Choosing a specialist to perform your ablation

[Thomps95]

If you are thinking about getting an ablation for AFib (I have lone paroxysmal) and there are choices of centres where you can get this done, do you first check and compare the success rates of the doctors who perform the ablation? Is it rude to request such information, and is it even available? I realize success depends on patient circumstances and may be considered over 1-3 procedures, but there must be a way of differentiating the most highly skilled from the less skilled and then making an informed decision. What have others done?

[BobD Volunteer]

Worms can of springs to mind. I had no option as there were few doing it when I started my AF journey, hence travelling from Devon To London for treatment. I do feel that the number performed and success rates may be confusing as you say since we are all different. You may have very odd structure in your heart or it may be text book but nobody knows till they get in there although the better the technician the better chance of success. I asked back along when he last killed somebody and once he realized where I was coming from he wasn't at all offended. I told him to put me on the list for the week after he did as I knew he would be more careful then.lol

Ask. What is the worst that could happen?

Bob

[Hidden]

I think the approach has to be largely anecdotal because of the reasons you stated and where you have confidence.

In the UK I will probably choose the Brompton in London as it is known as a good centre of excellence from comments here, which cross references with another medic who went there herself and the cooperative way my initial query there was fielded. Unfortunately, my cardio wants to steer me to 'his' London EP, who is very well qualified but treated me like one on the production line and that was paying for a private consultation.....haven't worked out how to tell my cardio yet without offending him!

[BobD Volunteer in reply to Hidden]

I think I'm with you on that Orchardworker. Having met quite a few EPs through AF A at meetings and conferences, I find that the persona at such places is not always that which patients see, I sometimes wonder which is best. To be treated like s--t and have a good outcome or treated like a person and maybe need two attempts but it shouldn't be like that. I actually think that the only reason that these "stars" have good results is that they can afford the latest equipment. One told me the the da vinci robot didn't make ablation any more successful, it just enabled him to sit in comfort outside the lab away from the x rays so he didn't get too tired. The newer touch sensitive catheters may give a more even burn and the few centres using more experimental methods such as laser balloon report good outcomes. Now that may well translate to better success rates with a fresher more alert EP. It really is a game of chance to a large extent and I'm not sure the medical profession would go for league tables on ablation.

I was under Brompton. Food was good too.

Bob

[Hidden]

Good food that settles it then!! Seriously though, useful info thanks Bob.

[rosyG]

I asked the EP I saw at the Brompton about the rate of complications she had encountered and she told me exact figures for stroke/ tamponade/ and all the other serious complications. I was very happy with the figures which were much much lower than other centres' figures. Complication figures are relevant but i agree with what others have said about success rates which must vary with the individual's circumstance.

[jennydog]

I thought that, by pure chance, I had been allocated the best and the nicest EP. When ablation day came he had to deal with a teenaged emergency. The EP who did my ablation was absolutely 100%.

I would choose a location which is convenient and where there is more than one EP working because of emergency or off-day. I know that you are in Australia so things will be different but in the UK we have to go to the hospital 5 or 6 times ie initial consultation, tests, pre-op, ablation, 3 months check-up, 6 months check.

Go for convenience to reduce the stress.

Very best wishes.

[Thomps95]

Thanks all - I'm not sure, it's something I've been considering for some time. I'm currently on a small daily dose of flecenaide and haven't been in fibrillation for about a year, but two days ago I started to get ectopic beats after eating a really heavy meal of pork (was at a friend's for dinner and it was put in front of me. Normally I eat very little meat and never pork). Well - to my distress it hasn't gone away. It doesn't feel like fibrillation, I'm not dizzy, I can exercise as normal, but I can feel it as plain as day and it seems to occur about 1-2 times per minute. I have no idea what's going on. Doc appt tomorrow -

[SNOWHAMMER]

As a South Yorkshire newbie with AF who only found out yesterday what an EP was!

I was wondering if anybody knew anything about the EPs at the Northern General Sheffield?

[AFAssociation1 in reply to SNOWHAMMER]

Dear Snowhammer, you can find a list of EPs by location here: heartrhythmspecialists.org/.... Why not email or give the hospital a call? EPs are used to being asked their success and complication rates so do not be afraid to ask!

[Thomps95 in reply to AFAssociation1]

Very helpful to know

[SNOWHAMMER in reply to AFAssociation1]

Many thanks, very helpful

[MarkS]

I came up with a short list of centres then emailed each one for their stats (number of ablations, success rate, numbers of complications, etc.). I got those. I think the better EPs appreciate being asked as they are proud of their achievements, even listing stats on their website. I think if you ask questions, it also puts the doctor on warning that you're a bit more demanding than the average patient and they'll take that extra bit of care.

[Thomps95 in reply to MarkS]

This approach makes a lot of sense to me. Were there any significant differences in the stats that you received?

[MarkS in reply to Thomps95]

Yes - the Southampton Centre I looked at only did 80-100 ablations a year with a fairly average success rate, whereas the London centre did 200 with a very good success rate, plus they had publsihed quite a few research papers. I was also attracted by the combined RF & cryo ablations they carried out.

[Durin]

It's your heart and it's your health, you have every right to ask questions, and if people are upset by your questions, they should be the ones to avoid! The best performers will want to tell you how well they do. There may well be a website that discusses success rates, but as others have said, this may not take into account the nature of the tasks being performed so you will need to consider other parameters too. Any good doctor worth their salt should embrace any patient taking a keen interest in their own treatment, and treatment outcomes.

Good luck with your search.

[Thomps95 in reply to Durin]

Sounds like very smart advice - thank you.

[CDreamer]

Sensible, not rude to me and yes, medical audits insist that all outcomes are published, unfortunately what that doesn't always show is the degree of complications for each patient, although there maybe a generalised criteria setting.

Would you employ an electrician for your house without checking their credentials?

[dedeottie]

Also some E.Ps will take on the more challenging cases and therefore may have less impressive success figures but others will only take on safe cases and may appear to be more successful. Just to confuse the issue! X

[philologus]

I am due to see an EP (Dr Simon James, James Cook Hospital, Middlesbrough) in late July because I have heart failure and am getting a lot of ectopic beats. He is likely to recommend an ablation of the Right Ventricular Outflow Tract (RVOT). I intend to ask him what his success rate is and I also will ask him what he considers success to be as I have read that most people need two or more ablations before they improve.

I have read elsewhere that there is a "tipping point" where an EP who does 100+ ablations a year is much more likely to have better outcomes and fewer complications than one who performs less than 100 a year so I will be asking him about this.

I will also ask whether he performs the ablation himself, or does he just supervise others.

I use an Alivecor device. For those who don't know about this, it is a small device that fits onto the back of a suitable mobile phone/tablet. You hold it between your left and right hand fingers for 30 seconds and it acts as a single lead (number1) ECG. Your ECG reading appears on the screen and, by using the free app, you can see it and print it on your computer. You can also use it as a number 2 lead by resting one side on your left knee and holding the other side with your right fingers. (Cost around £70)

There are plenty of websites that will help you to learn how to interpret the results.

I use: sgh.org.sa/Portals/0/Articl...

Mine tells me that I am in almost constant arrhythmia. Bigeminy, trigeminy, etc. but it has not detected Atrial Fibrillation yet.

I still don't know which came first- the arrhythmias or the heart failure - so I am hoping that by curing the arrhythmia the ejection fraction of my left ventricle will improve. It is currently at the most serious end of the scale.

If anyone has had dealings with the EP I will be seeing, or the cardio team at James Cook, I would appreciate any advice you may give and I am open to suggestions as to other questions to ask.

George