A patient was referred to the service with palpitations and blackouts having been previously seen multiple times in A&E and her GP practice. At the last GP attendance an ECG showed Atrial Fibrillation (AF).

The GP referred her to the Community Cardiology Service where she was fitted with an ambulatory ECG monitor (R test). The patient returned to the clinic the next day and the monitor was removed and analysed by the cardiac physiologist. This showed episodes of AF and a seven second pause, the cause of her collapse.

The physiologist alerted the GPwSi who called the cardiologist. The result was a prompt, seamless and direct admission to cardiac unit at the local hospital. After discussion with the patient a pacemaker was implanted within 24 hours.

A subsequent discussion on her future options included possible invasive treatment (AF ablation) or medical treatment for arrhythmia (AF). A shared decision was taken with the patient to pursue a medical strategy and on drug treatment along with the pacemaker, her symptoms completely resolved.