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AF Association
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Best Hospital for an ablation

Does anyone know how to find out which hospital or hospitals have the highest success rate for a first ablation? On their website St Bartholomews say they have higher than average success rates for heart procedures generally but do not refer to ablations specifically. Obviously, a hospital with even a 5% higher success rate would be worth looking at (provided its safety record is also good). Patients are supposed to be able to choose which hospital will treat them, but how can this be done in an informed way if the data is not available? I suppose it’s possible to ring the hospital, but it’s very difficult to know who would have this information. I tried on Friday with little success.

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How do you measure best....Barts does have a good reputation and Prof Schilling is probably one of the most revered EP’s but there are many in London who work to high standards and have good success rates. It should be possible to determine individual success rates but unless they are assessed in the same way for everyone and everywhere they are probably a bit speculative. My procedures were performed at St George’s Hospital, London and I was very pleased with the outcome.....good luck

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Dr Matt Wright at Guys and St Thomas’ and Richard Shilling (Bart’s) both went to France (Bordeaux) in the noughties to learn what was then a new and emerging technique (cardiac ablation). They both have a large series of cases and outstanding outcome data.

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My understanding is that the first RF ablations were done around 1994. Sabine Ernst now at Royal Brompton assisted the first in Germany that year. My first was 2005 .

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Mark O’Neill in St Thomas also trained in Bordeaux, I believe. He did mine and no AF for nearly 6 years. That doesn’t help you with statistics!!

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I think any of the major regional centres are good. I think it more important to go with an EP you know, respect and establish a good working relationship with.

There is a list on the AFA but if you are thinking private - go to the BUPA site for a more comprehensive list. If you are thinking NHS - I would also think waiting times and include that in your research criteria.

Personally I would do my own research and not rely upon others opinions or experiences. I chose an EP who trained and worked at Bart’s but the procedure was done at a private hospital, without the most up to date equipment. In hindsight - I would have done more research and asked more questions. That however was several years ago and I think most of the centres now do have excellent equipment as things move very quickly in this field.

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Richard Schilling at Barts and London AF Centre has trained quite a few outlying EPs over the years . He does , however , prefer cryo ablation and using the robots he does can perform many more such procedures a day than RF. Beware, therefor, that if your heart is nice and regularly formed cryo will be hightly successful but many people will need a second RF ablation to reach the areas the balloon can't reach.

I also think one needs a better description of success than seems to be generally accepted. Does success mean a reduction in symptoms where maybe a patient has none but is still on medication or does it mean no AF and no medication as in my own case (after three procedures). Does it mean no arrhythmias at all and I include ectopics. If it does I suspect real results are far lower than people think.

Richard Schilling once told me that if a patient had no AF (proved by a seven day holter) after five years he would say they were cured. I doubt that definition is used today.

I know from my own experiences that results in any sphere can be massaged by careful choice of subject. For example accepting only cases which appear simple can heavily weight results towards success. My own EP at Royal Brompton seems to get many highly complex cases so his quotes may be slightly lower than some others.

Remembering also that any and all treatment for AF is only ever about improving quality of life (QOL) so succes may well mean different things to different people.

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Bob - I don’t believe that Richard Schilling is using robotics at present. I spoke to him several months ago and he told me that the company producing the unit he was trialling had collapsed. I was surprised by this as I wouldn’t have expected robotic assistants to be significantly different between different medical disciplines.

Regarding cryoablation, this is probably appropriate if ablation is going to be restricted to the pulmonary veins, but in my case he used only RF as he anticipated a need to ablate other areas, also.

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I haven't spoken to him for a while but he told me that it was just a lot easier and safer for him not having to stand for long periods wearing lead armour and be able to sit outside and perform.

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Is the lead armour because the patient is exposed to a lot of radiation (x-rays)?

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No because the staff are. The waistcoats and kilts are quite fetching actually. To build up a picture of what is happening they do not use a continuous Xray but a pulsed one similar in principle to the old cathode ray TV screens I think so there is a lot floating about in a cath lab. I can't tell you the pulse per second but have an idea that this can vary from lab to lab.

Wheras the patient is only exposed for the period of the procedure, the staff are there all day every day so need long term protection.

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Bob said "Richard Schilling once told me that if a patient had no AF (proved by a seven day holter) after five years he would say they were cured. I doubt that definition is used today."

Given I wore a seven day Holter several times before my ablation and it never caught any of my AF episodes despite me pressing the button when I had problems, I would cast doubt on that definition as well !

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If you are referred through a cardiologist some have 'pet' EPs which could be a good thing as it means your cardiologist has a good connection with your EP. I was given a choice of going to Bristol or Harefield. I chose Harefield and had a phone consultation with my EP, David Jones. The next time I saw him was when I came round after the ablation! My cardiologist did the follow up appointment. My impression was that David Jones was technically good but had the bedside manner of a rugby player! As the technique was the most important thing to me I didn't care. But if you are a person who wants an in depth discussion and personal attention you need to look at that aspect as well.

Should say my ablation for AF and flutter was very thorough but after two years I began to have noticeable episodes again, though not nearly as extreme as before and only take the lowest dose of Diltiazem so QOL very much improved.

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PS I am sure you have heard the saying 'There are lies, damn lies and then there are statistics', particularly apt in this case because (play on repeat) all AF patients are different. And as someone already mentioned taking on more difficult cases would skew the stats. I could go on but you get the picture? Also bear in mind that your carefully chosen EP has been known to hand you over to someone else on the day, no doubt for a good reason.

There are definitely risks, some of them serious, so you need to bear in mind that the longer you delay the more difficult the procedure may become, and try to strike a balance accordingly.

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David G Jones has been a fabulous EP for me and I would say that he has the build of a rugby player but there was nothing wrong with his bedside manner at all!! He explained everything clearly and discussed all the options through my long tortuous AF journey. He is keeping another possible ablation up his sleeve for the future and I would trust him completely. A great EP/ Annel

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I accept it was probably the circumstances - long distance consultation - that gave me that impression, plus a hurried visit to decide whether it was safe to discharge me. I'm glad your experience has been different and I agree he is a great EP 💟

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I have two pieces of hospital paper saying "ablation succesful", which it probably was an hour or so after the procedure, but AF returned within hours and days of both. So, did the cardiologist record this as succesful? I was told by him that he had a very high success rate - based on days, weeks or months? Who knows? Having had AF for over 20 years, it now seems to be persistent/permanent, and having recently decided to stop all medication, (I've been on nearly all of them !) other that riveroxaban, have seldom felt better. OK, so I'm rather cynical about "success rates" and the pharmaceutical industry as a whole, and don't get me started on Statins !

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Richard Schilling actually publishes his audited results. They can be found on the London AF Centre website. So far as I know he is the only one that does.

Peter

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