Is AF ablation a big placebo?

Turkish authors boldly raised this question in a recent editorial. They likened AF ablation to renal denervation, a procedure in which RF ablation in the kidneys was felt to reduce BP. Many studies showed kidney ablation markedly lowered BP. Then a trial was done with a sham control (people got part of the procedure but did not have burns to the kidneys) and there was no difference. Does AF ablation work the same way? Is it a big placebo? In over 5000 reports of AF ablation in the medical literature, not one is a true sham-controlled study. People will argue AF ablation works; there are recordings before and after ablation (I have such tracings). Then there are these scenarios: A patient has incapacitating AF. Then he has an ablation. He feels much better. At follow-up three months later, he thanks me for giving him his life back. But…sit down for this… he’s in AF by the ECG. People will say a sham control study of AF ablation is unethical because of harm. Well, think of the thousands (perhaps millions) of patients who would have had their kidney’s ablated if not for a proper trial. Another example of placebo effect comes in using pacemakers for vasovagal syncope (fainting). The first study of pacemaker versus drug in vagal syncope showed pacemakers worked, but the second study in which pacemakers were used as a sham (either on or off), found no difference. There’s also never been a sham-control study of stents for the relief of angina. Gulp. We ...
Source: Dr John M - Category: Cardiology Authors: Source Type: blogs