AF, Ablation, Stents and Five Nuances

Joan has left an excellent comment on my recent 2019 AF ablation update. She brings up many important issues. Let’s dissect it. Q: Joan asks if it is common to see patients who think they are cured after AF ablation but are still in AF?  A: The scenario I described in my previous post is not common, but it is not rare. Since AF ablation entails much instrumentation and many burns, it can affect how the heart feels things. The heart has its own nervous system; yes, the heart feels. Also, the bigger the procedure, the bigger the placebo effect.  Q: If ablation doesn’t work, then I sure know a lot of people walking around who had ablation and are convinced it changed their lives.  A: First, I did not say AF ablation does not work. I wrote that we don’t know; it has not been adequately tested in a placebo-controlled blinded trial.  But let’s consider how ablation might change people’s lives without eliminating AF.  The sites of ablation in the left atrium are close to neural inputs to the heart. It may be that we change how the heart perceives AF simply by instrumenting the heart and ablating in the areas near where the nerves attach to the heart. This statement should induce little surprise because the majority of people who have AF do not know it. All cardiologists have observed a huge disconnect between an actual heart rhythm disorder and its symptoms. A Canadian study called DISCERN AF found that the ratio of asymptomatic to sy...
Source: Dr John M - Category: Cardiology Authors: Source Type: blogs