "Agree!! Technique and attention to detail is key. Not all AF ablation procedures are the same." (Amen to that)
I then pitched into the fray saying: "I could not agree more! Any EP who believes successful AFIB ablation of persistent AFIB equals a placebo must retire from doing any more AFIB ablations now."
I then added this following point: "With the 10yr history of all Medicare AF ablations ( in US from 2000 to 2010), where >/= 81% were done by EPs who do </= 25 AF ablations a year, this kind confused & wrong thinking results"
It's this big split we see in this field between so many undertrained EPs doing the majority of AF ablations most of whom have not progressed beyond a basic PVI -only approach that results in folks like Dr John being able to seriously ask themselves if maybe they are tricking themselves. You have to have a good number of failed outcomes where you are unable to restore durable NSR that can lead to such questions even being floated.
I don't blame other specialist for asking the question either, not when over 81% of all US ablations, as noted in the eye-opening Deshmukhs study two years ago, are being done by EPs doing 25 or less AFIB ablations a year ... and at small to modest sized centers/hospitals doing less than a total of 50 ablations a year!
25 ablations a year is simply not enough regular experience to even maintain basic muscle-memory and manual dexterity in manipulating a catheter inside the LA. And much less being able to actually improve your skill level. Instead, such an EP is far more likely to regress rather than advance their own skill and trade craft in AFIB ablations. Little wonder that this same important study found that this 81% of under-trained ablationist were responsible for, by far, the greatest percentage of complications and the least overall efficacy of ablation outcomes. No wonder, so many clinical EPs and Cardiology still hold a a mixed and uncertain view of AFIB ablation capability.
But this questionable view, is no where near the accurate real world reality that more elite level AFIB ablations are achieving every day. And this is why our website and forum is dedicated toward encouraging people to be very discriminating on who they choose to guide them toward durable freedom from this lousy condition. We saw the light along time ago, and understood from our own experience this stark dichotomy that exists in the EP world still yet, but that is improving all the time with real improvements in understanding beginning to reach a larger number of EPs, and thus leading to more and more EPs expanding their toolkits to include treatment of more advanced AFIB.
However, the net result still of this reality is this huge split between understanding and vision of what it even possible in an 'EXPERT ablation PROCESS' by so many otherwise often good and intelligent clinical EPs who either have not had an elite level persistent AFIB ablationist who does complex advanced AFIB ablations every day in their own practices, to lead their own AFIB fellowship training program.
And only a comparative handful of EP fellowship directors, as physician/educators, are themselves truly top volume elite level persistent AFIB ablation experts doing almost nothing else but AFIB ablations in their own daily practices. And any EP can only become so busy with such a huge demand for their services if they are a true AFIB ablation expert, the vast majority of EPs must do a lot of pacemakers, ICDs, CRT and other EP procedures each week to pay the bills and keep the lights on, as their location and/or skill level simply do not draw enough AFIB ablations to fill their schedules with mostly only AFIB ablations, and thus give them the experience base to become a genuine elite level persistent AFIB operator as a result.
This reality has a big impact on perceptions of what is possible with AFIB ablation, as no matter how well-rounded, smart and dedicated a given head of an EP fellowship program might be, and for sure the vast majority are excellent EP clinicians with a vast encyclopedic knowledge of the full scope of the field of EP, and most are outstanding educators on the bulk of EP topics each student needs to learn during their fellowship training. Nevertheless, it is simply not possible for a generalist clinical EP to also become an elite level advanced AFIB ablation expert too, as there are simply not enough hours in the day for a jack of all trades to become a true master of them all.
And it's not possible for new up and coming EPs who are not fortunate enough to be selected into one of the rare programs either directed by a maestro level persistent AF ablation expert, or at least whose program does have such a highly experienced ablationist in their group who can mentor these students and teach them their hard won nuances of complex advanced ablations that are far beyond the easiest Paroxysmal AFIB cases which generally require only a straight forward PVI/PVAI alone that every EP-ablationist learns as a baseline minimum.
Such EPs who lack either of these necessities for getting on the fact track toward themselves become elite level ablationists, are just going to have a much steeper mountain to climb if they are ever going learn and master those nuances and tricks of the trade that one can only realistically learn and master when working in the same room with a truly master ablationist for a number of years.
And, as such, its not too surprising how indoctrinated many EPs become to the philosophy and outlook on what is even possible with AFIB ablation, as well as adopting even what temperament they bring to the job, by the outlook and message that is continuously drummed into them by the head of their EP training! If that training emphasizes the more reticent largely cookie-cutter basic anatomical-only ablation approach, it is very hard for that new EP student to progress substantially and evolve beyond that perspectiveas they are so often wedded to the concept that only 'less is more' in AFIB ablation which is so appealing to their own lack of experience in even doing real time EP detection of non-PV triggers.
Its far more appealing for this class of EPs to simply relay on the fallback rules of thumb most often drummed into them by a very well meaning and intelligent clinical eP fellowship director and such EPs tend to be far more prone to accepting a promise of a quick and easy new ablation method like FIRM will tell them all jsut where to ablate outside of the anatomical PVI and spare them all having to learn real time EP sleuthing and decision making, while promising to make them all elite level ablationists without the years of training at a top volume ablation fellowship program that it now takes to even hope of joining such elite ranks.
In summary, there are so many here on our forum who have had intractable AFIB for any length of time in the past, especially the highly symptomatic advanced cases, and who have gone through and completed a full expert ablation process and are now enjoying a life of NSR, or at least dramatically reduced AFIB burden. Such a large number of former Afibbers, like myself, who can all attest wholeheartedly to what a ludicrous notion it is being floated by Dr John in this article, that such a sustained durable benefit is purely from placebo!
Funny how often I've seen an EP like Dr Natale, Rodney Horton, or Prof's Haissaguerre/Jais (on live video) .. etc .. achieve NSR when ablating a specifically detected real time trigger which was only detected during the middle of a challenging AFIB case while the patient was under general anesthesia and yet the patient sustained that NSR for many years there after. Must have been the result of placebo for sure :-)!
In all seriousness, though, if Dr John, or any EP for that matter, truly now believes, or is even leaning that way toward thinking that AFIB ablation is likely and primarily 'an elegant Placebo', as his thoroughly misguided proposition states, then by all means, morally and ethically he or she must recuse themselves of ever doing another AFIB ablation in their practice. At least so long as they still hold such a view.
When I posted that conclusion too on the EP twitter board yesterday after Dr John posted this new article, several top volume ablationist like Dr Al-Ahmad, Dr Garcia, Sergio Penski and Dr Joseph Cooper all agreed and retweeted my post showing their own support that if any EP actually believes and is promoting this view, they should stop doing ablations. At the very least every AFIB patient being offered and ablation has the right to know that his EP is reasonably confident he can do better than a placebo for his patients.
It is fine for a given EP and/or EP journalist to float such an idea of AF ablation = Placebo, and any such person is certainly entitled to his/her view and is free to express them as well. But as a practicing ablationist it just seems incompatible, if indeed any given EP actually is leaning toward AFIB ablation's effect being due to a Placebo effect. Certainly, if this is how they view the field, they should recuse themselves from performing any more ablations until, and unless, they regain more confidence and reassurance that there is an actual objective benefit to the procedure they are performing on real patients. And at the very least, such an EP must inform every prospective AF ablation patient that they hold such views about their craft and allow these patients the option of seeking ablation help elsewhere.
I sure would not want someone agreeing to doing an AFIB ablation on my heart when they either vocally, or even secretly, lacked confidence that they could fundamentally help me by their work. And not just rely on some 'elaborate placebo' to pull this rabbit of NSR from his or her hat!
And its just one more topic that is a red-herring to begin with, and that I don't have the time to address, but that our EP journalist friend has the uncanny timing to seemingly always drop on us all with such speculative musings that require a response on the forum right when Im trying to finish up an issue of the newsletter :-) :-/!
Glad to hear from you as its been a good while it seems afhound 99!
Shannon
Edited 5 time(s). Last edit at 06/28/2016 02:25PM by Shannon.
,
He brought up this crazy idea in an ongoing EP-oriented twitter conversation that a good number of top level EPs contribute too, including Drs. Natale, Amin Al Ahmad and Luigi DiBiase from St Davids most of us on this forum are familiar with, and EP Lab Director and elite level ablationist Dr Fermin Garcia and Dr. Pasquale Santangeli of Univ. of Penn as well as a host of other top level elite EPs like Sergio Penski and a quite a few others from around the world.
Even I have joined the group over the last couple of months and offer my two cents from time to time when a patient perspective might help flesh out a given conversation some, in addition to mostly the statistics and doctor's window on this condition.
Every single respected practicing EP ablationist in this twitter conversation responded to Dr John's trying to float this concept (and you could tell he was hoping it would gain some traction) with a resounding rebuke of the idea, offering solid, tangible real world vignettes and evidence from their every day experience ... or at least as much as is possible in a 140 characters/tweet on twitter, which is not much ... but all too the point. Enough, for sure, though to have inspired pause about embracing this projection before the author of this Medscape article might become inspired to actually print such a premise and thus risk confusing a whole bunch of folks.
And yet, here it is in print in Medscape in his column ... I guess it was just too enticing bait. Plus, the theme is in concert with his apparent growing skepticism and uncertainty when it comes to his own mixed feelings about AFIB ablation practice that he discusses on his blog, which is certainly his right. He certainly has had a different experience than I have, and so many others I know here that have also experienced first hand the life-changing relief from completing an expert ablation process by a top volume expert ablationist.
If Dr John is serious about really wanting to understand what is possible in this field, he would serve that desire to expand his perspective by going to spend a month at St Davids and witness first hand the gulf between such concepts he is now floating out to the world, and the reality of what is really possible with a very different perspective and understanding of how to address more complex arrhythmia. He would also be surprised to learn that folks who have undergone such an expert extended ablation process are doing very well in thier lives enjoying real freedom from the beast for the most part, and are not some kind of cardiac cripples that he has immplied in other musings as a rationale and defense from really investigating first hand how these advanced procedures really work that would totally undermine the mistaken concepts he promotes about more advanced ablation.
Alas, Im beginning to think Dr John is moved and motivated as much be wanting to simply take a contrarian view that is controversial ... perhaps to better support his predominant job now as a physician journalist, as much or more than he is concerned about being deliberate in considering the impact on patients and other non-EP medical specialties, by just tossing such concepts out there to get a rise out of the readers. Perhaps he just view his audience as the fellow EPs and doctors he is trying to encourage, and rightly so, to take a more life style risk factor view and stance in their own practices, but he seems to fail to understand how confusing and reticent his statements appear to regular afibbers trying to understand and blend the best of both worlds of learning and adopting better self-health care along with learning how to partner with the most experienced EP when, and if, adding in an expert ablation becomes ones next best choice to really have success in eliminating, or at least dramatically diminishing, the presence of AFIB/Flutter in our lives.
This idea of wondering is maybe the good results from AFIB ablation was all some kind of elaborate placebo was floated in an editorial by a Turkish group ... not exactly the hotbed of ablation research and leadership. It is exactly the kind of thought process that is likely to spring up when that persons first hand or second hand experience with AFIB ablation has been very mixed bag at best.
These folks would be stunned speechless to witness a maestro like Dr Natale render a man who had suffered from 24/7 non-stop symptomatic long standing persistent AFIB for 36 years!!! ... only to see Dr Natale convert this man within 43 minutes of his expert extended ablation protocol including LAA isolation, to pure NSR for the first time in 36 years, as over 250 of us witnessed in real time in the large amphi-theater room at St Davids during the two day EP-Live conference in Austin this past March!
I would just love to see Dr Mandrola try to stand up and posit this myth that what we just witnessed was a case of placebo in action with this fully anesthetized ULTRA-long 36 year duration of LSPAF patient!! He would have been tarred and feathered on the spot by the room full of EPs there.
In any event, Dr John is now promoting we do a double-blinded 'sham' ablation trial. Even though it is impossible to do a true double-blinded RCT with ablations (one can only blind the patients), unless you can figure out a way to blind your ablationist while he is performing the procedure ... and No thank you if he or she is going to do my ablation!! :-).
And brilliant EP Dr Kalyanam Shivkumar Director of the UCLA Arrhythmia program, gave a clear and insightful description to Dr John of why a 'Sham' AFIB ablation is an oxymoron from the outset, since just going inside and doing anything at all in the LA is going to change some EP parameters as it is. Not to mention the ethical hurdles of deciding which AFIB patients are going get the Sham procedure.
We are so far beyond even needing such a concept such as a Sham study, as Natale and quite a few other EPs stated in reply to Dr John on twitter.
In any event, Dr Amin Al-Ahmad, another very bright and skilled ablationist and EP educator, said in response to Dr John posting this new article on this twitter board yesterday: "AF Ablation in the wrong hands is placebo, Cryo for non-PAF (non-paroxysmal AFI
will fail with current technology."
And Dr Natale noted in one of his tweets in response to Dr Al-Ahmads comment, " (that is) Absolutely true ... and 'if you know what you are doing' and actually talk to your patients there is no doubt we're doing good things with ablations"
Dr Fermin Garcia: "Agree!! Technique and attention to detail is key. Not all AF ablation procedures are the same." (Amen to that)
I then pitched into the fray saying: "I could not agree more! Any EP who believes successful AFIB ablation of persistent AFIB equals a placebo must retire from doing any more AFIB ablations now."
I then added this following point: "With the 10yr history of all Medicare AF ablations ( in US from 2000 to 2010), where >/= 81% were done by EPs who do </= 25 AF ablations a year, this kind confused & wrong thinking results"
It's this big split we see in this field between so many undertrained EPs doing the majority of AF ablations most of whom have not progressed beyond a basic PVI -only approach that results in folks like Dr John being able to seriously ask themselves if maybe they are tricking themselves. You have to have a good number of failed outcomes where you are unable to restore durable NSR that can lead to such questions even being floated.
I don't blame other specialist for asking the question either, not when over 81% of all US ablations, as noted in the eye-opening Deshmukhs study two years ago, are being done by EPs doing 25 or less AFIB ablations a year ... and at small to modest sized centers/hospitals doing less than a total of 50 ablations a year!
25 ablations a year is simply not enough regular experience to even maintain basic muscle-memory and manual dexterity in manipulating a catheter inside the LA. And much less being able to actually improve your skill level. Instead, such an EP is far more likely to regress rather than advance their own skill and trade craft in AFIB ablations. Little wonder that this same important study found that this 81% of under-trained ablationist were responsible for, by far, the greatest percentage of complications and the least overall efficacy of ablation outcomes. No wonder, so many clinical EPs and Cardiology still hold a a mixed and uncertain view of AFIB ablation capability.
But this questionable view, is no where near the accurate real world reality that more elite level AFIB ablations are achieving every day. And this is why our website and forum is dedicated toward encouraging people to be very discriminating on who they choose to guide them toward durable freedom from this lousy condition. We saw the light along time ago, and understood from our own experience this stark dichotomy that exists in the EP world still yet, but that is improving all the time with real improvements in understanding beginning to reach a larger number of EPs, and thus leading to more and more EPs expanding their toolkits to include treatment of more advanced AFIB.
However, the net result still of this reality is this huge split between understanding and vision of what it even possible in an 'EXPERT ablation PROCESS' by so many otherwise often good and intelligent clinical EPs who either have not had an elite level persistent AFIB ablationist who does complex advanced AFIB ablations every day in their own practices, to lead their own AFIB fellowship training program.
And only a comparative handful of EP fellowship directors, as physician/educators, are themselves truly top volume elite level persistent AFIB ablation experts doing almost nothing else but AFIB ablations in their own daily practices. And any EP can only become so busy with such a huge demand for their services if they are a true AFIB ablation expert, the vast majority of EPs must do a lot of pacemakers, ICDs, CRT and other EP procedures each week to pay the bills and keep the lights on, as their location and/or skill level simply do not draw enough AFIB ablations to fill their schedules with mostly only AFIB ablations, and thus give them the experience base to become a genuine elite level persistent AFIB operator as a result.
This reality has a big impact on perceptions of what is possible with AFIB ablation, as no matter how well-rounded, smart and dedicated a given head of an EP fellowship program might be, and for sure the vast majority are excellent EP clinicians with a vast encyclopedic knowledge of the full scope of the field of EP, and most are outstanding educators on the bulk of EP topics each student needs to learn during their fellowship training. Nevertheless, it is simply not possible for a generalist clinical EP to also become an elite level advanced AFIB ablation expert too, as there are simply not enough hours in the day for a jack of all trades to become a true master of them all.
And it's not possible for new up and coming EPs who are not fortunate enough to be selected into one of the rare programs either directed by a maestro level persistent AF ablation expert, or at least whose program does have such a highly experienced ablationist in their group who can mentor these students and teach them their hard won nuances of complex advanced ablations that are far beyond the easiest Paroxysmal AFIB cases which generally require only a straight forward PVI/PVAI alone that every EP-ablationist learns as a baseline minimum.
Such EPs who lack either of these necessities for getting on the fact track toward themselves become elite level ablationists, are just going to have a much steeper mountain to climb if they are ever going learn and master those nuances and tricks of the trade that one can only realistically learn and master when working in the same room with a truly master ablationist for a number of years.
And, as such, its not too surprising how indoctrinated many EPs become to the philosophy and outlook on what is even possible with AFIB ablation, as well as adopting even what temperament they bring to the job, by the outlook and message that is continuously drummed into them by the head of their EP training! If that training emphasizes the more reticent largely cookie-cutter basic anatomical-only ablation approach, it is very hard for that new EP student to progress substantially and evolve beyond that perspectiveas they are so often wedded to the concept that only 'less is more' in AFIB ablation which is so appealing to their own lack of experience in even doing real time EP detection of non-PV triggers.
Its far more appealing for this class of EPs to simply relay on the fallback rules of thumb most often drummed into them by a very well meaning and intelligent clinical eP fellowship director and such EPs tend to be far more prone to accepting a promise of a quick and easy new ablation method like FIRM will tell them all jsut where to ablate outside of the anatomical PVI and spare them all having to learn real time EP sleuthing and decision making, while promising to make them all elite level ablationists without the years of training at a top volume ablation fellowship program that it now takes to even hope of joining such elite ranks.
In summary, there are so many here on our forum who have had intractable AFIB for any length of time in the past, especially the highly symptomatic advanced cases, and who have gone through and completed a full expert ablation process and are now enjoying a life of NSR, or at least dramatically reduced AFIB burden. Such a large number of former Afibbers, like myself, who can all attest wholeheartedly to what a ludicrous notion it is being floated by Dr John in this article, that such a sustained durable benefit is purely from placebo!
Funny how often I've seen an EP like Dr Natale, Rodney Horton, or Prof's Haissaguerre/Jais (on live video) .. etc .. achieve NSR when ablating a specifically detected real time trigger which was only detected during the middle of a challenging AFIB case while the patient was under general anesthesia and yet the patient sustained that NSR for many years there after. Must have been the result of placebo for sure :-)!
In all seriousness, though, if Dr John, or any EP for that matter, truly now believes, or is even leaning that way toward thinking that AFIB ablation is likely and primarily 'an elegant Placebo', as his thoroughly misguided proposition states, then by all means, morally and ethically he or she must recuse themselves of ever doing another AFIB ablation in their practice. At least so long as they still hold such a view.
When I posted that conclusion too on the EP twitter board yesterday after Dr John posted this new article, several top volume ablationist like Dr Al-Ahmad, Dr Garcia, Sergio Penski and Dr Joseph Cooper all agreed and retweeted my post showing their own support that if any EP actually believes and is promoting this view, they should stop doing ablations. At the very least every AFIB patient being offered and ablation has the right to know that his EP is reasonably confident he can do better than a placebo for his patients.
It is fine for a given EP and/or EP journalist to float such an idea of AF ablation = Placebo, and any such person is certainly entitled to his/her view and is free to express them as well. But as a practicing ablationist it just seems incompatible, if indeed any given EP actually is leaning toward AFIB ablation's effect being due to a Placebo effect. Certainly, if this is how they view the field, they should recuse themselves from performing any more ablations until, and unless, they regain more confidence and reassurance that there is an actual objective benefit to the procedure they are performing on real patients. And at the very least, such an EP must inform every prospective AF ablation patient that they hold such views about their craft and allow these patients the option of seeking ablation help elsewhere.
I sure would not want someone agreeing to doing an AFIB ablation on my heart when they either vocally, or even secretly, lacked confidence that they could fundamentally help me by their work. And not just rely on some 'elaborate placebo' to pull this rabbit of NSR from his or her hat!
And its just one more topic that is a red-herring to begin with, and that I don't have the time to address, but that our EP journalist friend has the uncanny timing to seemingly always drop on us all with such speculative musings that require a response on the forum right when Im trying to finish up an issue of the newsletter :-) :-/!
Glad to hear from you as its been a good while it seems afhound 99!
Shannon
Edited 5 time(s). Last edit at 06/28/2016 02:25PM by Shannon.
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