I don't have experience with either but I'm interested in learning more about the Cleveland Clinic's "2nd opinion service." Can you tell me more or provide a link to the service on their website (if they have it on their website)?

Travis

Hi, I am fortunate the company I work for gives us free access to Best Doctors which is awesome. I used them for my afib, especially since none of my doctors could agree on treatment. They are very through with the information they are given from all of your doctors when it comes to giving you their findings and recommendations, they also send their findings and recommendations to your doc too if you want them to. I was glad I used them, my report had so much info in I was shocked at the depth they went to. Many of my co workers have used them for anything from back pain to cancer to serious heart issues. I would recommend them, even with the hefty price tag I think it would be worth it. I would use them again even if I had to pay for it out of pocket. Hope this helps!

TVL,

Here's the link:

https://www.eclevelandclinic.org/myConsultHome

Create an account and log in for details. I have turned in all my paperwork, so we'll wait to see how long my local DRs take to provide the records.

Robert

Hey remember me?

Don't ask... but it has taken more than 3 months to finally get ALL records to CC.

I expect to get the results in about three weeks.

Robert
NOTE TO SELF: get a copy of all your records, including all images!

Wow 3 months, that is crazy especially in the days of technology we are in. Good luck and hope it helps give you some answers so you and your docs can make better decisions for your treatment. Keep us posted!

All, FINALLY!

I got my 2nd opinion results from the Cleveland Clinic after 4 months. Anyway, since we're all friends here, it's posted below.

Basically, it comes in two parts: 1.) my list of 10 questions, and 2.) second opinion recommendations. I'll skip the list of my questions and will post the recommendations.


RECOMMENDATIONS:
In summary, looking at your Holter, I see evidence of premature atrial complexes and nonsustained atrial tachycardia. These may be acting as triggers for your atrial fibrillation. One way to look for them is to see if these arrhythmias can be induced by intravenous administration of Isoprel (the later can act in a similar fashion to adrenaline and may unmask these arrhythmias). If we were able to induce them then we may be able to ablate them if we can locate the source. This will require another ablation. The other option is proceed with a surgical approach via laproscopic modified Maze procedure along with left atrial appendageal clipping. A third option would be a hybrid approach with both procedures (percutaneous and surgical procedures. I have to be honest with you, I dont believe that these approaches (redo ablation: substrate modification along with atrial tachycardia ablation with Isoprel infusion, surgical approach, or hybrid approach) is going to carry a 100% success rate or even your reported 98% success rate. I dont believe here we have a black or white situation. However, we do have reasonable options. The success rate of these procedures in patients who have not responded to multiple prior ablations remains unknown. However, in younger patients who do not want to be on antiarrhythmic medication, considering these options is very reasonable. Before you commit to a redo percutaneous ablation, I favor you sit and meet with a surgeon to discuss surgical option. I will send your file to Dr. Ed Soltesz who is great AF surgeon and I do recommend you follow up with him in case you would like to take that route here at the Cleveland Clinic.

Besides, I reviewed the reported MRI results. In fact there is evidence of pulmonary vein stenosis: at least moderate but not severe. This pretty much involve all pulmonary veins and is manifested by narrowing in the luminal diameters of the pulmonary veins along with increased velocities reported in the pulmonary veins. I think you need to keep a close eye on these. We have reported in the past progressive worsening in the stenosis even after the 3 months post ablation period. Thus I do recommend you get another imaging test with MRI or CT scan to reevaluate the narrowing. You may also need an echocardiogram to look for any evidence of pulmonary hypertension and may need additionally a quantitative lung perfusion scan to assess blood flows. I would recommend you follow up with your local physicians and if you wish to see somebody here at the Cleveland Clinic, I highly recommend you see Dr. Lourdes Prieto for further evaluation of the pulmonary vein stenosis.
END OF RECOMMENDATION

There were a few interesting comments: 1.) my AFIB may be caused by some (yet to be determined arrhythmia; so how do you determine that?), 2.) he indicates another ablation is a possibility (but my XYL says 'never'! since it will likely lead to more PV stenosis), 3.) brings up the pulmonary hypertension (interesting, could this be causing my acute SOB, and lethargic feeling?)

The good news is that my staff at DUKE (I sent them the results) and they have scheduled a followup appointment, and one with Dr. Bahnson to discuss what was in the report and his recommendations.

BTW, as I said earlier, get a copy of ALL your medical records. I'm going to send them to Best Doctors next.

Also, the CC will give you 30 days to submit followup questions. I'm already p to 6, and will add any feedback from DUKE.

After reading and digesting it, the feedback it provides is very good, but provides treatment recommendations which raises more questions.

Robert

Robert

Good luck. Rf. My friend

PV Stenosis is something that has given me hesitation over ablation, particularly since I have no symptoms, I "tolerate" afib well, and I am older with persistent afib.

You said: "In fact there is evidence of pulmonary vein stenosis: at least moderate but not severe. This pretty much involve all pulmonary veins and is manifested by narrowing in the luminal diameters of the pulmonary veins along with increased velocities reported in the pulmonary veins. I think you need to keep a close eye on these. We have reported in the past progressive worsening in the stenosis even after the 3 months post ablation period. Thus I do recommend you get another imaging test with MRI or CT scan to reevaluate the narrowing."

I really think they gave you a thorough opinion that was very honest and well worth the money!