Hi DB,

I think most on this board before they would be able to give you some advice would need to know more about your current situation.
1) How old are you?
2) Do you smoke, drink, overweight, high blood pressure, past history of stroke or other heart disease, general overall health?
3) How often do you currently get episodes and how long do they last?
4) How well do you tolerate your current symptoms? Is the afib impacting your life in significant ways (either when in NSR or in afib)?

If you end up seriously considering an ablation, you must seek out an EP who is highly experienced and does many cases a year. Most of these individuals are at major medical centers (but not always). These days, I would certainly make sure that they are using a force sensing catheter if they propose an RF ablation. While you will often see first ablation success rates as in the 65% range, this represents a mix of expexp[erienced and less experienced practioners. That said, I would be dubious of anyone telling you that they have higher than an 85% success rate on first ablations. I do not know where you live, but if travel is not an obstacle don't be shy about traveling to "interview" several EP's. Finally, take advantage of this board, people on here ar empathetic, have a wealth of knowlege and experience, and are anxious to share.

Good luck,
Rob

My visit to my EP was ......not what I expected. He asked me a lot of questions. Then he started to tell me about Ablation. I asked him why he thought I needed one, since it had not been recommended by my Cardio dr. He said, Everyone does better with an ablation asap. The sooner the better, and he could schedule me in a month....just call the office...and he was done. He half heatedly answered the few questions I asked...which I remember were about the best antiarrhythmic for me and did Magnesium help reduce palpitations, and was V8 juice helpful to drink daily.

He is the one I would choose If or When I choose to have ablation,
because he does so many!!!!

Thanks, Rob, I appreciate your response. I will certainly answer the questions if it'll help others offer me their advice.

I am 57, and I do not smoke. I have an occasional glass of wine with dinner, and I've really limited that in the last few months. I did have high blood pressure, but it has since lowered considerably since taking BP medication. My resting heart rate is usually in the high 40's or low 50's. My A-fib episodes were always every 6-7 months apart, almost like clockwork. I've had to have 2 cardioversions, but I usually convert on my own with a little extra Atenolol. I'm in a-fib or flutter for 2-3 days each time. The duration, also, has increased in the last few months. I had one episode in November and two in December. I've been in NSR since then.

Otherwise, my general health is good. I had two complete knee replacements two years ago, and my life has improved since then. I do suffer from bouts of anxiety both when I'm in and/or worried about going into A-fib. I am a school teacher, and it's very difficult to be ready for a substitute teacher when afib strikes in the middle of the night! I worry about it happening when something special is coming up (son's wedding, fieldtrips at school, ect.).

I am tolerating the medication without major side effects right now. I do not, though, want to take them the rest of my life if I don't have to. I do not have the energy and stamina that I used to have, but I'm not sure if that's the medication or just normal aging!

Thank you, again, for taking the time to offer me some insight into this first visit with an EP. I appreciate your thoughts!

If and when that day ever comes for me, therell be no lack of questions asked. Yes, one, how many have you done. Who else is going to be involved in the procedure, interns, students, am I going to be a guinea pig. Whats your success rate with 1 ablation. On average, how many more have been necessary 2-3.
Then the $160k questions. What guarantee is there for the long term, and how long. If I require 2 or more, and later Afib returns, will my heart be compromised to the point that I will not be able to have any more. Speaking of compromise, how much will my quality of life be affected, stamina , wind etc. Whats the chance that after all this I will still need Meds. What MEds, how much, will I ever be able to stop MEds. Will my risk for stroke be reduced with ablation and if so, by what percentage. I intend to make any EP earn his high salary if ever face to face with one.

Heres the list (more or less) that I took to my appointment. First I let him discuss and tell me what he thought was important. With that he answered most of the questions so actually I only asked a few.

1. Operator and Institutional Experience (institute: 600- 800 procedures is high volume) How many atrial fibrillation procedures have you done?
ANSWER: operator - minimum 100 procedures per year.
a. What is your success rate for the approach you would use for my type of AF? success rates (define success)
b. Are there any other patient characteristics that you have found make a difference in your success rate?
c. How long do you follow your patients to determine if they still have episodes of AF? How do you determine this?
d. What percentage of patients like me need a second procedure? What is the success rate for the two procedures?
e. Under what circumstances do you discontinue Coumadin?

2. Complication
a. What complications have there been using this procedure? What steps do you take to avoid complications?
b. Have there been any procedure-related deaths in your experience or that of your center? What were the circumstances? What steps have been taken to avoid such incidents in the future?
c. atrial-esophageal fistula. (Occurs with injury from the ablation goes through the heart and into the esophagus. )
i. How do you plan to avoid injury of the esophagus?
ii. how will the injury risk be minimized
iii. what will occur if the esophagus happens to be in the way to complete the procedure?

3. Radiation exposure (radiation exposure is cumulative)
a. How do you reduce my radiation exposure ? (During a procedure the Nation cancer institute recommends Less than 2 GY and the cumulative dose to less than 3 GY if possible)

4. General approach to ablation: conservative / aggressive

5. General questions / about ablation
a. Do you use any particular criteria in selecting patients? Are there patients you will not accept? I have [a heart or other condition you suspect might make a difference]. Will that make a difference in whether you accept me or in the success rate?
b. How long a wait would there be for an initial appointment, and for the procedure?
c. What do I do next? What records do you need and to what number do I have them faxed? What tests would I need to have and when?
d. How long does the procedure take?
e. How long is the hospital stay?
f. What is the range of time until full recovery for different levels of activity; for example, for office work and construction work? After how long would there be no exercise or work restrictions?
And finally:

Are there treatments in the pipeline that I should consider waiting for? If I were to call you back in one or two years, what new procedures or other developments in the field would you be telling me about?

The ultimate question:

If you were in my shoes, knowing what you know about ablation, what questions would you ask the person who would potentially perform the procedure on you?


Feel free to tweak this. I hope it helps.
Good luck on Monday and be sure to tell us how it went!
atp

Wow, once again, I am amazed at the kindness of this board! Thank you so much! You've sure given me some great info, and I will be able to compose my questions before I go next week. I will come back and let you know what I found out.