locating a good EP dr.

[jennyfi1234]

Hi everyone. I had my visit with the EP today. He said since I am having such a high number of pvcs (4,000) a day, I should have the ablation. I was confused because I thought 4,000 was not too high? He mentioned that if you have a lot like I have, it can lead to cardiomyapathy. The other thing is, I asked how many he has done, and he said "tons" I said I need a number. He said "we here have done up to 500". That does not sound like a lot to me, especially since a friend on here said less than 1500 is not enough. I live in a small town, and am cursious how to find a good reputable dr. should I eventually have the procedure. Thanks

[jennyfi1234]

Thank you all for the great information. Cindy707 thank you so much for all that information! The first thing I told my husband was "good thing Cindy gave me all that information!" I could have thought 500 was a lot of experience--so thank you. Also for the contacts to try and locate a good dr.

[Mom2four85]

You know there are so many conflicting research & reports about how many is "too many" pvc's it's just frustrating as a patient to me; many doctors differ - my EP told me anything between 6,000-8,000 pvcs they treat with meds and they typically treat anything above 15% - 20% of your normal 24 hr HB with surgery.

Even with some crazy 50,000 pvc's; which was about 40% of my 24hr total;  I did not want to have surgery - to me that was a last resort thing and I didn't believe I was as sick as they said or would develop cardiomyopathy.  I waited and researched and got 2nd & 3rd opinions and still was reluctant to have surgery.  1 year later I am back to a "ton" of pvc's and not sure I would have another ablation any time soon.

http://emedicine.medscape.com/article/761148-followup quite a few months ago they came out with this followup research - Premature Ventricular Contraction: Follow-up Updated: Mar 11, 2010 Look under Prognosis - 1st paragraph

"In asymptomatic patients without underlying heart disease, the long-term prognosis is similar to that of the general population. Asymptomatic patients with ejection fractions greater than 40% have a 3.5% incidence of sustained ventricular tachycardia or cardiac arrest. Therefore, in patients with absence of heart disease on noninvasive workup, reassurance is appropriate.

"One caveat to this is that emerging data suggest that very frequent ventricular ectopy (>4000/24 h) may be associated with the development of cardiomyopathy related to abnormal electrical activation of the heart. This mechanism is thought to be similar to that of chronic right ventricular pacing associated cardiomyopathy" which is contradictory to everything I've read for over a year and researched on pvc's and cardiomyopathy

For my peace of mind, I would get a 2nd & 3rd opinion if necessary if you're not having any other symptoms and have done everything you can to control your outside sources for the cause of pvc's stress, enviroment diet etc.  

An EP study is still surgery and there are risks involved and I don't know if I would feel comfortable having a surgeon who has only done 500 ep studies, but that's just my personal opinion. Luckily for me, I had a wonderful EP who was ready for anything and saved my life during the procedure.

[candi65]

Hi Jenny. I too live in a small town. I traveled by car for 6 hours to my EP/Cardi to have my ablation done for pvc's. I am 4 months out from the abaltion and feeling SOOO much better. I would really  search out the best Cardiologist for your procedure. Remember that experience counts when the going gets tough. Not only for you but also if a problem arises during the ablation. An experienced(more than 500 or "tons") Cardi and support team make a big difference in your aftercare as well. Best of luck.

[Jerry_NJ]

Experience is very important, and successful experience is even better.  

I can't get my Cardio/EP to agree to try an Ablation on my AFib, but I can say 500 ablations doesn't sound inexperienced to me - question remains how many surgeons are included in the "we".  

I had open heart surgery a couple of years back and was looking for a surgeon with a good reputation and settled on in a smaller hospital in Doylstown, Pennsylvanian (about 30 miles form my home) for several reasons.  I felt he was qualified when I was told he does heart surgery several times a week, some is bypass, not my issue, but about half were valve repair.  I was also impressed with him on my interview for his advice on surgery.  I had no complications and the valve repair is still working - but the mini-maze he did was not effective in stopping AFib.  Would I have done better at one of the major hospitals with a more experienced surgeon (say Cleveland Clinic)... maybe, I don't know.  The mini-maze is not a 100% deal anywhere, and I have an enlarged atrium to complicate the situation.  Still I went with a younger doctor (suppose late 40s, early 50s) who had a great resume and had been a surgeon in large hospitals before coming back "home" to take over as director of the Heart Institute in a smaller "local" hospital.

I would accept a surgeon who has done a procedure 500 times, if that means at least a "few" a week (more than one) for the last few years.   I think I might be concerned about a doctor who does several a day (5 days a week) as being one who may be too "automatic", or one who has done 1000, but it was this was accomplished over a 20 year period.  I like the steady hand of a younger doctor... robotic assist not considered, I understand the robotic tool can be set to filter out jitter.

[ireneo]

4,000 a day is about 2 - 3 a minute. That's a few (I run 1-5 a minute) and I'm sure they're noticeable. I've heard that amount is not outrageous either, not enough to cause problems anyway. Then again, I'm not an EP cardio.

500 ablations is not "tons" either. And did he say "we" have done up to 500 or "he" has done up to 500? It would be nice to know exactly how many he's done: mapped and decided where to ablate. It never hurts to ask questions.