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



Questions for Doctors

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.

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

 

7 Questions You’ve Got to Ask When Selecting a New Doctor

A-Fib.com Questions for Doctors Mockup

Download Our ‘7 Questions for Doctors Worksheet’

To help you scrutinize prospective doctors, we’ve written a set of 7 interview questions (8 questions if you’re a female). The questions help you find the right doctor for your treatment goals.

Use our 7 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.) 

After Your Interviews

Back home, compare answers and your notes about each doctor. To ‘interpret’ the doctors’ answers, see our article, “Choosing the Right Doctor: 7 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 binder for future reference (you might want a second opinion).

Never go to any doctor appointment alone. Always carry a notepad and pen to take lots of notes.

Choosing the Right Doctor: Questions You’ve Got to Ask (And What the Answers Mean)

red-heart-negative 150 pix by 96 resThis list of questions (+1 if you are female) is designed to solicit information to help you select the best doctor for you and your type of A-Fib. After each question, we’ve included typical doctor responses and an analysis of what those responses may mean to you.

1. What treatments do you recommend for dealing with or curing my type of A-Fib?

If the doctor only talks about different medications, you should probably talk to other doctors on your list. Overall, Drug Therapies have poor success rates, and don’t address the progressive nature of Atrial Fibrillation. Today, the best A-Fib treatments are with Catheter Ablation.

2. Do you perform Catheter Ablation procedures for my type of A-Fib? What type of procedures do you use, or prefer?

Response #1:    “I only work or prefer to work in the right atrium.” Or, “I will eliminate the Atrial Flutter in your right atrium first.”

These responses indicate a doctor may not have the experience or be comfortable working in the left atrium. Though it’s more difficult to work in the left atrium, most A-Fib comes from the left atrium pulmonary veins. You may have Atrial Flutter in your right atrium along with your A-Fib, but it may well be triggered by the A-Fib coming from your left atrium.23 You should probably talk to other doctors on your list.

Response #2:    “We recommend catheter ablation of the AV node and implanting a permanent pacemaker.”

Though this used to be one of the most common treatments for A-Fib, you don’t want to be burdened with a permanent pacemaker for the rest of your life when there are better options available.

Also, this procedure leaves you in A-Fib and dependent on medication for the rest of your life. Unless you have a Sinus Node problem and need a pacemaker, you should probably talk to other doctors on your list.

Response #3:    “We use Circumferential Ablation to eliminate A-Fib.” Or “Segmental Ablation… .” Or “Anatomically-Based Circumferential Ablation….” Or “Pulmonary Vein Antrum Isolation… .”

Circumferential, Segmental, Anatomically-Based Circumferential (also referred to as Left Atrial Ablation or the Pappone technique) and Pulmonary Vein Antrum Isolation (PVAI) are refinements or different Pulmonary Vein Ablation procedure strategies. All offer you a good chance of being cured of your A-Fib.

Circumferential is the most used technique.

Response #4:    “We use a special catheter sensor to pinpoint ectopic beats coming from areas of the heart, mostly from the Pulmonary Veins in the left atrium. We then ablate these areas.”

(Ectopic beats come from any region of the heart that ordinarily should not produce heart beat signals, such as the pulmonary veins).

This response indicates the doctor and/or medical center is targeting (focusing on) specific spots generating the A-Fib signals. This technique is called Focal Catheter Ablation which was the first technique developed to ablate A-Fib.

However, most centers today use either Circumferential or Segmental techniques to ablate or isolate the entire area around the openings of all four Pulmonary Veins. If the A-Fib signals persist, they will proceed to target and abate the specific source of the ectopic beats.

Response #5:    “Besides RF catheters, we also use the CryoBalloon Catheter to isolate the Pulmonary Veins.”

The CryoBalloon Catheter for A-Fib Ablation (FDA-approved technology in December, 2010), it has proven effective, safer, and faster than the various types of RF ablation.

But it is a relatively new method of ablation without a long-term track record of extensive data validating its effectiveness. However, anyone using the CryoBalloon Catheter is probably innovative, knowledgeable, and experienced in A-Fib ablation.

3. What is your success rate for my type of A-Fib? How do you define ‘success’?

Is the patient free of A-Fib and free from drug therapy? Or free of A-Fib but still on medications?”

Major centers with a lot of experience have a success rate of around 70-85% for Paroxysmal (occasional) A-Fib, with a higher success rate if a second ablation is necessary.

If their success rate is 50% or less, you should probably look elsewhere.

4. How long have you been performing catheter ablations for my type of A-Fib?

· How experienced are you with RF and/or Cryo?

· How many procedures do you perform a year?

It’s hard to quantify experience with specific numbers. When doctors say they have done a total of 20 Pulmonary Vein Ablations, they are probably still in their “training” stage or have just passed their certification.

At a minimum, electrophysiologists should perform 100 procedures a year. Therefore, if a doctor only does a few PVAs a month, this may not be enough to maintain or develop ablation skills.

There are many electrophysiologists and several medical centers that have been doing Pulmonary Vein Ablations for years and have done hundreds (or thousands) of Pulmonary Vein Ablations.

5. What kind of complications have you had after ablations?

Every A-Fib doctor has had some complications when doing Pulmonary Vein Ablation procedures. A PVA is a low risk procedure, but it is not risk free. Possible complications include blood clots and stroke, PV Stenosis (post-op swelling of pulmonary vein openings which can restrict blood flow and lead to fatigue, flu-like symptoms, and pneumonia), Cardiac Tamponade (pooling of fluid around the heart that can cause a drop in blood pressure) and Phrenic Nerve Paralysis (related to the diaphragm, and usually temporary).

Doctors and their office staff are usually very open about the complications they have had and can usually give you statistics. If they are not, you may want to look elsewhere for your doctor.

6. “What techniques or technologies do you use to increase the safety and effectiveness of your procedures? For example, how do you protect the esophagus?”

A doctor’s use of technology may improve their effectiveness compared to other doctors or medical centers. Examples: Using an imaging system that gives 3-D images of the inside of the heart, of the position of the esophagus, and of catheter placement and pressure; Using an energy source like the CryoBalloon catheter system to produce circular lesions around the pulmonary veins; Using magnetic or robotic arms that aid in more precise placements of lesions or ablations.

Damage to the esophagus during an ablation (called Atrial Esophageal Fistula) is a very rare complication (less than 1 in 1000+), but is often fatal. Heat from the RF catheter damages the esophagus which lies just behind the heart; over the next 2-3 weeks gastric acids can eat through the weakened area. Most doctors and medical centers take precautions to avoid this damage including prescribing Proton Pump Inhibitors to prevent gastric acid damage.

When you ask how the doctor protects the esophagus, you should hear answers like:

Response 1:     “We use low power at the back of the heart.”

Response 2:      “We use a temperature probe in the esophagus to make sure it doesn’t get too hot.”

Response 3:      “We use barium paste in the esophagus so that we can see where it is when we make ablations and don’t make ablations near the esophagus.”

Response 4:      “We give Proton Pump Inhibitors like Nexium for 2-3 weeks after an ablation to protect the esophagus.”

If you don’t get answers like these, especially about taking Proton Pump Inhibitors after an ablation, it might be wise to talk with other doctors.

7. Do you ever refer your patients for Maze or Mini-Maze surgery?

Some A-Fib patients might be better served by a Maze or Mini-Maze surgery. For example, someone who needs heart surgery for another problem might well combine that surgery with a Maze operation. Someone who can’t tolerate Warfarin (brand names Coumadin and Jantoven) or other blood thinners might be better served by a Mini-Maze surgery. Most Mini-Maze surgeries are the result of referrals by electrophysiologists.

If a doctor doesn’t normally refer patients for Maze surgeries, this isn’t necessarily a reason for rejection. They may be concerned about a loss of quality control if they send patients to someone who’s not a specialist in heart rhythm problems.

8. (For female patients) What is the extent of your training specifically related to women’s heart health?

Women tend to have different symptoms of heart disease than men, in part because their bodies respond differently to risk factors such as high blood pressure. Cardiologists who specialize in women are more common than ever. Medical centers now have clinics devoted to women’s heart health. Women with A-Fib may want to seek out a specialist who is up-to-date in this field of research.

Back to the top

Back to Finding the Right Doctor For You and Your A-Fib

Last updated: Thursday, December 8, 2016

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.

Back to top

 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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