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Finding a doctor for an ablation

Posted by mtwomey 
Finding a doctor for an ablation
January 14, 2023 06:00AM
I'm searching around the forums, but I'm not finding what I'm looking for - so I thought I'd just ask. If I'm missing a great resource on this please link me.

Brief background: I live in the Chicago suburbs. I have had paroxysmal afib for about 15 years. I (now) have maybe 30 episodes a year, always < 4-6 hours and always self converting. I take 300mg flecainide and 25mg metoprolol daily. Early on (year 1) things were really bad and I started down the road for ablation. However I happened to also try flecainide around the end of that year and for the most part, it completely solved my issues. So I stopped pursing the ablation. I have zero flecainide side-effects and during most of this 15 years I've only had 2 - 4 episodes a year. Sometimes I'd go more than a year without one. However *now* I'm having more and more breakthroughs.

It's been 15 years since I've really looked into an ablation and I'm sure things have advanced since then. Some things I'm starting to think about and would love for anyone to share their thoughts:

1. I assume the techniques and technologies have improved quite a bit over this time frame. Is there a "kind" of ablation that I should definitely be looking at? Or is this just something to discuss with the doctor?

2. 15 years ago there weren't all that many EPs with a high level of ablation experience and expertise. I hope this had changed by now? Back when I was originally looking into this - the only clear-cut, undisputed recommendation was Dr. Natale. I'm wondering how I can identify or find other good EPs who I also may wish to consider?

3. I quite like my current EP actually, but I have no idea how to think about: should I be thinking about him for the procedure? Is there "vetting" I can / should do before considering him? One thing I like about that idea is that any needed "touch ups" would be significantly easier and seeing him in person whenever I want is simple. That said, I definitely want excellent treatment over convenience.

For #2 and #3 - it's so hard, I'm not a doctor. I mean how the heck are I supposed to judge my options of doctors here?

Anyhow - please let me know if anyone has anything to share here.

-Matt
Re: Finding a doctor for an ablation
January 14, 2023 05:35PM
At a minimum you'd like a person who has done thousands of afib ablations, at a high volume center.

I've been on this board for over 18 years. I don't live in TX and I would travel from any place in the US to use Natale, if it was time for an ablation. Eight years ago, my best friend from childhood, who lives in Houston, had long standing persistent afib. I strongly suggested he go to Natale. He was like, "why, I live in Houston, we've got some of the best docs in the world here." I pushed hard and said, "go to Austin, then you'll understand." He checked out Natale and also the best guy in Houston and went, with some reticence to Natale. It took two procedures, including LAA isolation. His first procedure was complex and took longer than that of Shannon, our moderator, who told me his was the longest he'd heard of before my friend's. Now every time I see my friend and his wife, they thank me profusely for pushing hard for him to go to Natale.

There is also a friend of a friend (local) who'd been diagnosed with vfib by three of the best local EP's and was wearing a "shocker vest" in case he went out of rhythm. He was told by all that there was no procedure that could help him. I pushed him to Natale. Natale a) said the vfib diagnosis was incorrect; b) fixed the guy. This was 5.5 years ago. The guy recently contacted me to thank me again and said he's been riding his bike to work since shortly after his recovery period.

I could go on, but here is moderator Carey's story [www.afibbers.org] and a comment [www.afibbers.org]

My second choice would be an EP trained by Natale.



Edited 1 time(s). Last edit at 01/14/2023 06:56PM by GeorgeN.
Re: Finding a doctor for an ablation
January 15, 2023 02:21AM
Since nobody else is responding. If you truly want someone besides Natale, a place I'd start is with the EP organizers and presenters at this conference on the LAA.



Edited 1 time(s). Last edit at 01/16/2023 11:23PM by GeorgeN.
Re: Finding a doctor for an ablation
January 15, 2023 04:18AM
Quote
GeorgeN
Since nobody else is responding. If you truly want someone besides Natale, a place I'd start is with the EP organizers and presenters at this conference on the LAA:

Excellent resource, George. Shannon and I attended that conference the year before COVID shut down all the conferences, and the presenters there are the top EPs in the field worldwide. Average EPs don't even attend that conference, much less present at it. I'd say if you picked anyone from the list of presenters, you will have made an excellent choice.

And yeah, if I developed new onset afib, I would be on the phone to Natale's office the next morning without hesitation. Trust me, a couple days in a hotel and $1000 of travel expenses is more than worth it. Saving money by going second-best with some local EP is not worth it.
Re: Finding a doctor for an ablation
January 15, 2023 05:17AM
mtwomey: I have a similar history with Afib starting 12 years ago, taking flecainide for many years when it controlled my episodes and finally this last year when it stopped working and actually gave me serious side effects. At that point I decided to have an ablation and did choose Dr. Natale. I am a bit past two months post ablation and so far so good. My ablation turned out to be complex and I doubt if a lesser skilled EP would have been able to handle it. The care at St. David’s was excellent. The important thing is to choose an elite level EP who can deal with anything that shows up during the ablation. There are not that many so it is good to be willing to travel. If you name any EPs you are considering members here may be able to give you some input. Best wishes.
Re: Finding a doctor for an ablation
January 15, 2023 06:40PM
Thanks all - that is encouraging. To be clear, I am not, not wanting to use Dr. Natale. I just wasn't sure if there were tons of great choices all over the place now a days. I can afford to travel, so it sounds like there really isn't much reason I should look elsewhere. I'll give the Austin center a call on Monday and see how I can start the process.

Any tips on that?
Re: Finding a doctor for an ablation
January 15, 2023 09:17PM
Should be effortless. If you run into problems, drop me a PM and Shannon and I can grease some wheels for you.
Re: Finding a doctor for an ablation
January 15, 2023 10:48PM
Quote
mtwomey
Any tips on that?

This is the person to enquire about a single trip procedure:

Norma Bazerghi RN, MSN, MBA

Single Trip Procedure Coordinator for Andrea Natale M.D.

Texas Cardiac Arrhythmia

Direct Line: 512-615-6205



Edited 1 time(s). Last edit at 01/16/2023 04:33AM by Carey.
Re: Finding a doctor for an ablation
January 16, 2023 10:38PM
Thanks all - I left a message for Norma. TBH, I'm a little nervous, but that's the first step.
Re: Finding a doctor for an ablation
January 16, 2023 11:23PM
You should be orders of magnitude less nervous than if you were contacting any other EP. smiling smiley

I don't know if Texas Cardiac closes for MLK day, but they might, so if you don't hear back promptly then I would give her another call tomorrow because messages left on business lines often don't even get listened to.
Re: Finding a doctor for an ablation
January 17, 2023 12:04AM
Quote
Carey
I don't know if Texas Cardiac closes for MLK day, but they might, so if you don't hear back promptly then I would give her another call tomorrow because messages left on business lines often don't even get listened to.

I suspect that they were closed. I was expecting an email from them today but it didn't come.
Re: Finding a doctor for an ablation
April 29, 2023 12:37AM
Hi all, just a followup as this group as been very supportive and helpful to me (thank you). I will be out in Austin next week, having my ablation w/Dr. Natale on Wednesday. I'm excited but also nervous. The experience so far has given me nothing but confidence, but it's a first for me. I will also be traveling alone for this procedure, which I'm fine with - I have a hotel right near by, but adds a little nervousness.

Hope you all are doing well!
Re: Finding a doctor for an ablation
April 29, 2023 02:13AM
Quote
mtwomey
Hi all, just a followup as this group as been very supportive and helpful to me (thank you). I will be out in Austin next week, having my ablation w/Dr. Natale on Wednesday. I'm excited but also nervous. The experience so far has given me nothing but confidence, but it's a first for me. I will also be traveling alone for this procedure, which I'm fine with - I have a hotel right near by, but adds a little nervousness.

Hope you all are doing well!

I live in the Midwest also. After two failed ablations, I finally went to Dr. Natale last year. I made a second trip there in September for a touch-up ablation and a Watchman implant. It was the best decision I made. Everything that was said about him on this forum turned out to be true for me. I am sure you will have a positive experience as well.

Good luck and in my humble opinion, you made a great decision!
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