Are we making too big of a deal out of getting an ablation? Are we "burning daylight"?

I wonder if I spend too much time researching, fretting, and vacillating about getting an ablation. One of my associates, Tricia had Afib for just 9 months, did basically no research, went to a local heart hospital and had an ablation, and all is fine. It seemed so effortless and simple for her. Makes me wonder if I should "just DO it"!

Am I - are we - making too big of a deal out of getting an ablation? Tricia says she feels like her old self and is already back to exercising and a normal life (had ablation at the end of December)

I don't know about the rest of you, but i know I tend to over analyze situations and weigh and balance my decisions and this feels like a big one. Yet when i hear someone like Tricia talk, I feel a bit...foolish. Am I wasting years in and out of Afib when I could just get this over with?

I know there are risks...but I also know of several people now who did not go to "the best" doctors...they just went to very good ones and didn't even know much about the many things we all know about. And it all turned out fine.

Maybe it's better NOT to know too much...

What are your thoughts?

Barb

Hi Barb,

Its a two part question really.

1. Do people worry and procrastinate too long to get an ablation even when they need one .. answer is probably yes in many cases .. I know I did.

2. Then why not just wing it with any recommended doc in my local community since I have heard of a couple anecdotal reports of people who seem to doing fine now with just the local guy.

That one requires a more measured answer, First of all there is no questiion that some people do have decent outcomes with less skilled ablationists. Most often they are the folks with a combination of a fairly simple straight forward paroxysmal AFIB requiring only a simple PVAI to do the trick and also roll the dice with a little luck of the Irish on their side.

The real point is, that the main decision is when and if to have an ablation. Once that decision is pretty much decided, it doesn't take much longer or more drawn out effort to go to a top quality more experienced EP than the decent but relative newcomer with under 1,500 ablations under their belt.

The thing is that while its very true good results happen everyday with decent but unknown docs that are still climbing the experience ladder, its equally true that a significantly larger share of unwanted complication or less that satisfactory out comes happen with those Docs who are less experienced.

Fortunately things are improving, even with the less experienced EPs with improved technology, but if you can go to a real maestro for not too much more difficulty for the same procedure, your offs of having an excellent outcome all the way around including with his support staff is significant.

It all depends on what level of winging it you are willing to risk with your heart? If that is all you can do then make the best of it and the odds are things will work out reasonably well anyway. That's the silver lining part. But if you can at all add more insurance on your side then it seems more risky to just assume they are all a dime a dozen and just pick the best guy in your neighborhood.

The big issue is with more difficult and long standing AFIB like persistent. That is where it really pays off big time to be more deligent and not just throw caution to the wind.

Read the difference in outcomes in Hans' surveys between the top level centers and those who do less volume. There is some good info there and then decide what you are willing to do? That is a better course than taking comfort just from a few anecdotal reports of a handful of people who seem to have done okay.

Shannon

I think I would think about any surgery on my heart. I've only got one.

It certainly seems to me like the risk/return ratio for time spent researching something like this is high enoough to keep doing it. However, if you only want to do a little bit, go to one of the top 10 EP's and follow his advice. Procedures like that have not reached the back alley coat hanger stage quite yet.

Gordon

Barb,

Shannon is correct. If you know someone where it worked out, that seems great. There are also horror stories where people end up with tamponade, a new valve and a failed ablation and just missed death. It all depends upon who you happen to know. If you know somebody in the first category, you'd think this is easy, if you know someone in the second, you'd likely never get one. This is why statistical analysis is useful.

Gordon is also correct, if you go to one of the top operators, the outcome is much more likely to be successful and there is much less chance of an awful outcome.

George

My ablation was performed about 3 months ago. I was in a lot of pain (chest) afterwards for weeks, had insertion point lump and pain for 6 weeks, had some voicebox damage from anesth. insertion and it got infected, had major tachy right afterwards, still have problems with ANS affecting heart function, etc. I'm not yet out of the woods regarding afib either, as I have had several short episodes of less than 3 minutes duration.

I'm not sure if I would have a second procedure if the afib returns and is otherwise controllable...lot's to consider. Sometimes things can go wrong even in the best of hands. I'm glad I had the first procedure as I'm much better off than I was.

Tobherd, in my case yes I had had enough of AF and the Flec/Dilt PIP - a few times a month was bearable but 12 a month was a drag and that's how it was last summer and although I had a normal echo I didn't want to risk it getting persistent . I saw a very smart EP that had 6 years of daily experience and Mass General EP Lab (well, the whole hospital really) has a good reputation, so I made the decision pretty quickly and weighed the pros and cons as far as I was able. I didn't worry about the tamponade and the rest. It was 1-2% risk generally. So far, and it has been over 3 months it has been successful. It was "standard PVI", with no frills. I had some weird stuff go on once or twice for a few weeks but EP said it wasn't AF (maybe it was PACs at week 1 and 3 - they gave me an ECG recording device I could use if I had any symptoms). My heart rate was up there for a while (75-80) but now it seems to have gone back to where it was (50-55) before the ablation - I mean to ask the EP or Cardio what this is about next time I see one of them as I expected it to stay up for longer but I mainly want to ask them what is known about the effect on things like HRV and DC and other things that are (now) a bit late to let influence my decision.

Some folks have a difficult time making a decision. Do some research, find the best doc (in my case, Natale) and get it done, IMHO. It took me a year from 24/7 to the ablation, never regretted it. 7.5 years of NSR.

Thanks for all of your responses. I live in New York and could much more easily go to someone like Dr. Larry Chinitz at NYU (although I'm not sure of that situation as NYU hospital was out of commission due to Hurricane Sandy flooding....or another very good EP in the NYC area. He has a great reputation, but it is good enough or should Dr. Natale be the only one to really consider when "going to the best"?

What surprised me was that my own cardiologist told me that St. Francis hospital on Long Island was very good heart hospital overall, but not so good for ablations. Yet that's just where Tricia had hers done...

So is Dr. Natale the only doctor in the US that people consider to be "elite"?

BArb

Barb,
Dr Chintz's lab is up and running again and they are back to doing ablations.
That's the problem everyone talks about Natale as the only go to guy that it presents confusion and doubt about every other EP. If Natale was in New York I would have done it already myself........
So were stuck with "Chintz, Reddy and Steinberg"........ who ablate at 3 of the top hospitals in the country and have done over 6-7000 ablations between them !



Edited 2 time(s). Last edit at 01/27/2013 02:50AM by McHale.

No - there are a couple of EP's in Marin County, north of San Francisco, who participated in my ablation, and I would trust either of them to do an outstanding job. It does not have to be Natale, but someone who has an excellent record and has done many successfully.

7.5 years ago I was warned by my then cardio to NOT have the ablation done in Denver area because they were still learning. Hopefully, that has changed by now, but I would not go to just anybody.



Edited 1 time(s). Last edit at 01/26/2013 10:46PM by dnvrfox.

I was interested to see what Dr Pinksi said in the Cleveland Heart Q&A that was recently posted

Chris M: 2. How many ablations a year should a competent EP perform?

Dr. Pinski: There is no strict number. Once an EP is over the learning curve, a huge number of ablations are not required to maintain the skill. If the whole team, including lab staff, anesthesiologists and nurses are stable, 2 or 3 a week should suffice.

Chris M: 3. What is your opinion of the FIRM ablation and why do you hold that opinion?

Dr. Pinski: I do not have personal experience with FIRM ablation and I am eager to see more studies coming out in the future. For now, I am remaining skeptical that it is a “magic bullet”. In my experience and that of others, termination of atrial fibrillation during ablation has not been a predictor of long term success. Furthermore, when patients with recurrent atrial fibrillation undergo second ablation we almost invariably find reconnection of several pulmonary veins. Re-isolation of the veins generally results in long term success. My hopes in atrial fibrillation ablation reside in developing techniques for more reliable and durable pulmonary vein isolation.

Hi Barb,

Its not that Dr Natale is the only EP that can do an excellent job for you in the US, not at all. there are other excellent ablationist with a good and growing track record as well.

The thing is this... when coming to make such a decision the question you or any one else should ask is this.

Do I have the time, circumstances and resources .. including insuracne flexibility ... that would allow me to go to the very best and most experienced EP you can find in this country?? Secondly does it mean enough to me if all the above are good for you to then go to the added expense and possible inconvenience of having to travel out of your area for a five days to a week to get this done by the man who has done more such procedures than any other person in the world and has a truly excellent track record by any measure?

If you can check off all of the above, then the last question is 'Why on earth wouldn't you go see him?" Absolutely you may very well get just as good a results from any of the other top 20 or 30 EPs on any given day as well. I'm sure some of them even approach or possibly are equal in their skill with a catheter and it is very true that more and more people everywhere are getting very satisfactory results with other skilled EPs in different parts of the country as well ... no question about it.

It just comes down to your comfort zone, what you can and are willing afford in terms of time and resources just to insure you couldn't have put your self in any better hands no matter what the outcome.

There is no guarantee with anyone, but Dr N has a a track record as good as any on the planet right now, as affirmed by Hans surveys as well, so if you can at all get to see him, then why not is the best question?

Some day, hopefully AFIB ablation will be as routine and simple as SVT ablation where nearly any half way decent EP can get similar results 95% of the time, then it wont matter so much .. but even then if you can swing it why not go with the guy who has the most experience?

On the otherhand, if your circumstances for whatever reason dont allow you to travel or you would just much rather do it all locally, then by all means just use the same criteria for choosing the very best albationist you can find in your area and trust in the fact that the odds will very much be with you for an excellent outcome if you only do a good job of due diligence in whom you choose in your area.

With Dr. Natale its such an easy decision as you aren't going to find anyone with more ablation experience anywhere. But that doenst mean you wont also find a real gem in the EP in your local or regional hospital who can also do a top level job as well.

The emphasis many of us make on going for the best is simply due to the complexity of AFIB ablation and the steep learning curve it takes to really become elite as well, as the small but very real consequences of a rough experience with someone who is relatively unknown are certainly possible. That's all.

And those of us who have gone through the trouble of really searching for the best option for us and chose Natale and then had such a good experience with him and his whole staff, quite naturally want to help make everyone else's job easier when we see them wrestling with the same choices we once did.

Keep in mind that a top gun like Natale also sees a much larger percentage of very challenging cases than most other even very good regionally known EPs. Many of Natales patients are referred to him after multiple failed ablations elsewhere. As such, a fair number of his patients are one's that few other EPs would even consider offering an ablation to.

That is why at times you will hear that some of his patients needed several ablations to get every thing repaired and on track. I was one of those who only Haissaguerre and Natale agreed to treat me at the time.

I can tell you first hand, there is a huge amount of relief and comfort when you know that you have one of the very best handling your case. This is particularly true for persistent Afibbers. It only takes a week at most out of your life to go see him in Austin or SF, most people can at least afford the time, if not the added expense, it they really wanted too and felt it offered them any advantage over the more convinent options.

McHale mentioned Vivik Reddy and he is certainly a top EP himself, and very bright and with a bright future. He is a very good choice if you couldn't leave the upper east coast area and there are a few others as well in that general area. Dr Reddy has somewhere in the neighborhood of 2,000 AFIB ablations under his belt plus or minus 500.. that is a good amount.. Dr Natale has right at 9,000 AFIB ablations by himself by now.

More run of the mill paroxysmal afibbers with just a few years of AFIB certainly have more latitude for making a good decision for sure and can get very good and fully satisfactory results from a much wider group of ablationists.

Shannon



Edited 3 time(s). Last edit at 01/28/2013 04:11PM by Shannon.

Hi Shannon,

Let's say you are a paroxysmal Afibber with atrial flutter and needed an ablation. (not straight forward)
You haven't any choice what EP is doing the ablation, but he is the most experienced in your country and the cost is covered by the health service.
On the other hand you could mortgage your house and go to one of the top EP's in France.
You are retired with a little income plus the pension.
What would you decide.

Colin



Edited 2 time(s). Last edit at 01/28/2013 02:55PM by colindo.

That is a tough one Colin.

Normally you would think it's a simple decision to go for the local guy .. (which country are you in by the way and how many ablations has you top option there done?) ... The fact that you are still paroxysmal strongly argues in that favor for doing it locally. But it's at least first worth asking how many years have you been paroxysmal and how frequent the episodes and are any of them longer than 24 hours duration??

Even still, if you really have to mortgage the house to get it done in Bordeaux that is taking it to the limit for sure. Just double check on the number of ablations the best option in your country has done and go interview him and really ask a lot of questions and find out first hand the comfort and confidence level you will have with him. That will be the main factor considering the very high relative price you would have to pay to go to such a recognized elite center such as Bordeaux.

Obviously, if you feel reasonably comfortable with the local EP and he seems to have a good track record for paroxysmal cases you should go with him considering the financial burden of Bordeaux at this point. And then, if you get a good outcome its great all around! But even if its only a partial success, the odds are very high you willl get at least some benefit and you could then reconsider going to Bordeaux for a final 'fixer upper', if need be, at some point down the line...

Keep us posted,
Shannon



Edited 1 time(s). Last edit at 01/28/2013 04:36PM by Shannon.

McHale Wrote:
-------------------------------------------------------
> Barb,
> Dr Chintz's lab is up and running again and they
> are back to doing ablations.
> That's the problem everyone talks about Natale as
> the only go to guy that it presents confusion and
> doubt about every other EP. If Natale was in New
> York I would have done it already myself........
> So were stuck with "Chintz, Reddy and
> Steinberg"........ who ablate at 3 of the top
> hospitals in the country and have done over 6-7000
> ablations between them !

Hey McHale,

Good to hear Chinitz it up and going again. Why was his lab down do you know? All three of those EPs in the upper east are very good choices and I like Dr Reddy a lot from all that I have read and observed.

And in particular in a case like yours only Paroxysmal clearly, you will do fine with Reddy and there is no big pressure for you to go to Austin necessarily.

While its no doubt true that once an EP becomes much more experienced in the couple thousand range. there will be proportionally a smaller and finer and less critical degree of manual dexterity skills improvement compared with the gains in the first 2,000 ablations and thus his inherent skills with a catheter may well not differ a lot from a top Elite with several thousand greater number of ablations done.

And in a Paroxysmal case it hardly matters as much as any really good quality ablationist should have similar results.

WHile Chinitz, Reddy and Steinberg have between 6,000 and 7,000 combined ablations between them, Natale at 9,000 now has roughly half again more then all three combined. However, the real advantage, if any, with Natale over any one member of this group would lie in his greater amount of experience with very difficult and challenging cases.

Beyond just the manual dexterity skills which may be in the same ball park for all of them, it is hard to replicate all the nuance and knowledge that comes from seeing so many different and complicated scenarios, often having to pioneer new approaches on the fly.

I'm sure Dr Reddy is more than capable with persistent cases too, and certainly with your relatively straight forward situation McHale there is little reason for concern with him in your backyard. If you are having still AFIB breakthroughs on your Flec, my only concern would not to put ultimate faith in only the Xeralto, or any other blood thinner considering your prior TIA close shave!

When and if the Flec stops working so well, don't procrastinate too much longer to get some more help on your side.

Cheers!
Shannon

What country and where?
If in Ontario, for example, all costs are covered by government health insurance and we have two or three of the best in the world in Newmarket. You need to be an Ontario resident. The hospital is in Newmarket.

I don't know about other hospitals but I would sure want some say in who does the hands-on work. I know that the chances of a successful ablation are higher with a well experienced EP in a top facility. No question. The risk of complication is also lower. And your advice is going to be better as well. I am waiting for my left atrium to shrink below 50mm before I even consider an ablation based on statistics my EP shared with me. I am on Tikosyn and while I think I may be experiencing some mildly unpleasant side effects (not sure if it is the Tikosyn)... his words to me were essentially that the Tikosyn has me in 100% NSR 24/7 and my LA is shrinking as a result. He is happy with my supplementing and suggests that I stay on Tikosyn as long as I am okay with it. It is also free in Ontario. His words? "You can't get better than 100%NSR, shrinking LA, advancing technology. Why would you NOT wait? I would tell my own family to wait."

On the other hand, if nothing is working for you, I think I would want a consult with an EP.... ANY EP.... right away. It is likely that asides from the misery of AFIB, your heart may be remodelling, eventually expanding to the point where you are not in the running for ablation. I know it took me exactly one year to go from 50mm to 60mm and out of the running. I was back down to 55mm about 4 months or so ago and I think they want to see if I continue to shrink, so I will be going in for tests sometime soon (echocardiogram, MRI, CT scan?). And at some point down the road they will put a 24/7 monitor on me to see if I have ANY arrhythmias asides from the odd skipped beats (which is what they found in Nov/Dec 2012 at the one year mark of Tikosyn).

I feel that in Ontario I am in exceptional hands and caring hearts. I am given the straight dope, good, bad or indifferent. No holds barred. And when I am in a position to have an ablation I can then consider it. In the meantime, I am on Tikosyn 500mcg b.i.d. and in 100% NSR.

The one thing that I don't think you want to do is permit status quo if you are in aFib AT ALL. You want to address it as aFib begets aFib and your heart will be slowly remodelling itself unbeknownst to you. Don't make the error that I did and let it slide. Take affirmative action right away. THAT DOES NOT MEAN ABLATION by the way. It means find the best EP you can and get supervised. Educate yourself as best you can and this is a great forum for that (thanks to Hans). ADVOCATE for yourself. CONTEMPLATE your situation. Can you manage your aFib on drugs? There are a plethora of drugs out there; just be careful you don't get a quack that doesn't know one from another. That is the reason to educate yourself.

Supplement! By Lord.... SUPPLEMENT! If there was only ONE supplement for me, it would be Potassium at this point. I take in 3g of supplemental potassium and my heart is calm. Last night I did not take in my potassium as we were out all day and I forgot. I had what was apparently from prior examinations and information, skipped beats. Some will actually slip into aFib if Magnesium and Potassium go low. MY list of supplemtation is on the forum here; just do a search to see what I am on in terms of meds and supplements. I am having gut problems the past few weeks, having run out of probiotics. More about to be ordered from iHerb.

DO NOT accept status quo. Start reading everything you can get your hands on and make an attempt to get some semblance of NSR back. If you are still in misery, then you need to decide if the EP available to you wherever you are is sufficiently proficient and experienced; if the facility is cutting edge technology or uses sticks and scissors, etc. And compare that cost to the cost of travelling to your closest top 12 EP. I lucked out and got in to see one of the top EP's and he (they) turned out to be 15 minutes up the road. And being in Ontario, pretty much without cost whatsoever.

I spend $250 or so monthly on supplements and do not regret one penny of it. And I have not worked in several years and have two children in University here in Ontario and am EXPECTED to pay into their education by the government before they will give them a penny of student loan money, which is just fine with me. Ontario has a law on the books that regardless of the cost of the program, after the parents and student have kicked in a reasonable amount annually, the maximum repayable amount per yeat is about $7500. My son is in Engineering at $30K+ a year and my daughter is in 'pre-med' at just less than that. Thank goodness for heavy taxes.

If I was in misery and meds were not helping? If I HAD TO travel to see one of the better or best EP's, I would take a mortgage on my home in a blink rather than let some ham fisted quack touch me. Been there and done that. It was NOT a happy experience but there are plenty more disaster stories that make mine pale... Start reading.

Murray L

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

Thanks for the advise and by the way, I live in New Zealand which is a long way from Bordeaux.

Colin

Many excellent points and perspectives here. Thank you for sharing your knowledge and your thoughts.

I have had paroxysmal Afib for almost 10 years now. Within the first 5 years, it had gotten to the point that I had it at least once, sometimes twice a day. I never had an episode last more than 14 hours (most were less), and I always self converted - usually after a brisk walk. I got tired of walking, walking in all kinds of weather, sometimes late at night, so I gave in and started Flecaninde after about 5 years of dealing with this. I had to get on a high dose (150 mg twice/day...but I am mostly in NSR. I do still get episodes of Afib, but they are much less frequent, short, and manageable. Almost all of my episodes take place when I'm home - late at night, early in the morning....Flecainide usually helps to terminate them.

So I WAS a very frequent Afibber - now MUCH better - but not completely Afib free. It IS pretty manageable now, but I'm concerned that as I get older (just turned 60 - yikes!) - that the docs will start pushing blood thinners on me and maybe it's time to just get this over with. I am scared to death of having an ablation, but wondering if it's not as big of a deal as I fear. I could certainly go to Dr. Reddy - or Dr. Chinitz - maybe interview both and see which one I 'click" with more....but still hesitate...should I just hang in there and hope for even more improvements?

According to my cardiologist, my heart is fine. No enlargements, all if fine. Just this little Afib thing....haha.

So I continue to vacillate....some days thinking I should just go do this, and some days...NO.

Do I sound like one of the "complicated cases" that needs to see Dr. Natale due to my very frequent Afib past?

Ahhhhh.....why could I - WE - just have a hang nail?

Barb

P.S. Shannon - Dr. Chinitz was out of commission I believe because NYU hospital was....due to flooding from Hurricane Sandy

The decision for ablation is a very very personal thing and one needs to take many factors into account as you have read. If your heart seems to be steady and not enlarging/remodelling AND if you are okay with the meds AND if you are okay with the aFib spells AND if you and your EP logically conclude that waiting a couple of years to ablate is logically correct, that is what I would do: but that's me. If I reach a point where things change to point me at ablation, I may decide to ablate sooner than later, while I still have two or three of the best available to me just up the road 15 minutes. It is a complex decision for sure. One needs to educate, contemplate and then advocate. Worked out well for me thus far and my only complaint is "balloon head" on most mornings. I am at the point today where I can work out to build strength (muscular, oxygen, heart, etc.) and am getting to the point where I will work out 7 days a week for at least a half hour or 45 minutes. Perhaps twice a day. Easy enough to work out before showering in the AM with a decent stationary cycle, some weights and elastics. I have been cycling about 20km. and am up to 2-3 times a weeks now. I'd like it to be every day but find it incredibly boring (boring as heck) so I am setting up a TV in front of the cycle/weights. Perhaps even my laptop on a stand.... it has voice recognition and command so that I can actually answer my emails while I am cycling or working out. Eventually I have no doubt that I will choose to ablate.... but as my EP says "Why not wait for the state of the art to advance since you are in 100% NSR on Tikosyn right now. It does not get better than 100%.".

Murray L

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

Glad to hear you are in NSR 100% Murray. That must feel wonderful! Yes, I wouldn't mess with those results either. I agree with all of the "if's" that you mentioned at the top of your last post, but it's harder when some Docs think you should wait and some Docs think you should do it. I dont' really go to the EP I went to a couple of years ago as I haven't really needed to - just get checked by my Cardiologist - and she seems to think I should wait until I feel I really NEED to get one. But I sure dont' want to wait to the point where I feel I can't stand it anymore, as it may take months to actually get one and by that time, it could progress to a more persistent Afib.

I'm a lousy decision maker anyway, but this decision to DO or WAIT is a simple one.

Barb

Barb: I am absolutely amazed (more like 'horrified') by the number of ignorant cardiologists out there. They may be great cardiologists but know too little about aFib and should be referring to an EP. The EP is the 'specialist' for aFib to be sure.

My first cardiologist let my left atrium grow to 60mm before I got in to see a good EP.

Murray L

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

I am one who felt like I didn't have much daylight left to burn. If you have a CHADS score of zero you should be okay; if you are a 2, going on 3, then you don't have a lot of time left, because something could happen at any time that would put you over the edge. Not to be alarmist, but it can happen.

Yes Murray..good point. I probably should see an EP again, but I'm basically hanging in there OK...hate to stir things up. I just have a week sometimes when I get more Afib then usual and and tired of it...but again, it's manageable. I have no enlargement...all my tests were normal.
I believe my Chads score was 1, and that was because I have slighly elevated BP...but then sometimes it's not....

Good to have someone to bounce these thoughts around with, as non-Afibbers really don't understand...

Thanks for "listening" ~ Barb

I look at the question in another way - Is the complication risk worth it? Perfection would be 100% success rate with negligible major complications requiring hospitalization. Reality for the very top guns is around 80% single procedure success rate with around 1% chance of major complications per procedure. The average for all centers that took part in the Cappato world wide survey is around 2/3 success rate and 3-4% major complications. However, it is hard to get a handle on learning curve success and complication rates. There are very few doctors/hospitals that are willing to publish safety data especially for the newly established ablation practice. The last one I looked at was New Zealand (Australian and US trained EPs) that published their first year experience. 15% major complication rate and 50% success. That gives you a spectrum of what is available.

If the complication rate is uniformly low for top guns vs learners, then even a 50/50 coin toss would be worth it. However, that is not the real world. Complication rate should be the top priority for screening out ablationists For example, many of the non-top guns but busy EPs also have low complication rates near 1%, they may not yet have the experience to get to top gun type success rates. It comes down to 5-10% lower chance of success. As long as there is no added risk of complication, it may be acceptable.

By the way Cappato stated in his survey paper that that complication rates had no correlation with how busy the center was. Dont believe it. That aspect of his results were openly ridiculed as "strange" by a speaker at Venice symposium a couple of years ago.



Edited 1 time(s). Last edit at 02/04/2013 10:27AM by researcher.