I agree, for me an EP is needed only for an ablation and short term follow up

Thanks Paul! I was beginning to beieve that i HAD to have an EP to deal with my AFib. My cardio guy just gave me a drug called sotalol to start today. The insert says be in the hospital to start it but the cardiac nurse said that most of their patients take i out patient. I have an anxiety disorder so i am afraid to take anything new. Btw, i am taking Xerelto right now but its way too expensive for me. Can u give me some advice concerning Coumadin? Thanks man.

I think the EP is the backup for the cardio..........if your cardio sends you to one and you are happy with your cardio you should listen to them..... and go get the EP's take.

A very good question. I too had wondered why I do not see an EP. I do not think I need one at the present. I was on Zarelto (it is pricey) and Metropol, had to stop because of hemorrhage and go on Sotalol. I was hospitalized because of bleeding. I take Warfarin (coumadin), test every 3 weeks, eat some greens, avoid canola oil because it is made from cabbage related plant. I go to gym, cannot get my heart rate above 80 because of Sotalol although it can suddenly jump to 130 for a short time. No symptoms or episodes for a couple of months. I am comfortable most of the time.

RunningHorse: I was on Coumadin 5 years ago for 6 months, and tended to be very stable. After you become stable, you only need the blood monitoring every 2-3 weeks if you don't screw up your diet by eating thing high in Vitamin K like Swiss Chard, Kale and Collard Greens. Now there are home monitoring systems so you can do your own testing, like diabetes. Medicare will pay for home testing, but you must be stable on Coumadin for over 90 days (I think) and you also need a qualifying condition (AFIB should qualify). I point out the Medicare rules since private insurance companies might use it as a guide.
I've only been back on Coumadin for a month and am not stable yet. But it should be no problem. Most doctors I've talked to are avoiding the newer anitcoagulants, like Xarelto because there is no antidote. Coumadin has been around for decades so its action, and termination, is well understood.

Hi Paul,

I used to think the same way but after going to a rock star ep I felt differently.

As an example to illustrate my point - I was initially diagnosed with afib by routine cardiologist ecg. Cardiologist (who I hold in the highest regard) followed up with numerous tests like the ones you mentioned and since CHADSvasc was 0 prescribed aspirin.

I later went to a rock star ep who did a 7 day holter and although CHADSvasc was 0 recommend anticoagulation based on afib burden. EP was more knowledgeable in studies regarding afib burden and from personal experiences in dealing with afib patients that had similar profiles to mine.

Treating arrhythmias is all this ep does. And when he is not treating patients he is researching them, attending classes and conferences, talking to fellow ep, reading papers etc. It would not surprise me if he dreams about afib. All this translates into better patient care.

I dont think all eps are the same but in my opinion the average ep will have more knowledge and experience than the average cardiologist and that translates into better care.

Other than ablations, elite eps can do cardiac MRIs to assess fibrosis and give you a better sense of ablation outcomes, evaluate left atrial appendage morphology to work out anticoagulation strategies, etc. These are examples other than ablations that unfortunately cardiologists cannot do and may not even be aware of.

My 2 cents

Thank you Opsyn:
The first EP I saw wasn't interested in doing anything other than ablations, thus my less than stellar attitude. I saw my cardiologist today for a long talk, essentially going over what I said above. She recommended a different EP who she feels is much less inclined to (in my words), go for the knife. I'm going to try this new EP, you've given me some hope that this might be a worthwhile experience.

Well, I saw a general cardiologist the first few years with afib. He was content with rhythm control. As my afib became more frequent and interfered with my life more and more he referred me to an EP at my request. I love my EP! He gave me my options, did not push that an ablation was the only way to go. At the time my insurance wouldn't cover ablation without first failing an antiarrythmic med. So he started me on flecainide and it has worked so well that 3 years later I am not ready to have an ablation. He prescribes the meds, he stays on top of any testing needed. I do not feel my reg cardiologist was as thorough.
So, if I had stayed with my reg cardiologist he would have kept me on rate control and I would likely be in permanent afib by now.
I have no doubt that some EPs are only interested in surgery....hope you will find the right one for you.

Hi Paul: My EP only wants to see me again if I decide I want a 3rd ablation. He released me from his care after my second ablation follow up 2 years ago and advised me that my cardio will manage my care and medications. I think EPs primarily do procedures/surgery and leave continuing care to the referring cardiologist.

My comments... EPs are cardiologists.

Those with FACC designation also have attained the Fellow of the American College of Cardiology status. That requires a minimum of ten years of clinical and educational preparation and passing a rigorous two-day exam given by the American Board of Internal Medicine. Most EPs have passed this Cardiology Board exam.

So you get a cardiologist that specializes in heart rhythm problems. They are the most "up" on afib treatments. If heart disease (the plumbing kind) is your problem, see a cardiologist. There are tons of them. If you have afib, why not see an EP? Monitoring fibrosis, left atrial size, ejection fraction, CHA2DS2Vasc, atrial shape, etc... these are the things that EPs know most about.

petey

Thank you all for your encouragement and support. Today I'm going to make an appointment to see the new EP and its probably time for me to try a rhythm control drug. I would be nice for have a more stable heart -g-.

Because of A-Flutter, my PCP referred me to a cardiologist. The cardiologist suggested I see an EP, and referred me to an EP (at that point I had never even heard of an EP) without my even asking. I had an ablation for A-Flutter, which stopped it for six years. Then A-Fib reared its ugly head, and my EP referred me to another EP who specialized in just A-Fib. I was a bit surprised that my first EP would refer me to another EP. I was first put on a rhythm control med, which didn't work, then on a second rhythm control med, which also didn't work. This second EP was very careful to explain that I didn't have to have an ablation. He was very clear about the benefits and risks of having an ablation and of not having an ablation. I really liked the fact that he didn't "push" having an ablation, and left the decision entirely up to me. I decided to go ahead with the ablation, and last May I had the ablation, and so far (knock on wood) I have had zero A-Fib, even during the 90 period after the ablation. I am glad I had the ablation, and since ablations are a relatively new procedure, I have no idea the long term effect of the ablation, if I will have to have another one, etc. So I guess my point is that there are some really good EPs, and you should trust your gut feeling about any EP, which you are doing. Too bad you aren't in the Atlanta area, as I would suggest using my EP. Wishing you the best.

For what it's worth, the head of the electrophysiology group I go to doesn't even do ablations. His bio, along with all the doctors in that group that do ablations, lists both Cardiology and Cardiac Electrophysiology as specialties. I know it doesn't answer your question, but it's apropos I think.

I've been recently watching YouTube vids of Dr. Stephen Sinatra - a cardiologist (who did lots of surgeries) about heart health. He now recommends natural ways to heal your heart. Some really interesting stuff on what to take. This includes A-Fib as well as the other heart issues.

I feel an EP takes atrial fibrillation more serious than cardiologist. The cardiologist I went to told me I didn't do anything to cause it and I can resume my normal activities. That was bull. There's no way I could resume normal activities. Anyways I am very happy with my results of my 2 ablations. The reason your suppose to take soltalol in the hospital is because it can cause prolongation of the QT waves in which apparently you can pass out at any point. The first time I was on sotalol for 8 months I didn't have a QT prolongation and I was in hospital for 3 days each time they increased it. The second time I was put on sotalol I was still in hospital when they started it but about 6 weeks later my QT waves started prolonging. Found that out at an emergency room visit for afib and atach. Having an anxiety did order and craxy heart is a bad combination. You think each episode is yhe "big" one. I'm still on coumidin. The only hassel are the monthly blood test to check ur levels.