Should people with arrhythmias be seen by an EP or a cardiologist or both or does it depend on the Doctor? Do you only see and EP if you are going to have ablation?
I have seen numerous cardiologists and one EP, and feel like I should have been referred to an EP from the beginning but don’t really understand how it works.
An EP is a specialist in rhythm problems.
A Cardiologist is a general heart specialist.
The latter should understand but the former understands much more.
I have only ever been under the care of an EP.
Pete
Thank you Pete, the reason I asked is because I’ve noticed so many people seem to be referred in the first instance to a cardiologist ( understandably) but then never get referred on to an EP. I think that’s a shame. I also wanted to be sure just incase I advised someone to seek out an EP and it was the wrong advice.
I believe that the EP is the better option for the reason Pete has given - the EP knows rhythm and can advise more precisely.
There may also be an availability issue in some areas. I was first referred to an EP in Belfast where the NHS waiting list at that time was 13 months for routine referrals. I decided to see him privately and was then transferred back to his NHS list. Although i decided not to have an ablation, it was useful to open the door with an EP for the future.
PS - should have said that seeing the EP was the best decision I made.
Thank you for replying. Wow, 13 months is a long time to wait. I can imagine that seeing the right specialist swiftly must have really helped you to understand your options. 😊
In my area you are referred to an EP if medication prescribed by a cardiologist has failed to keep you in normal rhythm. My EP is really only interested in doing ablations. I've had three and still have periods of AF at times. He has said he can do no more for me, so I'm just under the care of my GP now.
Jean
Same here. Fortunately my a fib needs are few. Once EP found out I didnt want ablation, he wasnt too interested, so my cardiologist keeps an eye on me. Im fine with that. If we had an issue, I can always go back go EP( Im in the USA)
Thank you for reply, that’s funny I just posed the question to jean about wether EP’s are only really focused on ablation as a treatment.
Thanks jean, that’s really helpful. Do you think that that’s the way with most EP, really only interested in ablation as a treatment? Be interesting to know.
I have a friend whose EP sees her regularly and he doesn't appear to be steering her towards an ablation, so I don't think all of them direct you that way. Of course in general, ablations are their speciality and I guess a cardiologist only sends you to one when he thinks an ablation is the way to go. I think my cardiologist listens to me a lot more intently than my EP does. Just down to different personalities sometimes I guess.
My EP has certainly never discussed lifestyle changes with me. Looking back now I think that is one of the most important aspects of managing AF.
After a year and a half of seeing him, my EP said he would advise against ablation for various reasons but things could change and we could reconsider. No doctor has ever discussed lifestyle changes except foregoing alcohol with me either. I learned all that from this forum.
I think it's heartening that your EP advised against an ablation, it shows he's just not out to find himself work performing them.
Yes, I've learnt most of what I know from this great forum too. No medical professional I've met has ever advised lifestyle changes to me either. I'm just thinking wouldn't it be lovely if we all had Dr Sanjay Gupta as our cardiologist. I would trust what he advised completely.
It’s quite confusing isn’t it, if the problem is solely down to arrhythmias and not another problem with the heart then it would make sense that a doctor that specialises in arrhythmias would be the person to see. But I suppose you wouldn’t repeatedly consult with a surgeon after the initial operation, you would go back to the specialist who referred you to the surgeon, wouldn’t you? Does that make sense?
That’s where I am now Kelly. I see my original cardiologist every six months and he will report anything of note to the EP. So far, so good.
That’s great news!!
Is it weird that I feel like I just solved a jigsaw puzzle by figuring that out in my head 😂😂😂😂
My EP won’t perform any ablations now. He used to.
That’s interesting, Just on you or in general? I wonder why?
Would you ask a plumber to re-wire your house?
The usual route is GP or in extremis A and E and back to GP. Then if GP can't sort you out in a month or so refer to a cardiologist or arrhythmia specialist. If meds not working then can ask for referral to EP.
Some drugs (anti- arrhythmics ) can not be prescribed by GP only by consultant level in hospital. GPs first line is bisoprolol.
There are clear guidlines laid down by NICE for AF care but sometimes one needs to fight one's corner to get where you want.
Re an EP, I am reminded that I once commented that if you go to see a carpet salesman he will sell you a carpet. I do know , however, that many EPs here in UK have been known not to advise ablation. but advise life style changes as we have discussed elsewhere first to see if ablation can be avoided.
Thanks for the really helpful reply.The plumber analogy is great and is precisely why I asked this question. It seemed strange to me that the problem is with electrics yet you get sent to the plumbers office 😂 and it seemed to be so common, one of the things I’ve really noticed through the forum is how many people refer to “their cardiologist.”
Good to know the guidelines, shame that so many people seem to get to the cardiology referral and it stops there.
Also interesting that not all EPs immediately use ablation as the preferred treatment, I’ve just been wondering about that too. 😊
I had my first cardiologist appointment yesterday he said my ecgs 24hr monitor and heart scan all looked normal and was not happy my gp had put me on bisoprolol when not knowing what for. I started havibg palpitations somecwith dozziness in December they last from a few minutes to 30 mins. He said its not my heart but something else causing them. I have been on iron by my gp as is was low and i was slightly anemic and was not feelingvwell for a few months, feeling better with some iron and have my colour back. Im a little worried about coming of bisoprolol last time i was told to due to low blood pressure i had a bad episode 3 days after stopping iwas only on a very low dose. So im hoping he is right and wont get a bad episodes this time its not easy when your kids have to see you go through it.
You can wean off the Bisoprolol very slowly rather than just stop. This can be done by cutting pills in half then taking every other day. How small a dose are you on?
In down to half of 1.25 now thankyou for your reply
I would not stop it suddenly even if the doctor says you can. Often that last small dose is the hardest to abandon. If you are to stop it wean off to a half of that and after a few weeks try taking it every other day befre stoping completely. This helps allay any withdrawal symptoms.
Thankyou for information i will do rhat
Maybe sometimes too many cooks in the kitchen...
When electricity was very new, and everyone was using gas lights, it was the plumbers who did the electrical work. Earliest wiring was silk wrapped wire run in lead pipes!
I was once told (1960's) of an electrician who always believed a blown lamp should be left in the socket, or else the electricity would be wasted. I never fell for that one, but OTOH it wouldn't surprise me too much.
This takes the analogy to a whole new level. 😂
Although I'm in permanent a-fib and have a pacemaker and an AV node ablation that was almost three years ago.
In the group practice (very large) that takes care of my cardiac needs the usual procedure is to have a basic cardiologist and then an EP if you need one. When I had AF problems it became the norm for me to see both the reg cardiologist and the EP. So I was paying for more frequent visits often with overlapping info ( or sometimes dissenting recommendations).
I wasn't happy with the Cardiologist as she was fixated on prescribing statins which I didn't want and didn't think I needed. I began to dread my visits with her.
By this time I had the pacemaker and ablation, was off all meds except lasix and coumadin and was very stable and well-controlled compliments of my EP.
All I needed was to go to the pacemaker clinic followed by an EKG by the EP every six months. I also needed to get my lasix and coumadin Rx renewed. I did my own INR's which were signed off on weekly by the EP after I called them into the Coumadin nurse.
I really love and trust my EP so about 2 years ago I told him I thought seeing the cardiologist who I had no confidence in anyway was a waste of time, money, and added to my stress. BTW he agreed I didn't really need the statins.
He agreed to also act as my primary cardiologist so I no longer had to deal with 2 doctors.
My primary care doctor (PCP-US) (GP-UK) has nothing to do with my cardiac care-no EKG's, no prescriptions, - nothing.
My EP handles everything cardiac and this has worked well for me. I'm definitely on board with don't go to a plumber when you need an electrician.
My personal opinion is that since EP's are cardiologists with more specialized training and knowledge they are better equipped to take care of me.
I also realize I'm very lucky to have a say in being treated by the EP. In the US my insurance coverage is the same for visits to the cardiologist or the EP. Higher costs come into play over procedures, tests, etc and I know it is probably not the patient's option to choose in the UK and other countries.
I wish you were able to have more say over your care. Ir's reassuring to me to be able to choose my doctors, and refuse care from those I have no confidence in.
That’s so interesting, thank you so much. I’m really happy that you are under the care of what sounds like a brilliant EP, and you have such a great relationship with him.
It would be good to have more control and choice but that’s just the way it is. I think the hardest thing about our system is navigating it when you are not well. It takes a lot of energy and you may have an idea of who you need to see but you have to go through many different levels repeating the story before you get there, it’s easy to feel too overwhelmed to keep going and at that point you can get in a real mess.
I know. My sister was married and lived in England in the 90's. She had several encounters with surgery and hospitals. She received excellent care and overall was very pleased in the end but having to go round the Mulberry Bush at times was a new and frustrating experience for her.
I wish she still lived there so I could go and visit her more. She lived in a small village in Cumbria ( we took the train to Barrow-in-Furness(?) to shop.) I loved where she lived. You could see the sheep across the road from her living room and go down the road to get fresh eggs from the farmer. So different from our big cities here. (US)
And now we have the Orange Toddler to contend with!😡
What a pleasant way to live! Cumbria. 🐱
I lived in Cumbria for a few years and know Barrow in Furness well. I lived just outside Windermere and also in Ambleside. My very dear friend lives in Kendal so I go there often 😊
My sister lived in Millom and we would go to the train station in Haverigg (or maybe vice-versa). I really wished she was stilled married to her husband (He was a Scot from Colonsay-very nice man) and we all talked about me retiring there and living with them. I would have loved that.
I don't drink now but he introduced me to Lagavulin when I was a scotch-drinker back then.
Aw, sounds wonderful. I’m a Scot too, from the Isle of Arran. That’s where I would like to retire to many years from now 😊
is there room for me? I could pretend to be your aunt LOL. L l0ve the Hebrides. And Colonsay was really neat with the strand where you could walk to Oronsay at low tide.
Nothing like that in the US.
I've lived outside the US many years ago and really enjoyed being a part of another culture.
PS My EP didn't rush me to ablations or other procedures. He worked with me for 3 years trying different med combos, 2 stints with Holter monitors, 2 cardioversions, and anything else he thought might work before WE finally settled on the 'Pace and Ablate'. And actually it was me
who asked for it as I was tired of all the other things not working and the side effects from so many of the meds.
I'm happy I did it. It's been smooth sailing for me ever since.
That’s great, a really well handled approach by both of you to a solution that has worked for you.
After our conversation the other day I just wanted to say that if I had met my EP 12 years ago when I had my first AFib episode after many years of SVT I most definitely wouldn’t have had an ablation. It was mentioned to me various times over the years but I was so young and felt that it was not the right thing to do and no one could have convinced me otherwise.
I do believe that we have to be ready to do things much of the time. Sometimes when things are forced on us the timing may be wrong for us..
"When the student is ready the teacher appears..."
I disagree with you a little there Bob. I believe heart consultants know absolutely everything about the heart and it's electrics, but just don't perform ablations. Dr Sanjay Gupta as an example is a cardiologist and not an EP. I'd much rather hear what he had to say first to help my AF rather than going straight to an EP.
Over the years I've learnt that it's the food we put into our bodies that has the biggest effect on our AF and health in general. I really don't believe it's a good thing to direct people straight to an EP when they are newly diagnosed with AF. Far better for them to be sent to a dietitian who specialises in heart arrhythmias and what lifestyle/foods can cause/trigger it. I guess we can only speak from our experiences.
Jean
Jean I didn't suggest that. I merely laid out the guidelines . I quite agree about life style issues and know how important changes are to ones QOL.
I feel you are belittling Cardiologists, by saying they are plumbers and not electricians. Cardiologists know everything about hearts including the electrics, they just don't perform ablations.
its called a joke Jean. Let's not fall out over it please. EPs aren't carpet salesmen either.
One may be lucky enough to find a cardiologist who is fully up to date in all the latest procedures and ideas but there are still sadly a fair few dynosaurs around who don't seem to approve of EPs and what they do. Met a few of them!
We won't fall out Bob, you know it would take a lot more than a few words to do that. Friends can have different opinions and discuss them, as we all see things differently. Your structural knowledge of the heart and procedures relating to AF etc., is great and much respected by myself and other forum members. You're our leader in this odd cult. Lol.
In general, it happens quite a bit on this forum and not just by yourself, I don't think we should be directing people here to go to an EP so soon after diagnosis and diet should be the first important issue to address. Going to a cardiologist first can rule out structural problems with the heart and they are more expert than than us to decide if an ablation could help. I'm thinking now perhaps I should have made what I'm saying here a new post and directed it at everyone who promotes going straight to an EP as soon as AF strikes.
As I've said, I think our viewpoint all depends on what we have experienced from medical professionals and goodness don't they differ! I know it's not common, but let's not forget that some people (including my sister) have a few AF attacks and then they suddenly disappear and who knows what caused them. I just think good job she wasn't advised to go straight to an EP.
Looking forward to meeting you again at our breakfast meeting, you can hit me around the head then.
Jean
I know that you haven't been to any of the RD and E patient group meets that I have so maybe not met Steve, Matt or Lynn but what impresses me about the team there is that they do concentrate on life style issues. OK I also know that they have severe financial constraints with a very limited budget for ablation. Why would you offer ablation to a 22 stone heavy drinker when you know that it is not going to hold and it may mean a better candidate missing out? I have heard of quiet a few people being told to go and lose weight before ablation could be considered and whilst some may think this unfair I would argue it is a wise use of limited resources. Our NHS may not be perfect but it is not yet driven by financial greed on the part of EPs who get paid whatever. I do worry about some parts of the world.
As this started with a joke lets end it that way with one told by a doctor at our first every AFA Patient's Day.
A man was standing on a river bank in Africa with a cardiologist and an EP. In front of them was a fierce lion and in the river were lots of crocs. "Don't worry said the cardiologist i have a magic potion which will send the crocs to sleep and you can cross the river in safety" . "Oh No" said the EP "I have a rifle and can kill the lion and you will be safe"
The cardiolgist then leant over and whispered " Sometimes he misses".
Agree with all you've said and love the joke.
It's getting to the RD & E that's my problem. I only drive locally now as doing so in strange places stresses me!! Poor old girl!!!
Don't forget to have Bob send his jet to pick me up in Atlanta this time!!!
Will let him know. x
Can't resist: Judge Anderson passed away and when got to the Pearly Gates St Peter offered him a short orientation.
As they were walking around heaven St Peter said 'We don't have many rules up here but we do have one. Here everyone is equal so whatever honors we earned on earth we don't display. I'm afraid you can't wear your judge's robe up here.'
The judge agreed, thought that was fair. As they continued to walk the judge kept seeing a man walking around wearing a lab coat with a stethescope around his neck.
He was beginning to get annoyed and finally asked St Peter why this man could wear his doctor clothes and he couldn't wear his robe.
St Peter said, 'Oh, I forgot. We do have one exception. That's God and sometimes he likes to play doctor.'
Love it 😂😂😂
I think from the posts I've read that cardiologists and GP's in general may have a broader knowledge base in the UK as because of the NHS they are expected to treat more problems.
Here in the US there are so many specialists that most doctors guard their piece of the pie jealously and don't look fondly at doctors who overstep their field.
JMO!
I really wish I had found an interested cardiologist over the years but I think the paroxysmal aspect of the condition can make it more difficult.
I also wish I had been more aware of the diet and lifestyle effects, I had no idea until you mentioned it that there are even dieticians that specialise in heart arrhythmias. Really interesting stuff 😊
Very recently( only a few weeks ago) as I was being whisked to a&e the paramedic looking after me asked if I had ever seen an EP, I said no. He then went on to tell me that’s who I need to see, his explanation went exactly like this...
A cardiologist works with the guts of the engine and an EP deals with the fine tuning! Along the same lines as the plumber and electrician analogy. For me it just simplified how we see the different areas of expertise especially if you are really unaware that your condition has a specialist all of its own. I thought that EPs were cardiologists with a specialist area, is that not the case?
Hi Kelly, yes I believe EP's are cardiologists with a specialist interest in the heart electrics. I believe the majority of EP's lead you straight to an ablation and after having had three ablations myself I really wish I'd tried diet and lifestyle changes first.
Please be aware that my views and regards towards medical professionals differ greatly to most people. I believe in trying to find the cause of any health problem first before resorting to tablets and medical procedures. My GP recently told me that never in his medical career had he had another patient like me. Not sure if that was a compliment or an insult but he said it nicely. I just don't run with the herd and question rather than just accept what medical professionals tell us. I don't see them as gods who must be obeyed as some do.
Jean
Thank you jean 😊
I think your views are really interesting and not in anyway out there or unusual, I come from a family of inquisitive questioners particularly regarding their health. I agree 100% that lifestyle, stress and diet are the at the root of a lot of ill health. How can a body be healthy if it is not nourished and rested correctly or dealing with wine o clock everyday and processed foods containing really high amounts of sugar?
My constant questions and resistance to certain drugs like adenosine and the like have had me labelled as difficult, resistant and anxious. A doctor in a&e once told my husband he needed to talk me round after refusing adenosine, telling him I was very close to a cardiac arrest. I wasn’t.
I too always always search within and for a solution especially to health and I know that adhering to a healthy lifestyle might not cure all ills but it definitely helps you to feel better.
When my dad was dying the nurse gave him some pills to take as I was by his bedside, she didn’t explain what they were just that it was time for his medicine, he obligingly popped them in his mouth.he had pneumonia and was very weak but as soon as she was out of sight he sat up and spat them out and said “ I’m not taking that s**t anymore it makes me feel like death! We cracked up laughing. ❤️
Love the story of your dear dad spitting out his pills, his comment and making you laugh when he was so near to the end of his life - my kind of person!
You sound like a kindred spirit and I like the way you express yourself in your posts, you're interested, totally open and welcoming to all opinions you receive. A real breath of fresh air.
Yes, I feel some doctors don't like you asking questions. I wonder if it's because they're not sure of the answers. Ask questions and be punished by being labelled anxious, huh!
Jean
Aw, jean thank you so much, that was such a lovely reply to read.
My dad was a real character that’s for sure, he has only been gone 18 months and I do miss him.
One more story from his last few days in hospital....
The nurse arrived to give him a shot, it was a blood thinner I think. She administered it into his stomach and he asked her what it was she said it what make him feel better but didn’t tell him what it was. He said rather loudly “well now I know for sure it’s a bloody placebo I’m getting, look at the bloody state of me” he wasn’t joking either! But when she left he turned and glared at me and we completely cracked up. His mates used to call him paranoid pete 😂😂😂 he was very anti-establishment, a real free thinking free spirit.
That story made me laugh. I love free thinking spirits.
In the nursing home where I used to work we had an elderly lady who told me her father visited her every day. I listened intently and replied to her when she asked if I'd met him, that I never had, but how lovely it was that he visited. Who was I to say that he couldn't possibly visit her and perhaps he did in spirit, what a comfort it was for that dear lady to believe her father visited her. I try my best to keep my mind open to the unknown possibilities in this world and remain free thinking myself. Sometimes I find it best just to keep quiet about my views, until someone just hints that they may think in a similar manner!
I knew someone in a Home who not only saw her family on a daily basis although they were very dead but had frequent visits from the Queen who, she said, would take tea with all residents. One day she announced she had had a snake round her neck that morning and this, her visiting live relatives thought, was over the top and unwisely said so. In comes the nurse "Oh, she's been so brave! The man with all the exotic pets visited and she was the only one who would have the snake round her neck."
Sorry, Kellyjelly - in answer to your question my consultant is my EP who is in charge of my treatment, although I have been discharged. I can contact him should I need to. I was referred by a cardiologist but he is now out of the picture as I have no cardiology issues - just AF.
A great story and a lesson to the doubters.
Isn’t it lovely to know how much she enjoyed his visits, that was her reality and that’s real enough for me.
My dad was a lifelong fan of Bob Dylan, my whole family love him because of my dad. Now whenever I hear Bob Dylan’s music by chance I feel like my dad is around. Funnily enough on the way to the EP appointment I switched on radio 4 (not a music station) at the exact moment desert island discs was on and at the exact moment blowing in the wind was played. Random coincidence and really no big deal but I teared up and felt my dad was around.
Whatever gets you through eh? I’m not a religious or particularly spiritual person, inherited my dads free spirit I like to think x
I agree. I'm usually swimming upstream.
Sometimes I probably express my opinions too much on this forum. But I feel like I have friends here I can be open with,
One of the frustrating things for me is my senior living building is filled with 'Trumpers'. Sometimes I feel like I'm living in a Trump rally. When I first moved in 3 years ago I made a comment about 'T ' (I am a DEMOCRAT!) and I almost started WW 3. Trumpers are very militant so hnow I don't say much to most people here.
It's stressful not to be able to have an exchange of ideas with people who have different viewpoints. But these people are militants so I don't express my feelings.
The older I get and further removed from my days promoting mainstream dogma to patients the less trust I have in the American healthcare system and the less meds I want to take-especially new ones which are often touted as miracle drugs and are then recalled six months later.
Good for him!!
Having the same views myself and having suffered more than one misdiagnosis and serious adverse drug reaction I find I have a somewhat fraught relationship with doctors!
I can understand that totally. We have to keep our wits about us and question everything.
Me too at times, it can feel like a really disempowering experience sometimes. I read an article in the Sunday times about how women feel like they must show no emotion when visiting there doctor in order to be taken seriously. Isn’t that sad 😪
Very but I can understand it. They might clock you as hysterical if you cry!
I agree totally about your comments regarding lifestyle/foods (sugar particularly). A dietician who specialises in heart arrhythmia's I haven't come across. Can you provide any further information?
I would love to meet someone like that too. I would actually love to do that as a job.
I've not heard of one either, but that's what we need! Did you read the post a few days ago where someone, I think he was doctor, devised a diet that cured him of AF. He's written a book of recipes to help AF suffers.
Jean
Aw jean, we were all getting excited then 😂 I would love to do that as a job so much. Maybe when my heart is all better 🤞 I will retrain 😘 i did see that post the other day. I bought a book recently by a man that got rid of SVT, it’s called The Gut Healing Protocol by Kale Brock. I’m not making his first name up, I promise. Worth a look
Thanks for the tip, but I think you've made up the whole name Kale Broccoli. Lol
😂😂😂😂it is a real person I promise.
😂😂😂😂it is a real person I promise.
Some interesting books to look at:
1, Eat rich -Live long. Written by a doctor Jeffrey Gerber and Ivor Cummins looking at low carb and Keto diets, with well balanced, scientifically validated and clearly identified data drawn from reputable, large scale surveys.
It looks in great detail at the relationships between sugar, insulin, cholesterol and fat and its role in causing inflammation in the body, sticky blood, blocked arteries and obesity, insulin resistance and its links to diabetes 2 and heart disease. You will need to get your thinking cap on to read it as it is very thought provoking.
2. The Scandinavian Belly Fat Program Written by Berit Nordstrand a Norwegian physician and specialist in clinical pharmacology who devotes her career to the study of how medicine and food work on the body’s receptors. Also a certified cognitive therapist, Berit serves as chief consultant in a clinic specializing in addiction medicine.
Her book draws on practical recipes to deal the menace of Fat in your system. Again a very well researched book
Wow, thanks for that. I have a huge pile of partially read books by my bed and I dip In and out depending on how intelligent I’m feeling 😀
These sound like books that could join the pile for sure.
So do you intend to train as a nutritionist?
I really don’t know,I’m in a phase of great change in my life I think. My daughters have flown the nest and I’ve worked part time all their lives so that I could be an on tap mum. I love my job, I’m a housekeeper for a very lovely family and still work 9-3pm even though I don’t have to be at the school gate anymore. My husband is my biggest champion and wants me to pursue whatever path I want,I’m very lucky. I have lots of interests and just need to get this health stuff a bit more under control and then really think about it. Watch this space 😁
If I do become a nutritionist specialising in arrhythmias you can be sure that jean can have free consultations for life seeing as she invented it 😂
Nice one. I am sure she will be the first one at your door,
Along these lines I am seriously considering taking the supplement serrapeptase-still researching it, Anyone having opinions or experience would love to hear, Maybe start a new thread. From what I've learned it is used in Europe and esp in Japan but the US is dragging it's feet.
Probably I suspect because it is not a money maker, is simple to get, has good results, and Big Pharma is probably losing its collective mind.
I do agree about Sanjay Gupta and I watch and learn from his videos. He is definitely, IMO, a cut above and a brilliant man.
I also have met some cardiologists who don't seem to want to take on rhythm problems so I feel secure with an EP. But that's just me.
I have met so many cardiologists that showed so little interest in AFib and even less in SVT especially Paroxysmal presenting in someone under 20, 30 and even 40 years of age. It’s been really different meeting an EP
I was seen by cardiologists initially but after a bad episode when I had to have an angiogram I was told that if the change in meds suggested didn't work well I would be referred to an EP 'for ablation'. After a while the side effects from the meds became intolerable and dangerous so I was referred and had the ablation without even meeting the EP! I think this partly reflects how treatment has moved on - in the 18 years I have had PAF ablation has moved from a last resort to a standard procedure. In 2013 I was told to wait as long as possible for an ablation 'because they'll get better at it' suggesting my cardiologist didn't have great faith in EPs. I had my ablation end of 2015 with new state of the art equipment. It still didn't work for long but it may be the AF was too well established. What this ramble is coming to is that the most up to date advice would be to see an EP for arrhythmias asap but don't expect that you will automatically be offered an ablation. I still think it is best for a cardiologist to carry out tests on heart 'plumbing' first as that might reveal a cause such as leaky valve or pericardial effusion and those tests will have to be done before you can have an ablation as far as I know.
So I don't think you would have been referred to an EP from the beginning but you should certainly have been referred earlier. Several people have complained they have been 'left to get on with it' but then they hadn't kept complaining about their treatment, though from your experience that doesn't always help either 🙁
Thank you for such an interesting reply.
It does seem unbelievable now that you had your ablation without having even met the EP first, it perfectly highlights how things have changed over the years. I think that is why people get stuck and lost in the system because we are just coming out of an era when healthcare was a more passive experience and we were told what was going to happen. I honestly didn’t realise until surprisingly recently that you have to push and chase appointments etc and sometimes go into battle to get where you need to be.
I remember when I was about 25 a doctor saying pretty much the same to me regarding the new ablation procedure. I also remember reading and hearing about it from time to time in the media as a new treatment!
I would really like to know how many people have an EP that has managed there condition without ablation and still seems keen and interested( see my other replies)
I had a choice of pacemaker or ablation and when I chose ablation I had a choice of Harefield or Bristol, I chose Harefield, my cardiologist and EP consulted and my EP just phoned me up to tell me how things would go as I live a three hour drive away and it's very difficult to get to Harefield by public transport from here! The next time I saw him was after the ablation and my cardiologist did the follow up.
I also suffered from the 'Drisgod' syndrome until my sister in law died of metastatic bone cancer not picked up by her private GP and consultant. I lost trust in doctors from then on so I am now 'an informed patient' which going by something the doc said to me in A&E must be on my notes 😀
I can imagine, my father in law is a retired GP and he said they used to use all kinds of code words and punctuation like a well placed ? to alert other doctors to “difficult” patients( meaning patients asking too many questions)
The secret language of doctors eh 😊
That seems to me a terrible overall treatment plan and I'm sorry you had to go through your AF journey like that.
It’s interesting that NICE don’t appear to use the word electrophysiologist in these guidelines for GPs
cks.nice.org.uk/atrial-fibr...
Based on my experience of seeing 7 cardiologists and 3 EPs, I would say early referral to an experienced cardiologist improves the chances of getting balanced advice about the need for ablation. Perhaps wrongly, on the whole I see cardiologists as physicians and younger EPs as very skilled technicians. That said, I don’t remember any of the above giving me much advice about important lifestyle changes.
I also think that the NICE guidelines should emphasise that all patients should be directed towards the AFA website and this forum. It was 8 years after diagnosis before I found this site and most of what I know about AF has been learned here.
Agree with Oyster. EPs tend to be biased toward ablation. It's what they do. Seek out a good cardiologist, by all means get an EP consult, and above all do your own research, including forums like these. But be careful in that forums sometimes have their own bias led by more vocal members. Treatments for arrhythmias are not cut and dry. You want to find the approach you are most comfortable with.
Thank you for the interesting reply.
My experience with cardiologists is that they have viewed my condition as benign and rather dull especially the paroxysmal nature of it. I suppose it’s hard to feel particularly interested if the person in front of at that moment is checking out just fine with a perfect ecg, blood pressure and pulse rate. 😀
I completely agree regarding the AFA website and forum, my EP mentioned it and the arrhythmia alliance. It would be good if the outpatient clinics could have a template email that could be sent to new referrals along with confirmation of their first appointment. To be directed straight away to a place where you can really get support and find out how to best help yourself would be invaluable to so many people just as it has been to me/us 😊
I have several cardiac problems and my cardiologist deals with some of them but when my AFib started he refered me to an EP who has done the ablation. So I see them both.
Thank you for replying, that sounds like the perfect route through the system. The guidelines followed as they should be. Two specialists specialising in there own areas to make you better. 😊
This was after I'd insisted I be refered to a different hospital, my local cardiologist was doing nothing and even my gp thought I was making a fuss about nothing "it's just your anxiety" and I was deteriorating fast getting rushed in to resus on blues regularly. So I was refered to St Georges for second opinion and oh my goodness what a difference. And the GP is a bit more respectful now!
It is so dependant on which hospital you're refered to.
So not such a perfect journey to get there then, sounds all to familiar. So glad that your care is better now. It’s such a shame that people, especially women, have to battle so much.
I remember being told on day one that due to my fast heart rate medication would be tried first and if heart didn't slow 'mechanical' means would be tried. I also had to wait 3 months for an echocardiogram because of the heart rate over 100. I did feel fobbed off but as soon as the drugs did their job all the other obs and procedures fell into place. I learned that they know what they are doing and have to balance patient needs with financial constraints. But in a moment of crisis we want it all and we ant it now! At least I did. I'm due another echocardiogram and I will remind the h.f. nurse next time and take it from there. What a tangled web we weave😉talking about me of course!
Thank you for your interesting reply.
I agree with you, when you are navigating the system the enormity of the NHS hits you! I have seen recently the struggles the staff have and it really does feel like the system is bulging at the seams. However in my experience in my most intense moments of crisis that big machine works and I feel very grateful indeed.
Absolutely 😃
Hi There,I agree with you .Last week I suddenly collapsed but did not pass out.This was the second time in 5 months,and also the first instance I posted here.Unlike the first time,I called an ambulance.I had parox/AF overnight(this was now 10AM the following morning).I had take a Pip ,Flecainide the previous evening at 8.30 at onset of AF,followed by another at 6am.Later I took my usual daily Meds.Roughly an hour later I suddenly started shaking and fell forward ,lucky for me I was sitting on a stool reading,so the sideboard stopped my fall .About 2hours later the medics duely arrived.My ECG,BP,and pulse were all OK.Because of my situation(I live on my own in sheltered accomodation) they advised I should go with them to my local hospital Whipps Cross London.There I had another ECG,blood test,urine test.Again,all clear!Prior to this I have been getting AF 2/3 times a week,but always eventually sorted with Flec.Doc in A@E could only hazard a guess,but suggests possible interaction with Meds caused fainting probably due to sudden drop in BP.It makes sense to me.Now begins the long and winding Road,GP,Cardio,etc.Throughout all this ,I cant praise them enough, the paramedics,nurses,doctors,all at Whipps Cross A&E.They worked their socks off for everybodythat day,not just me
I’m so sorry that you had such a scary experience and I hope it was a one off and you are feeling better.
They do work so hard and it is so reassuring to know that you can call for help in this country and it will come, aren’t we lucky 😊
Take good care
Lucky to be born here - yes, but the NHS came into being after some determined and vocal opposition from the GP's in particular. It is interesting to watch the present government starting to privatise it.
I have both a cardiologist and an EP. I had AF, then ablation, which now has presented SVT. Back for second ablation soon. Anyway, in my case the EP only wants to deal with the problems of AFIB and SVT. Blood pressure, and now an issue with a fairly large dilation of aorta, he would rather have my regular cardiologist deal with. Interesting not that when I have ablations......my regular cardiologist performs the TEE while EP does the ablation. Lucky that both seem to be very good at what they do.
Thanks for your reply 😊So very much a tandem approach for you, sounds like a good team
On the subject of EPs wanting or not wanting to do ablations, I'm curious whether or not in the UK they are paid for each operation or just get paid a salary. Does anyone know?
In the US most doctors are in business for themselves and are paid by the insurance companies or the individual patients for each office visit and each operation. The one significant exception is an insurance system called Kaiser. In several states Kaiser owns their own hospitals and employs the doctors on salary. I've been told that the Kaiser doctors are given bonuses for discouraging expensive operations like ablations. For this reason the Kaiser doctors appear to me much less likely to recommend operations than the private doctors who are paid for performing them. I'm wondering if things are similar in the UK.
I would say a resounding no, as far as I’m aware they get a salary if they work for the NHS and that is not dependent on how many ablations they do.
The Kaiser system you describe sounds very scary to me. I’m a privileged 70s baby born into the NHS, I have never known a life without free healthcare pretty much available on demand to all when needed. Don’t get me wrong the system is far from perfect and god knows how long it will remain in its present state, stretched as it is by a burgeoning population and dire underfunding but even as the poor old NHS limps along it is made up by an army of people that dedicate their careers to working to provide “free” accessible healthcare to all.
You're right about HMO's (Health Maintenance Organization such as Kaiser (Permanente) discouraging doctors from from and financially rewarding them for handling as many problems using a patient's primary doctor and using less specialist referrals.
I'm in the US, and worked in the healthcare system here for years.
I always stayed away from HMO's for this reason as I feel my one right I want to protect is choosing my own doctors.
I once worked in a hospital years ago who provided their own HMO to the nurses as their insurance and I had no choice but to have surgery and care in their hospital. Though I worked in their O. R. I certainly never wanted to be operated on or cared for in that hospital.
Fortunately it turned out right in the end but it was not a smooth or pleasant experience.
I've had both American systems and I'm currently enrolled in Kaiser. Overall, I think it's better than the standard American system. At least this way no one gets sold on having unnecessary operations. With Kaiser, if you're turned down on something you think is necessary you can push and usually get your way.
In the UK system are you certain the doctors aren't rewarded for saving the country money? If not, it's otherwise very similar to Kaiser except that the Kaiser facilities are quite a bit nicer than the UK equivalents I've seen when I've been on business trips and have fallen ill several years ago.
I see what you mean about the Kaiser system, it’s really hard to wrap your head around the medical systems of other countries I think.
I’m not certain about the question you ask about doctors being rewarded for saving the country money, I really don’t know. Although I don’t think I’ve ever come across someone that feels they need an operation and it’s been denied to them, but that’s in no way a fully researched fact and it’s not backed up by any evidence. 😊
I’m glad you have nicer facilities and feel satisfied with your healthcare providers/system, it really makes all the difference when you need them, doesn’t it.
Systems and nicer facilities aside recently when I needed the emergency care of the NHS and I was lying in a bed in a chaotic A&E watching teams of nurses and doctors attending to sick people and saving lives I marvelled at how fortunate I was to be there. I often think in those situations about the millions of people on this planet that have no one to call on when they are sick, people that have no access to really nice facilities or overcrowded A&E facilities. I’m grateful to the NHS, it has seen me through some of the happiest and saddest times of my life. From the birth of my children to the death of my father, it supports every single aspect of our health and well being from our mental health to an ingrown toenail. It has long waiting lists and lots and lots of problems but it’s there and that makes me one of the lucky ones.
Hear hear!!!
When I had a big spinal operation not usually funded for people my age the surgeon suggested I write a letter of appreciation to the local commissioning group (the organisation which decides how much doctors can spend and on what) to help him in his arguments with them! And my GP said she couldn't prescribe something because she would get into trouble with the practice for wasting money. So there is definitely an emphasis on keeping within budget and being selective with procedures. Seven years ago I was offered a hip operation, put it off, now the criteria have changed so much there is no chance according to my physiotherapist.
I think that they definitely have budget constraints that are getting more difficult with cuts but I don’t know about EPs not doing ablations to save the government money or doing them to get bonuses.
I'm on Medicare now so my secondary private insurance is working well for-so far!
Hi KJ 
in the 2 years since I was diagnosed with P-AF ( after many years of having occasional undiagnosed episodes) I have yet to see a cardiologist or EP .
On the two occasions I have attended the local arrhythmia clinic I have seen only an arrhythmia nurse who conveyed my details to my assigned cardiologist who then suggested a drug regime and a year later I met the cardiologist's assistant who suggested I might like an ablation performed by a cardiologist I have never met in a hospital which has only recently started performing ablations and would like to increse the numbers. They only perform first ablations, failed ablations will have to be repeated in a hospital over 100 miles away. I said no thank you at this time.
I have been told I no longer need to attend the arrhythmia clinic and have been assigned to the care of my GP. I can telephone the cardiology department if I decide I might like an ablation.
In hindsight the lack of interest in my condition may have done me a favour, had I seen a cardiologist 2 years ago who suggested an ablation I might well have taken up the offer out of fear. Instead, I have done my own extensive research into alternatives and am doing well having made a number of lifestyle changes the latest being taking up Yoga
Ablation is certainly the right choice for many people particularly the young but I don't think it should be the recommended option for everyone. I find the level of inconsistency around the UK in treatment options and support on offer for AFers worrying. No one at the arrhythmia clinic mentioned lifestyle changes to me or the NICE pathway of offering an ablation 'if' medication fails to control the condition.
Wow, that is some story. I find it worrying too that it is such a lottery. I can’t believe you have now been signed off and just left with the GP but I am really glad that In some ways you see it as a positive and like you say it has led to you making positive changes and feeling better overall.
I’ve never had anyone talk to me about lifestyle changes either apart from to not drink.
I’m in the States, so the process & options may be different. I was sent to an EP 5 yrs ago when first diagnosed and he did my first ablation & followed me. Since the ablation stopped the symptoms, I didn’t consider needing a cardio.
When AF started up 2 yrs ago, my GP referred me to a cardio. The EP practice had become too stressful to deal with. I had EP #2 for ablation #2, which didn’t work. The EP didn’t recommend #3, but then I was really left hanging by him. He literally has nothing to tell me but that AF is a mystery, we may never know why I get episodes, take Flec & let me know if you want another ablation.
I’m now with cardio #2, who is open-minded about the path I’m on with supplements to support my heart.
My sense is that EPs are super specialized and are neither trained nor interested in exploring ways to find and resolve underlying issues that contribute to AF, including diet & lifestyle. Cardios really aren’t much either. It’s just the training.
It’s good to stay flexible with who you see and be clear about your needs.
I wish I’d connected with a naturopath years ago. They really focus on lifestyle & underlying issues. For me, where I am with it all, the cardio+naturopath+ GP is a good team.
If I need the EP, I’ll call him.
In my experience a "regular" cardiologist is the entry point into the system. That person(s) tries to manage the situation, and if deemed necessary, calls in an electrophysiologist for a consult. The electrophysiologist may take over case management at that point or offer suggestions and care continues to be managed by original cardiologist. At least that's how it's been in the cardiology practice I use.
I can't even get a referral to see an EP either from my local GP nor my cardiologist. They both say because i revert to NSR then I dont need one. Are we really behind here in Ozzie?? I feel like I am getting nowhere fast.
EP
Cardiologist 
EP
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NHS cardiologist appointment 
