Top questions to ask re Ablation.. Michigan ? also

I am going to see a new EP on Monday. I usually go to University of Michigan but this is the guy that did the cardio version so I thought what the heck. I will do a visit. First visit is with the PA though. And then my "regular " EP I have a visit with in a few weeks. ( Have had 2 afib episodes in as many weeks... before that long time between.). What are the top questions I want to ask. I asked my regular EP his success rate. He said he doesn't track. hmm..that made me wonder. Is that something people are usually provided? I saw the vascular clamp question. I honestly don't even know the language of ablations.. I see people say this or that and am a bit lost. Maybe there is an ablation 101 post in here somewhere. But if anyone can guide me to questions to ask that would be great. Also I am in Michigan. Open to other docs (yes I know Natalee is the best.. thinking I might try closure to home for a variety of reasons but open to driving to another state..)

I wonder how any EP here (in Belgium) could annonce his "success rate". I don't know for other countries, but here it would be nearly impossible. Patients are not obliged to stay in touch with their EP after an ablation.
Most do, I think, but maybe for some weeks or months.
So, may the EP having got 30% positive feedback (patients still in NSR one year after ablation) and 20% negative feedback (patients back in afib) pretend he's got 80% of success (no news = good news)?
How does it work in your country?

It's largely the same in the US but the vast majority of ablation patients will remain in contact with their EP for upwards of a year, and a year is actually a sort of the unofficial "success" criteria. If you're in NSR without the use of antiarrhythmic drugs 12 months post-ablation, your ablation is considered successful. It's almost unheard of for an ablation to fail past that point. If afib does return, it's almost always because a new locus of arrhythmia has developed outside the ablated areas.

Success rate is a completely valid question. The place that did your ablation should keep in touch with you for 6-12 months at least, if this isn't standard, I would go elsewhere.

You can also ask what type of ablation the EP does, see more here: [stanfordhealthcare.org]

Also: "what percentage of your ablations have complications?"

One of the most important questions is how many ablations do you perform per year. Ablation is a skill-based procedure and is related to frequency of application. Studies show that the centers and doctors that perform more ablations have less complications: [a-fib.com]. Recommended ablation volume is minimum of 25-50 per year per EP, though personally I would want my EP to be doing more than that...

(Also some insurance in the US only pays for elective procedures to be performed in the state you live in. That was true for my insurance but fortunately, Dr. Natale works a few days a month in CA.)

I hope you have Medicare. They'll pay anywhere.

Cleveland Clinic puts right on their website that for paroxysmal Afib their success rate is 85%, and for persistent Afib, it's 60%. Since you said you didn't know the lingo quite yet, paroxysmal is when you can convert back to normal sinus rhythm on your own. Natale used to be at the Cleveland clinic, so at least some of those doctors may have been trained by him. (If you can't get to Austin, Cleveland may be an option)

I agree with David K. Go to the EP who does at LEAST hundreds per year. No matter where you go, don't wait until it becomes "persistent".

I'm 5 months post ablation and AF Free!!! no blips! no afib, and hopefully in another month after my six month follow up, no more anticoagulant medication!

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LaniB
I hope you have Medicare. They'll pay anywhere.

Cleveland Clinic puts right on their website that for paroxysmal Afib their success rate is 85%, and for persistent Afib, it's 60%. Since you said you didn't know the lingo quite yet, paroxysmal is when you can convert back to normal sinus rhythm on your own. Natale used to be at the Cleveland clinic, so at least some of those doctors may have been trained by him. (If you can't get to Austin, Cleveland may be an option)

I agree with David K. Go to the EP who does at LEAST hundreds per year. No matter where you go, don't wait until it becomes "persistent".

I'm 5 months post ablation and AF Free!!! no blips! no afib, and hopefully in another month after my six month follow up, no more anticoagulant medication!

So, my initial aFib episode they ecv’d me, episodes 2 & 3 I self converted, episode 4 the ecv’d me. Am I paroxysmal or persistent?

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walt
So, my initial aFib episode they ecv’d me, episodes 2 & 3 I self converted, episode 4 the ecv’d me. Am I paroxysmal or persistent?

The definition of persistent is continuous AF for more than 7 days.

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LaniB
I hope you have Medicare. They'll pay anywhere.

Cleveland Clinic puts right on their website that for paroxysmal Afib their success rate is 85%, and for persistent Afib, it's 60%. Since you said you didn't know the lingo quite yet, paroxysmal is when you can convert back to normal sinus rhythm on your own. Natale used to be at the Cleveland clinic, so at least some of those doctors may have been trained by him. (If you can't get to Austin, Cleveland may be an option)

I agree with David K. Go to the EP who does at LEAST hundreds per year. No matter where you go, don't wait until it becomes "persistent".

I'm 5 months post ablation and AF Free!!! no blips! no afib, and hopefully in another month after my six month follow up, no more anticoagulant medication!

I guess I have always been persistent. I get ECV and convert back..but not on my own and not with meds (I am on dofetildie.). So that is persistent right? I have gone over a year without an episode though--- then twice in as many weeks. I have never waited out to the 7 day mark LOL. I did convert once as I recall. I think the most I waited was like 4 days. I also have congenital stuff so perhaps that is why they wanted to do the cardio version quicker.



Edited 1 time(s). Last edit at 10/12/2020 09:32PM by bettylou4488.

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bettylou4488
I guess I have always been persistent. I get ECV and convert back..but not on my own and not with meds (I am on dofetildie.). So that is persistent right? I have gone over a year without an episode though--- then twice in as many weeks. I have never waited out to the 7 day mark LOL. I did convert once as I recall. I think the most I waited was like 4 days. I also have congenital stuff so perhaps that is why they wanted to do the cardio version quicker.

No, if I understand you correctly, you have never been persistent.

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Carey

I guess I have always been persistent. I get ECV and convert back..but not on my own and not with meds (I am on dofetildie.). So that is persistent right? I have gone over a year without an episode though--- then twice in as many weeks. I have never waited out to the 7 day mark LOL. I did convert once as I recall. I think the most I waited was like 4 days. I also have congenital stuff so perhaps that is why they wanted to do the cardio version quicker.

No, if I understand you correctly, you have never been persistent.

because I didn't go 7 days yes? although I never tried going7 days. I always did ECV before that...



Edited 1 time(s). Last edit at 10/13/2020 02:01AM by bettylou4488.

It seems the way we revert to NSR has not to be taken into account...

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bettylou4488
because I didn't go 7 days yes? although I never tried going7 days. I always did ECV before that...

Then you don't know if you're persistent or not. My guess would be not since the cardioversions are readily effective, but it's kind of an arbitrary distinction. Since you're not continuously in AF the end result is paroxysmal, not persistent.