Dr John M

cardiac electrophysiologist, cyclist, learner

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New post up on Medscape/Cardiology: Ablation versus medicine as an intitial strategy for treating AF

March 25, 2014 By Dr John

Earlier this month I promised to put together teaching points from the Rich Peverley story. His was an interesting case of  sudden collapse that likely occurred as a result of atrial fibrillation therapy rather than atrial fibrillation itself.

This was my original report: Important lessons from the collapse of NHL player Rich Peverley (BTW: It set a blog record for pageviews on a single day.)

This was the follow-up post in which I discuss the fact that atrial fibrillation featured prominently in the mishap: Atrial fibrillation features prominently in Rich Peverley collapse

Mr Peverley and his doctors announced a great deal of details about his treatment. The case presented an opportunity to discuss the complicated decision-making in treating AF, especially the initial approach to rhythm control.

I put together a summary post for the Trials and Fibrillations Blog over at Medscape/Cardiology. The 1800-word post (with references) can be broken down into four parts.

In the first section, I introduce the case, and the three treatment options that all symptomatic AF patients face: 1. Live with the disease, 2. Take a precarious medicine, 3. Undergo an invasive expensive ablation procedure.

In the second section, I review the evidence base comparing ablation v drugs as an initial rhythm-control therapy of AF. There is not much evidence to discuss. And this leads to a great deal of leeway for clinical judgement and shared decision-making–e.g. doctoring.

In the third section, I offer seven thoughts to consider in the approach to the de novo patient with AF. This is the section of the post that regular readers here will recognize. Athletes with AF get special mention. I even find a way to work in a reference to Thoreau.

I conclude by citing a recent editorial on the nature of medical decisions. If nothing else, the link to that editorial, which uses the Moneyball analogy, may be worth your time.

I hope you want to read the piece. The title is: AF Ablation vs Drugs: Lessons From the Rich Peverley Case

JMM

Make note: Medscape/Cardiology, like theheart.org did, requires email registration. Be not afraid.

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Related posts:

  1. New post up at Medscape/Cardiology — Heart Rhythm Society’s Choosing Wisely List is tentative and cursory
  2. New post up at Medscape Cardiology: Are novel anticoagulants better than warfarin?
  3. New post up over at TheHeart.org-Medscape Cardiology — Part 2 of Progress in Cardiology
  4. New post up on theHeart.org/Medscape Cardiology…Where is the progress in Cardiology?

Filed Under: AF ablation, Athletic heart, Doctoring, Exercise, Healthy Living, inflammation

John Mandrola, MD

Welcome, Enjoy, Interact. john-mandrola I am a cardiac electrophysiologist practicing in Louisville KY. I am also a husband to a palliative care doctor, a father, a bike racer, and a regular columnist at theHeart.org | Medscape

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Find me on theheart.org | Medscape Cardiology

  • Electrophysiology commentary on Medscape/Cardiology

Mandrola on Medscape

  • My Medscape column on general medical matters

For patients...Educational posts

  • 13 things to know about Atrial Fibrillation — 2014
  • A new cure of AF
  • Adding a new verb to doctoring: To deprescribe is to do a lot
  • AF ablation — 2015 A Cautionary Note
  • AF Ablation in 2012–An easier journey?
  • Atrial Flutter — 15 facts you may want to know.
  • Benign PVCs: A heart rhythm doctor’s approach.
  • Caution with early Cardioversion
  • Decisions of 2 low-risk cases of PAF
  • Defining success in AF ablation in 2014
  • Four commonly asked questions on AF ablation
  • Inflammation and AF — Get off the gas
  • Ten things to expect after AF ablation
  • The medical decsion as a gamble
  • The most important verb in our health crisis
  • Wellness Requires Ownership

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