Could Ablation for AFib Be an Elaborate Placebo? – Dr. Carolyn Dean MD ND

Could Ablation for AFib Be an Elaborate Placebo?

August 1, 2016

Dr. John Mandrola, a cardiac electrophysiologist, practicing in Louisville KY, has been doing AFib cardiac ablations for 12 years. Back in 2012, he’s all gung ho, writing in his blog about how much easier ablations have gotten with new technologies, and he’s doing more procedures than ever.

Then in 2015 he writes a blog called “A Cautionary Note On AF Ablation”. He’s doing fewer ablations because he says the drugs and/or the ablation fix aren’t working on everyone. He talks about a new way of thinking about AFib, where cardiologists say that it seems to occur as a sign or symptom of something else. He’s surprised that he and his colleagues took so long to figure this out. The factors he lists include obesity, sleep apnea, alcohol, high blood pressure, inflammatory conditions (infections, trauma), excess exercise and stress. He says that, “most experts now agree that each of these conditions, either alone or together, create the milieu in which AF starts and perpetuates.”

Unfortunately, he gives no thought to the fact that, since AFib is an electrical condition, why not look at the electrolytes – especially magnesium? Instead he just says that “The above conditions (with inflammation and excess being the common thread) cause atrial chamber dilation, enlargement of individual atrial cells, loss of atria skeleton, change in cell membrane connections and deposition of scar. In total, we call these effects remodeling, and remodeling favors the development and persistence of AF.” He admits that, “Since embracing this holistic approach to people with AF, I’ve done far fewer ablations and redo ablations.” He concludes, “The take-home message for patients and doctors alike is that AF ablation remains a reasonable option for carefully selected patients. But we should no longer rush to treat a condition caused by scar by creating more scar.”

Then in June 2016, Mandrola gives it all up and posts on Medscape for all to read, “Could Ablation for AFib Be an Elaborate Placebo?” He says that AFib ablation has never been properly tested against placebo and cardiologists are beginning to question the procedure. His concerns seem to have been triggered by a trial of a more invasive ablation procedure to prevent recurrence of AFib. He said that “German authors called the 2-year results after cryoballoon ablation in patients with persistent AF ‘promising.’ How promising? The procedure failed in 22 of the 50 patients (44%). Not only are the results poor, but the procedure is big—ablation lesions in the left atrium, often millimeters away from the esophagus or phrenic nerve, general anesthesia, transseptal puncture, multiple vascular entries, and hours of bed rest put patients at significant risk. Creating scar to treat a disease that is often caused by scar hardly seems elegant.”

Please go to Medscape, become a free member, and read Mandrola’s 1,500 word paper “Could Ablation for AFib Be an Elaborate Placebo?” AFib ablation has only been around for 20 years. Perhaps it’s like many other therapies that have great success in the beginning because of a huge placebo effect and then that effect levels off. Mandrola even says that because AFib drugs have so many side effects “…in a comparison of ablation vs drugs, the ablation procedure could be neutral but look positive relative to drugs.” He asks a tough question, “Is it a stretch to posit that an…antiarrhythmic drug worsens symptoms when it converts intermittent AF to sustained flutter?”

Mandrola ends by saying, “I’ve ablated AF many hundreds of times over the past 12 years. I do fewer AF ablations now. I go slower. Patients and I have long chats about AF; we discuss their symptoms, the reasons for these symptoms, the vast uncertainty of AF and its treatment, and, mostly, the expectations of ablation or no ablation. Could a nurturing, respectful, and optimistic doctor-patient interaction deliver antiarrhythmic effects?”

Dr. Mandrola sounds like he’s ready to hear about ReMag for AFib, but I’m not going to tell him. Back in the early 1990’s, my licensing body came after me because I said bad things about sugar, so I’m sure they would send out a firing squad if I tried to tell doctors that magnesium can help treat AFib. No, I’ll just keep helping those people who do their research and homework and find me and my work.

In my AFib book, Atrial Fibrillation: ReMineralize Your Heart, I outline the 33 triggers for AFib (which are all caused by magnesium deficiency), and offer my treatment recommendations. The book is available Amazon Kindle for $0.99, or you can email Customer Service through our website and ask for a free PDF copy.

Carolyn Dean MD ND

The Doctor of the Future®

RESOURCES: Along the borders and in the links of my web site you can find my books, writings, and my call-in radio show. Email your questions to: questions@drcarolyndeanlive.com.

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