Notable EPs in USA

I'm not at this point yet, but expect to be soon. I'm willing to travel most anywhere in the USA for an ablation, which would be my first ablation, but probably not Hawaii, or Alaska, or territories. In the normal course of the year, I travel to several corners of the US, so the city/region is not important.

This forum already goes in depth on Natale, so I don't need anymore info on him at this point.

What other EPs in the lower 48 would you recommend? If there are notable details, such as 'taking part in study xyz', or 'known for technique xyz', or ..., I'd appreciate hearing that too.

I recently had an afib/flutter ablation at University of Pennsylvania Hospital in Philadelphia performed by Pasquale Santangeli, M.D. Dr. Santangeli was trained by Dr. Natale. He has been promoted to Cleveland Clinic. I had two prior ablations by local eps and was in need of a world renowned top-notch EP for complicated atypical flutter. I live close to Philadelphia and Dr. Santangeli graciously agreed to perform the ablation prior to his move to Cleveland Clinic. Many thanks to Shannon for guiding me through the process and his facilitation of my ablation. Serendipity!
Jill (cookie24)

Thanks @Cookie24. Cleveland Clinic is a possibility. I see Dr. Santangeli has published a fair amount, including some recent opinion pieces in journals, so one could get an idea of his take on the art.

I second Cookie's nomination of Santangeli. I have a few more in mind that I'll add to this thread when I get time.

It'd be good to know the list of Natale mentee's and their current locale, but they are all probably endorsed defacto here given the forums sentiment towards of Natale, which I don't disagree with, but ...

I'll put this in bold so the casual reader at 3am doesn't miss it. I'm particularly interested in learning of notable EPs in the US outside of Natale's circle mentees.



Edited 1 time(s). Last edit at 09/30/2022 04:11PM by Kwilk.

Not in the US, but my pick of somebody not in the Natale universe would be Prof. Pierre Jais, in Bordeaux Fr [www.ihu-liryc.fr]

One thing you should be aware of is that not all EP fellowships teach the advanced techniques necessary to deal with difficult cases.

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Kwilk
I'll put this in bold so the casual reader at 3am doesn't miss it. I'm particularly interested in learning of notable EPs in the US outside of Natale's circle.

That's actually a bit difficult since the EP world is relatively small, and all the top tier EPs know each other, train together, hobnob together at the conferences, and collaborate in research. If you're not in Natale's circle at least peripherally, it's unlikely you're a top EP.

One name I'll offer is Moussa Mansour at Mass General in Boston. Although I know he and Natale are familiar with each other, to my knowledge he has never trained under Natale.

Caveat: Mass General is a teaching hospital, and Mansour won't guarantee that a fellow won't be doing all or most of the procedure.

criminy, ok, I'll switch the words:

I'll put this in bold so the casual reader at 3am doesn't miss it. I'm particularly interested in learning of notable EPs in the US outside of Natale's mentees.



Edited 1 time(s). Last edit at 09/30/2022 04:10PM by Kwilk.

Really, I'm not trying to be argumentative, but I don't think you realize how influential he is in the field and how much training he's done over the years. Anyone considered a top EP is probably using many/most of the techniques he pioneered. If they learned those techniques indirectly from someone else, do you still consider them a mentee? If so, the list is probably blank.

Do you mind if I ask why you're so intent on this no-Natale list? You're asking for a list of top people in a field who didn't learn from a leader in that field, and that would be a very unusual thing in medicine (or any other discipline).

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Carey
Do you mind if I ask why you're so intent on this no-Natale list?.

Yes, please! If you have concerns about Natale, sharing them specifically would clarify the discussion. Your post gives the impression that you do have concerns but “hints” just make people wonder and/or uneasy—much better to be transparent.

If I were replying to this thread, I'd find it much easier to either write

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"Sorry, I don't know any notable EPs in the US who have not been Natale mentees. I'm not saying they don't exist, just that I don't know of any"

or write

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"I went to see Dr SoAndSo because my situation was complex and I felt I needed one who had a lot of experience with complex cases. She said she had / had-not trained with Natale. She provided a CV, which was impressive. Three years later, I feel I made the right choice in EP.

or write

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"At the risk of leaving some good ones out, here is a list of what I consider the top 10 EPs in the US. The EPs I know of that can handle any case no matter how difficult it becomes. For some indications and some techniques the list might be different, but for an allaround top 10, that's the list. I'm not sure of their backgrounds. You would need to investigate to find out if they've trained with Natale or not."

Is the patronizing tone really necessary? You don't get to dictate how people reply to your posts, and chastising them isn't a good way to encourage more answers. I gave you one suggestion, which you ignored. Daisy asked a simple question, which you also ignored. I have some other suggestions in mind but frankly I'm not encouraged to contribute to this thread.

Still, rather than attacking the questioner, or questioning their question, it'd be easier for me, if I was replying to this thread, to just answer the question, for example with a reply in one of the formats above.



Edited 1 time(s). Last edit at 10/02/2022 05:02PM by Kwilk.

Nobody attacked you, and as I said, you don't get to dictate how people respond to you. This is a discussion forum, not a courtroom. I made a few comments pointing out how difficult your request actually is, but you seem to have dismissed that. The idea of making a list of top EPs isn't a new one here and it's more difficult than you think or it would already exist. Yet here you are demanding that we not only make one but tailor it to some unexplained criteria you have that eliminates many, if not most, of the possible suggestions.

A little chill would help. How about you simply ask people to suggest top EPs and then you can do the work of weeding out the ones you don't like?

As an observer and occasional participant on this forum, it's clear that Natale gets 98% of all the recommendations on this forum. A handful of other EP's have been mentioned and praised, but there are so few, there is no way to make a list. Lots of folks have had "successful" ablations, but how many continue to visit this forum and post about their experiences in such a way for us to see the Dr's names with some level of frequency? - very, very few.

I have had two very successful ablations from a Dr. in Dallas, TX. (Kevin Wheelan), but I know of no one else on this forum that has seen that Dr. How do we make a list?

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Ken
How do we make a list?

This forum, and Shannon and I, have wrestled with that question for a long time.

I don't believe doctor rating sites have any validity -- they're just popularity contests and doctor bashing sites -- so that approach is out. So if it's not going to be by patient ratings, then what? Do we do the difficult work of contacting possible candidates and convincing them to provide us with stats on success, complications, etc? Yeah, good luck with that; I doubt most of them are even prepared to provide that data, much less be willing.

So if anyone here can imagine a good way to compose a "Top EPs" list that's fair, objective, and primarily based on fact, not opinion, then we would love to hear your ideas.

It would take an inordinate amount of work, and then only to rely on what continues to amount to anecdotal evidence. What you'd need is veridical data about all the types of interventions and problem-solving that EPs everywhere do, and then use a universally recognized metric to deem any one of the data points a 'success'. As Carey says, good luck with that.

If you google 'starbucks', ten-to-one the first six hits have a "I hate starbucks' blog due to some perceived slight of some kind. I don't believe 'rate my professor' any more than I believe amazon.com 'reviews'.

When I needed to replace our furnace, I went online to do my homework on furnaces, and I learned something very interesting about reviews. The first thing I noticed was that almost all the reviews I found were negative. I figure people tend to expect a furnace to "just work" so they're not motivated to post a review when it does what they expect, but they're sure motivated to post one if it doesn't since it's such a big ticket item. All in all, I found the reviews worthless for that reason.

I recall from the early 80's reading research showing that if someone had a negative experience with any product or service, they were likely to tell 20 other people (this is obviously pre internet). However someone with a positive experience was likely to tell one, maybe two people.

I just saw a presentation by Dr. Prystowsky - he is in Indianapolis and well known and respected EP. He shared in his presentation, that even the best EP's have a 60-75% success rate first go for ablation. He stated that if you talk to an EP who states over 80% success rate, get another opinion. Unfortunately, folks with AFIB will likely need to have more than one ablation in their life time- depending on a number of factors of course

So not sure having a who's who would be the bible. As Carey stated previously, look for volume and complication history, any research or studies involved in, etc. For more complex cases I would select centers rather local or regional center. I talked with a local EP in my region recently and after looking at my case, he told me he had nothing to offer and recommended I seek the Arrythmia Clinics in my state. I will have to travel.

My first lasted 10 years. Second 3 + years, I will be scheduled for a third. There is pro's and con's having the same EP do procedures, sometimes another set of eyes and perspective is needed.

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sldabrowski
My first lasted 10 years. Second 3 + years, I will be scheduled for a third.

Thanks for replying. Have you written up a summary of your experience? how things progressed? decisions made? I'd be interested in reading it.

First was mini maze procedure with LAA closure in 2007 In Atlanta - I was in a Clinical Trial with a cardio thoracic surgeon. AFIB came back 10 years later. The EP who did the ablation told me that the surgeon did an excellent job and AFIB free for 10 years was remarkable. By that point I also developed flutter. Given the fact I have had PAF for so long was no surprise for another procedure. Second was 3 + years ago. I was also told, that given my history a third procedure was not out of the question. It was a matter of when. My hope is that this would be the last, these days the hybrid procedure may eliminate the need for another procedure in the future. Also, the technology is even better than what I experienced over 3 years ago.

Thanks, that's quite the journey.
So afib started about 1980+- and was treated with meds for 25 years +-
Then you had a mini maze.
That solved it for 10 years, but towards the end of that you used meds for flutter.
Then another year or two on meds for afib and flutter.
Then a 2nd ablation somewhere around 2019.

Did the second ablation eliminate the afib and the flutter?

I'm not sure if the category 'Lone AF' was around back in the 1980's, but either way, would your afib have been classified as Lone AF when you had your first episodes? lone af meaning no other heart issues etc? I think of mini maze as only being done on patients who are opened up for another reason, but I suppose a clinical trial might be otherwise.

Mini Maze does not require open heart surgery. Maze procedure is done usually when another heart issue needs surgery.

You can look up Dr. Wolff - in Texas he does them all the time. He is considered to be the pioneer with that procedure. He also does LAA surgical closure when he does the procedure. There are also several centers around the country that offer this procedure.

I was told at the time of diagnosis that I had lone AFIB. To this day, still do not know the cause, best conjecture is genetics.

The second procedure fixed the flutter and the AFIB they could find at the time. I am back on meds for sporatic AFIB with PAC/PVC episodes.

This is like the game wack a mole.

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sldabrowski
Mini Maze does not require open heart surgery. Maze procedure is done usually when another heart issue needs surgery.

You can look up Dr. Wolff - in Texas he does them all the time. He is considered to be the pioneer with that procedure. He also does LAA surgical closure when he does the procedure. There are also several centers around the country that offer this procedure.

One of the issues of mini maze is it can create flutter, but can't fix it. From Shannon's post here.

"And just as often as with advanced endocardial ablation, an atypical left flutter circuit will also form after a hybrid/maze surgical ablation, and that then needs a follow-up procedure in any event. Alas, not a single cardiac surgeon that I know of performs endocardial Atypical left flutter ablation, so they have to farm that out to another EP.

So often, mini-maze and full maze surgeons down play their atypical left flutter ablation issues post maze, mini-maze or other hybrid procedures (such as the convergence procedure that is one form of an hybrid ablation, which includes both a CV Surgeon and an EP endocardial ablationist.)"

Thanks for filling in some blanks. Sounds like you are taking it in stride.

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sldabrowski
I was told at the time of diagnosis that I had lone AFIB. To this day, still do not know the cause, best conjecture is genetics.

If you think it could be genetic, there are about 14 Clinical Trials for listed for "gene therapy" + "atrial fibrillation", here is the link: clinicaltrials.gov: cond=Atrial+Fibrillation & term=gene+therapy

In terms of gene therapy, even this 2020 review paper is a little bit out of date, but it would be a start. My AF probably has a major genetic basis, so I'll be looking into this before I get my heart zapped.

Gene therapy for inherited arrhythmias

Thanks again.

I did not develop flutter until 10+ years after the mini maze. The article does not mention time frames. Keep in mind that in the clinical trial I was in, there was no EP involvement. Now there is. They keep learning.