Ablation in UK vs Bordeaux?

Hi all,

Knowing and accepting that an ablation is on the horizon for me at some point int he not-too-distant future, I would like to ask the forum members for their views as follows.

Since having first had diagnosed LAF in 1999 at age 38, I have for the last 10 or so years - thanks to this forum - been quite resolved to visit Bordeaux come the time. But that obviously incurs significant cost i.e. travelling abroad and paying privately as opposed to being referred here in the UK on the NHS - which my GP can and is prepared to do (I already consulted with/was referred by my GP to Prof Schilling back in 2008 who at that time told me to stay on the Flec 75mg BID for as long as it works - and it still does - and then come to him for an ablation as and when).

Whilst one's heart and its health are obviously beyond monetary value per se, it now nonetheless appears that there are good - as in very experienced and accomplished specialists such as Schilling, Ernst and Furniss - options here in the UK. What recently stood out to me in this regard was a recent posting by Mikej as follows:

"Mikej [ PM ]
Re: For Phil re U.K. Ablation new
September 11, 2013 08:35PM Registered: 6 months ago
Posts: 6
Phil, a Doctor pal of mine had the PVI done by Sabine Ernst in London in Oct 2011 and he hasn't missed a beat since apparently. He advised me that she has done over 3,000 procedures and has only a 15% repeat rate."

What I'm figuring is this. When I require an ablation, a perfectly good option - as in 98% (??) as good as going to Bordeaux - would be to visit/be referred to Sabine Ernst for a PVI ablation. What do you guys think?? Does Ernst operate a broadly similar procedure to the guys at Bordeaux, or do the Bordeaux team do additional ablating as well as just the PVs??

Any thoughts and views would be greatly appreciated - especially with regards to Sabine Ernst. 3000 procedures under her belt with 15% repeat rate and chosen by a UK GP looks good to me.

Best to all,

Mike F.

Mike

A few thoughts -

If yu have it done on the NHS, even if referred to Ernst or Schilling, whose hands will be on the catheter? If you are a private patient you can be sure it is the consultant doing it and not the registrar.

How long will you have to wait for it? What is your quality of life while you wait? Might you progress to persistent AF making the ablation more difficult?

I think these questions are more important than how the procedure is done.

If you are paying I would guess that Bordeaux would be cheaper. When I needed a TOE/TEE it was cheaper to go to Bordeaux than have it done privately in London, even including the air fare and one night in a hotel.

Gill

Mike, I don't know about the cost aspects, I'll defer to Gill on that. Also not sure how real the risk is at some centres of the EP you see not doing the procedure. I would have thought that could be cleared up at the consultation ie seek a commitment from the EP.

My two friends treated by Schilling and Ernst had their ops paid for by insurance. Sabine Ernst offers a great local option for you with apparently very impressive successful outcome stats. If you need some post PVI follow up it is I think more convenient having the EP near by. For example if you get Atrial Flutter in the first couple of weeks after you return from France. You will in the first instance most likely go to your local emergency ward. If it isn't transient (as most post PVI flutters are) then you'll have to go back to the EP. Then again the friend of mine who was treated by Sabine lives outside UK. He is prepared to go back if he needs to receive further treatment, so far so good for him.

Sounds like it will be a cost decision for you. I had my procedures done under Private Health Insurance. My EP said that in the event I wasn't covered he would do it under national health, it would just take a little longer to book me in. That may also be the case with Ernst or Schilling.

Cheers
Mike J

Mike,

Mike, in my mind it would depend upon the complexity of your case.

Several here have mentioned this. In my case, my 2 1/2 month episode nine years ago puts me in the complex category. Even though I've had relatively few episodes since. For seven years I had a total of around 10 episodes, then a year of many episodes, that I figured out was due to too much calcium intake. Today I'm back to the very long duration between episodes mode. Since the 2 1/2 month episode, I've terminated all my episodes with PIP flec in 1 to 4 hours (save the first which took 20). During the Ca++ year, I thought I was soon to be on my way to an ablation. Now I'm back to watchful waiting.

In any case, even though I've had nine years of relatively good control I know the 2 1/2 month episode means I will be going to either Bordeaux (with Jais or Hassaguerre) or Natale. A lesser operator would not have a good success rate on the complex case.

I'm sure Shannon can give you more info.

George

MikeJ

I asked my EP at King's College Hospital in London to do a referral to Bordeaux, which he did, faxing my records there. Afterwards he did all the aftercare, and I still see an EP there once a year for a checkup.

Regarding whose hands are on the catheters, in the NHS you don't really have any say in the matter. Even if you asked, I don't think they would be able to give you any commitment.

Gill

Mike F

Just navigating the route you mention and have got over first hurdle of being referred to Dr Ernst, given that I live in Manchester.

So far so good. Have an 8 week lead time to consultation in Dec this year but in the scheme of things for me (still paroxysmal after 6 years) not an issue. I will be asking if she is actually performing the ablation as one of many questions. I suspect the top UK NHS registered EPs do more private and research work but will still do some NHS ablations - perhaps with longer waiting time though.

Will update after consultation.

Regards

Phil

PS. If you go to Dr Ernst, she is not on the NHS Choose and Book system but needs referral sent via fax to her secretary.

Regards

Phil

Mike,

Steve's comments about Bordeaux being the only ones concerned he'd had a 60 day episode, along with a search of his comments about Bordeaux in general

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George

Thanks to all for the kind and helpful responses.

Gill; if I ask an EP if they themselves are going to perform a procedure (rather than a registrar/junior) and they assure me 'yes I will' then that's OK for me.

PhilS, please be sure to keep posting as to how things go Ernst-consultation-wise. My GP did get me a consult in 2008 with Schilling who said to come back to him for an ablation on the NHS no problem when the Flec loses its efficacy. I'm lucky that my GP is also a friend and am confident he'd similarly get me 'in' with Ernst if that's the way my GP and I adjudge it the best route to go.

Cheers,

Mike

I would read the admission papers very carefully before signing yourself into the hospital; very often they say in the small print that it is a teaching facility and that a brainless, half-educated, bumbling idiot may or may not get to play around inside your heart under the supervision of the EP you think is going to be 'hands-on'. READ THE SMALL PRINT. It matters not what your EP says to you. It matters what is on the paperwork. And you definitely want your EP, your EXPERIENCED EP to be hands-on from start to finish. No first year residents for me, thank you very much. Play around on someone else's ticker.

There are excellent EP's in the UK I am certain but you really need to make certain that it is they that are doing the work. There is no coming back for a refund nor a discount on the next ablation when it comes to heart surgery.

TRUST... yes. BUT VERIFY IN WRITING.

Murray L

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Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.