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Finding an electrophysiologist

How do I find a heart rhythm doctor?

There are several ways to find a heart rhythm doctor. The first would be to ask your primary care doctor or, if you have one, your cardiologist. Secondly, the Heart Rhythm Society can be contacted on-line to give you names of doctors in your area using this link, and enter “any” when asked for specialty. Not all of these doctors will necessarily be experts in ablation, but they all should be experts in arrhythmia management. Thirdly, talk to your friends – they may have seen an electrophysiologist and can tell you first hand about them. Lastly, you could call large hospitals or medical schools in your area and ask whether any electrophysiologists are on staff.

How do I find a doctor experienced in ablation?

This will require you to ask the doctor some questions. Some patients find this difficult to do. However, an ablation is a potentially-serious procedure for you to undergo, and you should ask as many questions as you have until you feel comfortable with understanding about the procedure and the doctor’s qualifications for performing it. Here are some questions to consider asking your doctor:

  1. Are you board certified in clinical cardiac electrophysiology? (a no would mean you should at least think about a second opinion)
  2. How many years have you been performing ablation? (doctors right out of training may not be as experienced, doctors out of training 30 years were trained before ablation was invented)
  3. How many ablations approximately have you performed since training ended? (these will be ablations where the doctor had to do all of it themselves without supervision – 500 or more would be reassuring)
  4. Do you regularly (e.g. at least monthly) or have you ever performed my kind of ablation procedure? If not why not? (some rare ablations are rare, but sometimes there are doctors in other locales with much more experience in these rare cases)
  5. Do you have advanced tools in case my ablation is complicated e.g. 3D mapping systems (Carto or ESI) and a cryoablation system? (a fully equipped facility is important!) If not, are you sure you will not need those tools?
  6. What sort of success have you had with my type of ablation procedure? (most doctors can give you a ball park idea, but few can give actual numbers)
  7. What chance of success would you estimate for my procedure? (most ablations in the top part of the heart have at least a 90% chance of success except for atrial fibrillation, which has about a 75% success rate. If you are quoted a lesser success rate, then ask why)
  8. What are the risks of my ablation procedure? (ablations in the right atrium, right ventricle or left atrium not for atrial fibrillation 1%, left atrium for atrial fibrillation 3-5%, left ventricle 1-2%: if quoted risks are higher ask why?)
  9. What is the risk that after the ablation, the problem will recur? (the doctor should give you some estimate before the ablation and a more accurate estimate after the ablation. Typical recurrence rates are as follows
    1. WPW < 5%
    2. SVT 2-10%
    3. Idiopathic VT < 10%
    4. Ischemic VT 5-20%
    5. Atrial Fibrillation 20-40%
    6. Atrial Flutter 5%
    If quoted risk is different, find out why?
  10. Will I be put out (general anesthesia) and if so, will either a CRNA (certified registered nurse anesthetist) or anesthesiologist (an MD or DO) do that part of things? (the electrophysiologist doing the ablation needs to be free to concentrate on the ablation).

Doctors should not be defensive about answering these questions. If they are, find another doctor – this is about your life, not their ego. Some doctors could ask one of their patients who has had your type of ablation to contact you to tell you what it was like.