Catheter ablation is not unlike other branches of medicine or life in general. The more you do the better you are. And the better is not just from the success standpoint but also from a risk minimization standpoint. One of the major questions we get is what is the success rate of these procedures?
The first thing we have to define is, I think us as electrophysiologists and certainly in a research and a clinical setting, we try to define success as freedom from all arrhythmias, both those you feel and those you might not feel; which we verify that with some kind of monitoring device after the ablation; off of all drug therapy.
So our goal is to get patients off anti-arrhythmic drug therapy, have them free of symptomatic arrhythmias — the ones you feel — and then also have them free of asymptomatic arrhythmias, ones you might not feel during sleep or other times during the day.
That’s a pretty steep bar. Now the challenge with atrial fibrillation ablation is the ablation takes place, and it can take up to three months for the lesions to mature and to really get an idea how that first procedure went. It’s one of the hardest concepts I have to educate our patients on is that very few things in medicine are this kind of delayed gratification, it might very well become that over three months but you can’t judge it as what happens in the first day, week or even month.
And so this concept of a blanking period has really established itself across the spectrum of atrial fibrillation and so we basically try to educate our patients when we do these procedures safely. We hope we get them home within 24 hours, and then we really see where they’re at after three months.
Now hopefully in that whole time period we’ve kept them in normal rhythm. But ultimately we don’t start thinking about “thumbs up, thumbs down” until that three month mark. Now it’s hard to put defined numbers on it, this concept that operators should do over 50 annually, kind of has established some traction.
I think most of us that spend a lot of time doing these we certainly do well over 100 or 150. And independent of the operator I think you want a system and a team because ultimately, what you may or may not know is we have at least three or four other individuals in the procedure with me.
And so you really want an experienced team as well because a fair amount of work happens before and after the doctor gets there. Nothing from the standpoint of a procedure but ultimately the setup and so the more experienced the team the faster it goes, the faster the troubleshooting goes.
And so I think a larger center that does a lot of these is going to have efficiencies of scale and through put issues that’s going to help make it a more streamlined process for patients.
We really provide we hope a reasonable amount of material that’s not overwhelming that really kinda lays out exactly what to expect, exactly what the pre-procedure, the peri-procedural, and the post procedure expectations are. The follow ups are set up before time. Often times an imaging study is necessary before a procedure.
So all that is meant to be fairly streamlined and so we provide a healthy amount of material that is meant to be additive and informative but not overwhelming. It’s very important that one goes to a center that does a lot of these procedures.
It’s just so many of these things that as long as you develop a workflow they go very smoothly. We do so many every week and it’s meant to be a very controlled environment for patients and our team. I’m very proud of our doctors here. And I’m very proud of our staff and nurses and nurse practitioners in the clinic. They’re really folks that have dedicated their life to this part of cardiology — Electrophysiologist
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