Newer type of ablation?

So, I have an ablation on the schedule. The type of ablation they offer is the thermal ablation, and I believe that is the only option. I saw an article today about doctors that are having success using a different method, I believe it is "pulsed field ablation. Here is a paragraph:
By contrast, pulsed-field ablation uses electrical fields to create tiny holes in the membranes of heart muscle cells. This causes the targeted cells that contribute to irregular heart rhythms to die without altering the overall structure of the tissue or affecting other cell types. Pulsed-field ablation has been used to treat cancer by killing tumor cells for about a decade; however, the technology has only recently been applied to the heart.

Anyhow, this will be my first ablation, naturally we all want our procedures to be safe but also successful in helping our issues. Wondering if I should be getting second opinions by talking to other doctors first about options or if I just go for it and hope/pray for the best outcome. I feel like on the forum here, there are many who have had unsuccessful ablations... especially first ones sometimes finding success with the 3rd or 4th?
Maybe Im wrong. Wanting to make the best decision. Thanks for any help.

Currently, Pulsed Field Ablation (PFA) is only permitted/sanctioned for pulmonary vein isolation (PVI). That's pretty much the first ablation they do with the huge majority of patients if they present with AF. The thermal method, or what we call radio frequency (RF) ablation is also used routinely for a PVI. The risk disparity is very tiny, but measurable, between the two. If it matters, I have had two RF ablations, one in July 22 and the second in February 23. Both were PVI, and I had no problems. IF you are offered a PFA ablation, by all means. If they offer you one next month, but not PFA, take it. It's the skill of the electrophysiologist (EP) that accounts for 98% of the success.



Edited 1 time(s). Last edit at 08/13/2024 04:44PM by gloaming.

To gloaming's point about EP skill, Carey's 6 ablation story here is illustrative. Spend your time finding the best EP you can arrange. Not the tools they will use.

George, thanks for your comment, and if you can elaborate please. How do you know whether your EP is the best? Do you go by reviews online? Do you ask them for references in reg. to the procedures they have done and success rates? Thank you!!

You can phone the local university hospital and ask to speak to someone in the cath lab. Ask them which of the EPs they'd send their husband/wife/son/daughter to if they could.

Talk to your family doctor (General Practitioner, or GP). Make an appointment and pay for the time, but make it the topic of interest. That person should provide you with a candid assessment of the local practitioners. Ask the same questions as above.

Ask around for any nurses in your circles. Ask to speak to two or three of them and ask them for help to navigate this quest. One or two of them might agree that Dr. X is da bomb.

I find that most online reviews tend to be negative, almost revenge-oriented. My own EP was the Top Candidate for Canada as awarded by the Canadian Cardiac Society, and is highly regarded by the nurses in the cath lab. They warn that he's all business, and won't invite you to his next back yard barbeque, but he's really good at what he does. Yet, the reviews, as I have found for most of the local internists who work in the local ER, are strongly negative about their arrogance, didn't listen, dismissive, etc. These are people who have not had their way, or what they thought they needed, from experts who have become very adept at discerning what is salient about each case and what is irrelevant. People don't like being told that what they've just related, that they think is key to their circumstances, is unimportant and that he/she can't help them...or do what they ask.

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LaDonna
George, thanks for your comment, and if you can elaborate please. How do you know whether your EP is the best? Do you go by reviews online? Do you ask them for references in reg. to the procedures they have done and success rates? Thank you!!

I've been on this board for 20 years, but have not had an ablation. Hence hopefully the people who have will give you their opinion.

You can phone the local university hospital and ask to speak to someone in the cath lab. Ask them which of the EPs they'd send their husband/wife/son/daughter to if they could.

Don't do this. The staff are too busy to take a call like this. Also, they will be very hesitant to answer questions such as this to a complete stranger especially when they are working. To answer a question like this as an employee they could find themselves in trouble w management. The EP's working there would not be happy if they knew employees while working were recommending patients see one particular physician. If I got a call like this, I would refer you to your Int med doc or cardiologist and tell you have a discussion w them. And it would get out that staff are recommending one MD.



Edited 2 time(s). Last edit at 08/15/2024 02:20PM by JakeS.

If you have access to the various symposiums - LAA closure symposiums, StopAFIB.org, etc. The people who go to these workshops (practitioners) are generally regarded as highly experienced. You can scroll down through the list of presenters and attendees and review their credentials. That may guide you to who you would like to reach out to. Many come from high volume institutions. In the past folks who have attended these either virtually or in person post the web site information. Carey may still have a few of those web sites from the symposiums that occurred this year. I do not know how long these symposiums keep the web site available.

I recently met a workshop participant who lives in northern California. She is contemplating an ablation. (her afib is quite significant even on drugs) Her insurance company sent her to their in-network EP. She asked him how many ablations he has done and success rate. His response was "several" and "pretty good" results. She is going out of network.

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sldabrowski
If you have access to the various symposiums - LAA closure symposiums, StopAFIB.org, etc.

The attached file is from the 2024 International Symposium on Left Atrial Appendage (ISLAA) conference.[islaasymposium.com] They are already redoing the website for 2025. Not all the presenters may be ablating EPs, but this is an excellent way to start. There are a number of people on this board who've had ablations by Dr. Andrea Natale in Austin, TX. He would be an example of an EP at the top of the list. Of course he will naturally have a significant waiting list for consults and ablations.