To Ablate or Not to Ablate – That is the Question  - Dr. Carolyn Dean MD ND

To Ablate or Not to Ablate – That is the Question 

June 27, 2018

Dr. Mandrola, a cardiac electrophysiologist who I cited in my blog “Could Ablation for AFib Be An Elaborate Placebo?” interviews a colleague, Dr. Gupta, in an article titled “What Is the Role of Ablation for AF in a Post-CABANA World?” about a new ablation study. This study was presented at the Heart Rhythm Society meeting in Boston. Ironically it was the Heart Rhythm Society that presented me with “The Arrhythmia Alliance Outstanding Medical Contribution to Cardiac Rhythm Management Services Award 2012.” My contribution is educating people about the clinical significance of magnesium in heart rhythm management.

Unfortunately, there are no magnesium reps that go to doctor’s offices to give them samples or educate them in the application of magnesium so it continues to be ignored. However, it really should be acknowledged since the recent study on cardiac ablation has failed to show that it’s an improvement on drug therapy.

The CABANA trial was long awaited, so much so that Dr. Gupta said “More than half of my practicing life has been spent waiting for the CABANA results.” It was an ablation-versus-drug trial and Gupta said it was important because ablation of atrial fibrillation is big business with hundreds of thousands of procedures done every year and growing exponentially.”

Mandrola said “The question that CABANA was trying to answer is whether AF ablation improves outcomes in patients with atrial fibrillation” compared to drugs. According to Gupta “this trial needed to be done, because nowadays we are being referred patients who are less symptomatic than they used to be 5 or 10 years ago, because of the belief that we’re making a difference to hard outcomes even though that had never really been studied.”

The results showed that “The primary endpoint was a composite of mortality, disabling stroke, major bleeding, and cardiac arrest. There was no difference with ablation versus drugs.” Mandrola said he would no longer be offering ablation to asymptomatic AFib patients. But Dr. Gupta said that the doctors who are believers in ablation will continue to do it on every one with AFib and a smaller group would hold back treatment of asymptomatic patients.

Dr. Gupta mentioned that “a lot of people believe that there’s a very strong placebo element in the improvement seen with AF ablation. We all know that. We all have patients who come to us thanking us because we have changed their life, and then you look at the ECG and it still shows AF. The fact of the matter is that most cardiovascular interventions will have a very strong placebo element to them, and there is no surprise that that’s true of AF ablation as well. It would be really good if we could design a trial that could tease out that placebo element and then show AF ablation in a truly honest light.”

And so it goes – the doctors who want to do AFib ablation, and probably make more money doing ablations, will continue to do the procedure in spite of this study. And neither the drug proponents or the ablation proponents will look beyond the end of their noses for the root cause, which for some is definitely magnesium deficiency.

I would never say to never get an ablation – for some people it is truly helpful, but I would say that ablation or not, please keep your body saturated with magnesium (ReMag).

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Carolyn Dean MD ND

The Doctor of the Future®

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