Cleveland Recommendation and Tikosyn I asked part of this question previously, but wanted to see if the reply was still valid. We live midway between Cleveland and Pittsburgh, so going to either location is not a problem. Previously Cary had recommended asking for Dr Santangli at Cleveland for a second opinion before going an ablation route. Is that still the recommendation, and is there any recommendation at UPMC in Pittsburgh as an alternate. As background, my dear wife has had Afib episodes for the past ten years following a cardiac cath. Until this past year she was being treated with Multaq, metoprolol, and warfarin. Her burden was approximately 3% (30 day monitor). Last year she advanced to 100% burden, but without any significant pain and discomfort, but overwhelming fatigue and shortness of breath. AT LONG LAST, her EP stopped the Multaq, inducted Tikosyn and after 2.5 days cardioverted her with a single 288 joule shock. Great, however that lasted about 56 hours, and she's back in Afib (determined by apple watch and Kardia). We don't know if the EP will tell us to just stay with the Tikosyn for a while, or if he's ready to go immediately to ablation - we will probably learn that this week - but his practice here in Youngstown has been to push for the ablation. (other medical pros here have said to NOT get it done in Youngstown, for "reasons", but go to Cleveland - or Pittsburgh. So: the question is about recommendations for Pittsburgh or Cleveland and secondly are we not giving the Tikosyn attempt enough time? (BTW, she did not self-convert after 40 hours on the Tikosyn, therefore requiring the cardioversion) Thanks for any guidance, . https://www.afibbers.org/forum/read.php?9,195324,195324#msg-195324 Sun, 20 Sep 2026 18:47:44 +0000 Phorum 5.2.23 https://www.afibbers.org/forum/read.php?9,195324,195325#msg-195325 Re: Cleveland Recommendation and Tikosyn https://www.afibbers.org/forum/read.php?9,195324,195325#msg-195325
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Previously Cary had recommended asking for Dr Santangli at Cleveland for a second opinion before going an ablation route. Is that still the recommendation, and is there any recommendation at UPMC in Pittsburgh as an alternate.
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Yes, my recommendation has changed. She has progressed to persistent afib, she's highly symptomatic, and now she's failed two drugs, with one of them being the second most potent antiarrhythmic drug there is. So my recommendation now is she doesn't need a second opinion -- she needs an ablation. And she needs it with the most experienced EP she can find. Trust me, distance from home is a very minor consideration in the grand scheme of things. I'm sure UPMC has some fine EPs, but none of them are on Santangeli's and Natale's level. Take your wife to a top dog, not a second best.]]> Carey AFIBBERS FORUM Sun, 24 Mar 2024 18:11:07 +0000 https://www.afibbers.org/forum/read.php?9,195324,195324#msg-195324 Cleveland Recommendation and Tikosyn https://www.afibbers.org/forum/read.php?9,195324,195324#msg-195324 We live midway between Cleveland and Pittsburgh, so going to either location is not a problem. Previously Cary had recommended asking for Dr Santangli at Cleveland for a second opinion before going an ablation route. Is that still the recommendation, and is there any recommendation at UPMC in Pittsburgh as an alternate.

As background, my dear wife has had Afib episodes for the past ten years following a cardiac cath. Until this past year she was being treated with Multaq, metoprolol, and warfarin. Her burden was approximately 3% (30 day monitor). Last year she advanced to 100% burden, but without any significant pain and discomfort, but overwhelming fatigue and shortness of breath. AT LONG LAST, her EP stopped the Multaq, inducted Tikosyn and after 2.5 days cardioverted her with a single 288 joule shock.
Great, however that lasted about 56 hours, and she's back in Afib (determined by apple watch and Kardia).

We don't know if the EP will tell us to just stay with the Tikosyn for a while, or if he's ready to go immediately to ablation - we will probably learn that this week - but his practice here in Youngstown has been to push for the ablation. (other medical pros here have said to NOT get it done in Youngstown, for "reasons", but go to Cleveland - or Pittsburgh.

So: the question is about recommendations for Pittsburgh or Cleveland
and secondly are we not giving the Tikosyn attempt enough time?

(BTW, she did not self-convert after 40 hours on the Tikosyn, therefore requiring the cardioversion)

Thanks for any guidance,
.]]> Searching9 AFIBBERS FORUM Sun, 24 Mar 2024 15:49:08 +0000