11 Questions to Ask Your Electrophysiologist

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2 How many years have you been performing catheter ablations, and how many catheter ablation

procedures have you performed in the last year?

3 Do you utilize advanced imaging tools such as 3D mapping systems?

INTERESTING VERY INTERESTING !!!!!!

The CryoBalloon Catheter for A-Fib Ablation (FDA-approved technology in December, 2010), it has proven effective, safer, and faster than the various types of RF ablation.

But it is a relatively new method of ablation without a long-term track record of extensive data validating its effectiveness. However, anyone using the CryoBalloon Catheter is probably innovative, knowledgeable, and experienced in A-Fib ablation.

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  • Some of this worries me. Every EP has to start somewhere with ablations and to discount someone who has been doing them for 6 months in favour of someone who has been doing them for 8 years is daft. It all depends on skill. Complacency could well have set in. I didn't know the EP who did my ablation and for all I know I was his first ever patient. I do know that he is a genius who dealt with my radiotherapy damaged heart and was kindness itself, visiting my room 3 times.

    Cryoablation would not have worked on me. I am one of the 25% of the population with conjoined pulmanory veins which enter the heart as a large hole. A cryoballoon is too small to cope with it.

  • Does it not depend how far away from the heart the veins join?

  • I see :(

  • Thanks for the post Maxicono

    For me this highlights some of the important differences between UK and US medicine and it's approach to things such as new technology.

    In the US an EP needs to effectively advertise him/herself often talking about new techniques, or how many successful ablations etc etc, and there must be a real fight for those up and coming EPs to try and make a name (and a career) for themselves unless they are taken under the wing of a big name EP. After all the the patient chooses with their wallet. I do believe that sometimes, this leads to the early adoption of new procedures.

    In the UK an EP will depend much less on private medicine, (of course with some notable exceptions) and although yes we have the right to choose which hospital and even which EP we see, only a relatively small number do, and we rely to a much larger extent on research which is shared (why wouldn't they?) and shared statistics.

    Now I am NOT arguing that one is better then another, simply that they are different and have a different approach to the new technology.

    I am sometimes asked is I were very rich, and suffered from highly symptomatic PAF what would I do and the answer would be rich? I would go and see privately one of the best EPs in the UK. If however I were a billionaire where money was no object, then for me I would be on the first plane to Bordeaux, and what has historically, in my opinion, proved to be the best research (and teaching) centre in the world for AF and other arrthymias and be treated at LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque)

    So coming back to your post if I may Maxicono, I think the major difference between the two is that if one sees Mr (or Mrs) A as an EP in the US one would usually expect the ablation to be carried out by the same person, perhaps with a junior up and coming helper.

    In the UK, I suspect that unless one pays for private care, then whichever EP you see is the supervisor of the ablation, and not necessarily the person actually performing it.

    Therefore questions such as how many have you performed, and perhaps even also which method would you use, can be less relevant to a UK patient.

    Having said that I have an awful lot of time for Dr John, who I find to be very grounded and a really good writer on AF matters, and who I really admire.

    Be well

    Ian

  • Thank you...... I update my post have look if you like there is some interesting about x-ray ........they will soon kick me out of the forum and end-up like Julian Assange for disclosing "CLASSIFIED MATERIAL" lol

    3. Minimizing Fluoroscopy Exposure. We guide catheters in your heart with fluoroscopy (x-ray) and 3 dimensional computer generated maps. Over the past decade the computer generated maps and mapping systems have advanced significantly. The majority of physicians that perform atrial fibrillation ablation utilize these systems. With increased reliance on these mapping systems there is less need of fluoroscopy. Fluoroscopy delivers continuous x-ray or radiation through your body while an image is being obtained. We use fluoroscopy for many procedures in cardiology (angiograms, stent placements, catheter ablation), gastroenterology (barium swallow studies or enemas), orthopedic surgeries for artificial joint placements, and many other radiology procedures.

  • I found Dr John's article really helpful.

    As someone who has had 9 ablations, the continuity of care has been critical to rate control and management of symptoms. I don't expect there will be a cure but incremental improvement of the symptoms which return with age.

    As you get older (now in 40s), the AF naturally increases risks and the idea that different or any EP you have never met can just pick up a case and ablate is quite worrying.

    In the UK even private EP's have a NHS base where they continue to learn.

    I think part of the problem in the UK, despite having some very excellent NHS research and ablation centres, there needs to be NHS EP hospitals in every region for screening the younger population, diagnosing earlier and providing treatment earlier. The savings are felt up stream when people are prevented with strike or costly a&e admissions.

    I also can't see why the NHS couldn't use private facilities to meet waiting time reductions.

    Lastly, when I started off on my AF journey, the NHS cardiologist warned me that only to let a reputable EP ablate because albeit ablation had just started, there were very few experts in a narrow specialist field.

  • Thank you for the links, Maxicono. I like DrJohn's website too and found many of the points raised in all three links very interesting, even though I am also in the UK.

  • Thanks my dear for all your kindness

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