A flawed study with positive results has sparked enthusiasm for implantation of left atrial appendage devices during AF ablation. it is a potential disaster.
As the Past Physician President of Austin Heart -the key is Austin-I can bet that I am absolutely living in the Afib ablation center of the world. Without a doubt if you need an ablation my local colleagues have done more per doc than anyone. (As an aside watching retired interventional docs succumb to malignancy I worry about them ).. That said they are all universally very articulate and aware of all the nuances of all the relevant studies. The local cardiology community is also aware and there will be pushback as 100% of patients are sent back to general cardiology post ablation.
On the downside I have heard similar grumblings about over use of mitral clips, TAVR etc as the skill of the docs have made most every patient a candidate.
I have told my colleagues to be cognizant of the "triumph of technology of reason" and the slippery slope that it creates.
Patients and families value action and dying in the battle , vs inaction and death years later because they discount the real morbidity of procedures. Doing "something" makes everyone "feel" better except the patient. I have had this exact conversation so many times but sadly its the seldom present guilt ridden out of town son, daughter who forces the issue ....
I'm sad to bring up COVID again though it seems like this lesson rings true for the pandemic as well. Explains why the masks and vaccines and everything, whether helpful or not, were clung to so severely.
One can argue about their effectiveness, for sure, but what seems clear more than anything is the degree to which people projected their own hope and insecurity onto those objects.
John-,the current EP MDs have evolved into proceduralists that focus on number of procedures and RVU generation. I agree with you that with this current study many more LAA devices will be employed. The corporate hiearchy is in full support.!Talk to Elon Musk and DOGE and make them aware-,that may be the only solution as ACC, HRS and AHA are controlled by device companies and pharma
I have been following your work on LAAC/Watchman for many years, ever since my dad got a Watchman implanted in around 2018. I applaud you for continuing to beat this drum.
A couple musings: To me it feels like there is the world of Sensible Medicine and Stop and Think, where doctors are carefully considering the outcomes and implications of these procedures, and then there is Everywhere Else in America, where doctors tell patients about this neato new device that will mean no more anticoagulants and the next thing you know, it's another Watchman in another parent (brother, sister, etc.). Most people, (particularly members of my parent's pre-boomer generation that have been conditioned to do so), are going to just "do what the doctor says."
Maybe your efforts here will attenuate the potential disaster.
He seems to be doing fine, 6ish years on, though he's generally healthy and has always been strong. He was told it was a good substitute for taking anticoagulants so I believe he feels it was worth it...I don't agree, but it wasn't my decision so I keep that to myself.
John, I'm curious why you think this is happening. Is it essentially just companies pushing products with not enough people concerned with something else other than profit able to hold them back?
Had my first watchman patient (that I’m aware of) have a stroke a couple weeks ago. Showered his cerebellum. TEE showed a big clot hanging off the watchman, just blowing in the breeze. Now on seizure medication and can’t drive. I immediately heard John’s voice say, “Told you so.” I’m a sold-out internist for practicing sensible medicine. I’m fully on board. Load up, y’all…we ride at dawn.
A Fib is mostly iatrogenic. And the “cure” is further procedures. Of course.
Most A Fib is caused by high rT3, high T4, and low T3. Many times, patients are prescribed T4 only and that is incredibly irresponsible.
A Fib resolves itself with fixing through administering natural T3 thyroid.
I’ve posted on this for months, but nobody ever comments. It is so typical. Doctors just are so rigidly trained not to be actual scientists and to read the literature. It’s sad.
The incidence of sinus tachycardia and ventricular arrhythmias were similar between groups. Triiodothyronine-treated patients had a lower incidence of atrial fibrillation (24% versus 46%; p = 0.009), and fewer required cardioversion (0 versus 6; p = 0.012) or anticoagulation (2 versus 10; p = 0.013) during hospitalization. Six patients in the T3 group versus 16 in the placebo group required antiarrhythmic therapy at discharge (p = 0.019).
In a group of elderly patients undergoing cardiac surgery, there was a strong association between a postoperative decrease of serum triiodothyronine levels and atrial fibrillation.
This is another example of the American healthcare industry that has allowed the incentives of all involved parties (apart from patients) to align perfectly. And it starts with the “regulatory” (in name only) agencies that have breached their fiduciary duties.
I don’t fault the device makers. They are doing exactly what you would expect them to do. But everyone else involved (many of whom are cardiologists) share in the blame.
As the Past Physician President of Austin Heart -the key is Austin-I can bet that I am absolutely living in the Afib ablation center of the world. Without a doubt if you need an ablation my local colleagues have done more per doc than anyone. (As an aside watching retired interventional docs succumb to malignancy I worry about them ).. That said they are all universally very articulate and aware of all the nuances of all the relevant studies. The local cardiology community is also aware and there will be pushback as 100% of patients are sent back to general cardiology post ablation.
On the downside I have heard similar grumblings about over use of mitral clips, TAVR etc as the skill of the docs have made most every patient a candidate.
I have told my colleagues to be cognizant of the "triumph of technology of reason" and the slippery slope that it creates.
Patients and families value action and dying in the battle , vs inaction and death years later because they discount the real morbidity of procedures. Doing "something" makes everyone "feel" better except the patient. I have had this exact conversation so many times but sadly its the seldom present guilt ridden out of town son, daughter who forces the issue ....
Great review as always
I'm sad to bring up COVID again though it seems like this lesson rings true for the pandemic as well. Explains why the masks and vaccines and everything, whether helpful or not, were clung to so severely.
One can argue about their effectiveness, for sure, but what seems clear more than anything is the degree to which people projected their own hope and insecurity onto those objects.
John-,the current EP MDs have evolved into proceduralists that focus on number of procedures and RVU generation. I agree with you that with this current study many more LAA devices will be employed. The corporate hiearchy is in full support.!Talk to Elon Musk and DOGE and make them aware-,that may be the only solution as ACC, HRS and AHA are controlled by device companies and pharma
This is why healthcare in the U.S. is unsustainable. Hopefully some changes will be made now.
Keep speaking the truth.
When you have a hammer in your hand, everything looks like a nail (specially if you get rewarded for every nail you smash)
I have been following your work on LAAC/Watchman for many years, ever since my dad got a Watchman implanted in around 2018. I applaud you for continuing to beat this drum.
A couple musings: To me it feels like there is the world of Sensible Medicine and Stop and Think, where doctors are carefully considering the outcomes and implications of these procedures, and then there is Everywhere Else in America, where doctors tell patients about this neato new device that will mean no more anticoagulants and the next thing you know, it's another Watchman in another parent (brother, sister, etc.). Most people, (particularly members of my parent's pre-boomer generation that have been conditioned to do so), are going to just "do what the doctor says."
Maybe your efforts here will attenuate the potential disaster.
I interested to know how your father got along after the Watchman procedure?
He seems to be doing fine, 6ish years on, though he's generally healthy and has always been strong. He was told it was a good substitute for taking anticoagulants so I believe he feels it was worth it...I don't agree, but it wasn't my decision so I keep that to myself.
John, I'm curious why you think this is happening. Is it essentially just companies pushing products with not enough people concerned with something else other than profit able to hold them back?
Thank you, Dr., for having such courage to speak out!
this will continue, WHY? it makes lots of money for everyone, who cares about problems?
To quote a friend of mine, who is a cardiac surgeon -"This is a "triumph of technology over reason" .
OPTION funded by Boston Scientific…who makes that device again?
Thank you for your analysis and insights!
Had my first watchman patient (that I’m aware of) have a stroke a couple weeks ago. Showered his cerebellum. TEE showed a big clot hanging off the watchman, just blowing in the breeze. Now on seizure medication and can’t drive. I immediately heard John’s voice say, “Told you so.” I’m a sold-out internist for practicing sensible medicine. I’m fully on board. Load up, y’all…we ride at dawn.
A Fib is mostly iatrogenic. And the “cure” is further procedures. Of course.
Most A Fib is caused by high rT3, high T4, and low T3. Many times, patients are prescribed T4 only and that is incredibly irresponsible.
A Fib resolves itself with fixing through administering natural T3 thyroid.
I’ve posted on this for months, but nobody ever comments. It is so typical. Doctors just are so rigidly trained not to be actual scientists and to read the literature. It’s sad.
https://www.sciencedirect.com/science/article/abs/pii/0003497596001026
The incidence of sinus tachycardia and ventricular arrhythmias were similar between groups. Triiodothyronine-treated patients had a lower incidence of atrial fibrillation (24% versus 46%; p = 0.009), and fewer required cardioversion (0 versus 6; p = 0.012) or anticoagulation (2 versus 10; p = 0.013) during hospitalization. Six patients in the T3 group versus 16 in the placebo group required antiarrhythmic therapy at discharge (p = 0.019).
https://www.sciencedirect.com/science/article/abs/pii/S1053077005000303
In a group of elderly patients undergoing cardiac surgery, there was a strong association between a postoperative decrease of serum triiodothyronine levels and atrial fibrillation.
https://academic.oup.com/ejcts/article/24/4/487/419294
Low basal fT3 concentration can reliably predict the occurrence of postoperative AF in CABG patients.
This is another example of the American healthcare industry that has allowed the incentives of all involved parties (apart from patients) to align perfectly. And it starts with the “regulatory” (in name only) agencies that have breached their fiduciary duties.
I don’t fault the device makers. They are doing exactly what you would expect them to do. But everyone else involved (many of whom are cardiologists) share in the blame.
Thank you for the excellent appraisal of the study. Excellent job.
LAAC devices like Watchman?
Yes