Categories
Atrial fibrillation Dabigatran/Rivaroxaban/Apixaban Doctoring General Cardiology General Medicine

Should You Take an Anticoagulant for AF? — Applying the 4 questions

Yesterday I posted the four most important questions to ask your doctor. Let’s apply those questions to a typical scenario: Whether or not to take an anticoagulant drug for prevention of stroke in the presence of AF. We need a typical patient. For this example we will pick a typical CHADS-VASC 2 patient. 65 year-old […]

Categories
AF ablation Atrial fibrillation Doctoring General Medicine Healthy Living Knowledge

Four Crucial Questions To Ask Your Doctor

I am seeing an increasing number of patients who did not know they had a choice about taking a medicine or having a procedure. Why did you have that heart cath? A: My doctor said I should. Why are you on that medicine? A: My doctor prescribed it. It’s time we re-review the basic four […]

Categories
Atrial fibrillation

Fake Atrial Fibrillation — A Growing Patient-Safety Issue

Fake atrial fibrillation (AF) is a growing problem. This is when the computer-reading on an ECG calls the rhythm AF, but it is not AF. When the doctor does not recognize the faulty read, the patient is misdiagnosed. Here are three pictures from the last month. (I have a stack of these.) Notice the computer-read […]

Categories
AF ablation Atrial fibrillation Dabigatran/Rivaroxaban/Apixaban General Cardiology General Medicine

Top-ten 2017 Update on Atrial Fibrillation News

I recently served on the faculty of the tenth annual Western AF Symposium in Park City, Utah. Dr. Nassir Marrouche of the University of Utah has grown Western AF into a huge gathering of global experts in atrial fibrillation. During the intense two-day meeting, I took notes and put together a post of top-ten highlights. […]

Categories
Atrial fibrillation Dabigatran/Rivaroxaban/Apixaban Doctoring

My latest on the NOAC drugs for AFib

Three weeks ago I wrote about the growing dominance of the new oral anticoagulant (NOAC) drugs for stroke prevention in patients with atrial fibrillation. (Another common name for these drugs is direct acting oral anticoagulants or DOACs.) The post generated many comments–some privately and some on the blog. Your responses induced me to think a […]

Categories
Atrial fibrillation Dabigatran/Rivaroxaban/Apixaban Doctoring

2017 update on the changing use of “blood thinners” for AF

Times have changed in the treatment of patients with atrial fibrillation (AF). First some background: The first of the four pillars of AF care is stroke prevention. The only proven means to protect patients with AF from stroke is use of drugs that block clotting factors–or anticoagulants. Some people call these drugs blood thinners. I […]

Categories
AF ablation Atrial fibrillation Dabigatran/Rivaroxaban/Apixaban General Cardiology

Say No to Watchman

Cardiology is on the brink of making a big mistake. We have embraced a new procedure called left atrial appendage occlusion. You may be seeing the ads for a device called Watchman. Like this one> The appendage-closure idea was a good one: during atrial fibrillation (AF), blood can pool in the left atrial appendage, and […]

Categories
AF ablation Atrial fibrillation General Ablation Healthy Living

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 […]

Categories
Atrial fibrillation Doctoring Knowledge Reflection

Politics and Understanding the Human Condition

I recently received this message: This is not the first time I’ve been scolded for straying from medical topics. Last October, during the Lown Institute’s RightCare Action Week, I wrote about our ailing healthcare system. This prompted a different reader to send a similar message: Stick with topics about atrial fibrillation–went the gist of that […]

Categories
AF ablation Atrial fibrillation Doctoring General Medicine Health Care

Should AF ablation require approval from a heart team?

A patient presents with atrial fibrillation (AF) and a rapid rate. He doesn’t know he is in AF; all he knows is that he is short of breath and weak. The doctors do the normal stuff. He is treated with drugs to slow the rate and undergoes cardioversion. During the hospital stay, he receives a […]

Categories
AF ablation Atrial fibrillation Doctoring General Cardiology Health Care Knowledge

Is AF ablation a big placebo?

Turkish authors boldly raised this question in a recent editorial. They likened AF ablation to renal denervation, a procedure in which RF ablation in the kidneys was felt to reduce BP. Many studies showed kidney ablation markedly lowered BP. Then a trial was done with a sham control (people got part of the procedure but […]