List of the top 5 Electrophysiogist in the United States We all know our sweet Dr. Natale is #1 but who would be considered #2/3/4/5 https://www.afibbers.org/forum/read.php?9,166224,166224#msg-166224 Mon, 21 Sep 2026 11:07:41 +0000 Phorum 5.2.23 https://www.afibbers.org/forum/read.php?9,166224,166431#msg-166431 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166431#msg-166431 tsco AFIBBERS FORUM Sat, 24 Nov 2018 02:55:41 +0000 https://www.afibbers.org/forum/read.php?9,166224,166410#msg-166410 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166410#msg-166410 Kleinkp AFIBBERS FORUM Fri, 23 Nov 2018 18:47:37 +0000 https://www.afibbers.org/forum/read.php?9,166224,166370#msg-166370 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166370#msg-166370
Quote
Kleinkp
When the operator is in your heart can he/she tell if triggers are beyond PVs?

Yes. And if they're good at what they do they'll be able to locate the precise locations and ablate them.]]> Carey AFIBBERS FORUM Wed, 21 Nov 2018 22:33:01 +0000 https://www.afibbers.org/forum/read.php?9,166224,166364#msg-166364 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166364#msg-166364 Kleinkp AFIBBERS FORUM Wed, 21 Nov 2018 20:36:30 +0000 https://www.afibbers.org/forum/read.php?9,166224,166358#msg-166358 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166358#msg-166358
Quote
Carey

OPERATOR SKILL MATTERS. There’s just no overstating this.

In my opinion, RF in the hands of a highly skilled operator will outperform cryo.

What he said.

Cryo is a reasonable approach if it's your first ablation, you're paroxysmal, and your EP isn't highly experienced. It gives you roughly a 65% chance of success. If it's not your first ablation, if you're persistent, or if your EP isn't highly experienced, then you need RF ablation from an expert and shouldn't even consider cryo.

My first EP did RF back in 2009. I had almost 10 years of relief from it. He used Cryo the second time around and if the issies would have just been reconnection or missed areas it would not have been an issue. However, it was less thatn 3 months before I was back into persistant afib which was worse than where I started.

An EP entering your heart doing Cryo is tying his hands. If your triggers lie beyond the Pulminary Veins, as was the case for me, there is nothing he can really do unless he pulls and reneters with the RF Catheter. that is assuming he has the skills to address triggers that lie beyond the pulminary veins.]]> rocketritch AFIBBERS FORUM Wed, 21 Nov 2018 10:57:50 +0000 https://www.afibbers.org/forum/read.php?9,166224,166355#msg-166355 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166355#msg-166355 Joe AFIBBERS FORUM Wed, 21 Nov 2018 08:07:00 +0000 https://www.afibbers.org/forum/read.php?9,166224,166353#msg-166353 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166353#msg-166353
Quote
wolfpack
OPERATOR SKILL MATTERS. There’s just no overstating this.

In my opinion, RF in the hands of a highly skilled operator will outperform cryo.

What he said.

Cryo is a reasonable approach if it's your first ablation, you're paroxysmal, and your EP isn't highly experienced. It gives you roughly a 65% chance of success. If it's not your first ablation, if you're persistent, or if your EP isn't highly experienced, then you need RF ablation from an expert and shouldn't even consider cryo.]]> Carey AFIBBERS FORUM Wed, 21 Nov 2018 06:13:35 +0000 https://www.afibbers.org/forum/read.php?9,166224,166351#msg-166351 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166351#msg-166351 JakeL AFIBBERS FORUM Wed, 21 Nov 2018 05:03:56 +0000 https://www.afibbers.org/forum/read.php?9,166224,166350#msg-166350 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166350#msg-166350
Quote
Kleinkp

RF for paroxysmal what can make it more effective then the ballon?

Thanks!

It’s always going to come down to operator skill. An expert with a balloon could easily outperform a greenhorn with RF. That being said, take a moment to think about the tools and how they work. The balloon inflates, gets cold, and makes a big lesion all at once. If this lesion is both continuous and transmural then great. If it has “holes” in it then maybe not so great. And that’s all assuming that the only source of ectopy are the pulmonary veins. The RF catheter has a finer point to it and delivers a very focused heat. I’ve said before it’s basically a soldering iron. About 40W of power in a pencil tip. The operator can makes “dots” (or lines in the case of Natale), and he or she can go back and re-do spots that may need it. Burns can be made elsewhere in the left atrium as required. It’s a much finer and more precise tool. Of course, it can also do more damage in the hands of a poorly skilled operator. It can burn a hole through the heart. It can “weld” the esophagus to the heart and precipitate an almost always fatal complication of atrioesophageal fistula in the days or weeks following an ablation.

OPERATOR SKILL MATTERS. There’s just no overstating this.

In my opinion, RF in the hands of a highly skilled operator will outperform cryo. Everyone is, of course, entitled to form their own opinions.]]> wolfpack AFIBBERS FORUM Wed, 21 Nov 2018 02:32:20 +0000 https://www.afibbers.org/forum/read.php?9,166224,166348#msg-166348 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166348#msg-166348
Quote
Carey

What determines where in the atrium the ablation will take place? How is it determined to isolate only pulmonary veins?


It takes place where the pulmonary veins enter the left atrium, which is on the roof of the atrium. The balloon freezes a circle around the PVs thereby creating lesions that turn into scars and electrically isolating them.

The pulmonary veins have been found to be the most common source of afib signals, so that's they they are isolated. Doing only the PVs will stop about 65% of paroxysmal afib and about 40% of persistent. Cryo is totally inappropriate for persistent.

RF for paroxysmal what can make it more effective then the ballon?

Thanks!]]> Kleinkp AFIBBERS FORUM Wed, 21 Nov 2018 01:57:45 +0000 https://www.afibbers.org/forum/read.php?9,166224,166347#msg-166347 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166347#msg-166347
Quote
Joe
How do they establish the source of the stray electrical impulses prior to actually going in with a catheter and therefor be in a position to choose if cryo or RF is the best way to do the job?

They don't, because it's not possible. The only way to map the electrical activity inside the heart is to be inside the heart with the mapping catheter. At that point you've chosen your EP and he or she has chosen the tool.]]> wolfpack AFIBBERS FORUM Tue, 20 Nov 2018 23:48:23 +0000 https://www.afibbers.org/forum/read.php?9,166224,166346#msg-166346 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166346#msg-166346 How do they establish the source of the stray electrical impulses prior to actually going in with a catheter and therefor be in a position to choose if cryo or RF is the best way to do the job?]]> Joe AFIBBERS FORUM Tue, 20 Nov 2018 23:42:12 +0000 https://www.afibbers.org/forum/read.php?9,166224,166345#msg-166345 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166345#msg-166345
Quote
Kleinkp
What determines where in the atrium the ablation will take place? How is it determined to isolate only pulmonary veins?

It takes place where the pulmonary veins enter the left atrium, which is on the roof of the atrium. The balloon freezes a circle around the PVs thereby creating lesions that turn into scars and electrically isolating them.

The pulmonary veins have been found to be the most common source of afib signals, so that's they they are isolated. Doing only the PVs will stop about 65% of paroxysmal afib and about 40% of persistent. Cryo is totally inappropriate for persistent.]]> Carey AFIBBERS FORUM Tue, 20 Nov 2018 21:14:23 +0000 https://www.afibbers.org/forum/read.php?9,166224,166339#msg-166339 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166339#msg-166339
Quote
Carey

Cryo is always done with a balloon. It's more of a cookie cutter, one-size-fits-all procedure that's much less dependent on operator skill than RF ablation. It isolates only the pulmonary veins, so if that's the sole source of your afib, it can be very successful. If you have sources outside the PVs, it won't be successful.

What determines where in the atrium the ablation will take place? How is it determined to isolate only pulmonary veins?

THANKS!]]> Kleinkp AFIBBERS FORUM Tue, 20 Nov 2018 19:19:41 +0000 https://www.afibbers.org/forum/read.php?9,166224,166330#msg-166330 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166330#msg-166330
Quote
Joe
Thank you!
Any particular reason why you don't want CBA? The reason i'm asking is because my EP refered me to his 'boss' who does cryo but i don't know if it is with a balloon until i see him in December.
Got a previous impression that it is the operator rather than the method used???

Cryo is always done with a balloon. It's more of a cookie cutter, one-size-fits-all procedure that's much less dependent on operator skill than RF ablation. It isolates only the pulmonary veins, so if that's the sole source of your afib, it can be very successful. If you have sources outside the PVs, it won't be successful.]]> Carey AFIBBERS FORUM Tue, 20 Nov 2018 16:21:13 +0000 https://www.afibbers.org/forum/read.php?9,166224,166328#msg-166328 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166328#msg-166328 Any particular reason why you don't want CBA? The reason i'm asking is because my EP refered me to his 'boss' who does cryo but i don't know if it is with a balloon until i see him in December.
Got a previous impression that it is the operator rather than the method used???]]> Joe AFIBBERS FORUM Tue, 20 Nov 2018 03:25:24 +0000 https://www.afibbers.org/forum/read.php?9,166224,166326#msg-166326 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166326#msg-166326 Kleinkp AFIBBERS FORUM Tue, 20 Nov 2018 02:37:49 +0000 https://www.afibbers.org/forum/read.php?9,166224,166324#msg-166324 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166324#msg-166324 Joe AFIBBERS FORUM Mon, 19 Nov 2018 21:13:11 +0000 https://www.afibbers.org/forum/read.php?9,166224,166319#msg-166319 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166319#msg-166319 Kleinkp AFIBBERS FORUM Mon, 19 Nov 2018 14:25:20 +0000 https://www.afibbers.org/forum/read.php?9,166224,166309#msg-166309 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166309#msg-166309 should be. BUT, doing too many back to back because of high demand may lead to rushed/botched ablations. Same with any surgery, so looking at the total number done alone is not a full proof measure of the quality of the surgery. Just a skeptic/realist.]]> Ken AFIBBERS FORUM Sun, 18 Nov 2018 14:48:10 +0000 https://www.afibbers.org/forum/read.php?9,166224,166299#msg-166299 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166299#msg-166299
Quote
Kleinkp
At least list of high volume RFA operators would be great.

That might be a more achievable objective and it would definitely be of value.]]> Carey AFIBBERS FORUM Sat, 17 Nov 2018 05:59:12 +0000 https://www.afibbers.org/forum/read.php?9,166224,166297#msg-166297 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166297#msg-166297
At least list of high volume RFA operators would be great.]]> Kleinkp AFIBBERS FORUM Sat, 17 Nov 2018 02:55:55 +0000 https://www.afibbers.org/forum/read.php?9,166224,166255#msg-166255 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166255#msg-166255
The same issue(s) apply to all medical procedures when looking for the best available Dr.

Bottom line - it isn't going to happen. We all struggle to find the best doctors for whatever care we need, and the best way is usually knowing enough folks in the medical field to ask who they would go to, to have a particular procedure done. I have been lucky in that regard since my wife was in hospital management and administration for most of her career.]]> Ken AFIBBERS FORUM Wed, 14 Nov 2018 15:25:48 +0000 https://www.afibbers.org/forum/read.php?9,166224,166231#msg-166231 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166231#msg-166231 I know of one allegedly top EP working in a top hospital who did 3 ablations in 18months to get a result - so far so good. This EP doesn't inspire me with a lot of confidence.
Last visit to my EP i mentioned that and he told me data on success rate of EPs is not available to his knowledge. However, he knows a number he would be happy to do a procedure on him. He ruled himself out (he is quite young) as having not enough experience to do it by himself. He also recommended that i see his boss who trained him.]]> Joe AFIBBERS FORUM Tue, 13 Nov 2018 05:27:02 +0000 https://www.afibbers.org/forum/read.php?9,166224,166227#msg-166227 Re: List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166227#msg-166227 Carey AFIBBERS FORUM Tue, 13 Nov 2018 02:12:10 +0000 https://www.afibbers.org/forum/read.php?9,166224,166224#msg-166224 List of the top 5 Electrophysiogist in the United States https://www.afibbers.org/forum/read.php?9,166224,166224#msg-166224 Anonymous User AFIBBERS FORUM Tue, 13 Nov 2018 00:07:33 +0000