Questions to ask an EP

[Stay_Frosty]

Is it wrong to ask an EP how many people he/she has killed? There's a vague statistic online that 1/1000 die during an EP study. So for the EPs who have done many thousands of these, it would seem almost normal that they killed at least a few patients. I would be afraid to ask, because it would send my anxiety through the roof. Maybe I should just stick with "how many of these procedures have you done"...

It's so tough for me to say yes to the procedure because my heart is 99% NSR. It's super rare for me to even have a PVC as proven by 3 months of holter monitoring. I get more PACs than I do PVCs, but even those are fairly minimal.Yet 3 weeks ago BAM I get a tightly grouped set of NSVT that went like this:

At rest, sitting down, working in a computer lab while on business travel:

3 beats of vtach, 2 beats normal, 10 beats of vtach, 3 beats normal, 8 beats of vtach, back to normal. All of this in a 10 second window.

No doctor can answer why. Only test left to do at this point is an EP study.

[Stay_Frosty]

I already saw an EP before this when I had 7 beats of NSVT during sleep. All he told me was "this can lead to passing out or worse..." So of course I leave there thinking I'm going to die.

He didn't give me any reassurance like this forum does that NSVT in a healthy heart is usually benign. He just jumped straight to "you need an EP study".

He also misdiagnosed SVT based on one holter recording at 185 bpm. I told him I was riding my bike and really pushing myself at 110%, but it didn't seem to register with him. Same deal with my cardiologist. He jumped right to "this is SVT" because of the high heart rate. Hello! I purposely pushed myself to get some stress testing onto the holter. This is my high intensity exercise heart rate, not SVT.

Same cardiologist also refused me an MRI because he didn't want me to get all of the radiation. What radiation??? It's an MRI! Is this guy a real doctor or does he just play one on TV?

My new cardiologist is much smarter. But again, not much reassurance. When he saw my latest NSVT episode (outlined in the original post), he jumped right to the scary questions: "Any family history of sudden cardiac death? Are you sure you never passed out?" etc... I know he's being cautious but it's still scary to be asked those questions.

He referred me to a new EP who is supposed to be one of the best in the area, so we'll see what he recommends. I'm sure it'll be the same thing. "You need an EP study."

Again, it's tough. If I had thousands of PVCs a day coupled with NSVT then yeah, I'd jump into an EP study in a second. But when you only average 0-3 PVCs in a 48 hour period, and a very infrequent but very panic inducing NSVT, what do you do? Live with it and hope you don't die? Get an EP study for further reassurance?

Can anything else cause NSVT other than a purely electrical problem? What if I had a hiatal hernia that was pushing up against the heart or vagus nerve? Could that do it? Can something be going into spasm in there and setting it off?

I do get these nasty vague sensations in my chest and throat that come on in waves. If it's a digestive thing, it's unlike any digestive thing that I've felt in the past. Trapped air maybe? I don't know... I feel very unstable when it happens, as if I'm prone to a nasty heart rhythm, but my holter monitor has always shown NSR during these episodes...

[tom_h]

I must be a little more direct.  Of course I asked him!  He has my life literally in his hands.  I asked hime how studies he performe, and what was his mortality record.  I asked his of two EP's before selecting.  Both had excellent records, and deep experience in the field.  But I chose the one who had a confidence about him.  He had lost one patient ouf of approximately 2300 patients.  The death had extenuating circumstances as the patient had extensive heart failure present.

I had 54 years of SVT before I had mine done.  If you feel it has reached a point where in interferes with your lifestyle, I would recommend it to you.

[DeltaDawn23]

I certainly would not ask the question worded that way.  I agree with achillea that most doctors don't go into medicine to cause problems.  "How many patients have you killed is kind of a "have you stopped beating your wife?" question.  I would find a doctor other doctors respect and do your homework -- ask how many procedures they have done and what their success/complication rates are, and yes, you could ask how many they've done and how many have resulted in death.  Cleveland Clinic and University of Michigan Hospital answer these questions in a staightforward way in handouts they give their patients regarding the procedures.  A more to-the-point question might be "what are the risks to me if I do not do the procedure?"  I do not know how serious your condition is, just thinking it might be better to focus on your condition and your possible outcome.  What complications others suffered may not relate to your situation at all.  I would not let "vague statistics online" help me make this decision.  I have never read that particular statistic.  Cleveland Clinic states in 5,000 ablations over 5 years, none have resulted in death.  U of Michigan states in 5,000 ablations one person died and explained the death and how they now take steps to prevent that particular complication.   A decision like this is a calculated risk.  What is the risk of doing nothing vs. doing the ep study?  Try to find a perspective that you can feel at peace with.  I will be keeping you in my thoughts and prayers.

[achillea]

I dunno, Frosty.  No doctor (nor indeed any professional of any type) goes into business with the idea of doing bad work and certainly not of causing death.  We all know it happens, though.

Also, I can't think how asking a doc how many of his patients have died could possibly make him feel more secure while threading a cath through you--and we want the doctor to feel very calm and secure while doing that!

It would be OK to say that you are feeling VERY nervous and would like to know how often he has had things go unexpectedly badbad.  Not that that information would do you much good, right?

If you are really worried, there are online services where you can see how patients rate your particular doctor and others that, for a fee, will let you see how often a doc has had lawsuits against him.