Healthcare: The Real World

How effective and safe is this procedure?
Radiofrequency ablation has a success rate of over 90 percent, a low risk of complications and the patient can resume normal activities in a few days. It causes little or no discomfort and is done under mild sedation with local anesthesia. For these reasons, it’s now widely used and is the preferred treatment for many types of rapid heartbeats.

“Here’s a challenge: Pick up a cardiology or electrophysiology journal and show me a negative piece about catheter ablation of atrial fibrillation. It’s true; our world is mostly free of doubters.
“Then there is the real world, one populated with other medical specialties, and those daring enough to ask, “What, exactly, are you ablating?” As it turns out, not all doctors think so highly of the notion of ablating a disease that we do not fully understand.”

“Because ablation has never been studied in a randomized blinded fashion, we cannot know whether patients experience fewer symptoms after ablation because subjective symptoms frequently decrease following a procedure or whether the ablation itself was beneficial. Furthermore, the clinical benefit on survival and morbidity of this invasive procedure, which has substantial procedural risks, remains to be established.”

In a comment accompanying the study, David E. Haines, MD, of Oakland University William Beaumont School of Medicine in Royal Oak, Mich., observed that atrial fibrillation ablation “has offered the promise to free patients of symptoms of palpitations, dyspnea, and fatigue,” and to reduce long-term risks of stroke and death. “These advantages are compelling, and they explain the wide adoption of a procedure that is technically challenging and has results that can be characterized as mediocre at best,” Haines argued. Haines particularly cautioned against the performance of complex procedures such as this in low-volume centers by clinicians with insufficient experience. “As long as a hospital is able to profit from supporting interventional procedures by its physicians, there will be a tendency to set a low bar for granting privileges to any doctor who claims proficiency,” he stated.



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