AF Association

Scheduled an Appointment with an EP

Appointment on March 27th, though I'm on the cancellation list so it might be sooner. How many visits to the EP does it usually take to convince them you're a good candidate for an ablation? Does it differ person to person?

I went for a visit to my cardiologist early last week, as I'd been in AF for 4 days straight and it was horrendous the final evening. He told me on the phone to take an extra metoprolol (which weirdly hadn't occurred to me) and it eventually shifted it somewhat (slow release).

While I was at the cardiologist's I asked about an ablation and he said I could request one if it was what I really wanted. So I did. I'm just hoping now I can keep the ball rolling and get in and get it done. I'm in the US so the timeline might be different to the UK, but I'm hoping it all goes through fast and I see some results.

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I guess it depends on how much cash you have. Over here it is similar of you wish to pay but a long process (maybe 9 months to a year) on NHS.

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Thanks Bob. Didn't realise it could take that long. Boo!

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don't really know how it works in the States afafaf, but in the UK it can take a while from first appointment with EP to having the ablation on the National Health Service (open to all who pay their taxes and a good few who don't). Normally, a patient will have seen their general doctor (GP) and he would refer the patient to a Cardiologist and then on to an EP so it is not unusual for a year to pass before having an ablation if that's the agreed treatment plan. We can opt to go private initially then transfer to the NHS for ongoing treatment. The benefit is that it's much quicker to get the initial appointment, but (and rightly so) it does not reduce waiting times for any procedures or other treatment. All waiting times vary considerably around the country and seem to be getting longer for a variety of different reasons.

Generally, ablations on the NHS are only carried out if the patient is experiencing problems with medication and/or the AF has an adverse effect on their quality of life. From many of the posts we see on this forum, treatment varies considerably in the UK, whereas, rightly or wrongly, in the USA there is an assumption that the ablation route is the preferred way forward when treatment is primarily funded by insurance....can't think why!!!!

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It depends on the insurance company here Flapjack. Some will let you go right ahead and do it while others prefer you to try all possible medications first, and others want you to try at least two different meds before considering it.

Sounds like a pretty common procedure for a (sadly) very common ailment.

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The point is that ALL and ANY treatment for AF is only ever abut improving quality of life (QOL). There is no guaranteed cure after all and even ablation may need to be repeated several times. Changes to life style have been seen to greatly improve QOL so work on those while you wait. Reduce reliance on meat products . no alcohol, reduce over exercise if appropriate. weight loss down to max BMI 25 etc all have been shown to be beneficial.

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Agreed Bob. I find the less I drink, the more exercise, the healthier I eat, etc., all results in my feeling much more "normal".

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Hi afafaf I'd be surprised if you had to wait long at all. When I first seen my EP he was ready to do ablation as soon as I was on AC's long enough and I don't have the best insurance. Was pretty surprised reading posts how long they have to wait for appointments/procedures in UK unless paying out of pocket. Good luck moving forward.

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Thanks Shaun. So you have to be on AC's before they'll do it? I'm on the lowest possible dose of Metorpolol and I take a baby aspirin a day.

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Aspirin is a waste of time as it has no stroke preventative effect yet still can cause harm like internal bleeding. Anticoagulation for at least three months my EP told me. Here in UK we are much more conservative but at the same time have far fewer bad outcomes such as stroke of death from ablation than in US.

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Interesting. I'll have to look at those numbers Bob. So why would my cardiologist put me on aspirin? He tells me that on a scale of 1 to 10 my AF is a 1. I believe he's basing this on the fact that my daily dose of Metaoprolol is one-tenth the allowable maximum dose. My resting heart rate is also very good, as I work out regularly on an elliptical machine and my heart is in good shape (apart from the AF).

But believe me, when I am having a bad AF episode, I wouldn't call it a "one out of ten", by any means. Is there any reason at all why I'd be on aspirin then? To thin my blood? I don't get it.

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He is out of date . Here in UK aspirin was removed from list of approved drugs for stroke prevention in AF four years ago. It has uses in other heart conditions such as when a stent or artificial valve is used to prevent platelets sticking to those foreign bodies but not for AF. You need an experienced EP pronto.

(Sorry for slow reply been up country. )

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Thanks Bob. I will bring this up to the EP when I see him.

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Hi afafaf, I live in the states and getting scheduled doesn't take long at all. It depends on when your doctor has time to perform the procedure and when a space is available on the cardiac cath lab schedule. Neither of these involves a lengthy wait time. It may tale 1-2 weeks to get on the schedule. It varies re where you live, what hospital your doctor uses.Most doctors have certain days of the week they operate on -sometimes with different days for different procedures. IE. a doc may do ablations on Monday or Wednesday etc. Because the US operates on the insurance system no one usually has to wait very long for anything. (Time is money over here-as you know). Good luck if you decide to go ahead. You'll have a consult with the Electrophysiologist and if he decides you have no other health probs to be taken care of first will probably get you scheduled before you leave the office. It's all very organized. I signed my consent for the procedure at the end of my consult visit because I knew I wanted to go ahead, then went to the desk where I got my surgery date right away. As I recall it was about 2 weeks away (2 Mondays away-in2016) Hope this helps. I feel we are very lucky to be able to avoid long waits and the anxiety that accompanies them. Take care. irina1975

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One more point re time frames. With US insurance companies doctors know the right words and justifications to use in their notes so insurance companies won't balk and will approve the procedure right away. There is also the added incentive to not make you wait because the sooner a procedure is done the sooner the insurance pays the doctor. I am not at all implying that this is the main reason you get your procedure asap. It;s just how our (US) system works. (I don't think any country has the perfect healthcare system. We certainly have our problems but it is nice not to have to wait. And depending on the insurance one chooses (and pays the premiums for it) the faster things can move along. I'm lucky to have a plan where I can call a specialist directly and request a visit without a referral from m PCP/GP. This cuts out a lot of waiting time.

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Thanks for all that irina1975. I agree we are very lucky to have what we have here, even with Obamacare bumping up costs it's still good. The EP I'm scheduled to see is very highly rated and has done a lot of ablations, and the centre where they do them is known for being a good one. Here's to a quick visit, cheers!

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Cheers!

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Just reread Bob's post and he's right about anticoagulants.If your EP decides on ablation you will most likely have to be on a bonafide anticoagulant (not aspirin) 4 weeks before surgery to avoid possibleclots which can happen during ablation..

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One very important thing to note, which applies to all surgery in general, but especially to cardiac ablation in the USA, is to make sure that you get a VERY EXPERIENCED EP in a big specialist centre to perform the ablation. You want them to do 100 ablations per year and have done over 1000 ablations in total. You can probably find this online, otherwise do ask.

When looking at data before my ablation it seems that some small US centres have bad results in terms of adverse events and also efficacy. My philosophy is that people are happy to travel long distances for holidays, so how much more important for your health! So if you have to travel then do so.

Good luck and I hope it goes well for you.

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Judging by this EPs profile on the Web, and based on what my cardiologist says, he has a lot of experience in a really good cardiac centre, but I'll be sure to get some more numbers off him as regards how many ablations he performs on a weekly/monthly/annual basis, as well as get a good idea of what he considers to be a successful outcome.

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