Canadian seeking guidance with selecting an experienced EP for an ablation

Hello everyone. I’m new to this forum, but not new to a-fib. I’m a 75-year-old gal who has had paroxysmal a-fib for 11 years, starting with a few short episodes a month and progressing to my current advanced state of being in a-fib 54% of the time. Episodes are now occurring every couple of days or so, with most lasting between 24-48 hours. At this point, I’ve decided it’s time to have an ablation before I progress to persistent a-fib. And I’m looking for some assistance/guidance with selecting an experienced EP.

If finances weren’t a consideration, I’d have no hesitation in arranging to have the procedure done by Dr Andrea Natale or the folks at the Bourdeaux group. However, finances are part of the equation, so my hope is that there’s a high-volume center with a highly regarded ablation expert closer to home where I won’t have a financial outlay.
I live in Canada (Ottawa, Ontario). Our health care system is publicly funded and administered on a provincial basis. This means that it won’t cost me anything to have an ablation procedure done here. The restriction, though, is that it would have to be performed in Ontario because that’s the province in which I live.

From a convenience standpoint, my first choice would be to have the procedure done in Ottawa. The city boasts Canada’s largest heart health centre and is highly regarded for treating heart disease. But, from the limited information available, it appears they are not a high-volume center for a-fib ablations, and I haven’t been able to determine how experienced and skilled their EPs are. The only way I might be able to find out is to ask my GP to refer me to their arrhythmia clinic where I might be able to ask the questions. You don’t get to talk to specialists here without a referral. Not sure about wait times here from initial appointment to procedure, but I think it would be several months.

My second choice would be to have the procedure done elsewhere in Ontario. In my research, there’s one name that has popped up several times: Dr Atul Verma at Southlake Regional in Newmarket, Ontario. From comments on this forum as well as other a-fib sites/forums, Dr Verma seems to be highly regarded. And I also read somewhere that Southlake has the highest volume ablation program in Canada. The down side of going there is the distance from my home (a 4-hour drive) and the question of support afterwards if a touchup is required or complications arise. I’ve also read on this forum that the wait time to get it done can be 6 to 9 months from acceptance.

The third option, and the best, would be to go to either Natale or Bourdeaux. The chances of a successful outcome on a first ablation would be higher. While the cost is substantial, it would be worth it if the procedure was successful on the initial ablation and no follow-ups were required. But if a 2nd ablation were required, there would be an additional financial outlay of the same amount (ouch!). And I think their wait times are long as well.

So what to do? There are pros and cons for each. I need to make a decision and move forward with something now while I’m still in paroxysmal a-fib and chances of a successful outcome are higher.

Does anyone on this forum (Shannon perhaps) have any words of wisdom that would help me decide. Thanks!

If you go with Natale or Bordeaux, I strongly suggest you choose Natale over Bordeaux.

Carey -- is there a reason for suggesting Natale over Bourdeaux?

Quote
Lorraine
Carey -- is there a reason for suggesting Natale over Bourdeaux?

<[www.afibbers.org]

Bourdeau will be cheaper. Some of our posters here from the UK & Ireland can be more specific.

and from a Shannon post from 2016 "Once you decide on an ablation, the best place for AFIB Ablation in Canada is, as GeorgeN noted above, at Southlake Regional Health Center in Newmarket Ontario ... which fortunately, I assume, is the province you live so you should not have any trouble hooking up with Dr Atul Verma who is the EP I would chose were I needing an AFIB ablation in Canada. His Colleague Dr Khaykin is also very experienced too with some good reports about him as well. Dr Verma has trained with Dr Andrea Natale who is peerless when it comes to AFIB ablation, though it has been over 10 years since Dr Verma worked with Dr Natale it is still a very good association to have had when he was at Cleveland Clinic when Dr Natale helped build CC's AFIB Center into a true world renowned research center when he was still there leading that program. " <[www.afibbers.org]



Edited 1 time(s). Last edit at 12/11/2018 08:57PM by GeorgeN.

Since you are a Canuck (like my wife Magdalena) Atul Verma at Southlake is very good Lorraine. I’ve sent a number of people to Dr Verma who did well and Dr Verma did train with Dr Natale long ago back in the Cleveland Clinic early glory days for AFIB ablation under Natale’s vision and guidance back then up though late 2007.

What ever you do though Lorraine, please Do NOT make an AFIB ablation decision based primarily, or even significantly, on ‘convenience’. Sometimes that approach may work out okay, but in my long experience working closely helping to usher so many people through their expert ablation process, I’ve seen many regrets from those who rolled the dice based on “the best EP ablation doc close to me”. This is your one heart, so be highly discriminating in choosing the very best and most experienced ablation expert you can possibly arrange for yourself if that requires 5 or so total days of travel!

Dr Natale is, without a doubt, my hands down number one choice in the world for AFIB/AFlutter ablation! He has objectively performed the most AFIB/Flutter ABLs on the planet at well over 11,000 and counting total and, as I’ve noted before, it is even more telling and important that over 75% of Natale’s annual caseload is comprised of LSPAF and persistent cases!

This fact is simply a phenomenally impressive and meaningful acheivement that literally separates even most other top tier EPs from Dr Natale’s unique career path, and no one else on the planet comes anywhere close to having so much individual experience with such a huge volume of cases often referred to Dr Natakr by other truly top ablation docs when they give up and punt their most difficult patients to Natale to fix when they may have taken three of four cracks at a given tough nut to crack and have not had real success yet.

It is extremely hard to attract that large of a percentage of the most challenging cases largely because it does require having become a defacto elite maestro in the eyes of so many other very experienced ablation EPs who will turn to you to help solve their biggest challenges. This presents a real catch-22 when it comes to anyone else ever catching up to Andrea anytime soon, even up through when he finally hangs up his catheters which, at nearly 58yrs old in two months, he likely won’t do for a good long while yet, and not with the passion and dedication Natale has for this field.

As a comparison, the director of the large UCSF ablation center serving the greater Bay Area with roughly 8,000,000 people said their average LSPAF patient Ablation case load average represent about 5 % of their total ablation case load!

Again, one would have to essentially mimic Natale’s entirely unprecedented EP ablation career to approach such a huge percentage of the most challenging cases and unless you perform very large numbers of such difficult and challenging cases yourself, which very few do, it’s extremely difficult to excel in every degree of difficulty of AFIB/AFlutter progression without having a similar large percentage of such patient’s to learn from over many years.

Those lessor numbers of ablation EPs who even offer persistent AF ablations, typically only do relatively modest numbers of persistent ABLs each year as it is, and yet for persistent and LSPAF patients, you truly should hold out for the most highly experienced persistent/LSPAF expert with the highest perscentage of cases just like your case and a renowned track record for consistent success as well, that are acheived every single day in their EP-Labs, to entrust your hearts care to their hands.

That is the safest bet in how I can do the very best for our Afibbers, bar none, as if each and every one were part of my family (not to mention my own over a decade of total freedom now from a 16 year bout of what eventually become an aggressive case of persistent AFI. I’ve simply found, in reality, that starting ones search ... and finishing it ... with the most experienced world-renowned operator grants the greatest odds of achieving durable freedom from even the most challenging cases of all Atrial Arrhythmias with typically the least amount of total work required... which is the key thing by far in my book!

Of course, there are other excellent ablation EPs available such as Drs. Rodney Horton, Luigi DiBiase, Pasquale Santangeli, Fermin Garcia, Amin Al-Ahmad just to name a few, and a good number of which were mentored by Dr Natale. And I readily recommend those patients who simply can’t make it to Dr. Natale, for whatever reason, to one of these relatively select highly skilled EPs, such as Dr Verma in Canada, Profs Jais & Haissaguerre in France and Claudio Tondo/Antonio Della-Russo in Milan Italy, etc., and others.

However, I almost always recommend Dr Natale as your first best choice from my many years now of seeing first hand how reliably those Afibbers I send to him are filled with gratitude many years later at what Dr Natale has done for them in: “giving me my life back” as the most ubiquitous comment I’ve heard over and over and over again so many times over these many years! It’s very hard to argue with that kind of success.

So long as Dr Natale remaims active at the peak of his prowess and the field, I suspect he will remain the go to guy, doubly so for the most challenging cases.

Also, in my book, Afibbers especially with persistent and LSPAF should not compromise one iota more than one absolutely has to in choosing your expert ablation EP. The more advanced your AFIB/Flutter, ever the more discriminating you should be in making this single most important choice that will have, by far, the biggest impact on your future AFIB history going forward!

Cheers and Happy Holidays!
Shannon



Edited 4 time(s). Last edit at 12/12/2018 10:36AM by Shannon.

Wow, thanks Shannon! Really appreciate all the information and your words of wisdom. Very helpful. I’ve been mulling it all over and have made a decision. My gut says go with Dr Verma so that’s what I’m going to do. I hope it’s the right decision.

Thanks also to Carey and GeorgeN for your inputs.

Merry Christmas!
Lorraine

Lorraine,

I’m from Canada as well and I went to Bordeaux about 3.5 years ago for an ablation. I have no hesitation in recommending that team. I did research Natale as well and would have loved to have had him but the price was prohibitively high (like 4X or more).
If you have any questions, let me know or shoot me a PM.

Monty

Thanks Monty. I'll send you a PM shortly.
Lorraine