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


The Hybrid: Surgery+Catheter Ablation

AF Symposium New Report: Live! Convergent Hybrid Ablation for Atrial Fibrillation

Background: The Convergent Hybrid Ablation is currently used for patients with persistent and longstanding persistent atrial fibrillation.
The Hybrid is performed under general anesthesia. First the surgeon accesses the outside (epicardial) of the heart and creates lesions on the posterior left atrial wall and around the pulmonary veins (PVs). Next, the EP performs a standard PV catheter ablation from inside (endocardial) the heart, uses mapping systems to detect any gaps in the surgical ablation lines, and completes the surgeon’s lesion set, if needed.

Via live streaming video, AF Symposium attendees got to watch a Convergent Hybrid operation/procedure performed from Emory Heart and Vascular Center at Saint Joseph’s Hospital, Atlanta, GA.

PATIENT DESCRIPTION: A DIFFICULT CASE

The patient was a 62-year-old man who had been in A-Fib for 21 years, 10 years of those in persistent A-Fib. He was also very tall. He also complained of being very fatigued.

They didn’t know the amount of fibrosis the patient had developed. They mentioned that they hoped the fibrosis was localized rather than diffuse and that the patient did not have a Utah 4 or a Strawberry-type of large fibrosis area. (About Utah and fibrosis, see High Fibrosis at Greater Risk of Stroke and Precludes Catheter Ablation)

The patient had been on rate control drugs and the antiarrhythmic Sotalol. It was not mentioned if anyone had ever tried a normal catheter ablation on this patient before going to the Convergent operation/procedure.

Phase I: SURGERY ON OUTSIDE OF HEART

In this version of the hybrid, the cardiothoracic surgeon accesses the outside posterior of the heart through the subxiphoid process cutting through the central tendon of the soft tissue of the diaphragm making a 2-3 cm incision.

Important: Read my extensive Editor’s Comments at the end of this report.

The surgeon achieves direct vision of the posterior cardiac structure with a miniature camera (from EnSight by AtriCure). (The xiphoid process is a cartilaginous section at the lower end of the sternum.)… Continue reading my new report from the 2019 AF Symposium->

2019 AF Symposium: Live! Convergent Hybrid Ablation for Atrial Fibrillation

by Steve S. Ryan

Convergent surgical lesions pattern

Background: The Convergent Hybrid Ablation is currently used for patients with persistent and longstanding persistent atrial fibrillation.
The Hybrid is performed under general anesthesia. First the surgeon accesses the outside (epicardial) of the heart and creates lesions on the posterior left atrial wall and around the pulmonary veins (PVs).
Next, the EP performs a standard PV catheter ablation from inside (endocardial) the heart, uses mapping systems to detect any gaps in the surgical ablation lines, and completes the surgeon’s lesion set, if needed.

Live Case from Atlanta: Sequential Endocardial and Epicardial Operation/Procedure

Symposium attendees got to watch a Convergent Hybrid operation/procedure performed Live from Emory Heart and Vascular Center at Saint Joseph’s Hospital, Atlanta, GA. Presenting doctors were cardiothoracic surgeon Dr. Michael Halkos and cardiac electrophysiologists (EPs) Dr. David DeLurgio and Dr. Kevin Makati.

Patient Description: a Difficult Case

The patient was a 62-year-old man who had been in A-Fib for 21 years, 10 years of which were in persistent A-Fib. He was also very tall. He also complained of being very fatigued.

They didn’t know the amount of fibrosis the patient had developed. (One would think someone in A-Fib for such a long time would have developed a significant amount of fibrosis.) They did not measure the patient’s amount or type of fibrosis. They mentioned that they hoped the fibrosis was localized rather than diffuse and that the patient did not have a Utah 4 or a Strawberry-type large fibrosis area. (About Utah and fibrosis, see High Fibrosis at Greater Risk of Stroke and Precludes Catheter Ablation)

The patient had been on rate control drugs and the antiarrhythmic Sotalol. It was not mentioned if anyone had ever tried a normal catheter ablation on this patient before going to the Convergent operation/procedure.

Surgery on Outside of Heart

In this version of the hybrid, the cardiothoracic surgeon accesses the outside posterior of the heart through the subxiphoid process cutting through the central tendon of the soft tissue of the diaphragm making a 2-3 cm incision. The surgeon achieves direct vision of the posterior cardiac structure with a miniature camera (from EnSight by AtriCure). (The xiphoid process is a cartilaginous section at the lower end of the sternum.)

Size comparison: Atricure EPI-Sense device size vs. ablation catheter

Convergent Catheter vs. PVI Ablation Catheter: The catheter used to make the burns in the Convergent operation is unlike a standard point-by-point RF catheter with force sensing.

The Atricure EPi-Sense Guided Coagulation System with VisiTrax® technology: How it works.

Instead it is a long linear catheter with multiple RF coils on its side which is placed horizontally to make long, large burns on the heart.(AtriCure EPi Sense Coagulation Device).

The burns are normally 90 seconds long at 30 watts. This catheter can also be used for pacing, sensing, and to produce electrograms. Impedance drops (10%) are used to verify lesion effectiveness. The catheter has a notch on the top which can be used to orient the catheter.

Phase I: Live Surgical Operation

When starting, the Symposium audience watched as the surgeon, Dr. Michael Halkos, accessed the outside of the heart through the diaphram. Then he identified the left inferior and right inferior PVs.

Illustration of surgical lesions to outside of heart

Using these benchmark structures, he then started to ablate the whole of the posterior left atrium including any other areas of the posterior left atrium he could access.

The burns can overlap and can be repeated. (We only saw them make 2 burns, but usually 20 to 40 burns are made.)

We also saw the surgeon use a suction catheter to remove any blood and liquid from the area being worked on. Note: The pericardium sac is filled with saline to help prevent damage to the esophagus.

Phase II: EP Procedure

Because of time constraints, we didn’t get to see Dr. David DeLurgio, the cardiac electrophysiologist (EP) work on this patient after he was wheeled into the EP lab.

Dr. DeLurgio was scheduled after the surgery phase to later perform a PVI ablation and ablate the right atrium Cavo-tricuspid Isthmus (CTI) to prevent Flutter.

His tasks would also include using mapping technology to check the surgeon’s lesions and fill in any gaps.

Editor’s Comments
Who should consider a Hybrid Ablation for Atrial Fibrillation? Patients with persistent and/or longstanding persistent atrial fibrillation. Specifically, the Hybrid Surgery/Ablation might be an effective option for:
  • highly symptomatic patients with persistent atrial fibrillation and longstanding persistent atrial fibrillation who have failed one or two catheter ablations,
  • for someone with a significantly enlarged left atrium, or
  • for someone who is morbidly obese (making it difficult to create imaging maps necessary for catheter ablations).
This 62-year-old Patient:  It was not mentioned if anyone had ever tried a normal catheter ablation on this patient before going to the Convergent operation/procedure.
I hope for this 62-year-old male patient that he was treated first with a less invasive PV catheter ablation (or two). If the ablation(s) failed, only then would his doctors recommende the much more invasive and riskier convergent surgery.
This was a “sequential” Hybrid approach. There is also a “non-synchronous” or two-staged version where the surgeon and the EP work on the same patient but at different times and/or places.
“Minimally invasive”: Though called “minimally invasive,” the Convergent operation is still major heart surgery. It’s invasive, traumatic, complicated, requires considerable surgical skills and experience, and is potentially risky.
My Bias: Please be advised that I am personally biased against the Convergent Hybrid operation/procedure. Whenever I see it, I get nauseous and sick to my stomach watching them burn the whole of the posterior left atrium wall. To me this is overkill.
The outside posterior left atrium is turned into dead, fibrotic tissue. There is no more blood flow, transport and contraction function no longer work, nerve transmission is destroyed, normal heart muscle fibers turn into non-contracting scar tissue. The ability of the left atrium to contract risks being hindered.
The surgeon does tremendous damage to the outside posterior left atrium which can never be restored. This may weaken the heart and contribute later to heart problems like congestive heart failure.
I can’t imagine having my outside posterior left atrium wall destroyed like that. All too many patients today suffer from weak hearts due to heart muscle damage.
Difference between Surgeons and EPs: Cardiac Electrophysiologists (EPs) do often ablate in the inside posterior left atrium such as by creating a box lesion set. But they try to do as little permanent damage to the heart as possible.
Similar ablation techniques are called ‘hybrid ablation technique’, ‘convergence process’, ‘Convergent Maze Procedure’ and ‘Convergent Ablation”’
.
Whereas surgeons in the Convergent operation try to do as much damage as possible. Their goal is durable posterior wall isolation.
My concern: Is it really necessary to completely obliterate the outside left atrium posterior wall to make a patient A-Fib free? Perhaps. In some patients this may indeed be necessary. But is this necessary in every patient having a convergent operation?

For more about the Hybrid approach, see my article: Advantages of the Convergent Procedure and the VIDEO: The Hybrid Maze/Ablation for Atrial Fibrillation for Persistent A-Fib Includes animation and on-camera interviews. Published by Tenet Heart & Vascular Network. Length 4:30

If you find any errors on this page, email us. Y Last updated: Thursday, August 27, 2020

Return to 2019 AF Symposium Reports

NEW VIDEO: The Hybrid Maze/Ablation for Persistent A-Fib

We’ve posted a new video about the Hybrid Maze/Ablation.

Video animation frame: Surgeon placing lesions on outside of heart at A-Fib.com

Animation frame: Surgeon placing lesions on outside of heart

For persistent or long-standing persistent atrial fibrillation, it combines the complementary efforts of both the cardiothoracic surgeon and the cardiac electrophysiologist.

The surgeon works on the outside the heart and the EP on the inside of the heart to eliminate the Atrial Fibrillation signals.

In this video, two cardiac EPs and a cardiothoracic surgeon describe the advantages, safety and effectiveness of the Hybrid approach and who is a good candidate. Includes animation and on-camera interviews.  Length 4:30.  Go to video->

VIDEO: The Hybrid Maze/Ablation for Atrial Fibrillation for Persistent A-Fib

For persistent or long-standing persistent atrial fibrillation, the Hybrid Maze/Ablation (also called the Hybrid Convergent Procedure) combines the complementary efforts of both the cardiothoracic surgeon and the cardiac electrophysiologist. The surgeon works on the outside the heart and the EP on the inside of the heart to eliminate the Atrial Fibrillation signals.

In this video, two cardiac EPs and a cardiothoracic surgeon describe the advantages, safety and effectiveness of the Hybrid approach and who is a good candidate. Includes animation and on-camera interviews.

Published by Tenet Heart & Vascular Network. Length 4:30. 

YouTube video playback controls: When watching this video, you have several playback options. The following controls are located in the lower right portion of the frame: Turn on closed captions, Settings (speed/quality), Watch on YouTube website, and Enlarge video to full frame. Click an icon to select.

If you find any errors on this page, email us. Y Last updated: Tuesday, July 17, 2018

Return to Instructional A-Fib Videos and Animations

Hybrid Surgery/Ablation Procedure: An Introduction with Dr. Robert Joy

Dr. Robert Joy gives a short overview of the hybrid procedure to treatment for Atrial Fibrillation in which a cardiothoracic surgeon and an electrophysiologist work together in a single procedure; How it opens up a new opportunity for A-Fib patients with difficult cases of Atrial Fibrillation (1:26 min.) Published by Ellis Medicine, 2012. Dr. Robert Joy is an an Interventional Cardiologist with Ellis Medicine.

YouTube video playback controls: When watching this video, you have several playback options. The following controls are located in the lower right portion of the frame: Turn on closed captions, Settings (speed/quality), Watch on YouTube website, and Enlarge video to full frame. Click an icon to select.

Note: The genius of the Hybrid approach seems to be its complementary nature: the surgeon works on the outside the heart and the EP on the inside of the heart to eliminate the Atrial Fibrillation signals.

If you find any errors on this page, email us. Y Last updated: Thursday, January 18, 2018

Return to Instructional A-Fib Videos and Animations

My Top 5 Articles: Surgical Treatment Options for Atrial Fibrillation

When drug therapies fail or if not a candidate for catheter ablation, patients look to surgical treatments to reduce the risk of stroke, to ease symptoms or to cure their Atrial Fibrillation.

Here are my top 5 articles about the Maze & Mini-maze surgeries and role of the left atrial appendage:

  1. The Cox-Maze & Mini-Maze Surgeries and the Hybrid Surgery/Ablation
  2. Advantages of the Convergent (Hybrid) Procedure
  3. Considering a Mini-Maze? Don’t Destroy the Ganglionic Plexus
  4. The Role of the Left Atrial Appendage (LAA) & Removal Issues
  5. The Watchman™ Device: The Alternative to Blood Thinners

BONUS VIDEO
Mini-Maze Surgery with Cardiac Surgeon Dr. Dipin Gupta

See our library of videos about Atrial Fibrillation

Cardiothoracic surgeon Dipin Gupta, MD, discusses this surgical treatment for persistent atrial fibrillation. The Mini-Maze is done without open-heart surgery and using a small incision on the side of the chest. Published by MedStar and Cleveland Clinic. March, 2015 (4:35) Go to video->

Helping Doctors Understand A-Fib from the Patients’ Point-of-View

ssr-lake-zurich-400-x-300-pix-at-96-res

Steve Ryan in Zurich, Switzerland

Have you ever wished you could give your doctors an episode of Atrial Fibrillation, just so they would understand what you are going through? That’s what I did in Zurich last week (well, sort of).

I’m back from Zurich, Switzerland, where I was the only patient speaking at the 2-day 2016 Multidisciplinary Arrhythmia Meeting (MAM), a gathering of cardiologists and surgeons from leading institutions in Europe, the US and Asia who treat Atrial Fibrillation.

The Patient’s Point of View

After dinner on the first night, I spoke to a room of 200+ cardiac electrophysiologists (EPs) and surgeons. I was there to help them better understand A-Fib from the patient’s point of view. I focused on the psychological and emotional impact of A-Fib on patients―how the anxiety, fear and stress of the disease can be as bad (or worse) as the physical symptoms.

My Wish: Let Doctors Experience A-Fib for 60-Seconds

I shared my own journey with A-Fib and described my own stress, fear and frustration; then how I did extensive research and found my cure in Bordeaux by a catheter ablation (one of my Bordeaux doctors, Dr. Dipen Shah, was in the audience).

With Dr. Stefano Benussi, my host in Zurich

With Dr. Stefano Benussi, my host in Zurich

I next shared my wish that each of them could experience an episode of A-Fib for just 60-seconds―it would change their perspective of A-Fib forever. They wouldn’t soon forget the fear (am I going to die?) and anxiety (God, please stop this!).

My Challenge: Be a Resource for Your Patients

Then, I challenged them to go beyond the physical symptoms and help patients deal with their anxiety and fear. Knowledge is empowering so I recommended they personally check out and be ready to recommend at least two books and 2 websites about Atrial Fibrillation. In addition, I suggested they vet at least three psychiatrists who understand A-Fib and who could help patients in need of counseling and medication to address their anxiety.

Being Back in Normal Sinus Rhythm: Life Changing

And finally, I thanked them, on behalf of all the patients they have made A-Fib-free. There are few medical procedures as transformative and life changing as going from A-Fib to Normal Sinus Rhythm. For me, it was getting my life back.

I think I really made an impression. I don’t think anyone had ever talked to these doctors like that before. I hope my efforts will trickle down to helping others with A-Fib.

MAM 2016 300 x 100 pix at 96 resMultidisciplinary Arrhythmia Meeting 2016

The goal of MAM was to improve interaction between cardiac electrophysiologists (EPs) and surgeons who treat difficult A-Fib cases through a new Hybrid approach. Both a surgeon and an EP work together, one from inside the heart, the other from outside the heart. (Note: In the past, it’s been a rare occurrence for a surgeon to work with a cardiac electrophysiologist.) To learn more about the hybrid approach, see THE HYBRID SURGERY/ABLATION.

I want to thank my host, Dr. Stefano Benussi, University Hospital, Zurich, Switzerland, for his personal invitation to attend and speak at MAM 2016.

Look For My Reports

I’ll soon be writing reports on the key presentations. Just look for 2016 MAM.

Hybrid Surgery/Ablation Topic of the Multidisciplinary Arrhythmia Meeting (MAM)

Background: The Hybrid approach is an unusual team effort and is complementary in nature: the Surgeon works on the outside of the patient’s heart and the Electrophysiologist on the inside of the same patient’s heart.
Hybrid Surgery/Ablation is becoming an increasingly important and effective strategy for highly symptomatic patients with persistent atrial fibrillation or longstanding persistent atrial fibrillation who have failed one or two catheter ablations, and for the patient with a significantly enlarged left atrium. (Read more: Hybrid Surgery/Ablation.)

Multidisciplinary Arrhythmia Meeting (MAM)

Multidisciplinary Arrhythmia Meeting (MAM) GFXThe goal of MAM is to improve interaction between cardiologists and surgeons through multiple examples of cooperation in dealing with Atrial Fibrillation. [Note: In the past, it’s been a rare occurrence for a surgeon to work with a cardiac electrophysiologist.]

Zurich stamp GFX

Reporting for A-Fib.com

Cardiologists and surgeons from leading institutions in Europe, the US and Asia will discuss their experiences with hybrid simultaneous, hybrid stages, and multidisciplinary sequential approaches, and report their results.

Reporting from Zurich in September: I’ve been invited to attend this first Multidisciplinary Arrhythmia Meeting (MAM) by the organizers. I’ll be reporting on the key presentations and writing summary reports for our A-Fib.com readers.

US Centers Performing the Hybrid Surgery/Ablation – a List from A-Fib.com

Steves List logo 200 pix at 96 resUS Centers performing the Hybrid Surgery/Ablation Procedure

There are very few centers offering the Hybrid Surgery/Ablation approach because it’s relatively new, and because it’s extremely rare to have the tremendous expertise necessary in both catheter ablation and surgical A-Fib ablation at the same institution.

Note: Similar multidisciplinary ablation techniques are called ‘hybrid ablation technique’, ‘convergence process’, ‘Convergent Maze Procedure’ and ‘Convergent Ablation”’.

HOW TO FIND CONTACT INFO

Return to Steve’s Lists of A-Fib Doctors by Specialty

Medical Center City/State/PhoneNotes
Allegheny General Hospital’s Cardiovascular Institute Pittsburgh, PA 877-97HEARTInformational link
Arrhythmia Center of Florida/FDM PLC/Interventional Cardiac ConsultantsHudson, FL (727) 819-2338Informational Link
Aurora St. Luke’s Heart and Vascular InstituteMilwaukee, WI (888) 649-6892Informational link
Bridgeport Hospital’s Connecticut Cardiac Arrhythmia CenterBridgeport, CT (203) 384-3000Informational link
Banner Good Samaritan Medical Center/Cavanaugh Heart CenterPhoenix, AZ
(602) 839-7393
Informational link
Danbury Hospital/Western Connecticut Health NetworkDanbury, CT
(203) 739-7000
Informational link
Doylestown Cardiology Assoc.Doylestown, PA
(267) 253-8938
Informational link
East Jefferson General HospitalMetaire, LA 70006 (504) 503-5000Informational Link
Ellis Medicine/Medical Center of Clifton ParkSchenectady, NY (518) 831-8840Informational link
Florida Institute for Atrial FibrillationPalm Beach Gardens, FL (561) 630-8570 Informational Link
Georgia Regents University/Medical College of GeorgiaAugusta, GA
(706) 721-2426
Informational link
Mount Sinai Medical Center/Columbia Un. Division of CardiologyMiami Beach, FL (305) 405-0455Informational Link
Pinellas Arrhythmia AssociatesClearwater, FL (727) 587-6999Informational Link
Sarasota Memorial HospitalSarasota, FL
(941) 917-8791
Informational Link
Stanford Cardiac Surgery/Salinas Valley Medical CenterSalinas, CA
(831) 759-3289
Informational Link
Stanford Hospital & ClinicsPalo Alto, CA (650) 723-5771Informational link
St. Joseph’s Hospital/Advanced Center for Atrial Fibrillation/Bay Heart GroupTampa, FL (813) 877-2342 (AFIB)Informational Link
Tampa Cardiac SpecialistsTampa, FL (813) 229-9292Informational link
TriStar Centennial Heart & Vascular CenterNashville, TN (800) 242-5662Informational link
UNC Health Care System, Cardiac Surgery & Electrophysiology ServicesChapel Hill, NC (866) 862-4327Informational link
The University of Chicago Medical CenterChicago, IL (888) 824-0200Informational link
Vanderbilt University Medical Center Nashville, TN (615) 322-5000Informational link
Washington University & Barnes-Jewish Hospital/Heart & Vascular Center St. Louis, MO (866) 534-8403Informational link
Virginia Cardiovascular Specialists, The Heart Rhythm CenterRichmond, VA (804) 521-5800Informational link
HCA, Cardiothoracic Surgical AssociatesRichmond, VA 804-282-8777, 804-297-0822Informational link

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Return to Steve’s Lists of A-Fib Doctors by Specialty

HOW TO FIND CONTACT INFO: Use the “Search our site” box (upper right on this page) to get to the right Directory page. Then, open your browser’s ‘Find on Page’ feature (‘CTRL+F’) to locate the name on the page.

NOTICE: We offer no preferential listings. We accept no fee, benefit or value of any kind for listing a specific doctor or medical center. A-Fib.com is not affiliated with any practice, medical center or physician.

Disclaimer: this directory is provided for your convenience only.  We make no endorsement of a specific physician or medical facility. Choosing a physician is an important decision and should be based upon your own investigation of each physician’s training, education and experience. This directory offers you the opportunity to locate and contact a healthcare professional directly.

A-Fib.com—your independent source of unbiased information about Atrial Fibrillation, research and treatment options.

Last updated: Sunday, March 18, 2018

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

Footnote Citations    (↵ 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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