EP Recommendations in the Atlanta area (or Southeast)?

Does anyone have any recommendations for a top flight EP that performs ablations in the Atlanta area?

Been diagnosed with lone AFIB. Currently taking Flecainide and Metoprolol to get me back into sinus rhythm, but still having episodes every few days. I guess I'm one of those that doesn't really notice when I'm in AFIB unless my heart rate gets high (it usually hangs in the 80's when in AFI.

Regardless, I was scheduled to do the Admire / Biosense trial for pulsed field ablation with Dr. Natale in Austin. After I being accepted into the trial, and given a procedure date, they called to say the trial is now closed.

So ideally, I'm looking for an EP still participating in the trial (would fly), or a top tier EP in the Atlanta area if I can't find and EPs still enrolling.

Thanks in advance!
Jeff

I'm unaware of any top tier EPs in the Atlanta area or southeast, but Chris Ellis at Vanderbilt in Nashville would be a good choice. But frankly, if I were going to travel to Nashville, I'd just keep going to Austin. It's just a few extra hours of flight time, and trust me, that's an irrelevant factor when choosing an EP to do an ablation.

But may I ask why you want an ablation if you're largely asymptomatic? Does your heart rate stay in the 80s during afib even without the metoprolol? And please add some details like your age and general health status.

Hey Carey! Thanks for the reply. I will check our Chris Ellis at Vandy. At least Nashville is driveable from Atlanta (roughly 4 hours).

As for why I want an ablation if I'm asymptomatic... good question. I've heard is easier to "fix" while it's not persistent, and since I know that AFIB continually progresses, I'm thinking it's best to handle now with one procedure instead of multiple once it becomes persistent?

I'm 53 athletic, tall, slim. No health concerns besides AFIB. Been diagnosed with "lone AFIB" since echo shows everything working fine.

Whenever I get in AFIB, I convert out within an hour or so of taking Metroprolol with Flecainide. But I've found, neither drug by itself works, and they need to be taken on an empty stomach to work. I'm afraid I may have started to develop some peripheral neuropathy (slight nerve damage in my legs) from flecainide. And know that I'm going to eventually have to keep upping the dosage as my body gets used to it.

I'm "asymptomatic" for the most part in AFIB. But I can feel when my heart races, and notice a bit of shortness of breath at times. So I guess not truly asympomatic, but a lot of times I don't know I'm out of rhythm until I confirm with my Apple Watch. I'd say a couple of times a month my heart rate with spike into the 130's while in AFIB. When that happens, I can definitely feel the shortness of breath. But for the most part when I'm in AFIB my heart rate doesn't really get out of the 70's or 80's. I've had my heart rate in the 60's and my Apple Watch or shows AFIB.

But... I've found my triggers - slightly intense exercise (heavy cardio), certain types alchohol (IPAs usually), cold beverages and foods, sex (unfortunately!). So, I've noticed I'll avoid doing things I love just because it will get me out of rhythm. I guess I'll like to be free from having to worry if something throw me into AFIB.

Thanks again for all your help!

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Carey
I'm unaware of any top tier EPs in the Atlanta area or southeast, but Chris Ellis at Vanderbilt in Nashville would be a good choice. But frankly, if I were going to travel to Nashville, I'd just keep going to Austin. It's just a few extra hours of flight time, and trust me, that's an irrelevant factor when choosing an EP to do an ablation.

But may I ask why you want an ablation if you're largely asymptomatic? Does your heart rate stay in the 80s during afib even without the metoprolol? And please add some details like your age and general health status.

Dr William Stevenson at Vanderbilt was highly recommended to me.

FWIW, when I was introduced to Shannon in 2016 and told him where I lived, he said there was no one, EP that is, he would recommend anywhere between Philadelphia and Austin, so I became a Dr. Natale patient. Three ablations, the first a real major job, and a Watchman FLX later I'm in fine shape.

Okay, so you're not really all that asymptomatic. Considering your age and health status, an ablation does make sense. You've got a lot of years left for it to become persistent, and even without the neuropathy, the flecainide will probably stop working someday. Then you'll be on the antiarrhythmic merry-go-round.

Here's the scenario you absolutely do not want to get into by choosing a less than top-tier EP. You do an ablation, and instead of lasting relief, you come away with atrial flutter, or afib possibly even worse than it is now. So you go back for a touch-up, and that doesn't solve the problems either. So you do yet another, but now you're officially a complex case and only a top tier EP will be able to fix you. In which case you finally go to someone else like Natale, and they finally fix it for you. But now you're 5 years down the road, thousands of dollars out of pocket, and have undergone 2... 3... 4... 6 ablations. I've been there, done that, and you don't want to go there. Why go to a "good" EP when you can go to the best there is? I sure wish I'd done that. All it would have cost me was a plane ticket and a couple nights in a hotel. Instead, I shelled out 10s of thousands of dollars over the course of 7 years.

Incidentally, I'd never heard of flecainide causing neuropathy, so I looked it up. There are only a few rare cases reported. Did someone diagnose it as being flecainide induced? Have you had the neuropathy looked at? You don't want to overlook a different, possibly treatable cause.

Or jd can wait until dr Natale has another pulse trial if he is not symptomatic and still young enough to wait until the pulse is generally used.

This is awesome advice Carey... thanks again for all your help.

In your opinion is there much of difference between choosing Dr. Natale vs. an EP like Dr. Chris Ellis (at Vandy)?

Dr. Natale is out of network for BCBS / Anthem (even though its a PPO). Total out of pocket costs would be $17K+. Which I'm fine paying if I knew it were a one-time shot. But I know there are no guarantees.

Also, I'm assuming anyone enrolling in the Admire / Biosense pulse field ablation trial would be a top flight EP. Is that a safe assumption?

For some reason, primarily based on Dr. Natale's office recommendation, I'm really gravitating towards trying to find a Dr. that does pulsed field. Evidently, Dr. Natale loves it and has seen great success with it --likes the reduced recovery time and all the benefits that come with it.

If you think I should just shutup, stop researching and just re-schedule with Dr. Natale then I will.

Oh... I didn't think about this. I COULD call back his office and ask if they'll be doing another trial soon. Good idea!

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jdittrich
In your opinion is there much of difference between choosing Dr. Natale vs. an EP like Dr. Chris Ellis (at Vandy)?

Yes. The difference is good vs. the best.

Now, the truth is in most cases "good" is perfectly adequate for an uncomplicated index ablation. It's the more complex cases where someone like Natale becomes vitally important. But starting off with the best does offer the highest probability of success. No question about that. And it's always possible to do what I did: being fooled into thinking that impressive credentials and a lofty position equal competence doing ablations. I learned the hard way they do not. I've had 6 ablations. I believe if I'd gone to Natale first that number would be 1, or 2 at most. Even Natale will tell you that a touch up may be necessary.


Are you sure Natale doesn't take BCCS/Anthem? That seems surprising he wouldn't take such a large plan.

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Carey

In your opinion is there much of difference between choosing Dr. Natale vs. an EP like Dr. Chris Ellis (at Vandy)?

Yes. The difference is good vs. the best.

Now, the truth is in most cases "good" is perfectly adequate for an uncomplicated index ablation. It's the more complex cases where someone like Natale becomes vitally important. But starting off with the best does offer the highest probability of success. No question about that. And it's always possible to do what I did: being fooled into thinking that impressive credentials and a lofty position equal competence doing ablations. I learned the hard way they do not. I've had 6 ablations. I believe if I'd gone to Natale first that number would be 1, or 2 at most. Even Natale will tell you that a touch up may be necessary.


Are you sure Natale doesn't take BCCS/Anthem? That seems surprising he wouldn't take such a large plan.

Awesome! Thanks again for your help. It sounds like Dr. Natale's office may be enrolling in a new clinical trial for pulsed field ablation "early next year." If that's the case, I'll wait.

It's weird about the insurance, but yeah... I had Dr. Natale's office run the numbers for me for out of pocket cost. The sad part is there is NO remuneration for participation in the pulsed field ablation study (or very little).

Oh, I get it. It's not that Natale doesn't accept BCBS/Anthem, it's that no insurance plan is going to cover PFA because it's still considered experimental until it gets full FDA approval. It only has FDA approval for investigational use right now.

If I were you, I would definitely hold out for a clinical trial. You're in a good position to wait.