There seems to be an ablation in my future. I came to this site in search of a way to find out who the top six or so doctors are in the USA who perform them.

But instead I find the consensus here is there is only one doctor to sign on with: Natale.

I am not opposed to that suggestion, but my instinct is there surely must be other doctors who have done more than a thousand ablations, and I would like to learn about them as well. I guess it comes down to I like to make my own choices. I would feel more comfortable if I choose Natale on my own, after reviewing his competition.

I found one website that ranks surgeons on how many different procedures they perform. That is not what I want at all. I want a doctor who does ablations almost exclusively. I watched the Youtube of Dr. Kneller doing an ablation, and it struck me what a challenging procedure it is. Working a probe into a beating heart, then applying therapy in precise points!

My wife thought I should be able to enter my zip code somewhere and get a list of 6 doctors in my area who do ablations. I told her she missed the point entirely! I am very willing to travel anywhere in the states to get one of the very best.

I may do another post with more specifics about my case. But for a brief background, I was diagnosed with 100% Afib burden on July 1. I waited three months before I could get a cardioversion. I was back in Afib a week later. Now I am waiting another 3 months for my initial consult with a regional EP. And meanwhile, I have read that Afib is harder to correct if it goes on for 6 months. So his definitely feels like I am stuck in the "slow business as usual" timeline. And it sure feels like I need to get on a more proactive path.

Looking for the top EPs who do ablations is exactly the right path. You want the EP who eats, breathes and lives ablations. I'll give you another name of an EP who's on par with Natale: Pasquale Santangeli at Cleveland Clinic. He trained with Natale.

I would also ask you to at least consider one or two at the Mayo facilities.

You want a high-volume EP at a top-ranked Cardiac Hospital. They get the best results. If they are not in your region, worth the travel, because you want the best chance to get it right the first time.

US News and World Report is a good resource for the rankings. Depending on your budget and insurance, interview at least three to see the best fit. I think I spoke to five or six before deciding. I am still in normal rhythm two and a half years later. Many will do virtual visits for the first consultation, so you only have to travel for the procedure itself. Pre-testing and follow-up can be handled locally.

Take your time and learn along the way. The best EP for Jack is not necessarily the best EP for Jill. Ablation is part science and part art, they don't all do it the same. Good luck.

Jim

Which docs at the Mayo Clinic do you recommend? Specifically Minnesota. Thanks!

The presenters at the annual ISLAA confererence are the top of the heap. Not all would qualify, but it is a universe where I'd start my search, as I posted here:
[www.afibbers.org]

Here is the list from the Jan 2025 conference: [islaasymposium.com]

If you wonder why the list is small, read Carey's post here: [www.afibbers.org]

I don't have a name for you at Mayo in Rochester, but I do have recent experience there, spending a week seeing doctors and having multiple tests done, not as a patient, but as an advocate for a family member. And it's an amazing place with a distinctly different culture than I've ever seen.

The doctors are excellent, but so are doctors elsewhere. The difference is that you will really get heard, just not talked to. We spent close to two hours with the intake internist, who started with a thorough medical history, not in an exam room where you are draped, half-dressed, and uncomfortably sitting on an exam table, but fully dressed in his office, in comfortable chairs across from his desk. And the physical exam was done as you read in textbooks, not with the skipped steps we have begun to accept from most doctors today. And for someone who asks a lot of questions, I think for the first time I actually ran out of them, lol. The same scenario was repeated when we saw the cardiologist and a few other specialists in this case. And all testing is centralized and often ordered and completed within days, which can save literally months or even a year, if gotten piecemeal from specialists at different institutions. And did I mention all the appointments started on time?

Rochester is a storybook city, more like an old-fashioned town where people (including the doctors) all seem to walk to work, and if not, those little green Lime electric scooters are everywhere, which I used daily to get from the hotel to the clinic. Being there felt as much like a vacation as anything else, but with the camaraderie of fellow patients from all over the world that you met every day in the stores, restaurants, streets, and hotel lobby

So I definitely give the place four stars and might even show up one day as a patient, if need be.

Jim



Edited 2 time(s). Last edit at 11/02/2025 01:19PM by mjamesone.

Thank you for all the responses, fellows. Now it is time for me to work the phone.

Libby, I am in Canada and so know of none at Mayo for cardiac arrhythmia pathology. However, my father was referred to Mayo for Coccidia infection by my wealthy relatives living in Milwaukee. He got top-drawer treatment and was cured within 12 months of the formal diagnosis. Mayo is arguably the best hospital facility on the planet, so you should anticipate excellent diagnostics and subsequent care at any of their several facilities. You can pretty much pick one EP and go from there.

From my iatrogenic experiences, I don’t think it’s the best rated hospital. It’s the best EP and good equipment. An example is once I found out I may have had cancer, I flew to the second best cancer hospital in the United States-Sloan Kettering because I had family in NY. Houston was #1. Unfortunately there are too many inexperienced residents at top notched hospitals and my MRIs that showed my cancer growing didn’t get detected by an attending for years-even after I flew in twice a year for imaging. My diagnosis slipped through the cracks by inexperienced residents.

I remember my oncologist waiting in the hallway for me with a hug and a hospital stationary letter in her hand saying due to human error (residents not followed up by attending) , I had a big tumor -later pathology said with a 24% survival rate. Had I gone elsewhere where radiologists actually look at imaging instead of relying on inexperienced residents, my cancer would had been diagnosed earlier and perhaps I would had been spared from aggressive chemo cocktails that affected my heart.

I say find the best EP, find out if it’s a learning hospital and if residents and fellows are getting their experience by practicing on you. I had another cancer surgery in June and the attending left the arena to wash up and his inexperienced resident did not know I’m allergic to steri-strips. The infection went to the bone and to this day I still need weekly wound care.

1. Find a good EP
2. A hospital with Proper high tech imaging equipment
3. Backup on call NP or another EP if you arrive at the ER after hours during a holiday or night. Someone on call.
4. Hands on by experience EP not shared with resident or fellow.

Susan, thank you for relaying your honest assessment of your experiences. I am sorry that you had them. It seems like hospitals should have a management system in place that prevents these types of oversights, but often the system creaks and fails.

We depend on those hardworking, conscientious staff members who focus on our needs despite all the distractions and misdirection the procedures throw at them.

Today I will see how much success I have getting through the phone mazes of a couple of doctors.

Thanks, Jim!!

Wow!! I'm so sorry you had such bad experiences! Definitely good advice to double check information with staff at a teaching hospital!!

Thank you, Gloaming!!

I sympathize with you and what happened. And one of the first questions I ask the EP — or maybe it's the last question — is who will be doing what part of the procedure, because I too worry.

That said, studies show that it's the high-volume centers that have the best results for ablation, and that, in the mai,n are the teaching hospitals. And in most cases, it will be an experienced Fellow assisting, and I doubt residents are even allowed in the operating room except to observe.

However, and not to contradict myself, one EP did suggest best not to have an ablation in July or August, because that's when the new rotations come in. He said, by September, everything should be fine!

Jim

Quote
mjamesone
That said, studies show that it's the high-volume centers that have the best results for ablation, and that, in the main are the teaching hospitals. And in most cases, it will be an experienced Fellow assisting, and I doubt residents are even allowed in the operating room except to observe.

I agree that high-volume centers have the best results. Some years ago a member here had an ablation at a center considered one of the top teaching hospitals in the country (not just for electrophysiology). The Fellow was threading the catheter and ripped a valve and (from my memory) created a tamonade. It was negatively life changing for them. The EP was very prominant and was out of the room when this happened.

It is one reason Natale would be my ablating EP choice if I wanted an ablation.

Quote
GeorgeN
It is one reason Natale would be my ablating EP choice if I wanted an ablation.

Yes, he does everything himself.

That's unfortunate, but unfortunately, a Tamponade can happen even in the best of hands and is one of the known risks of ablation.

In any event, a single case doesn't change the fact that studies show that overall complication rates at major teaching hospitals are about the same or better than at private centers. And that's not just because of high volumes, but because more eyes and hands can sometimes make a positive difference, distributing both workload and decision-making.

What's troubling about that member's case is that the supervising EP was out of the room during a critical part of the procedure. How long ago was that? I don't believe current hospital and Medicare standards allow that today.

Wherever you go, always good to go over who will be doing what before any procedure, and never make any assumptions. Personally, I never let them put on the mask until I see and identify my doctor walking into the room!

Jim

Quote
mjamesone
Personally, I never let them put on the mask until I see and identify my doctor walking into the room!

That's smart! I was knocked out before the EP made it into the OR

I was knocked out before the EP made it into the OR

Allegedly, made it into the room You had your ablation at a teaching hospital, right?

Jim



Edited 1 time(s). Last edit at 11/07/2025 12:29AM by mjamesone.

My EP came up to my operating table, arms held up in the 'I'm sterile' position, and began to ask me questions. So, I knew he was present and ready to begin.'

"What is your name?'

'Why are you here today?'

"Who will be performing the procedure?

When I answered, 'Dr. Paul Novak,' he replied 'Perfect!" and then began calling for drugs and tools while the mask was slid over my face. I was pretty confident that he was going to be manipulating the catheter because nobody else was introduced to me beforehand as an assistant.

What is your name?'

'Why are you here today?'

"Who will be performing the procedure?

That's the standard pre-surgical verification. What's unusual is that the doctor is asking, it's usually the nurse. Also, unusual that the questions are being asked in the OR and not in the holding area. Unusual, but good unusual. Sounds like a meticulous and conscientious doctor.

Then, when they knock you out, they are supposed to do what is termed a "time out", where they review who, what, and why, at least they are supposed to, but who knows, since you are knocked out

But while awake, you can call a "time out" yourself, and a good idea if anything doesn't feel right, like they are prepping your shoulder when you're in for a knee transplant. Happens

Jim