The Procedure: “Ready for Prime Time”
AA
I wasn’t the only one waiting anxiously at Pam’s bedside in the Hopkins ICU that day in March, 2002. She’d been wheeled straight over from the cath lab, heavily sedated. As I held her hand and mulled over just how to gently break news to her when she woke up that things… well, things hadn’t gone exactly according to plan, various surgeons were sidling up to the bed, looking things over, checking monitors, reading strips. Just checking, they’d say… just checking.
In the brochures about Catheter Ablation for Atrial Fibrillation at Johns Hopkins, there are pictures of smiling, grateful patients sitting up shortly after the procedure, watching television or entertaining visitors. Looks like you don’t even have to spend the night at the hospital.
A 1999 Hopkins press release touting catheter ablation for arrhythmias other than Afib announces that “the first comprehensive, multi-center study of the techniques effectiveness is now complete. It was led by Johns Hopkins director of electrophysiology Dr. Hugh Calkins.” The procedure is represented as being proven and painless, safe and effective:
“A doctor guides a catheter with an electrode on its tip to the source of the problem. It then fires a painless burst of energy, ending the electrical misfires. Problem solved. The first comprehensive, multi-center study of the technique’s effectiveness is now complete... Johns Hopkins director of electrophysiology Dr. Hugh Calkins. The basic findings of the study were that catheter ablation is in fact a safe and effective procedure. Overall, on over a thousand patients, it was successful 95 % of the time, had a 6% recurrence rate, and a 3% incidence of complications.
Equally rosy scenarios are painted on a Hopkins website about the Afib procedure, entitled Finally a Way to get Rid of Afib, published in 2003, a year after Hugh Calkins let a trainee do a job on Pam.
It tells the literally heart warming story of one David Erdman, a rugged outdoorsman who was “sure he had climbed his last mountain” because his Afib was getting worse. After an episode of heart palpitations during a recent hiking expedition caused him to fall by the trail side, Erdman was sure he was going to die:
“But Erdman’s cardiologist felt differently. He’d heard that electrophysiologist Hugh Calkins was offering a new technique to treat A-Fib at Hopkins and encouraged his patient to give it a try. Calkins would thread a catheter from Erdman’s leg up to his heart and, using a high energy probe, burn the tissue that was causing the problem…
Results have been encouraging. The ablation has been able to cure 80 percent of the patients Calkins has treated for intermittent A-Fib and 50 percent of those with chronic A-Fib. The secret to success, Calkins says, is knowing how to use MRI and a special catheter-shaped like a branding iron and armed with some 20 electrodes- to zero-in on the disruptive tissues in the four pulmonary veins. “Target the active pulmonary vein and the success rate jumps to 90 percent,” he says… “The procedure is ready for prime-time,” Calkins says. “Physicians and their patients should know about it.”
Essentially, Hugh Calkins was claiming to the public that he had a cure for atrial fibrillation in 2003. The last word from Hopkins is that “Erdman hasn’t experienced AFib in a year and currently is planning a six-day backpacking trip to Mt. Whitney in California’s High Sierras.”
So Pam and I had been living in Brochure Land, only she hadn’t wakened to it yet. In Brochure Land, the outlook is always sunny, bright and confident. But in the medical journals, which patients don’t read because they trust their physicians, the landscape is much grimmer, and strewn with complications and bad outcomes. This professional dispatch from Hugh Calkins was written in 2005, three years after he nearly killed my wife:
” …there has never been a procedure in the field of electrophysiology with such a high complication rate. There have been more than a handful of deaths from this procedure, and as more and more people start doing it and are on that learning curve, it could be a bit of a mess.”
Indeed.
