EP in So CA? Cyro PVI?

I've been fighting LAF for about 3 years now and my cardiologist just doesn't seem to get it. He referred me to an EP Dr Jay Lee in his practice. Dr Lee did a 15 minute assessment of my case with me and suggested a cryo PVI. I asked him about how many of these procedures he has performed and he indicated 10-15, that makes me a bit nervous based on what I've read about cyro procedures. (he's done a lot of RF but not many cyro)

What are your thoughts on this and/or does anyone have a good recommendation for an EP and/or does anyone have experience with Dr. Lee?

Thank you for any input, I'm new to this forum and still reading through all the old threads.

etjim,

When you read a lot here, you'll see that 10-15 is on the tiny end of the scale. People to use have done thousands. Arguably the best guy in the world, Andrea Natale, practices part of his time in San Diego at Scripts. I would strongly suggest you make any effort you can to go see him. Natale gets the most difficult cases, after the other guys have failed. He's in the 8,000 range. Start with him!!!

Shannon can give you contact info for SD.

For right now, call Barbara Thomas 512-415-7830 in Natale's Austin office. Tell her that Shannon Dickson referred you and you are a member of afibbers.org. Ask her who to talk to in San Diego.

George

Dr Lee has done thousands of RF ablations but only recently started doing cyro and that is what really concerned me................

Does Dr Natalie do both RF and cyro?

No Cryo for Natale. I'm not an ablation expert, but what I've read here is that the really top centers are not using cryo.

Natale is strictly RF no cyro nor laser nor any combo; doesn't feel cyro compares to RF durability.

McHale

Etjim, I'm curious if you don't mind sharing, with all his experience with RF why did Dr Lee suggest cyro ablation.

Thanks

Craig

Atjim,

Welcome to the forum,

First of all, we all know it can be a daunting task finding and choosing the best ablationist EP for ourselves. I'd like to ask where you got the impression that the 43 year old doc who you were referred to by his in-house practice cardiologist partner (according to health grades he is 43) has 'thousands' of AFIB ablations under his belt? I would be extremely surprised and want to clearly verify that claim from where ever it arose

Just a few red flags here for me, as Craig noted, if he was truly that experienced and honed with RF ablations, which does require more skill to perform at a high level than Cryo which appeal is mainly used for the PVI only portion of an ablation, he would be a very busy man doing only AFIB ablation 4 days a week with multiple procedures a day AFIB all year long, yet his CV lists a large laundry list of thoracic surgery procedures in which is trained to perform as well.

At such a relatively young age, he simply would have had to be near 100% dedicated to EP ablations alone, and of those EP related ablations they would have to have been of almost entirely left atrial origin for him to have thousands of AFIB ablation skins on the wall by now or at least a very high percentage of his time would be AF ablation only. As such, how he would have the time to maintain even basic proficiency in all, or any really, of the other procedures he offers according to his published CV on the various Doc eval websites is beyond my imagination. Such non-cardiac procedures as esophageal operations and lung lobectomy procedures including for cancer removal and a long list of other procedures no where near the left atrium give me real pause.

Unless there are two cardio trained docs in greater Los Angeles area who perform catheter ablations for AFIB, which could be possible with a common last name of Lee but nonetheless would be a real surprise to find two exact same name ablationist EPs in the same city. In any event, the records I found on the physician by this name in LA area indicated that you should really investigate much further before signing on the dotted line there to confirm all the facts.

And while one has to be extra careful about going to an EP for ablation that just happens to be in your own cardio's group, it is of course possible one could have a cardio in a group with a very experienced elite level Ablationist, even if it's a very lucky draw when it happens. And then the 10 to 15 cryo's under his belt that he offers to you, I would want my guy to have a good deal more experience than that with the Cryo catheter system before jumping on board.

Some people do well with a Cryo ablation in experienced hands though the question of long term durability of the lesions is still not fully answered. And typically with an EP who is very experienced in RF ablation and has spent many years of dedicated focus honing those skills to suddenly switch over to mostly or only Cryo is very unusual.

Some experienced EPs like to use Cryo in select patients for PV isolation and then use RF catheters for any non PV work, but the vast majority of top level elite EPs prefer a state of the art Thermocool RF systems overall for long term consistent results. Cryo often appeals most strongly to those who have difficulty getting consistently transmural lesions around the PVs and find too many reconnections. And there are some experienced docs who use it for the time saving aspect of doing a PVI.

In any event, ideally like in all things of this nature you want to go to an EP who is not only vastly experienced in your procedure but who is using a familiar methodology as well.

ETjim, it is really hard for a relatively lesser known EP, at least within the relatively tight nit AFIB ablationist community, to build up such a large demand and patient base at such a young age without becoming more widely known to those of us who follow this world very closely. It could happen, of course, but if I were in your shoes, I would most definitely run, not walk, to some second opinion interviews with other better known and likely far more experienced EPs ablationists before signing up with the first doc you were referred to who just happens to be in your own cardios practice. Also, continue doing a lot more due diligence in investigating, as you are doing now, and try to get more specific answers.

Also ask your prospective doc how many pacemaker/ICD installs he does and how many of the long list of other offerings shown in the published CV on health grades I read, does he typically do a year? To truly be excellent at AFIB Ablation takes near total dedication to doing only that and very closely related procedures. If a doc has his hands in several
other pies, please just politely thank him or her for their time and walk away. You just don't want a 'Jack of all trades' dabbler when it comes to AFIB ablation.

In southern Cal there is Scripps Green Hospital too in La Jolla, as George mentioned, where you can access unquestionably a world leading expert in Dr Natale with a modest and well worth the wait waiting list, and also Dr Doug Gibson there who is very good too and who has trained some years with Natale as well.

Contact Linda Couts there at 858-554-5049. If you can travel to northern Cal you can find Dr Natale too at CPMC where he does ablations one week per month and is an excellent group there too, and that includes very experienced colleagues Dr Steven Hao and Dr. Hongo who have both been mentored by Dr Natale as well, ask for Sandy at 415-923-6503. There are a few other experienced EPs in the broader region of California too including Dr. Roger Winkle at Silicon Valley Cardiology as well.

Best wishes,
Shannon



Edited 3 time(s). Last edit at 11/21/2014 06:37PM by Shannon.

Hi etjim, top 2 experts in available in socal are Natale and Nademanee. Both very experienced and skilled. Cryo is safer with respect to lower perforation risk but has higher phrenic nerve injury risk. Recurrence as a result of reconnection is more frequent as Shannon wrote so you will have a higher chance to having to do repeat procedure(s) that will end up requiring RF catheter(s) anyway. The higher skilled ablation specialists use RF almost all the time. Unless it is right sided AVNRT and even then, RF is still preferred by the best specialists. The guy (Zeev Hed) that invented the arctic front told me long ago that it was designed to treat enlarged prostate. It didn't work well there and ever since, it's been a hammer looking for a nail.

Thank you for all the feedback. Dr Lee told me about how much "better" cryo was for PVI because it was much more complete and required less frequent repeat procedure(s). I wasn't comfortable with his 15 minute evaluation of my case and wanting to schedule a procedure. Based on everyone's feedback here I'm now completely convinced that I need to get another opinion.