FINDING A DOCTOR
   

      When your regular doctor first suspects you have A-Fib, he/she will probably send you to a Cardiologist, a doctor who specializes in the heart. The Cardiologist will probably put you on different medications over the next six months to a year to see if any of these medications will stop or control your A-Fib. This may not be the best option for you. Current A-Fib medications are not very effective and often have bad side effects. And, time is of the essence in treating A-Fib. The longer you wait, the more your A-Fib may "remodel" your heart (change it physically and electrically).

RESEARCHING DOCTORS AND MEDICAL CENTERS

    Instead of a Cardiologist, you should consider seeing an Electrophysiologist (EP)---a Cardiologist  who specializes in the electrical activity of the heart and in the diagnosis and treatment of heart rhythm disorders. It's easy to find a local Electrophysiologist yourself. The Web site of the Heart Rhythm Society Web site has a feature called Finding A Heart Rhythm Specialist. When you type in your city and state, the site gives you a list of Electrophysiologists in your area. However, not all EPs perform and have sufficient experience in Pulmonary Vein Ablation. See the sections on Questions For Doctors and Doctors/Facilities performing Pulmonary Vein Ablation to help find the right Electrophysiologist for you.

    While researching EPs who treat A-Fib, you will notice acronyms indicating the physician’s credentials and certifications. (You can check on a doctor's certification yourself at http://www.abim.org/services/verify-a-physician.aspx) Besides the familiar “MD”, you may see one or more of the following common designations following a physician’s name. Here’s what they stand for and what they mean to an A-Fib patient.

FACC  Fellow of the American College of Cardiology: Designates a Cardiologist who has completed a minimum of ten years of clinical and educational preparation and passed a rigorous two-day exam given by the American Board of Internal Medicine. It's not an absolute requirement for an EP, but most EPs have passed this Cardiology Board exam.

FHRS  Fellow of the Heart Rhythm Society: Not an academic title and not limited to physicians. Membership is based on peer review. Designates heart rhythm professionals working in the field of electrophysiology and/or pacing, provided that the majority of their time is not devoted to marketing and/or sales. Most EPs in the US with FHRS credentials have also achieved FACC. Internationally this may not be the case. 

CCDS  Certified Cardiac Device Specialist: Designates an EP who has passed an exam for cardiac devices such as pacemakers. The exam is given by the International Board of Heart Rhythm Examiners (IBHRE) affiliated with the Heart Rhythm Society. This credential may not be totally relevant to A-Fib ablation.

DO      Doctor of Osteopathic Medicine: (Like an MD, DOs are fully qualified physicians licensed to perform surgery and prescribe medication; DOs practice a "whole person" approach to medicine, and receive extra training in the musculoskeletal system.)²⁶⁷

MBBS/MBChB/BMBS            Bachelor of Medicine & Bachelor of Surgery: Awarded on graduation from medical school in various countries which follow the tradition of the United Kingdom (The Commonwealth of Nations). (Like a Doctor of Medicine degree, MD, in the U.S.)

    In this author's opinion, though 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.

    For insurance or liability reasons, many Electrophysiologists today may not perform a Pulmonary Vein Ablation unless you have been on at least two different medications without success in fixing your A-Fib. (But see Calkins: catheter ablation approved as first line therapy for A-Fib patients.)

IF YOU ARE HAVING A CATHETER ABLATION PROCEDURE

    Caution: A Pulmonary Vein Isolation Ablation (PVA(I)) is the most challenging, demanding and complex catheter ablation an Electrophysiologist performs, but no specific certification is required. Any EP is allowed to do PVIs.
 
    Therefore, 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.
    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."²⁶⁶

    Over the last several years there has been an astounding and welcome growth in the US of 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. (The author is working on developing a data base which lists how many PVIs a doctor does a year or how experienced he/she is.)

PROBLEMS IN THE A-FIB FIELD/PROFESSION/INDUSTRY

    This is a subject I find very difficult and even painful to talk about. There is a small number of A-Fib doctors who don’t meet professional standards, who, for example, do "Five-Minute" A-Fib ablations, then load patients with toxic antiarrhythmic drug(s). Hospital administrators allow and even promote these doctors, because they run many patients through their facilities and bring in a considerable amount of money to their hospitals. The doctors don’t admit to poor results for patients. They justify their methods by saying there is no current certification process for EPs (or Surgeons) doing A-Fib ablations, and there is no established A-Fib ablation procedure that is a standard for the industry. That is true.
 
    A-Fib is a huge business and is attracting EPs, Surgeons, Device Manufacturers, etc. some of whom are unscrupulous, unqualified, unskilled, inadequately trained, and greedy. Currently any EP or Surgeon can do an A-Fib ablation. There is no oversight board certifying an A-Fib doctor’s results or skills. These doctors often use direct marketing techniques which are very successful in attracting the ever increasing number of people with A-Fib.

    Because there is so much money to be made in the A-Fib field and because it is wide open with modest effective regulation, you can expect entrepreneurial types with little professional ethics to flock to the field. (This isn’t a phenomena unique to A-Fib.) Unfortunately in our world they do succeed. They develop a thriving practice and make a lot of money. Their poor results are hidden by hospital administrators wary of law suits. These doctors unfortunately will probably be practicing for a long time.

    But please don’t interpret these remarks as an indictment of all doctors and professionals, etc. in the A-Fib field. While there may be a few bad apples, the vast majority are dedicated, competent, caring, skilled professionals who have enviable records of restoring A-Fib patients to full health.

HOW THEN DO YOU DEFEND YOURSELF?

    Scrutinize the credentials of prospective doctors. 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;
• The American Board of Medical Specialists (ABMS) Directory of Board Certified Medical Specialists;
• The Cardiothoracic Surgeon's Network Directory of Surgeons;
• HealthGrades and Vitals: independent healthcare ratings organizations which provides physician's profile, education, awards & recognition, insurance accepted, hospital affiliations, and malpractice and sanctions.
• Online discussion groups and forums; read what other A-Fib patients have written about specific doctors.
• Be cautious of all doctor info on web sites (including this one). Doctors may be listed or appear most prominently because they pay for that privilege.

    But don’t depend entirely on the typical doctor informational websites or 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).

    Don't rely on a single source when researching and selecting doctors. Consult several sites. Compare information. Seek recommendations from other patients. If you know any nurses or support staff who work in EP labs, they are often a great resource.

FINDING A DOCTOR IN YOUR AREA

    We recommend as a first step that go to the Heart Rhythm Society web site Finding a Specialist section http://www.hrsonline.org/PatientInfo/specialist_locator.cfm.
    Check the box "Limit the Results to Fellows of the Heart Rhythm Society (FHRS)."
    These EPs have been recognized by their peers. (Unfortunately this list leaves out many younger A-Fib EPs who are doing excellent work. But we haven’t found an unbiased way of identifying these younger A-Fib doctors and welcome suggestions as to how to do this.) (We're not aware of a database that lists A-Fib Surgeons by area.)
    See also: FHRS-designated EPs who perform A-Fib ablations in the US which is an evolving directory of EPs with the FHRS credential listed by state and city.

    In an ideal world we could rely blindly on our doctor, insurance company, and government regulators to take care of us. But that isn’t the world we live in today. An important step in finding the right doctor is to get information from a doctor or his office about: (See Questions For Doctors.)

1. Results, success rates.

2. "How long have you been performing Pulmonary Vein Ablations for my type of A-Fib? How experienced are you with RF and/or Cryo? How many procedures do you perform a year?"

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?"

    But be cautious. This 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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Disclaimer: the authors of this Web site are not medical doctors and are not affiliated with any medical school or organization. The information on this site is not intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health professional prior to starting any new treatment or with any questions you may have regarding a medical condition. Nothing contained in this service is intended to be for medical diagnosis or treatment.

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(This page last updated 1/03/11)