Seemingly big news today in cardiology: patients with hard-to-control atrial fibrillation were better off getting a catheter ablation than trying different medical therapy.

An international team of researchers tested a procedure known as catheter ablation against medical treatment in patients who have already failed medical treatment for atrial fibrillation.

The study was funded by the company that makes the device used in the ablation procedure.

The LA Times gushed today, "Surgical procedure urged for atrial fibrillation."  I had actually been looking for a review of the new Paul Reubens show from last week ("genius"), when I came across this news.

I'm not sure I agree with the general thrust of the LA Times article, written by an LA Times staff writer.

The LA Times article seems to imply that the study found that atrial fibrillation needs to be treated by catheter ablation, and not medical therapy at all.  I'm not sure where that conclusion comes from, but it wasn't really the study itself.

The study looked at a narrow question: How best to treat patients with refractory or persistent atrial fibrillation.  

The study had a narrow endpoint: The amount of atrial fib patients had later on.  

This study wasn't designed to show that catheter ablation improves mortality, strokes, or congestive heart failure, all important effects of atrial fibrillation.  It only demonstrated that catheter ablation resulted in a longer relapse-free period.  Presumably there will be a paper about the secondary clinical outcomes later, but don't count on it.

The introduction to the paper discusses the health risks of atrial fib, but the main design of the study wasn't powered to address the health risks.  Instead, much is made of the improvement in quality of life seen in patients who had the catheter ablation procedure.  As an oncologist, don't get me wrong, I understand how important quality of life can be, but I think if you're going to use a strong word like "urged" in your newspaper headline, you should have a compelling reason for doing so. 

I can see a patient coming in to a cardiology office and saying to his doctor, "I need this procedure because experts are urging I have it," not realizing that there was a positive study reporting only improvements in quality of life.  Perhaps this particular patient is not symptomatic from atrial fib, but feels that the data are sufficient to compel him to have the procedure.  A market-driven medical environment would probably not stand in his way, which is why the LA Times headline is propaganda-ish.

I think I prefer the Reuter's headline: "Heart procedure beats drugs for irregular heartbeat."

This paper has the potential to "electrify" the subspecialty of cardiac electrophysiology (pun intended).  The high-profile publication in JAMA, the randomized trial design, and the media hype will all combine to send thousands of cathter reps into thousands of cardiology offices, stoking the flames kindled by today's announcement.  Catheter ablation's been around for years, but it appears to be having it's "Viagra moment" today.

Perhaps I should have a feature on InteractMD.com giving a propaganda rating for each article.  The problem is that even I get caught up in media hype sometimes, and it can take me a good half day of introspection to calm down enough to write about something objectively.

UPDATE: True to that point, I talked to an EP cardiologist today, who basically said, "We've been here doing these procedures, it's just that nobody outside our field knew it.  The JAMA article just brings notoriety.  I didn't know anybody read JAMA anymore!"  They don't, but they do read NYT and WSJ, and those guys get their news from JAMA.