I have only recently joined the AF Association and this is my first time on the forum, so please forgive me for providing a rather lengthy description of my situation.
I am a 63 years old male living in Dorset in the UK and my heart problems started about 6 years ago when I suffered several quite frightening episodes of very rapid heart rate. After the third of these I went to my GP and was hospitalised whereupon I was diagnosed as having atrial flutter. I was prescribed Ramipril, Bisoprolol and Atorvastatin, together with Warfarin (all of which I am still taking), but continued to suffer episodes and after again being hospitalised with a heart rate of 250-270 bpm I underwent a cardioversion. Initially, this was unsuccessful in restoring normal sinus rhythm (NSR), although it did reduce my heart rate to around 100 bpm, but on a follow-up with the cardiologist 4 days later I was found to be in NSR. Unfortunately, this did not endure and after couple of further episodes resulting in hospital admissions, I underwent a right atrial ablation. This greatly improved my condition, although I continued to have a few episodes, but fortunately these resolved in a matter of hours without treatment. Nevertheless, I noticed the episodes were gradually becoming more frequent and lasting longer and after about 2 years I suffered another particularly distressing one (250+ bpm) which landed me back in hospital and prompted a second right atrial ablation. This again proved successful in temporarily improving my symptoms, but the electrophysiologist (EP) told me that whilst he was performing the ablation, the monitoring equipment was showing that there were also spurious electrical impulses in the left atria. He explained that he was unable to treat these at the time because it required a different procedure involving piercing of the septum between the right and left atria in order to gain access to the initiation sites of these impulses in the latter. He also explained that being in the left atria these impulses were most likely the result of atrial fibrillation (AF), rather than the original atrial flutter which is a predominantly right atria condition. He told me that AF is a progressive condition and episodes were likely to get worse and more frequent as I got older. At the time of this follow-up consultation, some three months after the ablation, I had only suffered one further episode and I said that as long as they didn’t get significantly more frequency, I felt life was manageable. Unfortunately, and something I am extremely annoyed about, he neglected to explain that ‘AF begets AF’, in other words the longer you have AF the more AF you get and more importantly the harder it is to restore NSR. Had I known this I would have elected for a left atrial ablation (AF ablation) 18 months ago. The result of the EP’s oversight is that my AF has now developed from paroxysmal (intermittent) AF into permanent AF and my local cardiologist has advised me that this being the case the chances of an AF ablation restoring NSR is virtually zero. It has been left too long!
He has added Digoxin to my list of medications in an effort to reduce my heart rate (the rate at which the ventricles are contracting/relaxing) and thereby relieve stress on my heart muscle, but I have been taking it for 2 months without any discernible improvement. Moreover, from the research I have undertaken over the past few months it seems that the medication I am taking will do nothing to prevent the atria from continuing to fibrillate at 500-600 bpm and nothing to reduce the risk of a stroke, which has increased fivefold with the onset of AF. I am now suffering an episode on average once a fortnight and they are lasting between 12 hours and 3 days, which means I am spending around a quarter of my waking hours in bed. The episodes are completely random; there appears to be no trigger for them nor any indication that one is about to occur. One of the biggest problems is that during the initial 2-3 hours of an episode I am having to urinate every 10-15 minutes and I can’t hold-on for long. Covid-19 aside this means that I am unable to do, or plan to do, anything that results in me not having immediate access to toilet facilities. I have also lost confidence to undertake anything strenuous such as joinery, which is my hobby; I am no longer living but merely existing – things look pretty bleak!
I intend to seek a second opinion on the treatment options available, in particular the efficacy of an AF ablation in stopping my atria fibrillating and giving me some rest bite from this awful debilitating condition. Unfortunately, it appears that even if my AF can be stopped, albeit for only a couple of years, statistics indicate that this will not reduce the probability of suffering a stroke. This seems counterintuitive as you would think stopping the atria fibrillating and thereby allowing them time to contract/relax in order to pump blood effectively into the ventricles would prevent pooling in the lobes of the left atrial appendage and thus the potential for the generation of clots, but this appears not to be the case. This leaves me with something of a dilemma; is there any point in having an AF ablation, with the attendant risks involved, if it is not going to make any difference to the main potential consequence of AF, namely a stroke?
This is the main question I shall be asking when seeking a second opinion from another EP. To this end can forum members please advise me on the person (or perhaps a small list of people) considered to be at the very pinnacle of AF treatment in the UK. My research thus far has highlighted the following candidates:
•Dr Phang Boon Lim – Hammersmith Hospital, Imperial Private Healthcare at Imperial College London and OneWelbeck Heart Health.
•Prof. Gregory YH Lip – Liverpool Heart and Chest Hospital and BMI The Edgbaston Hospital, Birmingham.
•Prof. Richard Schilling - St Bartholomew’s Hospital, London Bridge Hospital, London AF Centre and OneWelbeck Heart Health.
•Prof. Sabine Ernst – Royal Brompton Hospital and Imperial College London.
•Dr David Wyn Davies - St Mary's and Hammersmith Hospitals and 78 Harley Street.
Thank you in anticipation of your help.
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Cleopatra170710
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Hello Cleopatra and welcome to the forum. You must have seen Buffafly’s recent post because I think you have won first prize on the information stakes! I was going to comment on your nickname too, but as you are a bloke, best I pass on that one. (If anyone mentions Ethel, ignore them...😉).
Cutting to the chase, selecting an EP that you have confidence in can be a very real challenge. All the ones you have listed have excellent records and Prof Schilling is a Trustee of the AF Association. The other considerations are the practical ones regarding travel, especially where you decide to have any overnight treatment.
The AF Association produce a list of specialists, but as I understand it, they are Doctors who ask to be listed rather than based on recommendations.
At the end of the day, most of decide on someone who has a good track record and gives us confidence in their ability to know what is best for us. I wish you luck in your search......
Thanks for your reply. Cleopatra is our dog's name. I have looked at heartrhythmspecialists.org, which has a link on the AF Association website, but as you rightly point out it seems to include virtually all cardiologists/electrophysiologists in the UK listed by location and doesn't rank them is any way. As far as travel, overnight stays, etc., are concerned I don't care where they are located, I simply want to consult with the best in the field of AF treatment and in particular AF ablation.
What it important to undersatand is that any and all tretament for AF is only ever really about quality of life (QOL) by removal of symptoms. The outcome for any patient is not affected by termination of AF. as you have noted. The stroke risk remains which means continuation of anticoagulation. My AF was ended eleven years ago after three ablations in the left atria (though I now have other arrhythmias) but I would never consider stoping my warfarin.
The point is that provided rate is well controlled there is no difference in end result with ablation, rate or rhythm control. In fact many people with permanent AF live far happier lives that those in paroxysmal since the body soon aclimatises to it and the violent swings are not felt.
Life style changes such as weight loss (BMI less than 26) less meat and more plant based diet, less stress and of course no alcohol or caffeine have all been shown to greatly reduce AF burden so there is much that can be done.
FInally all the EPs you mention are good and as Flapjack mentions there is a list by area on the Main AF Association website. Richard Schilling has trained a great many others spread across the UK .
I understand from my research that there is no permanent cure for AF and certainly medication has been unsuccessful in terms of rhythm control. One of my concerns is that continued fibrillation of the atria will cause a gradual deterioration of the heart muscle leading to a reduction of up to 30% in the capability of the heart to pump sufficient blood for my body’s needs, particularly when I am undertaking strenuous activity. The only way I can see of preventing this is to stop the atria fibrillating in the first place and given that medication has been ineffective in this regard the only alternative is an AF ablation or an even more invasive maze procedure. Unfortunately, medication has not provided effective rate control either. My resting heart rate is now normally somewhere in the range 35 to 60 bpm, but can be as high as 150 bpm when I have an episode; the latter was much higher before each of my two right atrial ablations. Rest assured that because of the ongoing risk of stroke, I have no intention of stopping the warfarin.
I was certainly overweight (21½ stone) in the past, but now weigh just under 16 stone and still reducing. I retired 2½ years ago so stress level has greatly reduced. We eat a well balance diet with plenty of vegetables and little red meat as my wife has ulcerative colitis. I only drink one mug of decaffeinated coffee a day and I don’t drink alcohol. However, none of this seems to have improved my condition and I don’t know what else I can do in respect of lifestyle changes?
Thanks for endorsing Prof. Richard Schilling. He and Dr P Boon Lim are at the top of my shortlist.
I'd agree about stopping the fibrillation. It's my personal opinion that regaining NSR as the best outcome is a no-brainer, and that studies on QOL etc of successful ablation vs rate control are seriously missing the point of what it feels like to have a badly symptomatic AF. I had an ablation years ago but I suffered an AD in 2017 and my AF came back post-operatively. I then went 4 months in permanent AF and on Metoprolol and slowly found the AF got less bothersome, and began to think "oh, this must be what they say about it not so bad being in permanent AF".
Then I got onto Amiodarone and converted to NSR in 2 weeks. WHAT a difference. The idea of permanent AF being "acceptable" is in my view because you simply get used to being unwell. Going back into AF again is my biggest fear, but of course I'd like to get off Amiodarone!
Part of the problem is the ventricular rate and the only permanent treatment for AF is a pacemaker with ablation of the AV node so the ventricles are not overworked. This is the last resort but very effective and if you do have an occasional resting HR of 30 you would be a candidate for a pacemaker anyway. I’m not suggesting it of course but you should be aware of it.
My cardiologist has suggested that this could be the route to go down, but I realise that once done there is no going back. Moreover, it does nothing to stop the atria fibrillating and dilating and little to protect the heart muscle (or at least the upper part surrounding the atria) from deteriorating. Nevertheless, I am not ruling it out in the long run, but I want to explore all the alternatives first.
Well said. I am always astounded when there is a promotion to go to permanent AF as if being in that state is equivalent to having no AF without addressing how the heart is completely remodelled to the detriment of the patient. Plus, permanent AF is far below sinus rhythm on many levels. Currently, there are trials being done that prove it is better to strive for sinus rhythm rather than live in a state of arrhythmia.
Hi cuore. It is my aim to have NSR restored if at all possible. I am just so angry that the EP I saw previously did not explain the longer you leave AF the harder it is to achieve.
I fully accept that I don’t read every post word for word but when has there ever been “a promotion to go to permanent AF”?! That would be remarkably stupid.
Having just read a comment by BobD I shall now refer to my AF as persistent and I can assure everybody that NSR is far superior to persistent AF. If you have found a treatment that keeps you in NSR for the majority of the time then you are very, very lucky. Some of us not so.
Recent posts by myself and another chap who is in permanent AF were purely meant as a reassurance that, if all else fails in treating your AF, then life does go on. I trust that these aren’t posts that you read as ‘promoting permanent AF’?
Part of the reason that I have accepted my condition for the time being is that my wife’s cancer and it’s treatment (now delayed due to COVID) is of far more importance and concern than my AF.
Nobody wants, or promotes AF. That would be very silly. We all want, and promote NSR.
Those on the forum that are in permanent AF who give knowledge, guidance, and comfort to others that are also in permanent AF ,or about to be , are commendable. Those not in permanent AF but who empathize as well as comment from a research position are also commendable, But, in communication, there is the intention of a statement and the reception of the same statement that can get cross-wired. Of course, this is my value judgement and can be totally refuted. In making my statement, I was targeting no specific person, rather a distilled reaction to multiple comments. I do not recall reading specifically your post or the other chap you mention whoever that person might be.
It is also commendable how you have prioritized your wife's cancer above your AF. Best wishes to you both.
Sorry, not a common thing, Aortic Dissection. Not good. I needed open heart surgery, replaced my aorta from the aortic valve right round to the top of the descending.
My ablation was done by Dr David Jones at Royal Brompton and Harefield. I know he will go the extra mile in a difficult case as shown by his efforts on behalf of one of our members who is determined to avoid a Pace and Ablate procedure which is the last resort for symptomatic permanent AF. He is a colleague of Dr Ernst.
If you have not had a recent unsuccessful cardioversion your cardiologist cannot say that your AF is permanent, also it seems that most people in permanent AF are almost asymptomatic which doesn’t fit with your experience at all! Your description fits with frequent PAF instead. Your life sounds miserable and I should get your GP to refer you to an EP ASAP and ditch the unhelpful cardiologist.
Yes; there are EPs nearer to me than the ones I listed, including the two that performed my right ablations. The trouble is that none of them appear on any of the medical sites I viewed on the internet (with the exception of heartrhythmspecialists.org, which seems to list virtually every cardiologist/EP in the country, but with no ranking) so I don't know if they are highly rated or not. The only article I could find that claimed to identify 'The Best Heart Rhythm Surgeons in Britain' was one produced by the Daily Mail, so I don't know how much confidence to invest by it; hence my request for recommendations on this forum. That said, it did identify Prof. Richard Schilling.
In your story you say, "He explained that he was unable to treat these at the time because it required a different procedure involving piercing of the septum between the right and left atria in order to gain access to the initiation sites of these impulses in the latter. " It sounds as if your EPs are performing limited ablations which would greatly make me question their skill. At this point in the game, you are on the right track to seek the best which you greatly need. And, you are right, AF begets Af. Current trials are concluding that it is better to follow the rhythm control route (in your case ablation) rather than follow rate control that will eventually lead to permanent AF with a heart completely remodelled and with less physical ability than being in sinus. Stay on your course and don't be persuaded otherwise.
Hi there, I was diagnosed last year and suffered debilitating PAF like you, ending up in hospital on 2 occasions. I have flutter and Afib and saw 2 cardiologists who advised differently with treatments. I soon learned that an EP would be best so looked for recommendations like you. I was told that Professor Andre Ng at Glenfield Heart Hospital was a top EP and responsible for teaching and pioneering treatment for heart arrhythmias. Following on from this he had an article in The Mail on Sunday about a new super fast ablation technique which he is pioneering - a very interesting read. If I can copy and post it on here I will. I went to see him privately, he was very good, factual and told me straight what to expect from afib/flutter. He changed my treatment to Sotalol BB twice per day along with apixaban NOAC blood thinner. My afib has improved (fingers crossed) with only one episode since November. I am dud to see him again on 8th Feb where we are going to agree next steps. He quoted me 80% cure rate at first attempt of the ablation and I intend to go for it! I will update you.
You make an interesting comment about my cardiologist being unable to say my AF is permanent without a recent unsuccessful cardioversion. At my last consultation I raised the issue of PAF v Permanent AF and made the point that all of the recent monitoring I had undergone, first via a CardioCall unit and subsequently through a Holter Monitor, had been whilst I considered myself to be suffering an 'episode' as I call them. He merely took my pulse and based on that reaffirmed that I was in PAF and had probably been so for many weeks if not months. I am most definitely not asymptomatic, so that only goes to support your contention that I am not in permanent AF. This is an important factor since, as I understand it, it has a significant bearing on the success rate of an AF ablation.
I have already consulted EPs in my local area and it was they who performed my two previous right atrial ablations. But as I said in my original post, I now feel it is time to see one of the top electrophysiologists in the UK; someone at the very cutting edge of developments in AF treatment. I will certainly consider your suggestion of Dr David Jones and any other recommendations will be welcomed.
Just to clarify the issue of premanent or not. Permanent AF only exists if both patient and doctor agree that no further intervention is appropriate. You may be persistent but you only become permanent when you agree to acept that situation. An important point to make.
Thanks Bob. Did not know this either. Then I would say I am in persistent AFIB as I was never offered intervention other than rate control meds. Fortunately my resting rate is 58 and my usual rate is 78. I was never offered an ablation or recommended to see an electrophysiologist. Last time I spoke to my heart specialist he said - it was not offered because my QOL seemed okay and my age. I was 70 at the time. Now going on 73 this year. I am concerned because my father passed away from coronary thrombosis at 60 and feel being in persistent AFIB will damage my heart over time. To date I have no symptoms but feel very tired after a workout. I walk, do Pilates, ride a bike and sometimes go on the treadmill + lift weights. Not all frequently enough. FYI I live in Canada and have managed to lose a few pounds but could loose a lot more to my liking.
I'm in a state of persistent AF and have been for nearly 2 years now. I had a successful cardioversion last January. It held for a few weeks, not sure when it went back to AF because I didn't feel it. A routine check for something else found it. I have not been offered another cardioversion. I haven't seen the cardiologist since Covid either. I had a 6 month check up last summer converted to a phone call. My GP ran the ECG and blood test for him and I ensured that the secretary had them. He then phoned on the wrong number and had neither of the test results with him. Waste of time. I had my next 6 month check for this coming week. Cancelled until much later in the year.
However, my PAF was awful. Totally debilitating whilst it was running. Came out of nowhere. No triggers. I had a bout around every 10 months. Then one day it started and didn't stop, only it reduced. Now I don't normally feel it unless it acts up and then it's just a bit fluttery or fast feeling for a while. It doesn't stop me doing things and I don't worry about it. My Dad had it for donkey's years. He had it worse than me. A maze procedure failed as did an ablation. I am hoping I don't follow his path, but for now my hypothyroidism and menopause are causing me far more trouble than the AF. I've never seen an EP. I might ask for a referral to Birmingham. But then now is not the time for appointments.
I was slim, fit and very active when AF started. I've never drunk much or smoked. I stopped caffeine immediately and now almost never drink. I am now fat and slouth-like because of the hypothryoidism, but neither states has made the AF worse.
Just wanted to share a story of a "living with persistent" person.
Just to clarify, early in your post you say you are still taking Warfarin but later you say you not taking anything to protect you from the higher risk of stroke. I assume you are aware that that’s what the Warfarin is for......as has been suggested, you cannot be in permanent AF unless attempts to convert you have failed, by that we mean literally have not even converted you for minutes. Personally, I am always reluctant to recommend anything to anybody because we are all different but I think you will have picked up where I and others are coming from. I have also met Dr Jones and although he has not treated me, I know a good few here who have great faith in his ability. He certainly knows his business!
Yes; I am aware that Warfarin is an anticoagulant intended to prevent blood clots leading to a stroke and I apologise for not acknowledging that in my original post.
I have only ever had one cardioversion and that was unsuccessful in restoring NSR even though at that time my arrhythmia was not as well established as it is now. Surely, when I consider myself not to be experiencing an episode there must be means other than a cardioversion (i.e. patient activated monitors or an ECG) of determining whether or not my atria are fibrillating permanently?
Thanks for your added comments regarding Dr David Jones. Based on Buffafly's recommendation I have added him to my list and will read up about him further.
You could buy a Kardia, which is a small device which while connected to a smart phone allows you record a rhythm strip up to 5 minutes long whenever you like. For full details look it up in AFA or its website - Alivecor. Obviously this needs to be when you feel you are not in AF and it will give you a reading : Normal, Possible Atrial Fibrillation or Unclassified. Sensible cardiologists/EPs accept these as evidence even if they might sometimes disagree about the AF (hence Possible). It would show if you are ever in NSR or maybe that your HR fluctuates wildly. If you do a search on the site you will find many hymns of praise to the Kardia. It costs about £100 for the basic model - don’t get the 6lead, too sensitive so hard to use.
You could copy your email to Sanjay Gupta of York Cardiology. Have a look at his videos on YouTube. He's got a website and he's on facebook. He does reply to emails.
Leave out the bit about wanting recommendations for top EPs.
I have had an arrhythmia condition since 1996 (now 66), had a Flutter ablation in Feb 2019, when it was found that I did not have flutter, they found that I did have "chaotic" atrial signals which they called Multifocal Atrial Tachycardia which could not be ablated - you can read my journey through posts on this site.
The point I am trying to demonstrate is that doctors know best and only doctors can know best but they don't know everything about our condition. During my ablation the EP did do a number of ablations which improved my condition to nearly good as new. However there are anomalies which are still a mystery. The EP said my Afl was caused by the Flecainide he told me to take 4 months earlier, however whilst the flutter was worst after taking Flec, I know I did suffer fluter when I was on a higher doses of Bisoprolol before starting the Flec - consequently it was the medication that caused the flutter with Flec being the worst but not the only culprit. He also said I had MAT, but my symptoms were not MAT symptoms (MAT produces an erratic rate whilst mine was regular - apart from 3 AF episodes during recovery).
I believe the "MAT" triggered my other arrhythmia, still trying to figure out what causes the MAT. I found a combination of Docs and self help the best, for me a combination of reducing PPIs, taking magnesium complex and D3/K2 supplements to maintain my electrolytes, having less sugar and drinking more water but this will be different for everyone.
Regarding your quest for the best EP, think of them as footballers, the are all at least adequate and they all have good days and bad days, none are perfect, some have days they perform miraculously, others have not so good days, none have howlers, none know everything or are good at everything. They are better at particular roles and not so good at others (a goalkeeper may not be a good striker and vice versa).
Regarding the question on ablation, to me this is a no brainer, take the Docs advice and if you feel the need get a second opinion (don't even think about it) as not all Docs are the same. If not already done so look at the Dr Gupta videos from York Cardiology (do a "yorkcardiology" search on youtube).
Morning Cleopatra, I have read your post and can highly recommend Prof Schilling at Barts. He performed my ablation in November and is a god in my eyes. The team there are amazing and the care is second to none. Good luck with your journey. X
Hi I would suggest trying to reduce that to 25 or under, a ton of evidence around about the huge impact of weight loss on AF symptoms and progression. Have a look at the website of Dr John Day, he is based in the USA but it's a very informative site and he has a new book out in March on natural control of AF. There is also a trial I believe of a new ablation mapping system for complex cases, no idea where that's up to but Bob may know more, I think it was rolled out a year or so ago but may have got lost in all the chaos of the last 12 months.Andy
Good morning Cleopatra and welcome to the forum. I use to live in Dorset, not far from Cerne Abbas. Afib didn’t affect me until I moved to West Yorkshire some 16/17 years ago. I have had 2 ablations, the last one being 11 weeks ago. I too researched for an EP and was prepared to travel anywhere. I chose Dr. Todd at Liverpool Heart and Chest Hospital as he came highly recommended and was also on the Daily Mail article. I wasn’t disappointed. I saw him privately for initial consultation (£250) and then changed to NHS for procedures. You have had some good advice and been recommended some top people. I wish you well and hope you find someone who you feel comfortable with and can give you all the help and advice you need. Let us know how you get on.
I lived at Hilfield just below Batcombe. My GP was Dr. Dobbs, who is still there. I think he was the kind of GP who had I developed AFib then would have pointed me in the right direction. Was/is a superb GP and very caring. x
I know it well. My GP is in Dorchester and the surgery has recently been voted best in the county, but I am now under the care of a cardiologist who has been most helpful and caring and who refers me to the local EP as and when necessary. Unfortunately, I feel I have reached the stage where I need to seek the advice/opinion of the best in the field of AF treatment and that means looking farther afield.
Hello, you seem to be in a difficult situation, I have had a cardioversion and two ablations, the last one has achieved NSR. So far I am 14 weeks in and all ok.
My Cardiologist and Electrophysiologist is Dr Ashley M Nisbet and the procedures were at The Spire in Bristol. I have every faith in her as she will explain all details you wish to know. Also excellent follow up. You can also check with Bristol Heart Rhythm Centre
Hi Cleopatra, I can also highly recommend Prof Schilling. He did my ablation 10 years ago which was quite complicated. You can find out more here: londonafcentre.com/ though this is the private arm. He also does NHS. There is an AF centre in Southampton which I considered, but Prof Schilling had the right sort of experience and number of ablations (i.e. lots).
Good morning MarkS. Thanks for your endorsement of Prof. Schilling. He is emerging as a prime candidate, along with Dr Boon Lim at Hammersmith hospital. I considered Southampton, together with Bournemouth, since they are in my NHS area. However, none of the EPs at these locations appeared on any of the medical sites I found on the internet, with the exception of heartrhythmspecialists.org which seems to list virtually all cardiologists/EPs in the country, but without any form of ranking.
eurekalert.org/pub_releases... The above is just one article where Prof Ng conducted an ablation live in 2008. Since then there are many other articles. The one I have was in the Mail in Sept 2019 (13th I believe) let me know if you can't find it.
Hi Cleopatra, I can confirm what other members are saying about Prof R Schilling, I have seen him and also had SVT and AF ablutions by his team at the Barts Heart Centre.
I would wholeheartedly, sorry about the pun, recommend Prof Schilling. For a relatively modest fee you could have an speedy initial appointment to discuss options. At least you would know exactly where you stand and whether another ablation would be efficacious. Peter
Good morning PeterIt is my intention to see the chosen EP privately, since I have Bupa insurance. The only things that re currently holding me back are:
a) Selecting the appropriate EP. The suggestions on this forum are proving most helpful in helping me make the selection;
b) The Covid-19 situation, which makes me very reluctant to travel anywhere.
Hopefully, the COVID issue will be much diminished in the next few weeks once a significant part of the population has been vaccinated. I had treatment, via my health insurance, at London Bridge and the care was excellent. Peter
I also highly recommend Professor Andre Ng. He did my ablation last January and I have been AF free since then. He is very good at explaining clearly procedures and issues. He and his team were fantastic.
Hi Cleopatra, I too can recommend Prof Shilling, he performed my second ablation in 2017 and I have been AF free so far since, he also successfully operated on a friend of mine who was in permanent AF (mine was paroxysmal) in 2019 and he too is currently AF free. As an aside we both went private at London Bridge AF centre and the care there was first class. Best of luck!!
As I understand it the stroke risk doesn’t go down even if long-standing AF returns to NSR because the atria have enlarged so you still get the butter churn effect that can throw clots
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