Australian EP

I just met an EP in Australia, by the name of Dr David O'Donnell from Warringal (or Austin) hospital.
He's very jovial, very reassuring, and comes across as very knowledgeable, by far the best specialist I have met so far.
He knows of Dr Natale from Texas, and Dr Prash from Adelaide, South Australia. He also mentions that a couple of people he trained has also then trained under Dr Natale. He studied/trained in the UK.
When asked about his success rate, he replied something to the effect that he has the best success rate (I assume in Australia). When queried about Dr Prash, he did say that Dr Prash has a slightly lower success rate, but that he (Prash) claims to accept more difficult cases. As he (O'Donnell) was very easy going and jovial, I wasn't sure if he was joking. At no time did he come across as a braggart.
My gut feel is he is very competent. I'm booked in for ablation later this year with him, but just wondering if anyone else has heard of Dr David O'Donnell.

Bob.



Edited 1 time(s). Last edit at 07/11/2014 08:28AM by ozbob.

Bob,

Maybe Shannon or someone else can frame these questions better, however I would ask both how many afib ablations they have done, how many per year they do and try to get a feel for difficulties of the ablations they perform.

My sense of both the Bordeaux and Natale teams is that they have success statistics as good as anybody, with a much more difficult caseload.

Also, what you need depends upon your situation. Are you considered a "simple" or a "complex" case. For example, even though my control now is excellent - I haven't had an episode in 14 months - 10 years ago I had an episode that lasted 2 1/2 months. I'd be a complex case and likely need an extensive ablation. I'm not sure what episode length would be considered the cut off - maybe seven days and requiring at chemical or electrical cardioversion to convert to NSR.

George

Hi Bob, I have not heard of him, but that doesn't mean he isn't good, Australia is a bit beyond my radar range.

Other Aussies here lurk here may jump in with some feedback. But George is right and I would ask too how many AFIB ablations has he done and how does he measure his success rates longer term?

Make sure he has at least 1,500 to 2,000 AFIB ablations under his belt and with a solid success rate as far as you can discern.

Best wishes, Shannon

George, Shannon. I forgot to mention that he performs about 1000 ablations a year now. His first ablation was 1999. It escaped me to ask him how many he has got under his belt. I will ask that next time I see him.

My case is considered simple: young, non permanent afib. Now that I'm taking notes, I'm averaging about 1 afib episode per 8-9 days, with each self converting after 20 hrs. I'm on sotalol for rate/rhythm control and no other PIPs, with only Aspirin for clot prevention. My last afib 2 days ago was, I think, due to lack of sleep because I had attended an overnight sleep observation. I only managed maybe 4.5hrs sleep there.



Edited 1 time(s). Last edit at 07/11/2014 05:58PM by ozbob.

Bob , what did the find if anything at the sleep observation? Any sleep apnea??

Also, if your prospective EP actually told you that he does 1,000 AFIB ablations a year and you did not misunderstand him, he either has a very poor mind for numbers and is just spouting off what sounds impressive, or if he really said that with a straight face and was serious Id have a hard time believing much of what he might say.

It is utterly impossible for any humanoid on planet earth to do 1,000 AFIB ablations a year ... And he certainly would not have had the time to chat you up in a consult too, not to mention not having time to consult with any of his other 'thousand per year' patients either!!

I'm hoping you just heard that wrong or maybe got a zero added on there. The most experienced ablationists on earth renowned for their fluid blazing speed going flat out can do no more than around 525 ablations tops per year ... 550 at the very max ... and that's only possible following a truly Herculean schedule!!

Not to mention that there are very few ablationist who are under enough demand to ever reach the 500 a year range of demand on their time as well and these few elites are among the most respected and well known operators around, and unless this fellow magically is, by far, the most experienced EP on earth hardly anyone has ever heard of and who has an endless clientele lining up around the block in what would have to be the largest AFIB epidemic on earth concentrated down under ... and even if we assume for a moment that that fantasy scenario were true, he still would not have enough hours in a year to perform 1,000 ablations while sleeping more than a few winks ... then I'm afraid he is blowing some smoke up your sleeve Bob.

Anyway, there may well be an innocent mistaken explanation for that 1,000/year number, and I truly hope so. But if he really claimed that figure with a straight face and you can verify for yourself that this really is his position. Then I'd be strongly inclined to run for the hills as you would for evermore have a hard time relying on any other assurances he might make as well. A doc that would willingly exaggerate his or her experience level to that degree has got some issues and I don't want him or her anywhere near my heart.

As such Bob, in light of what you've been led to believe are his stats, I would really give this guy a serious third degree walk through of this issue, exposing the impossibility of such a claim, if indeed he sticks to that and it wasn't just a mistaken slip of the tongue. You can tell him too, if he still stands behind that claim that Id love to interview him as the world needs to know of this phenomenon and most experienced EP in the world who has been accomplishing such feats in obscurity down in Australia.

If he was able to first attract that many patients to actually have an ablation with him, and continuously so, and then could miraculously some how manifest the time to pull it off year after year now as he implies, he would instantly become THE most in demand speaker at top EP conferences around the world as well.

I'm truly sorry if all this winds up shooting your good prospect for an EP in the foot, but this is a serious issue to get right and having a doc you can really trust is high on the list of desirable criteria.

Cheers!
Shannon



Edited 4 time(s). Last edit at 07/12/2014 01:46PM by Shannon.

Hi Bob,

Regarding your AFIB activity it does sound like you are in a good window still for a likely PVAI style ablation to have a good chance for success with one procedure with skilled hands doing the ablation (and not a trainee actually doing your procedure under the name and guidance of the more experienced EP).

But it does sound like you might be at the point where some additional non-PV triggers could be involved too with your longer 20hr episodes.

Generally when you start to get up into the 20 to 24 hour duration episodes even with periodic paroxysmal AFIB, that often
Implies some degree if structural remodeling is taking place, which in turn, often is associated with finding more trigger sources outside of strictly just the PVs and so its a good idea to choose an ablationist very comfortable and experienced in working beyond just a straight anatomical PVI only or PVAI only approach.

You want an EP who can handle whatever your scenario might require once he is in there.

But overall you sound like a good candidate for an expert ablation and best wishes on finding a solid EP there to take care of business.

Shannon

Well, that's just embarrassing on my part. After re-checking, he does about 200 ablations per year. I think he's got between 1000-2000 under his belt. Maybe that's why the thousand figure stuck in my head.

I am still waiting for the review of my sleep observation. I'll follow up when I have more info.

Thanks for the clarification Bob,

That sounds much more like it and the good news is his reputation is still intact. I feel much hearing that he wasn't really making such outlandish claims.
Best wishes on your ablation when it comes about. Please keep us up to date as things move along and ask any questions as they arise.

Take care,
Shannon

Hi Bob, I also have Dr. O'Donnell as my doc at the Austin, although I have never met him, I see someone who works under him. He has recommended against ablation for the time being simply because they call my a/f "controlled" a/f (between 60-85 bpm). I have an episode between 5-10 days but it does last quite a bit. I am on warfarin bcos of a stroke 2 years ago - and wasn't on any blood thinners except when in a/f (aspirin). What's your story, regards, Sunny

Hi Sunny,
Sorry didn't see your post sooner.
My afib is quite regular, occurring about once every 14 days give or take 2 days. It usually starts around 4am and will last around 20 hours. It self converts during sleep the following day. ie. If it starts at 4am today, I will be back in NSR around 12am the next day.
I have had sleep test done and result was mild apnoea with initial recommendation to try sleeping aids such as cushion. I am using Bumper Belt with little success. I believe I do get a better sleep, but afib is still there. Next step will be mandibular devices and/or tongue holding devices.

I have been on aspirin and sotalol, but have just replaced aspirin with Pradaxa as a lead up to ablation in less than 2 months.
To complicate matters, I have recently been advised to seek another opinion as Dr O'Donnell and Austin "are not the best in Melbourne". I have been recommended to see Dr Peter Kissler (of Cabrini and Alfred hospitals). If anyone has heard of Dr Peter Kissler, please enlighten me. I have not been successful in searching for his name on this forum.

cheers,
Bob.