Very happy to find you here @ezekio--& look forward to your continued presence 🙂

Here's Dr. Mandrola's takedown of the Pro-Ablationist evangelists (in the treatment of persistent atrial fibrillation), who are very loud in their Pro-Ablationist evangelism & very often succeed in drowning out and/or suppressing divergent & evidence-based views, including those advocating what now-deceased Dr. Stephen Sinatra termed "metabolic cardiology" & prevention in general (of which Dr. Mandola, who is also a triathlete, is a vocal advocate):

"CAPLA Challenges Expert Opinion on Ablation of Persistent AF and Should Change Practice" (https://www.medscape.com/viewarticle/979804).

A noteworthy quote from his pointed commentary on the CAPLA presentations/findings:

"But, as it so often is in the practice of medicine, less proved as good as more when tested in a rigorous trial. In 2015, Atul Verma, MD, and colleagues published the results of the STAR AF II trial, which randomized patients with persistent AF to PVI alone or to two other strategies of PVI plus more ablation. They observed no differences in the primary endpoint of freedom from AF.

Despite this strong evidence, the idea of additional ablation for persistent AF remained strong. One year after STAR AF II, a group of influential electrophysiologists published a nonrandomized study of 52 patients and concluded that isolation of the posterior wall of the left atrium "provides additional benefits" over standard PVI.

Two years later, many of these same authors wrote a review article on approaches to ablation of nonpulmonary vein triggers that included this line: "Therefore, empirical isolation of the left atrial posterior wall should be performed in all patients undergoing AF ablation." Their seven citations for this proclamation included observational studies and small randomized controlled trials.

These opinions plus the plausibility of posterior wall isolation led many electrophysiologists to accept the practice of adding it to standard PVI in patients with persistent AF. This became a therapeutic fashion."