Bordeaux or London AF Centre (Prof. Schilling)

I'm still agonising about where to go for an ablation. I've had various email correspondence with Bordeaux (both admin and Prof. Jais himself) and they have been most helpful and courteous. Bordeaux is obviously absolutely right up there at the top of the list. If I were a French national living in France OR resident in a country lacking any top tier EPs and having enough money to pay privately then clearly Bordeaux would be a total no-brainer. But as a UK resident and being of modest financial means there are cost and logistical issues that I need to factor in - not least given that there are some top EPs here in the UK - notably Schilling and Ernst. Right now if having an ablation in the UK I'm favouring Schilling - not least because he has been doing AF ablations since 1998 and openly publishes his own stats year on year for his own private (not NHS at St. Barts - where it would be his team rather than him himself doing the procedures) ablation work at London Bridge Hospital.

Bordeaux-wise, Prof. Jais estimates me to have around 80% chance of being successfully ablated for my paroxysmal AF with one procedure. Appreciating that my financial means are limited, he has also kindly said that he will do his very best to so far as he reasonably can avoid any chance of PVI reconnection.

Here are Schilling's stats for 2016 (2017 stats not available yet as the 18 month follow-up period obviously hasn't elapsed yet):

[londonafcentre.com]

In 2016 for paroxysmal AF he achieved 79% success for one procedure (no AF and no meds at 18 month follow-up - his criteria for success or failure are very clearly stated in 'Background on page 2) and 91% success with 2 procedures (average 1.2 procedures per patient). In his stats he also includes any adverse consequences he's experienced (no strokes at all). He now takes an average of 61 mins per procedure (cryo is invariably quicker to do than RF) and uses just 2 minutes of X-ray time, All of the other info on the London AF Centre website is very comprehensive and helpful also. Schilling also ablates the right atrium for AFL as part of the procedure as well as going and looking for and ablating any other problem areas (as also obviously do Bordeaux). Schilling uses the latest cryo-balloon 2 for PVI that results in far less PVI reconnection than did the earlier cryo-balloon 1 equipment. In fact, research shows that PVI reconnection rates are now almost identical for cryo-balloon 2 and for contact force catheters using RF rather than cryo.

You can view Schilling's stats from 2012 to 2016 inclusive here:

[londonafcentre.com]

One major potential issue I as a UK resident have ran into Bordeaux-wise is that they tell me I would have to have a TOE here in the UK 'a few days' before the procedure. That's all well and good except for two things. First, when giving up Flecainide as I must 5 days before the procedure then that combined with the stress of travelling on my own not speaking any French it's better than 50:50 that I'm likely to get AF AFTER I've had the TOE here in the UK 'a few days' before the ablation - which kind of defeats the point of the TOE. Secondly, it is not that straightforward for me to just get a TOE here on the NHS (I'm guessing privately might be a bit easier to organise but again at significant cost) a few days before/to suit my ablation date. So here's another good thing about Schilling and the London AF Centre: if Prof. Schilling considers that a TOE is required (his website says that it 'may' be required) then it will be done on the morning of/as part of the procedure. This to my mind at least seems so much more logical (i.e. to allow for any clot that might have formed after the TOE in the not unlikely event that AF occurs in the 5 days prior to the procedure with me having stopped taking Flecainide) not to say logistically appealing.

Another major factor is whether or not I'd need a second/touch-up procedure a few months down the line. At Bordeaux it would likely cost me another E16.5K end of. If I pay for Schilling privately for a first procedure at London Bridge and then require a touch-up the indications are favourable that I could get a second/touch-up procedure on the NHS at St. Barts on the basis that Schilling would be more likely/compelled to want to finish off his own work than let someone else do it for him.

So my decision-making process continues. My next step is to have a private consult with Schilling and then go from there.

Many thanks to all here who've responded with their views and opinions.

Mike F.



Edited 4 time(s). Last edit at 03/24/2018 11:28AM by mwcf.

Mike

The point of the TOE is not to see if you are in AF but to show if there are any clots behind the heart.

I was first booked into Bordeaux in November 2002 and had the same problem getting the TOE at the right time via the NHS or paying for it. Bordeaux told me that they could do it immediately before the ablation, which was much much cheaper than paying in UK, so that’s what I did.

They found a clot!! I was turfed out of the hospital pretty quickly with full instructions on what to do, supplies of what I needed and a prescription for more supplies. Back in a London King’s did what was necessary re blood tests and prescriptions, and two months later I needed another TOE to confirm that the clot was gone.

I investigated all options and it was cheaper for me to fly to Bordeaux for the TOE, including fares and one night in a hotel, than to have it privately in London, so that’s what I did. All was clear so I needed to book another ablation - the team were brilliant, had assumed I would be back so had reserved a slot for me in January 2003, with the TOE immediately beforehand. This time there was no clot so the ablation went ahead.

Gill

Thanks again Gill.

Yes I appreciate that the TOE isn't to see if I'm AF. I'd know about that! Plus being in AF for the procedure would, if anything, be an advantage rather than a disadvantage from the EP's viewpoint.IIRC they're looking/checking for any clot in the LAA.

Interesting - and in contrast to what they've told me via email (and as per their latest patient info sheet) - that Bordeaux did the TOE on the morning of the ablation for you and moreover cheaper than privately than here in the UK; so that's good to know and investigate/confirm. The fact remains - especially as was the case in your own circumstances - that it's a lot easier just to let Schilling's team do the TOE on the morning of the ablation as part of the procedure here in the UK rather than involve another possibly abortive return trip to France (and having not had Flecainide for 5 days) were a clot to be found.

The main question in my head at the moment - indeed as per my message of earlier today - is why pay privately and go to France for an 80% success rate for one procedure for PAF when I can get pay privately here in the UK and get pretty much the exact same success rate.

Thank you again and with kind regards,

Mike F.

Mike

I sympathise with your dilemma! In 2002 I didn’t have the same decisions to make because only a couple of EPs in UK were beginning to consider ablations, so Bordeaux was my only option. I had been in long term persistent AF for 18 months and the prospects for success were not good. I consider myself very lucky to have had all these years of sinus rhythm.

Hope you too get it all sorted for a good outcome.

Gill

Hi again Gill,

I checked with Prof. Jais today (!) and he confirms that I definitely have to get the TEE done before travelling to Bordeaux so that particular dilemma remains. I’ll be looking very closely at the self-funded/private option with Prof. Schilling next week and will keep you up to speed!

I hadn’t previously picked up that you’d been in LTPAF for 18 months prior to your ablation, so a really good job back in 02 by those Bordeaux folks for sure!

Many thanks again and thank you for your kind wishes,

Mike F