Has anyone heard of Dr. Paul Zei at Brigham and Women's hospital (Boston) July 10, 2018 08:54PM |
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Re: Has anyone heard of Dr. Paul Zei at Brigham and Women's hospital (Boston) July 11, 2018 12:10PM |
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Re: Has anyone heard of Dr. Paul Zei at Brigham and Women's hospital (Boston) July 11, 2018 02:53PM |
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Re: Has anyone heard of Dr. Paul Zei at Brigham and Women's hospital (Boston) July 11, 2018 03:14PM |
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bolimasa
How do you decide who is great ablation PE and who isn't.
Re: Has anyone heard of Dr. Paul Zei at Brigham and Women's hospital (Boston) July 11, 2018 03:55PM |
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Carey
How do you decide who is great ablation PE and who isn't.
It's the same as choosing a surgeon -- volume. You want the EP who's done thousands of ablations, not hundreds. The first thing you do is simply ask them. Any EP should have a pretty good estimate of how many he does every year and for how many years.
One way to get a good estimate is this site. Although it's derived from Medicare data, it includes non-Medicare patients as well. Just enter the EP's last name, wait for the list of choices to come up, then select the right one and click Search. Scroll down to the details, and what you're looking for is "Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm". Look at the rankings for that procedure and what you want to see is an EP who is in the top 25% or so.
That data isn't perfect. It undercounts sometimes because credit for the procedure may be assigned to the center director, or an assistant EP, or various other reasons. So treat it like a statistical sample rather than a raw count. For comparison purposes, it says Natale did 101 in 2015, but that's almost certainly an undercount. So judge other EPs accordingly. But all in all, it provides the most accurate, objective count of how many procedures an EP actually does.
Re: Has anyone heard of Dr. Paul Zei at Brigham and Women's hospital (Boston) July 11, 2018 04:29PM |
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Re: Has anyone heard of Dr. Paul Zei at Brigham and Women's hospital (Boston) July 11, 2018 05:04PM |
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wolfpack
If the MRI was of the delayed enhancement variety then it may have been done to look for fibrosis which, unfortunately, is used by some centers as an exclusion protocol for AF ablation. If in your case that was done and didn't show anything then I don't suspect you'll hear much about it at all. The MRI also estimates the dimensions of each heart chamber. LA anterior to posterior is the big one here - > 45mm will start to "scare away" EPs. It also can look for evidence of thrombus and estimate LV systolic function (ejection fraction). Those are all good questions to ask, especially if you have the report in hand.
I had the DE-MRI done on the day prior to my ablation. I never heard a word about it afterwards. I downloaded the report and it was Shannon, I think, who was kind enough to decipher it for me well after the fact.
Re: Has anyone heard of Dr. Paul Zei at Brigham and Women's hospital (Boston) July 11, 2018 05:31PM |
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Re: Has anyone heard of Dr. Paul Zei at Brigham and Women's hospital (Boston) July 11, 2018 06:58PM |
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wolfpack
Yes, excess fibrosis or a very large left atrium will, like I said, "scare away" some practitioners. They are indicators that a PVI-only ablation probably won't work.
Yours looks pretty vanilla to my layperson's eyes. Ask them, though. Your insurance probably paid a pretty penny for it, so get your money's worth!
Re: Has anyone heard of Dr. Paul Zei at Brigham and Women's hospital (Boston) July 13, 2018 05:01PM |
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Re: Has anyone heard of Dr. Paul Zei at Brigham and Women's hospital (Boston) July 31, 2018 04:58PM |
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Re: Has anyone heard of Dr. Paul Zei at Brigham and Women's hospital (Boston) February 19, 2019 09:47AM |
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Carey
One way to get a good estimate is this site. Although it's derived from Medicare data, it includes non-Medicare patients as well. Just enter the EP's last name, wait for the list of choices to come up, then select the right one and click Search. Scroll down to the details, and what you're looking for is "Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm". Look at the rankings for that procedure and what you want to see is an EP who is in the top 25% or so.
.