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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. “More than 81% of A-Fib ablations procedures in the US were performed by operators with an A-Fib volume of less than 25 (Medicare patients) per year.” (See Catheter Ablation Complications.)

Let me repeat that. The vast majority of A-Fib ablations in the US are performed by operators who are probably the least proficient and certainly have the highest complication rates.

“My Local EP Does About a Dozen Procedures a Year…”

Travis Van Slooten, of LivingWithAtrialFibrillation.com, recently shared about his ablation:

“My local EP wanted to do my ablation. He was a really nice guy but only does about a dozen or so procedures every year. He had me convinced that I was an easy case and that he could easily take care of it. Most people would have settled with the local EP in this situation.

Had I done that it would have been a disaster. It turned out to be far more complex as you’ve noted in your report, How and Why to Read an Operating Room Report.

[Travis’ ablation turned into an extensive one. After ablating potentials in the Pulmonary Veins (PVs), Dr. Natale ablated non-PV potentials in many other parts of Travis’ heart, made linear ablation lines, ablated electrograms and found A-Fib signals in the right atrium as well.]

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

To read about Travis’ ablation experience, visit his blog post, My A-Fib Journey.

All Electrophysiologists (EPs) Are Not Equal

How can this be happening?

There is no government program to test EPs for ongoing competency.

There are all too many EPs today who do very few A-Fib ablations, have high complication rates, don’t use the proper equipment, haven’t been trained by Master EPs, don’t use proper ablation protocols, and have lost or possibly never had competency in doing A-Fib ablations.

There is no government program to test EPs for ongoing competency, to require they undergo updated training by experts and Master EPs, to require they learn and use newer and better ablation technologies and strategies.

For example, even though the new Contact Force sensing catheters have been proven to greatly improve A-Fib ablation results, no EP is required to learn and use them.

This is not the case in other professions where lives and health are at risk. Airline pilots, for example, must regularly re-certify, undergo intense training, flight simulation, learn how to use new equipment, etc. to maintain their pilot’s license.

What This Means to Patients

Don’t just settle for an EP just because they have an office near you.

All EPs are not equal. (Where I live, I’ve heard of so many tragic cases of incompetence.)

Don’t just settle for an EP just because they have an office near you.

I know it’s a lot of effort. You have to work at finding the right EP―do your due diligence. You have to be prepared to travel if that’s what it takes.

Remember: You must be your own best patient advocate.

See Finding the Right Doctor for You and your A-Fib for the steps to find the right EP. Our Directory of Doctors and Medical Centers and Steve’s Lists of Doctors by Specialty offers you the opportunity to locate and contact a healthcare professional directly.

References for this article

NOTICE: We accept no fee, benefit or value of any kind for listing a specific doctor or medical center in our Directory of Doctors and Medical Centers or for inclusion in Steve’s Lists of Doctors by Specialty.

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