The Case Against Watchman

Many readers have asked me to update my feelings about Watchman and other percutaneous appendage closure procedures. The short answer is that I remain unconvinced that this is a beneficial procedure. New data has been sparse and unconvincing. I’ve recently started a newsletter on Substack. It’s called Stop and Think. In the latest post, I… Continue reading The Case Against Watchman

Survey for Athletes with AF

Hey Athletes: My colleague, Professor Rachel Lampert, from Yale, along with the patient group, seek to learn more about how atrial fibrillation (AF) and its treatments affect athletic people. If you are an athlete or if you regularly exercise vigorously, please give the Yale researchers a few moments of your time. Here is the… Continue reading Survey for Athletes with AF

Still Negative on Watchman

Many readers have contacted me to ask whether my negative viewson left atrial appendage occlusion with Watchman have changed since 2017.   The short answer is no. My views are even more negative today.  In 2016, I published an editorial on | Medscape Cardiology arguing that this procedure should stop. One of the rebuttals was that… Continue reading Still Negative on Watchman

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… Continue reading AF, Ablation, Stents and Five Nuances

AF Ablation Update 2019

Most years I write an update on any big developments in AF ablation. This year’s version will be a short one. I have little new to report. But it’s worth reviewing some basic issues. We still do not know the cause of atrial fibrillation (AF). That makes it hard to fix with ablation. Knowledge Deficits:… Continue reading AF Ablation Update 2019

Thoughts on the Apple Watch

Apple products are cool. I love them. But (even) Apple will struggle delivering health. Making healthy people healthier is fraught with problems. At the core of this issue are the many snags of screening people for disease. Here are 600 words I wrote for Medium: I’m a Heart Doctor. Here’s Why I’m Wary of the New… Continue reading Thoughts on the Apple Watch

How dangerous are NSAIDs in patients with AF?

One of the most commonly asked questions in the office is the treatment of arthritis pain. This comes up because of the concern over taking NSAIDs (non steroidal anti-inflammatory drugs) in patients who are on anticoagulants (such as warfarin, or dabigatran, rivaroxaban, apixaban). My views on this matter have changed. But first, I want to… Continue reading How dangerous are NSAIDs in patients with AF?

How Hubris Impairs the Care of the Elderly

An elderly man with atrial fibrillation (AF) asks whether to continue taking a clot-blocking drug to prevent stroke. This is the gist of a case my colleague Dr Anish Koka recently posted on Twitter. It’s a great thread. Click here to get to the discussion. The first question Anish raised was whether you would keep… Continue reading How Hubris Impairs the Care of the Elderly

Musings on the CABANA trial — AF ablation vs Drugs

Last week at the Heart Rhythm Society meeting in Boston, Dr. Douglas Packer from the Mayo Clinic presented results of The Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial. I cannot remember a more consequential HRS (Heart Rhythm Society) meeting. Before and after the presentation, CABANA talk dominated conversations amongst colleagues. I wrote… Continue reading Musings on the CABANA trial — AF ablation vs Drugs

Thoughts on CABANA — The biggest study in AF ablation in years

(The CABANA trial is slated for release in two days at the 2018 HRS Meeting. Here is a preview.) Technology has made modern life easier. This is good for lots of things, but not for avoiding atrial fibrillation (AF). As people in Western society grow older, heavier, less physically active, more distracted, and perhaps more… Continue reading Thoughts on CABANA — The biggest study in AF ablation in years

Take-home messages from Western AF 2018

The Western AF symposium may have had corporate sponsors, but it was no boondoggle. The sessions start at 0715 and go through 1830. Your head spins at the end of the conference. I learned a lot. Here are some fast-writing thoughts: New Energy Source for Ablation Electroporation looks to be a promising new energy source… Continue reading Take-home messages from Western AF 2018