pls recommend Bangkok doc for ablation for (paroxysmal) atrial fibrillation

[david_je]

If you have had this procedure recently, I'd appreciate hearing about your experience.

And is the new pulsed field technique available in Thailand?

Thanks.

[Sheryl]

This doctor is expert in it:

 

 

https://www.bumrungrad.com/en/doctors/Koonlawee-Nademanee?gclid=Cj0KCQjwm66pBhDQARIsALIR2zDdEHAXJa9pAQiDELL1rmH1gLs_M9a4wCgko4WzzalxYwoCspp5T6gaAkEkEALw_wcB

 

You can read more about his expertise specific to RF ablation here:

https://myacare.com/doctor/prof-dr-koonlawee-nademanee-thailand

 

Pulsed field technique is extremely new, the results of the first random controlled trial were only released in August 2023. It is not widely available yet anywhere and not available in Thailand at all  as far as I know.  Doesn't seem to offer much advantage that I can see. https://www.acc.org/Latest-in-Cardiology/Articles/2023/08/23/19/16/sun-555am-advent-esc-2023

[timoti]

On 10/16/2023 at 2:08 PM, Sheryl said:

This doctor is expert in it:

 

 

https://www.bumrungrad.com/en/doctors/Koonlawee-Nademanee?gclid=Cj0KCQjwm66pBhDQARIsALIR2zDdEHAXJa9pAQiDELL1rmH1gLs_M9a4wCgko4WzzalxYwoCspp5T6gaAkEkEALw_wcB

 

You can read more about his expertise specific to RF ablation here:

https://myacare.com/doctor/prof-dr-koonlawee-nademanee-thailand

 

Pulsed field technique is extremely new, the results of the first random controlled trial were only released in August 2023. It is not widely available yet anywhere and not available in Thailand at all  as far as I know.  Doesn't seem to offer much advantage that I can see. https://www.acc.org/Latest-in-Cardiology/Articles/2023/08/23/19/16/sun-555am-advent-esc-2023

Can someone request this doctor for this operation?

[TorquayFan]

Sheryl - spot on with your recommendation there. Dr Nademanee did a catheter ablation for me in 2013. When later discussing it with an eminent Doc in Bristol, UK, I was surprised to hear that Dr Nademanee was regarded as the top expert worldwide in this field and in fact holds the patents for much of the technology in the equipment. 

 

So Dr Nademanee would be ideal at Bangkok Heart Hospital. I understood then that he had practices in the USA but in addition, visited Thailand for some months each year to work. He may or may not be available but BKKHH no doubt have a competent team.

 

BTW, I remember waking up as the Nurse was dressing the exit wound at the top of my leg and eating a hearty lunch an hour later. Good luck !

[TorquayFan]

Hi again David - I've just read Sheryl's links and it seems Dr Nademanee might be back from the USA now and is based at Bumrungrad, (which I had also visited before my operation). That's good news as to his availability.

 

I'm sure you can ask for him but he will have a top team around him no doubt.

 

ATB

[timoti]

Would April intl pay for this if you only have IP?

[domdom]

Hello

I strongly recommend Dr Sacchana Pumprueg in Sririraj Hospital.. My husband got 2 procedures done (informed from beginning surely 2 procedures would be requested as he has at least 3 problems)..He is assistant professor in this university..got 1 procedure in December 2022, improved greatly the situation but still crisis, 2nd procedure one month ago..Dr Sacchana speaks perfect English, explains everything., he is very human and involved..he even communicates through mail if you don't live in Bgk for the follow up..even helped arranging for appointments in the hospital as on private side, price is double than in public sector (same operation room, same doctors etc..etc..) 

He consults on private side on Sunday afternoon and I think Wednesday and also 8n Thonburi hospital I think Sunday morning.

for consultancy better to go to private sector..

I recommend 200%

Have a good day

[Sheryl]

20 hours ago, timoti said:

Can someone request this doctor for this operation?

Of course.

[Sheryl]

18 hours ago, TorquayFan said:

Sheryl - spot on with your recommendation there. Dr Nademanee did a catheter ablation for me in 2013. When later discussing it with an eminent Doc in Bristol, UK, I was surprised to hear that Dr Nademanee was regarded as the top expert worldwide in this field and in fact holds the patents for much of the technology in the equipment. 

 

So Dr Nademanee would be ideal at Bangkok Heart Hospital. I understood then that he had practices in the USA but in addition, visited Thailand for some months each year to work. He may or may not be available but BKKHH no doubt have a competent team.

 

BTW, I remember waking up as the Nurse was dressing the exit wound at the top of my leg and eating a hearty lunch an hour later. Good luck !

 

He seems to no longer be at Bangkok Heart Hospital but rather at Bumrungrad now

 

[Sheryl]

9 hours ago, timoti said:

Would April intl pay for this if you only have IP?

Of course. Why wouldn't they?

 

In Thailand they usually admit overnight for this but even if they did not, it would be a day surgery, which is covered under IP policy.

[timoti]

2 minutes ago, Sheryl said:

Of course. Why wouldn't they?

 

In Thailand they usually admit overnight for this but even if they did not, it would be a day surgery, which is covered under IP policy.

How much do you reckon ablation for afib would cost at Bumrungrad? BPH quoted 700K.

 

Also do you know if using a personal medical ECG device is enough for diagnosis? Almost like a holter but have time limit like 10 min for each recording.

 

Using holter i never managed to capture episodes. Doctor said it's better to confirm and 10 mins is too short.

 

And the AI analysis in the software of the device i have says my ecg have everything under the sun like Afib, PAC, PVC, Ventricular tachycardia, couplet PAC/PVC, supraventricular tachycardia, etc.

 

That's why i showed them to a specialist. He said heat ablation is better for you than cold to fix both of the issues be identified in the graph but no issues in ultrasound or treadmill.

[TorquayFan]

Timoti  - "Also do you know if using a personal medical ECG device is enough for diagnosis? Almost like a holter but have time limit like 10 min for each recording. Using holter i never managed to capture episodes."

 

I don't KNOW Timoti but IMO a self-diagnosis approach is NOT advisable. Go to any good Hospital and get them to test you appropriately - (BTW I was tabbed up for a Holter for 48 hours so 10 minutes is not likely to be helpful at all.)

 

And this - "AI analysis in the software of the device i have says my ecg have everything under the sun . . . . " Again -  Go to any good Hospital and get them to test and analyse you appropriately.

 

You don't mention what these 'episodes are.

 

Please put your kit in the cupboard and go to a Doctor !

 

Good luck . . . .

[timoti]

1 hour ago, TorquayFan said:

Timoti  - "Also do you know if using a personal medical ECG device is enough for diagnosis? Almost like a holter but have time limit like 10 min for each recording. Using holter i never managed to capture episodes."

 

I don't KNOW Timoti but IMO a self-diagnosis approach is NOT advisable. Go to any good Hospital and get them to test you appropriately - (BTW I was tabbed up for a Holter for 48 hours so 10 minutes is not likely to be helpful at all.)

 

And this - "AI analysis in the software of the device i have says my ecg have everything under the sun . . . . " Again -  Go to any good Hospital and get them to test and analyse you appropriately.

 

You don't mention what these 'episodes are.

 

Please put your kit in the cupboard and go to a Doctor !

 

Good luck . . . .

I went to the doctor and he saw the results. Their tests are ok. Just have to do holter. The trick is the catch the episodes because one day you might have SVT another day PVC etc. I think i was able to capture different events in 2 days but i didn't have holter.

 

Event recorder is better but they didn't have it.

[Sheryl]

I don't know what cost is at Bumrungrad.

 

Doctor would need to make his own diagnosis. Nobody is going to do an ablation (or anything else)  based on home ECG device.  Not only are the durations short but the interpretation is not so reliable. It really needs a skilled human to read the rhythm strips, machine generated reports are quite fallible  especially when it comes to diffrrentiating between types of premature beats and types of tachycardia. 

 

Occasional PVCs and PACs are usually not a big concern but if you are actually having bursts of V-tach that is worrying.

 

In addition ablation may not be indicated if the "events" are just occasional. Instead medication and reduction of triggers (like caffeine and smoking)  might be tried first.

 

No substitute for an evaluation by a specialist in arrhythmias. 

 

See the suggested doctor for a thorough evaluation. 

 

What exactly are your symptoms?

[mania]

10 hours ago, timoti said:

That's why i showed them to a specialist. He said heat ablation is better for you than cold to fix both of the issues

That is odd ?

AFAIK Cryo-ablation  first freezes the pathway to check of your system will stay up....IF it goes down the cryo thaws & all is well. If there is no problem after freezing they then will burn which is permanent

 

But in the burn only method if your system goes down after burning a pathway then a pacemaker is needed

 

AFAIK the difference in using cryo is just a safer route & I remember many years ago checking & Bumrungrad had it then

 

All that aside as others have said you may want to check if your psvt is not life threatening then it is just a bother & will eventually fade in most folks.

 

Also folks who have an ablation many times will need more as they rarely hold long term.

 

I have had psvt,pvc's, pac,s on & off for decades now. As others have said see if you can note the triggers...keep a diary. In my case it was mainly stress & I occasionally had alcohol which I no longer drink due to that trigger.

 

Good Luck!

Edited October 19, 2023 by mania

[timoti]

3 hours ago, Sheryl said:

I don't know what cost is at Bumrungrad.

 

Doctor would need to make his own diagnosis. Nobody is going to do an ablation (or anything else)  based on home ECG device.  Not only are the durations short but the interpretation is not so reliable. It really needs a skilled human to read the rhythm strips, machine generated reports are quite fallible  especially when it comes to diffrrentiating between types of premature beats and types of tachycardia. 

 

Occasional PVCs and PACs are usually not a big concern but if you are actually having bursts of V-tach that is worrying.

 

In addition ablation may not be indicated if the "events" are just occasional. Instead medication and reduction of triggers (like caffeine and smoking)  might be tried first.

 

No substitute for an evaluation by a specialist in arrhythmias. 

 

See the suggested doctor for a thorough evaluation. 

 

What exactly are your symptoms?

 

3 hours ago, mania said:

That is odd ?

AFAIK Cryo-ablation  first freezes the pathway to check of your system will stay up....IF it goes down the cryo thaws & all is well. If there is no problem after freezing they then will burn which is permanent

 

But in the burn only method if your system goes down after burning a pathway then a pacemaker is needed

 

AFAIK the difference in using cryo is just a safer route & I remember many years ago checking & Bumrungrad had it then

 

All that aside as others have said you may want to check if your psvt is not life threatening then it is just a bother & will eventually fade in most folks.

 

Also folks who have an ablation many times will need more as they rarely hold long term.

 

I have had psvt,pvc's, pac,s on & off for decades now. As others have said see if you can note the triggers...keep a diary. In my case it was mainly stress & I occasionally had alcohol which I no longer drink due to that trigger.

 

Good Luck!

That's also why I am surprised because before he said I need holter for confirmation but when I asked isn't both ECGs the same, he said 10 mins is short but then he said we can do ablation. So not sure if they just want to get the money.

AI report said I have those but in the report they said paroxysmal afib and PVC. He was saying you can use cold if you like cold but later said heat is better because he can fix both issues.

 

For me it always seem to happen after eating some big heavy carb meal later in the evening, because I dont eat much early on so I might eat a big meal at 8-9pm and this happens then but not always. Sometimes i can even bigger meals and nothing happens,  but when it happens I noticed always when I finish the meal or almost finish it.

 

Also the doctor said it's better you do ablation so these episodes dont turn into more serious complications.

[mania]

4 minutes ago, timoti said:

 

That's also why I am surprised because before he said I need holter for confirmation but when I asked isn't both ECGs the same, he said 10 mins is short but then he said we can do ablation. So not sure if they just want to get the money.

AI report said I have those but in the report they said paroxysmal afib and PVC. He was saying you can use cold if you like cold but later said heat is better because he can fix both issues.

 

For me it always seem to happen after eating some big heavy carb meal later in the evening, because I dont eat much early on so I might eat a big meal at 8-9pm and this happens then but not always. Sometimes i can even bigger meals and nothing happens,  but when it happens I noticed always when I finish the meal or almost finish it.

 

Also the doctor said it's better you do ablation so these episodes dont turn into more serious complications.

Yeah that sounds a little sketchy

 

Holter is always good as they have small wireless ones you wear now for up to 14 days & shower etc with it. It gives a good show of events if your having them often

 

If your young they will likely fade & also if it is certain types like I sad those are not dangerous but bothersome as of course folks worry.

 

But aside from learning triggers to keep from starting you can also learn ways to make them stop quickly

Valsalva maneuver usually woks for many. When I was young mine would run sometimes 10+ hours then I'd go to the ER & they would give me a shot of adenocard which stopped it instantly

 

But for me I found if I have one I lay on floor butt close to wall....feet/legs on wall pointing straight up...take a deep breath slowly in & slowly out & it usually stops right away 😉

 

Here is a pic of the new modern type monitor that can track you for two weeks

 

Good Luck & try not to worry too much. These things are quite common in many folks

 

[timoti]

16 minutes ago, mania said:

Yeah that sounds a little sketchy

 

Holter is always good as they have small wireless ones you wear now for up to 14 days & shower etc with it. It gives a good show of events if your having them often

 

If your young they will likely fade & also if it is certain types like I sad those are not dangerous but bothersome as of course folks worry.

 

But aside from learning triggers to keep from starting you can also learn ways to make them stop quickly

Valsalva maneuver usually woks for many. When I was young mine would run sometimes 10+ hours then I'd go to the ER & they would give me a shot of adenocard which stopped it instantly

 

But for me I found if I have one I lay on floor butt close to wall....feet/legs on wall pointing straight up...take a deep breath slowly in & slowly out & it usually stops right away 😉

 

Here is a pic of the new modern type monitor that can track you for two weeks

 

Good Luck & try not to worry too much. These things are quite common in many folks

 

I asked them for an event recorder they said they only have holter that can record up to 7 days it and it had something like a screen so bigger than that but she also said i cant shower for 7 days. she asked if that's ok.

Edited October 19, 2023 by timoti

[Sheryl]

1 hour ago, timoti said:

 

That's also why I am surprised because before he said I need holter for confirmation but when I asked isn't both ECGs the same, he said 10 mins is short but then he said we can do ablation. So not sure if they just want to get the money.

AI report said I have those but in the report they said paroxysmal afib and PVC. He was saying you can use cold if you like cold but later said heat is better because he can fix both issues.

 

For me it always seem to happen after eating some big heavy carb meal later in the evening, because I dont eat much early on so I might eat a big meal at 8-9pm and this happens then but not always. Sometimes i can even bigger meals and nothing happens,  but when it happens I noticed always when I finish the meal or almost finish it.

 

Also the doctor said it's better you do ablation so these episodes dont turn into more serious complications.

I do not think the doctor you spoke with is expert in cardiac electrophysiology (not the same as just being a cardiologist) nor experienced in ablation. Only a handful of doctors in Thailand are.  And they would nto recommend anything based just in a home ECG monitor.

 

Regarding Holter monitoring it can be done for any duration desired, 24 - 48 hours is usual and I doubt 7 days would be required. Nobody is likely to do an ablation for an arrhythmia that is so infrequent it does not occur even every 2 days.

 

While wearing the monitor you cannot shower whole body per se but can do sponge bath or use showerhead/ bidet nozzle to wash only lower body then sponge bath the rest. Not onerous for just 1-2 days.

 

Please disregard your  prior discussion and see recommended doctor in Bangkok .

[Sheryl]

1 hour ago, timoti said:

 

For me it always seem to happen after eating some big heavy carb meal later in the evening, because I dont eat much early on so I might eat a big meal at 8-9pm and this happens then but not always. Sometimes i can even bigger meals and nothing happens,  but when it happens I noticed always when I finish the meal or almost finish it.

 

 Notice how? again - what symptoms?

[timoti]

24 minutes ago, Sheryl said:

 Notice how? again - what symptoms?

Basically I will immediately notice the heart palpitations like something is off. It always starts like that. Then after 20-30 mins or 1h or never, it might also have rapid heart beating. This feeling is different. If that happens, again my ECG shows me these if I grab it. In the rapid heart beating, I saw it go up as high as 170 beats and feeling a bit warm in the head as it goes higher and then the warmth is gone when it drops back down. Before I reckon even higher beats where my eyes were almost going full dark but then reverted back down. But then this cycle of up and down can repeat so many times as long as a few hours. I didnt have ECG then to confirm these.

 

But not always I get the rapid beating. Mostly it's the irregular beats where I hear skipped beats or closer beats in the ECG sound. I guess also sometimes the beatings might be strong enough that if I am lied down I will feel my body almost moving sideways because of the movement of the heart. Sometimes 2 months nothing but sometimes 5 days in a row. Doing exact same things don't always trigger it.

[domdom]

Sririraj hospital public side 1st procedure December 2022 (4 and 1/2 hour) one night hospital 376.000 bahts with highly experienced Dr Sacchana (private side same procedure, same Dr same team quotation 800.000)

2nd procedure september 2023 where they did a lot of "mapping" to find out exactly where wrong electric signals were coming  and of course burning Total : 426.000 bahts..3 and a half hour procedure.. more expensive because precise mapping needed a very special catheter ..cost of this catheter only was 75.000 bahts..

Again same team, doctor and OR..1 night inside ..next morning out..

Informed that to really "heel" heart needs 2 to 3 months..one EKG after 1 month and again after 2 more months

Our insurance would not cover 800.000 bahts..and anyway service is the same between public or private sector.

 Less of marble and luxury but treatment is what is required, not a 5 star resort holiday

Have a good day

[timoti]

1 hour ago, Sheryl said:

I do not think the doctor you spoke with is expert in cardiac electrophysiology (not the same as just being a cardiologist) nor experienced in ablation. Only a handful of doctors in Thailand are.  And they would nto recommend anything based just in a home ECG monitor.

 

Regarding Holter monitoring it can be done for any duration desired, 24 - 48 hours is usual and I doubt 7 days would be required. Nobody is likely to do an ablation for an arrhythmia that is so infrequent it does not occur even every 2 days.

 

While wearing the monitor you cannot shower whole body per se but can do sponge bath or use showerhead/ bidet nozzle to wash only lower body then sponge bath the rest. Not onerous for just 1-2 days.

 

Please disregard your  prior discussion and see recommended doctor in Bangkok .

That doctor you mentioned here is the expert i should see for consultation then?

[Sheryl]

1 minute ago, timoti said:

That doctor you mentioned here is the expert i should see for consultation then?

Yes

 

https://www.bumrungrad.com/en/doctors/Koonlawee-Nademanee?gclid=Cj0KCQjwm66pBhDQARIsALIR2zDdEHAXJa9pAQiDELL1rmH1gLs_M9a4wCgko4WzzalxYwoCspp5T6gaAkEkEALw_wcB

 

 

[timoti]

28 minutes ago, Sheryl said:

Yes

 

https://www.bumrungrad.com/en/doctors/Koonlawee-Nademanee?gclid=Cj0KCQjwm66pBhDQARIsALIR2zDdEHAXJa9pAQiDELL1rmH1gLs_M9a4wCgko4WzzalxYwoCspp5T6gaAkEkEALw_wcB

 

 

Ok they told me they charge 1.2m for the same procedure. I will have to see him first and see what he says of course.

 

I hope he can use the same treadmill and ultrasound results though because i paid 10k for these.

 

Additionally i wonder if i should go to a smaller clinic to get holter and capture an episode then bring it to him than trying to catch an episode in bkk with their holter, because i don't live there.

Edited October 19, 2023 by timoti

[Sheryl]

50 minutes ago, timoti said:

Ok they told me they charge 1.2m for the same procedure. I will have to see him first and see what he says of course.

 

I hope he can use the same treadmill and ultrasound results though because i paid 10k for these.

 

Additionally i wonder if i should go to a smaller clinic to get holter and capture an episode then bring it to him than trying to catch an episode in bkk with their holter, because i don't live there.

Wait and see what he recommends is my advise. As mentioned I think 48 hours for Holter may suffice.  Just plan on several days in Bangkok.

 

Do NOT try to get Holter on the cheap as the interpretation is complex and needs to be done by people specialized in cardiac electrophysiology.

 

 

[Sheryl]

P.S. Re cost as you have insurance there will be back and forth between hospital and insurer and costs may come down as a result.

 

You can get ablation (if indicated) done for less at Siriraj Hospital but, even in their private wing, I don't think they are very skilled at dealing with international insurers and might even not have direct payment mechanism.

[timoti]

1 minute ago, Sheryl said:

Wait and see what he recommends is my advise. As mentioned I think 48 hours for Holter may suffice.  Just plan on several days in Bangkok.

 

Do NOT try to get Holter on the cheap as the interpretation is complex and needs to be done by people specialized in cardiac electrophysiology.

 

 

Oh yes I meant going to a hospital or BPH to get a holter for recording. I won't buy one myself. You wouldn't advise that also? I just worry I wont be able to capture it in bkk in a few days but who knows. I got it for the last 2 days so we will see if it will happen tonight.

[Sheryl]

35 minutes ago, timoti said:

Oh yes I meant going to a hospital or BPH to get a holter for recording. I won't buy one myself. You wouldn't advise that also? I just worry I wont be able to capture it in bkk in a few days but who knows. I got it for the last 2 days so we will see if it will happen tonight.

 

I meant do not try to go to an inexpensive clinic to get the Holter done.  I wouldn't try it at BPH either, might waste your money. Have it done at a proper arrhythmia center.

 

If it is really a problem for you to stay in Bangkok for the duration and they recommend a longer period of monitoring, returning to Pattaya first and then coming back to Bangkok when the monitoring period is up could be an option. No problem to travel with the device on, in fact it is advantageous for it to record under a variety of types of activity.

 

Sometimes simply doing an exercise stress test is enough to provoke whatever arrythmia the patient is  having and this alone may give enough information in some cases.. That can be done on the spot. Again, need to consult expert in this area and be guided by his advise.

 

 

[timoti]

1 hour ago, Sheryl said:

 

I meant do not try to go to an inexpensive clinic to get the Holter done.  I wouldn't try it at BPH either, might waste your money. Have it done at a proper arrhythmia center.

 

If it is really a problem for you to stay in Bangkok for the duration and they recommend a longer period of monitoring, returning to Pattaya first and then coming back to Bangkok when the monitoring period is up could be an option. No problem to travel with the device on, in fact it is advantageous for it to record under a variety of types of activity.

 

Sometimes simply doing an exercise stress test is enough to provoke whatever arrythmia the patient is  having and this alone may give enough information in some cases.. That can be done on the spot. Again, need to consult expert in this area and be guided by his advise.

 

 

Thx i will do that. I lift weights every day but never had afib episode during those times only after eating some big meal. BPH doctor didn't comment on this so i hope the bkk doctor have insight on this. I heard acid reflux or gerd can also cause afibs.