What to ask the Electrophysiologist

Hi All,
I am new to AFIB and I am so overwhelmed by it! I have an appointment this evening with an EP.
I have prepared a few questions for him however please share with me the questions you would ask an EP.
Thank you for sharing.

When I first had AF, I recall seeing the disappointment on the EPs face when I declined his persistent attempt to have me schedule an ablation as soon as possible. Any EP eager to ablate you should be run away from.

Interview EPs, and several of them, with the same due diligence you would a financial adviser or potential mate. The wrong decision and even the 'right' one will affect you the rest of your life.

At the end of the day, it's a coin flip. There's an omerta in many professions where they won't speak ill of each other and patients can easily become victims.

Just don't jump in bed with any EP or MD and see what can be done to avoid a procedure that may negatively and permanently impact your life.

Ask them for copies of all of the contracts, waivers, disclosures you'll be asked to sign when presented with them only 30 minutes before the procedure in advance. You'll likely not get them.

Then realize anything that goes wrong you will likely have no recourse for if/when it does goes wrong.

Ask her/him what approach he/she intends with you once he/she is inside your heart and poking around. What will that person poke around for, and will he/she merely play by the numbers? That is, will he/she simply build a stockade of scar tissue around the pulmonary vein ostia, and count that as a let's-wait-and-see-what-happens first step, or will that person continue to map out your spurious signal pathways and foci and zap them while you're flat on your back and out cold the first time?

A great many of us can get away with a single ablation and be happy and treated for quite a few years. Some of us, me included, will need a touch-up at least, meaning back onto the slab I go, or more extensive treatment that includes ablating other chambers if it seems warranted. One of our moderators here, Carey, has had numerous ablations. He admits freely, and often, that it turns out the he ought to have done more thinking and research and gone to the gentleman physician who ultimately put his AF to rest. (I think I have that essentially correct.) He didn't know to ask for the EP's surgery history, for example, or even his place of study.

So, again, my message is to ask the person if it's just a simple PVI (pulmonary vein isolation) that he intends, or does he intend to continue to look for other foci and to test you for several long minutes with isoproterenol before he releases you from the surgery?



Edited 1 time(s). Last edit at 12/08/2022 10:33AM by gloaming.

Pavan, I think your response paints an overly pessimistic picture. There's plenty of time to read the waivers and whatnot, and I guarantee those things will all be boilerplate and pretty much the same.

Marty, I think the first question you need to ask is how the EP thinks treatment should go. Do they want to start with medical management (ie, drugs), or go straight to ablation. Ablation is considered first line treatment these days. If the answer is ablation, then the very next and most important question you'll ever ask that EP is how many afib ablations they've done in their career, and how many they currently do per month. The answers you want to hear are thousands in total and at least 5 per month.

It would be helpful to know more about you to guide more in depth questions. How old are you? How's your general health? How many episodes are you experiencing and how long do they last? How high does your heart rate get during an episode?

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PavanPharter
At the end of the day, it's a coin flip. There's an omerta in many professions where they won't speak ill of each other and patients can easily become victims.

Just don't jump in bed with any EP or MD and see what can be done to avoid a procedure that may negatively and permanently impact your life.

So true!

I first saw all of the paperwork when I was already in the gown. I don't see me as being pessimistic but reflecting the realities of my post ablation life. I'm not the same person and never will be. My heart operates in a narrow range all of the time now that prevents me from resuming my lifestyle prior to the ablation.

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PavanPharter
I first saw all of the paperwork when I was already in the gown. I don't see me as being pessimistic but reflecting the realities of my post ablation life. I'm not the same person and never will be. My heart operates in a narrow range all of the time now that prevents me from resuming my lifestyle prior to the ablation.

I was sent all the paperwork electronically weeks before the ablation. Yes, getting it “in the gown” is not the best timing.

Here is a list of questions to get you started: [www.biosensewebster.com]

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ggheld
Here is a list of questions to get you started:

I would boldly ask if out of all of his patients, how many hold the record for unsuccessful repeat ablations and what is his record of number of ablations he has perform on a single person since no ep is 100% successful?

I then asked if I held his record but I didn’t get a reply.



Edited 2 time(s). Last edit at 12/09/2022 04:13AM by susan.d.