December 24th, 2011 by John Mandrola, M.D. in Opinion
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You may have heard that AF is a tough disease to understand. Questions far outnumber answers.
What causes AF?
Why do some not feel it at all, while others are incapacitated?
What’s the best treatment? Drugs? Ablation? Surgery? No treatment?
Should I take a blood thinner…and which one?
Where should one go for the best AF care?
This short email from a reader captures the essence of AF support group mayhem: Read more »
*This blog post was originally published at Dr John M*
August 12th, 2011 by M. Brian Fennerty, M.D. in Opinion
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The first cases of Barrett esophagus (BE) ablation in the late 1980s used YAG and Argon laser. Since then, a myriad of ablation techniques have been described, including multipolar electrocautery (MPEC), argon plasma coagulation (APC), cryotherapy, radiofrequency ablation (RFA), and endoscopic mucosal resection (EMR). Each technique has had its advocates, and some of the techniques appear to have certain advantages in certain types of BE: e.g., long segment, nodular, etc.
Most cases of BE are short segment, and most neoplastic cases do not have nodules or erosions. So the question I would like to see discussed is: In a patient with 1–2 cm of otherwise featureless flat but neoplastic BE:
What ablation technique would you use, and what do you feel makes this technique advantageous? Read more »
*This blog post was originally published at Gut Check on Gastroenterology*
July 10th, 2011 by John Mandrola, M.D. in True Stories
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The staff was concerned that she came to the office without her interpreter.
How would we communicate? How would I assess her symptoms?
“Should we get a translator from the hospital?” they asked.
I knew this patient well. I had done battle with rogue circuits in her left atrium more than once. I could even remember the fractions of the fractionated potentials–the squiggles of the squiggly line. I could recall my body’s joyous sensations when burning that precarious ridge of heart muscle steadied her heart’s rhythm.
“Got it,” we say.
Or Read more »
*This blog post was originally published at Dr John M*
May 29th, 2011 by John Mandrola, M.D. in Opinion
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I have been in Hamburg, Germany for the past five days. I enjoyed an amazing opportunity to visit one of the world’s most respected heart rhythm labs. Among other things, the main purpose was to learn a new way to ablate atrial fibrillation.
It was an incredible learning experience, one for which I owe an enormous debt of gratitude to the kind and generous people of Dr Karl-Heinz Kuck’s EP lab. Though these people are famous, they treated me as a respected colleague.
Details of all that I learned regarding this newly-approved ablation technique is a matter for future posts. Suffice it to say, I already feel like a better AF doctor.
For now, may I highlight a few of the more striking differences between Europe and the States, as noted by a Kentuckian on his first trip across the Atlantic? Read more »
*This blog post was originally published at Dr John M*
May 6th, 2011 by John Mandrola, M.D. in Health Tips
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The number of emails that come from fellow cyclists (and endurance athletes) with heart rhythm issues amazes me. I am more convinced than ever that our “hobby” predisposes us to electrical issues like atrial fibrillation (AF)—that the science is right.
Obviously, my pedaling “habit” creates an exposure bias. I hear from many of you because we cyclists understand each other. Like you, I consider not competing a lousy treatment option.
As a bike racer, I know things: that prancing on an elliptical trainer at a health club doesn’t cut it, and, that spin classes may look hard, but do not come close to simulating real competition. I know the extent of the inflammation required to close that gap, to avoid getting dropped when one of the local Cancellara-types have you in the gutter in a cross-wind, or the worst one of all, to turn yourself inside out to stay with a group of climbers over the crest of a seemingly endless hill—”ten more pedal strokes and I’m out”…Then ten turns to 20, then 40, and maybe you hang, and maybe not. The common denominator of all this: suffering.
It’s little wonder that we get AF.
With that as a backdrop, my goal for this post is to provide a modest amount of insight to the most common question asked by athletes with AF.
“Should I have an ablation, or not.”
Though my two episodes of heart chaos amount to only a mild case of AF, I think it’s fair to say that personal experience with a problem helps a doctor better understand your choice. I’ve thought to myself, on more than one occasion, what would I do if the watt-sucking irregularity persisted? Would I have an ablation; would I live with it; would I stop drinking so much coffee? Read more »
*This blog post was originally published at Dr John M*
