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Guy's and St Thomas’ NHS Foundation Trust, Tim Kelleher

Clinical Articles, Lead Article


A cardiac researcher at Guy’s and St Thomas’ hospital has won the European Heart Rhythm Association’s electrophysiology case college prize, after describing to its biennial meeting in June how he diagnosed and cured his patient’s two different arrhythmias, one of which masked the other.

Dr Tarvinder Dhanjal, a trainee in electrophysiology, had treated a patient who had undergone transcatheter aortic valve implantation (TAVI) surgery but retained a very rapid heartbeat that was unresponsive to drug treatment.

After a surface electrocardiogram (ECG) showed an atrial flutter, the patient underwent an electrical catheter study to diagnose and destroy the aberrant region. However, his elevated heart rate did not decrease.  Dr Dhanjal then diagnosed and treated a second arrhythmia, an atrioventricular nodal re-entry tachycardia (AVNRT), which had been masked because, at 180 beats per minute, it was exactly half the speed of the flutter.

Dr Dhanjal had described the case at one of his department’s weekly electrophysiology training sessions, which allow registrars and physiologists from Guys’ & St Thomas’ and King’s College hospitals to share their knowledge, as well as being questioned and taught by consultants.

dhanjal inside“I am delighted and proud that I won this competition,” said Dr Dhanjal.  “Guy’s and St Thomas’ cardiology department is highly unusual in having set up these weekly educational sessions where we discuss our work with consultants and our peers, and are quizzed on ECGs and what diagnosis and treatment we should consider.

“They are tough sessions but were the perfect grounding for my presentation at a conference packed with the world’s heart rhythm experts.  As someone who spends half my time on research and half my time on clinical work with patients, I can honestly say that these sessions bring together the best of science and medicine to improve health professionals’ skills and patient care. I’d like to see them repeated in every heart department in the country,” said Dr Dhanjal.

Dr Matthew Wright, who established the weekly sessions a year ago with fellow consultants Michael Cooklin and Mark O’Neill, said:  “Tarvinder is a true clinician scientist and we are all very pleased that his work and our regular educational sessions have resulted in this very important prize,” said Dr Wright. “This demonstrates the effectiveness of our teaching programme; the way in which we make sure that knowledge and teaching is shared ensures excellence in medicine”.

He told Arrhythmia Watch: “Historically, training in the UK has been a little bit haphazard.  It’s often been learning by just hanging around and picking things up as you go along.  If you look at the North American model, their fellowship schemes have definite goals, achievable targets, and there’s an examination at the end of it.  Both myself and Dr O’Neill went and did the board review course…it was a real eye-opener”.

“Formal teaching is something that we currently don’t have enough of in the UK and something that is useful.  It should become part of the learning experience for junior doctors”.

Published on: August 2, 2011

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