ABOUT 'BEAT YOUR A-FIB'...


"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

"Your book [Beat Your A-Fib] is the quintessential most important guide not only for the individual experiencing atrial fibrillation and his family, but also for primary physicians, and cardiologists."

Jane-Alexandra Krehbiel, nurse, blogger and author "Rational Preparedness: A Primer to Preparedness"



ABOUT A-FIB.COM...


"Steve Ryan's summaries of the Boston A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation."

Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

"I love your [A-fib.com] website, Patti and Steve! An excellent resource for anybody seeking credible science on atrial fibrillation plus compelling real-life stories from others living with A-Fib. Congratulations…"

Carolyn Thomas, blogger and heart attack survivor; MyHeartSisters.org

"Steve, your website was so helpful. Thank you! After two ablations I am now A-fib free. You are a great help to a lot of people, keep up the good work."

Terry Traver, former A-Fib patient

"If you want to do some research on AF go to A-Fib.com by Steve Ryan, this site was a big help to me, and helped me be free of AF."

Roy Salmon Patient, A-Fib Free; pacemakerclub.com, Sept. 2013


Doctors & Facilities

Your Nearest ‘Certified Stroke Center’ Could Save Your Life

A Certified Stroke Center could save your life or avert the debilitating effects of an A-Fib stroke. But only if you get there within four hours.

What is a Certified Stroke Center?

A certified or ‘Advanced Comprehensive Stroke Center’ is typically the largest and best-equipped hospital in a given geographical area that can treat any kind of stroke or stroke complication.

Only a fraction of the 5,800 acute-care hospitals in the U.S are certified as providing state-of-the-art stroke care.

Why Do I Need to Know the Closest?

If you have a stroke and get yourself to a Certified Stroke Center within four hours, there is a good chance specialists can dissolve the clot, and you won’t have any lasting damage. (Hurray, you dodged a bullet.)

A Certified Stroke Center will have drugs such as Tissue Plasminogen Activator (tPA) to dissolve the clot. They can use Clopidogrel or acetylsalicylic acid (ASA) to stop platelets from clumping together to form clots. Or use anticoagulants to keep existing blood clots from getting larger.

Be Prepared for a Stroke Emergency: Do Your Homework

We offer you two sources to look up the nearest certified or ‘Advanced Comprehensive Stroke Center’. Just enter your zip code or other parameter to see a map and list of centers:

Find A Certified U.S. Stroke Center Near You/NPR News
Find a Certified Comprehensive Stroke Center

How about your workplace? Find and post the closest ‘Advanced Comprehensive Stroke Center’.

Graphic: Keep your medical records in a binder or folder. A-Fib.com

Print the name, address and phone number of the closest Certified Stroke Center. Store extras in your A-Fib Records binder or folder.

Post at home for easy access during a medical emergency.

If EMT responders come to your home, tell them where to take you and give them a handout (insist they take you there).

For more tips on preparing your family in the event you have a stroke, see our FAQ and answer: In Case of Stroke, What Your Family Should Know Now.

‘TOP DOCTORS’ Added to A-Fib.com Directory of Doctors

When using our A-Fib.com Directory of Doctors and Medical Centers, you may now see an additional qualification after some doctor’s names: “Listed in Castle Connolly TOP DOCTORS.”

Castle Connolly TOP DOCTORS are selected through peer nominations and extensive research and screening by Castle Connolly’s doctor-directed research teams.

TOP DOCTERS added to A-Fib.com Directory.

‘TOP DOCTORS’ added to A-Fib.com Directory.

To add Castle Connolly top-rated EPs to our own Directory, we first combed through the cardiologists listed in ‘America’s Top Doctors’, then manually selected those who specialize in electrophysiology (EP).

Important: Just like Steve’s Directory of Doctors and Medical Centers, Castle Connolly Top Doctors cannot request or pay to be listed.

Caution: Don’t rely on any single source of recommendations (including our own directory). You still need to do your own due diligence when selecting a doctor. For guidance, see our article: Finding the Right Doctor for You.

References for this article

CryoBalloon Ablation: All EPS Are Not Equal (Part II)

Second in a two-part series by Steve S. Ryan, PhD

In Part I of this article, I shared my dismay at reading two O.R. reports of Cyroballoon Ablations that left me alarmed and disturbed. The first case was performed at one of the most prestigious A-Fib centers in New York City.
In each case, what’s alarming is what the EP didn’t do! The CryoBalloon ablation was less than the standard. The very minimum steps were taken.

Is Performing CryoBalloon Ablations Too Easy?

That relative ease has lead some EPs to cut corners. They just isolate the PVs without doing anything else.
CryoBalloon ablation is relatively easy to perform compared to RF (point-by-point) ablation.

That relative ease has lead some EPs to cut corners. They just isolate the PVs without doing anything else—they don’t bother to identify where A-Fib signals (potentials) are coming from and they don’t try to induce A-Fib after the ablation.

Some EPs performing CryoBalloon ablations may not have a full skill set. Others may lack the motivation to hunt for non-PV triggers.

My fear: If this becomes a trend, I fear CryoBalloon may become a step backwards as a treatment for A-Fib patients. Could CryoBalloon Ablation turn into a second-tier or inherently inferior procedure?

Choosing an EP for a Cryoballoon Ablations

Are you considering a catheter ablation (RF or Cyro)? Before selecting your electrophysiologist (EP), you must do your research and check their credentials and experience. For guidelines, see our Find the Right Doctor for You and Your A-Fib.

When choosing an EP for a Cyroballoon Ablation, you should research:

1. Are they certified in Clinical Cardiac Electrophysiology (CCE)?
2. Did they have a good track record doing RF ablation before they switched to CryoBalloon ablation?
3. Do they perform at least 25 ablations a year to maintain their proficiency?
4. Will this EP commit to pursue and ablate non-PV triggers?

Take Away: All EPS Are Not Equal

You want an EP with a proven track record in RF ablation who can call on those skills if needed to identify and ablate non-PV triggers.

You don’t want an EP new to the field who is only doing CryoBalloon ablations because they are so much easier to do. EPs don’t all have the same training, skill level, and motivation. Indeed, many non-CCE certified EPs perform catheter ablations for A-Fib.

You want an EP with a proven track record in RF ablation who can call on those skills if needed to identify and ablate non-PV triggers. The EP should have established protocols for doing this and should be able to explain them to you. For example, something like this:

“If you are still in A-Fib after Cryoablation of the pulmonary veins, I will withdraw the CryoBalloon catheter and replace it with an RF catheter. I’ll identify the non-PV trigger spots, then isolate each with the RF catheter.”

All EPs are not equal. To become A-Fib-free, do your homework! Find the right EP for your Cyroballoon ablation.

Additional reading: To learn more about O. R. reports see our Special Report: How & Why to Read Your Operating Room Report

CryoBalloon Ablation: Alarming O.R. Reports (Part I)

A two-part series by Steve S. Ryan, PhD

Often when A-Fib patients contact me, I’ll advise getting a copy of their O.R. (Operating Room) report so I can read exactly what was done during their ablation. The details in an O. R. report can be quite revealing and usually reassure me that their EP did a good job.

An O.R. report of a catheter ablation is a blow-by-blow account of your EP’s actions.

But sometimes the report is disappointing. I just read two O.R. reports of CryoBalloon ablations that left me alarmed and disturbed.

O.R. Report #1: Ablation Without Identifying the Source of A-Fib Signals

The first CryoBalloon ablation was performed at one of the most prestigious A-Fib centers in New York City.

At the beginning of the ablation, it appears the Electrophysiologist (EP) made no attempt to first map the source of the patient’s A-Fib signals (mapping at the beginning or before hand is standard procedure at most A-Fib centers).

During the ablation the EP did not check for non-PV triggers or even attempt to identify the source of her A-Fib signals or potentials. The EP merely ablated the pulmonary veins (PVs), but did check for entrance and exit block.

At the beginning of the CryoBalloon ablation, the EP made no attempt to first map the source of the patient’s A-Fib signals.

At the end of the CryoBalloon ablation, he did not verify all A-Fib signals had been terminated by trying to trigger A-Fib with pacing or drugs like isoproterenol. (Triggering A-Fib means a new round of A-Fib isolation.) Once again, this verifying step is standard protocol for most ablations at most centers.

Result: the CryoBalloon ablation appeared to successfully isolate the patient’s PVs, and luckily she seems to be doing well.

My Observations

What’s alarming is what the EP didn’t do! This CryoBalloon ablation was less than the standard.

The very minimum steps were taken: isolate the Pulmonary Veins and little more. There was no effort to check for non-PV sources of A-Fib signals. No verification that all A-Fib sources were terminated. In fact, this patient may still have spots producing A-Fib signals.

Why go through an ablation if the EP didn’t do a thorough job? If the patient’s A-Fib returns, a second ablation may be required.

Now you know why I was disturbed by this O. R. report. Now, let’s look at the second report.

O.R Report #2: Non-PV Triggers Still Causing A-Fib

I read another O.R. report of a CryoBalloon Ablation on a patient who was in persistent A-Fib for two months before the ablation.

After isolating the PVs, the patient remained in A-Fib.

After isolating the PVs, the patient remained in A-Fib…the EP simply electrocardioverted the patient back into normal sinus rhythm.

Instead of looking for and ablating the source of these non-PV triggers, the EP simply electrocardioverted the patient back into normal sinus rhythm. (That’s certainly faster and easier than looking for non-PV triggers.)

Result: The patient was back in A-Fib within a month.

MY OBSERVATIONS

According to the patient, when the patient and his family first met with the CryoBalloon ablationist, they asked the right questions:

“What will you do if I still have A-Fib after the ablation?”

The EP said he would not stop until all the A-Fib spots were found and ablated.

In reality, instead of doing that, he just electrocardioverted the patient back into normal sinus rhythm without looking for and ablating the patient’s still-firing non-PV triggers.

It’s no wonder the patient was back in A-Fib shortly after this ablation.

Again, I was alarmed and troubled by what I read.

Take Away: O. R. Reports

An O.R. report is a blow-by-blow account of your EP’s actions. Indeed, the details in an O. R. report can be quite revealing. In these two cases, alarmingly so.

Read our free report.

Read our free report.

If you’ve had an ablation that was less than successful, you want to know why! Your O.R. report would show what they found in your heart, what was done, and possibly why the ablation didn’t fulfill expectations.

Read more about O. R. reports in our Special Report How & Why to Read Your Operating Room Report

NEXT TIME, IN PART II: Is Performing CryoBalloon Ablations too Easy?

Don’t be Fooled by Pay-to-Play Online Doctor Referral Sites

Independent, unbiased assessment of medical care is more important today than ever. Don’t be fooled! Anyone can draw up a “best of” list, and many organizations do.

Drug companies favor those doctors who are high prescribers of their drugs. To many health insurance companies, a physician’s fees are often a more important factor than quality. Many publications and websites recommend health care providers who pay to get their names mentioned.

Pay-to-Play Directory Listings Common

Pay to Play Doctor directories: Doctors can pay to be in your search results; At A-Fib.com

Doctors can pay to be in your search results

Paying to be listed in a doctor referral service is common among online directories. In addition, doctors can pay extra to be listed first in your database search results.

The article ABC News Investigates Top Doctor Awards: Are They Always Well Deserved?’ includes a warning:

“Don’t be confused by sound-alike websites like ‘TopDocs.com’. ‘TopDocs.com’ does not claim to rank doctors in any way. In fact, regardless of true top doctor status, a spot at TopDocs.com is available to any physician who pays for membership. The cost to buy a spot on the TopDocs.com website ranges anywhere from $1,500 to $10,000, in addition to an annual fee of $1,600.”

Don’t fall prey to hype, advertising, or third parties that have something to gain by recommending a particular healthcare provider.

Consumer Ratings of Doctors May be Just as Flawed

Some people believe that patient ratings are the best source of information on doctors. Unfortunately, that is a misguided assumption. Patients may be able to rate a doctor’s “bedside manner,” but they know little about the complexity of medical care.

In fact, an article in Forbes magazine stated:

“The current system might just kill you. Many doctors, in order to get high ratings (and a higher salary), over-prescribe and over-test, just to “satisfy” patients, who probably aren‘t qualified to judge their care. And there’s a financial cost, as flawed patient survey methods and the decisions they induce, produce billions more in waste.”

Takeaway

Some web sites for A-Fib patients may be biased, often for financial gain. When searching online, always ask yourself:

“Who is paying for this website, and what is their agenda?”

Do not rely entirely on doctor ratings or doctor referral sites. Instead, get personal referrals, refer to our Directory of Doctors and Medical Centers as needed, and then do your own research on each doctor. For guidance, see our article: Finding the Right Doctor for You.

At A-Fib.com, we accept no fee, benefit or value of any kind to be listed in our Directory of Doctors and Medical Centers. A-Fib.com is not affiliated with any practice, medical center or physician.

Caution - when searching A-Fib websites always ask: who is paying for this site and what is their agenda?

A word to the wise…

References for this article

How to Find the Right Doctor: Steve’s Directory of Doctors & Medical Centers

Doctor acronyms wide 150 pix wide at 96 res

Article: Physician Credentials and What They Mean

Are you looking for a cardiologist who treats A-Fib patients? Or do you want to change doctors? We make it easier for you with our A-Fib.com Directory of Doctors and Medical Centers.

What Makes our Directory Unique?

Unlike some other directories on the web, we accept no fee, benefit or value of any kind for listing a specific doctor or medical center.

We list only those cardiologists and electrophysiologists who treat Atrial Fibrillation patients. We include doctor’s names and contact information. Our Directory is organized in three parts:

How to Select the Right Doctor for You

Be sure to refer to our article: Finding the Right Doctor for You and Your A-Fib. It covers what you need to know to research and select the best doctor for you and your treatment goals.

What do FHRS, FACC and CEPS mean after a doctor’s name? Read our article: Physician Credentials: Acronyms and What They Mean for Atrial Fibrillation Patients.

NOTE: This evolving list is offered as a service and convenience to A-Fib patients and is not an endorsement of any doctor or medical facility.
NOTICE: Unlike some other directories on the web, we offer no preferential listings to be in our Directory. We accept no fee, benefit or value of any kind for listing a specific doctor or medical center. A-Fib.com is not affiliated with any practice, medical center or physician.

Why Choose a Doctor Who Understands the Significance of Rotors?

After posting my article, Rotors! Rotors! Rotors! Good News for Patients with Persistent A-Fib (2016 AF Symposium), I was surprised when Patti said we didn’t have the term ‘rotors’ in our Glossary of A-Fib Terms. So we just added it:

Rotors: underlying drivers that sustain or propagate an A-Fib signal after it has been triggered (like an echo). Elimination of rotors by catheter ablation improves long-term freedom from A-Fib.

Why You Want a Doctor Who Understands the Significance of Rotors

The ability to diagnose rotors enables a more patient-specific treatment approach by focusing on just a few critical areas in each individual patient’s heart and results in fewer lesions (ablation scars).

Stay away from EPs who ablate only the pulmonary veins (PV).

This is important. You should stay away from EPs who ablate only the pulmonary veins (PV) and don’t check for non-PV triggers like rotors and focal points. That is a one-size-fits-all approach. (See my editorial: Huge Growth in Number of EPs Doing Catheter Ablations, But All EPs Are Not Equal)

A more reasonable approach tailors treatment to each individual’s specific physiology. This requires a more experienced EP and precise location identification using advanced mapping techniques (such as the FIRM Mapping and Ablation System by Topera/Abbott Laboratories or the ECGI/ECVUE system by CardioInsight Technologies/Medtronic).

What This Means to Patients

You want an experienced doctor (EP) who understands the significance of ‘rotors’; who will use advanced mapping techniques, when needed, to search for and isolate non-PV triggers.

You must do your due diligence to find the right EP. I know it’s a lot of effort. Don’t settle for an EP because their office is nearby. Be prepared to travel if that’s what it takes.

Remember: You must be your own best patient advocate.

How to Select Your Doctor

To learn more about how to select the right doctor for you and your treatment goals, see my article: Finding the Right Doctor for You and Your A-Fib.

Never see a doctor alone - at A-Fib.com

Doctor-Patient Relationships: Do You Trust Your Doctor?

Doctor with stethescope

Do you like and trust your doctor?

At A-Fib.com, we stress the importance of a good doctor-patient relationship. In our A-Fib.com section, Finding the Right Doctor for You and Your A-Fib, you’ll find step-by-step how to research, find and interview prospective doctors. It’s important to select a doctor who will team with you to reach your A-Fib treatment goals.

Indeed, recent research proves that patients do better when they have a good rapport with their doctor. Researchers at Massachusetts General Hospital analyzed the results of 13 high-quality studies of doctor-patient relationships.—Read my full report.

After Ten Years, Repeat Ablation by Dr. Kerwin at Cedars-Sinai (CryoBalloon)

Pete & Beth Nyquist his A-Fib story on A-Fib.com

Pete & Beth Nyquist

A longtime A-Fib.com reader, Pete Nyquist, recently wrote us with an update about his A-Fib:

“My first ablation 2006: Thanks to your A-Fib.com website, I found Dr. Walter Kerwin and Cedars-Sinai Medical Center in Los Angeles. He did my Cryo Focal ablation in 2006, and it lasted almost 10 years without a problem.

My second ablation 2015: Recently, (September) I came out from Nashville, TN, to have Dr. Kerwin perform another procedure on me. This time it was the Cryo-Balloon. It took six hours, but Dr. Kerwin feels it was a great success. I was released on September 11, 2015 and since then feel great.

I highly recommend anyone considering having a Cryo-Balloon ablation done, to fly to Los Angeles and have Dr. Kerwin do it at Cedars-Sinai. Don’t just settle for anyone who can do an ablation. (see: All EPs Doing Abaltions Are Not Equal). Dr. Kerwin pioneered the Cryo Balloon and has devoted his entire life to curing A-Fib.

Thanks again for your A-Fib.com website and for leading me to Dr. Kerwin. I welcome emails from A-Fib.com readers.

Regards. Pete Nyquist, Nashville, TN, Ptnyquist(at)sbcglobal.net”

For more patient A-Fib stories, visit our page: Personal A-Fib Stories of Hope for over 80 first-person reports by patients, many of whom are now free from the burden of atrial fibrillation.

Huge Growth in Number of EPs Doing Catheter Ablations, But All EPs Are Not Equal

by Steve Ryan, PhD

Back in 2002 when we started A-Fib.com, we listed only seven centers doing catheter ablations. Today our FREE Directory of Doctors and Medical Centers lists over 1,800 EPs from all corners of the US and many others from around the world. (We only list EPs who have the “Clinical Cardiac Electrophysiology” certification and who register “AF Ablation” as part of their “Practice Information”. )

It’s very encouraging for A-Fib patients to see so many new EPs and centers performing catheter ablations. Few medical advances have been so rapidly and widely accepted.

Has This Growth Been Too Fast?

This rapid progress raises some issues. Has this growth been too fast? Are all these new EPs getting the training and hands-on experience they need? In fact, some EPs currently performing ablations have never passed their Clinical Cardiology Certification.

One measure of competency is the rate of complications following an ablation procedure. A study of Medicare data is very revealing about in-hospital complications following catheter ablations.

Low Volume Operators Have the Highest Complication Rates

What was the biggest predictor of complications? The centers with an A-Fib ablation volume of less than 25 ablations per year had the highest rate of compilations.

Imagine what my ablation would have looked like and turned out had I gone to an inexperienced EP?” −Travis Van Slooten.

Shocking―the facts get worse. … Continue reading this report…->

Free Report: How & Why to Read An Operating Room Report

Special 12-page report by Steve S. Ryan, PhD

FREE 12-page Report by Steve S. Ryan, PhD

In our free Special Report, How and Why to Read Your OR Report – Special Report by Steve S. Ryan PhD – A-Fib.com, we examine the actual O.R. report of the catheter ablation of Travis Van Slooten, publisher of Living With Atrial Fibrillation performed by Dr. Andrea Natale, Austin, TX.

What is an O.R. Report?

An O.R. report is a document written by the electrophysiologist who performed the catheter ablation. It contains a detailed account of the findings, the procedure used, the preoperative and postoperative diagnoses, etc.

It’s a very technical document. Because of this, it’s usually given to a patient only when they ask for it. You need to call your doctor or his office to obtain it.

Why to Request and Read Your O.R. Report

The O.R. report is a historical record of how you became A-Fib free.
The O.R. report is a blow-by-blow account of your EP’s actions. It’s as close as you’ll get to understanding your own ablation without actually looking over the EP’s shoulder during the ablation. The O.R. report is a historical record of how you became A-Fib free. (File with your A-Fib medical records for future reference.)

If you’ve had an ablation that was less than successful, you want to know why! Your O.R. report would show what they found in your heart, what was done, and possibly why the ablation didn’t fulfill expectations.

Studying an O.R. report can be very revealing…you may decide to change EPs going forward!

Reading an O.R. report can be very revealing. Were there complications? Was your fibrosis more extensive than expected? Was there a problem with the EP’s ablation techniques? Or with the EP lab equipment? This information will help you and your healthcare team decide how next to proceed.

Also, depending on what you read in your O.R. report, you may decide to change EPs going forward!

O.R. Report with closeup

Close-up of O.R. Report with markups

FREE Report: How & Why to Read Your Operating Room Report

In our FREE Special Report: How and Why to Read Your OR Report – Special Report by Steve S. Ryan PhD – A-Fib.com, I make it easy (well, let’s say ‘easier’) to learn how to read an O.R. report.

Along with an introduction, I’ve annotated every technical phrase or concept (in purple text) so you will understand each entry. I then translate what each comment means and summarize Travis’ report.

Get your PDF copy TODAY. Download How and Why to Read Your OR Report – Special Report by Steve S. Ryan PhD – A-Fib.com our FREE 12-page Special Report (Remember: Save to PDF  to your hard drive.)

Tip: If you’ve had an ablation, ask for your O.R. Report. If you or a loved one is planning a catheter ablation, make a note to yourself to ask for the O.R. report.

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If you find any errors on this page, email us. Y Last updated: Monday, July 18, 2016

Steve’s Inbox: International Mail & A-Fib Awareness Month

Many people email me for advice and support. This past week was quite the international experience for me. In addition to emails from the US, I also received emails from Syria, South Africa and Ecuador! Let me share a few with you.

The A-Fib Patient in a War Zone: Someone in a war-torn country was trying to find medical help for his A-Fib. A doctor started him on a heavy dose of amiodarone for his A-Fib. I told him about the toxic effects of amiodarone, but recognized that he was lucky to find any kind of medical help in a war zone. I couldn’t find any EPs still practicing in his country, but did find two centers in an adjacent country not at war. But I don’t know if he will be able to travel there. Please think positive thoughts/pray for him.

Airport Rendezvous: A traveler described a chance meeting in an airport with a well-known EP. This was more like a ‘sign’ than a chance occurrence. This wonderful EP answered her A-Fib questions and referred her to another EP near her for an ablation. She wrote that talking with the ‘airport’ EP helped her make the big decision to have a catheter ablation. (She had been looking at another surgery treatment option which I suggested might be overkill for her.)

Our A-Fib Support Volunteers were so supportive and helpful that she decided to become a volunteer, too.

A-Fib Support Volunteers in Action: Another woman described an all too common frustration with her primary care doctors and cardiologists who didn’t take her A-Fib symptoms seriously. They wouldn’t even refer her for a cardioversion. She was helped a lot by getting in touch with five of our great A-Fib Support Volunteers who had widely different experiences. They were so supportive and helpful that she decided to become an A-Fib Support Volunteer herself.

Amiodarone Advice: Another patient wrote that his cardiologist put him on a heavy dose of amiodarone when he first started having A-Fib episodes. I recommended the patient get a second opinion, that amiodarone is a very toxic med usually only prescribed as a last resort or for short periods of time like during the blanking period after a catheter ablation.

Negative Feedback: I warned someone about an EP whom I had heard negative things about. I referred the patient to a ‘master’ EP in his area for his ablation. I also told him to give his long-suffering wife a hug from all of us. All too often spouses of A-Fib patients put up with a lot and often feel alone and overwhelmed. I told them about the wonderful story “The Spouse’s Perspective: A Young Wife and Mother Copes with Husband’s A-Fib” in our book “Beat Your A-Fib: The Essential Guide to Finding Your Cure.”Top 10 Questions Families Ask About A-Fib - 150 pix at 96 res

September is A-Fib Awareness Month: As you see, there are many, many A-Fib patients out there seeking help and answers for their particular situation. A-Fib is not a one-size-all kind of disease. But A-Fib can be Cured! You don’t have to live a life on meds! Won’t you pass on our message to others with A-Fib and their families and friends? Send them a link to our special FREE report: The Top 10 Questions Families Ask About Atrial Fibrillation.

—Your A-Fib friend, Steve

Primary Care Doctor Ignorant of Electrophysiology?

I recently received an email from an A-Fib.com reader relaying a unexpected experience and asking my advice:

“When I was talking with my primary care doctor, he wasn’t sure what an ‘Electrophysiologist (EP)’ was or even if they were regular doctors. I had to explain how an Electrophysiologist (EP) is a cardiologist who specializes in heart rhythm problems, and is board certified in internal medicine, cardiology, and more importantly in Electrophysiology.

No wonder they didn’t refer me to an EP.

How widespread is this problem? How can we make the A-Fib community more aware of this?”

For decades, drug therapy was the traditional treatment for A-Fib. Today, it’s still common for a primary care doctor or general practitioner to treat A-Fib patients with rate and rhythm control medications rather than referring them to a heart rhythm specialist.

Treatment alternatives didn’t come until the pioneering research and procedures first developed by Dr. James L. Cox and Dr. Michel Haissaguerre (the Cox Maze surgeries in 1987 and pulmonary vein catheter ablation in 1996, respectively). Still, it has taken twenty years for Catheter Ablation procedures to be accepted as a first-line therapy for A-Fib patients (see the AHA/ACC/HRS. 2014 Guideline for the Management of Patients With Atrial Fibrillation).

On the A-Fib.com website, one of our core tenets is to encourage patients to seek the advice of one or more heart rhythm specialists (a cardiologist who specializes in heart rhythm problems is called an electrophysiologist or EP).

A-Fib is an Electrical Problem. While most people have heard of a cardiologist, they aren’t familiar with the term ‘electrophysiologist’ (EP) or what they do. They don’t know that cardiologists focus on the vascular function of the heart while electrophysiologists (EPs) specialize in the electrical function (think ‘plumber’ of the heart vs. ‘electrician’ of the heart).

Back in 2002 when we started the A-Fib.com website, our list of recommended electrophysiologists and medical centers offering catheter ablations to A-Fib patients had only seven facilities listed. Today, our Directory of Doctors and Facilities lists over 1,800 electrophysiologists and medical centers.

You can find an Electrophysiologist (EP) on your own; refer to our Finding the Right Doctor page and related readings; look for ‘board certified’ in ‘Clinical Cardiac Electrophysiology.

Speak out on A-Fib Forums: It is vital for A-Fib patients to seek out a heart rhythm specialist, i.e. an electrophysiologist (EP). (I often feel like John the Baptist in the desert trying to spread the word about EPs.) To help, you can post your comments and start a discussion on one or more of the online Atrial Fibrillation Support groups, groups such as Daily Strength Atrial Fibrillation Support Group and Facebook Group: Atrial Fibrillation Support Forum.

For a list of recommended groups see our page: A-Fib Online Discussion Groups and Message Boards.

References for this article

How to Find the Right Doctor: Steve’s Directory of Doctors & Medical Centers

Doctor acronyms wide 150 pix wide at 96 res

Article: Physician Credentials and What They Mean

Are you looking for a cardiologist who treats A-Fib patients? Or do you want to change doctors? We make it easier for you with our A-Fib.com Directory of Doctors and Medical Centers.

What makes our directory unique?

We list only those cardiologists and electrophysiologists who treat Atrial Fibrillation patients. It’s organized in two parts: by U.S. state and international. We include doctor’s names and contact information. (This evolving list is offered as a service and convenience to A-Fib patients.)


IMPORTANT: Be sure to refer to Finding the Right Doctor for You and Your A-Fib. It covers what you need to know to research and select the best doctor for you and your treatment goals. And read our article: Physician Credentials: Acronyms and What They Mean for Atrial Fibrillation Patients.
NOTICE: Unlike some other directories on the web, we offer no preferential listings to be in our Directory. We accept no fee, benefit or value of any kind for listing a specific doctor or medical center. A-Fib.com is not affiliated with any practice, medical center or physician.

Who’s Performing Maze and Mini-Maze Operations?

If you aren’t a candidate for a catheter ablation, another option is the Maze/Mini-Maze surgeries. We’ve compiled a list of Medical Centers and doctors performing the Maze surgeries and organized it by US state.

Go to US Centers and Surgeons Performing Maze and Mini-Maze Operations.

We include doctor’s names and contact information. Be sure to refer to Finding the Right Doctor for You and Your A-Fib. It covers what you need to know to research and select the best doctor for you and your treatment goals.

NOTICE: Unlike some other directories on the web, we offer no preferential listings to be in our Directory. We accept no fee, benefit or value of any kind for listing a specific doctor or medical center. A-Fib.com is not affiliated with any practice, medical center or physician.

 

Catheter Ablation: The Bordeaux Group Procedures & Costs

“I’ve heard good things about the French Bordeaux group. Didn’t Prof. Michel Häissaguerre invent catheter ablation for A-Fib? Where can I get more info about them? How much does it cost to go there?”

Prof. Häissaguerre and his colleagues invented catheter ablation for A-Fib (Pulmonary Vein Isolation). the Bordeaux group at the Cardiologic Hospital of Haut-Lévêque is still considered one of the top A-Fib centers in the world. (They cured my A-Fib back in 1998. I was their first U.S. patient. Read my story.)

In particular they are doing cutting edge research using ECGI (CardioInsight) to map and ablate persistent A-Fib. ECGI will probably revolutionize how ablations are mapped and performed.

How to Contact the Hôpital Cardiologique du Haut Lévêque-(CHU) de Bordeaux 

Links to University Hospital of Bordeaux, Cardiology and Electrophysiology services (June 2016):

• Cardiology and Electrophysiology and Pacing ServicesHead of department: Pr Jean-Michel Haïssaguerre

• Electrophysiology and Ablation, Head of Unit: Prof. Pierre Jais

• Patient Care: Services and Appointment Request – online form

Bordeaux Procedures and Costs

Here is something they wrote a few years ago which explains their methodology and the costs of being treated at Bordeaux (2010). Published as: Are you a good candidate? http://Are you a good candidate?

CATHETER ABLATION OF ATRIAL FIBRILLATION

Currently the only treatments that cure atrial fibrillation (AF) are:

a) Surgery (such as the Cox Maze operation and its variations)
b) Catheter Ablation

The main goals of catheter ablation of AF are to:

1) restore the heart to normal sinus rhythm, thereby eliminating the symptoms of AF.
2) relieve the patient from the associated risks of AF, such as blood clot formation, stroke, cardiac failure, and increased mortality. (It has not been proven that a successful Catheter Ablation will achieve these goals in all A-Fib patients.)

In the catheter ablation procedure a catheter, a soft, thin, flexible tube with an electrode at the tip, is inserted through a large vein in the groin and moved into the heart. This catheter delivers Radiofrequency (RF) energy to cauterize and eliminate the sources or spots in the heart (ectopic foci or wavelet circuits) that are triggering or maintaining the episodes of AF. These sources or spots in the heart are usually found in the pulmonary vein openings. The catheter also makes linear lines or lesions to segment the atrial tissue, thereby interrupting the errant electrical waves responsible for maintaining AF.

This isolation of the pulmonary veins cures the intermittent (paroxysmal) form of AF in 80% of patients (without having to take any medications). An additional 10% of patients are improved—an antiarrhythmic drug keeps them is sinus rhythm without the need for blood thinners.

For patients with permanent or persistent AF (lasting more than 48 hours or who have had Electrocardioversion), isolation of the pulmonary veins is less effective and should be combined with linear lines or lesions. This is because the longer one has episodes of AF, the more the sources or spots in the heart which produce AF signals tend to spread outside the pulmonary veins.

Ablated heart tissue has a tendency to heal itself and recover. For this reason and to increase the success rate to 90%, more than one procedure is required after 1-3 months of follow-up.

Pre-ablation Management

For safety reasons (to avoid clot formation during the catheter ablation procedure) the patient should take oral anticoagulation (coumadin, not aspirin) at an optimal therapeutic range (INR 2-3) for at least 1-2 months before the procedure. In addition, a transesophageal echocardiogram should be performed a few days before hospitalization to make sure there are no clots in the heart, particularly in the left atrial appendage. If clots are found, the procedure must be postponed a few days until these clots can be dissolved by blood thinners.

Anticoagulants should be interrupted 48 hours before the day of the procedure. If the patient is taking antiarrhythmic drugs, they should be stopped on admission.

Catheter Approaches

General anesthesia is rarely performed on adult patients, in order to minimize the associated risks of anesthetic drugs. The patient is slightly sedated and a local anesthetic is applied to the groin area. Usually three catheters for mapping and ablation are inserted through one or two femoral veins in the groin and moved up into the heart.

The mapping catheters have multiple electrodes mounted in a longitudinal or circumferential shaft. (Other configurations including investigational designs may be used for individual situations.) The ablation catheter has an irrigated tip to prevent local clot formation and to allow greater energy delivery if needed (at thick parts of the cardiac tissue). To insert these catheters into the left atrium, it is usually required to make a puncture of the transseptal wall between the two upper chambers (atria) at what is called the foramen ovale. After the ablation procedure, this foramen ovale closes back up and heals over. (In 20% of patients this foramen ovale hole never closes up completely and remains open, creating a pathway between the two atria chambers.)

Two or three physicians usually perform the catheter ablation procedure. They are involved in positioning the catheter, and in the collection, analysis and interpretation of heart signals obtained during conventional or computerized mapping.

RF ablation is performed around the openings of the pulmonary veins, one by one or two by two, using a limited level of energy to avoid swelling of the pulmonary vein openings or atrial perforation. Isolation of the pulmonary vein openings is successfully performed in 100% of cases.

In paroxysmal (occasional) AF, PV isolation cures AF in 60-70% of cases. Ablation of the appropriate site in the right atrium (Cavotricuspid Isthmus) is also performed to prevent right atrial flutter. Linear block here is successfully achieved in 99% of cases.

In persistent AF (lasting more than 48 hours or with a history of electrical cardioversion), PV isolation is rarely sufficient. Additional RF applications are required to eliminate spots of AF activity outside the pulmonary veins. In the most resistant cases (usually long lasting AF), linear ablation similar to surgical incision is performed in the left atrium between the two superior PV and/or from the vein to the mitral annulus (mitral “isthmus”). This achieves linear block in 90% of cases. The success depends on achieving continuous and coalescent cauterizing lesions to create a complete barrier. Any gap in the lesion line, even of a millimeter size, allows AF signals to cross thereby keeping the heart in AF. A gap in the lesion line is due either to a too thick atrial wall or recovery of atrial tissue during the 1-4 week healing process following ablation.

Pain and discomfort associated with ablation are controlled by Midazolam and Morphine. Because there are no nerve endings in the smooth tissue of the heart and veins, the pain and discomfort are minimal and usually well tolerated.

Duration of Operation and Hospital Stay

The duration of the procedure varies from one to five hours depending on individual conditions:

• the number of ectopic sources in the atrial tissue (outside the pulmonary veins) may require more mapping time.
• successful lineal ablation lines depend on the thickness of the heart wall which varies from one patient to another and can not be precisely determined by pre-ablation imaging.

The end point or goal of the procedure is the achievement of local block in all targeted structures (veins and isthmuses) so that no AF signals travel through the heart. In addition, after the ablation multiple pacing maneuvers are used to try to induce sustained AF. In paroxysmal AF, multiple pacing maneuvers do not induce AF in 90% of cases.

A second procedure may be needed within 3-5 days in 25% of AF patients due to partial recovery of ablated tissue and/or secondary AF sources not ablated in the original procedure. In difficult cases of multiple or unmapable ectopic foci (heart tissue generating AF signals), a second linear ablation may be required in the left atrium.

Patients are hospitalized 4 to 6 days depending on the number of procedures required. Typically they return to the normal care

unit after ablation and are ambulatory 12 to 24 hours later. They are monitored by telemetry during the next 3 days when any recurrence of arrhythmia is most likely to occur. The likelihood of recurrence decreases over the next month.

Patients are usually admitted on Monday and can leave the hospital for the week-end, if there are no complications. They must stay in the region during the week-end and must return the following Monday for outpatient evaluation, which could result in re-hospitalization if needed.

The occurrence of complications may increase the duration of the hospitalization and therefore the cost. In our experience, this happens to 2.5% of patients.

If AF symptoms do not reoccur, patients can return home and resume normal activities. Anticoagulants are recommended for at least 1-3 months after ablation, and can then be stopped if there is no AF or other risk factors. In persistent AF, antiarrhythmic medications are recommended for 1-3 months after ablation to enable the atria to return to normal (this process is called “remodeling.”)

Population of Patients

Catheter ablation of AF has been performed since 1994 in Bordeaux. As of October 2009, over 6,000 patients have been treated. At least 15 cases of atrial fibrillation or flutter are treated every week. The clinical characteristics of patients cover a wide spectrum of age (15-84 years old, average 52 years old). 78% of patients are male, while 22% are female. 80% have paroxysmal (occasional) AF, 20% have persistent AF. All patients were resistant to or intolerant of an average of 4 antiarrhythmic drugs and experienced at least weekly episodes of AF at their referral.

Some patients had documented pauses in their sinus heart beat after an attack of AF. They were cured by AF ablation, and thus avoided pacemaker implantation. 12% reported a previous embolic event (stroke), most in the circulation of the brain.

In patients with heart failure and permanent AF, the restoration of sinus rhythm (normal heart beat) is associated with a significant improvement of ventricular function in 80% of the patients.

Risks Associated with AF Catheter Ablation

Currently no one has died of a catheter ablation procedure in our department. Compared to other catheter procedures a 0.1% risk of death is a reasonable estimation.

The other risks of catheter ablation of AF are:

• bleeding in the pericardial sac surrounding the heart and requiring drainage (0.5-1%)
• embolic event (stroke) (0.2%)
• groin access hematoma (bruising) (4%)

There is no risk of sinus node or AV node damage by ablation which would require implanting a pacemaker.
World-wide there have been deaths reported by the use of high wattage catheters (50 watts or higher) creating a fistula (burn through) to the esophagus, usually 2 days after the procedure. We have not observed this complication.
Pulmonary vein narrowing (stenosis), if it did occur, would not usually cause symptoms. Out of 6,000 patients treated in our institution, 7 developed symptoms due to PV narrowing (>70% of lumen [opening] diameter) and required angioplasty and stenting.

The above risks compare very favorably with the risks involved in living with untreated AF. The risks of catheter ablation also compare very favorably with the risks involved in taking antiarrhythmic drugs and anticoagulants.

Procedure Costs (2010)

This cost is fixed by the public health administration.  The cost for a private service (operators: Drs. M. Haissaguerre/P. Jais/ M. Hocini) is 5000 euros (around $6,000) (hospital and physician charges). The total cost of AF catheter ablation depends on the duration of one’s stay in the hospital, which depends on the difficulty of individual ablation cases.

The typical hospital stay of 5 days with an ablation including pulmonary vein isolation and ablation of the right and left atria would cost about 10,328 euros (around $12,600). One day more or less would be 2044 Euros (around $2,500).

The total costs of a 5 day stay and ablation would be 17,600 euros (around $21,500).
For patients accompanied by a family member and without local accommodations, a meal, bed and breakfast is provided in the same room 27,10 euros/day (around $33.00).

The current waiting time for a procedure is 2 months.

Patients should come with personal clothes, since it is possible to walk outside. Patients are generally expected to wear their own clothes, including pajamas. Since the hospital only provides small towels, you may wish to bring your own towels.

(Costs updated 6/2/2010.)

Information about the Hospital

Cardiologic Hospital of Haut-Lévêque is a 300 bed hospital entirely dedicated to medical and surgical cardiology. It is located in Pessac and is a 20 minute drive from the airport, and a 20-30 minute drive from the center of Bordeaux and the TGV station.

Languages spoken: English and Spanish

The web site is: http://www.chu-bordeaux.fr/LES-HOPITAUX-ET-SITES-DU-CHU/Groupe-hospitalier-Sud/Hôpital-Haut-Lévêque/.

Choosing the Right Doctor: 7 Questions You’ve Got to Ask (And What the Answers Mean)

red-heart-negative 150 pix by 96 resThis list of 7 questions (8 if you are female) is designed to solicit information to help you select the best doctor for you and your type of A-Fib. After each question, we’ve included typical doctor responses and an analysis of what those responses may mean to you.

1. What treatments do you recommend for dealing with or curing my type of A-Fib?

If the doctor only talks about different medications, you should probably talk to other doctors on your list. Overall, Drug Therapies have poor success rates, and don’t address the progressive nature of Atrial Fibrillation. Today, the best A-Fib treatments are with Catheter Ablation.

2. Do you perform Catheter Ablation procedures for my type of A-Fib? What type of procedures do you use, or prefer?

Response #1:    “I only work or prefer to work in the right atrium.” Or, “I will eliminate the Atrial Flutter in your right atrium first.”

These responses indicate a doctor may not have the experience or be comfortable working in the left atrium. Though it’s more difficult to work in the left atrium, most A-Fib comes from the left atrium pulmonary veins. You may have Atrial Flutter in your right atrium along with your A-Fib, but it may well be triggered by the A-Fib coming from your left atrium.23 You should probably talk to other doctors on your list.

Response #2:    “We recommend catheter ablation of the AV node and implanting a permanent pacemaker.”

Though this used to be one of the most common treatments for A-Fib, you don’t want to be burdened with a permanent pacemaker for the rest of your life when there are better options available.

Also, this procedure leaves you in A-Fib and dependent on medication for the rest of your life. Unless you have a Sinus Node problem and need a pacemaker, you should probably talk to other doctors on your list.

Response #3:    “We use Circumferential Ablation to eliminate A-Fib.” Or “Segmental Ablation… .” Or “Anatomically-Based Circumferential Ablation….” Or “Pulmonary Vein Antrum Isolation… .”

Circumferential, Segmental, Anatomically-Based Circumferential (also referred to as Left Atrial Ablation or the Pappone technique) and Pulmonary Vein Antrum Isolation (PVAI) are refinements or different Pulmonary Vein Ablation procedure strategies. All offer you a good chance of being cured of your A-Fib.

Circumferential is the most used technique.

Response #4:    “We use a special catheter sensor to pinpoint ectopic beats coming from areas of the heart, mostly from the Pulmonary Veins in the left atrium. We then ablate these areas.”

(Ectopic beats come from any region of the heart that ordinarily should not produce heart beat signals, such as the pulmonary veins).

This response indicates the doctor and/or medical center is targeting (focusing on) specific spots generating the A-Fib signals. This technique is called Focal Catheter Ablation which was the first technique developed to ablate A-Fib.

However, most centers today use either Circumferential or Segmental techniques to ablate or isolate the entire area around the openings of all four Pulmonary Veins. If the A-Fib signals persist, they will proceed to target and abate the specific source of the ectopic beats.

Response #5:    “Besides RF catheters, we also use the CryoBalloon Catheter to isolate the Pulmonary Veins.”

The CryoBalloon Catheter for A-Fib Ablation (FDA-approved technology in December, 2010), it has proven effective, safer, and faster than the various types of RF ablation.

But it is a relatively new method of ablation without a long-term track record of extensive data validating its effectiveness. However, anyone using the CryoBalloon Catheter is probably innovative, knowledgeable, and experienced in A-Fib ablation.

3. What is your success rate for my type of A-Fib?

Major centers with a lot of experience have a success rate of around 70-85% for Paroxysmal (occasional) A-Fib, with a higher success rate if a second ablation is necessary. If their success rate is 50% or less, you should probably look elsewhere.

4. How long have you been performing catheter ablations for my type of A-Fib? How experienced are you with RF and/or Cryo? How many procedures do you perform a year?

It’s hard to quantify experience with specific numbers. When doctors say they have done a total of 20 Pulmonary Vein Ablations, they are probably still in their “training” stage or have just passed their certification. At a minimum, electrophysiologists should perform 100 procedures a year. Therefore, if a doctor only does a few PVAs a month, this may not be enough to maintain or develop ablation skills.

There are many electrophysiologists and several medical centers that have been doing Pulmonary Vein Ablations for years and have done hundreds (or thousands) of Pulmonary Vein Ablations.

5. What kind of complications have you had after ablations?

Every A-Fib doctor has had some complications when doing Pulmonary Vein Ablation procedures. A PVA is a low risk procedure, but it is not risk free. Possible complications include blood clots and stroke, PV Stenosis (post-op swelling of pulmonary vein openings which can restrict blood flow and lead to fatigue, flu-like symptoms, and pneumonia), Cardiac Tamponade (pooling of fluid around the heart that can cause a drop in blood pressure) and Phrenic Nerve Paralysis (related to the diaphragm, and usually temporary).

Doctors and their office staff are usually very open about the complications they have had and can usually give you statistics. If they are not, you may want to look elsewhere for your doctor.

6. Do you ever refer your patients for Maze or Mini-Maze surgery?

Some A-Fib patients might be better served by a Maze or Mini-Maze surgery. For example, someone who needs heart surgery for another problem might well combine that surgery with a Maze operation. Someone who can’t tolerate Coumadin or other blood thinners might be better served by a Mini-Maze surgery. Most Mini-Maze surgeries are the result of referrals by electrophysiologists.

If a doctor doesn’t normally refer patients for Maze surgeries, this isn’t necessarily a reason for rejection. They may be concerned about a loss of quality control if they send patients to someone who’s not a specialist in heart rhythm problems.

7. What techniques or technologies do you use to increase the safety and effectiveness of your procedures? For example, how do you protect the esophagus?

A doctor’s use of technology may improve their effectiveness compared to other doctors or medical centers. Examples: Using an imaging system that gives 3-D images of the inside of the heart, of the position of the esophagus, and of catheter placement and pressure; Using an energy source like the CryoBalloon catheter system to produce circular lesions around the pulmonary veins; Using magnetic or robotic arms that aid in more precise placements of lesions or ablations.

Damage to the esophagus during an ablation (called Atrial Esophageal Fistula) is a very rare complication (less than 1 in 1000+), but is often fatal. Heat from the RF catheter damages the esophagus which lies just behind the heart; over the next 2-3 weeks gastric acids can eat through the weakened area. Most doctors and medical centers take precautions to avoid this damage including prescribing Proton Pump Inhibitors to prevent gastric acid damage.

When you ask how the doctor protects the esophagus, you should hear answers like:

Response 1:     “We use low power at the back of the heart.”

Response 2:      “We use a temperature probe in the esophagus to make sure it doesn’t get too hot.”

Response 3:      “We use barium paste in the esophagus so that we can see where it is when we make ablations and don’t make ablations near the esophagus.”

Response 4:      “We give Proton Pump Inhibitors like Nexium for 2-3 weeks after an ablation to protect the esophagus.”

If you don’t get answers like these, especially about taking Proton Pump Inhibitors after an ablation, it might be wise to talk with other doctors.

8. (For female patients) What is the extent of your training specifically related to women’s heart health?

Women tend to have different symptoms of heart disease than men, in part because their bodies respond differently to risk factors such as high blood pressure. Cardiologists who specialize in women are more common than ever. Medical centers now have clinics devoted to women’s heart health. Women with A-Fib may want to seek out a specialist who is up-to-date in this field of research.

Back to the top

Back to Finding the Right Doctor For You and Your A-Fib

Last updated: Wednesday, May 6, 2015

 

Steve’s List of EPs Installing the Watchman Device

If you are at high risk for stroke but can’t take anticoagulants, your doctor may suggest closing off the Left Atrial Appendage using an occluder such as the Watchman Device. Use of the Watchman is a relatively new treatment option (recently approved by the FDA for use in the US).

For Steve’s List of doctors who participated in the trial, go to US EPs Installing the Watchman Device – by US State.

We include doctor’s names and contact information. Be sure to refer to Finding the Right Doctor for You and Your A-Fib. It covers what you need to know to research and select the best doctor for you and your treatment goals.

NOTICE: Unlike some other directories on the web, we offer no preferential listings to be in our Directory. We accept no fee, benefit or value of any kind for listing a specific doctor or medical center. A-Fib.com is not affiliated with any practice, medical center or physician.

Looking into the Hybrid Surgery/Ablation Procedure?

There are very few centers offering the Hybrid Surgery/Ablation approach because it’s extremely rare to have the tremendous expertise necessary in both catheter ablation and surgical A-Fib ablation at the same institution. If you are interested in this treatment option, see Steve’s Lists: US Centers performing the Hybrid Surgery/Ablation Procedure.

Similar ablation techniques are called ‘hybrid ablation technique’, ‘convergence process’, ‘Convergent Maze Procedure’ and ‘Convergent Ablation”’.

We include doctor’s names and contact information. Be sure to refer to Finding the Right Doctor for You and Your A-Fib. It covers what you need to know to research and select the best doctor for you and your treatment goals.

NOTICE: Unlike some other directories on the web, we offer no preferential listings to be in our Directory. We accept no fee, benefit or value of any kind for listing a specific doctor or medical center. A-Fib.com is not affiliated with any practice, medical center or physician.

 

List of Doctors Specializing in Persistent/Long-standing Persistent A-Fib (US and International)

Surgeons performing Maze & Mini-maze

Surgeons performing Maze & Mini-maze

If you have Persistent A-Fib and Long-standing Persistent A-Fib you know these types of A-Fib are often difficult to cure. If you are highly symptomatic, you may need a highly skilled, experienced specialist.

Steve’s List is a starting point for you. Go to: Doctors Specializing in Persistent/Long-standing Persistent A-Fib (US and International).

We include doctor’s names and contact information. Be sure to refer to Finding the Right Doctor for You and Your A-Fib. It covers what you need to know to research and select the best doctor for you and your treatment goals.

NOTICE: Unlike some other directories on the web, we offer no preferential listings to be in our Directory. We accept no fee, benefit or value of any kind for listing a specific doctor or medical center. A-Fib.com is not affiliated with any practice, medical center or physician.

 

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