Ablation options for U.K. resident

Hi all,

With two episodes in a week (with only a couple per year for the last 19 years), I’m thinking that the daily 100 BID Flecainide (last 10 years and PiP before that for a couple of years) is likely losing its efficacy.

My heart has felt twitcher in general for the last 4 months.

Hence an ablation beckons.

My choices are:

1. EP in Leeds (80 miles from me) who has been doing 4 AF ablations per week for the last 15+ years - currently at around 75% success rate for one procedure and no fatalities or strokes to date. He has worked with Professor Schilling in London (widely regarded along with Sabine Ernst as the best in the U.K.) in the past. My GF is a gynaecological surgeon who is medical director at the Nuffield private hospital in Leeds where he has his private consults and she has the utmost respect for him and says she’d seriously consider him were she to require an ablation - at least as a ‘first go’ given it could be done at no cost to me on the NHS. According to my Internet research his patient feedback is five out of five across the board. He’s aparently a quiet under the radar kind of guy who doesn’t particularly seek out notoriety and just gets the job done. I could also get this guy on the NHS here in the U.K. with it being more likely - given all the circumstances as aforementioned - being that it would be him doing the procedure rather than one of his team - in contrast with Schilling or Ernst unless one went privately.

2. Richard Schilling in London - would have to go privately and pay circa £15K per procedure to be sure to get him doing the job rather than more than likely one of team. His stats for his private work for PAF are 80% for one procedure and 90% for two. No fatalities to date.

3. Sabine Ernst in London. As per Schilling above but I don’t yet have stats for her. Slightly more expensive than Schilling.

4. Bordeaux at circa 16K Euro (I think) per procedure. Peerless stats and credentials.

I guess my two main options are 1 or 4 above - 1 as it wouldn’t cost me anything and is relatively local to me at 80 miles away, and 4 if I was paying as Bordeaux is, well, Bordeaux! I presume Bordeaux’ reputation remains as top notch as previously? Does anyone here know their current success rates for ablating PAF?

I’m not at all wealthy but could just about come up with funds to go privately at a push - but it would be at a push!

Is PVI the mainstay of AF ablation these days or do such as Natale do PVI PLUS segmental ablation? What type of ablation do the folks at Bordeaux do these days?

Lastly, so far as I can ascertain cryo and rf have equal success rates at the present time with cryo being quicker and ‘easier’.

Whilst I’m guessing that the consensus here will be ‘go to Bordeaux’, any other general views and thoughts would be most welcome.

Best regards to all,

Mike F.

If I could afford it, I wouldn't hesitate one second. I'd be on the next train to Bordeaux.

But Professor Schilling sounds like a reasonable choice and obviously is financially attractive. If you go with him, it's possible you could need a second "touch up" procedure because that's a possibility with any operator. If that happens, and the second procedure isn't a 100% success, do not -- repeat DO NOT -- allow him to attempt a third time. Get on that train to France. That's a lesson I learned from bitter personal experience.

In order from my first preference, only from what I've learned here: 4), 3) , 2), 1).

Given you aren't having a huge problem, with money a constraint, I'd probably go with 3) and then 2).

Best regards, Mike.

George

Thanks guys - much appreciated.

Have been doing some more reading + found an info document from Bordeaux that I was sent 5 years ago - I've just emailed them for an up to date copy.

I guess if former afibbers forum founder/moderator Hans went to Bordeaux for his ablation... that just about says it all. Is Hans keeping OK these days? If I recall correctly, Pat Chambers (PC here on this forum) also went to Bordeaux a few years ago - does anyone here know if he's still doing OK??

I just spoke to Ernst's private PA and when I asked for Ernst's latest stats all she said was you'd have to ask her if and when you see her as it's a personal thing.... This being in stark contrast with Schilling who so clearly and fully publishes his own stats year on year [londonafcentre.com] and Bordeaux. That said, Ernst's PA doesn't seem all that interested in talking to someone looking for info for going with the NHS rather than privately: that's fair enough I suppose, but when one tries to go the NHS route it really does all start to get shambolic and it's almost certain that on the NHS one can't be assured it would be Ernst (or Schilling) guiding the catheter for one's ablation...or even that they would be in the room directing operations. For that - with either Ernst or Schilling - one would have to go private/self-funding. In which case I suppose one might as well go to Bordeaux.

Mike F



Edited 1 time(s). Last edit at 03/20/2018 11:13AM by mwcf.

The NHS is a gamble, acute services can be brilliant but you can’t be sure you are getting the best person's hands on the catheters. In your position, if I could possibly afford it, I would choose Bordeaux.

When I had my ablations there (see my post on your other thread) I was not charged anything for the second procedure. Of course things might have changed since 2003.

(Ms) Gill

Mike,

Sounds like you need a crystal ball! My understanding (such as it is) is that if the activity is confined to your pulmonary veins, an EP who can do a good PVI will be able to take care of you, whether RF or Cryo. In that case, your option #1 sounds viable. BUT - if the activity extends beyond the PVs, most EPs are not trained in finding and isolating those areas. This is where the elites separate themselves from the pack. The challenge of course, is how do you know ahead of time?

For me the issue was that I was "paroxysmal going to persistent", so while I was hoping my AF was confined to my PVs I knew it might not be - and if it wasn't I wanted to be sure that the EP would be able to handle it. After talking to Shannon I went to Texas and have been very thankful for that advice. But, for me the options were all the same cost except for travel expenses, so for incremental expense and inconvenience I got a lot of peace of mind - an easier decision tree than yours.

If you decide to go private pay my vote would be for Bordeaux and Dr. Haisaguerre. I was worried about a lot of things as I lay awake the night before my procedure, but Dr. Natale was not one of them.

Hopefully Shannon will chime in and provide some insights for you on the EPs you're considering.

All the best with the decision, and NSR,

Clay

Gill,

Thanks for your post/s. My understanding from my conversation today with Stephanie at Bordeaux is that any touch-up/attention within the few days after -procedure stay at the hospital is included in the cost of the first procedure. That’s a big plus over going private in the U.K., but that said any second procedure after a month or two and one would be paying the full amount again just as in the U.K. if going privately/self-funded.

Clay,

Many thanks for your post also. I’m still firmly paroxysmal as I have been for almost 20 years. I do, however, get AF where the AF alternates with a fast (for me - normal resting HR of 60) regular but bounding rhythm running at 80-90 BPM. This hasn’t ever been caught on ECG so I don’t know if it’s 4:1 flutter or a rapidly firing focus in the PVs or some other macro reentrant atrial tachycardia emanating NOT from the PVs. As you say, if all my woes originate from the PVs, then a straightforward PVI - whether rf or cryo - would likely do the job. I know how common atrial flutter is after AF ablation (if I don’t already get it with my AF as aforementioned), so I definitely want a right flutter ablation at the same time as a PVI and for this I’m figuring I need rf rather than cryo (or can one have both cryo for the PVs and rf for the flutter in the same procedure?). The guy at Leeds is fine with doing a right aflutter ablation at the same time as the PVI. (And the guy at Leeds is free to me on the NHS for procedure 1 and procedure 2 as and if required.) All that said, the fact remains that at Bordeaux they have the most experienced EPs and they go after everything causing any issues all in the first procedure and their success rates and other stats are right up there with the best in the world.

Thanks again and with best regards,

Mike



Edited 1 time(s). Last edit at 03/24/2018 04:57PM by mwcf.

If you can afford it, pay. There’s not a dollar (or Euro) better spent than on a loved one or one’s own quality of life.

I may not envy you the bureaucracies of state-run health care, but I do admire the relatively lower cost of out-of-pocket procedures across the pond. To have that done here in the States, it may well run north of $50k. We are not a model of efficiency!

Thanks wolfpack.

Shannon tells me Natale would be circa $40K (£30K) were I to come to the US on an obviously none-insurance basis. My present thinking is that IF I can get Ernst - definitely right up there with the best EPs in the world - herself doing the procedure funded by the NHS here in the UK, then that's an excellent not to say very financially attractive option. That said, it's good to know that there's always Natale in the background if needed - even though I'd have to downsize my house to afford it!



Edited 1 time(s). Last edit at 03/26/2018 06:06AM by mwcf.