Doctors & patients are saying about 'A-Fib.com'...


"A-Fib.com is a great web site for patients, that is unequaled by anything else out there."

Dr. Douglas L. Packer, MD, FHRS, Mayo Clinic, Rochester, MN

"Jill and I put you and your work in our prayers every night. What you do to help people through this [A-Fib] process is really incredible."

Jill and Steve Douglas, East Troy, WI 

“I really appreciate all the information on your website as it allows me to be a better informed patient and to know what questions to ask my EP. 

Faye Spencer, Boise, ID, April 2017

“I think your site has helped a lot of patients.”

Dr. Hugh G. Calkins, MD  Johns Hopkins, Baltimore, MD 


Doctors & patients are saying about 'Beat Your A-Fib'...


"If I had [your book] 10 years ago, it would have saved me 8 years of hell.”

Roy Salmon, Patient, A-Fib Free, Adelaide, Australia

"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

"...masterful. You managed to combine an encyclopedic compilation of information with the simplicity of presentation that enhances the delivery of the information to the reader. This is not an easy thing to do, but you have been very, very successful at it."

Ira David Levin, heart patient, Rome, Italy

"Within the pages of Beat Your A-Fib, Dr. Steve Ryan, PhD, provides a comprehensive guide for persons seeking to find a cure for their Atrial Fibrillation."

Walter Kerwin, MD, Cedars-Sinai Medical Center, Los Angeles, CA



Doctors & Facilities

Selecting a New Doctor? 10 Questions You’ve Got to Ask

A-Fib.com Questions for Doctors Worksheet

Free download

Looking for a new cardiologist or electrophysiologist? To help you scrutinize prospective doctors, we’ve written a set of interview questions. The questions help you find the right doctor for your treatment goals.

Our worksheet has the questions to ask each doctor and an area to note their responses. Print a copy of this worksheet for each doctor you talk to.

Afterwards: How to Interpret the Answers You Received

Back home, study your notes about each doctor. To ‘interpret’ the doctors’ answers, see our article, “Choosing the Right Doctor: 10 Questions You’ve Got to Ask (And What Their Answers Mean)“.

We’ve included the various responses you might receive, and what each response means to you when searching for the right doctor for you and your treatment goals.

DON’T FORGET: File your worksheets and other notes in your A-Fib binder or folder for future reference (later, you might want a second opinion).

Download the FREE PDF and save to your hard drive
(separate browser window will open). Print multiple copies.

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

Searching for electrophysiologists who treat A-Fib patients? Or looking to change doctors? We make it easier for you with our A-Fib.com Directory of Doctors and Medical Centers. (See the left menu for the Directory link)

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

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.

Don’t fall prey to hype, advertising, or third parties that have something to gain by recommending a particular healthcare provider. See my article: Don’t be Fooled by Pay-to-Play Online Doctor Referral Sites

NOTICE: Unlike some other directories on the web, at A-Fib.com we offer no preferential listings to be in the A-Fib.com Directory of Doctors & Medical Centers. We accept no fee, benefit or value of any kind for listing a specific doctor or medical center. In addition, A-Fib.com is not affiliated with any specific treatment, practice, medical center, device manufacturer or pharmaceutical company.

What Makes our Directory Unique?

We list only those cardiologists, electrophysiologists (EPs) and surgeons who treat Atrial Fibrillation patients. It’s in two parts: U.S. and international. Organized by city/state or country/region, you’ll find doctor’s names and contact information. (This evolving list is offered as a free service and convenience to A-Fib patients.)

Doctor acronyms

Doctor credentials


Tip: Refer to our page, 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. (Also, look at our article: Physician Credentials: Acronyms and What They Mean for Atrial Fibrillation Patients.

Listed in Castle Connolly ‘Top Doctors’

You may see an additional qualification after some doctor’s names: “Listed in Castle Connolly TOP DOCTORS.” Castle Connolly ‘Top Doctors’ are selected through peer nominations, extensive research and screening. Important: Just like the A-Fib.com Directory of Doctors & Medical Centers, Castle Connolly Top Doctors cannot request or pay to be listed.

Finding the Right Doctor for You and Your A-Fib

By Steve S. Ryan, PhD, Updated December 6, 2016

Seek Your Cure: See an EP A-Fib.com

Seek Your Cure

When your family doctor first suspects you have A-Fib, they will probably send you to a cardiologist, a doctor who specializes in the heart.

The cardiologist will want to put you on different medications (called Drug Therapy) over the next six months to a year or more to see if any of these medications will stop or control your A-Fib. But current A-Fib medications are not very effective. They work for only about 40% of patients and frequently stop working over time. Many can’t tolerate the bad side effects.

Know that time is of the essence in treating A-Fib. The longer you have A-Fib, the more your A-Fib may “remodel” your heart (i.e., change it physically and electrically). “…once the diagnosis of atrial fibrillation is made, it’s important not to spend too much time trying to keep a patient in normal rhythm with medical (drug) therapy” before referring them to catheter ablation, according to Dr. Oussama Wazni, Co-Director of the Center for Atrial Fibrillation at the Cleveland Clinic.

With this information in mind, drug therapy may not be the best option for you.

 How to Start Your Search

To seek treatments beyond medications, you may need to change doctors.

Since Atrial Fibrillation is an electrical problem, you should see a Cardiac Electrophysiologist (EP)a cardiologist who specializes in the electrical activity of the heart and in the diagnosis and treatment of heart rhythm disorders.

A-Fib is an electrical problem. Patients should see an Electrophysiologist, an EP, a cardiologist who specializes in the electrical activity of the heart.

The EP’s primary concern is creating a ‘treatment plan’—an organized path to finding your A-Fib cure or best outcome.

To find the right doctor for you, seek recommendations from your General Practitioner (GP) and from other A-Fib patients (see Resources/Bulletin Boards for a list of online discussion groups).

If you know nurses or support staff who work in the cardiology field or in Electrophysiology (EP) labs, they can be great resources.

Finding a Heart Rhythm Specialist’ Online

Click: graphic opens in new tab

To find a local Electrophysiologist yourself, we recommend the Heart Rhythm Society website and their feature called ‘Finding a Heart Rhythm Specialist’. ‘Check’ the box “to limit the results to Fellows of the Heart Rhythm Society (FHRS)”. (EPs with the FHRS designation have been recognized by their peers and are experienced heart rhythm professionals working in the field of electrophysiology and/or pacing).

When you type in a U.S. city and state (or country), the site gives you a list of Electrophysiologists in your area. Check for their list of specialties (not all EPs perform catheter ablations, for example; some focus on pacing/pacemakers, or clinical research, etc.). Look for additional information such as which medical insurance they accept.

A-Fib.com Directory of Doctors and Steve' Liists at A-Fib.com

Click to open directory in new tab

 Our A-Fib.com Directory

This A-Fib.com Directory of Doctors and Facilities is an evolving list of the physicians and medical centers who treat patients with atrial fibrillation. Our directory is offered as a service and convenience to A-Fib patients.

It’s divided into sections: U.S. Doctors and Centers by state/city and International listings by country or geographic region. In addition, I’ve compiled several rosters, called  Steve’s Lists’ of doctors by specialty.

 Organize Your Research

My A-Fib records at A-Fib.com

Go to ‘Why You Need an A-Fib Notebook and 3-Ring Binder’

To find the right doctor to cure your A-Fib, start your research with a notebook and a three-ring binder or a file folder. Learn Why You Need an A-Fib Notebook and 3-Ring Binder.

You need to organize the information you will be collecting: printouts of information from the internet, copies of documents from your local public library or medical center library, notes from phone calls, and answers to “interview” questions during doctor consultations.

Your 3-ring binder, or file folder is also where to collect copies of all your lab tests, notes from doctor visits, doctor correspondence, etc.

Obtain Copies of Your Medical Records, Tests, and Images

If you need to request copies of some medical records, read our article, How to Request Copies of your Medical Records. We give you three ways to request your medical records from your doctors and healthcare providers.

Later, when you are ready to interview new doctors, you will want to send each office a packet with your medical records, test results, and images or X-rays. (As a back-up, bring your three-ring binder with the originals.)

We strongly encourage you to get in the habit of keeping a copy of every test result you get in a designated three-ring binder. Don’t leave your doctor’s office or hospital without a copy of every test they perform. Or if the test result isn’t immediately available, have them mail it to you.

Back to top

 Researching Doctors and Centers

Don’t rely on a single online source when researching and selecting doctors. Be cautious of all doctor informational listings you find on web sites (yes, including this one).

Doctors may be listed or appear most prominently because they pay for that privilege (but not so at A-Fib.com). Read my article, Don’t be Fooled by Pay-to-Play Online Doctor Referral Sites.

Don’t depend on websites of patient’ ratings of doctors or with patient surveys. They lend themselves to manipulation. Ratings often reflect how well-liked a doctor is, not competency. Consult several sites.

 How to Find the Information

You must do your own homework. To narrow down your list of prospective doctors you will want to scrutinize their credentials. To research each doctor, consult the internet or your local library. One or more of the following online resources may be helpful.

Credential Acronyms: For an explanation of the acronyms following a physician’s name, see Physician Credentials.

The Heart Rhythm Society ‘Find a Specialist searchable directory for a doctor’s specialties, insurance accepted, etc.;
The American Board of Medical Specialists (ABMS) Directory of Board Certified Medical Specialists;
The American Board of Internal Medicine; Check a doctor’s certification;
The Cardiothoracic Surgeon’s Network Directory of Surgeons;
Vitals, an independent healthcare ratings organization; provides physician’s profile, education, awards & recognition, insurance accepted, hospital affiliations, and info on malpractice and sanctions.

 Your Consultation Appointments

Narrow down your list to the top three doctors. Now you are ready to set up a consultation appointment with each doctor. Think of this as an interview. Don’t worry, doctors are also ‘interviewing’ you to determine if they can help you.

What to say:

1. You have Atrial Fibrillation, and what kind (paroxysmal, persistent or long-standing persistent);

2. You want to consult with the doctor about your treatment goals, for example, you are seeking to cure your A-Fib, not just manage it with drugs.

Note: some EPs have a “referrals only” policy, which means they won’t talk to you directly. You have to be referred by a cardiologist or a family doctor.

Send Your Medical Records Beforehand

Before your appointment, send each doctor a packet with your A-Fib-related medical records. To learn what to include in your packet of medical records, read Why You Need an A-Fib Notebook and 3-Ring Binder and Your Personal A-Fib Medical Summary.

10 questions-to ask when inteviewing doctors for your A-Fib at A-Fib.com

Click to download 

Questions to Ask: Use Our Free Worksheet

To help you scrutinize prospective doctors, we’ve written a set of 10 interview questions to help get you started. Download the FREE PDF and save to your hard drive. Then, print a worksheet for each doctor you interview. 

Prepare and add your own list of questions for each prospective doctor.

During Your “Interview”

Never see a doctor aloneWhen you arrive at the doctors offices’, make sure they have indeed received your medical records. (As a back-up, bring your own originals from your three-ring A-Fib binder.)

Be sure you have your worksheets and list of other questions, a notepad and pen to take lots of notes.

Audio Recording: In addition, consider using an audio recorder to help you remember things. (Most doctors don’t mind, but always ask permission beforehand.) Many cell phones can be used to make a recording.

Take Along a Trusted Friend: You may want to take along a trusted friend or family member. As needed, your ‘personal advocate’ can question the doctor for you and verify your list of questions have been answered. It’s hard to be on top of your game when you feel ill and anxious. Studies show that patients immediately forget up to 80% of what’s discussed during a doctor visit, and get about half of the remainder wrong.

Afterwards, your patient advocate friend can help you evaluate the doctor’s answers, discuss anything that’s unclear and comment on the doctor’s demeanor.

Afterwards: How to Interpret the Answers You Received

Back home, study your notes about each doctor. To ‘interpret’ the doctors’ answers, see our article, “Choosing the Right Doctor: 10 Questions You’ve Got to Ask (And What Their Answers Mean)“.  We’ve included the various responses you might receive, and what each response means to you when searching for the right doctor for you and your treatment goals.

Also Assess the Doctor’s Manner and Personality

Warning - cautionYou’ll also want to assess the doctor’s manner and personality. Is this someone who will work with you? Someone who listens to how A-Fib makes you feel? Does this doctor inspire confidence? Is this someone you feel comfortable with and trust with your health care?

Your relationship with your doctor is important. See our post: ‘Do you Like’ Your Doctor, Do You ‘Connect’?…How it Affects Your Health

Rudeness, bad temper, boorish behavior, etc. from a doctor, no matter how highly recommended, should be a red flag for you. That kind of behavior is not just personally offensive but can be dangerous for your health.

Gender bias: Does he/she respect you? Women in particular should be wary of condescending behavior. ReadIt’s All In Your Mind” Her MD Said. Women in the US often don’t receive the proper diagnosis and treatment of their A-Fib.

Does the poor behavior also extend to how the doctor treats his staff? Patients of doctors “who don’t show respect for their medical staff have much higher rates of adverse effects, than patients of their more congenial colleagues,” according to Gerald B. Hickson, MD of Vanderbilt University Medical Center.

If your doctor is condescending or dismisses your concerns, you’re getting poor care. If a doctor is too busy to talk with you and answer your concerns, he’s probably too busy to take care of you properly.

But do give the doctor a break. They may be having a bad day or may have heard your questions too many times before. So say something, speak up! Or contact the patient-relations representative at the medical center. They want to know if a doctor is rude (those patients are more likely to sue!). Once a doctor’s bad behavior is called to his attention, they are likely to do better. And you’ll feel better, too.

 Caduceus at A-Fib.comEvaluate the Consultations

After seeing your top three doctors, compare their answers. Did one doctor stand out?  If not, you may want to go back to your research list for number four and five on your list and set up appointments with them too.)

 Directory of Doctors and Medical Centers

Steves Lists and Directory of Doctors at A-Fib.com

Click for Steve’s Lists

The A-Fib.com Directory of Doctors lists US & international physicians and medical centers treating Atrial Fibrillation patients. This evolving list is offered as a service and convenience to A-Fib patients. (Unlike other directories, we accept no fee to be included.) The directory is divided into three categories.

US Doctors and Medical Centers (by state/city)
International: Doctors and Medical Centers (by country or region)

For a list of EPs doing Catheter Ablation procedures, see Steve’s Lists/US EPs with FHRS-designation performing A-Fib ablations by US State/City.

 For surgeons performing Maze/Mini-Maze operations, see Doctors & Facilities/Steve’s Lists Doctors by Specialties and more specifically, US Surgeons performing Maze and Mini-Maze operations.

 Return to A-Fib.com Where to Start

Last updated: Wednesday, May 10, 2017

Resources for this article

 

Do You ‘Like’ Your Doctor, Do You ‘Connect’?…How it Affects Your Health

The more people like their doctors, the healthier they tend to be. This is what researchers at Massachusetts General Hospital found in a review study where they examined 13 research reports on this subject.

Being the “Best in the Field” Isn’t Enough

A-Fib doctor with stethoscope - A-Fib.com

You’re heatlthier if you like your doctor!

Even if a doctor(s) is the best in their field and an expert in your condition, that may not help you if you don’t communicate well with them and don’t relate to them. If we don’t like our doctors, we’re less likely to listen to them.

Some doctors (particularly those from overseas) often communicate poorly, or talk in “medicalize” and are nearly incomprehensible. Other doctors come from a medical school with a tradition of aloofness and keeping a distance from patients (with women in particular).

Relationship-Based Strategies Improve Patients’ Health

This mega-study review looked at doctors who were trained in “relationship-based strategies” such as making eye contact, listening well, and helping patients set goals. The results: these strategies significantly improved their patients’ health compared to control groups. Their patients achieved lower blood pressure, increased their weight loss, reduced pain and improved glucose management.

If You Don’t Like Your Doctor, Look For a New One!

It’s intuitive, isn’t it? But now a review of studies backs it up. If you like, trust and respect your doctor(s), you’re more likely to accept and follow their advice. Developing a good relationship helps you feel comfortable asking questions and getting feedback in a give-and-take environment.

If you don’t have this rapport with your current doctor(s), it’s worth looking elsewhere for a new doctor―even if they are “the best” in their field.

In the article, Know When it’s Time to Fire your Doctor, CNN.com Senior Medical Correspondent Elizabeth Cohen discusses five ways to know when it’s time to think about leaving your doctor, and the best way to do it. The highlights are:

1. When your doctor doesn’t like it when you ask questions
2. When your doctor doesn’t listen to you
3. If your doctor can’t explain your illness to you in terms you understand
4. If you feel bad when you leave your doctor’s office
5. If you feel your doctor just doesn’t like you — or if you don’t like him or her

Don’t Be Afraid to Fire Your Doctor

Changing doctors can be scary. According to Robin DiMatteo, a researcher at the University of California at Riverside who’s studied doctor-patient communication. “”I really think it’s a fear of the unknown. But if the doctor isn’t supporting your healing or health, you should go.”

To learn more, read our page: How to find the right doctor for you and your treatment goals.

Resources for this article
Top 10 List #2 Don't be afraid to fire your doctor at A-Fib.com

 

Patient Advice: You May Need to ‘Fire’ Your Current Doctor

Cloud graphic - Michele Straube, A-Fib-free after 30 years - A=Fib.com

A-Fib-free after 30 years, Michele Straube from Salt Lake City, Utah.

‘I Want to Cure My A-Fib, Not Just Manage It.’

Keep in Mind: For many A-Fib patients, their best outcome came about only when they told their doctor, ‘I want to cure my A-Fib, not just manage it.’ (And, if needed, they also changed doctors.)

How to Find the Best Doctor for You

To be cured of your A-Fib, you may need to ‘fire’ your current doctor.

An electrophysiologist (EP), is a cardiologist who specializes in the electrical functions of the heart.

Seek an electrophysiologist (EP), a cardiologist who specializes in heart rhythm problems (the electrical functions of the heart). Do your research.

Look for a doctor who will partner with you to create a treatment plan—a path to finding your cure or best outcome. To learn how to make this happen, read Finding the Right Doctor for You and Your A-Fib.

Personal A-Fib Story: To learn the importance of finding the right doctor, read Michele Straube’s personal A-Fib experience: Cured after 30 years in A-Fib.

Run―don’t walk―to the best EP you can afford.

Conflicts of Interest—The Hidden Cost of Free Lunch for Doctors

by Steve S. Ryan, PhD, updated September 18, 2016

Few people in the U.S. today are shocked or scandalized that the Drug and Device Industry (DDI) basically bribes doctors and hospitals to prescribe their drugs or use their equipment. It’s so commonly done that we take it for granted.

In the U.S., in general, it isn’t considered unethical or immoral for doctors to accept payments or favors from the Drug and Device Industry (DDI). Nor is it illegal.

(Added May 2017: Pharma companies signed onto a set of policies, the PhRMA Code of Conduct, regarding the way they would interact with physicians which is basically a code of conduct. Updated in 2009, here are some major points or changes in how sales reps should conduct themselves:
• No Personal Gifts
• No Entertainment of Recreational Events
• No Branded Products
• “Modest” Meals are OK – in context of education

Many academic centers now enforce stricter policies limiting access of pharmaceutical reps to physicians, and strict punishments or fines for rule violations. [Medpage Today, May 4, 2017])

U.S. patients can now simply type in our doctor’s name in the Open Payments Database and see how much they are being paid by the DDI and what conflicts of interest they have.

Open Payments DataThanks to the Sunshine Act (a provision of the U.S. 2010 Patient Protection and Affordable Care Act), the DDI must report when they make a payment to a doctor for meals, promotional speaking or other activities.

This data is available at https://projects.propublica.org/docdollars/ Just type in your doctor’s name. See also, OpenPaymentData.CMS.gov and the ProPublica Dollars for Docs project.

Influencing Doctors’ Prescriptions for the Price of a Meal

In a recent JAMA Internal Medicine report (DeJong, C., June 2016), the authors compared meal payments to doctors with the drugs they prescribed to Medicare patients.

Even doctors who accepted only one free meal were more likely to prescribe the brand name drug.

Not surprisingly, they found that physicians who accept free meals from a drug company are more likely to prescribe that company’s brand name drugs rather than cheaper (and usually more proven) generic drugs. This study only focused on physicians who received meals.

Even doctors who accepted only one free meal were more likely to prescribe the brand name drug. Doctors who accepted four or more meals were far more likely to prescribe brand name drugs than doctors who accepted no meals. Furthermore, doctors who accepted more expensive meals prescribed more brand name drugs.

In another related JAMA Internal Medicine report (Yeh, JS, June 2016), researchers found similar evidence that industry payments to physicians are associated with higher rates of prescribing brand-name statins.

Steer Clear of Conflicts of Interest

The publication, Bottom Line Personal, offered words of wisdom on this subject.

“Studies have found that when there is a conflict of interest, it is almost impossible for even well-meaning people to see things objectively.”

Dr. Dan Ariely of Duke University described how, if a doctor must choose between two procedures, they are likely to pick the one that has the better outcome for their bottom line.

“That doesn’t mean the doctor is unethical…it just means he is human. We truly seem to not realize how corrosive conflicts of interest are to honesty and objectivity.”

He advocates that we steer clear of people and organizations with conflicts of interest “because it does not appear to be possible to overcome conflicts of interest.”

Conflicts of Interest: Be Suspicious of Doctors

Doctors are only human. If a drug rep does them a favor, of course they will be inclined to favor that rep’s drug.

Whenever you visit a health/heart website ask yourself: “Who owns this site?” and “What is their agenda?”

But be suspicious if your doctor tells you:

• to take an expensive new drug
• to just “live with your A-Fib”
• insists that catheter ablation is too dangerous or unproven
• that A-Fib can’t be cured
• that you have to take drugs for the rest of your life

If this happens to you, RUN and get a second opinion (and even a third opinion).

Conflicts of Interest: Be Suspicious of Health/Heart Websites

When I attend talks at most A-Fib conferences, the first slide a presenter shows is often a list of their Conflicts of Interest.

But this is not required of websites! Health/Heart websites are not required to be transparent and reveal their conflicts of interest.

Whenever you visit a health/heart website, ask yourself: “Who owns this site?” and “What is their agenda?” (Hint: Check their list of “sponsors” and follow the money!)

Drug Industry Owns or Influences Most Heart/Health Web sites

The drug and device industry owns, operates or influences almost every health/heart related web site on the Internet!

The fact is most health/heart web sites are supported by drug companies who donate most of their funding.

For example, did you know that the drug company Ely Lilly partially owns and operates WebMD, the Heart.org, Medscape.com, eMedicine.com and many other health web sites?

The fact is that most health/heart web sites are supported by drug companies who donate most of their funding. Consider how that may affect the information they put on their web sites―they’re not going to bite the hand that feeds them.

 

About A-Fib.com: Read A-Fib.com disclosures on our website and check
A-Fib.com’s 990s at GuideStar.org.

Be Suspicious of A-Fib Info on the Internet

Steve Ryan video at A-Fib.com

Video: Buyer Beware of Misleading or Inaccurate A-Fib Information.

In our crazy world, you can’t afford to trust anything you read on the Internet.

At one time I tried to keep track of all the mis-information found on various A-Fib web sites. When we’d find something wrong, we would write the site. I don’t think we’ve ever received a reply. Finally, we gave up. (See my video: Buyer Beware of Misleading or Inaccurate A-Fib Information.)

Many web sites put out biased or mis-information. Be skeptical. You can tell if someone is trying to pull the wool over your eyes. Truth will out. If you feel uncomfortable or that something is wrong with a site, it probably is. When you find a good site, the truth will jump out at you.

In today’s world, you have to do your own due diligence. You know what makes sense and what doesn’t.

For more, see my article: EP’s Million Dollar Club—Are Payments to Doctors Buying Influence?

References for this article

 

Inspiration: Choosing the Right Doctor: The Plumber vs The Electrician

For the Newly Diagnosed

When diagnosed with Atrial Fibrillation, you need to find the best heart rhythm specialist (a cardiac electrophysiologist, or EP) you can afford.

From Michele Straub, now free of A-Fib after 30 years, comes this:

My advice to those with A-Fib:  Go to an electrophysiologist A-Fib expert right away, one with a high success rate at getting patients back into normal rhythm — you deserve nothing less.”

How to Find the Right Doctor

Go to our A-Fib.com page to learn how to find the right doctor for you and your treatment goals.

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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Return to: Free Offers & Downloads

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

Get Your FREE Download: Questions for Doctors Worksheet

A-Fib.com FREE PDF Download Worksheet

FREE PDF Worksheet

Looking for a new cardiologist or electrophysiologist? Here’s a FREE worksheet with a list of interview questions to ask each doctor with spaces to note each response. Just download the free worksheet and save to your hard drive. Print a copy of the worksheet for each doctor you talk to.

Afterwards, read our article Choosing the Right Doctor: 7 Questions You’ve Got to Ask (And What the Answers Mean. We offer you the various answers your doctors may give you. And then, we interpret what those answers mean to you when choosing a doctor to help you reach your treatment goals.

Prepare TODAY. Download our Free PDF worksheet (separate browser window will open).

Remember to file your worksheets with your other A-Fib papers and research for future reference (you may want a doctor for a second opinion).

 

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.

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