Doctors like me have performed AF ablation for more than a decade without knowing whether the major procedure improves outcomes. That sounds crazy but it’s true. Until now, the only evidence we had that doing all these burns or freezes in the heart helped people was that it made people feel better than they did […]
Recap of 2017 in Cardiology
Hi all. TheHeart.org | Medscape Cardiology published my picks for the top stories of 2017. Here is the link: Mandrola’s Top 10 Cardiology Stories of 2017 I called it the year of the medical reversal. Medical reversals occur when a superior study contradicts current practice. I love medical reversals. First, they make you think about history. […]
A Corrosive Force in Medical Care
It comes in a large white envelope each month. It’s marked confidential. When I hold it up to the light, I can see through the envelope. I can’t see the details, but the colored graphs give it away. It’s my monthly productivity report. Most employed doctors get these graphs. These “dashboards” of value include your […]
2017 European Heart Rhythm Meeting Update
I attended the European Heart Rhythm Association meeting last week in Vienna. Here is an update on the stories I found most interesting–the ones I wrote about on the heart.org | Medscape Cardiology. Brain Lesions after AF ablation: Electrophysiologists do not talk much about the small brain lesions that appear after procedures in the left […]
AF Ablation is Overused in the US
A colleague recently asked me if atrial fibrillation (AF) ablation was overused. Yes it is. AF ablation has become the wild west of electrophysiology. There is essentially no scrutiny of this invasive, expensive and risky procedure. I also include here the add-on “maze-like” procedures done during heart surgery for other conditions. I believe they too […]
Are women with AF being under-treated with ablation?
This post is an introduction to commentary I made recently over at theHeart.org on Medscape. Gender features in the discussion, but there are lessons for men and women with AF. *** A large study from a group of Stanford researchers made three big observations on AF ablation: Women, compared with men, presented for first AF […]
AF ablation still has a role
I have been seeing a new trend in the AF clinic. I never thought this would happen, but I’d estimate that at least once daily, often multiple times daily, a patient says they have read this blog before the visit. That is nice. Many of these patients, some who have traveled across the country, or […]
On PVCs, think anew but think slowly
Premature ventricular complexes (PVCs) remain a common and vexing problem in cardiology. PVCs deserve attention because they often induce fear in both patient and doctor. In US healthcare, fear is bad. Fear sets the stage for over-treatment. The approach to the funny-looking beats has not changed much in the last two decades. That may be […]
Writing update: Lown Institute Conference and ACC2015
Hi all, I have been busy in the last few weeks. Here is an update of my happenings and posts. From March 8-11, I attended and presented at the third annual Lown Institute Conference in San Diego. I have never felt more at home in a conference than I did at the Lown conference. Take […]
New post up on Cardiology Medscape: Lessons learned from the failure of Renal denervation for high blood pressure
Most people come by it honestly. They eat too much, move too little, skimp on sleep, take on too much stress and then succumb to buying larger clothes. The word we use in medicine is insidious. High blood pressure (hypertension – HTN) is one of the leading cardiovascular problems of this time. Some have called […]
Recap of 2013 American Heart Association Session
Just a few weeks before the 2013 American Heart Association Sessions, Shelley Wood, the managing news editor of theheart.org emailed to ask if I was up for going to the meeting. With trips to San Francisco, Denver, Athens and Amsterdam already in the books this year, I had counted 2013 as a win. I was […]
Recent Comments