On Baltimore:
Human beings rioting in the streets of an American city forced cancellation of an important cardiology meeting. This is a vivid example that doctors do not practice in a vacuum. We are connected to this world. Here in Louisville, just a few miles north, an HIV crisis runs amok because of IV drug use. Despair. Inequality. These are no small things. What bothers me most about our healthcare system is the waste. We burn money. If we stopped doing that, we would have more to do for the less fortunate. I make a call out to every day physicians to stop burning money. Medicine Can’t Ignore Baltimore and Ferguson.
On a failure of a safety method in AF ablation:
The most devastating complication of AF ablation is damage to the esophagus. Thermal lesions can lead to a connection (a fistula) between the esophagus and the left atrium. This–thankfully rare–event leads to death in the great majority of people. Most doctors take evasive action to protect the esophagus. One maneuver is to monitor temperature in the esophagus. The idea is that if a burn in the heart causes a rise in temp in the nearby esophagus, the operator stops burning and damage is avoided. Sounds good, right? Except a new study from Germany suggests the act of temperature monitoring associated with dramatic increases in thermal lesions. AF Ablation: Esophageal Monitoring Harmful or Helpful?
Podcast for May 1, 2015:
This 12-minute video podcast includes my comments on Baltimore, outcomes in LVADs, gene-therapy for heart failure, statins for all elders, and an FDA alert on hand sanitizers. May 1 Cardiology News Podcast
Podcast for April 24, 2015:
This 11-minute video podcast includes my comments on a consensus statement from AHA on the treatment of adults with congenital heart disease, safety of sports in youngsters with Long QT syndrome, the vital importance of treating sleep apnea in patients with AF, the cardiovascular risk of divorce, and the Dr. Oz controversy. April 24 Cardiology News Podcast
Mention in the Houston Chronicle:
Markian Hawryluk is an accomplished healthcare journalist who contacted me for my thoughts on the Watchman, a device used to occlude the left atrial appendage in patients with AF. It was a long slog through the FDA process but Watchman finally made it. I am worried about where this chapter in cardiology is headed. You can read my quotes here: New device effective in preventing blood clots, but experts fear overuse, high costs. I will surely have more to say about this focal solution for a systemic problem in the months to come. My stance has changed little since I wrote Eight Reasons to Remain Doubtful on Watchman in 2013.
Personal Note:
I am currently on a Mark Twain kick. My recent reads include, The Handmaid’s Tale (Margaret Atwood), Hitch-22, (Christopher Hitchens’ memoir), The Sun Also Rises (E Hemingway), The Human Stain (Philip Roth), Writing Tools and How to Write Short (Roy Peter Clark).
I am back to running and mountain biking. I like both–for lots of reason. One is that they keep my legs sufficiently tired so that I am less likely to succumb to criterium thoughts. It is that season. And crits are so beautiful.
JMM
2 replies on “Update: Baltimore, Safety in AF ablation, Podcasts, and some personal notes”
Concerning the LAA, the advisability of its ligation or occlusion, and its role in fostering AF.
I asked Dr Lakkireddy this question about the LAA in jafib.com :
“Dr Lakkireddy, I understand that many patients have the LAA as the origin of their arrhythmia. There are surgeries and devices to effectively remove the LAA. But it serves various functions. Why not ablate around its entrance as you do around the pulmonary veins, preserving its capacity to maintain compliance and produce peptide? This would serve the aging active athlete better than elimination, yes?”
Dr Lakkireddy’s response – 4/18/2015:
“In paroxysmal AF patients LAA seems to play a much bigger role in arrhythmogenesis. Ablating around the LAA from inside seems to be appealing – there are technical and anatomical difficulties in getting the job done. Complete electrical isolation of the LAA is very difficult and oftentimes they reconnect much faster. When it is isolated it loses its contractile function – despite rhythm control there will be a significant stasis of blood resulting in the clots and higher risk of stroke. Oftentimes the area around the LAA ostium is paper thin and has pits that can lead to a perforation and major complications. So removing it either by ligating or clipping it eliminates the arrhythmic source also reduces the effective LA volume and we believe also results in the alteration of the sympathetic systems to result in better AF control. In most of the people the other parts of the heart and body compensate for the acute loss of atrial natriuretic peptide. So that is not something we should worry about.”
A glimpse of what can’t be done and what might be done, and a revelation of our limited means.
Have the 5 Box TTM done then you will not have to worry about this side effect and you will be A-Fib free like me!