Hi everyone,This is only my second post and I found all your responses very helpful.
I hadn't heard of electrophysiologists until I joined the group, but I have done some research and
there are electrophysiologists in a hospital near me.
I have a constant fast heartbeat and am diagnosed with bigeminy SVT. I am taking verapamil and the dose keeps being altered as it isn't making a lot of difference. My GP sends ECGs to the cardiology department and they prescribe the dosage changes, but I haven't had an appointment with the consultant yet (I'm waiting).
My question is this:
Should I see a cardiologist or should I see an electrophysiologist?
I don't know if my GP has been consulting an
electrophysiologist or a regular cardiologist, but I will ask at my next appointment.
Actually I have another question:
Is a private appointment with an electrophysiologist very expensive? I am in the UK.
I realise it will vary but if possible it would be good to know a ballpark figure.
Thanks everyone ☺️
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Ilovedogs12
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Thanks Jim. I am waiting to see a cardiologist and I wondered if they would then refer me to an electrophysiologist. If so I would want to go directly to the electrophysiologist to save time.
I'm in the United States where seeing an electrophysiologist appears to be a lot easier. In fact, with my Medicare insurance, I can even self refer myself to an electrophysiologist without going through a GP or a regular cardiologist. My understanding is you would probably have to go through your Cardiologist unless you go Private but hopefully someone from the UK system will clarify.
Private appointment here in UK likely to be circa £250 max. usually well worth the outlay to get proper advice. You can always revert to NHS afterwards. Beware any tests, blood, ecg etc would be extras.
It is worth while doing some research at the cardiologists at your local hospital - really easy to do - look at their training and special interests which should give you guidance. Look to see who also has a private practice. You can ask your GP to refer you to a named cardiologist of your choice on the NHS, you may however, need to wait a little longer for the appointment. Knowing how the system works, although it is in constant flux, does help you to navigate it.
Going to see that person privately means you can then ask to be transferred back to their NHS list.
I paid £180 for the last private consult with EP about 3 months ago.
I would do the research yourself rather than ask your gp. And you don't need a referral. They'll he happy to take your money! Have a look into who is around and who you want to see. I have an excellent cardiologist and EP here in South Wales but I paid to see someone in London (did a phone consult) in addition because a) he knew the family history as he'd done my cousins surgical procedures and b) I wanted to get a sense of what other options might exist if I wasn't geographically bound. As it turned out my own cardiologist was way more helpful and the EP here did an excellent job doing a third ablation for me but I felt assured by an additional view before ruling out other options.
Agreed. This is what I did a. .self referral. I trawled the internet looking for electrophysiologists with proven track record and found a lovely man 3 hours away. I am on his NHS pulsed field ablation list now. Private consultation....what a difference sadly, to NHS so efficient, thoughtful, etc. As said I'd do my own homework., look for reviews.
My cardiologist has already made it clear to me that he has limited experience in this field and has said I’d be better seeing a EP , this really surprised me , he also said he didn’t do ablation either !
I had a private consultation when my watch alerted me to possible AF in 2020 when getting an NHS appointment was near impossible but it was with a cardiologist. It was just over £200, I then had a private echocardiogram £400 and a follow up consultation £150 if I remember correctly for the result and was then transferred to the same cardiologist’s NHS list for a follow up in 6 months for further investigations (Holter monitor, exercise stress test etc.) . I was on medication for almost 3 years then before (after asking) they referred me to electrophysiology and 3 months later had an ablation. Knowing what I know now and mostly learned from this forum then I would have asked to see an EP in the first place as they are the arrhythmia specialists.
Did you have to go somewhere else for the echo? I live in South Africa where my Province is very short of EPs, so I see a Cardio. At my appointment he does the echo in his rooms, the private heart chaps have all sorts of equipment in their offices - is this not the case in the UK?
In the UK we have the NHS state hospitals and a number of private hospitals around the country. The consultants in the private hospitals usually work for the NHS as their main job and do private work on certain days or evenings. Some work for more than one private hospital also. The private hospitals also have their own scanners and teams to operate them on a separate appointment usually.
Yes, I am an ex- Brit Pat. but I didn't realise that the same specialists that work for the NHS also did private work. I thought they just had their own private practices and equipment and assistants.
NHS consultants have restrictions on the number of hours they must work for the NHS meaning that most private appointments are out of normal working hours - evening & week-ends.
If you ever have an ECG don't forget to ask for a copy for yourself, then you can take it to the EP you see.
In my area EP's are really only interested in seeing patients who want ablations, However I know that other EP's are different.
I've had AF for 19 years and have seen both cardiologists and EP's. I've had 3 ablations and lots of cardioversions. A few years ago I was told that I wouldn't be offered any more of either of these. Fortunately my heart rate only goes between 60-90bpm now when at rest and I can cope with that.
It takes a lot of getting used to having AF, I've learnt that the more attention you give it, the more you will have. Stress/worry almost feeds it. Has taken me years to get that into my thick head. Bob always said it and it used to annoy me, but he was right.
I can see what you say - that worrying about it would make it worse, that makes sense. Until it was constant I didn't pay it any attention, I just used to think it would pass, it was normal for me.
But when I had the constant racing heart pounding in my chest it was a different matter.
It's hard not to worry but I use mindfulness and I draw and paint which takes concentration.
But when it is always there it's difficult to ignore.
I understand exactly how you feel, it took me 10+ years before I could accept what I had. I think changing my diet for one more plant based, adding magnesium and other vitamins to my diet, cutting out artificial additives and especially sweeteners helped calm my heart.
At my worst my heart would beat so fast I had to struggle to stay conscious and poured with sweat. AF is a hateful condition make no mistakes. Many times it would strike in the night and I'd think I would be found dead next morning, but here I am alive and kicking. AF is not known for killing people, so take comfort in knowing that.
It's good that you use distractions to help yourself, so it sounds as though you're on the right path.
This forum was fairly new when I first found it and over the years we've all shared our knowledge and through doing that have learnt so much. Stick with us and learn all you can.
Reading other people's stories on this forum and realising that there are many others just like me has already given me some comfort. It's interesting that you add magnesium to your diet because I had wondered about that myself but I've read somewhere else that it's not a good idea. It's another thing to add to my list of questions for my GP!
I also wondered about folic acid, because I have been prescribed it a few times over the years after blood tests showed low folate even though I eat a lot of green vegetables. I've had palpitations on and off for almost 40 years and I'm wondering if folate might be a factor.
There's a history of heart disease on both sides of my family, but I have a small family so there's no way of knowing how widespread it would be if there were more of us. To be honest it's not something I was conscious of, I never thought about it affecting me because I've always been healthy. Even with the palpitations I didn't see a connection.
I've only been in hospital to remove my tonsils when I was young and to have my children, so I've been lucky so far.
My husband had a DVT 12 years ago, and because there was no obvious reason for it he was told it could happen again. Since then I have been very conscious of diet and exercise etc to keep him safe. We grow some of our vegetables, almost every meal is made from scratch, we occasionally have alcohol and have never smoked.
So the sudden onset of the continual racing heart came as a shock and was frightening. I felt like I was on the slippery slope, but fortunately my heart is healthy so I have to make myself think it's nothing serious.
I'm grateful for your reply, it's given me encouragement that I'm doing the right thing.
Ilovedogs12 Have you had an echocardiogram to determine the overall function of your heart ? And has your GP considered another medication besides verapamil ?
Seems you definitely need a referral to a cardiologist or EP. Perhaps to a cardiologist first to determine your overall heart health including valve functions.
You are correct in this a great forum where we learn from others experiences. But only your doctor knows your medical history to determine proper treatment for your individual case. Best to You !
Thanks.I have had an echocardiogram and I'm lucky, my heart is healthy. It's the electrics that aren't working properly.
I am waiting for an appointment with cardiology. I will ask my GP about changing my medication. I don't have any real knowledge but he said verapamil cuts down the amount of calcium going to my heart and apparently that is important.
I've read this now, it's made things a lot clearer for me. There are so many terms used by everyone that I didn't understand and this explains so much. It's a very useful link, thank you for giving it to me.
Not enough you need ECHO and 24-hr Heart Monitor when your new meds are in place. Then another ECG on new med. In 2021 I add 3 x monitors to see how the heart was coping with new med.
I my dog JAZ too @ 10 years I did not breed from her because she has heart murmur without symptoms and has stayed at Level 1.
I took my first mini schnauzer to UK and found 2 top range Boys to mate my first LACEY. Beautiful puppies. She had top American breeding in her and added Risepark. Very gentle little ones - black & silver my preference.
If its the electrics you need an ep if it's the plumbing you need a cardiologist. I would research ep consultants at your local hospital and also nearby ones where you would beable to travel.if you do a search on the drs by name it usually tells you their specialities and which private hospitals they work from as well as the hospital Trust whereaboutsdo you live ?I attend LGI where there are about 8 eps
Hi,I'm in the north east near Newcastle. I Googled EPs in the Newcastle area and a few came up based in a local hospital. I haven't got as far as checking if they do private work, but it's encouraging to know there are some nearby.
TRY Diltiazem 120mg first. I dropped from 120 plus at rest to 51 on 180. Too much so 120mg AM. For Heart Rate.
BB Bisoprolol for BP
Cardiologist is best as he/she takes your history and learns about your heart symptoms, asks for ECG, ECHO and follows up with 24 hr Heart Monitor.
When all these are done either Cardiology or Electrophysiologists I think have a say in what ablation best or cardioversion or other pills from basic pills to control your BP and H/Rate.
If you are in central England you can go directly to the Birmingham Heart Rhythm Group. You will find that several of them are registered and practice as both Cardiologists and Electrophysiologists. check them out at birminghamheartrhythmgroup.... They have been keeping an eye on me very well for almost 20 years.
In many who post to the internet AF forums, especially the Facebook ones, there seems to be something of a fixation on the term "EP". This is patient rather than doctor led. I think it arose because of the private health care system in the USA where a lot of money is made carrying out cardiac ablations.
An electrophysiologist is a cardiologist who has taken a short training course in the use of cardiac catheterisation, from six-twelve months, usually. Does this make an EP more expert in treating arrhythmias? Not necessarily. Do some EPs choose to make themselves more than usually expert in arrhythmias? Yes, some do. Are all cardiologists experts in treating in arrhythmias? Yes, from training and experience. Are some cardiologists more expert than EPs in arrhythmias? Most definitely, but they cannot carry out catheter ablations.
That's useful information, Steve, thank you! I have wondered because here in the UK I don't see 'Electrophysiologist' listed that often though I do see lots of cardiologists listed as specialising in arrythmias.
I gather that we are desperately short of both. It’s so sad that the NHS has been well, dismantled so.
I think most cardiology teams have one or more EPs at most training hospitals. I think UK doctors stuck with what they are and call themselves a cardiologist - but it might be changing. American influence is strong in the UK.
Many EP cardiologist led teams have shorter waiting lists than general cardiology because they are focussing on a more limited range of cardiology issues. I was surprised at the short wait.
It didn’t help me going privately as the Consultant EP Cardiologist I really wanted (recommended by medic friends) does no private work. Because I had panicked about the wait (the wait that didn’t happen!) I saw a private EP Cardiologist and it cost £250 for a desultory 15 minutes! When I was seen in NHS I had excellent care, despite being in Covid. But all areas vary. Research your nearest good cardiology service, and try to jump in as others have said.
Thanks. I need to discuss this properly with my GP. To be fair he is very good, he usually gives me an appointment at the end of his day and gives me extra time. I have a lot of confidence in him.
I am under one of the Countries best EPs at Glenfield in Leicester - Prof Andre Ng. I see him privately every 6 months but having an ablation under the NHS at the end of March.It cost me £275 for the first appointment and now follow ups are £185
The EP we saw privately was definitely worth the amount we were charged several months later. We spent some two and a half hours with him and happily paid the £200 odd some months later when possibly his wife remembered to request payment! My surgery offered nothing after the lowest dose of Bisoprolol proved dangerous for me and he introduced me to the wonders of a smart phone and Kardia and after I’d acquired them and sent him a reading of my heart in AF, he sent a prescription for Flecainide to my surgery! I took it as a PIP first and since being on 100mg twice daily I have not had an episode for well over a year now.
I too have been introduced to Kardia by private cardiologist/EP with the smart phone. What an incredible piece of technology. This is when technology comes into its own. Good luck
This is a great thread and has answered quite a few of my questions about EP v Cardio and also cost of a private consultation. I know I need an echocardiogram and a monitor + altho probably for more than 24 hrs.
My pulse is quite slow - but then if it was normally 60 but is now 80 that is still a hike up. But I don't have any symptoms. At the moment
Because I was 2 weeks away from surgery when the pre-op ECG flagged AF I don't want to wait too long - I can go back on the operating list as soon as I get myself sorted out.
And I do feel that it is a question of self management and parting with some cash to help that.
I love the NHS for urgent care - recent experience with very poorly husband was second to none - once we got past the para medic appointments at the GP surgery and saw a GP who had him in hospital same day. But it was several weeks of take the anti biotics and thinking he wasn't going to make it first. His problem was not treatable with anti biotics.
I am currently in the process of booking a private appointment with an electrophysiologist at the Royal Brompton Hospital in London and have been quoted £300 max.
I too had never heard of an electrophysiologist until I joined this forum. This site has been a Godsend for me and congratulations to those who set it up. I'm not an expert, but I believe that an EP is also a cardiologist with the extra qualification. In simple terms, I think the cardiologist studies the mechanics of the heart and the EP the electronics, i.e. arrhythmia, AFib, etc. I was diagnosed with AFib back in September, many things happened thereafter, including a heart attack and was hospitalised for five days. When discharged from hospital my cardiology follow up NHS appointment wasn't until mid March, and that was only a telephone consultation. I would have liked to know how he was going to test my BP over the telephone! I wanted something resolved earlier because of problems with medication side effects and GP was hopeless. Cardiac Rehabilitation team were brilliant but can't resolve too many medical issues. Booked privately to see a cardiologist/EP last week and it's the best £250 I've ever spent! I hate the fact that we are being forced down the private route, but that's where you're going to get answers. He has now told me that I possibly don't have AFib and have been incorrectly diagnosed. Am being monitored by him and hopefully he will get to the bottom of it eventually. I would definitely advise you to cut out the GP and go directly to a private cardiologist/EP. Let us know what happens as I think we're all interested in other people's issues as it might help ours. Good luck! Maglyn
It sounds like you were let down by the NHS. Maybe the service is better in some places than others. I also think age comes into it. Although I was never a frequent visitor to the GP practice I have noticed that since I hit 60 I always get a same day appointment no matter what the problem is. But you don't want to wait, especially when your heart is the problem.
Many thanks for your response. I don't think I would say it was the NHS that let me down, more the GP practice. I have had numerous visits to A&E in the last few months and they have been fantastic. Also, the Cardiac Rehabilitation Team are also brilliant who are NHS. and also the hospital staff during my 5 day stay in hospital. I'm 76 and female and I simply cannot get an appointment with my "assigned" GP as she only works two days a week, with the remainder in the private sector! Quite often I feel that being female and elderly, I've been treated as "neurotic"! The specialists I have visited, including an oncologist and urologist, are all excellent and don't treat me with disdain! I telephoned at the correct time of 8.30 am to obtain a GP appointment for a UTI recently and was told I couldn't see a GP for two months! A UTI has to be treated urgently. I have a record of frequent UTIs with radiation cystitis from radiotherapy 7 years ago. I agree with you, it depends on the area. I live in the South East (Kent) area and our practice is constantly being criticised. I have written two letters of complaint, and had profuse apologies from the head receptionist and practice manager, but nothing ever changes and it's virtually impossible to change doctors in our area. Good luck with your treatment as it sounds as if you have a great GP! Long may it continue
I'm so sorry to hear this, it sounds dreadful. Apologies count for nothing if they're not genuine, and if they were genuine they would make an effort to improve. I hope things do improve for you ❤️
When I think of my heart, my electrophysiologist is the electrician and my cardiologist is the plumber. The heart's electrical system is addressed by the electrophysiologist and its structure is addressed by the cardiologist. My "plumber" has it easy as he is just monitoring my minor blockages (no meds) while my "electrician" has to do all the work (afib, ablation, PVCs, etc.).
Hi, Im UK based and was diagnosed with SVT last June via a NHS Stress Exercise Test. My NHS Cardiologist and Electrophysiologist where both present during the test. Following on from this it was decided that I had an Implanted Loop Recorder fitted. If I make any recordings on the loop I email my EP to advise him, and he then instructs me to complete a full download. My EP then sends the results to my Cardiologist, in order to analyse the data. This has led me to believe that my Cardiologist is far more qualified. All follow up appointments are with my Cardiologist and not the EP. I hope that helps 🙂
Thank you, it's interesting to hear your story. I haven't heard of an implanted recorder,it sounds very advanced and I'm going to Google it. I'm not up to speed with computer technology and I'm interested to know how you download from it. I think it makes sense that a cardiologist covers a lot more than an EP. Thanks for your reply.
It's a tiny little device that sits just under the skin in my chest. It monitors my heart rate 24/7. I have a small box plugged into the wall next to my bed, it communicates with my implant every night.. so any abnormalities are sent straight to my cardiology department via the box. Should I experience an episode of any symptoms I carry around a little key fob that is also linked to my implanted device.. it kind of puts a marker on so that the Cardiologist can see what exactly is going on with my heart at that time. It's amazing technology and has so far picked up all STV events and Junctional Bradycardia. The only issue is that there's a lag of communication between the EP and Cardiologist. In my case, its the Cardiologist that analysis the data and not my EP. All my EP does is download the data and forward to my Cardiologist. It's a really simple procedure having the device inserted, It's put my mind at ease and has helped massively with a diagnosis 🙂
This is so clever. And you said it is done through NHS, have I understood that correctly? So you are in the UK?
I'm wondering if this is new as you say you were diagnosed in June. And how many people in this forum have been told about this and how many have the same thing.
Yes, I'm UK based, and it was done by the NHS. It'll stay in between 3 or 4 years.. I barely notice that it's there now. Incredible eh! It's taken 4 years to get to this point though, it's been a battle to get medical staff to take me seriously. My symptoms started in 2019, but they were intermittent and are mostly brought on by exercise/exhursion. I'd had a number of ECGs, CT's, and Echocardiograms all coming back as normal. I kept pushing for an exercise test, as that's when I am symptomatic. After purchasing a Kardia device and documenting an episode, they finally booked me in for an exercise test. The test was terminated at stage 2 as I went into a SVT episode, so the Loop Recorder was implanted a few weeks later. My heart goes into an SVT, usually lasting around 6 minutes, then plummets into Junctional Bradycardia.. the symptoms floor me, but, i would never have known this if it wasnt for the Loop Recorder. Like you, I have also been prescribed Verapamil. I'm unsure if the meds are working to be honest, as I've lost my confidence out walking in the mountains, I'm way less active sadly. I'm seeing my Cardiologist on Tuesday to discuss the Bradycardia, I've been offered Ablation, but I'm a wimp 🤣
I really hope you manage to get to the bottom of your issues, it's such a worry, isn't it! I really recommend both the Loop Recorder and Kardia though 🙂
As I’ve written here before, my surgery in the UK didn’t come up with anything after the lowest dose of Bisoproplol proved too much for me to take daily after only three days! Thanks to the AFA site we found a lovely private EP ( the cardiologists who deal with electrical problems in the heart - the electricians rather than the plumbers) and he suggested getting a smart phone and a Kardia and app as he wasn’t convinced I had it. After I’d sent him a reading of my next af episode, he sent a prescription for Flecainide to my surgery for me, which I originally took as a PIP but now twice daily and I have not had an episode for over a year now. His bill didn’t come for several months and was something over £200 but definitely worth it! We spent over 2 hours with him-
I am in the U.S. An Electrophysiologists is also a cardiologist. But they are more in tune with the hearts electrical system. Which is exactly what you want and need if you have an arrhythmia.
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