Hi Travis, I had to wait 3 mos to see my EP. I think he is well worth the wait. If or when I have ablation, I feel I have the Best, and that is what is most important to me.

I want a Dr. that I can trust his knowledge and skills. I want to be able to talk to him and be 'heard' with my concerns. When I have not been comfortable with what I have been told to do, I want an explanation that will relieve my discomfort, or the chance to find a compromise that I'll be OK with trying.

I have left 2 Cardio Dr.s because one would not listen to me and the other who was very charming and so nice and likable, but gave poor advice.

I still use a Cardio Dr. along with my EP because, my EP is hard to get in touch with when I need timely advice. My Cardio Dr, is readily available, knowledgeable and helpful.

Having a Dr. I trust and respect is a Blessing to me!

Travis: I personally would go to the second guy. The first guy I would play golf with. The second guy doesn't come home till after dark (working 12 hours a day). Since you have less than 1 afib episode in 2 years, it doesn't seem like wait time is an issue. I would think you would have follow-ups once a year (?) maybe to see how you are doing and check out how your med is working. Twice a year at most. FYI, many say Propafenone is not appropriate for Vagal AFIB (if that's what you have), Flecainide is. If you are in Adrenergic AFIB, I don't know. Many doctors don't even care what kind of AFIB you have when prescribing rhythm drugs. PIP definitely is the right approach, unless the episodes increase. You probably will never use them or will have to check the expiration date on the bottle if you do. The whole idea is to reduce or eliminate the AFIB attacks as much as possible so that it doesn't progress or remodel the heart. Ablation evolving rapidly. FIRM ablation is a great example. You don't want to have the EPs burning or freezing areas that don't need to be. Watch your diet, the list of typical triggers, alcohol, smoking... all that stuff. Do moderate exercise. If you need an ablation in 10-15 years, they will definitely have a cure that is durable. petey

BTW, there are 51 electro-physiologists listed with the Heart Rhythm Society. FHRS is the highest designation (Fellow of the Heart Rhythm Society):


Michael J. Ackerman, MD, PhD
Mayo Clinic College of Medicine
200 1st St SW Guggenheim 501
Rochester, MN 55905-0001
(507) 284-0101


Wayne O. Adkisson, MD
Univ of Minnesota, Cardiovascular Div
420 Delaware St SE
MMC 508
Minneapolis, MN 55455-0341
(612) 625-0816


Adrian K. Almquist, MD
Minneapolis Heart Institute
920 E 28th St
Ste 300
Minneapolis, MN 55407-1195
(612) 863-3900


Alan J. Bank, MD
United Heart and Vascular Clinic
225 N. Smith Ave.
Suite 400
St. Paul, MN 55102
651-241-2047


David G. Benditt, MD, FHRS, CCDS
Univ of Minnesota
420 Delaware St SE
MMC 508
Minneapolis, MN 55455-0341
(612) 625-4401


Barry A. Boilson, MD
Mayo Clinic, Cardiology
200 First St SW
Rochester, MN 55905
(507) 266-3089


David A. Burton, MD
Children's Heart Clinic
2545 Chicago Ave
Ste 106
Minneapolis, MN 55404-4541
(612) 813-8800


Lin Yee Chen, MD, FHRS
University of Minnesota Medical School, Cardiology
420 Delaware St Se
MMC 508
Minneapolis, MN 55455
(612) 625-4401


Parvin C. Dorostkar, MD
University of Minnesota, Pediatric Cardiology
2450 Riverside Ave
MM 555
Minneapolis, MN 55454
(612) 626-5824


David N. Dunbar, MD
HealthEast Heart Care
45 West 10th St
Saint Paul, MN 55102
(651) 471-1183
Website: http://healtheast.org


Ann Dunnigan, MD
Central Minnesota Heart Center
1406 6th Ave N
Saint Cloud, MN 56303-2735
(800) 448-3455


Paul A. Friedman, MD, FHRS
Mayo Clinic
200 1st St SW
Rm 4-523MB
Rochester, MN 55905-0001
(507) 255-2446



Bernard J. Gersh, MBChB, DPHIL
Mayo Clinic, Cardiovascular Div
200 1st St SW
Rochester, MN 55905-0001
(507) 284-4139


Charles C. Gornick, MD, FHRS
Minneapolis Cardiology Associates
920 E 28th St
Ste 300
Minneapolis, MN 55407-1195
(612) 863-3900

Gregory A. Granrud, MD
Healtheast Heart Care
45 W. 10th St.
Saint Paul, MN 55102
(612) 750-4433
Website: http://gagranrud@healtheast.org


Hongsheng M. Guo, MD, FHRS
Park Nicollet Health Services, Heart and Vascular Center
6500 Excelsior Blvd
Saint Louis Park, MN 55426-4702
(952) 993-3363


Stephen C. Hammill, MD, FHRS
Mayo Clinic, CV Medicine
200 1st St SW
Gonda Bldg SLW335
Rochester, MN 55905-0001
(507) 284-4888
Website: http://www.mayo.edu/int-med/fellowships/cv/cv-fell-home.htm


Robert G. Hauser, MD, FHRS
Minneapolis Heart Institute
920 E 28th St
Ste 300
Minneapolis, MN 55407-1195
(612) 863-3792


David L. Hayes, MD, FHRS, CCDS
Mayo Clinic, Cardiology Dept
200 1st St SW
Rochester, MN 55905-0001
(507) 284-3684

Douglas D. Hodgkin, MD, PhD
North Memorial Heart and Vascular Institute
3300 Oakdale Ave N
Ste 200
Robbinsdale, MN 55422-2926
(763) 581-5400


Stephen T. Hustead, DO, MS, CCDS
Mercy Hospital
4040 Coon Rapids Blvd NW
Ste 120
Minneapolis, MN 55433-4568
(763) 427-9980


Suraj Kapa, MD
Mayo Clinic
200 First Street SW
Rochester, MN 55905
(973) 885-5851


Rehan M. Karim, MD, FHRS
Hennepin County Medical Center
Hennepin County Medical Center
701 Park Ave, O-5
Minneapolis, MN 55415
(612) 873-2875


William T. Katsiyiannis, MD, FHRS
Minneapolis Heart Institute
920 E 28th St
Ste 300
Minneapolis, MN 55407-1195
(612) 863-3900


Hon-Chi Lee, MD, FHRS
Mayo Clinic, Dept of Internal Medicine
200 1st St SW
Rochester, MN 55905-0001
(507) 255-8353


Huagui Li, MD, PhD
University of Minnesota Physicians Heart at Fairview
6405 France Ave S
Ste W200
Edina, MN 55435
(952) 836-3700


Jian-Ming Li, MD, PhD, FHRS
VA Medical Center, Cardiology
1 Veterans Dr
Ste 111-C
Minneapolis, MN 55417-2309
(612) 467-2129


Joseph C. Lin, MD
Mercy Heart and Vascular Center, Metopolian Cardiology Consultants
4040 Coon Rapids Blvd
Ste 120
Minneapolis, MN 55433
(763) 236-9112


Margaret A. Lloyd, MD
Mayo Clinic
200 1st St SW
Rochester, MN 55905-0001
(507) 284-8087


Fei Lu, MD, PhD, FHRS
Univ of Minnesota, Dept of Cardiolgy
420 Delaware St SE MMC 508
Minneapolis, MN 55455-0341
(763) 420-7516


Christopher J. McLeod, MBChB, PhD, FHRS
Mayo Clinic, Cardiology
200 1st St SW
Rochester, MN 55905-0001
(507) 255-4152


Simon Milstein, MD, FHRS
Central Minnesota Heart Center
1406 6th Ave N
Saint Cloud, MN 56303
(320) 656-7020


Michael E. Mollerus, MD
St. Mary's Medical Center
2320 E 1st St
Duluth, MN 55812-1807
(218) 724-9736


Julia Montgomery, MD
St Mary's Duluth Clinic, Cardiology
407 E 3rd St
Duluth, MN 55805-1950
(218) 786-3443


Thomas M. Munger, MD
Mayo Clinic
200 First St SW Gonda 6-411
Rochester, MN 55905-0001
(507) 284-3585

Douglas L. Packer, MD, FHRS
Mayo Clinic - St. Mary's Hospital
1216 2nd St SW 2-416 Alfred Bldg
Rochester, MN 55902-1906
(507) 255-6263

Robert F. Rea, MD
Mayo Clinic Rochester
200 1st St SW
Rochester, MN 55905-0001
(507) 255-4152


Scott Sakaguchi, MD, FHRS
Univ of Minnesota, Cardiology Division
MMC Box 508
420 Delaware St SE
Minneapolis, MN 55455-0341
(612) 625-4401


John A. Schoenhard, MD, PhD
CentraCare Heart & Vascular Center
1406 Sixth Ave. N.
Saint Cloud, MN 56303
(800) 448-3455


Jeffrey J. Shultz, MD
Park Nicollet Heart and Vascular Center
6500 Excelsior Blvd
HVC
Saint Louis Park, MN 55426-4702
(952)-993-3665

Jay S. Simonson, MD, FHRS, CCDS
Park Nicollet Heart & Vascular Ctr - Heart Clinic
6500 Excelsior Blvd
Saint Louis Park, MN 55426-4702
(952) 993-3665
Website: http://parknicollet.com

Andrew J. Smith, III, MD
Park Nicollet
6500 Excelsior BLVD
St. Louis Park, MN 55426
(952) 993-3246

Kenneth M. Stein, MD, FHRS
Boston Scientific
4100 Hamline Ave N
Saint Paul, MN 55112-5700
(651) 582-3422

David M. Steinhaus, MD, FHRS
Medtronic, Inc.
8200 Coral Sea St NE MVC 42
Mounds View, MN 55112
(763) 514-4239

Chuen Y. Tang, BS, MBBS, FHRS, CCDS
Minneapolis Heart Institute
920 E 28th St
Ste 300
Minneapolis, MN 55407-1195
(612) 863-3900

Venkatakrishna N. Tholakanahalli, MD, FHRS
VA Medical Center
111C One Veterans Dr
Minneapolis, MN 55417
(612) 467-3662


Pierce J. Vatterott, MD
United Heart and Vascular
255 Smith Ave N
Ste 100
Saint Paul, MN 55102-2518
(651) 241-2122

Mevan N. Wijetunga, MD, FHRS
CentraCare Heart & Vascular Center
1406 6th Ave N
Saint Cloud, MN 56303-2735
(320) 656-7020

Dennis WeiXi Zhu, MD, FHRS
Regions Hospital Heart Center
640 Jackson St
Saint Paul, MN 55101-2502
(651) 254-2487


petey

I meant "listed in Minnesota"

So anyway, Mayo Clinic is a top electrophysiology/afib treatment location. Below is one of the afib "rock stars" as they call them:

Douglas L. Packer, MD, FHRS
Mayo Clinic - St. Mary's Hospital
1216 2nd St SW 2-416 Alfred Bldg
Rochester, MN 55902-1906
(507) 255-6263

There are probably numerous people there that are good.

petey

One other thing... Dr.Packer was the Lead Investigator on the Cabana Trial, comparing drugs versus ablation. He should know something about the subject:

http://www.stopafib.org/newsitem.cfm/NEWSID/298/

OK, I'm done. :-)

petey

Travis,

This is a tough choice. It's good you got a second opinion. I had an ablation by a doc at Cleveland Clinic and his wait time was about 3-4 months. Same as your guy, he's in surgery many hours a day and is just backed up, esp since the ablations are not small surgeries.

I would go with the doc who has the most experience. It would be nice if that doc at great bedside manner too, but hard to get everything.

Tough situation, but good thing you got a second opinion.

It takes 5 months to get in and see my doc. Even though my results haven't been the best with my ablation, he is supposed to be good. I agree with Petey and would go with the second one. My doc would never suggest an ablation and would not do one if I was having episodes only a few times a year. I would hold off until it became more frequent or started having very long episodes. Don't be afraid to try the PIP method. I did it for a long time and started out with the Flecanaide. I found the best pill for me was a beta blocker. I still had bad episodes, but it helped reduce the rate so my heart could try to kick back in. If you can, wait for more technology to come out. Good luck.

Travis,

When I was initially diagnosed with afib I asked my cardiologist for ep recommendations. Based on his recommendations and my research I decided to see 3 ep's as I wanted to get diverse opinions and also to see where their were consistencies.

Each ep gave me a different treatment recommendation. All 3 ep's were well known and I felt each was very competent. One of the ep's did suggest an ablation. I decided that since I was asymptomatic, paroxysmal I did not want an ablation. I still go to this ep along with another ep because I still want a second opinion; in addition, if I ever want an ablation then I would go to this ep because of his extensive experience.

Since I am responsible for my health I feel that I need to be the one that ultimatley chooses my treatment.. I always discuss ep recommendations with my cardiologist who is also my primary doc and knows my health the best as I have gone to him for many years.

So right now I am going to 2 ep's and I like the idea of getting second opinions. Both ep's agreed with the initial medications that my cardiologist prescibed.

Recently one of my ep's suggested anticoagulation. I ran his recommendation and rationale by the second ep, my cardiologist and a new third ep (also a rock star but different than any of the initial ep's I had seen) and they disagreed. So I had one ep saying anticoagulation and 3 other docs against it.

So my point is that ep's will disagree. A doctor friend once told me that medicine is 75% science, 25% art. A second doctor friend agreed that medicine involved art and science but he disagreed on the percentages saying that art was higher.

Although it takes a long time to get appointments with my ep's, I find that they or their staffs are very responsive to email.

Hope this helps

opsyn

Travis,
I agree with opsyn, I had different opinions from 2 cardiologists and an EP, although all said that the decision to get an ablation was really up to me. I decided to go for the ablation because I had afib episodes every 3-4 weeks.
The small, but real, danger of the procedure was in my mind less important than quality of life. So I decided to go for the ablation an I am glad I did.
What I am trying to say is that YOU have to decide, depending on your priorities concerning quality of life vs risk taking. Curing afib is more art than science, don't expect docs to decide for you.
Good luck whatever you decide.

What I'm learning is to stick with one EP. Whichever one it is, stick to him or her alone. Crossfire does not work well.

For example, my first EP wanted me on pre-ablation Coumadin. Second EP recommended Pradaxa. First EP had the soonest availability for the procedure. But I said hey look there's this other anti-coag, Pradaxa, which doesn't require 3 pre-procedural INR blood tests, and I can still eat spinach. So first EP approved the Pradaxa. On Game Day the EP had to abort ablation due to clotting on the transeptal sheath. It's an anomaly, but guess what the one difference will be next time? Coumadin instead of Pradaxa. (I will also be better hydrated day of surgery and request Ativan the second they get that first IV in me to calm me down - I was practically in shock by the time they administered general anaesthesia). It's anecdotal, but telling.

What I'm also learning after seeing several EPs is that *I* am truly in charge of my own care. My EP (who attempted the ablation - he is now my man) just recommended that I either up my dose of propefanone or switch to Tiknol, after failing flecainide and 2x225mg propefanone. Well Tiknol requires loading in the hospital in case long QT sets in. I said, "Give me a week to think about it." So if a-fib comes back on hard, I will probably up my propefanone dose from 225 to 325mg as next step. Meanwhile, it is really on me to decide whether to test my coagulation system again during a second procedure (hematologist cleared me as normal).

I've also become proactive about my diet - things EPs don't discuss a whole lot. My breakfast is now a magnesium cocktail of pumpkin seeds, almonds, half avocado, banana, and kefir. I also couple this with a high DHA fish oil pill (triglyceride form from Nordic Naturals). There is some solid peer reviewed literature to suggest that EPA oil is pro-arrhythmic while DHA is anti-arrhythmic. Of course, good luck getting an M.D. to weigh in on this.

Just my thoughts. Thanks for the discussion. Best wishes choosing one EP.

Sean

Sean,

Thanks for your advice. I just made an appt with a new EP to just get his take on things because he's much closer and easier to get to. YOu do have a point.

Too many cooks in the kitchen sometimes don't mix well...

@Petey:

Thanks for the useful info! Where did you find that list of EP's? I was glad to see my 2nd guy was on the list:)

@Sean:

Do you have the info on the peer reviewed literature you mentioned regarding EPA vs. DHA? I'd be interested in reading more on that. By the way, good luck with your situation. If I ever have an ablation, they'll have to load me up with Ativan too. I don't do well at all when it comes to needles, procedures, or anything medically related...lol. Does the extra magnesium do anything for you?

Travis

Petey,
I know you have been a fan of the FIRM ablation for a while...now, when Mellanie posted a few weeks back, she listed a number of ablation options that were being discussed in Texas, including the one I had (cardiofocus laser balloon ablation). But there was a new one that as I recall, you asked her about. Do you remember what that one was, and have you heard anything more about it? Wish I could remember the name, but at this point, I am glad that I remember to log in to dailystrength.org! Sigh....

Bad memory Bill
P.S. Travis, I went very early in the process for an ablation. In Europe, ablation is a first line approach, and the center in Bordeaux is considered THE best in the world (well, everyone has an opinion, and I read a few online that said this). The American approach is to try drugs first. It is a VERY personal decision. There seems to be so much progress being made on ablation methods that it would seem like a good time to wait if you don't need one, but again, personal choice. I would also dump the first EP if you have a bad vibe about him. Obviously, you would be trusting this guy with your life. Not something to take lightly. Here I say "Alles van die beste," if you are really a Dutch boy (but if you are, you will recognize that this is Afrikaans, or "baby Dutch.")

Bill

Travis. Check hrsonline.org "find a specialist". Petey