I have been offered an ablation at St Bart’s for my PAF, which has become more frequent over the last year or so, but uncertain whether to accept.
I was told by the Consultant at my appointment that ablations there are carried out by the doctors on a rota basis, so you cannot know who will do it until the day of the procedure. It was stressed to me that there is no guarantee a Consultant would carry out the ablation and that it could be a registrar in training albeit with a Consultant in the room. This causes me to be even more anxious about having the ablation. I perhaps naively thought The Consultant I saw at clinic would be the person doing the ablation. Am I being ridiculously over concerned? Any thoughts gratefully received.
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Londonlass
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I was in same position at a London hospital for my first ablation. I too thought that the consultant I had been seeing would be doing it. Didn't know any different until I walked into the Cath lab!
I nearly walked out....but was reassured !
The registrar is now an excellent consultant EP whom I've been seeing for the past 10 years !
You will be very closely monitored so try not to worry.
I can totally understand your concern. This happened to me years ago but to be honest I had real faith in the whole team.
However Barts is a centre of excellence and the consultants are some of the best in the land and even the world.
I am fortunate enough to now have a consultant that worked at Barts but he is now working as one of the senior consultants at another centre of excellence. He is marvellous and it’s clear that he was mentored very well by the other experts at Barts.
If you are still concerned I suggest you talk to them again before the day this way they will be particularly aware of how you feel and I’m sure it will all go fine.
My view is that if a registrar in training might carry out the procedure, the prospective patient should be informed of this during the initial appointment- he or she could then take a decision on whether to go ahead or not. An ablation isn’t just any procedure; it depends on operator skill to high degree, so potentially, the choice of operator might affect the outcome. I aim to speak to the hospital about this this morning; if they are not able to provide assurance, then I may ask to be re-referred to a different hospital.
I totally agree with you an ablation is a very complex procedure. However, Barts is one of the top Centres of Excellence in the world and have for example Prof. Schilling as part of the team.
Most of the trainees at Barts go on to be consultants at other hospitals. Prof Schilling makes sure they know what they are doing. Relax. If they hadn't told you then you would be none the wiser.
To be honest I was so grateful to be given the opportunity ...I was so desperate I didn't care who was going to it...It could have been a cleaner..for all I know...but touch wood it was successful...good luck
I’m very interested in your post as I am awaiting an appointment for an ablation at St Barts. Nothing was said about trainees being allowed to carry out the procedure. I will be ringingn them this morning!
Trainees is a pretty demeaning word when you understand that they are already trained cardiologists . As I have already said earlier Prof Schillling would not allow this if they were not capable. They probably have more understanding and skill than many EPs in other parts of the world. How do you think the Prof learned his trade.?
“Trainee” may not be the best word, but I was told via a friend who knows a retired US cardiologist -and have also read independently- that someone (in who has carried out the procedure preferably hundreds of times is a very important determinant of the success of the procedure. My immediate inclination is to say that I wouldn’t want to go ahead with this- it’s just too dangerous.
This makes no sense!!!! Unless the experts of today pass on their knowledge and techniques, then when they retire there will be no-one to take up their places. Everyone has to be trained in order to gain experience. It's highly unlikely that some inept 'trainee' with no idea of what they're doing would be let loose on your heart!!! Close your eyes and you'll not have a clue who's on the tools!!!! Very best of luck and I hope all goes well.
The question of whether a hospital, for logistical reasons, needs to use “trainees” to carry out procedures is distinct from the matter of a patient consenting to having the procedure carried out by such a trainee. Some people may be happy with this, others will not be. My view, as I said, is that it’s fine providing the patient is informed *from the outset*.
I have not been told by the hospital that this is applicable in my case, so I don’t want to make any prior assumption about what they will say.
It remains my view that this factor has the potential to affect the outcome of an ablation and as such is a legitimate concern.
OK I undestand your views but consultants may not have many hundreds of ablations under their belt when appointed. I do know that in some countries where money is more at stake there are some pretty inexperienced people working which does very much affect outcomes . Not here in UK though. As for danger there is just as much danger doing nothing IMHO.
Maybe “hundreds” is unrealistic, but the consultant should have done “lots” which a trainee would not have. There is certainly danger in doing nothing too. I’m just saying that if a hospital is going to use someone who is still learning how to carry out the procedure then it’s incumbent on them to inform the patient right at the outset so they can decide whether to get a referral to another hospital. It’s absolutely unacceptable when the patient, who may be under considerable stress already, has this additional factor to contend with.
I had an ablation at St Barts in Feb this year. I too thought my consultant would perform the procedure. However I was introduced to a different consultant just before I went to the lab who would perform the ablation. Everyone was so professional I felt in good hands and was introduced to the whole team once I got to the lab so I never doubted their ability. I cannot praise enough all the staff at St Barts and I felt incredibly lucky to have had access to this procedure at this amazing hospital. Good luck
If it’s a different *consultant* that’s fine- I have been told that here is no nominated consultant. The situation I would be concerned about is where someone who is essentially learning his craft is involved (eg a registrar in training).
Another vote for St Barts. I had two ablations in 2016 last one lasted over two years, I must admit it didn’t cross my mind to question who would be doing the ablation just assumed it would be the consultant I saw Mr Sporton. They were all just so professional and friendly when I went into the cath lab it was no problem. As had been said anyone who does the procedure there is already a very highly qualified specialist. I’m going to talk about the possibility another ablation there in November and wouldn’t hesitate to recommend it.
Whilst I've not had an ablation at Bart's yet, I have had a great deal of experience with this hospital, all of it good. Thanks to negligent, sub-standard treatment at my two local Essex hospitals, one of which is a designated "Centre of Excellence", I ended up having open heart surgery in Bart's. The treatment was the best you could wish for, the doctors excellent, the nurses superb and the standards the highest possible. I was particularly struck by the teamwork and mutual respect from students to consultants and for patients. I am now under the cardiac team at Bart's for all my heart treatment and am grateful for all they do for me. I wish you all the very best with your ablation. The staff there are terrific.
Like Bluenomore above I had an ablation at Barts in March this year. In the lab, having been introduced to the whole team and their roles explained, I was sedated. At this point the lead consultant said "Good luck everybody". I jokingly said "you're not supposed to say that in front of the patient, it doesn't inspire confidence". He soothingly told me that they were using a new technique for the very first time. Whilst Ron Cohen was in charge, his registrar carried out the procedure. It was fine and the procedure worked. Ron told me afterwards that he'd tried to get my heart in flutter, but couldn't make it so the procedure had been a success. He showed me the map on the computer screen of where they had created scar tissue. Both the pre-procedure assessment, and the post-procedure follow-up (strangely on a videolink on my phone) were very professional. You will be in very good hands as Barts is a very well run outfit. I won't wish you luck as by now they will have perfected the technique!
The other thing is that these ablations are now routine and not rocket science... So whereas a heart transplant in the 1960s could only be done by one or two people in the world, these ablations are knocked out like colonoscopies... So much so that they are being done earlier and earlier after the condition arises, and with a growing first time success rate. I have only had one flutter (April), but if I have another, I bet they ablate me straight away... When I had to decide on Cyberknife for my prostate cancer, the likely outcome was either success, or wearing nappies for double incontinence for life. I looked at the statistics and decided to do it.. Success! The nuclear robot operator looked like a homeless guy, but he did a perfect job....
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