Electrophysiologist Needed in Florida

Hi Everyone,

I'm brand new to this forum. I appreciate the wealth of info here and just starting to dive in.

I'm looking for an electrophysiologist in Florida. I live in Jacksonville, but willing to drive and possibly fly if my insurance will cover an out-of-state doc. Not sure yet.

I appreciate any suggestions on how to find a great EP!

Thank you in advance!

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Amara
I'm looking for an electrophysiologist in Florida. I live in Jacksonville, but willing to drive and possibly fly if my insurance will cover an out-of-state doc. Not sure yet.

Not close by for regular visits, but for an ablation, I suggest Sergio Pinski at Cleveland Clinic Weston [my.clevelandclinic.org] He trained under Dr. Natale. Years ago we had a number of people who drove quite long distances in FL to see Dr. Pinski. In 2009, my cousin was getting what I thought was bad advice and I suggested a second opinion with Dr. Pinski. Pinski ablated him and it has been durable since. Later, my cousin's wife was also ablated by Dr. Pinski and it has also been durable.

Thank you for that info! I'll look into Dr. Pinski. It would be worth the drive. I'm also going to check with my insurance about seeing an out-of-state EP and if they will cover it.

I don't recommend Mayo Jacksonville. I'm going there now and can't wait to find a different solution.

What is your situation? Are you looking for an ablation? Is your afib stil paroxysmal (intermittent) or is it longstanding persistent? If you are looking for an ablation, then the higher your afib burden, the more complex the ablation is that is usually required to solve the problem.

I second George's endorsement of Pinski.

Thank you, Carey.

Thanks for asking. It is a long story....

I've had 3 ablations to this point. 2 in Phoenix and 1 at Mayo in Jacksonville.

My Situation:
I had Covid in July 2020 and had damage to my vagus nerve affecting my heart rhythm causing ectopic beats. It is not a typical problem so I've had a difficult time with diagnosis and treatment. My rhythm initially was 30% PAC burden, bigeminy and trigeminy constant, cannon A waves with each PAC, and increasing with time, daily SVT with occasional PVCs. Essentially rendering me with a poor quality of life, SOB w exertion, exercise intolerance, severe HA's, and some other less severe symptoms. I have no other health problems and was very active before all this.

I've been intolerant to every cardiac med they have tried, seven to this point. Antiarrhythmics are proarrhythmic for me. Each med seemed to aggravate my problem and make my symptoms worse for a couple of weeks. The docs scratch their head at this. I feel it is a symptom of the problem.

My first ablation was in May of 2022. The EP mapped the arrhythmia to my AV node and didn't proceed. She burned a couple of fo areas trying to clear what she could away from the AV node. I have had 1st-degree AV block since this procedure in addition to my other arrhythmias. Zero improvements.

The second ablation June of 2022 was with a former Mayo EP in Phoenix who planned to ablate the AV node if needed and implant a pacemaker. He also mapped to the AV node but felt there was still an unknown so tried a few burns and stopped. Zero improvements. He was at a loss and afraid to make things worse, so I kept looking for another EP. I was moving to Florida so choose Mayo next.

Third ablation 12/2022 at Mayo Jacksonville. (Mayo has been difficult to deal with from the beginning but that's another story.) Initially, it seemed like a success with zero PACs for the first 2 weeks and no pacemaker. The ectopic area was at the Bachmans bundle and not the AV node. He thought the SVT was from the PACs so he did not look for it during the procedure. I had early expected early arrhythmias and chest pain that passed. Week 3 was the best with little to no problems or arrhythmias. In week 4 it all started to come back. I am not back to the level of 30% PAC burden at this point, but it increases each week. I have more SVT and tachycardia than before the procedure, daily and most of the time. My quality of life is back to what it was before the ablation and sometimes worse. The symptoms are a bit different, but the same outcome.

The EP at this point refuses to listen to my concerns or have a conversation about it because he is so busy. He just keeps saying it's expected. I now have frequent chest pain, SOB, and retain fluid after repeated bouts of high heart rate. I went to the Mayo ER and everyone just wants to hand it back to the EP. The EP office tells me if I'm having problems I should go to their ER. While at the ER one of the cardiology fellows did an unofficial bedside echo and showed me where the blood was shunting from one side of my atria to the other (from the atrial septum puncture during the ablation). This was disregarded by the cardiologist on call. They just keep sending me back to the EP office who is too busy to see me and then they tell me to go to the ER......crazy.

I'm very frustrated at this point. I know it could take more than one procedure so that is not the problem. They are not listening to my concerns and helping with a solution. I'm afraid I'm going to end up with heart failure if this continues. It takes time to get into an EP office so I'm anxious to get moving forward.

I consider mine a complex problem so looking for a top-tier EP. I need someone who's a problem solver and who doesn't give up when things aren't easy. The EPs I've worked with so far consider my issue similar to Afib or Aflutter since it's atrial.

I truly appreciate the listening ear and suggestions. It's difficult to know how to navigate the system and get the help you need.



Edited 4 time(s). Last edit at 02/12/2023 09:13PM by Amara.

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Amara
I'm also going to check with my insurance about seeing an out-of-state EP and if they will cover
it.

You have had quite a journey! I’m sure you will hear this suggestion from others, but if your insurance will cover it, Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin, might be your best bet. He is the go-to EP for really complex cases. Many of us here have been to him for ablations, including me.

Yes, it has been a journey.

Thank you for the recommendation Daisy. I will definitely look into Dr. Natale tomorrow and see if he is covered by my insurance. I will go to whatever lengths I can afford to resolve this problem. It's good to have a couple of EPs to check with my insurance on.

I've been diving into the topics here and appreciate everything that has been shared on this forum. It's helpful to hear about others' journeys who can relate.

Natale would be my number 1 pick, if you can go out of state & insurance covers.

Okay, that's good to know. Thank you, George

After hearing your full history I think you should without question find a way to visit Dr. Natale. You have met and exceeded the criteria of being a complex patient beyond the capabilities of most EPs. There are probably only a handful of EPs in the country who can help you, and you can bet that all of them trained with Natale.

If you've never read it before, please read about how and why I ended up with five unsuccessful ablations. You're headed down the same road I went down and I highly recommend you apply the brakes immediately and make a sharp turn.

Amara — Feel for you and your frustration. So sorry you’ve gone through everything in your post and arrived at a worsened status.

Agree with the previous comments recommending the most competent / experienced EP you can find. Wish you the best for the future.

Your case also highlights to me the serious potential risks of ablations. For years now, practitioners and facilities have inundated the media with marketing proclaiming terrific success rates intended to lure patients to these money-making operations. So often these claims are misleading and / or false... or based on actual stats or a legitimate definition of “success.” Then when the patient remains “unfixed,” the recommendation is a repeat ablation, or a third or fourth one, or “just a touch-up.” Aaaaaargh!

/LarryG

Hi Carey,

Wow, you did have a complex and frustrating journey!!! Thank you for sharing it. I'm happy you found the road to success
You have brought me back to reality.

You are right, I'm on the same path.

Brakes on and finding a way to head to Austin..... I appreciate the reality check!

Thank you, Larry!

I agree that they act like it's all just a cakewalk. None of the EPs ever truly explained the possible complications before the procedures or admitted it when they causes problems. I did look it up myself so had a good idea of what can go wrong of course way before my ablations.

I read a recent healthcare article stating that since the reimbursement rates have now gone down for ablations, we can expect that EPs will be doing more initial and repeat ablations to make up for the difference. I bet that's where the marketing is coming from. It's always good to keep our eyes open.

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Amara
Brakes on and finding a way to head to Austin..... I appreciate the reality check!

FYI, here is Natale's info: [tcaheart.com]

None of the EPs ever truly explained the possible complications

That totally goes against the doctrine of consent and doctors know this is a legal requirement and yet they continue to ignore it. I just had my first consult with an EP. He spent over an hour w me and he discussed everything from the importance of magnesium, complications, and the other alternative treatments (a legal requirement for consent) that I could consider.



Edited 1 time(s). Last edit at 02/13/2023 09:31AM by JakeS.

Thank you, George!

Jake, I agree. They should have explained thoroughly. It sounds like your EP did a good job explaining. That's a good first impression.

It sounds like your EP did a good job explaining. That's a good first impression.

Yes. My wife and I were extremely impressed. Wife felt he was the first physician since I started this journey that really showed he cared and had a good knowledge. There was no rushing. I discussed my history w/o interruption, he active listened and wrote. He taught, explained, answered all questions. I left w confidence in him and wanting him to perform the ablation.

The unfortunate part. He is busy. I waited two months to see him. I am looking at a possible 11 month wait for the ablation but still do not have a date. The facility he does the procedure at may be opening additional dates but we will not know for another month.

Couple of weekends ago I had some issues. Notified my cardiologist through the portal including sending him my ekg. His office assistant called me and told me he was off, returning the next day, she will speak to him and we will be in touch. I waited 11 days w/o a call. Decided I was done with him and scheduled an appointment w new cardio and one that works w afib patients. The afternoon that I set up the appointment w new cardio my current cardio office calls and tells me he does not want me to wait and has a new EP at another facility (well known university hospital) that can probably schedule me in May or sooner. He recommends I go to him. I really like the first one. Not that it is everything but the first EP has 50 patient reviews online and everyone is 5/5. Not one rating lower. My PCP has had a few of his patients get treated by him and told me that they all had successful ablations. The 2nd EP only has 9 reviews and his rating is much lower w complaint about him as well as the office staff.

I have not answered her back since she just called Friday. I am inclined to stick it out w the first EP. I know it's a gamble.

This forum has been great. I learned so much coming here. One of the things I have realized is the doctors I encountered in the ED, hospitalists, and my cardio do not teach you anything. It is here is a medication. Let us know if you have any problems. Change in health, lets change your dose. See you later.

11 months is a long time to wait! If you can tolerate your symptoms, and don't have a dangerous rhythm, it may be worth the wait based on what you shared. Like you I still look at the reviews online to see what people are saying. I know they are not reliable, but sometimes they can give you some tidbits of info to help make the decision. All the EPs I went to got 5-star reviews online and all do ablations weekly for more than 20 years. The last EP that did the ablation has been doing them for over 30 years. He was the best of the 3. I'm learning how important it is to choose an EP with the most experience doing ablations.

Maybe you get on a waiting list for cancellations to try to get in sooner.

You are likely to be at least several months out on the new one after waiting for an appointment and then waiting to get on his ablation schedule.

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JakeS
Not that it is everything but the first EP has 50 patient reviews online and everyone is 5/5. Not one rating lower. My PCP has had a few of his patients get treated by him and told me that they all had successful ablations. The 2nd EP only has 9 reviews and his rating is much lower w complaint about him as well as the office staff.

This is just my personal opinion, but I put almost zero value on online doctor rating sites. They may be okay at rating office staff efficiency and the doctor's bedside manner, but I don't think they mean diddly when it comes to the doctor's skills. The first EP I went to in 2010 has glowing ratings on those sites, but I know for a fact he is incompetent at ablations. And I even know he hasn't gotten any better since 2014 when he last touched me because I met a woman recently who had an unsuccessful ablation from him last year that went exactly as mine did. He hasn't learned what his fundamental mistake is in the last 13 years, but he gets glowing reviews nonetheless. But he IS a very nice, personable guy with a good bedside manner, and I think that's what gets him his glowing reviews.

Your personal experience with him is a much, much better gauge. Ignore the ratings and go with what you found yourself.

Good news! I was able to get things started today with Dr. Natale's office. He is out of network with my insurance, so it will cost me double on my out-of-pocket which is high. I'm going to do it anyway regardless of the cost. I need an EP I can count on and some resolution.

His nurse recommended I get an echo for the possible shunting in my atria because she said the intended puncture is typically closed by now. Not necessarily a mistake by the EP, but a possible complication. I'll need to figure that out because my current EP is not going to do it. I'm looking for a general cardiologist so I have someone local anyway. They said they would order one in the ER, but decided to refer back to my EP instead... It will be good to get an outside opinion anyway.

Are you on traditional Medicare, a Medicare Advantage plan, or private insurance? It might be possible for you to switch to a plan that's in network for him. Others here have done that.

Carey that's a great idea! I have private insurance. I'm going to look into that. Since I just moved recently, I will qualify for a new enrollment period.

Thank you Much appreciated



Edited 1 time(s). Last edit at 02/14/2023 10:05PM by Amara.

See my post for Medicare Advantage in NY paying for Natale ablation

There are some Medicare Advantage plans that do cover out of state care. I have UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO), live in NY, and had it cover 2 Natale ablations in Austin and just paid a copay each time.

From their description:
This PPO plan gives you freedom to see any provider nationwide that accepts Medicare plus access to network costs when you see doctors participating in the UnitedHealthcare® Medicare National Network.

Monthly Premium: $16

I changed my insurance coverage last year to see Dr. Natale. I have AARP Medicare Advantage Open Plan 2 (PPO). The premium is $33.00 a month. There are copays for some services but no deductible. What appealed to me is it has a maximum out-of-picked of $4,200.00, something alot of plans do not have.

I was happy with this coverage when I saw Dr. Natale after 2 failed ablations by a prior EP, a follow-up 12 minute touch up and a watchman implant. He is 2400 miles from where I live, but I would not see anyone else!

Those sound like great Medicare plans! I like that they are a PPO plan and let you travel out of state.

I'm not yet on Medicare and have private insurance. Sorry, I misstated it in my last post. I just corrected it. Does anyone have any experience with changing to a different private insurance company they can recommend?

I'm happy to hear Pixie that your ablations with Dr. Natale went well. I know how discouraging the 1st 2 failures can be. All of the input here has encouraged me that there's light at the end of the ablation tunnel.



Edited 1 time(s). Last edit at 02/14/2023 10:06PM by Amara.

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Amara
I'm not yet on Medicare and have private insurance. Sorry, I misstated it in my last post. I just corrected it. Does anyone have any experience with changing to a different private insurance company they can recommend?

Before you do anything check to see if Natale accepts your current insurance. If it's a big national company and not an HMO he probably does.

Is your current insurance through an employer?

It is BCBS of Oklahoma PPO and a cobra plan through a prior employer. When I called BCBS they said it's out of network, but I'm also going to wait to see what Natale's office says. like you suggested, in case they have more recently contracted with them.

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Amara
Those sound like great Medicare plans! I like that they are a PPO plan and let you travel out of state.

I'm not yet on Medicare and have private insurance.
.

Amara, I am sorry I missed the part about you having private insurance. Maybe the information JakeL and I provided will be helpful in the future,

Good luck with everything.

No worries Pixie, I wasn't clear initially.

Thank you

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Carey



This is just my personal opinion, but I put almost zero value on online doctor rating sites. They may be okay at rating office staff efficiency and the doctor's bedside manner, but I don't think they mean diddly when it comes to the doctor's skills....

Yes, very true. My own EP was the Canadian Cardiovascular Trainee of the Year for 2022. Not so shabby. The reviews on 'rate my doctor' locally are not what I would call effusive. Rather, they are highly critical of his demeanor and his bed-side manner. They call him arrogant and dismissive. Here is the real gen: the nurses are wary of him because he's hard on them. My nurse this Tuesday said she has got on his good side and they treat each other as equals. She has earned his respect. But every nurse I have talked to about him say he's top drawer, and that I'm lucky he accepted me as a patient.

Some want all the 'There-theres' and hand-holding an authority will give to them, even from the truly gifted and busiest of experts. They want all the smoke they can take up their backsides. I replied with my own comment after several had impugned Dr. Novak with a 'get real' comment that a busy, brusk, and competent person is far better working for you than an incompetent but oh-so-nice, self-aggrandizing 'expert' who hopes you'll still give him an attaboy when it's all over and you're obviously no better off.

Your situation sounds so familiar. I have not had the extent of complications, but I, also, have close to a 30% burden if PACs, live in bigeminy/trigeminy much of the time, and have sometimes up to a 50% burden of PACs. I have paroxysmal SVT and also have exercise intolerance. Mine also does have a vagus nerve component. I am so sorry to hear that you have had such a terrible time. My challenge has been finding anyone to recognize that the extremely high burden of PACs/SVT/Atrial Tachycardia is even a problem. They seem to act like it is just not really a big deal. I will be curious to hear how things turn out for you. Please keep us posted! I, too, have decided to consult with Natale. Have you tried a TENS unit with vagus nerve stimulation? I am having some relief with that!

Megan

Hi Everyone,

I haven't been active on here for a while. When I saw Megan's post I realized I never updated you all on my procedures. I've been in and out of the hospital since last May so have been a bit distracted.

Last May Dr. Natale and Dr. Kerendi (heart surgeon) performed a hybrid epicardial and endocardial procedure on my heart in Austin. It's the new procedure they do for inappropriate sinus tachycardia in clinical trials. It was successful, but I had complications, a damaged phrenic nerve and pericarditis. The surgeon let me know I had LVH and should have it worked up and also consider a diaphragm plication for the damaged phrenic nerve. I had the LVH worked up by a cardiomyopathy specialist and found out I had early-stage cardiomyopathy from all the tachycardia and PACs I experienced over the last year or so before the procedure.

A month after the procedure, I started having tachycardia, SVT, and a much lower level of PACs. I had a touch-up ablation done by Dr. Natale in August. More complications. I had a pericardial effusion and a pacemaker placed. I kept going into a junctional rhythm after the procedure. We waited a couple of days with very little improvement, so one of Dr. Natale's team EPs placed a PM before I left Austin. Dr. Natale did tell me in advance that during the initial surgery in May, I kept going into a junctional rhythm and was at a higher risk for needing a PM during this procedure.

When I returned to Jacksonville, I was worked up for the phrenic nerve damage. I was very symptomatic and my diaphragm was paralyzed from it. My liver started moving up into my chest and compressed my lung by 50% because the diaphragm could no longer keep it pushed down. Once again, I was researching options for an unusual problem and talking with many surgeons to weigh out my options. It seemed too risky to have a thoracotomy and have a neurosurgeon try to fix the phrenic nerve. I talked with several thoracic surgeons that warned of the possible serious complications with a nerve repair. Ultimately, I ended up having a robotic thoracic diaphragm plication last month. It's a big surgery and I'm just starting to get back to somewhat normal functioning.

The good news.... The cardiomyopathy has resolved more than 50% at this point. I don't have SOB anymore. I'm just starting to be active again since the surgery, but don't have the cardiac-related symptoms with exercise. My liver and abdominal organs are back where they belong....yay... I can sleep lying flat again. I have occasional SVT, but a very short duration and I don't notice it much now. I see it on my PM report or Wellue report when I wear it. I have an occasional episode of tachycardia but it seems to be getting less and less. I did start having some PACs again after the local device clinic did the first interrogation on my PM. It irritated my heart and caused them. At this point, I'm pretty sure the PACs and tachycardia are induced by the PM. The clinic doesn't seem to know how to adjust the settings correctly and the local EP isn't much help. I have a single lead in my right atrium due to the sinus node dysfunction. Mine automatically adjusts the rate with activity, but it adjusts in s funky way. I have an appointment with the device clinic this Friday to try to get it adjusted better. I'm planning to ask them to get the Medtronic rep to help. I may end up having to drive to Orlando 2+ hours to a different device clinic where the cardiomyopathy specialist is. The EPs in Jacksonville aren't that great at difficult issues and there's a 3 month wait any time you need anything.

I feel like I'm on the mend finally, and fingers crossed....cardiac arrhythmias are under control. Hopefully, this will last and no more touch-ups will be needed. Dr. Canby did a great job on placing my PM and you can hardly see the scar. I don't think I could have navigated all this without my nursing knowledge and background.

So all in all, Dr. Natale did help me and stop the arrhythmias, but I did end up with quite a few complications. I'm still following up with him.

I really do appreciate you all for your input, suggestions, support, and help. So, thank you! Having difficult arrhythmia problems is very challenging and being able to talk it through with you all has been very valuable to me.