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.
My cardiologist just switched me from Metoprolol to Sotalol 80 mg twice daily. FYI. This is a combo of Beta blocker and anti-arythmic drugs. In addition to my hypertension I have an episode of A-fib every 6 to 10 days that doesn’t convert to NSR without a single dose of 600mg of propafenone. After searching the web for detailed info on Sotalol I am very nervous about switching.
Most of the literature on the web states that this med should be initiated while in the hospital for up to 3 days for close monitoring. My doctor did not mention the need for a hospital stay. Can You give me some advice about this??
I would like to communicate with some people who are actually on this drug before I switch from metoprolol to sotalol.
Nat
210-492-1733.
cell 210-865-1733
Nat, I can understand the concern with a change of medication, I’ve taken 80mg sotalol 2pd for the last 6yrs
also have pacemaker. the sotalol is to slow the heart rate
pacemaker to control heart rate. I have Afib which can last for 24 hrs but since my cardiologist put me on coversyl 2.5mg (blood pressure tablet} the Afib has really eased.
My G.P. told me that was the aim for being placed on coversyl 2.5. {Hope this can help.} Seth.
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I have been living with a-fib for quite some time. I am in the healthcare field myself as a cardiovascular technologist (echocardiographer). I have had three a-fib cardioversions since 2001. The first one lasted about a year, and nothing was done for a long time to correct it. This was because I am asymptomatic. I had another cardioversion back in May 2009, which lasted 6 months, and still another cardioversion back in January 2010, which lasted a little over a month. My doctor at this point has decided that an ablation was the way to go. I am meeting with a surgeon in a couple of days, because they have to use a different procedure on me. I was born with Atrial Septal Defect, a congenital heart defect, in which the hole in the fetal heart does not close completely after birth. That was corrected in 1972, when I was 4 years old. I was told that they are going to have to go trans xyphoidally to perform the procedure, which is a bit more invasive than the normal ablation. The end result is the same, no more a-fib. Will see what happens.
No real risk? A mapping catheter is a dangerous instrument: htp://adventuresincardiology.com/
Dan,
I mentioned that the “doctor doing the procedure is a highly-experienced practitioner”. I also mentioned the Second Worldwide Catheter Ablation Survey – the survey found that the most experienced practitioners and centers had success rates that were higher and risks/complications that were lower.
So in the hands of an experienced practitioner, there is less risk from the mapping catheter or any other part of the procedure. But in the hands of a trainee or inexperienced practitioner, there certainly can be risk in any part of the procedure. That’s why members of the afib community encourage each other to find the most experienced practitioners.
The situation you and Pam experienced is unusual. I hope others learn from it, which I believe is one of the reasons you’ve written extensively about it. My heart goes out to you both.
Mellanie
Hello Again,
I am not a satisfied customer of a pulmonary vein ablation. Prior to the procedure I was in and out of A-fib about twice a week. I would take 600mg dose of propafenone and convert to NSR within 20-24 hours. MY EPS doc put me on Sotolol and I was still getting the episodes. My insurance company approved the ablation and I had it done in March of 2010. I was a-fib free for about 2 months. then I had 3 episodes about 6 weeks apart. I was and still am on Sotolol 160mg twice daily and they keep coming. Each episode lasted about 20 hours. My episodes are now about 2 weeks apart and clearly getting closer together. Any suggestions for topics that I can discuss with my Doctor??
Nat,
I’m so sorry that the PV ablation procedure was a problem. Are your doctors sure that your problem is still afib, or could it be atrial flutter? (They would probably have you wear a monitor for a few days or more to determine what rhythm it is.) Flutter is sometimes a by-product of ablation, but is usually easily fixed with a simple flutter ablation. Good luck.
Mellanie