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.
VFM says
In the Medscape article Point #4 is that “FIRM ablation is promising.” It’s surprising to me that use of the FIRM ablation method/technology isn’t increasing very quickly, since there is compelling, if preliminary, evidence of its effectiveness. Is there a good reason for its slow uptake?
Thanks.