For Ablation, Not Necessary to Go to Top-Name A-Fib Centers To Have Excellent Care and Good Results
by Greg White
A DIFFICULT DECISION PAYS OFF
I fought intermittent and chronic A-Fib through medication for ten years before finally undergoing a successful ablation in December of 2008. For me, the decision to have the ablation procedure was a very difficult one. I have always taken great pride in my excellent physical condition and have lived a very active lifestyle, even when I was in A-Fib, except for brief periods when my ventricular rate was not yet controlled by medication. My greatest fear in considering whether or not to have an ablation was that the ablation might leave me worse off. It took quite a while to overcome that fear.
However, after the ablation I have now been free of A-Fib for nearly six months, except for a brief period I’ll explain later. I am now off warfarin and take only 25mg per day of metoprolol just as a precautionary measure, something that I hope to completely eliminate within the next year.
PHENOMENAL IMPROVEMENT AFTER ABLATION
Even though I thought I was in good physical condition before the ablation, able to do nearly any physical activity I wanted, my improvement following the ablation and change in medications has been phenomenal. I have lifted weights as exercise for 30 years, something I continued even during A-Fib episodes, but now I find that I can lift more weight and do more repetitions than I’ve done for nearly ten years. I’ve never been a runner, but now I feel so good that I’ve taken up running as part of my exercise routine. I’m definitely very glad that I had the procedure done.
MY PERSONAL EXPERIENCE
The information provided by this particular web site (A-Fib.com) was one of the biggest factors in my eventual decision to undergo ablation. I used the web site extensively as a resource to help guide my decision-making regarding treatment options. While I found the “Personal Experiences” section very helpful, I also began to realize that everyone is different in their experiences with A-Fib and their responses to treatment. It was especially frustrating to me that in many cases the personal experiences did not provide enough information for me to compare my particular circumstances with others when trying to evaluate whether the path they had followed might also work for me. Now that I have gone through a successful ablation procedure, I decided to write about my own experiences in the hope that they might provide a useful guide to others. So that others might be able to relate my particular circumstances to their own, I have provided as much detail as possible. I hope this will not prove too boring, but will instead allow someone to perhaps recognize similarities between our situations, and thus benefit from both my successes and failures.
FIRST A-FIB ATTACK 40 YEARS EARLIER
I am currently 61 and will soon retire after 35 years as a university professor teaching business administration at Southern Illinois University Carbondale. My wife, who is a nurse, and I have been married for 28 years and have an adult son. For at least 30 years I have maintained an active lifestyle by exercising, including weightlifting, for several hours at least three times per week; but my first experience with A-Fib actually occurred nearly forty years ago when I was a graduate student.
Although I was in my early twenties, it was a time in my life when I was under a lot of stress, both mental and physical. When the A-Fib attack occurred, I had been studying, then got up to walk up several flights of stairs. When I got to the top, I noticed my heart seemed to be beating unusually fast; but I attributed that to the long climb. Although I did not realize it at the time, this pattern of A-Fib being precipitated by sudden exercise was one that would recur many times thirty years later. In any case, when the fast heartbeat had not gone away after several hours, I went to the E.R. They told me I had atrial fibrillation and admitted me to the hospital.
I don’t know whether A-Fib was relatively uncommon then in the early 1970s, but I was kept in the hospital for four days. Every med student came by to listen to my heart. On the fourth day I was told that if I did not convert to normal rhythm on my own that day, they would take me up to the O.R. and electrocardiovert me. Fortunately, I did convert spontaneously that day, apparently while I was in the shower. I was released to go home and was put on Inderal (propranalol) and Valium (diazepam). Over the next several months I had no more A-Fib attacks, so was gradually weaned off both drugs. To my knowledge, I had no other A-Fib attacks for nearly thirty years after that.
After college, I became more physically active, getting into a regular exercise routine that involved extensive walking, weightlifting, ballroom dancing, and an active lifestyle. My weight and clothing sizes today are still approximately what they were in college, I think primarily due to the high level of physical activity I have maintained in spite of an occupation that is relatively sedentary. When not in A-Fib, my resting heart rate is usually in the 50-60 range.
PVCS, THEN A-FIB
About twelve years ago I entered another period of high stress in my life and began noticing a feeling that my heart seemed to be skipping one beat out of every three or four, except when I exercised. These skips were eventually diagnosed as PVCs (premature ventricular contractions), and I was placed on a low dose of Calan (verapamil), which eliminated the PVCs. To ensure that there were no structural heart problems, I underwent a treadmill stress echo, which I passed with flying colors. There was only slight exercise-related hypertrophy, but nothing else. After several months with no more PVCs, I was eventually taken off the Calan.
About a year or two after that I began noticing that sometimes, when I started exercising, I would get a feeling that my heart was beating very slowly, but unusually hard. One day as I carried a heavy load of garbage up our driveway, I noticed the sensation again. As I reached the top of the hill, I was aware that my heart was then beating very fast. I drove in to work, but the fast heartbeat continued. It was then I realized this felt like the atrial fibrillation I’d had thirty years earlier as a graduate student. An EKG later confirmed it was indeed A-Fib. This was New Year’s Eve. Again, I was not aware of it, but a precedent had been set. For some reason I still cannot fathom, I ended up in A-Fib for the majority of New Year’s Eves after that until the year following my ablation. I’m aware of what’s called “holiday heart,” which is A-Fib that can be precipitated by heavy drinking; but I drink very little alcohol, even around the holidays.
The physician who diagnosed this second A-Fib attack, who was not a cardiologist by the way, started me on digoxin. It did slow down my heart rate, although I had a low tolerance for exercise. After several days on the digoxin, I converted back to normal sinus rhythm and stopped the digoxin. I was given another stress echo, which I again passed, and no structural problems were identified.
PRAIRIE CARDIOVASCULAR CONSULTANTS
After another month or so I had another attack of A-Fib, which again lasted a day or two; but I converted spontaneously. While in A-Fib, even moderate exercise left me feeling short of breath and my heart beating very fast. During this time I was not on any anticoagulant, although I have taken a baby aspirin every day on the advice of my primary-care physician. My wife suggested I needed to see a cardiologist. So I went to one affiliated with Prairie Cardiovascular Consultants, a group centered in Springfield, Illinois, but with an office in Carbondale where I’m located.
The cardiologist I saw started me on atenolol to prevent future A-Fib attacks. But it must have dropped my blood pressure too much, because after my first dose I could not get out of bed without feeling faint. I do not remember precisely what other drugs were tried, but none of them were what I would consider true antiarrhythmics. I believe most were either calcium channel blockers or beta blockers. They all seemed to only moderately reduce the incidence of A-Fib, but did help me better tolerate being in A-Fib by lowering my ventricular rate during an attack. During this time I might go several months or longer between attacks, or I might have an attack every month, but usually not more often. Attacks usually lasted only a matter of days.
A-FIB GETS WORSE—AMIODARONE EXPERIENCE
I eventually had an A-Fib attack that dragged on for several weeks. My cardiologist decided to start me on Coumadin (warfarin) and a low dose of amiodarone (200 mg twice a day). To me, amiodarone was a wonder drug. Even though I was still in A-Fib, my heart rate eventually became nearly normal, even with exercise. After several months, I converted back to normal rhythm and was taken off the Coumadin and amiodarone. I was told to start the amiodarone again if I went into A-Fib.
SLOW, HARD HEARTBEATS
I continued to have A-Fib attacks every few months. They usually lasted only a few days. In every case, the A-Fib began when I had a sensation of a slow, hard heartbeat that was precipitated when I suddenly went from resting to exercise. Surprisingly, exercise also often precipitated a conversion back to normal rhythm. I started taking the amiodarone whenever an attack occurred, but then stopped it after I converted. Because the slow, hard heartbeat always occurred at the beginning of an A-Fib attack, I questioned my cardiologist about this. He used an event recorder to identify what was happening. He determined that when I felt the hard beating, my atria and ventricles were actually beating out of sync. The atria were usually going about 100 beats per minute while the ventricles were beating at a much slower rate. He thought that the reason it felt like hard beats to me was that the ventricles were trying to compensate for the lack of synchronization with the atria. However, he never really explained why this would sometimes deteriorate into A-Fib. In an effort to reduce the incidence of these “disassociation” attacks, I was placed on Toprol (metoprolol, 25mg/day as I recall), which did seem to help somewhat.
During this same time I had also begun to read about some of the serious side effects of amiodarone, which concerned me greatly as I continued taking it, but only when I was in A-Fib. Unfortunately, about this time my cardiologist left practice (to go into the ministry!). However, the amiodarone seemed to be working. And my primary-care physician, who had firsthand experience with amiodarone and its side effects, was not very concerned due to the low dose I was taking and fact that I only took the drug when I was in A-Fib.
A-FIB ATTACK THAT LASTS SEVERAL MONTHS
Eventually, I had an A-Fib attack that lasted several months. I decided it was time to find another cardiologist. My new cardiologist, who is also with Prairie Cardiovascular, questioned whether the amiodarone was really having much effect since I didn’t start it until I was in A-Fib. And most of my A-Fib attacks lasted only several days, a period he thought was too short for the amiodarone to reach a therapeutic dose. However, I insisted that I thought the amiodarone worked and wanted to stay with it, something he agreed to. He did decide, though, that instead of the Toprol that I had been taking on a regular basis, he wanted to switch me to sotalol, 80 mg per day. The sotalol did seem to reduce the incidence of “hard beating” periods, and also the number of A-Fib attacks. It also seemed to work quite well to slow my ventricular rate when I was in A-Fib. My resting rate during an A-Fib attack would generally be 70-80, although with exercise I could get it up to 140 or higher pretty easily. I continued on sotalol for several more years.
Aside from changing medications, my new cardiologist also suggested that I might want to consider an ablation procedure. I had read only briefly about this, but it seemed like it was still fairly new. Also, I was still able to function quite well, even in A-Fib. A procedure so apparently drastic seemed unnecessary. I decided to file it away for future reference, but continue treating the A-Fib as I had been.
Over the next several years I continued to have A-Fib attacks precipitated by the hard beating that occurred with sudden exercise. Although I tried to avoid sudden exercise, I found it impossible. For example, one attack occurred when I stood up after a long airplane flight and simply picked up my carry-on bag. Although exercise would precipitate an attack, it also frequently ended them. In fact, many times this occurred while I was dancing, especially faster, more energetic dances. My cardiologist and I began to joke about what we called the “cha cha conversion.” As you can see, I tried to let the A-Fib affect my life as little as possible, staying fairly active. The only time I really had to cut back on exercise appreciably was during the first few days of an A-Fib attack, when I usually had quite a low tolerance for any very strenuous exercise.
Things continued like this for several years, but my A-Fib attacks gradually started to become more frequent and last longer. I was concerned about the possibility of a stroke but really wanted to stay away from Coumadin. Fortunately, research shows that for someone of my age with no other stroke risk factors than A-Fib, aspirin provides sufficient protection from stroke. With the agreement of my doctors, I increased my daily aspirin dose to one full adult aspirin.
THE ABLATION OPTION
Because of the increased frequency and length of the A-Fib attacks, I decided I had reached a point where I needed to explore other options for dealing with the A-Fib. I asked my primary-care physician for a recommendation to someone who might help me consider different options. He recommended two electrophysiologists affiliated with Prairie Cardiovascular in Springfield, Illinois. My physician indicated he had sent patients to heart centers throughout the U.S., and that he thought the two he recommended were as good as anyone in the country. I decided to pick one (Dr. Brian Miller) who did not do ablations, so that he might be more unbiased about all the possible options.
When I met with Dr. Miller, I explained my experience with A-Fib. After a few minutes he said that he thought I was a perfect candidate for ablation, which I had not mentioned up to that point. I explained my concerns about the procedure, that it was still evolving, that there could be serious (even fatal) consequences. He eventually agreed that I was not ready mentally for the procedure, but he also indicated he thought I should stop taking the amiodarone. He counseled that even though I took a low dose, and only when I was in A-Fib, that amiodarone’s effects could be cumulative, and that I had been using it for quite a while. He indicated that, after I had been without amiodarone for long enough, he would like to start me on dofetilide (brand name Tikosyn). As instructed, I weaned off the amiodarone.
MORE FREQUENT, LONGER (CHRONIC) A-FIB ATTACKS
Over the next few months I began having A-Fib attacks that were extremely unusual for me. Some started while I was asleep, which had never happened before. Some lasted only a few minutes or hours, although my previous attacks had been for at least a day.
The attacks also became much more frequent, even several a day. At this time I had also read more information about Tikosyn and realized I did not really like the path that drug would be taking me down if I started on it. I decided it was time to look more seriously into the possibility of an ablation. About this time I also had another attack of A-Fib that did not resolve, but continued for over a week. I decided to re-start the amiodarone to see if that would stop it. It did not, and the A-Fib attack went on for months. I began to worry that I had gone into chronic A-Fib. In fact, the A-Fib did not end until six months later when I was electrically cardioverted for the first time in my life during the ablation procedure.
CHOOSING AN A-FIB ABLATION DOCTOR
I am very fortunate to have excellent health insurance that would essentially pay for me to have an ablation done anywhere I would want, so I began to consider the many options available to me. Based on information I had obtained from this web site, I knew the major centers and many of the best-known physicians. I talked with my primary-care physician and with my cardiologist to get their inputs. In my mind, there are some definite advantages and disadvantages to each option. For instance, I considered going to Bordeaux, often regarded as the top A-Fib center in the world. I have visited France before and speak some French, so that would not be a problem. On the other hand, my French does not include medical terms which would be a concern. And my wife, who might be called on to act on my behalf, speaks almost no French. Furthermore, if problems occurred later, it could mean another long trip to go back there.
Another option was to go to one of the major A-Fib centers in the U.S. While this would eliminate the language problem, it would also mean a long trip, being away from home for a period that could be quite long, and the necessity of a long return trip if problems developed later. Also, these centers often have a long waiting list, and the well-known physicians are booked up far in advance. Given that my A-Fib now appeared to be chronic, and knowing that ablation success rates are usually lower for chronic A-Fib, I did not want to wait any longer than necessary. I also was told by my cardiologist that it is often difficult to get in touch with the big-name people if questions arise, because those people are just so busy with heavy demands on their time.
The person Dr. Miller had recommended for an ablation was Dr. Ziad Issa, who is also with Prairie Cardiovascular in Springfield, Illinois. Springfield is about a four hour drive from where I live, so it would be a reasonable distance to travel. Furthermore, my cardiologist, who had sent patients to some big-name people as well as to Dr. Issa, thought that the results obtained by Dr. Issa were as good as anyone else’s. Furthermore, as luck would have it, a “friend of a friend” had recently had an ablation done by Dr. Issa. I talked with her, and it sounded as though her A-Fib problems had been worse than mine. She had both A-Fib and A-Flutter. She was now cured and was extremely happy with the work Dr. Issa had done. I scheduled an appointment to meet with Dr. Issa and discuss the possibility of an ablation.
For my appointment with Dr. Issa, I took along the list of questions from this web site, as well as other questions I had developed from my reading about ablation. I found Dr. Issa very open, knowledgeable, and willing to spend time with me. His answers all fit well with what this web site indicated are good answers. He had been doing ablations for about 5 years and had done about 150 of them. His success rate matched what I had been reading as the success rate for most large A-Fib centers. He’d had only one problem, which was with a patient who developed pulmonary vein stenosis, and that was corrected with a stent.
I came away from my meeting with Dr. Issa feeling very good. I did think of a few questions afterward, so I called his office and was able to speak with his nurse, Leslie Ardebili and his medical secretary, Julie Reed, both of whom were very helpful. One question I had was whether they ever had any patients who ended up worse off after the ablation. The answer I got, which put my mind greatly at ease, was that as far as they knew, all of their patients felt better after the ablation. Even those who were not cured of A-Fib felt better as they were able to use drugs with fewer side effects or lower dosages of their drugs than before to control their A-Fib. Dr. Issa had also mentioned that the procedure usually lasted 3 to 4 hours, whereas many accounts I had read of ablations talked of six hours or more. When I asked Leslie about this difference, she indicated that as Dr. Issa and his team gained experience, they worked together more efficiently and were able to position the equipment in less time. So the procedure time was reduced.
ABLATION WITH DR. ISSA
Based on the information I obtained, I decided to go ahead and schedule my ablation with Dr. Issa. Although his office could have scheduled me sooner, I decided to wait until our university’s Christmas break so that I would be done teaching for the semester and would not have to miss any classes.
TEE (TRANS-ESOPHAGEAL ECHOCARDIOGRAM)
I was told that I would have to start taking warfarin and that I would need to have a TEE (trans-esophageal echocardiogram) to check for blood clots in the atria, because I had been in A-Fib without being on warfarin. Fortunately, the TEE could be done locally by my cardiologist the week before I was scheduled to travel to Springfield for the ablation.
Once I decided to go ahead with the ablation I had no fear about that, but the TEE gave me a lot of concern. Sometimes knowledge isn’t such a good thing, and I had read enough about the TEE procedure that I knew it wasn’t very pleasant. Even though I knew I would be partially sedated, I was still very nervous about having a tube inserted down my throat.
On the day of the TEE I reported to our local hospital, had my INR checked, and was given an ECG. I was then sent down to the cath lab and prepped for the TEE. We had to wait a while for my cardiologist to finish another procedure, and as I waited I could feel myself getting more nervous. I was hooked up to a heart monitor, so my heart rate was displayed. The nurse with me could see the rate kept going up. She told me to relax – something easier said than done.
Fortunately, the cardiologist arrived, and they started injecting the Versed (midazolam) and Fentanyl for sedation. They then sprayed my throat with something to numb it which, as they explained, made my tongue feel like it was swelling. Again, not a comfortable feeling, but then the next thing I knew I became aware that I was trying to swallow and felt something in my throat. The nurse told me the procedure was over and they were just removing the scope. They hadn’t found any clots, so I was cleared to go ahead with the ablation procedure. The TEE, or at least what I remember of it, hadn’t been as bad as I expected.
I had been told to report to the Prairie Diagnostic Center the day before I was scheduled for the ablation, so they could perform a CT scan of my heart. The results of that CT scan would be combined with fluoroscopic images during the procedure to provide a 3-D picture that would allow Dr. Issa and his team to guide the catheters during the ablation. They also needed to measure the diameter of my atrial veins to know what size catheter to use for the ablation. One concern was whether there would be a problem getting a good CT scan, because I was still in A-Fib. Fortunately, the staff indicated they had learned that they could still obtain a good CT scan, so that was not a problem. After the scan was completed, then I went to St. John’s Hospital and the Prairie Heart Institute, where the procedure would be performed, to pre-register. This involved more blood work and a chest X-ray. Once finished there, I was told to report the next morning for my procedure.
The day of my ablation I arrived at the cath lab waiting room first thing in the morning. Because I had taken care of the pre-registration procedure the day before, I was able to go right back to a prep room where I changed into a hospital gown, had some IV needles inserted, then met with the anesthesiologist. Although others on this site have described being awake during the ablation procedure, I was given the choice of either general anesthesia or “conscious sedation.” I chose the latter. I don’t think I would want to be totally conscious through the procedure, so I was glad that was not an option.
I don’t know why it is, but hospital hallways and procedure rooms always seem exceedingly cool. After having come in on a snowy morning with nothing to eat since the night before, I was feeling pretty chilled. But I got a pleasant surprise when they moved me onto the table for the procedure. I was lying on a heated pad that felt absolutely heavenly. There were people all around me, and one asked me to extend my arm. That’s the last thing I remember until I became aware of movement and lights passing by overhead as I was being wheeled from the cath lab to the Cardiac Recovery Unit (CRU).
HEART BEATING NORMALLY!
As the sedation gradually wore off, I remember one of my first thoughts was whether I could tell if my heart was still in A-Fib or beating normally. I became aware of a regular beeping sound, which I assumed was a heart monitor. It sounded fairly slow and steady, which made me very happy. As I became more aware, I realized the sound was coming from above my head, so I craned my neck around to look and realized I could see a number that looked like 60-something. My resting heart rate when not in A-Fib had been about 60 or less, but was in the 70-80 range with A-Fib. I hoped this was my heart rate. It didn’t appear to change much, but I cranked my head around every minute or so to be sure it was still in the 60 range. It stayed there.
Before the procedure, both my wife and I had been told that the procedure would probably take about 3-4 hours. Just a little over an hour after they took me in for the procedure, Dr. Issa called for my wife in the waiting room. She said she knew it was going to be either really good news or really bad news. Fortunately, it was good news. The procedure had gone extremely well. They had stopped the A-Fib, ablated around the four pulmonary vein openings, and found no other areas with potential to generate A-Fib. So the procedure went very quickly.
One thing that I don’t remember other accounts of the ablation procedure mentioning, so it was something for which I was not really prepared, was the level of chest pain following the procedure. I really felt as though a horse had kicked me square in the middle of my chest. It was not a sharp pain, but felt like the type of pain from a really bad bruise. Anything other than a very shallow breath was very uncomfortable because of the pain.
Part of the various devices that were hooked up to me in the CRU must have been something that monitored how deeply I was breathing. If I was not breathing deeply enough, apparently a cause for concern, an alarm would sound and the nurse assigned to me would yell “breathe deeply.” This became a bit of a game as I tried to breathe just deeply enough to avoid setting off the alarm, but shallow enough to avoid much chest pain. For some reason, I never thought to ask for anything to control the pain. I think I was just happy to be back in normal sinus rhythm and wanted to avoid anything that might upset that.
RECOVERY IN THE HOSPITAL
The only problem I had was that right after my procedure my blood pressure was rather low. They thought I might be dehydrated, so they gave me several bags of I.V. fluids. That brought the pressure up somewhat, but still not to a normal level. I think they eventually needed my bed in the CRU, because they decided to go ahead and move me to the cardiac telemetry unit where I knew I’d be staying overnight. On the CRU they had been measuring my blood pressure through an arterial line that had been inserted during the procedure, but was taken out before moving me from the CRU. On the floor, they checked my pressure with a regular cuff. It showed low normal, so the arterial line might have been inaccurate.
I also had a urinary catheter that had been inserted during the procedure, and that was removed on the telemetry unit, which made me a lot more comfortable since I could then move around somewhat normally. I’m a big believer in becoming mobile as quickly as possible after any kind of surgery. So once the catheter was out and my blood pressure appeared to be stabilized, I got permission to get up and start taking short walks, which felt really good. However, the chest pain and gauze pads in my groin where the incisions had been made to insert the catheters, kept me from walking very fast.
That night in the hospital was not exactly the best night’s sleep I’ve ever had. Even though I was given a couple of Tylenols for pain, my chest still hurt very much, and it was difficult to find a comfortable position. Lying on my side, I could feel my heart beat. It just about drove me crazy waiting to see whether I would go back into A-Fib. On my back, I didn’t feel my heartbeat as much; but the pain was worse. I eventually managed to adjust the bed into some crazy half-sitting, knees up position so I could get some sleep.
The next day, Dr. Issa came to see me and explained that the procedure had gone very well. They needed to do some more lab work and another chest x-ray; and if all that was okay, then his nurse would come in and discharge me.
Upon discharge I returned home with orders to take it easy and not walk up or down stairs for a couple of days, then gradually resume my regular activities except to not lift any heavy weights for a week. I probably overdid it a bit by going in to work the first few days, because the chest pain did get quite a bit worse when I was walking. Fortunately, Dr. Issa’s nurse, Leslie, was always available to speak with. She told me I had probably just over-exerted and needed to actually take it easy. The chest pain gradually went away, although it took at least several weeks. During this time I also had frequent feelings of skipped beats and occasional, perhaps once or twice a day, feelings of A-Fib that lasted only a few seconds. Over time these also gradually decreased.
I reported back for a checkup about a month after the procedure and was told everything was going well. Then, about three months after the procedure I had an attack of A-Fib on the first day of my vacation, while I was on a small boat in the Caribbean. So there wasn’t much I could do but live with it. The attack started while I was sleeping on my left side, but then it went away some time the next afternoon, having lasted only about 12 hours. However, this was very discouraging as I thought it might be a sign the ablation had failed, and I would begin having A-Fib attacks again. I contacted Dr. Issa’s office immediately after returning from vacation and was told that the attack was actually a good sign because I had converted spontaneously, and that I shouldn’t be concerned. Fortunately, I have had no other attacks since then.
I continue to feel better all the time. I still have occasional feelings of skipped beats, but these are usually relatively infrequent. Every few days I may have a feeling of A-Fib that lasts only a second or two. Before I could stop taking the warfarin, I was required to wear a Holter monitor for 48 hours to ensure that I was not having any more A-Fib or A-Flutter. During that 48 hour period I did have the feeling of a short attack of A-Fib, but the report came back that there was no sign of fibrillation or flutter. So these feelings may have been just a series of PVCs.
Now that I am apparently cured, my advice for someone with A-Fib would be to thoroughly investigate all your options and learn as much as you can. Although the ablation procedure is still being improved, I think it has reached the point that it is the closest thing to a cure currently available. I would also say that my experience shows it’s not necessary to go to one of the top-name A-Fib centers to have excellent care and good results. However, it is necessary to thoroughly investigate the person who will be performing the procedure to be sure his/her skills are up to-date and that he/she has the requisite experience and knowledge to provide a high probability of success. If anyone who reads this has any questions, please feel free to contact me.