Pre-Ablation Questions for EP

Hi everyone,

I feel like this kind of list of questions must exist somewhere already, but I couldn't find one. (I've seen some basic "What to ask your EP" questions online but they aren't very specific.) So I'm reaching out again, asking if more knowledgeable folks will take a look at my list below and make suggestions. I expect my EP will go over much of this, but I don't want to miss anything important (taking into consideration her probably limited time with me). What would you add to the list? Take off the list? What do you wish you had asked or known about? I would really appreciate your input!


How many ablations have you done? For AF? For AT (atrial tachycardia)?
What is your success rate for each?
How do you define success for each?
What is your rate of complications? (What were the complications? Were they transient or treatable?)
(Specific questions about protecting the esophagus, phrenic nerve, pulmonary vein, etc?)
How often have you seen a need for a second, “touch-up” ablation?
Do you do radio frequency, cryo, or PFA?
What would your approach be for me? (Is there anything about my particular case that makes it unusual or challenging, or will it be most probably a simple PVI?/Can you ablate both the AF and AT?)

Would I need to discontinue current meds (metoprolol, in my case) before the procedure?
What sort of anesthesia do you use? (lightly sedated or out?)
How is the mapping done?
What happens if you cannot induce the arrhythmias?
Is there anything I can do the day/night before to increase the odds of the arrhythmias showing up?
In my particular situation, what do you think the chances are for long-term success?
Is there any chance that the ablation might make things worse? (What would that scenario be?)

How long do you expect the procedure to take?
How long should I expect to be in the hospital afterwards?
How long should I plan to have a family member stay with me afterwards?
What, if any, meds will I need after the procedure and for how long?
Do you expect that I will be able to get off meds altogether? (at least until I hit 65, when DOACs may be a good idea)
Are there any specific things that I should watch for immediately after the ablation and in the blanking period?
How long before I can return to light exercise (walking) and more vigorous exercise (lifting heavy-ish weights)?

All things considered, would you recommend an early ablation or advise waiting to see what new treatments become available in the next few months/years?
How would you approach the risk/benefit decision?
If I want a second opinion, is there anyone you would recommend talking with?



THANK YOU!



Edited 1 time(s). Last edit at 11/02/2024 04:46PM by Nancy9.

Those are a lot of questions, probably requiring a full hour to answer, perhaps more with discussion of several of them.

If it were me:

About how many ablations do you perform in a week or in a month?

Do you know your own success rate for index ablations?

Is there anything about my particular case that makes it unusual or challenging, or will it be most probably a simple PVI?

Will I have ready access to your technicians or yourself if I need a little hand-holding or if I develop problems that your post-op instructions say I should deal with right away? Or should I go to Emerg?

The other questions are almost certainly answerable by doing some www research, or maybe your cardiologist has handouts.

Quote
gloaming
Those are a lot of questions, probably requiring a full hour to answer, perhaps more with discussion of several of them.

If it were me:

About how many ablations do you perform in a week or in a month?

Do you know your own success rate for index ablations?

Is there anything about my particular case that makes it unusual or challenging, or will it be most probably a simple PVI?

Will I have ready access to your technicians or yourself if I need a little hand-holding or if I develop problems that your post-op instructions say I should deal with right away? Or should I go to Emerg?

The other questions are almost certainly answerable by doing some www research, or maybe your cardiologist has handouts.

Thanks for your input. I take your point that I will need to prioritize, so I added some strike-throughs to the list, trying to pare it down to questions whose answers will determine 1) do I want to do this now? and 2) do I want to continue with this EP or talk to another? Honestly, though, I can't imagine going into a procedure like this without asking asking a lot of questions.

[
How many ablations have you done? For AF? For AT (atrial tachycardia)?
What is your success rate for each?
How do you define success for each?
What is your rate of complications? (What were the complications? Were they transient or treatable?)
How often have you seen a need for a second, “touch-up” ablation?
Do you do radio frequency, cryo, or PFA?
What would your approach be for me? (Is there anything about my particular case that makes it unusual or challenging, or will it be most probably a simple PVI?/Can you ablate both the AF and AT?)
In my particular situation, what do you think the chances are for long-term success?
Is there any chance that the ablation might make things worse? (What would that scenario be?)

How long do you expect the procedure to take?
How long should I expect to be in the hospital afterwards?
How long should I plan to have a family member stay with me afterwards?
What, if any, meds will I need after the procedure and for how long?
Do you expect that I will be able to get off meds altogether? (at least until I hit 65, when DOACs may be a good idea)
Are there any specific things that I should watch for immediately after the ablation and in the blanking period?
How long before I can return to light exercise (walking) and more vigorous exercise (lifting heavy-ish weights)?
All things considered, would you recommend an early ablation or advise waiting to see what new treatments become available in the next few months/years?
How would you approach the risk/benefit decision?



I cut down your list. Ask the anesthesiologist one of the questions. It’s your body and your decision. I would include ALL of Gloaming’s questions not listed above first and then add your questions above in this interview. You have to feel comfortable doing this procedure with this EP and you need some handholding in making this decision not rushed.

My list was longer for my index. Find out by his scheduler how long the appointment will be and explain you have some questions. By my second ablation I only asked if I can be scheduled the first of the day. By my third I asked the same one question. 4th was with a new EP and by his answers I realized he had zero bedside manner nor patience in answering questions. I like to be in kept in the loop.

I would add if he uses plugs to seal the femoral vein so you will know your mobility afterwards to get up and use the bathroom.

Thanks for the input, ideas, and support for questions, Susan! Fortunately, my EP has always been happy to answer as many questions as we can fit into an appointment, and understands why I need to ask them. One of the many reasons that I keep going to her…

Quote
Nancy9
Thanks for the input, ideas, and support for questions, Susan! Fortunately, my EP has always been happy to answer as many questions as we can fit into an appointment, and understands why I need to ask them. One of the many reasons that I keep going to her…

If it's not too late, these are questions which I might have for myself. I am in a similar position and have an EP appointment in Dec.

Some or all of the answers to the questions below may be in the forum already.
Are there circumstances where you advise that an ablation can wait for another year or more? If so, is that possible for my situation?
What range of BPM do you expect that my heart "rate" will return to after the ablation? Can I go off the anti-coagulants and beta blockers then?
Would you use Pulsed Field Ablation for the Pulmonary Vein Ablation and radiofrequency ablation for other areas unreachable with the PFA method?

Wishing you a most fruitful appointment.

Thank you! I've been wrestling with whether to wait or not, since I've had only two episodes in a year and a half (the first in response to a kidney stone and other stressors and the second lasting maybe 2 minutes.) I had my appointment and my EP said my case would likely be a "simple" PVI, for which she normally does cryo. But she will be doing PFA in a couple of months, so I'm thinking of waiting until she has a few of those under her belt. She has done thousands of ablations in her career, so I imagine the learning curve will not be steep. I asked whether there was any advantage in waiting, and her response was "not really."

About the heart rate after ablation question... I ran across an article comparing that for thermal vs. PFA, and so far studies seem to indicate that PFA does not have this effect. I can only find the article below comparing RF to PFA right now, but I know i saw one saying the same thing about cryo. It's my understanding that the higher rate is usually temporary, settling back to baseline over the course of months up to a year?

cryo.[pmc.ncbi.nlm.nih.gov]).

Wishing you a good appointment too!