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how to choose dr. to perform rf ablation for svt
My 10yo son has SVT, local ped cardio group recommends rf ablation to be done locally. They tell me it is low risk, almost "common", etc. but recommended ped cardio ep doc does less than 50 ablations annually.After some research, I conclude that the most important criteria in choosing who to perform the procedure is volume of cases. Am I correct? I have the ability and willingness to travel anywhere and get my son someplace that does lots and lots of these procedures. Can you think of any reason I shouldn't travel out of my state to seek a doc with more experience? Will a highly experienced ped cardio ep doc be willing to take my son's case from out of state even though it is "common"? Or would they prefer to take something more interesting and less routine?
When considering any suggestions you may be gracious enough to give, please pretend that my brilliant 10yo boy will change the future course of history for the greater good of all mankind. : ) I mean, this is my beloved kid we're talking about, and won't finding the right doc minimize the complication risks as much as possible? Thank you, thank you for taking the time to read this and possibly answer.
When considering any suggestions you may be gracious enough to give, please pretend that my brilliant 10yo boy will change the future course of history for the greater good of all mankind. : ) I mean, this is my beloved kid we're talking about, and won't finding the right doc minimize the complication risks as much as possible? Thank you, thank you for taking the time to read this and possibly answer.
MEDICAL PROFESSIONAL
Dear Gently,
It appears that you have done plenty of homework in trying to get the best care that you can for your son’s supraventricular tachycardia (SVT). And, I fully understand that you want to reduce the risks for your child. After all, as we all know, percentages and relative risks are just numbers…until it happens to your child—then it’s 100%. Obviously, no program can honestly quote you a 0% risk for complications. But, pediatric radiofrequency ablation has been performed for approximately two decades, so the learning curve has improved upon and risks have been lowered. You could say that it is done commonly. I can’t say for sure whether the center to which you were referred is appropriate for his needs or not, but I can give a few general thoughts on it.
By the way, for the other readers, the pediatric cardiologist who performs the radiofrequency ablation is called an electrophysiologist; this is a cardiologist who has done even more study of the electrical system of the heart after routine pediatric cardiology training. A radiofrequency ablation is a procedure that is performed by placing special catheters with electrodes on the end of them inside the heart in strategic locations to electrically “map” the heart. The catheters are placed in the heart through veins in the groin and/or neck. The mapping allows for abnormal or extra electrical pathways to be located. Then, another special catheter, called an ablation catheter, is placed in the heart with the tip on the abnormal pathway. Radiofrequency energy can be sent through the catheter to place a tiny burn in the heart to eliminate the pathway. The electrical mapping is then repeated to make sure that there are no other pathways that require ablation. This procedure is usually done under anesthesia.
I think that there are a few things to keep in mind when choosing both the doctor and the facility for the procedure. First, I think that most electrophysiologists, no matter where they are, would be happy to help you and your child; this is why they are in the field that they have chosen. A patient with a “common” case of SVT who undergoes ablation is still exciting to an electrophysiologist, because although the diagnoses may be similar, the potential locations of the pathway differ; there are probably some electrophysiologists who would say that there is no such thing as a “common” case of SVT, as they are each unique. It allows the electrophysiologist to do the interventional procedure and to use knowledge, creativity, and skill to achieve the optimal goal. It is also an opportunity to use these skills to help improve a child’s life, of which we should never lose sight.
In regards to case volume, although there has not a published threshold level of annual ablation cases to maintain adequate skills, there is some older data to suggest that performing fewer than 25 cases per year is associated with higher rates of complications. Fewer than 50 cases may be adequate although, as an example for comparison, our center does 120-150 cases per year. Also, an electrophysiologist who is at least several years out from their initial training would probably mean someone with a fair bit of experience.
As well, just being able to perform the radiofrequency ablation does not mean that all the necessary tools are available to the operator, such as being able to switch to cryoablation (using a freezing technique, which may be indicated in certain circumstances) or to utilize three-dimensional mapping, to better localize the pathway. It is important to also remember that you are getting more than just a caseload or experience. You are also getting someone with whom you feel comfortable caring for your son, explaining to you the aspects of his problem as well as the potential complications, managing the complications, and managing long-term follow-up, if it needed. You get a host of other people who care for him as well, both pre- and post-procedure. This would include, among others, pediatric anesthesia and pediatric nursing.
Overall, I can’t promise that a much higher case rate will lower the complication rate. However, there is pediatric and adult cardiac surgical data that suggests that a higher case volume does end up leading to better outcomes, up to a certain point. I’m not sure that we can fully extrapolate this to radiofrequency ablation, but it is likely similar.
It appears that you have done plenty of homework in trying to get the best care that you can for your son’s supraventricular tachycardia (SVT). And, I fully understand that you want to reduce the risks for your child. After all, as we all know, percentages and relative risks are just numbers…until it happens to your child—then it’s 100%. Obviously, no program can honestly quote you a 0% risk for complications. But, pediatric radiofrequency ablation has been performed for approximately two decades, so the learning curve has improved upon and risks have been lowered. You could say that it is done commonly. I can’t say for sure whether the center to which you were referred is appropriate for his needs or not, but I can give a few general thoughts on it.
By the way, for the other readers, the pediatric cardiologist who performs the radiofrequency ablation is called an electrophysiologist; this is a cardiologist who has done even more study of the electrical system of the heart after routine pediatric cardiology training. A radiofrequency ablation is a procedure that is performed by placing special catheters with electrodes on the end of them inside the heart in strategic locations to electrically “map” the heart. The catheters are placed in the heart through veins in the groin and/or neck. The mapping allows for abnormal or extra electrical pathways to be located. Then, another special catheter, called an ablation catheter, is placed in the heart with the tip on the abnormal pathway. Radiofrequency energy can be sent through the catheter to place a tiny burn in the heart to eliminate the pathway. The electrical mapping is then repeated to make sure that there are no other pathways that require ablation. This procedure is usually done under anesthesia.
I think that there are a few things to keep in mind when choosing both the doctor and the facility for the procedure. First, I think that most electrophysiologists, no matter where they are, would be happy to help you and your child; this is why they are in the field that they have chosen. A patient with a “common” case of SVT who undergoes ablation is still exciting to an electrophysiologist, because although the diagnoses may be similar, the potential locations of the pathway differ; there are probably some electrophysiologists who would say that there is no such thing as a “common” case of SVT, as they are each unique. It allows the electrophysiologist to do the interventional procedure and to use knowledge, creativity, and skill to achieve the optimal goal. It is also an opportunity to use these skills to help improve a child’s life, of which we should never lose sight.
In regards to case volume, although there has not a published threshold level of annual ablation cases to maintain adequate skills, there is some older data to suggest that performing fewer than 25 cases per year is associated with higher rates of complications. Fewer than 50 cases may be adequate although, as an example for comparison, our center does 120-150 cases per year. Also, an electrophysiologist who is at least several years out from their initial training would probably mean someone with a fair bit of experience.
As well, just being able to perform the radiofrequency ablation does not mean that all the necessary tools are available to the operator, such as being able to switch to cryoablation (using a freezing technique, which may be indicated in certain circumstances) or to utilize three-dimensional mapping, to better localize the pathway. It is important to also remember that you are getting more than just a caseload or experience. You are also getting someone with whom you feel comfortable caring for your son, explaining to you the aspects of his problem as well as the potential complications, managing the complications, and managing long-term follow-up, if it needed. You get a host of other people who care for him as well, both pre- and post-procedure. This would include, among others, pediatric anesthesia and pediatric nursing.
Overall, I can’t promise that a much higher case rate will lower the complication rate. However, there is pediatric and adult cardiac surgical data that suggests that a higher case volume does end up leading to better outcomes, up to a certain point. I’m not sure that we can fully extrapolate this to radiofrequency ablation, but it is likely similar.
Like your name ;) do you trust your son's cardiologist? if you do then I don't think he/she would recommend someone that doesn't know what they are ****? as far as going out of state you have to consider 2 things, will your insurance cover it since there is a doctor available in your area? and how far are you willing to travel, especially if he will need a post op check (which I am sure he will need) Also you can go online usually you can see what these doctor's specialize in and if you have the chance to meet them and talk to the doctor before hand, I would do that to make sure you are very comfortable. you and your son need to feel comfortable with the doctor.
My son didn't have the same thing as yours but I never even got to meet the surgeon that did his open heart we had to trust what our doctor was saying. also a bigger hospital doesn't always mean better.
My son didn't have the same thing as yours but I never even got to meet the surgeon that did his open heart we had to trust what our doctor was saying. also a bigger hospital doesn't always mean better.
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