What are the common symptoms that your patients tend to present with?

It's quite varied. If the patient has been appropriately referred, it is usually because of palpitations. That's the most common symptom among the patients that I would see.

Patients may also be referred with dizzy spells, breathlessness, lightheadedness, or even loss of consciousness. Oftentimes, patients will have researched their symptoms online in advance and will have decided that they should visit a doctor. Ectopic beats are a common symptom for which patients self-refer.

Sometimes a specific arrhythmia diagnosis has been made or suspected elsewhere and the patient has been referred for specialist arrhythmia-focused investigation and management. The most common confirmed diagnosis made elsewhere and for which I am referred patients is atrial fibrillation. Less common but very amenable to curative treatment is an ECG-confirmed diagnosis of either atrial flutter or supraventricular tachycardia.

Some patients may have a family history of heart troubles and they just want to be checked out to make sure they don’t have the same problem.

What are the treatments that you're able to offer your patients?

We can investigate and treat every form of heart rhythm disorder. The treatments break down into two broad categories – those for bradycardia (excessively low heart rates) and tachycardia (excessively high heart rates). For bradycardia, the treatment may be implantation of a pacemaker; for tachycardia, the treatments options are broader and depend really very much on the diagnosis. This could vary from medication to catheter ablation to implantation of a defibrillator.

The majority of our work is seeing patients who have symptoms, but who don’t necessarily need an intervention and distinguishing those from the patients who do need an intervention, or whose quality of life could be improved by considering one.

The most common intervention by far that we perform is catheter ablation for atrial fibrillation which is not surprising as this is the most common heart rhythm disturbance!

What are your areas of sub-specialist interest?

My practice is built on a strong academic base. I'm engaged in ongoing research into the conditions that I ultimately treat in patients, particularly atrial fibrillation. My team has a very broad-reaching research portfolio to investigate mechanisms of atrial fibrillation, but also to identify the patients who would benefit most from intervention and hopefully to avoid invasive treatments in patients where the likelihood of arrhythmia cure is low.

Atrial fibrillation is a blunt diagnosis, made on the basis of a single heart rhythm ECG recording but actually it represents a spectrum of electrical disorder of the heart. So, being able to tailor appropriately the investigation and management to the patient in front of us is very important. I would argue that this is something we do very well, helped in part by our extensive research work (over 250 peer-reviewed journal papers) specifically in the investigation and management of atrial fibrillation.

We also have strong links with cardiac imaging, bioengineering, and computational modelling to support our research in atrial fibrillation. Although we are electrophysiologists, we have access to expertise in these complementary fields that permits us to offer something beyond standard electrophysiological practice. Whether that makes us better or not, I don’t know, but it certainly makes us evidence-based and unlikely to offer treatment on the basis of gut feeling or tradition!

The investigation and treatment our patients receive are based on the most contemporary data in the field of arrhythmia medicine and where appropriate, our own published work.