Qualified EP ??

Hi I am new here and hoping to get some advice. Here is my pertinent info, and questions:

My situation:
- 52 year old male
- Paroxysmal afib; started with infrequent episodes 3-4 years ago
- Now get episodes several times per week
- I have cardiovascular disease and repaired atiral septal defect
- Trying sotalol to manage symptoms
- Considering ablation if sotalol doesn't work long-term

Questions:
- If the sotalol works, will heart still continue to remodel?
- Should I get ablation anyway, since it is most effective when done in first 3-4 years of suffering afib?
- I do have an EP now. How do I determine if he can provide a safe and effective procedure?
- If he is not the best, how do I find a qualified EP on my plan?
- If I can't find the best EP on my plan, I assume I will have to cover all the costs myself??

Thanks,

Gary

Gary,

- I have cardiovascular disease and repaired atiral septal defect
How are you addressing your cardiovascular disease? There are data that suggest reducing comorbidities can be beneficial to afib.

- If the sotalol works, will heart still continue to remodel?
If you are in normal rhythm, your heart should not remodel.

- Should I get ablation anyway, since it is most effective when done in first 3-4 years of suffering afib?
I will have had afib for 13 years in July. I've kept it in excellent remission since the Nov. after it started (2 months after my first episode had a 2 1/2 month episode). In the last 3 3/4 years, I've had 3 episodes totaling ~2 1/2 hours out of rhythm and converted with flecainide. My opinion is my disease has not progressed and I will continue to defer an ablation until I see a very significant increase in afib burden.

- I do have an EP now. How do I determine if he can provide a safe and effective procedure?
Want to have someone who specializes in afib ablations, and does 100's of ablations a year, ideally >300/year.

- If I can't find the best EP on my plan, I assume I will have to cover all the costs myself??
Perhaps you can make a case that going to the best (which may not cost them more) will be more cost effective in the long run

George

George,

Thanks for your response.

I have never had a heart attack or suffered any heart damage. I believe I am doing what I should do in regard to heart disease--except that my exercise has trailed off since the afib started.What particular things do you think are helpful, or what studies have you seen? I don't have high BP, don't smoke or drink, not over weight, I eat well, etc. Not sure what else there could be except maybe better sleep and exercise.

BTW, how can you take flecanide with heart disease and structural heart issues? It is contraindicated.

- I have never had a heart attack or suffered any heart damage. I believe I am doing what I should do in regard to heart disease--except that my exercise has trailed off since the afib started.What particular things do you think are helpful, or what studies have you seen? I don't have high BP, don't smoke or drink, not over weight, I eat well, etc. Not sure what else there could be except maybe better sleep and exercise.

When you say you have heart disease, what do you mean specifically?


-BTW, how can you take flecanide with heart disease and structural heart issues? It is contraindicated.

I believe it is contraindicated for those with heart failure - I think they were killing those guys in the original flec studies. As I have no heart issues beyond afib, I've not looked into the details on those studies. When first prescribed to me 12 1/2 years ago, EP said I was fine to take it.

There was a study in Olmstead County MN (location of Mayo Clinic) where they studied lone afibbers for 30+ years and compared to the population (published 8-10 years ago). The lone afibbers actually lived longer, but I noticed they got metabolic illness like everybody else and their health deteriorated like everyone else. At that point I determined that was not going to be me.

My heart disease: ten years ago I had to have a stent due to blockage in a major artery. I have high cholesterol and some atherosclerosis.

I found out that my EP does 90 per year. Do you know where the 300 standard comes from?