Treating atrial fibrillation with catheter ablation on TV may not be ethical

Mauricio Arruda performed a live atrial fibrillation ablation at University Hospitals in Cleveland on the Today Show recently.

The 6-minute segment was relentlessly upbeat. The TV producers pulled every trick in the book to overcome the inherent difficulty of portraying a hard-to-explain disease like atrial fibrillation and an even harder-to-explain procedure like catheter ablation. Instead of making any effort to truly educate their viewers, the producers took the easy route. Arruda, staring at a bank of large display monitors, might as well have been playing a video game, for all anyone watching might have known.

And the reporter, NBC Medical correspondent Dr. Nancy Snyderman, substituted schmaltz for substance and presented the “heartwarming” story of the patient, a great-grandmother, accompanied by stirring music and sentimental images.

Although the procedure was still in progress (and in fact Arruda had not even finished the mapping portion of the procedure), Snyderman said that “thanks to technological advances in cardiology Dr. Arruda will be able to fix Bernice’s heart.” The patient was also well trained and thoroughly on message: in a clip filmed before the start of the procedure she said, “I’m excited and I’m not afraid.”

Just in case anyone hadn’t somehow caught the positive message, Snyderman told her viewers that the patient’s life (even before the procedure was finished) now ”has new promise thanks to a dedicated physician, a world-class medical center, and extraordinary medical advances…”

Snyderman then said the success rate of the procedure is 85%, but that wasn’t quite good enough for Arruda, who informed Snyderman that ”the success rate is 85-90% with this particular technology.” As if that wasn’t upbeat enough, Snyderman then reassured her audience that ”the radiation risk is minimal.”

Finally, Snyderman promised her audience that “we’ll follow-up in a few months, but by all accounts… we expect her to do really very very very well.”

What’s wrong with this picture?

Watching this short segment reminded me of one of those pictures in a child’s puzzle book where the reader is asked to find everything that’s wrong in the picture, and the longer you look the more wrong things you find. Even after staring at the picture for several minutes you’re still surprised when you realize the man walking across the center of the picture has only one leg.

Didn’t anyone at NBC think about the ethics of broadcasting a live medical procedure? Suppose something had gone drastically wrong during the live broadcast? I think there are legitimate questions worth raising about the public display of any medical procedure, but a live broadcast on a major television network is indefensible, in my opinion.

Even if you believe it is ethical to broadcast a live procedure, it’s unethical and irresponsible to report it with this kind of relentless, upbeat mindlessness. Let’s be clear: there is no evidence in the literature to support the statement of an 85-90% success rate for catheter ablation of  atrial fibrillation. To present this kind of statistic to the general public, many of whom may have atrial fibrillation, or may know someone who has atrial fibrillation, is completely irresponsible. Catheter ablation is emerging as an important therapeutic option for some patients with atrial fibrillation, and it is indeed an impressive medical advance, but it comes with a lot of caveats.

The misuse of statistics illustrates another clear reason why procedures shouldn’t be broadcast live. It would have required enormous fortitude for Arruda to challenge, on live TV, Snyderman’s assertion of an 85% success rate, and it would have been equally difficult for Snyderman to press Arruda on the statistic while he’s in the middle of a procedure. Quite simply, a live television broadcast is simply not the proper place for an intelligent reflection on a complex procedure.

The shoddiness of the reporting becomes even more apparent when Snyderman declared the procedure a success, and the patient cured, before the actual ablation had even started, and without the long-term followup that can provide the only real measure of success. You would never know from the report that last year atrial fibrillation ablation received a mixed review from a Medicare advisory committee and was the subject of a critical AHRQ review. Further, it is typical of reporting like this that a genuine issue of concern like radiation is only mentioned in the context of saying “the radiation risk is minimal.”

An anecdote is not evidence. By focusing exclusively and obsessively on single stories with happy endings, reporting like this has raised viewers expectations to such a degree that they will inevitably be disappointed and give up on the very real but more modest and unmiraculous aspects of modern medicine.

Larry Husten is a writer and editor of CardioBrief.org.

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