Dr. Mandrola

I found this doctor thru a podcast on something else. (They said in the podcast that they themselves listen to "EP cardiologist Dr. Mandrola" so I perked up my ears. LOL) Anyway here Is his page on afib and ablation. I find it interesting and somewhat balanced. A few articles down on it there is reference to some studies. Anyway I bet half the people already know of him but I found his website and Twitter feed interesting (and I'm not a twitter person..). Use as you wish...

[www.drjohnm.org]

I find both his writings and Dr John Day's interesting, but to be taken with a serious pinch of salt. I particularly dislike all "blame the patient" approachs, and, for me, both are in this league, even if differently.

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Pompon
I find both his writings and Dr John Day's interesting, but to be taken with a serious pinch of salt. I particularly dislike all "blame the patient" approachs, and, for me, both are in this league, even if differently.

interesting.. I will have to re-read with that in mind. I kinda of took it the opposite.. like a partnership. I was just reading an article he wrote on "medical conservatism" that was super interesting. it is a term I have never heard.

Mandrola has made a career out of writing articles based on fear, uncertainty and doubt, and often thin, outdated, and misinterpreted information. He's become a cardiology rabble rouser of sorts. I would not recommend him as a source of information.

And yes, his view of afib is it's all your fault.

Mandrola does spend allot of time online. I have spoken to him a couple times early on and he was very open and approachable. That of course was quite some time ago. He has had his own bout with affib and comes from a very conservative approach focusing on health and lifestyle choices as a first line defense to affib. So at the very least he has personal experience with it as it was most likely due to him being an athlete

I could not say for sure how he would handle a complex case of affib. Nor am I aware if his track record when it comes to ablation. Nor am I here beating the drum for him. Just some perspective.

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rocketritch
Mandrola does spend allot of time online. I have spoken to him a couple times early on and he was very open and approachable. That of course was quite some time ago. He has had his own bout with affib and comes from a very conservative approach focusing on health and lifestyle choices as a first line defense to affib. So at the very least he has personal experience with it as it was most likely due to him being an athlete

I could not say for sure how he would handle a complex case of affib. Nor am I aware if his track record when it comes to ablation. Nor am I here beating the drum for him. Just some perspective.

thanks for piping in. I really do like him for reading material. He's a thinker.. someone who involves his patients. And doesn't go straight to ablation. I respect that. And I think we should all take a hold of our health and healthcare. (I say that while eating a bit of chocolate right now.... but not the whole bar.LOL. I'm enjoying it while in afib because I don't usually eat it when I'm not... ) I reached out to him on twitter but I don't do twitter much so I should probably go see if he responded LOL. I'm sure he isn't for everyone.

I pay some attention to what Mandrola says. I appreciate that he puts his point of view forward, i.e. he publishes on substack and appears on a weekly podcast. I wish there were more EPs and cardiologists speaking out like this. Its good to hear different opinions. I often find his attitude irritating, and his arguments at times seem premature or lacking a sound foundation, but he can make valid points.

Eg. On this week's podcast, i.e. This Week in Cardiology, he discussed two recent studies - one was about whether chronic stress affects the aging process, and another was how two forms of anxiety — neuroticism and worry — affect cardiometabolic (CMS) risk.

He offers his opinion on the stress study: "these results make us think a lot about the non-procedural, non-pharmacologic factors that could help us help our patients. We can’t just tell people to reduce their stress, or change their personalities, but we can recognize the importance of lifestyle, life choices, and coping techniques. This study doesn’t tell us what to do. But it does remind us that health stems from far more than pills and procedures."

And on the anxiety study: "you can’t just tell people to be less anxious or neurotic. But stress and how one handles stress is likely quite relevant to vascular health. Clinicians would do well to not ignore it".

I don't have all that much experience with clinicians, but the cardiologists and the EP I've talked to recently emphasized that as far as they are concerned there is only one path I can follow now that I have presented with symptoms of a-fib and that is to go on sotalol while waiting for an appointment with an EP who will do a catheter ablation.

I have turned them down for the moment. I feel that a root cause of my a-fib is the way I deal with stress and more generally, the way I deal with life. I look on my a-fib episodes as turning points in my life, as a strong signal I need to change. I look on antiarrhythmic drugs and catheter ablation as second line therapies, to be turned to if I can't find my way into remission by reducing risk factors for a-fib, such as stress, exercise, diet, etc. I am also having acupuncture treatments once a week, and I feel they are doing me some good.

I have a bit more confidence now when speaking to clinicians, as I turned down their advice 3 1/2 years ago yet found my way to 3 1/2 years of a-fib free existence.

The advice then was I had no choice but to take amiodarone, and if I couldn't stand the side effects or if the drug did not work, to submit to an ablation. No choice. The cardiologist dismissed my concerns that amiodarone seemed a bit drastic. If I had taken amiodarone and then an ablation, if I then had 3 1/2 years of zero symptoms, they would have been convinced that their therapy was successful. If I then had the two recent a-fib episodes I have experienced, they'd say well let's just do a "touchup" ablation. They'd still be thinking they are the ones I should be listening to.

They aren't so convinced that whatever I did to keep my a-fib in remission had anything to do with my 3 1/2 years of a-fib free life. I am. I took up meditation at the local Zen center and made sure I found 30 minutes to an hour a day, every day, to meditate. By doing this I learned about how my mind works, and that experience helped with all aspects of my life, especially with how to deal with stressful situations. I could also find a place of deep relaxation while meditating, which gave me a hour or so of freedom from the lifetime high stress I was experiencing at that time.

So when Mandrola writes "stress and how one handles stress is likely quite relevant to vascular health. Clinicians would do well to not ignore it", or "This study doesn’t tell us what to do. But it does remind us that health stems from far more than pills and procedures", I agree.

I have yet to listen to a podcast but will make a point to listen to that one. I have a 21 yo with autism. Stress is here- a lot. I can't change the circumstances. I have also had 5 open heart surgeries.. I obviously can't change that. I would venture mine is a combo. I have done the drugs.. I have an ablation scheduled.. and I have also tried lifestyle as I can. But I like what you were saying in the quotes-- about how you can't just say "stress less." LOL. I do have a functional cardiologist (Joel Kahn) who is trying to help me with what I can be helped with. I am blessed to have doctors that take into account my desires. I am not 100% sold I will have this ablation but I am in constant afib now.. seems like I have to give it a go. still I wish there were more like Dr. Mandrola that say "try XYZ first.." I have kind of done that on my own.

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David_L


So when Mandrola writes "stress and how one handles stress is likely quite relevant to vascular health. Clinicians would do well to not ignore it", or "This study doesn’t tell us what to do. But it does remind us that health stems from far more than pills and procedures", I agree.

David, thanks for sharing your experience 👍

He’s easy to find with simple Google searches on a-fib. That’s how I found him. After years of my own experience and reading his posts, I’m not really impressed to be honest. He does have the honor of being rebutted in a published medical journal by a non-MD, though. That’s something.

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wolHe does have the honor of being rebutted in a published medical journal by a non-MD, though. That’s something.[/quote

LOL!

I sure wish this site had a "like button"