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THE GOOD DOC­TORS GUIDE

TO­DAY: FAULTY HEARTBEATS

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Ex­clu­sive: Bri­tain’s best con­sul­tants – as cho­sen by their fel­low doc­tors

WHAT are the hall­marks of a good doc­tor? Skill and tech­ni­cal ex­per­tise, of course. But also vi­tal is some­one who un­der­stands you and some­one you trust.

In fact, re­search has proved that a good re­la­tion­ship with a doc­tor can ac­tu­ally im­prove your chances of a suc­cess­ful out­come. But how do you find a spe­cial­ist who fits the bill?

That’s where this unique se­ries of guides, which started in Satur­day’s Mail and con­tin­ues ev­ery day this week, can help you out.

We have iden­ti­fied the coun­try’s top con­sul­tants — as judged by their peers. We’ve can­vassed the views of more than 260 of them, across seven spe­cial­i­ties, and asked them this very sim­ple, but key, ques­tion: ‘If your own near­est and dear­est were to need treat­ment in your field, to whom would you re­fer them — and why?’

The con­sul­tants who earned the most votes from their peers are the ones who made it into our guides.

Pa­tients should bear in mind, though, that this is not a sci­en­tific study and there are many su­perb, highly skilled pro­fes­sion­als na­tion­wide who didn’t make it on to our list, but who are mak­ing a real dif­fer­ence to pa­tients ev­ery day.

To help you make in­formed choices about your own care, or that of your loved ones, we’ve also talked to ex­perts about the very lat­est think­ing on var­i­ous treat­ment op­tions.

To­day, we look at the best doc­tors for heart rhythm prob­lems.

REV­O­LU­TION IN TREAT­MENT

MORE than two mil­lion peo­ple in the UK have a faulty heart­beat, or ar­rhyth­mia. Un­for­tu­nately, up to half-a-mil­lion go un­di­ag­nosed and, as their con­di­tion hasn’t been spot­ted and, there­fore, treated, their risk of stroke is sig­nif­i­cantly raised. The good news for those who

have been di­ag­nosed is that there’s been a rev­o­lu­tion in the treat­ment of heart rhythm disor­ders in re­cent years.

These disor­ders oc­cur when the heart’s elec­tri­cal cir­cuits, re­spon­si­ble for keep­ing it pump­ing, be­come scram­bled, send­ing faulty mes­sages that over­ride the heart’s nat­u­ral pace­maker, a clus­ter of cells known as the si­nus node. This prob­lem can be some­thing you were born with or a con­se­quence of coro­nary heart dis­ease or age­ing.

Ar­rhyth­mias can range from a slow heart­beat, where the or­gan can’t pump enough blood around the body, to the most dan­ger­ous form, ven­tric­u­lar fib­ril­la­tion — the lat­ter can be fa­tal with­out rapid emer­gency treat­ment.

Symp­toms range from the mild to the alarm­ing. Your heart may seem to flut­ter or skip beats. Or it can race like mad, even though you’re just qui­etly watch­ing TV. Or you might find yourself sud­denly ex­hausted, short of breath and prone to faint­ing.

The most com­mon ar­rhyth­mia is atrial fib­ril­la­tion, which causes a fast, chaotic heart­beat. This tends to oc­cur mostly in peo­ple over the age of 60 and af­fects around a mil­lion Bri­tons.

Here, ran­dom elec­tri­cal charges cause the up­per cham­bers of the heart (called the atria) to quiver, af­fect­ing the heart’s abil­ity to pump blood ef­fi­ciently.

The most se­ri­ous con­se­quence of un­treated atrial fib­ril­la­tion is stroke, be­cause the heart’s fee­ble pump­ing ac­tion al­lows blood to pool, caus­ing clots, which can break off and travel to the brain. This is why one of the first steps in treat­ing the con­di­tion is blood-thin­ning med­i­ca­tion.

What­ever the type of ar­rhyth­mia, med­i­ca­tion can be used to try to con­trol or pre­vent it.

Other op­tions in­clude giv­ing a shock to the heart in or­der to re­store a nor­mal rhythm, or im­plant­ing a pace­maker or an ICD (im­plantable car­dioverter de­fib­ril­la­tor), which gives an elec­tric shock if an ab­nor­mal heart rhythm is de­tected.

A min­i­mally in­va­sive al­ter­na­tive is catheter ab­la­tion. This non­sur­gi­cal pro­ce­dure is be­com­ing the gold stan­dard way to re­solve prob­lems with heart rhythm, par­tic­u­larly atrial fib­ril­la­tion, says Philippa Hob­son, a se­nior car­diac nurse at the Bri­tish Heart Foun­da­tion.

It is per­formed by an ex­pert car­di­ol­o­gist, known as an elec­tro­phys­i­ol­o­gist, and takes be­tween two and four hours. A thin wire with an elec­trode at its tip is threaded through the veins — usu­ally start­ing in the thigh — to the heart to cre­ate scar tis­sue, ei­ther with heat or freez­ing, to de­stroy rogue tis­sue re­spon­si­ble for send­ing faulty sig­nals, or ef­fec­tively block ab­nor­mal elec­tri­cal cir­cuits in the heart.

How­ever, as one lead­ing car­di­ol­o­gist told us, it would be a dread­ful shame ‘if the tech­no­log­i­cal de­mands eclipsed the hu­man side’.

Dr Ed­ward Row­land, who is based at St Bartholome­w’s Hos­pi­tal in Lon­don, says that em­pa­thy and a car­ing at­ti­tude are im­por­tant, too — par­tic­u­larly when pa­tients are wor­ried.

Suc­cess­fully treat­ing pa­tients, he sug­gests, is not just about the ab­la­tion op­er­a­tion, but how the pa­tient is treated in the run-up to it and their aftercare.

‘When your heart starts go­ing crazy and you think you are go­ing to die, it is not sur­pris­ing that pa­tients can be­come very anx­ious,’ says Dr Row­land.

‘Tech­ni­cal ex­per­tise is very im­por­tant — but this has to be ac­com­pa­nied by other hu­man fac­tors to pro­duce the best re­sults pos­si­ble.

‘There are some car­di­ol­o­gists who are excellent tech­ni­cally, but you would not nec­es­sar­ily send your clos­est fam­ily to them.’

So, how do you find an elec­tro­phys­i­ol­o­gist equipped with not just the tech­no­log­i­cal nous, but also the bed­side man­ner that can help peo­ple con­quer a dis­tress­ing, and some­times dis­abling, dis­ease?

We asked 40 con­sul­tants across

the coun­try who they be­lieve are the top per­form­ers. Here, we re­veal their choices — along with some of their rea­sons for se­lect­ing them.

CAR­DI­OL­O­GISTS THEIR PEERS RATE PRO­FES­SOR RICHARD SCHILLING St Bartholome­w’s Hos­pi­tal in Lon­don

WHAT THEY SAY

ABOUT HIM: ‘ He was one of the very first to push atrial fib­ril­la­tion ab­la­tion in the UK and this has had a mas­sive and pos­i­tive im­pact on the lives of so many peo­ple — he is very skilled at it,’ says one of his peers.

‘He’s a great pa­tient cham­pion and works closely with the Ar­rhyth­mia Al­liance, a net­work of spe­cial­ists, pa­tient groups and char­i­ties, try­ing to raise aware­ness of these con­di­tions and im­prove di­ag­no­sis and treat­ment.

‘He’s also made an im­mense aca­demic con­tri­bu­tion to the sub­ject of ar­rhyth­mias as a key re­searcher,’ says an­other.

‘This mat­ters to pa­tients be­cause it is a sign of some­one keen to de­velop and re­fine treat­ments.’

PRI­VATE PRAC­TICE: Lon­don Bridge Hos­pi­tal.

DERICK TODD Liver­pool Heart and Chest Hos­pi­tal

WHAT THEY SAY

ABOUT HIM: ‘A ter­rific op­er­a­tor and a lovely guy with im­pres­sive depth of skills,’ ac­cord­ing to one of his peers. ‘ He is com­pas­sion­ate, a good lis­tener, tech­ni­cally very ca­pa­ble and highly in­tel­li­gent.

‘He is also a huge be­liever in the power of au­dit­ing his unit’s re­sults — this close scru­tiny is the way to im­prove, as it is the only way to mea­sure what you’re do­ing right and where things could im­prove.’

‘Dr Todd pi­o­neered the treat­ment of chil­dren with heart rhythm disor­ders where — be­cause you’re work­ing on a far tinier scale — the risks are higher and the need to be excellent is paramount,’ says an­other of his peers.

‘Out­side of St Bartholome­w’s Hos­pi­tal in Lon­don, his Liver­pool base is now the largest heart cen­tre in the coun­try. Pa­tients should be as­sured they are get­ting the best.

‘Derick is the per­son I’d go to for ab­la­tion for atrial fib­ril­la­tion.’ PRI­VATE PRAC­TICE: Spire Cheshire Hos­pi­tal.

ED­WARD ROW­LAND St Bartholome­w’s Hos­pi­tal in Lon­don

WHAT THEY SAY

ABOUT HIM: ‘One of the most re­spected elec­trop h y s i o l o g i s t s [ the branch of car­di­ol­ogy that treats heart rhythm prob­lems] in the coun­try,’ ac­cord­ing to one who nom­i­nated him. ‘He is highly ex­pe­ri­enced and tech­ni­cally good, which means he can ma­nip­u­late very small wires in the heart.’

‘He is “old school” in a good way and is charm­ing, re­as­sur­ing, a great com­mu­ni­ca­tor and ex­tremely skilled, but he is not ob­sessed with the tech­nol­ogy,’ re­veals an­other.

‘He takes a holis­tic view of what will be best by weigh­ing very care­fully the risks and ben­e­fits of treat­ing his pa­tients and will say no to treat­ment if he feels this is in the pa­tient’s best in­ter­est.

‘He would be my first choice for my­self.’ PRI­VATE PRAC­TICE: The Har­ley Street Clinic and Bupa Cromwell Hos­pi­tal, both in Lon­don.

PRO­FES­SOR MARK O’NEILL St Thomas’ Hos­pi­tal in Lon­don WHAT THEY SAY ABOUT HIM:

‘On the lead­ing edge, he has built an in­ter­na­tional rep­u­ta­tion based on his pro­lific re­search work,’ is the ver­dict of one of his peers. ‘ He is also known to pro­vide a mea­sured opin­ion on what is best for pa­tients.’

An­other car­di­ol­o­gist says: ‘He’s an ex­tremely as­tute doc­tor, par­tic­u­larly in di­ag­nos­tics. He will look at pa­tients very ob­jec­tively and pick up very sub­tle clinical signs that oth­ers could over­look.’ PRI­VATE PRAC­TICE: Lon­don Heart Rhythm Group and The Har­ley Street Clinic in Lon­don.

STEPHEN MUR­RAY Free­man Hos­pi­tal in New­cas­tle

WHAT THEY SAY

ABOUT HIM: ‘ He has great em­pa­thy and knows what he is talk­ing about,’ says one of his peers. ‘He’s also tech­ni­cally very good.

‘ He di­rects a highly pro­duc­tive and in­no­va­tive unit — he has adopted new tech­niques for iden­ti­fy­ing the origin of heart rhythm prob­lems, par­tic­u­larly in atrial fib­ril­la­tion.’

‘He’s also worked hard on achiev­ing the most ef­fi­cient use of re­sources. That mat­ters be­cause mis­takes cost money and, if you’re pru­dent with your fund­ing, there is more money for in­no­va­tion,’ says an­other of his peers.

‘He works hard to boost pro­fes­sional stan­dards

and he is also very per­son­able and de­ter­mined — he won’t give up on a pa­tient.’ PRI­VATE PRAC­TICE: Free­man hos­pi­tal in New­cas­tle.

TI­MOTHY BETTS

(Pic­tured be­low) John Rad­cliffe Hos­pi­tal in Oxford WHAT THEY SAY ABOUT HIM: ac­cord­ing to one car­di­ol­o­gist, He e is a ris­ing star in elec­tro­phys­i­ol­ogy [the branch of car­di­ol­ogy that treats heart rhythm disor­ders]. ‘He has great em­pa­thy, and what we call in medicine “good hands”, as well as a won­der­fully friendly ap­proach to pa­tients and a steely de­ter­mi­na­tion never to give up on them when lesser car­di­ol­o­gists might.’ An­other re­veals: ‘ He has a grow­ing in­ter­na­tional pro­file as a re­sult of his re­search. ‘ How­ever, most im­por­tantly, with his en­thu­si­asm and quiet con­fi­dence, he car­ries his pa­tients with him.’ PRI­VATE PRAC­TICE: Nuffield Health The Manor Hos­pi­tal in Oxford.

KIM RAJAPPAN

John Rad­cliffe Hos­pi­tal in Oxford WHAT THEY SAY

ABOUT HIM: ‘ He has excellent per­sonal qual­i­ties and is easy­go­ing, hum­ble and un­der­stand­ing,’ says one of his peers.

‘Some pa­tients who suf­fer from ar­rhyth­mias are very fas­tid­i­ous and high­main­te­nance per­son­al­i­ties who, as a re­sult, may come in to see him armed with a sched­ule of the time of on­set and ending of an episode of their atrial fib­ril­la­tion.

‘While some might prickle at this ap­proach, he doesn’t, and pa­tients re­ally like him. He also does an enor­mous num­ber of pro­ce­dures and has great ex­pe­ri­ence.’

Ac­cord­ing to an­other of his peers: ‘In ad­di­tion, he has got what we in medicine call “great hands”. In other words, ma­nip­u­lat­ing the wires into the heart seems ef­fort­less to him. This takes huge skill to do well.’ PRI­VATE PRAC­TICE: Nuffield Health The Manor Hos­pi­tal in Oxford.

WYN DAVIES

St Mary’s Hos­pi­tal in Lon­don

WHAT THEY SAY

ABOUT HIM: The con­sul­tant who treated for­mer Prime Min­is­ter To n y Blair’s ar­rhyth­mia back in 2004 is ‘seen as a fa­ther of elec­tro­phys­i­ol­ogy [ the branch of car­di­ol­ogy that treats heart rhythm prob­lems]’, is the ver­dict of one of his peers.

He has an excellent tech­ni­cal abil­ity and ‘ abun­dant hu­man qual­i­ties that would mat­ter if I needed a car­di­ol­o­gist for my clos­est rel­a­tive,’ re­veals an­other.

The Har­ley Street Clinic in Lon­don. PRI­VATE PRAC­TICE:

YAVER BASHIR

John Rad­cliffe Hos­pi­tal in Oxford WHAT THEY SAY

ABOUT HIM: ‘Re­ally fan­tas­tic, in­cred­i­bly nice, con­sid­er­ate and a font of knowl­edge,’ says one car­di­ol­o­gist.

‘ He also has one of the best elec­tro­phys­i­ol­ogy brains in the coun­try [elec­tro­phys­i­ol­ogy is the branch of car­di­ol­ogy that treats heart rhythm prob­lems]. He is care­ful to try to take on board the pa­tient’s view on treat­ment.’

‘Wis­dom cou­pled with com­mon sense,’ adds an­other of his peers.

Nuffield Health The Manor Hos­pi­tal in Oxford. PRI­VATE PRAC­TICE:

MAR­TIN LOWE

The Heart Hos­pi­tal and Great Or­mond Street Hos­pi­tal, Lon­don WHAT THEY SAY

ABOUT HIM: ‘ He takes on ex­tremely com­plex cases, par­tic­u­larly with chil­dren and adults born with heart prob­lems,’ ac­cord­ing to one of his peers.

‘ When you are deal­ing with a much smaller scale — with pae­di­atric pa­tients — you have to be very good tech­ni­cally, but he also has the de­ci­sion­mak­ing skills that de­fine the best doc­tors.’ PRI­VATE PRAC­TICE: The Har­ley Street Clinic in Lon­don. ALSO HIGHLY THOUGHT OF . . .

CHRIS PEP­PER

Leeds Gen­eral In­fir­mary

WHAT THEY SAY

ABOUT HIM: ‘Very sound, sen­si­ble and well­liked by pa­tients,’ says one who nom­i­nated him. ‘NHS treat­ment guide­lines don’t pro­vide you with all of the an­swers and he is some­one who thinks out­side the box, with­out be­ing cav­a­lier.’

‘He’s held in high es­teem, but is quite hum­ble, too,’ says an­other.

PRI­VATE PRAC­TICE: Nuffield Health Leeds Hos­pi­tal.

PRO­FES­SOR PIER LAMBIASE

St Bartholome­w’s Hos­pi­tal in Lon­don

WHAT THEY SAY

ABOUT HIM: ‘An excellent doc­tor, ac­tively engaged in re­search — at the fore­front in terms of di­ag­nos­ing and treat­ing in­her­ited ar­rhyth­mia.’ PRI­VATE PRAC­TICE: The Har­ley Street Clinic in Lon­don and the Lon­don Heart Cen­tre.

GUY HAY­WOOD

Der­ri­ford Hos­pi­tal in Ply­mouth WHAT THEY SAY

ABOUT HIM: ‘A highly ex­pe­ri­enced car­di­ol­o­gist who is won­der­ful with pa­tients and has de­vel­oped a very im­pres­sive ar­rhyth­mia ser­vice in Ply­mouth,’ says one of his peers. ‘When he set this up maybe 20 years ago, ar­rhyth­mia was seen as a Lon­don do­main and pa­tients would have had to travel up to the cap­i­tal to get treat­ment.

‘What he of­fers in Ply­mouth is as good as could be had in Lon­don — and pa­tients ac­cess it lo­cally.’

PRI­VATE PRAC­TICE: Nuffield Health Ply­mouth Hos­pi­tal.

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