ABOUT 'BEAT YOUR A-FIB'...


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

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

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

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

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

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



ABOUT A-FIB.COM...


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

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

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

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

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

Terry Traver, former A-Fib patient

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

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


medical records

We Make it Easy to Request Your Medical Records

How to Request Copies of Your Medical Records

Seeing a new doctor or specialist? You’ll want to supply them with a copy of all your relevant A-Fib related medical records. This may involve requesting files from current and former physicians and medical centers.

In the US, under the HIPAA legislation, you have a right to copies of your records.

To start the process you need to submit a written request to each doctor or medical practice.

To make this easy, use the sample letter provided by the Privacy Rights Clearinghouse, a non-profit patients advocacy group.

Download the free PDF file from their website and print or save the PDF file to your hard drive. 

HIPAA stands for the Health Insurance Portability and Accountability Act of 1996.

Using their sample letter as a template, replace the sample patient information with your own and create a letter for each doctor or practice. Then print and hand-deliver your request to your doctor’s office or mail or fax it.

The doctor’s office is required to respond in a specific number of days. To learn how long they have to respond and what they are allowed to charge you for copies, see our article, “How to Request Copies of Your Medical Records”.

Your Personal A-Fib Medical Summary

Your Personal Medical Summary

Your Personal Medical Summary

Your Personal A-Fib Medical Summary

by Patti J. Ryan

Doctors appreciate knowledgeable, informed, and prepared patients. Each doctor will probably ask you much the same questions. For efficiency, prepare your ‘Personal A-Fib Medical Summary’ and include a copy with each packet of medical records you send to doctors.

In their special report Atrial Fibrillation: The Latest Management Strategies, Drs. Calkins and Berger suggest before your appointment that you prepare answers to the following questions about your Atrial Fibrillation.

•  What particular symptoms are bothering you?
•  When did you first begin to experience these symptoms?
•  Did you start taking any new vitamins, supplements, or prescription drugs before the onset of symptoms?
•  Are these symptoms paroxysmal (occasional or intermittent, beginning and stopping on their own), or persistent (present all the time, or lasting at least a week at a time continuously)?
•  On a scale of 1 to 5, with 1 being little of no bother and 5 being severely bothersome, how would you rate your symptoms?
•  Is there anything that appears to worsen your symptoms?
•  Is there anything that appears to lessen your symptoms?

Include other pertinent information such as names and contact information for doctors you see regularly and why. Type up your summary and attach a copy to each set of medical records you send to doctors. And add a copy to your three-ring binder.

Healthcare trend: ‘The Personal Health Record’ (PHR)

There is growing momentum to encourage consumers to take another health-related step: to maintain their own health records.

The idea behind the personal health record (PHR) is that the more consumers know about their health, the more control they will take over it and the healthier they will be. PHRs also encourage consumers to collect and share more health-related information with each of their providers. For this reason, healthcare providers, employers, insurers, vendors, and the federal government are all interested inpromotingPHRs.

What is a personal health record (PHR)?

Shoe pocket by Vital ID;  Your Portable Medical Information Kit

Shoe pocket by Vital ID

USB credit card-size by ER Card

Credit card-size USB by ER Card

A personal health record (PHR) is a means of storing, managing, and sharing your personal medical information. PHRs can be paper based or electronic. Electronic records can be kept on different media, including personal computers, “smart” cards, thumb drives, CDs, or web-based applications.

Of the two types, paper records may be easier to secure, but electronic records are more convenient.

If you are considering a PHR to maintain your health records, look for a list of resources and a ‘Quick Guide to Creating a PHR‘ from the American Health Information Management Association (AHIMA), a national non-profit professional association.

Also see our article, Your Portable Medical Information Kit for a sampling of small, easy to store and carry USB devices for the print and digital versions of your PHR info.

References for this article

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Last updated: Monday, August 24, 2015

3 Ways to Request Copies of your Medical Records

How to Request Medical Records

Request Medical Records

by Patti J. Ryan, Updated March 2016

Before meeting with any electrophysiologist or surgeon, you will want to send each a packet with your medical records, test results and any images/X-rays. (You should be collecting this information all along in a three-ring binder or file folder.) So, how do you gather copies of medical records you’re missing?

Your Right to Your Medical Records

To begin, you may ask, “Do I have a legal right to my medical records?” Yes.

Be aware that while your medical information or data belongs to you (the patient), the physical pieces of paper, X-ray film, etc. belong to the hospital or health care provider.

Patients have the legal right to access both paper and electronic records, to view the originals and to obtain copies of their medical records.

This right is guaranteed in the U.S. by the Health Insurance Portability and Accountability Act of 1996 [HIPAA]. If you live outside the US, know that over 89 countries have adopted Data Privacy Laws. For example, Canada has the Personal Information Protection and Electronic Documents Act (PIPEDA) and in Europe there’s the EU Data Protection Reform.1,2,3

Keep your medical records in a binder or folder.

File copies of your medical records

Do an Inventory of Your Medical Records

You want to compile a list of the offices you need to contact. (You may already have many of these records in your A-Fib binder/folder and just need to identify those you are missing.)

Begin with a list of all the doctors, emergency rooms, labs, specialists and other health care providers and facilities who have provided you with medical services related to your A-Fib.

Request your prescription records, as well, from pharmacies and health plans. (You may already have online access to this information, depending on your service provider.)

Also, request records of any major medical event from the past two years (i.e., surgeries, medical emergencies, allergic reactions, etc.)

Review Your Records for Accuracy

Before requesting copies, you have the right to review your health records (not just ask for copies).

Your doctor’s medical records staff can help guide you to find the information you are interested in reading. Look over your records to make sure they are correct. Ask questions. If you spot any errors, ask to have them corrected before they are shared with another doctor or hospital.

Make Medical Record-Keeping a Habit: Don’t leave your doctor’s office or medical canter without a copy of every test they performed (if the test result isn’t immediately available, have them mail it to you). Store in a three-ring binder or file folder.

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Three Ways to Request Your Records

1. You’ll find the instructions for requesting records for each provider in their ‘Notice of Privacy Practices’—you signed and received a copy of this notice on your first visit. (It’s also posted at the facility where patients may see it.) It should provide instructions for requesting records as well as contact information for asking questions or filing complaints. Follow the instructions to request your records.

2. Or, if visiting the medical office, ask for an ‘Authorization for Release of Health Information’ form. You can complete and submit the authorization form in person or take it home. Many medical practices post the ‘Authorization for Release of Health Information’ form on their website for download.

3. You can also write your own ‘Request Your Medical Records’ letter (see sample below). The Privacy Rights Clearinghouse offers a sample letter template to help you compose your own letter asking for your medical records. (See sample letter below at end of this article.) Fax or mail your request letter.

Plan ahead: It may take some time for your request to be processed. It’s a good idea to ask when you can expect to receive the information and an estimate of the reproduction cost.

Will You be Charged for Copies?

For hard copies expect to pay duplication costs. HIPAA allows doctors/practices to charge a “reasonable, cost-based fee.”  They can charge for supplies, staff time for copying and processing, and mailing costs, if applicable.

For no cost copies, ask if they will copy electronic files to your USB Flash drive or to a disc/CD you supply.

However, they may not charge for the time a staff member spends searching for the record.  In addition, they should not adopt a policy of charging a flat fee or charging a patient to view a record.

Note: U.S. state laws may limit the amount the doctors/practices charge for duplicating records.

You’ll Need Multiple Copies

You may receive paper copies, x-ray film and/or electronic records (on CDs or USB flash drive). You can ask for multiple copies or make your own. (For duplication services, check office supply retailers like Office Depot or Staples.)

If you expect to interview three to five doctors, have a packet made for each doctor (better to have an extra packet rather than too few).

Take your A-Fib binder to your appointments.

As a backup, take your A-Fib binder to your appts.

File Originals and Backup Digital Records

Store your originals in your binder or file folder. Store CDs in binder sleeves or copy to your PC. Make backup copies of any digital records.

Day of Your Appointment

When you arrive at the EP’s office, make sure they have indeed received your up-to-date medical records. As a back-up, bring your own three-ring binder with the originals.

Don’t Forget: take along a pen and your ‘office visit notebook‘.


Sample Letter Format and Template to Request Your Medical Records4

Download this sample letter as PDF file (then save to your hard drive).

[Your name]
[Your address]
[Date]
[Name of care provider or facility]
[Address]

RE: [Your medical identification number or other identifier used]

Dear [Name of care provider or facility]

The purpose of this letter is to request copies of my medical records as allowed by the Health Insurance Portability and Accountability Act (HIPAA) and Department of Health and Human Services regulations.

I was treated in your office [at your facility] between [fill in dates]. I request copies of the following [or all] health records related to my treatment.

[Identify records requested, e.g. medical history form you provided; physician and nurses’ notes; test results, consultations with specialists; referrals.]

[Note: HIPAA also allows you to request a summary of your medical records. If you prefer a summary, you should agree to a fee beforehand.]

I understand you may charge a reasonable fee for copying the records, but will not charge for time spent locating the records. Please mail the requested records to me at the above address. [If you request that the records be mailed, you may also be charged for postage.]5

I look forward to receiving the above records within 30 days as specified under HIPAA. If my request cannot be honored within 30 days, please inform me of this by letter as well as the date I might expect to receive my records.6

Sincerely,
[Your signature]
[Your name printed]

Never see a doctor alone - 350 wide at 300 res

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Last updated: Monday, March 7, 2016

References    (↵ returns to text)

  1. Greenleaf, G. Global Data Privacy Laws: 89 Countries, and Accelerating (February 6, 2012). Privacy Laws & Business International Report, Issue 115, Special Supplement, February 2012; Queen Mary School of Law Legal Studies Research Paper No. 98/2012. Available at SSRN: http://ssrn.com/abstract=2000034
  2. Personal Information Protection and Electronic Documents Act. (PIPEDA or the PIPED Act). Wikipedia.org. URL:  https://en.wikipedia.org/wiki/Personal_Information_Protection_and_Electronic_Documents_Act
  3. Protection of personal data. European Commission’s Directorate General for Justice and Consumers. URL: http://ec.europa.eu/justice/data-protection/
  4. Reproduced with permission from the Privacy Rights Clearinghouse, Fact Sheet 8. Last accessed October 17, 2014, URL: https://www.privacyrights.org/Letters/medical2.htm
  5. Under HIPAA you can be charged a treasonable fee for copying records. You may also be charged for postage if you ask that records be mailed to you. HIPAA allows 30 days for a provider to respond to your request for records, with one 30-day extension for good reason.
  6. Your state laws may include a lower fee for copies of records or a shorter time for the provider to respond to your request.

Finding the Right Doctor for You and Your A-Fib

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 probably 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 and often have bad side effects.

In addition, time is of the essence in treating A-Fib. The longer you wait, the more your A-Fib may “remodel” your heart (i.e., change it physically and electrically). Drug therapy may not be the best option for you.

 HOW TO START YOUR SEARCH

Why a cardiac electrophysiologist (EP)? graphic at A-Fib.com

Click for graphic: Why you need a cardiac electrophysiologist (EP).

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

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.

To be cured of your A-Fib, you need to find the best doctor for you and your treatment goals. You need a doctor who will work with you to create a treatment plan—a path to finding your cure or best outcome.

To find the right doctor for you, start by creating a list of possible doctors to consider. Seek recommendations from your 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 are often a great resource.

Instead of a cardiologist, you should see an cardiac Electrophysiologist (EP)—a cardiologist who specializes in the electrical activity of the heart and in the diagnosis and treatment of heart rhythm disorders.

 And use the internet. 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; see more about FHRS below).

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 PVIs; some focus on pacing/pacemakers, or clinical research, for example). Look for additional information such as which medical insurance they accept.

Unfortunately this FHRS list leaves out many younger A-Fib EPs who are doing excellent work. (We haven’t found an unbiased way of identifying these younger A-Fib doctors and welcome suggestions as to how to do this,)

Start your research with a notebook and a three-ring binder…to organize the information you will be collecting.

Steves List - Doctors by Specialty for Atrial Fibrillation, A-Fib, a fib, afib

Doctors by Specialty

 Our A-Fib.com Directory

This A-Fib.com Directory of Doctors and Facilities is an evolving list of the physicians and medical centers in the U.S. and internationally treating patients with atrial fibrillation. It is offered as a service and convenience to A-Fib patients.

In addition, I’ve compiled several rosters of doctors by specialty called Steve’s Lists’.

For a list of EPs with the FHRS credential listed by state and city, see Steve’s Lists: Doctors by Specialties and more specifically, US EPs with FHRS-designation Performing A-Fib Ablations by US State/City.

We strongly encourage you to get in the habit of keeping a copy of every test result you get in your 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.

 Organize Your Research

Keep your medical records and notes handy

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.

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.

Obtain Copies of Your Medical Records, Tests, and Images

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

We strongly encourage you to get in the habit of keeping a copy of every test result you get in your 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.

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 medical 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. When you arrive at the EP’s office, make sure they have indeed received your up-to-date medical records. As a back-up, bring your own three-ring binder with the originals.

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 Researching Doctors and Centers

Don’t rely on a single online source when researching and selecting doctors.

Credential Acronyms While researching EPs, you will notice acronyms following a physician’s name. For an explanation of these credentials and acronyms, see our article Physician Credentials.

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).

Don’t depend entirely on the typical doctor informational websites or online directories. A doctor with a good lawyer can keep their name free of sanctions and board actions. And the patient surveys on these sites aren’t very scientific and lend themselves to manipulation (one can get friends or paid people to respond to the survey). Consult several sites.

Please bear in mind than not all EPs perform and have sufficient experience in Pulmonary Vein Ablation. See my “Choosing the Right Doctor: 7 Questions You’ve Got to Ask” page and my list  Doctors/Facilities/Steve’s Lists/EPs Performing Pulmonary Vein Ablation to help find the right Electrophysiologist for you.

Over the last several years there has been an astounding and welcome growth of US centers and doctors who do Pulmonary Vein Isolation (PVI) procedures. But some are low volume centers with limited facilities and training who may do as little as 20 PVAs a year.

It’s tough to quantify experience with specific numbers. But if a doctor only does 20 PVAs a year, that may not be enough to maintain and develop ablation skills. A typical experienced EP does over 50 PVIs a year. For more see our article, Considering a Catheter Ablation? Know Complication Rates When Choosing Your Doctor.

 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. You’ll be looking for information such as:

• Where did they attend medical school?
• Where did they do their residency program?
• What board certifications have they received?
• What are their hospital affiliations?
Where and from whom did the doctor receive special training to treat A-Fib?

On the negative side:

• Have they lost privileges with any hospitals?
• Have they been sanctioned by any medical entity?

To research each doctor, consult the internet or your local library. The following online resources may be helpful.

The Heart Rhythm Society ‘Find a Specialist online searchable directory; Also: includes the doctor’s specialties, insurance accepted, and more
The American Board of Medical Specialists (ABMS) Directory of Board Certified Medical Specialists
The American Board of Internal Medicine. http://www.abim.org/services/verify-a-physician.aspx; to check on a doctor’s certification
The Cardiothoracic Surgeon’s Network Directory of Surgeons
HealthGrades, Vitals, and RateMDs: independent healthcare ratings organizations which provides physician’s profile, education, awards & recognition, insurance accepted, hospital affiliations, and malpractice and sanctions. But be aware that these sites usually don’t review a doctor’s competence.
Online discussion groups and forums; read what other A-Fib patients have written about specific doctors. (see Resources/Bulletin Boards.)
FindACase™ http://co.findacase.com

 Create Your ‘Short’ List

Narrow down your list to the top three-to-five doctors. The next step is to get specific information from each doctor or their office personnel (call their physician assistant, nurse practitioner or office manager). Hint: you get better service if you ask for a specific doctor by name or for their physician assistant or nurse. (When you call, sound like you know the doctor.)

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.

Gather the following Information about each prospective doctor:

  1. How long have you been performing Pulmonary Vein Ablation for my type of A-Fib? How experienced are you with RF and/or Cryo? How many procedures do you perform a year?
  2. What is your success rate with PVI/PVA? How do you define ‘success’? (No A-Fib and drug-free, for example.)
  3. What kind of complications have you had? What kind of precautions do you take to prevent complications like Atrial Esophageal Fistula?
  4. What kind of A-Fib ablation procedures and equipment do you use? What would you use for my type of A-Fib? 
  5. Do you refer patients to surgeons for a Cox Maze or Mini-Maze operation?

Most doctors and centers will welcome these questions and respond frankly to you. If they don’t, that may be a sign you need to look elsewhere. For a list of specific questions to ask doctors and how to interpret their answers, see my Questions for Doctors page.

Be Cautious: information from the doctor or their practice is ‘self-reporting data’. There is no independent entity to verify the doctor’s or their office’s responses to you. If it sounds too good to be true, it probably is.

If the doctor or their office seems reluctant to give you the info you need, it might be wise to talk with another doctor.

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 Your Consultation Appointments

Select your 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.

Send Your Medical Records Beforehand

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 the free PDF

Before your appointment, send each doctor a packet with your A-Fib-related medical records. When 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.

Questions to Ask: Use Our Free Worksheet

To help you scrutinize prospective doctors, we’ve written a set of 10 interview questions to help you find the right doctor for your treatment goals. Use our free PDF download, ‘Questions for Doctors Worksheet‘, to interview and question each prospective doctor.

Download the FREE PDF and save to your hard drive. Then, print a worksheet for each doctor you interview. 

During Your “Interview”

Never see a doctor aloneNever go to any doctor appointment alone. Always carry 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 make a recording for you.

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. Afterwards they 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, compare answers and 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.

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

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?

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. “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. To read more about gender bias by doctors, read The Facts About Women with A-Fib: Mother Nature and Gender Bias—Or—Get Thee to an EP ASAP/

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.1 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.

Overview of All of Treatment Options

 Treatmant Option: Catheter Ablation

Illustration: Radio frequency (RF) catheter ablation at A-Fib.com

Illustration: Radio frequency (RF) catheter ablation

A Pulmonary Vein Isolation Ablation PVA/I is the most challenging, demanding and complex catheter ablation an Electrophysiologist performs.

But surprisingly, no specific certification is required. Any EP is allowed to do PVIs. When doing your basic research, make sure the EP has obtained “Clinical Cardiac Electrophysiology” Certification. It’s surprising how many EPs never pass this exam but still do PVIs. Certification in “General Cardiology” or “Internal Medicine” are more basic and not what you’re looking for.

Patients are advised to consider the more experienced EPs in the PVI field. One indicator is the credential “FHRS” after a doctor’s name. A Fellow of the Heart Rhythm Society (FHRS), is an EP certified by the American Board of Internal Medicine (ABIM) in clinical cardiac electrophysiology (CCEP), has letters of support from current FHRS members, and has been vetted by the HRS Membership Committee. Learn about FHRS designations.

According to the Heart Rhythm Society:

“The FHRS designation distinguishes members among health care providers for their specialization in electrophysiology, clarifies the referral process, and serves as a credential for quality care for patients, media and government. FHRS members are characterized by advanced training, certification, and prominence in research.”2

New Article icon - red-heart-negative 75 sq at 96 resSince Pulmonary Vein Ablation (Isolation) is a relatively new procedure, select facilities and doctors who are more experienced with it. For more, see our article, Considering a Catheter Ablation? Know Complication Rates When Choosing Your Doctor.

In this author’s opinion, although certain centers and doctors are more experienced than others, there is no first and second tier of A-Fib doctors. In general, Electrophysiologists performing Pulmonary Vein Ablation (Isolation) are highly trained, experienced and technically gifted. Your chances of being cured by a PVA(I) are very good at most A-Fib medical centers.

Steves List - Doctors by Specialty for Atrial Fibrillation, afib, a fib, A-Fib

EPs & Ablations

 Steve’s Lists: Electrophysiologists Performing Catheter Ablation Procedures

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

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 Treatment Option: Maze or Mini-Maze

Video still of Dr William Harris - Mini-Maze Surgery 150 x 96

Mini-maze surgery

After your consultation, your Electrophysiologist may recommend a Cox Maze or Mini-Maze operation for your A-Fib. Your EP will probably recommend a short list of surgeons. You will conduct the same research for finding the right surgeon as you did for finding the right EP. Unfortunately, we’re not aware of a database that lists A-Fib Surgeons by geographic area, except for the list on A-Fib.com (see Steve’s Lists/Surgeons Performing Cox-Maze and Mini-Maze Operations).

Caution: Any surgeon is allowed to perform a Maze and Mini-Maze operation, but not all have a great deal of experience doing it. There are currently no training courses or certification exams specifically required for Maze and Mini-Maze surgeries. (The same is true to some extent for catheter ablation.)

A study from the Un. of Michigan found that surgical death rates are directly related to experience with the particular operation being performed. You are four times more likely to die if your surgeon performs your operation only rarely, compared to a surgeon who performs it regularly.3 Ask your surgeon or his office how often he performs the Maze and/or Mini Maze. Call other doctors in this field to see how often they perform Mazes. Be cautious about a surgeon who performs Maze operations far less than the average.

If a surgeon specializes in exactly your condition and if 50% or more of his practice relates to your type of A-Fib, they may be a good choice.

It’s hard to establish a specific number that indicates sufficient experience and skill level, but here’s an example that may help, The death rate after pancreas surgery is 14.7% for surgeons who average fewer than two operations a year. It is 4.6% for those who do four or more. A survey done by the New York State Department of Health found that hospitals with surgeons who did relatively few operations had patient-mortality rates that were four times higher than the state average.4

Steves List - Doctors by Specialty for Atrial Fibrillation, afib, a fib, A-Fib

Surgeons & Maze

Steve’s Lists: US Surgeons Performing Maze and Mini-Maze Operations

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.

 Other considerations: Surgeons vs. EPs

You may also want to consider the mind set and attitudes of Surgeons vs. Electrophysiologists.

Keep in mind: a surgeon’s primary concern is in performing a successful operation, whereas EPs have devoted their careers to dealing with heart rhythm problems. The EP’s primary concern is creating a ‘treatment plan’—an organized path to finding your A-Fib cure or best outcome.

In an ideal world, a surgeon would work with and consult with an EP, especially if the surgery didn’t work. But, with certain exceptions, that generally isn’t the case today.

The Hybrid Surgery/Ablation

For more about surgeons and EPs performing procedures together, see our Treatments/Maze/Mini-Maze/Hybrid Procedures page.

You may also want to read: Advantages of the Convergent Procedure by Kiser/Mounsey, and Boston AF 2011/Edgerton “Hybrid Ablation (Combining Surgery with Catheter Ablation) for Persistent A-Fib“.

 Additional Readings

Physician Credentials and Acronyms: What They Mean for Atrial Fibrillation Patients
How to Request Your Medical Records: Instructions and a sample letter (for US patients)
Pre-visit Appointment Worksheet: From American Heart Association (www.heart.org)

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 Return to A-Fib.com Where to Start

Last updated: Tuesday, December 6, 2016

References    (↵ returns to text)

  1. Shannonhouse, R. “Is Your Doctor a Bully?” Bottom Line Health, September 2013, p. 2.
  2. Fellowship in the Heart Rhythm Society (FHRS) Information. Heart Rhythm Society website. Accessed April 8, 2014. URL:http://www.hrsonline.org/Membership/FHRS-Information
  3. Makary, Marty. “7 Things Your Hospital Won’t Tell You (That Could Hurt You)” Bottom Line Personal, Volume 34, Number 2, January 15, 2013. p1.
  4. Makary, Marty 2. “Surprising Dangers in the Hospital.” Bottom Line Health. Volume 27, Number 2. February 2013, p6.

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