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In today's fast-paced world, many of us are turning to wearable technology to help us monitor our health and fitness. Among the various metrics these devices track, Heart Rate Variability (HRV) stands out as a critical indicator of our overall well-being. But what is HRV, and how can wearables enhance our understanding of it? This article will explore the connection between wearables and HRV, revealing what your watch can show about your heart and the limitations of those insights. Understanding Heart Rate Variability (HRV) Heart Rate Variability measures the variation in time intervals between heartbeats. Unlike a consistent heartbeat, higher HRV indicates that your body can adapt to physical and emotional stress effectively. Research shows that athletes often have HRV values that are 20-30% higher than those of sedentary individuals. Lower HRV is often linked with stress, fatigue, and even health issues, making it essential to monitor this metric. HRV is affected by several factors, including your age, fitness level, and lifestyle choices, including nutrition and emotional health. It's also subject to fluctuations throughout the day based on your activities and sleep quality. For instance, after a night of poor sleep, many people see a drop in their HRV readings, showing how interconnected these elements are. The Role of Wearables in Monitoring HRV Wearable devices, such as smartwatches and fitness trackers, have simplified HRV monitoring. They typically use photoplethysmography (PPG) technology to gauge heart rate and calculate HRV. By examining the intervals between heartbeats, wearables can provide valuable insights into HRV trends over time. Many devices also let users track HRV during various activities such as workouts, sleep, and relaxation. A study found that athletes who monitored their HRV daily and used it to guide their training reported improved recovery times and overall performance. What Your Wearable Can Tell You About HRV Daily HRV Trends : Most wearables offer daily HRV readings that let you track changes over time. For example, someone might notice a pattern where their HRV dips on days filled with high stress at work. Recognizing this can help you manage workload or stress-relief strategies. Stress Levels : Some devices measure stress based on HRV readings. A study found that individuals using wearables to monitor their HRV saw a 50% increase in awareness of their stress responses. A sudden drop in your HRV might indicate heightened stress, suggesting it’s time to take a break or practice mindfulness techniques. Recovery Insights : Athletes often rely on HRV data to determine recovery status. A higher HRV post-workout indicates good recovery, while a drop can signal the need for more rest. Studies suggest that athletes with consistent HRV monitoring improve their performance metrics by up to 15% over time. Sleep Quality : Many wearables analyze HRV during sleep, revealing how well your body is rejuvenating overnight. A recent survey found that users who tracked their HRV during sleep could better identify sleep disturbances, leading to actionable changes in their nighttime routine. Limitations of Wearable HRV Data Though wearables provide useful insights into HRV, they come with limitations: Accuracy : The accuracy of HRV readings can differ depending on the device. Variations in skin temperature, movement, and even sensor placement can skew results. It's crucial to choose a reliable device and be aware of its limitations. Context Matters : HRV is influenced by hydration, nutrition, and emotional health. Wearables may not capture these factors, leading to potentially misleading interpretations. For instance, an athlete may experience a drop in HRV due to dehydration, not necessarily stress or illness. Not a Diagnostic Tool : HRV can provide valuable health insights, but it’s not a replacement for a medical diagnosis. Changes in HRV should prompt discussions with healthcare professionals for comprehensive evaluations. Best Practices for Using Wearables to Monitor HRV To maximize your wearable’s HRV tracking capabilities, consider these best practices: Consistency : Measure your HRV at the same time each day—preferably in the morning before getting out of bed. This routine gives you more reliable data and clearer insights into your health. Combine with Other Metrics : Integrate HRV data with other health metrics, like sleep quality and stress levels. A comprehensive view enables you to spot trends and make better health decisions. For example, if low HRV correlates with inadequate sleep, it might be time to adjust your sleep hygiene. Listen to Your Body : While wearables offer valuable data, personal intuition matters too. Significant changes in HRV should motivate you to alter your lifestyle or consult a medical professional if necessary. Final Thoughts The rise of wearable technology has transformed our understanding of health, placing a spotlight on HRV as an essential metric for assessing cardiovascular fitness and overall well-being. While wearables can provide useful HRV insights, it’s crucial to recognize their limitations and interpret the data in context. By combining HRV data with other indicators and tuning into your body's signals, you can make informed decisions that support your health and well-being. As technology advances, the ability of wearables to enhance our understanding of health will continue to expand. Embrace the insights your watch offers, but remember: it’s just one piece of the puzzle in your quest for optimal health. A smartwatch showing HRV data on its screen A peaceful landscape encouraging relaxation and mindfulness

If you have been referred to a cardiologist, you may have already undergone some initial tests, such as an ECG or heart scan. Your GP or referring doctor will typically send these test results directly to me, ensuring that I have all the necessary information before your appointment. This streamlines the process and allows us to focus on next steps instead of repeating tests unnecessarily. For private consultations, it is important to check whether your insurance covers the appointment and any additional tests that may be required. If you are self-funding, you will need to be aware of the costs involved, as further investigations may be recommended during your consultation. Whether you are seeing me privately or through the NHS, my recommendations are always based on what is best for your health, without any influence from financial considerations. If you are being seen via the NHS, your referring GP or specialist may organise additional investigations before your appointment. While the NHS pathway can sometimes take longer than private healthcare, it remains a reliable and comprehensive way to access necessary cardiac assessments. I usually see patients within a few weeks of receiving a referral, but if your case is urgent, I will do my best to accommodate you sooner. Before your appointment, you can contact my PA, Kitti, or her team if you have any questions about logistics, paperwork, or appointment details. They can be reached by phone or email, and they will help ensure everything is in place for your consultation. How to Get Referred to a Cardiologist There are several ways to get referred to a cardiologist: ·        GP Referral: The most common way is through your general practitioner, who will assess your symptoms and decide whether you need to see a heart specialist. If they believe a cardiology consultation is necessary, they will send a referral either through the NHS or privately, depending on your preference. ·        Self-Referral: If you wish to be seen privately, you can contact my team directly to arrange an appointment. Many patients choose this route to expedite the process and avoid waiting times. ·        Referral from Another Doctor: Some patients are referred by another specialist, such as a respiratory physician or neurologist, if their symptoms suggest a potential heart-related issue. If another doctor has recommended that you see me, they may provide you with a letter or directly forward the referral to my clinic. If you are unsure about how to proceed, my team is happy to guide you through the process and ensure you receive the care you need. Whether through the NHS or private healthcare, the goal is always to get you the right diagnosis and treatment as efficiently as possible.

Atrial fibrillation (AF) is a disorganised arrhythmia affecting the top chambers of the heart, known as the atria. It is the most common sustained heart rhythm disorder and one of my particular areas of expertise. When I was in medical school, I was taught that AF is a purely chaotic and random rhythm. However, we now know that this is not entirely the case. The underlying mechanisms are more structured, driven by fibrosis and disrupted electrical conduction in the atria. AF often develops due to ageing, high blood pressure, diabetes, and even long-term endurance exercise. Over time, these factors cause scarring (fibrosis) in the atria, which slows and disrupts electrical conduction. The veins leading to the back of the heart, particularly the pulmonary veins, normally dampen extra beats. However, when fibrosis alters this electrical balance, these veins start firing off ectopic beats that spread through the atrium. If enough scarring is present, these signals can trigger a self-perpetuating cycle, leading to rapid and irregular heartbeats. This chaotic rhythm then conducts to the ventricles, causing an erratic and often fast heartbeat. Why Does Atrial Fibrillation Matter? AF presents several risks, the most serious being the risk of stroke. The left atrial appendage, a small reservoir in the left atrium, is particularly prone to blood pooling when the atria are not contracting effectively. This can lead to clot formation, which, if dislodged, can travel to the brain and cause a stroke. The risk of this happening depends on various factors such as age, high blood pressure, diabetes, and previous strokes. Most patients with AF require anticoagulant (blood-thinning) medication to significantly reduce this risk, bringing their stroke likelihood back down to near-normal levels. Another major concern is the effect of AF on the heart's pumping ability. If the heart beats too fast for prolonged periods, it can weaken the heart muscle, leading to a condition known as tachycardia-induced cardiomyopathy. This can cause heart failure, where the heart struggles to pump blood effectively. To prevent this, controlling the heart rate is critical. Medications such as beta-blockers or calcium channel blockers are often prescribed, and in some cases, digoxin may be added. For some individuals, rate control alone is insufficient, and restoring a normal heart rhythm becomes a priority. Restoring Normal Rhythm For many patients, maintaining a normal heart rhythm improves symptoms and prevents long-term heart damage. There are two primary approaches to achieving this: medication or procedural interventions. One method is cardioversion, where an electric shock is used to reset the heart’s rhythm. This is often combined with antiarrhythmic drugs, such as amiodarone, which help maintain normal rhythm. However, long-term use of these medications carries significant side effects, and for many patients, they are not a viable option over extended periods. Catheter Ablation: A More Effective Long-Term Solution The limitations of medication have led to the development of catheter ablation, a procedure designed to target the underlying triggers of AF directly. Ablation involves threading thin catheters through the blood vessels into the heart and using energy to modify or destroy problematic electrical pathways, typically around the pulmonary veins. This prevents ectopic beats from initiating AF, significantly reducing its recurrence. Traditionally, radiofrequency or cryoablation has been used, both of which have been effective but come with some risks, such as collateral damage to surrounding structures. However, a new technique called pulsed field ablation (PFA) is revolutionising how we treat AF. Instead of using heat or extreme cold, PFA delivers ultra-short electrical pulses that selectively target heart muscle cells without damaging surrounding tissues such as the oesophagus or nerves. I have been using PFA in my practice and achieving outstanding results. The precision and safety profile of this technology mean that patients experience fewer complications and shorter recovery times. In fact, our latest data on PFA treatment has shown excellent success rates, and we will be publishing these results soon. What Does Treatment Look Like for AF? For most patients, treatment decisions are based on their symptoms and risk factors. The approach typically follows a sequence: ·        Assess Stroke Risk If stroke risk is high, anticoagulation is prescribed. ·        Control Heart Rate Medications are used to prevent excessively fast heart rates. ·        Evaluate the Need for Rhythm Control: If symptoms persist or heart function is affected, cardioversion, medication, or ablation is considered. ·        Perform Ablation if Necessary: For many patients, ablation—particularly using advanced techniques like PFA—offers the best chance of long-term success. What if Ablation Fails? First-time success rates for AF ablation are typically around 70–80%. However, in patients with persistent AF (where the arrhythmia is present all the time), approximately one-third will need a second procedure. In rare cases, a third ablation may be required. This is usually due to a fast, regular rhythm called atrial flutter, which is closely related to AF but responds very well to ablation treatment. For some patients who have had AF for a long time or whose atria have been significantly damaged by ageing, high blood pressure, or other conditions, complete elimination of AF may not be possible. In these cases, ongoing medical treatment can often keep symptoms under control. In certain patients, particularly those whose AF cannot be effectively managed with medication or ablation, a pacemaker can be a very good option. While pacemakers do have some downsides, they are a straightforward procedure and can be the right choice for select patients who need more reliable heart rate control. Living with Atrial Fibrillation AF can be a challenging condition, but with the right management strategy, most patients can lead normal, active lives and we can prevent those feared complications of Heart Failure or Stroke. The key is a personalised approach, considering factors such as symptom burden, heart function, and stroke risk. Advances in ablation techniques, particularly with PFA, are transforming treatment options and providing better outcomes than ever before. As research progresses, our ability to manage and potentially cure AF continues to improve. My focus remains on delivering the most effective treatments available, ensuring patients receive the highest standard of care.

Cardiology appointments are generally straightforward, and there is no strict dress code. However, wearing the right clothing can make the process smoother and more comfortable, particularly when it comes to examinations and tests. While you don’t need to dress in a specific way, considering ease of access to certain areas of the body can be helpful. During most appointments, I may need to perform an ECG, listen to your heart and lungs, or, in some cases, perform an echocardiogram. Therefore, it is helpful to wear clothing that allows easy access to your chest and arms. For example, loose-fitting tops or those that can be easily unbuttoned or lifted are ideal. If you are wearing layers, it is best to avoid wearing too many, as removing multiple items can be inconvenient when taking blood pressure readings or performing examinations. For women, a separate top and bottom rather than a dress can be more practical, as it allows easier access for tests while maintaining comfort. However, even if clothing is more complex, we can almost always work around it, so there is no need to worry too much. It is more about ensuring convenience rather than following strict rules. Blood pressure measurements are routinely taken during appointments, so it’s helpful to wear short sleeves or a top with sleeves that can be easily rolled up. Tight or restrictive clothing around the arms can make it challenging to obtain an accurate reading, which may require removing layers. If you choose to wear long sleeves, opt for something loose-fitting that can be adjusted with minimal hassle. For procedures, wearing really relaxed clothing—such as a tracksuit, sweatshirt, or similar—is ideal. The most important thing is to feel comfortable and flexible, as some procedures require you to remain in one position for a period of time. Additionally, if you are having blood tests as part of the procedure, there is always a small chance that a spot of blood could get onto your clothing despite the best efforts to avoid it. For this reason, it is best to avoid wearing anything too special or that would be difficult to clean if this were to happen. Loose, breathable fabrics can also help to keep you comfortable, especially if you are in the hospital for a longer period. Footwear is also important to consider. While cardiology appointments usually do not require much physical movement, wearing comfortable shoes can be helpful if you need to walk to another department for tests or scans. Avoid shoes that are hard to remove in case you are asked to lie down for an examination. No matter what you wear, I always ensure that a chaperone is present for any physical examination to maintain professionalism and patient comfort. Your well-being is the priority, and I strive to make every appointment as easy and stress-free as possible. Ultimately, your health is the priority, and while practical clothing can make things easier, we can usually adapt if needed. If you have any concerns, you can always ask in advance to ensure you are comfortable and prepared for your appointment. Dressing in a way that allows easy access for tests while keeping you relaxed is the best approach to making your visit as smooth as possible.

I am a consultant cardiologist, and people often wonder what exactly my role involves. In simple terms, a cardiologist is a doctor who specialises in heart conditions. However, there are many different types of cardiologists. Some focus on general heart-related issues, while others, like myself, are highly specialised in particular aspects of heart health. In my case, I specialise in diseases of the heart’s electrical system, a field known as cardiac electrophysiology. Cardiology itself is a vast field. Many cardiologists work in general cardiology, diagnosing and managing common conditions such as high blood pressure, coronary artery disease, and heart failure. Others specialise further into areas such as imaging, congenital heart disease, or interventional cardiology, which involves procedures like angioplasty and stenting. My particular area of expertise is heart rhythm disorders. The heart's electrical system controls its beating, and when this goes wrong, it can lead to symptoms such as palpitations, dizziness, blackouts, or even cardiac arrest. I diagnose and treat all kinds of problems related to heart rhythm disturbances. The most common condition I deal with is atrial fibrillation, the most frequently occurring cardiac arrhythmia. It can cause irregular heartbeats, breathlessness, fatigue, and an increased risk of stroke. A significant part of my work involves performing catheter ablation, a specialised procedure that can cure many patients of their arrhythmia problems. This is a minimally invasive technique where fine wires (catheters) are passed into the heart via the blood vessels to identify and treat abnormal electrical signals. For many people, this offers long-term relief from their symptoms and can dramatically improve their quality of life. Some patients require devices to help regulate their heart’s electrical function, such as pacemakers or implantable cardioverter defibrillators (ICDs). Pacemakers are used for slow heart rhythms, ensuring the heart beats at a safe and steady rate. ICDs, on the other hand, are used for patients at risk of dangerous heart rhythms that could cause cardiac arrest. These devices monitor the heart continuously and can deliver life-saving shocks if necessary. Becoming a cardiologist requires extensive training. After completing medical school, I undertook around five years of general cardiology training before specialising in cardiac electrophysiology. I qualified from Oxford University in 2001 and became a consultant in 2014. Along the way, I also completed a PhD at University College London, which gave me additional expertise in heart rhythm disorders. On a day-to-day basis, my work is split between seeing patients in outpatient clinics and performing procedures in the hospital. In clinic, I spend much of my time diagnosing conditions and deciding on the best course of treatment. Often, patients come to me with an established diagnosis, and my role is to determine whether medication, lifestyle changes, or an intervention such as ablation or a pacemaker is the best approach. If a procedure is required, the next step is to schedule and carry it out. After that, I follow up with patients to monitor their recovery and manage any ongoing issues. Some conditions can be fully treated, while others require long-term management to keep symptoms under control. Being a cardiologist is a fascinating and rewarding job. It is intellectually stimulating, involving constant learning and problem-solving. It is also highly practical, requiring hands-on skills for procedures. Most importantly, it is fulfilling because it allows me to make a real difference to patients' lives. Treating heart rhythm disorders can transform a patient’s health, giving them back their energy, confidence, and quality of life. Overall, cardiology is a diverse and exciting field with many subspecialties. Whether diagnosing high blood pressure, performing complex ablations, or implanting life-saving devices, the aim is always the same: to keep hearts healthy and help patients live longer, better lives.

Heart rate variability (HRV) is a topic that often comes up in discussions about heart health and overall wellbeing. In simple terms, HRV is a measure of the small variations in the time intervals between each heartbeat. This article aims to explain what HRV is, why it cannot be used reliably as a stand‐alone diagnostic tool, and how changes in HRV might reflect other underlying health effects. What is Heart Rate Variability? Heart rate variability is not a measure of how fast your heart beats, but rather how the time between beats fluctuates naturally. Every heartbeat is influenced by the autonomic nervous system – the part of the nervous system that controls involuntary functions such as breathing, digestion, and heart rate. The autonomic nervous system is divided into two branches: the sympathetic system, which prepares your body for ‘fight or flight’, and the parasympathetic system, which promotes ‘rest and digest’ activities. When you are active or under stress, the sympathetic nervous system becomes more dominant, typically resulting in a more uniform, faster heart rate. Conversely, when you are relaxed or asleep, the parasympathetic system takes over, and there tends to be more variability in the time between each heartbeat. This natural fluctuation is what we call heart rate variability. It is important to note that some degree of variability is normal and even a sign of a healthy, responsive cardiovascular system. Why HRV Cannot Be Used as a Stand-Alone Diagnostic Tool Although HRV provides valuable insights into how the body responds to different physical and emotional conditions, it is not suitable for diagnosing specific health issues alone. There are several reasons for this. Firstly, HRV is influenced by a wide range of factors that differ from person to person. Individual differences, such as age, physical fitness, and genetics, can all impact HRV readings. For example, younger individuals tend to have higher HRV compared to older adults, and physically active people may exhibit a different pattern compared to those who are less active. This natural variability means that what is considered normal for one person might be abnormal for another. Secondly, HRV can change considerably from one day to the next, even within the same individual. Daily fluctuations may be related to temporary factors such as stress, sleep quality, or even the time of day the measurement is taken. Therefore, a single HRV reading cannot provide a clear picture of overall health. Additionally, interpreting HRV is complex. A low HRV reading may indicate that the body is experiencing stress or that there is an imbalance in the autonomic nervous system; however, it is often unclear whether this stems from a specific health condition or is merely a temporary state. For these reasons, clinicians prefer to use HRV as one component of a broader clinical picture rather than relying on it as a definitive test. Factors Influencing HRV Although HRV is not used to diagnose conditions directly, its fluctuations can provide insights into your overall health. Many common conditions and lifestyle factors can affect HRV, and understanding these factors can help you recognize why changes in HRV need to be interpreted carefully. Several factors that can affect HRV include: ·        Stress and anxiety : Chronic stress or acute anxiety can reduce HRV as the body remains in a state of heightened alertness. This is a natural response to stress, where the sympathetic nervous system becomes more active, leading to less variability between heartbeats. ·        Sleep quality and disorders : Good quality sleep is important for restoring the body and balancing autonomic function. Conversely, sleep disorders such as insomnia or sleep apnoea can lower HRV, reflecting the ongoing strain that poor sleep places on the body. ·        Cardiac conditions: Heart-related issues, including high blood pressure, coronary artery disease, or heart failure, can influence HRV. In these cases, a lower HRV may indicate that the heart’s regulatory mechanisms are compromised. However, it is crucial to understand that HRV changes are secondary to the underlying heart condition, which is diagnosed using more direct methods such as electrocardiograms (ECGs) and imaging studies. ·        Autonomic dysfunction : Conditions that affect the autonomic nervous system, such as diabetic autonomic neuropathy, can lead to abnormal HRV readings. This type of dysfunction can disrupt the normal balance between the sympathetic and parasympathetic systems, resulting in lower variability. ·        Lifestyle factors : Physical activity, diet, alcohol consumption, and smoking can all have an impact on HRV. For instance, regular exercise tends to improve HRV by enhancing cardiovascular fitness and reducing stress levels, while excessive alcohol intake or smoking may have the opposite effect. It is clear from these factors that HRV is a dynamic marker influenced by many aspects of health and lifestyle. Because of this complexity, a single HRV measurement does not provide a definitive diagnosis, but rather a snapshot of how your body is coping with various demands at a given time. Interpreting HRV in the Context of Overall Health HRV is typically measured as part of a broader health assessment. This might include clinical examinations, detailed patient histories, and other diagnostic tests. If a significant change in HRV is noted, it should prompt further investigation rather than being taken as a sign of a specific problem. For example, a lower-than-expected HRV may raise questions about whether you have been experiencing increased stress, whether your sleep has been disrupted, or whether an underlying health condition might be affecting your heart. Similarly, an unusually high HRV in a specific context may suggest that your body is responding well to relaxation and recovery, though this is not always the case. The key point is that HRV serves as a supportive metric, offering additional context to your overall health status rather than acting as a standalone diagnostic measure. Clinical research continues to explore the potential of heart rate variability (HRV) in monitoring and even predicting certain health outcomes. However, current evidence suggests that while HRV can indicate that the body is under stress or that there is an imbalance in the autonomic nervous system, it is not sufficiently specific or reliable to be used alone for diagnostic purposes. Practical Implications for Patients For patients who monitor their HRV using wearable devices, it is important to remember that the primary goal is to gain a general understanding of how their bodies are responding to various daily influences. Consistent patterns over time can be useful in indicating changes in stress levels, sleep quality, or overall physical condition. However, occasional fluctuations in HRV should not cause undue concern, as they are often temporary and influenced by many factors. If you notice significant changes in your HRV readings, it is advisable to discuss these with your healthcare provider. They can help determine whether further investigation is needed or whether the changes simply reflect normal variations in response to lifestyle factors. In the meantime, focus on maintaining a balanced lifestyle – this includes managing stress, getting regular exercise, ensuring adequate sleep, and following any advice your doctor may have regarding diet or other habits. Conclusion In summary, heart rate variability (HRV) is a useful marker that reflects the dynamic nature of the heart’s response to everyday life. However, due to the multitude of factors that influence HRV—including stress, sleep quality, cardiac conditions, and lifestyle habits—it cannot be relied upon as a diagnostic tool alone. Instead, HRV should be viewed as one element in the broader context of health, offering insights that need to be interpreted alongside other clinical information. While changes in HRV can be indicative of underlying issues, they are generally secondary to other health effects rather than a direct cause for alarm. By understanding the factors that affect HRV and recognising that its measurement is only part of a comprehensive health assessment, you can better appreciate its role in monitoring overall well-being. Maintaining a healthy lifestyle and working closely with your healthcare provider remain the best strategies for managing your heart health.

One of the most common questions I hear from patients is "How long will my cardiology appointment take?". It's a reasonable concern, especially when managing busy schedules. In my clinic, most cardiology appointments are scheduled in half-hour slots, which is usually sufficient to cover all the necessary ground, particularly for new patients. During these initial appointments, we spend time reviewing your medical history, discussing any previous conditions, and formulating an initial management plan. This time is crucial for ensuring that we have a comprehensive understanding of your health and can set the right course for treatment. However, as thorough as we try to be, half an hour can sometimes feel tight, especially if your case is particularly complex or if there are many details to cover. In such instances, it may be necessary to schedule a follow-up appointment to ensure that all aspects of your care are fully addressed. My goal is always to provide the best possible experience, so I make every effort to accomplish as much as we can within the allotted time. That said, I’m also very mindful that some cases require more time, and I’m happy to arrange additional appointments if needed to get everything "down pat" as it were. The time required for follow-up appointments is generally shorter—typically around 10 to 15 minutes. The reason for this is straightforward: we already have a baseline understanding of your condition, so these appointments are more focused on monitoring your progress, adjusting treatment plans, and addressing any new concerns. This streamlined approach allows us to manage your care efficiently without compromising the quality of attention you receive. In some cases, after your initial or follow-up appointment, we may need to conduct tests immediately. When this occurs, and if we can obtain the results quickly, I’ll do my best to provide feedback on those results during the same visit. However, it’s important to note that this isn’t always feasible due to the time needed for certain tests or the requirement for further analysis. In such instances, we’ll typically schedule another appointment to discuss the findings and any necessary adjustments to your treatment plan. I also offer video and telephone consultations, which are designed to be just as comprehensive as face-to-face appointments. These remote consultations generally take about the same amount of time as in-person visits. Whether in-person or virtual, my focus remains on giving each patient my full attention and ensuring that all their concerns are addressed. One thing I’d like to mention is that despite our best efforts to stay on schedule, there are occasions when appointments can overrun. This can happen when a particular case is more complex than anticipated or when a patient requires additional time. While it’s common for doctors to occasionally run late, I always strive to keep my patients informed if I’m running behind schedule. I greatly appreciate my patients' patience and understanding when these situations arise. In summary, the length of your cardiology appointment can vary depending on whether you’re a new patient, the complexity of your condition, and whether additional tests are required. My goal is always to provide thorough, attentive care within the time we have, but rest assured that I’m committed to ensuring you receive the best possible treatment, even if that means scheduling extra time when needed.

Atrial fibrillation (AF) can be a worrying diagnosis, but in most cases, it does not require an emergency hospital visit. Once the key risks—such as stroke and heart failure—have been properly managed, most AF episodes can be treated and monitored as an outpatient rather than in the emergency room. However, there are circumstances where seeking urgent medical attention is necessary. If you are experiencing AF for the first time, you should get an appointment with your doctor at the very least to confirm the diagnosis and ensure the right management steps are being taken. Additionally, if your heart rate becomes excessively fast and you experience symptoms such as severe dizziness, breathlessness, chest pain, or fainting, you should seek emergency care. In these situations, doctors can assess your heart rhythm, stabilise your condition, and provide urgent treatment if needed. For those already diagnosed with AF, a hospital visit is rarely required unless symptoms are severe. Once the appropriate treatments are in place, AF can usually be managed through regular outpatient care. Many patients find their symptoms uncomfortable or distressing. Still, the good news is that AF itself is not usually life-threatening once stroke prevention and heart rate control have been addressed. I understand that experiencing an AF episode can feel alarming, especially if it causes palpitations, breathlessness, or fatigue. However, in the vast majority of cases, these symptoms can be handled without an emergency admission. By working with a specialist to develop a tailored management plan—including the right medications and strategies—you can significantly reduce the need for hospital visits, even if unexpected episodes occur. If you are ever unsure whether you need urgent care, it is always best to err on the side of caution and seek medical advice. Otherwise, focusing on proactive outpatient management with a cardiologist will help keep your condition under control and minimise unnecessary hospital trips.

I recently had the incredible opportunity to attend the Heart Rhythm Society 2024 conference in Boston. It was a fantastic experience, showcasing the latest advancements in technology and the newest scientific breakthroughs in our field. One of the highlights for me was seeing the attention our techniques from London, particularly those from our centre at Barts and One Welbeck, received. It was gratifying to present our science and posters, and to be recognised for being at the cutting edge of cardiac electrophysiology. However, what stood out even more was the chance to learn from other centres and their unique approaches from around the world. The exchange of ideas and the diversity of methodologies were truly enriching. I want to extend my heartfelt thanks to the organisers at the Heart Rhythm Society for orchestrating such an impactful event. I can’t wait to bring back my learnings to better manage and treat my patients.

--- The Value of Second Opinions in Healthcare Recently, I had the privilege of providing several second opinions, an experience both flattering and challenging. As experienced healthcare providers, we understand the importance of delivering the best possible care and service to every patient. This is especially vital in busy settings like the NHS, where the demand can sometimes be overwhelming. Offering a second opinion allows me to take an inclusive approach to healthcare. It's an opportunity to reassess a patient’s situation with fresh eyes—an essential step, as even the most thorough care can occasionally miss something. Second opinions are tremendously valuable. They can bring new perspectives and options to a patient's treatment plan. It's important to remember that differing opinions between consultants do not necessarily mean one is incorrect. More often, they simply reflect different angles or priorities in approaching a patient’s care. If you ever find yourself uncertain about your treatment path or if something about your care doesn't feel quite right, I encourage you to seek a second opinion. Doing so can provide reassurance or offer new avenues to consider, ensuring that you are on the best path for your health. As a doctor, I am always here to provide my perspective or offer a second look at your care plan, helping ensure that you receive the care you truly deserve. ---

Being part of start-up companies means that I have incredible opportunities to visit experts around the world. I was delighted to be invited to several hospitals in the United States, where I was able to support cases for treating atrial fibrillation with the Star Apollo mapping system, which I developed as part of Rhythm AI. Not only is it great to see techniques and technology that we pioneered here in London having a worldwide impact, but I was able to learn huge amounts from the skill and workflows of Dr Nair and Dr Matthew McKillop, both of whom I spent time with. A particular highlight was seeing how the use of intracardiac echocardiography (a tiny ultrasound probe used by the vein) can help minimise x-ray exposure during even the most complex cases. These are the sorts of innovations that I can put into place right away in my practice, both in the NHS and in the private sector. Thanks to all my hosts for making me so welcome and teaching me so much!

Atrial fibrillation (AF) can be a disruptive and concerning condition, but fortunately, there are treatment options available like an AF ablation procedure. While it may sound complex, let's break down the basics to help you understand what it involves: The Procedure: Performed under local or general anesthesia, often as a day case procedure. Involves inserting thin tubes (catheters) into a leg vein and threading them to your heart. The doctor uses various techniques (burning, freezing, or electrical shocks) to target and disable tissue causing AF, usually near the pulmonary veins. If normal rhythm isn't restored, electrical cardioversion might be necessary. Success Rates: Vary depending on factors like AF type, duration, and overall health. For intermittent (paroxysmal) AF, long-term success can range from 70-85% in some individuals for a single procedure. Persistent AF may have lower success rates from one procedure (typically 50-60% but as low as 30% or less especially in certain cases). Repeat procedures may be needed in 30-50% of cases, but overall success rates can reach >80% for paroxysmal and >70% for persistent AF. Potential Risks: Minor and temporary complications like bruising, chest pain, or temporary AF episodes are most common. Nerve injuries affecting digestion or breathing can occur (1% chance), usually resolving within weeks. Serious complications like blood leaks or leg vein injury occur in around 2% of cases. The risk of death is less than 1 in 2,000, usually due to rare complications. Remember: This information is for general understanding only and shouldn't replace a consultation with your doctor. Discuss your individual case and risks with your doctor to make informed decisions about AF ablation.