AF ablation Atrial fibrillation

Misleading information in AF-ablation

True or False: Local TV “health reporting” is a reliable source of medical information?

Let me tell you a story, as a hint.

Just when one thinks mainstream media cannot sink much lower, we witness this fantastically misleading and sophomoric reporting, on the complex treatment options for atrial fibrillation.  Their moniker says that they are “working for you.”  We shall see.

Patients with AF have symptoms, lots of symptoms. They want help, more than just pills—which are only partially effective or have troublesome side effects. They want a “fix,” and so, they want to believe. This vulnerability is why overly-hyped and non-researched “medical reporting” is so troublesome.

The topic of the piece is the so-called “Convergent Procedure.” It is a combined epicardial (from 3 abdominal incisions) and endocardial (typical ablation) ablative approach to the atrium. Never heard of this procedure before?  Well, perhaps this is because there are no major studies published in any reputable medical journals. Or, it may be because you don’t follow the twitter feed of the “Techno-College Programme at the European Association of Cardiac Thoracic Surgeons.” No, I am not making this up.  It seems Professor Gersak, from Ljubijana, Slovenia is convinced that this procedure is the answer to AF therapy.

In America, the hub of the Convergent procedure appears to be the golf-resort town of Pinehurst NC, at the FirstHealth of the Carolinas Arrhythmia Center. (Lo and behold, they indeed have a foundation.)  And, as it turns out, many of the news reports on the Convergent procedure list as their source, nContact Surgical Inc—the makers of the tools for the epicardial portion of the procedure. It gets better: nContact Surgical is only 73 miles from the Pinehurst, NC Hospital in which the Convergent procedure is featured. There is even a professionally done website.

Enough background, let’s get back to the story.

The numerous falsehoods that our friendly anchorwoman, Ms Lori Lyle, purport in her piece are listed here:

  • She says that the Convergent Procedure’s “little” incision is much smaller than the typical heart surgery approach.  False, and misleading. Outside of St. Louis, AF therapy has never been conventionally approached with a median sternotomy. Coronary bypass surgery has, but AF therapy has never involved any incision at all.
  • She also says catheter ablation of AF is often associated with unsuccessful outcomes. Which journal is this from? False again. Catheter ablation of AF approaches 80-90% success rates.
  • She says the new procedure is easier, and just as thorough. Really?  This easy approach takes the so-called experts in Pinehurst, NC up to 5-6 hours. It takes three incisions in the abdomen, a chest drain, plus the usual ablation catheters in the groin. The patient stays in the hospital 2-3 days, not just overnight like typical AF ablation patients. A typical AF ablation in a non-dabbler’s hands takes no more than 4 hours—usually around 2-3 hours. 
  • She reports that the Convergent Procedure success rates are 80%. But she doesn’t report their source. Well, I watched the guru’s-from-NC video link. They indeed report an 80% success rate—on a total of 13 patients, only 5 of which have more than 6 months follow-up. It would have taken her less than 20 words to tell us how many patients our local doctors have done.  (Heck, a simple cardioversion works in more than a few patients over just a few months.)

And the errors of omission:

  • There were no comments on the procedure’s potential (or actual) complications. 
  • The new procedure is supposed to work best for patient’s with longstanding or permanent AF, but there was no mention that patients’ with years of AF often have much more pressing clinical problems than their irregular heart beat.
  • Innovative procedures should improve on a current approach, be it more effective, faster, less risky or preferably all-of-the-above.  But in the Convergent procedure, the surgical portion–which accomplishes pulmonary vein isolation–is, in fact, the easiest component of a typical catheter-based AF-ablation to accomplish.  In the Convergent procedure, the surgeon leaves the ablationist with the mitral Isthmus line, and the CS line–two much more vexing areas to achieve successful ablation. Basically, the surgical portion of the procedure does what a skilled AF-ablationist finds to be straightforward. 

Let it be known that I am not opposed to surgical approaches to AF and have occasionally referred selected cases for AF surgery. I also realize TV spots are not the NEJM. However, this story’s gross misrepresentation of facts, its lack of even the most basic research, and its failure to point out the untested nature of this invasive surgery is breathtakingly irresponsible.

Enough said, the original answer is false…obviously.


Disclaimer: I work primarily at a competing hospital, and I do AF ablation the typical way. The way it is described in peer-reviewed medical literature. Also, I declare that I am not opposed to innovative medical procedures.  

3 replies on “Misleading information in AF-ablation”

I am not surprised that surgeons want to jump on to the AF bandwagon; after all, a number of them are looking for work in this PCI era. I am more surprised that 2 electrophysiologists are involved in that group. Surely, you can deliver the entire lesion set endicardially anyway, especially if you have GA, Carto 3 and 4-5 hours. (Unless they too are 'AF dabblers' and their own results are not up to scratch')….
Two halves do make a whole, after all!

The endocardial ablation procedure is the emperor's new clothes. The cure rates do not approach anything even close to 80% even in a paroxysmal patient. The only circumstance in which these results can be validated is in an approach that does not involve outpatient telemetry monitoring.

The new machismo in the EP world is talk about how fast or how successful you are with your AF ablations, and if anyone dares say that they are unable to reproduce those results, there is the invariable reply of (to paraphrase), "you are an AF dabbler." Sounds like a familiar fable.

Furthermore, the peer reviewed literature is short on hard outcomes, and achieves significance mostly based upon subjective measures.

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