I am fast losing faith in the medical profession. After two visits to A&E to reduce Atrial Flutter (and a promise of a referral which has never materialised) and two years of AFib, which is becoming more regular, I have now been on a low dosage of Bisoprolol for 6 weeks and feel rubbish! I have seen three different doctors at my practice and not one of them has a clue about the condition, the last one asked me 'So what is your plan? What do you want to do now?' One doctor told me I must continue taking the Bisoprolol, the latest one said to take it as a pill in the pocket.
Sorry, just needed a bit of a rant his morning.
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NanT
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My newly qualified GP is really very thorough but she admitted to me that she didn't know much about arythmias. This is what we are up against.
Ask your GP for a referral to a Consultant Cardiologist who will assess you and then refer you on to an EP ( ElectroCardiologist) if that is what's needed.
You need to be acertive. Don't let things ride. Take control of your treatment yourself. Make sure that they realise that you're having a rotten time of it and need help.
You obviously go to the same GP practice as me . That is precisely what they say to me and they haven't a clue about arrhythmias. They just dish out Bisoprolol like Smarties. Luckily some of them know they haven't a clue, but others, unfortunately, are positive they know everything, and one of those is one that asked me what as EP was when I asked for a referral . When I told him what an EP was he went silent, he'd clearly never heard of one.
But I now don't expect anything from them at all, and simply don't discuss arrhythmia with them, other than to ask for a referral. A couple of years ago, I went to my GP for about a year getting worse and worse. Eventually, I just went in and asked to be referred to an EP privately (open referral? not sure).
I've had an ablation and seen my EP quite a few times now, so if I have a problem I email or phone his secretary direct and usually get a quick response (that's NHS by the way).
Koll
A lot of GPs don't know a lot about it - our practice just swears by Bisoprolol. I think they'd probably explode if I asked for something else! I figure for many of us a request to see an EP is the way forward if we need extra help...
I know how frustrating it is believe me! Tell your G.P. that your plan is to see an E.P. with a view to dealing properly with the symptoms of A.F. but you will probably have to explain what an E.P. is
I believe that A.F. has only really been taken seriously since 2007 but a member of my family has just become a G.P. and she had never heard of an E.P. so I think the training needs revising! X
I was in a very similar situation to you. I attend a medical centre where there are lots of GP'S, also a good few locums. I had conflicting views from four different Doctors and prior to my last visit I was made to feel like I was wasting their time and my appointment slot should have been given to somebody else.
I asked friends and family who attended the practice for advice on which Doctor they deemed best and their advice paid off. I booked an appointment with said DR and even though I had to wait just under two weeks it was worth it. He listened to my concerns and we agreed a plan for me to take.
Agree with all said so far- one way forward is to ask the AFA ( number on their website0 who is suitable near you and then go to your GP with the details and say you want to be referred through choose and Book they have to allow this
I would suggest you try to find out if there is a GP at your surgery who specialises in heart problems. If not, find out if another surgery nearby does and transfer to there.
The GP I'm registered with at my surgery is fantastic. He knows just about everything regarding AF. If my pulse starts racing I ring the surgery and go there immediately for an ECG. After my GP has looked at the results he then faxes and posts copies of it to my EP at one hospital and also my cardiologist at another. In my 8-9 years of PAF, Bisoprolol has never been suggested for me.
My let down is my EP, he is totally disorganised and there is never any come back from him regarding the abnormal ECG results he has been sent. I didn't have my follow up appointment until 6 months after my last ablation and that was just by telephone. I have a telephone consultation with him every 6 months and no earlier, regardless of whether I've spent days/weeks in my local hospital with my pulse racing away. Also you only go to see him if you are going to have an ablation, otherwise he's not that interested.
My cardiologist is fantastic too, easy to talk to and helpful, as is his AF team who perform cardioversions. I can usually get to see them within 24hrs and they are really supportive. My cardiologist knows exactly how disorganised my EP is, as does my GP.
It has always surprised me when others on this forum suggest a referral to an EP for advice, those of you who can contact yours easily are so lucky. However, I must say that I believe my EP is good with regard to performing ablations.
Hope you soon have your faith in the medical profession restored.
Thank you all for your replies. I have asked at my surgery if any of the doctors specialise in heart conditions and was told that none of them do. I can see that it is up to me to take the situation in hand and ask to see an EP. I think I will wait a few days before making another appointment, I feel rubbish at the moment. II need to get my head around things and be more assertive. I just wish there was an alternative treatment! Thank you all again...at least you all understand the frustrations.
I have noticed how pro-ablation, rush-to-an-EP this group seems. As someone with (so far) paroxysmal AF, nothing I have heard here would make an early ablation go to the top of my list of priorities. ( pause while someone quotes the stats in favour of early intervention and says that AF is always progressive.).
Having received disastrous procedures via my groin probably also makes me biased against. I have also had open heart surgery. Putting that aside, ablation is a very serious procedure and unless you are already symptomatic, one which will make you feel worse for a while. Given that you will (or so it seems to me) almost certainly need more than one ablation, that's a few recovery periods to look forward to.
See a general cardiologist and consider less drastic options as well. And never assume that anyone, medically qualified or not, knows more than you about your condition.
Those of us who have had ablations that have very significantly improved our situation are probably biased and possibly lucky to have come through a serious procedure almost unscathed - I felt OK afterwards and felt back to normal within days, though I made an attempt to take it easy. I was able to return to my usual walking schedule fairly quickly. I've not had any problems. I did have a good bruise.
Thus I veer towards seeing an EP and give ablation a go as soon as one can. I'm absolutely enthusiastic about the procedure. Yes, it can go wrong. I was left in no doubt about the many and unwelcome possible complications. I don't know about the stats but I think the failures are very few and most ablations are a success to a lesser or greater degree. I am much much better that I was six months ago, have given up taking flecainide and I wish I had seen my EP earlier.
It was my second ablation. The first I think was fairly shambolic as my heart didn't behave and I had 6 cardioversions and after a while they thought they'd stop and see how I would get on with flecainide. Again I bounced back well afterwards and the flecainide seemed like waving a magic wand.
I am thankful we live in times when such skill and technical expertise is available.
I agree with much of what you have said, but being referred to an EP, a specialist in arrythmias, is not necessarily being referred for ablation.
Ablation is a serious procedure, and I am not going to quote stats, certainly at the conferences we have been told by ablation providers that "the earlier the better" and for many people with paroxysmal AF there are not that many options. It depends of course on the severity of the symptons, there is always a judgement call to be made between the risks of an ablation versus the severity of living with the episodes, or being on potentially fairly "heavy" rhythm control drugs if things are that bad.
My personal view is that a general cardiologist will simply not know as much as an EP, at my last visit to my cardio (admitedly a registrar) She listened to me talking about things and told me I knew much more than her about AF.
The point here is that any good EP should consider all the options, and not merely ablation, you need of course the knowledge yourself to be able to be able to question properly.
So all I would say is I agree with all you say, except that seeing an EP is not necessarily "rushing into ablation".
I don't disagree with some of your thoughts on ablation Mrs Pat but why would anyone be content to simply "see a general cardiologist', when EPs, the experts in arrhythmia including AF, are out there? It seems very odd advice indeed to tell folk they should accept less than the best medical professional for one's condition. We may not all get the best but that's no reason to give up striving for it......
The expert that I see specialises in adult congenital heart disease, which is my underlying condition and different from general cardiology. I am also fortunate in being under the care of a major hospital. My AF may be an effect of that condition. I expect the cardiologist to tell me when/if I need to see an EP as she is the expert on my condition overall.
The point that I'm trying to make is that one size doesn't fit all and having been on this forum for a while, it's obvious that there are many pathways through AF treatment. GPs are supposed to be able to guide us to the best available treatments and experts. It is equally obvious that GP education is lacking in this respect and so is the knowledge of many people in this forum. I bet GPs get fed up with people trying to bypass them.
I understand that there will be folk on this AF forum who may well have additional conditions requiring other specialisms and individuals will I expect understand that. But it is an AF forum with most of us having and discussing a problem with the 'electrics' of the heart rather than the 'plumbing'. The consistent and best advice therefore is to see an EP whenever you can.
Without wishing to sound critical of GPs - most do a wonderful job - but they are inevitably short on specialised knowledge. Therefore, I don't think you can possibly compare the knowledge of someone who's had AF for a few years and a GP when it comes to an understanding of AF. Most of us know much more about AF than any GP simply because we've studied it in much more detail and over a longer period. My EP, on the other hand, knows infinitely more about my condition than I.
I have AF - nothing else thankfully - so when it comes to deciding on the merits of consultations with a GP, a cardiologist or an EP? In who's company do you think I'm likely to get most benefit?
Unfortunately, when new or recently diagnosed people ask a question, there is a tendency for other people to cut to the chase and propose warfarin and ablation as the immediate way forward. As well as there not being one size fitting all, there are quite a lot of opinions masquerading as fact.
People don't always take time to understand the particular and personal medical history involved and may make inappropriate suggestions. It takes someone very skilled to ask the right questions and propose a solution. There are some great GPs around and some terrible cardiologists. That I do know for a fact.
This is an AF discussion forum which provides just what it says on the tin. It has provided me with a wealth of information on the subject of AF and I believe it is immensely helpful to many. Largely providing a 'pick and mix' of ideas, there are, of course, certain consistent suggestions made, such as the importance of being on anti-coagulants which, other factors aside, is a no-brainer when, unprotected, we would all be at least 5 times more likely to have a stroke than any other member of the general population*. Of course none of us know "the particular and personal medical history" of other forum users and while I am one of warfarin's greatest advocates, I'm not prescribing them for anyone on this site. A qualified doctor will do that.
Hi Mrspat - One size certainly doesn't fit all, that I agree with. Ablations have given so many people a better quality of life, so they are going to sing its praises. There will be people on here who are very happy on their medication and if there are no side effects will happily pop pills for as long as they work.
What I have found so far with my AF is the GP'S and Cardiologists I have seen do not see it as a serious condition (My opinion based on my consultations). They see me as a fairy young fit guy who has very little symptoms whilst in AF, so whilst I don't complain too much they are happy for me to jog on.
They're the medical professionals and I take what they say as gospel, but I do feel like I need to speak with somebody who specialises in my condition. After all AF is progressive, so if I am to take their word, which I currently am doing. What if I was to develop further problems down the line, that may have been averted by seeing somebody who specialises in AF? I haven't seen an EP yet, but if my symptoms do progress I will certainly request it, through the correct channels
I was told by my cardiologist that if my extra medication did not 'settle me down' he would refer me to a an EP for an ablation 'but the longer you wait the better they'll get at it' which suggested to me that it is still seen as a bit of an experimental procedure so as long as my QOL is fairly good I'm waiting.....
As I understand it, ablation is a procedure with a very good track record and a high percentage of success, even if not first time. It does have very serious possible complications which happen rarely. I've seen the list and been very whiffled by it as I waited to wander along to the Cath Lab. I wondered if they would be the last steps I would take. Minor things too can go wrong, but I've come though two ablations unscathed and considerably better off.
As I've said, I would have another without hesitation but I don't think any procedure that pushes wires through your veins and into your heart will ever be guaranteed trouble free.
Incidentally my first ablation was carried out before I had tried any antiarrhythmic drugs.
Don 't down tools always push forward it's your life xx
Oddly, I have just posted my update this morning on my journey for a referral too, it's been a long one. Maybe GP's are like a child with a new toy they just don't want to let go, since getting there new funding and being the decision makers on who is referred. I have seen a few Consultants lift there eyebrows about this new power GP 's have on patients. Let's hope it's not us the patient who pays for this change.
For the moment I am not feeling the need to see an E.P., but when I saw my G.P. to-day I mentioned the possibility of being referred to one if it should prove necessary in the future. In a very curt manner I was told that only a cardiologist could refer me to an E.P., and then it would only be if he deemed it absolutely essential. I was left wondering exactly what "absolutely essential" meant!
From what I understand, you do have to be referred to an EP through a cardiologist and they will only refer you to one if several types of medication have failed to halt your AF. Then when you see the EP he will suggest an ablation. That's been my experience.
That's the kind of doctor/patient relationship that belongs to an earlier time. A time when doctors and vicars were spoken of in hushed tones by their 'ever so grateful' hat-doffing, patients and parishioners. God preserve us from such self-deprecation!
Your GP can most certainly refer you to an EP and not just any EP - one of your choice. This is your right and it will occur when you, no one else, deems it is time. Please don't accept a curt manner from your GP. Of course he may simply have been having a bad hair day (don't we all now and again) but, in general Langara, you deserve much better than that and if it persists, change your GP. You have a right to do that too....
I agree with a lot of what has been said- I insisted on Choose and Book so asked for a particular hospital and was very impressed with the EP I saw- If I was symptomatic enough I would be happy to have the risks and go for ablation- however she is not so good on the intermediate position- as someone else has mentioned, so ideally i would ask to see a cardiologist- you have a right to insist on this through choose and book, but ask the AFA for advice as you want one who will refer you to an EP for ablation if that is that best option- or treat you if it's not!!
Mmmm I was referred in my hospital bed by a cardiologist who came to discharge me onto an EP there was no GP involvement whatsoever. In fact the letter was done before I'd got dressed and left the hospital......I dont know why this happened which must have annoyed my practice not having any control over that decision
After my AF and my annoyance at the lack of treatment from this GP and a previous GP which I believe caused me to end up in hospital with AF in the first place I started to make appointment after appointment I kept going back until they were sick of the sight of me to get what I want on anything I did this when they were being funny about prescribing Apixaban and I got it in the end. I used to be a GP surgery whimp and accept what was said to me but not anymore..and I can't wait to sink my teeth into two GPs in that practice when the opportunity arises
After terrible treatment from my local hospital I found the AFA and this forum. Researched the list of EP specialists provided and contacted the specialist I now see. He was happy to see me privately on referral from my GP. Recommended ablation and warfarin. Had my ablation two weeks ago and don't regret it one bit. My GP is very knowledgable about AF. That could be because he did his training in cardiology at Barts hospital. Looking forward now to a better quality of life.
I am lucky that my Regular GP does know about Heart and AF conditions and tablets but would not acknowledge that I also have lung conditions independent from my heart problems. It was only when I found I had been working with asbestos and I insisted on a spiro test did it prove after a consultants visit I have RLD as well!
They are what they say on the tin General Practitioners not specialists but human beings.
Don't forget you can request a specific Consultant Cardilologist specialising in EP to GP using NHS choose and book. That way you could choose a very experienced major EP clinic for what would be infrequent visits.
Thank you all for your replies. This discussion has been very interesting and informative. Just as an addendum - I went into Atrial Flutter on Friday morning at 150 bpm which had not rectified itself within 3 hours. Got myself to the hospital and was treated in A&E by an excellent doctor who I think is the EP specialist there. Sent on my way with much more information than previously. I am awaiting an appointment at the clinic (waiting time 8 weeks!). Had another short episode last night but only lasted about 30 minutes. So...watch this space.
I hated bisoprolol made me so tired and weak , came off after month now take mosoprolol as pill in pocket , only needed it once and was good ,ask to change or take as and when , good luck
I was on a cocktail of drugs last year and most of them I am off now, they made me very very ill and were not right. Statins made me really poorly, heart pain, neck pain, nausea and Bisoprolol knocked me out, in fact I couldn't exercise as I felt like fainting all the time. The cardiac rehab nurse I spoke to was really helpful and told me that there are many different beta blockers and mentioned nebivelol as "a baby beta blocker" which I now take at 1.25mg - the smallest dose and even that is a bit high for me and I scrape a little bit off with a knife so probably take about 1mg. My blood pressure is still very low but at least I can cope and I can now exercise. Good luck with getting someone to take you seriously. Sometimes they don't tell you about drug options as these other drugs are more expensive.
Keep on keeping on! Feel free to rant too. It can be really important to get things off your chest.
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. That is precisely what they say to me and they haven't a clue about arrhythmias. They just dish out Bisoprolol like Smarties. Luckily some of them know they haven't a clue, but others, unfortunately, are positive they know everything, and one of those is one that asked me what as EP was when I asked for a referral 
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