MedPage: Ablation for Afib Dogged by Complications

April 29, 2013

Action Points

  • This study found that catheter ablation for atrial fibrillation — with its promise of drug-free symptom relief and long-term outcome benefits — thus far has been hindered by high rates of periprocedural complications and a frequent need for rehospitalization.
  • Older age, female sex, prior hospitalization for atrial fibrillation, and recent hospital procedure experience were all associated with a higher risk of complications and/or 30-day readmission after ablation

 

http://www.medpagetoday.com/Cardiology/Arrhythmias/30461


REVIEWS

October 19, 2011

“I am on my SECOND reading of this book. And I will probably have to read it several times to have its sheer magnitude sink in.  It is truly astonishing.”

“It is indeed essential reading… “

Collateral Damage is more than simply a book about statistics and afib and we need to be very clear on this. It is a book about big business, the drug and medical products business, teaching hospitals,  and much, much more… “

“A searing, poignant and cautionary tale. This book has really shaken me. I urge everyone to read it… “

“Thought provoking and very well written… “

“Outstanding and a must read for anyone over 40 or anyone who is contemplating surgery. A real eye opener to say the very least. I am on my third reading…”

“Five Stars. This book is an on-target indictment of  dangerous, unethical, and money-driven factions within our health care industry. Many ill patients receive quality care in America, but far too many are also victims of the dark heart that poisons American healthcare. Read it. It could save your life.”  – Patient Safety America

“It lays bare an example of the issue that lies at the base of our skyrocketing medical costs and our skyrocketing rates of medical harm.  I think it is a bombshell.”

“A gripping narrative… a good read…” – Brad Wright, Wright on Health

“I can tell you one thing for certain, it will give you background to be able to ask some very difficult questions with tact and diplomacy and it will most certainly motivate you to ask the questions that need to be asked… “

“A brilliant expose´ of the current role of industry in rapid technological advance and its need for profit from its efforts. Dan Walter highlights the uncomfortable relationship that industry now has with the medical profession… an eloquent indictment of the health care mess.”

– Brian Todd, Author, The Third Lion

“Riveting…  A fascinating story, and a very important one… “

– UKAPress.com

“It is, simply put, a must read for anyone who truly cares about patients. Pam’s experiences can fill a textbook in what NOT to do from both a medical and nursing standpoint. Thanks for being courageous enough to write about your experience …  As for me, I think that I have learned much by seeing this unique viewpoint.”

- Hypocafeinemia

“A great story,  a must read by all interventional cardiologists and electrophysiologists. This is a real life experience of  a patient who underwent a electrophysiology study and   ablation   procedure for atrial fibrillation. It describes how the procedure became a nightmare. Written in a  most  readable fashionInterventional cardiologists need  not get hurt by this  narration  instead  they should  do a  reality check on the dangers  of  the some  of the  complex  procedures.”

Dr. S. Venkatesan

“I highly recommend this book. It is a well-written study of one person’s experience at the hands of the most exalted research hospital in our country. I am a medical malpractice defense attorney. I read Mr. Walter’s book because I wanted to hear a patient’s viewpoint… Mr. Walter brilliantly tells the story of how one of the foremost teaching/research hospitals in the country practiced on his wife without disclosing that they were doing so. I was riveted, and ultimately ashamed of what is an all too common practice.  I wish that all of the physicians at Johns Hopkins would read it, and realize that their patients are not research rats.”

— Amazon.com Customer Reviews

“This is a high-speed read. The torture this patient endured is vividly told not to mention the heartache – so beautifully described – of both. It is well researched and diligently narrated. As I read it, I can feel a number of emotions ranging from sadness, frustration, fear and then anger. I didn’t know whether to blow a big whistle or just cry. The voice is both clear and compassionate. I love this book.”

–Claire Stibbe, Author, Chasing Pharaohs

“It is very difficult to adequately explain to patients the complexity of this procedure, the uncertainties regarding success and the myriad of complications that can occur. I will recommend this book to every patient considering this procedure from now on.”

“Please do not change your account to ease the feelings of those who consider it inflammatory. The situation deserves an emotional response.”

“Good Writing! Intriguing style.”

“I am a practicing cardiologistwho did electrophysiology training. Your story is honest, true and a very apt and telling description of a horror story.”

“I work at Hopkins and unfortunately have experienced a similar situation. Your voice is important. Thank you for publishing this. We need to look at ourselves and understand if we’re really performing as the BEST hospital. We have a long way to go. Your story needs to be heard by all. Continue publishing.”

“My knees and hands were trembling as I read the already published nine chapters.”

” … scared the *&#% out of me! I’ve had more bad experiences than good (involving Emergency care) not inpatient as your wife had. I realize how vulnerable we all are and pray that the person holding my heart (literally and figuratively) will treat me as that they would their own wife, mother, daughter or sister.”

“Interesting, well written… “

“An eye opener and very sobering for those of us who perform such procedures.”

“You tell ‘em Dan. I like your site. You tell it the way it is … “

“I think your story is perfect as published. It is truth, and truth is what all of us need to see, and act upon.”

“Thank you for taking the time to write this. You’ve performed a significant public service.”

“These words of tragedy help us, and I am grateful you wrote them.  They help us learn, and this makes us better, both as clinicians and as people.”

“Thanks for sharing this true account. I applaud the bravery of anyone who writes an expose’. The public should be aware of the corruption involved in the medical establishment despite how troubling the reality.Rated with six stars.”

–Walden Carrington,  Author Titanic: Rose Dawson’s Story

“As for Dan’s book, from my perspective it is not really about this particular procedure. What Dan has done is to expose the mechanisms of medical corruption, and particularly the corruption of medical research.  There has been a lot of excellent investigative work in the press about corruption, conflict of interest, and subversion of the medical literature.  Some of these stories are very specific, such at the Milwaukee Sentinel Journal on back surgery and other specific procedures and devices.  But I have not seen anyone do what Dan has done, with detailed research documents that use the doctors’ own words against them.  The value of Dan’s book is in the fact that it lays bare an example of the issues that fuel the skyrocketing rates of medical harm and the medical costs that go with it. I think it is a bombshell.  But people need to understand the significance of what he is saying.”

************** editing

Louise E.
Date:   04-23-11 18:05

I read Dan’s book, a searing , poignant and cautionary tale. Although I remember Pam’s postings on the Forum from several years ago, this book has really shaken me. Not only was Pam’s health status permanently changed through multiple medical errors, but both she and Dan were again victimized in their efforts to seek justice. I urge everyone to read this account.

____________

Author: Murray L.
Date:   04-29-11 08:21

1. I concur that reading this outstanding but poignant account of the Walters experiences should be made MANDATORY for anyone considering ablation procedure(s). It is indeed essential reading.

2. I am on my SECOND reading of this book. And I will probably have to read it several times to have its sheer magnitude sink in. I am a scientist (physics) and business management/IT ‘expert’ (well, it’s been a long time since Physics 101 but the scientist never leaves) and as such demand total understanding of the situation. It is truly astonishing.

3. Answering my own question; Kindle readers will actually read the book to you in voice quite well. I am just installing the Kindle reader for my IBM PC platform and it is also avaialable for most smartphone platforms at no charge (I can ‘read’ the book while otherwise occupied or in transit in the car).

This book is ‘smack on’…. and to whomever said they were sitting there and hearing their doc sound just like one of the characters in the book I can only concur with that as well. I am up for a change in cardiologist who considers me a piece of meat (I understand now) and is pushing me at a teaching hospital for reasons unknown (now I know) and a doctor that I have never heard of for reasons unknown (now I know).

Read the book.

__________________

“Collateral Damage” is more than simply a book about statistics and aFib and we need to be very clear on this.

It is also a book about big business, the drug and medical products business, teaching hospitals, ensuring one knows who is diddling inside their beating heart, spotaneous stupidity or, as with my barbeque “not reading the directions twice” before assembly, and much much more.

Pam Walter, truth be known, is simply a player in the book. A ‘for instance’ and a figurehead perhaps. It is a dreadful story and one that garners my absolute empathy to be sure, but understand that the book is so far and above “MORE” than a story about Pam.

It is a ‘must read” for all aFibbers. NOW! Not the night before you are going in for ablation, etc. It is thought provoking and very well written in my humble opinion and will, at the very least, make one think to the extent that when sitting down with your EP you will know some questions that you really DO want to ask. The top question on my list is going to be “Just exactly who is going to be diddling around inside my beating heart and where will you be during the course of this procedure, from start to finish?” It will bring you directly to face your own mortality and the possibility that things can and do go wrong, albeit rarely.

I can tell you one thing for certain, it will give you background to be able to ask some very difficult questions with tact and diplomacy and it will most certainly motivate you to ask the questions that need to be asked.

Thanks to Dan and Pam for bringing this book to us. Sympathy and empathy for the grief gone through in making it possible. And thoughts and best wishes for the future to both of you.

With my personal thanks for just one more piece of enlightenment that no aFibber should really be without.

“These words of tragedy help us, and I am grateful you wrote them.  They help us learn, and this makes us better, both as clinicians and as people.”


Orginal Front Page Chapter One

March 5, 2008

A Work in Progress …

Hugh Calkins Johns Hopkins Cardiology

PreviewCHAPTER ONE:

“A Mitral Valve, Flapping in the Breeze, Prolapsed into the Atrium …”

Johns Hopkins Medicine has a long tradition of prioritizing patients, and striving for the bottom rung are the anonymous poor.

If, for example, you catch a bullet on a Baltimore street corner, or your mother presents you at the ER as a feverish welfare child, then it’s open season for the med students, well meaning as they may be. They can practice on you because if  their actions result in an adverse outcome—which is to say that if you are mangled or killed—nobody will question said outcome, precisely because… you are a nobody.

At the other end of the spectrum are wealthy and prominent patients, who get treated by doctors who have already learned what not to do from the mistakes inflicted upon the lower classes.

My wife landed somewhere in the middle. We got snookered by all the hype from US News into thinking that she was going Hugh Calkins Johns Hopkins Cardiology to be treated by the best doctor at “The Best Hospital in America.”

Hugh Calkins, MD was to maneuver tiny wires around in my wife’s heart and burn scar tissue in the wall of the atrium to stop atrial fibrillation.

The job required someone with a cool head and a keen eye, and Hugh Grosvenor Calkins, MD, FACC, FAHA, FHRS, Professor of Medicine, Director of the Electrophysiology Lab at Johns Hopkins University School of Medicineand graduate of Harvard Medical School—assured us that he had done plenty of these procedures, and, he said, “experience counts.”  So we knew we were in the best of hands. What we didn’t know is that Professor Calkins—according to what he later told colleaguesfollows the practice at most teaching hospitals wherein “the attending shows up to be there during the burn.”

What he meant by that was this:

The patient is etherised upon a table, and wheeled into the laboratory.  A student of the  treatment  performs and is responsible for routine aspects of the procedure.  According to the rules, all this is to be done under close supervision.  With blue vinyl fingertips feeling their way under bright white light, the trainee practices finding the femoral vein in the patient’s groin, high up inside the thigh, pressing and probing and picking a spot and then pushing the point  of a large needle into the flesh until it punctures and there is blood.

The trainee then inserts the sheath for the catheter into the vein and snakes it up into the pumping heart. Then he inserts the catheter wire up into the sheath, and here is where one would expect the experienced attending physician to step in because it is a very tricky business to navigate a thin wire around in a beating heart guided by cloudy X-Ray imagery, even if you know what you’re doing.

But since he only “shows up to be there during the burn,” Hugh Calkins was presumably relaxing with colleagues down in the doctor’s lounge or out selling TASER guns while a young cardiology trainee by the name of Richard Wu—whom we’d never met—was sweating out a decision in the lab. He had a stranger laid out on the table before him and a new type of catheter in his hand.

It appears that young Wu wasn’t sure into which chamber of the heart the catheter was to be inserted.

Richard Wu Cardiology

He went for the left ventricle (it says right on the box to not do that) and the catheter got tangled in the muscles of her mitral valve. Her chart read: “only the first 50% of the circular portion of the catheter tip could be withdrawn into the sheath and pulsatile motion could be appreciated.”

Pulsatile motion.

They were trying to cajole the catheter back into its sheath, but it was tugging right back, like they’d hooked a five pound bass. A nurse noted here that the “patient is waking and moving around, with chest pain @ 7/10.”

Imagine that.



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