Earlier this week, Dr. Nancy Snyderman, of the NBC Today Show, took viewers inside an Electrophysiology Lab to show a live catheter ablation by Dr. Mauricio Arruda.
The atrial fibrillation patient community was excited to see coverage of something related to atrial fibrillation on national TV. However, there was considerable angst in the professional community over showing a procedure that could potentially result in death because such has happened in medical conference live cases.
While that may be a very valid concern at a medical conference, which might inherently be riskier because live cases encompassing newer or more innovative medical techniques are valued, that might be far less of an issue in a fairly-routine catheter ablation. Because the electrophysiologist wasn’t performing a procedure for his peers, he was less likely to choose a risky case.
In fact, these concerns seem overblown considering that no real catheter ablation actually occurred on TV. All we really saw was the mapping to determine where the catheter should be applied when the procedure actually started. Thus, there was no real risk, and I suspect that all of this was thought through thoroughly so as not to incur any risk on TV.
Even if the catheter ablation had actually been shown, considering that catheter ablation is becoming somewhat routine, and the doctor doing the procedure is a highly-experienced practitioner, the odds of a problem would seem relatively small. After all, the overall mortality (death) rate reported by Cappato in the recent Second Worldwide Multicenter Catheter Ablation Survey was approximately 1 in 1,000. That number was a composite from the results of lower- and higher-volume centers as well as less- and more-experienced electrophysiologists. So for a center and a doctor with lots of experience, the odds of death were somewhat small.
There was also much angst over the mindlessness of the reporting, but who was the intended audience? This wasn’t being shown for the benefit of trained medical professionals, especially not EPs, as most were probably busy doing their own procedures by that time. This was an overview for a consumer audience, and it simplified and communicated what that audience might need to know. My hope is that those who look down on the way this was reported won’t also look down on the intended audience for it.
The Real Problem
My biggest concern with the piece, however, was that it was completely positive. Even when asked specifically about the risks, they didn’t answer the question.
Patients considering the procedure need to know that there are risks, too. While the adverse events reported in the second worldwide survey were less than those in the earlier survey, there are still real risks, because any procedure carries risk. Even the manufacturers will tell you that there are risks.
So treating any catheter ablation as totally risk-free—though not overtly stated, it was implied—was the real disservice of this TV segment. However, if it made patients more aware of options for atrial fibrillation treatment, then it succeeded in educating them. Hopefully they will research and learn more about catheter ablation procedures before discussing this with their doctors.
Read the critiques and controversies, which are valid perspectives for EPs and others who treat afib, at:
Disclaimer (2-5-10): StopAfib.org and the Atrial Fibrillation Blog have no financial relationships with the companies related to this TV segment, though we have met people from these companies at various atrial fibrillation-related medical conferences and have spent time asking questions in their exhibitor booths.