The challenge of ablating in the human heartâ€¦

Some very sad words from the comments section of a previous post on atrial fibrillation…

Anonymous said,

Is there anyone out there that has hypertrophic cardiomyopathy and was told to have an ablation? Any problems??? My husband of 45years and I believed that his cardio doctor would not put him in harms way by letting an associate/dr. perform this procedure which was nothing short of a disaster.After he came out of surgery dr.said he would be in recovery room for two hours and go home….. We couldn’t even get him up in two hours….. I asked the nurse to get him some jello so I could get something in his stomach when we got him up…. When she helped get him up and I fed him a few spoonfulls he laid his head back on the pillow a few seconds later blood was coming out the sides of his mouth….. The 5 family members ran in the hall to get the nurse, she started phoning doctor,,, He answered page after two hours then told her he would be down in a few minutes …She came back in the room 45 minutes later and sadly told us Dr……. went HOME….. anyhow things got worst….The two hour procedure plus two hour recovery room wound up being six days the doctor never stepped foot in my husbands room all the days he was in that hospital. The day he left that doctors assistant brought in an appointment for 3 months later…. My husband was never the same again….He passed away 5 weeks

Dear Anonymous,

I am very sorry for your loss.

Making many ablation lesions in the left atrium confers significant risk. Your tragedy highlights the dilemma of medical decision making. Indeed, AF ablation is often successful, but there is risk, and complications can be life-altering or life-ending, as your words describe.

We ablators struggle with this balance of information. We have to inform our patients of the risks, and these words of admonishment should be clear. However, patients can be scared out of a potentially curative procedure if presented with a litany of disasters in an un-elegant manner. Herein lies the delicate balance of treating atrial fibrillation –a highly symptomatic, but not immediately life threatening disease –with a potentially life threatening, but mostly safe procedure.

Many years ago, a colleague spoke the words, “AF is not a life threatening disease, don’t make it one.“

Complications occur and I wish they didn’t. When I have them, it changes my life, and my practice of medicine, but one thing for sure; the affected patient will be seeing more, not less, of me afterwards. Paradoxically, some of my most gratified patients are ones who have suffered procedural complications, who as a result of the adverse outcome, garnered much attention from me.

These words of tragedy help us, and I am grateful you wrote them. They help us learn, and this makes us better, both as clinicians and as people.

JMM

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