Medicine without ablation for SVT or AF

@doclarrea In some EP's hands, their success rate is as low as 68% according to the literature I have seen, which is only somewhat better than a 50/50 chance. In the hands of the most skilled and busiest EPs across the globe, their success rate rises to a whopping 90%, as is the case for Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin, TX. Dr. Pasquale Santangeli at Cleveland Clinic enjoys such a reputation as well, and there are dozens of others across the country. If the ablation is successful (one full year free of the treated arrhythmia), and if there are no other comorbidities and risk of stroke (their CHA2DS2-VASc score puts them at less than 2.0), many EPs will agree that the patient can stop taking a DOAC like apixaban or rivaroxaban. For those who are on the fence with their score, or higher, it may be that the installation of a Watchman device will reduce their risk considerably, once it has been shown to be free of leakage, and the patient may also be encouraged to cease their DOAC. Some patients do continue to have a risk, even with no leaks, and they would be encouraged to continue their DOAC, or they may also have incipient hypertension and would be encouraged to continue with metoprolol, as an example, but at a low dose. As always, the cardiologist or family physician should be consulted.