EP consult - lots of unanswered questions and concerns

HI eveyone - Last Tuesday I had a consult with an EP from the office of my cardiologist, regarding his feelings on ablations and what he recommended for me. I had no intention of using him should I have an ablation, but decided to talk with him anyway, at the suggestion of my cardiologist (who I do like).

Dr. Altman said a few things that seemed wrong to me...First that ablations just go to (thorugh?) the pulminary veins. I thought Dr. Natale did more than that, no? He said that women have more strokes than men...(isn't that because more women live longer in the first place?)

He also said that since I"m a female and also have had high blood pressure (on and off), that would give me a CHAD score of 2, and that he would have me on a blood thinner as I have a higher risk of having a stroke. (since the BP wasn't high now, maybe not...but definitely by the time I turn 65...I"m 59 now). I am on a very low dose of a diuretic (potassium sparing), and my pressure was only 120/80 while in there. I had also had a stress test and echo at the same hospital a few days prior, and my pressure started at 130/90 (I was nervous about the test) and went down to 120/70 before I left...so I don't think my BP is a big issue. As for the stress test and echo - all was fine - no problems. When I told my cardiologist what Dr. Altman said about a stroke, she said she didn't think it was a concern for me, based on my history and test results. However, she was the one who recommended this EP....? She thinks he's good with ablations, but just doesn't have a lot of experience yet.

Is that true that a Chad score of 2 is a concern, and being a female plays into that (giving me an automatic Chad score of 1 no matter what?) and is a blood thinner really necessary by the time am Afibber is 65 - especially a female?

I didn't think he seemed very good - he only does about 1-2 ablations/week...and his information didn't feel right to me.

My cardiologist also said she feels I shouldn't go for an ablation until I really feel I'm desperate (or similiar words..)

What do you all think about any of this?

~ Barb

Barb,

Being female plays no part in the CHADS2 score and neither does age over 65. So your CHADS2 score is 1 (for hypertension). However, the EP may have been referring to the CHA2DS2-VASc score which does consider female gender and age over 65 as risk factors. In my opinion, using chronological age as a risk factor does not make sense. For more on the two scores see [www.afibbers.com].

Doing one or two ablations a week is not enough to make an EP competent. The "top guns" do two or three a day and have been doing so for 10 or more years.

As far as when to go for an ablation. In the "old days" (8-10 years ago) we used to say: "You are ready for an ablation when your quality of life is so bad that you don't care whether you leave the operating room alive." I believe most afibbers nowadays go for an ablation well before this stage is reached most often if episodes are highly symptomatic and occuring on a weekly or more frequent basis. It is generally advisable not to wait till the condition becomes persistent or permanent as doing so is associated with a lower chance of a successful outcome.

Hans

Hi Tobherd

I am a recent ablatee (if that's a word) and I went to an experienced EP, someone with 7 years of doing 3 days a week in the EP lab at a top hospital with a good EP lab reputation. I am sure the more experience the better, but as the regulars here agree, doing 1 or 2 a week for a few years doesn't inspire confidence in this kind of work. To me it's like getting a root canal from my regular dentist only with more than a tooth at risk. Just my 2c

Time to run like a bunny. You may like your cardiologist and you may even have been comfortable with the EP, but the fact of the matter is that you want to sit down with the best cardiologist/EP that you are able for a consult and workup.

I made the mistake of going to a cardiologist that did not know Afib from a hole in the ground and never did get to see an EP for over a year until I DEMANDED a referal to two of the best who happen to be located 20 minutes up the road.

I am absolutely comfortable with the experience they have and knowledge of aFib. I have been on TIKOSYN since December 2011 and in NSR. They have no hesitation in putting me on a long term event monitor, etc. Our last meeting was two weeks ago at which time they said that my event monitor (worn for almost a month and removable for showering every morning) showed skipped beats and nothing more. Nothing but NSR and skipped beats. They went along with supplementation and skipped beats have again disappeared pretty much as long as I maintain my supplements and dietary restrictions. My BP is a bit high and they have addressed that with some meds for the moment. TIKOSYN is not for everyone... in fact, it gives me a fuzzy head most mornings that takes two hours to clear.... but my wife has the same until she has her second cup of coffee (none for me).

I think that if I were in your place I would respectfully ask my cardio or family doctor for a referal to a top ranked cardiologist/EP. aFib, I can assure you, is nothing to be fooled about with. Regular aFib episodes caused my left atrium to expand to 60mm. In NSR it is not shrinking.... how much we don't know. Hopefully over time it will shrink back to normal size (about 40mm; it is 54mm now). No guarantees. But I would surely want to be sitting across from the best in the business whether I was having my car worked on OR my heart. You deserve no less.

Free advice is worth double what you pay for it. Zero.

Murray L

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Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.

Barb,
What hospital is this EP affiliated with?
I thought I read your cardiologist raved about Dr Reddy at Mt Sinai?????

Yes, I agree...this EP did not seem competent enough for me - or knowledgeable enough either. I do understand your comment about not waiting until the afib becomes persistent or permanent, Hans, but I have had this for 10 years - and have not progressed to either at this point. Just had a stress test and echo.and heart was fine - no enlargement, everything was normal. Under those circumstances, it seems OK to wait some more.....in my opinion anyway.

Yes, McHale - she did recommend Dr. Reddy highly. Why did you write it like you were in disbelief? Did you have some kind of negative experience with him??

Barb

Hi Barb,
I really liked Dr Reddy even thou he was a bit rushed with me since he was running late.
My disbelief was with your cardio even recommending Dr Altman after he told you Dr Reddy was a genius if I remember your post correctly......
I still haven't scheduled anything....it's hard when your in NSR
I know I know my recent TIA