- Hey, everyone, I am Dr. Morales,
and I'm here with Senthil Thambidorai,
who is an E.P. at the Dallas Fort Worth area.
And so we're gonna hear talking about how he approaches
new patients, and sort of what his tactics are,
and how do you counsel a new patient.
So, Dr. Thambidorai, when you get a new patient who
diagnosed at afib, what are some of the main things
that you like to make sure you hit on or talk about,
especially in that initial consultation.
- Yes, so, thanks for the opportunity.
- Thank you.
- The first thing is, I like to make sure that they
understand there's two things in atrial fibrillation.
One is the risk of stroke, so make sure
that is addressed first, either by blood thinners
or any procedures that are available.
The next thing we address is we try to talk about
the stages of afib, as they like to call it.
Early being Paroxysmal, where your afib
kind of comes and goes.
Then, talk about Persistent where it's a little bit more,
you know, they require medications, shock procedures.
And I think I try to give them an understanding
of where certain therapies work better.
For example, medications work better in the early stages.
And as you approach the latter part of the early stages
or the second stage, sometimes you do need a procedure.
And then, when it gets too far out, burnt out,
then that's when a lot of these options
for atrial fibrillation actually don't work as well,
and people end up with a pacemaker sometimes.
So, I think that's mainly what I'd like to explain to them,
and explain to them afib is not a one-thing, one-stop shop.
It's something of a continuous process,
and we like to change the process and help them
so that they can have a meaningful life,
without suffering too much from atrial fibrillation.
- Yeah, that's something I see quite a lot as well,
because people will say, I'll meet them and they'll say,
"Well, I had so-and-so, I know my friend, they had afib,
"and they had a procedure, it didn't work."
And I don't think people really understand
the stages and progressions of the disease,
and how at the earlier stages when it
hasn't been around that long, or specifically in Paroxysmal,
you have the best treatment options.
And I don't feel that people get referred, necessarily,
to an electrophysiologist as often as they do a lot.
Do you see that you're not seeing patients
as much as you would like to in those earlier stages?
- Yes, I think, exactly right.
I mean, as an electrophysiologist I do feel that
being a specialist in atrial fibrillation,
we've had a lot of advances in the last decade, so to speak,
so there is more awareness to be created, saying,
to tell the patients but also the referring providers that,
"Hey, some of these options we have are better off
in the earlier stages of atrial fibrillation."
And they, you know, it's a challenge trying to get them
referring the patients early because
patients, if they're not in atrial fibrillation,
in their clinic, and it kind of becomes a
secondary diagnosis and they're talking
about other things and not addressing it.
But as we know, the medications, procedure options
for atrial fibrillation are better off in the early stages.
So, yes, it's a challenge, I think.
Doing to improve the things in the community
is very important.
- Yeah, and you brought up a good point.
You have to educate other doctors as well because
a lot of times, doctors won't send their patients
to an electrophysiologist until they feel like,
"Well, I can't handle it anymore, it's becoming
a little too difficult, so let's refer to a specialist."
But those earlier stages are when you're gonna again
have the best treatment options and the best success.
So when you first meet somebody, do you tend to favor more,
and this may be hard to answer, but more medications,
lifestyles, or procedures?
You know, how do you kind of approach it
with that first patient?
- Yeah, it's a good question.
So, I think the first is, depends on how much
the referring provide has already
talked to the patient about.
But I think we, as long as they get an understanding
of where they are in afib, then you can
talk about the next stages.
I definitely would talk about medications
as the first option.
And, you know, we'd talk about the benefits, side affects.
You know if they're a 40-year-old
how long are they gonna be taking medications,
whereas if they are and 80-year-old.
So it really depends on patient to patient.
But we give them all the options,
and now with the procedures, we just have to
give them the latest information on how
the success rates have improved from when it started.
And also the risk profile is changed that
these procedures can be done safely and effectively
in someone who deals with this on a regular basis.
- Right, right.
Well, Dr. Thambidorai, thank you for taking a few minutes
of your time and interviewing with me today,
I really appreciate it.
- Well, thanks for your time.
- Thank you, appreciate it.