What are the issues with traveling for ablation?

I’m planning on an ablation sometime in the next year, probably spring time. I could go with a local EP who seems perfectly competent using well established RF approach. Or I could drive about 7 hours and go with a very well known highly experienced EP that is using the latest PFA.

Seems at first the obvious choice is to travel. But I’m concerned that the follow up care might be more challenging. I’m also very anxious about it all and sleeping in my own bed the night before would be a big help (sometimes I struggle with insomnia). I also have a local cardiologist who might frown upon me leaving the local network for an ablation, and might not collaborate with the other EP for follow-up monitoring and care as well. I’m in Canada, and I get the sense it’s kind of expected we take what we are offered…And I just like the idea of being able to walk back into the hospital I get it done at if there are any issues and being able to ask what gives. I also expect multiple ablations in my future as my rhythm issues are a bit rare and complicated.

Does anyone here have any thoughts on this matter? Anyone traveled for an ablation and realized staying local would have been preferable? Are rhythm clinics less helpful for issues that occurred from ablations with a different clinic?

Really appreciate any input, thank you!

If your cardiologist or the clinic is reluctant to treat you just because you went somewhere else for an ablation then that would be extremely petty and unprofessional of them. I don't think you should allow that to influence your thinking.

In reality, there's rarely a need for in-person follow-up after an ablation. My final ablation was done 2000 miles from my home and follow-up was easy. I stayed in town for two days after the procedure as they recommended but after that I sent the NP a Kardia recording weekly, and I could talk to her any time I needed by email or phone. It might take a day or so to get back to me, but even if you stay local you'll still have to deal with that. I did go to a follow-up visit with my local EP whom I really liked, and I did annual follow-ups with him just to maintain the relationship (until COVID ended that), but I never really needed anything from him. He was totally okay with me going to someone else (in fact, he admitted to being relieved).


All in all, I don't think my care was any better or worse than if I had used a local EP, and I got the benefit of a much more experienced EP. I was a complex case and I had failed multiple previous ablations, so I think that experience was crucial. You say you have complex issues, so that in my mind is a good argument for the most experienced EP you can get.

Thank you Carey. I suppose in this day and age, being in person for follow ups really isn't what it used to be. And I see your point about the local clinic not worth continuing with if they took issue with my going elsewhere for procedure. Things are a bit different in Canada here as far as seeing an EP in my experience. You either agree to the procedure or they don't have time for you. Pressure from our Canadian health plan system to move things along... I do wonder about if something goes wrong though, like esophageal fision or something like that, if then it would be better to be close to the hospital that did the procedure. Just walk into the ER and the EP wouldn't be too far away.

Probably the bigger thing for me is whether I will be okay sleeping in a hotel before and after the procedure rather than my own home. And the whole travel day too. In addition to sleep issues, I have chronic back/neck pain, particularly when nervous, which can make a long drive hard.

In the extremely unlikely event you develop an atrioesophageal fistula (AEF), you don't need your EP or any EP. You need a thoracic surgeon and you need them yesterday. The only complications that come out of ablations usually occur during or immediately after the procedure, which is why my EP recommended staying in town for 2 days after the procedure. An AEF, on the other hand, tends to develop 2-3 weeks after the procedure. But really, AEFs are so scary that EPs have spent years trying to make them never happen, and that's largely true now. It's an extraordinarily rare complication.

So what's left that can go wrong days or weeks later that you didn't know about when you left the hospital? Honestly, I can't think of anything. And I can't recall anyone reporting such a complication here. The real problems you'll be facing can all be dealt with by phone or emails. It will be things like meds that need to be changed or adjusted, continuing bouts of afib or flutter, PACs, and so on.

Don't know what would help the sleep issues but maybe ask the EP for a couple of days worth of a sleep aid? And is it not possible to swap a flight for that 7-hour drive?

The care you'll need won't be of concern to an EP unless you relapse and it's something he/she can, or should ethically, fix for you. The care you need is monitoring only, and the results of the 10 week Holter can be sent to him/her digitally these days. Other care involves your GP,...maybe (it was my instruction to see my GP at the six-10 day mark to check in health and heart rhythm). It turns out he detected that I was in AF already, only six days out of surgery. He had me go to the local ER, they confirmed with an urgent ECG, and I was admitted and put on Amiodarone immediately. The internist in the ER did get ahold of my EP, and the agreement must have been for Amiodarone with the dysrhythmia the ECG showed.

I would urge you to avail yourself of any care, great care, that you can get within a reasonable distance and effort, but don't worry so much about post-op. The EP won't hasten to redo your failed ablation if your GP says you're back in AF or in PVC unless it's a life-threatening condition, quite apparently, and then you'll be scheduled as an emergency. At that point, you'll probably need to be driven, or you'll need an ambulance. For most of us, it's back home, rest, get up and move around some over the next few days, and strive for normalcy within 10 days.

Thanks Carey, yes I could fly but I'm quite tall and find flying uncomfortable, haven't flown in nearly two decades, so would rather drive. I do have sleeping pills I take occasionally, but feel awful the next day after taking them. I just want to avoid the situation where my body is a wreck going into a procedure...

If I had to go to the ER after, they would have an easier time getting in touch with the local rhythm clinic as it's only a hundred feet down the hall. But I do see your point, Gloaming, about most potential issues being easily dealt with remotely.

I think the further away clinic has shorter wait times and more resources at their disposal, so that would be another point in traveling to get it done.

I'm not actually in afib. Haven't got stuck in it for any period of time for over a year. My issues is alternating RR interval (electrical alternans possibly) any time I try even light exercise, or even just postural changes can trigger it. And it is degrading with time. I need a EP study for them to figure out what is going on. But given I have a history of afib, it will make sense to do the pulmonary vanes. And I'd rather have that done with PFA.

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Probably the bigger thing for me is whether I will be okay sleeping in a hotel before and after the procedure rather than my own home. And the whole travel day too.

If sleep is an issue for you, there is a pretty good chance that you won’t sleep the night before no matter where you are! Particularly true if you are first up, requiring a 5 AM arrival at the hospital. And, I did travel and had to stop taking, a prescription sleep aid for 24 hours before the ablation as it could possibly suppress Afib.

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Daisy
Probably the bigger thing for me is whether I will be okay sleeping in a hotel before and after the procedure rather than my own home. And the whole travel day too.

If sleep is an issue for you, there is a pretty good chance that you won’t sleep the night before no matter where you are! Particularly true if you are first up, requiring a 5 AM arrival at the hospital. And, I did travel and had to stop taking, a prescription sleep aid for 24 hours before the ablation as it could possibly suppress Afib.

To add, if I may, the kind of stress/unusual behavior and circumstances involved, will stand a good chance of putting you into AF anyway...it does for a great many of us. This is great because you ideally want to be in arrhythmia when they commence the mapping process. You want your heart to suddenly lurch back into a nice 'n steady NSR when they zap the right spot(s). Confirmation comes when they challenge the heart right before releasing you from the cath lab and find that your heart wants to remain in steady NSR.

Thank you all. I'm glad I asked this question here. I'm still undecided, but now I have more info for my brain to mull over... One way or another, it's got to happen.

The advantage of a local doctor is IF you get any problems, it’s good to have a local doctor who has attending privileges at your local hospital. I had this problem when my EP flew back and his NP went on maternity leave and the Austin’s NP who was taking her calls was away on vacation.

Thanks Susan, that definitely sounds like a good instance of a local advantage