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—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 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.
by Steve S. Ryan, PhD, February 2015
In our A-Fib.com section, Finding the Right Doctor for You and Your A-Fib, we stress the importance of a good doctor-patient relationship. Indeed, recent research proves that patients do better when they have a good rapport with their doctor.
Results from Studies of Doctor-Patient Relationships
Researchers at Massachusetts General Hospital analyzed the results of 13 high-quality studies of doctor-patient relationships.
Those patients who were treated by doctors trained in “relationship-based strategies”—such as providing more eye contact, careful listening and goal setting—did better than patients in control groups.
According to Dr. Gerald B. Hickson of Vanderbilt, patients who trust their doctors are more likely to follow their advice, ask questions and discuss how treatments are working. Doctors in turn may be more engaged.
Recent research proves that patients do better when they have a good rapport with their doctor.
‘Interview’ to Find the Right Doctor for You
Don’t just go to a doctor because their office is nearby. Get referrals from friends and co-workers. Check credentials online. Narrow your list to 2–3 doctors then schedule a consultation appointment with your #1 choice.
When you meet the doctor, consider it an ‘interview’. Tell the doctor what you are looking for in your doctor (do you need someone who’s easy to get to see, or someone with special expertise, or someone who will team with you to cure a specific illness, etc.)
Here’s an excerpt from our page, Finding the Right Doctor for You and Your A-Fib: Your Consultation Appointments: ‘Questions for Doctors’:
“You’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? Does he/she respect you? Women in particular should be wary of condescending behavior. “It’s all in your mind.” “Take a Valium.” (Women in the US often don’t receive the proper diagnosis and treatment of their A-Fib.)
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 only personally offensive but can be dangerous for your health.
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.” “As a patient, you’re also a member of the health-care team,” explains 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 heart 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 so will you.”
If the first doctor you interview doesn’t meet your needs, move on the second doctor on your list, etc. Yes, I know it takes time and energy, but a good doctor-patient relationship is important. You’ll do better when you have a positive rapport with your doctor.
Last updated: Wednesday, November 2, 2016