
Ablation vs Medication for Atrial Fibrillation: What's the Gold Standard?
Dr Aaisha Opel, Consultant Cardiologist at Welbeck Heart Health, looks at the treatment options available for atrial fibrillation patients.

Specialty: consultant cardiologist and electrophysiologist (heart rhythm specialist) with particular expertise in heart rhythm disorders, autonomic dysfunction, women's heart health and cardiovascular disease prevention
Conditions seen: atrial fibrillation, supraventricular tachycardia (SVT), ventricular tachycardia, ventricular fibrillation, ectopic or skipped beats, bradycardia (slow heart rate), inherited cardiac conditions, syncope (blackouts and collapse), cardiomyopathies, heart failure, high blood pressure, high cholesterol, carotid artery stenosis, and heart rhythm problems associated with long Covid
Tests, treatments and procedures: electrocardiogram (ECG), continuous ambulatory ECG monitoring, implantable loop recorders, remote heart rhythm monitoring, ambulatory blood pressure monitoring, private echocardiogram, electrophysiological study and ablation, atrial fibrillation (AF) ablation, pacemakers and device therapy, patent foramen ovale (PFO) closure
Often consulted by patients with: palpitations, chest pain, breathlessness, dizziness, or blackouts and collapse, and by patients wanting cardiovascular risk factor control, screening or prevention
Patient ages seen: 18+
Also: clinical director of medical specialties at North Middlesex University Hospital; established the first day case atrial fibrillation ablation service in a district general hospital; council member of the British Heart Rhythm Society and of the Specialist Advisory Committee for Cardiology
Languages: English, Hindi, Punjabi and Urdu
Dr Aaisha Opel is a consultant cardiologist and electrophysiologist (heart rhythm specialist) at Welbeck's Heart Health centre in London. She consults on all aspects of cardiology, with a special expertise in heart rhythm disorders, autonomic dysfunction and women's heart health. Dr Opel assesses symptoms including palpitations, chest pain, breathlessness, dizziness and blackouts or collapse, with particular expertise in diagnosing and managing atrial fibrillation, supraventricular tachycardia (SVT), fast and slow heart rates, and inherited heart rhythm conditions. Her practice also covers cardiomyopathies (heart muscle diseases), heart failure, high blood pressure, high cholesterol, carotid artery stenosis and heart problems associated with long Covid, alongside heart health screening and cardiovascular disease prevention.
As an electrophysiologist, Dr Opel specialises in investigating the heart's electrical system and treating abnormal heart rhythms. She uses a range of diagnostic tests, including electrocardiograms (ECGs, continuous ambulatory ECG monitoring, implantable loop recorders, remote heart rhythm monitoring, ambulatory blood pressure monitoring and echocardiography, as well as electrophysiological studies to investigate more complex rhythm problems. Her treatments include catheter ablation, which uses fine tubes passed into the heart to target tissue responsible for abnormal electrical signals, including atrial fibrillation ablation. She also offers pacemakers and other cardiac device therapies, alongside patent foramen ovale (PFO) closure.
Dr Opel established the first day-case atrial fibrillation ablation service in a district general hospital, allowing patients to undergo treatment and return home the same day. The service has won several awards, been adopted by other hospitals and featured in published research. She is also regularly invited to speak at conferences about her experience of developing the service and improving access to specialist heart rhythm treatment.
After completing her specialist training at Barts Heart Centre, Dr Opel worked as a consultant in cardiology and electrophysiology at Royal Brompton and Harefield and Chelsea and Westminster hospitals. She is now clinical director of medical specialties at North Middlesex University Hospital, a role she has held since 2021.
Alongside her clinical work, Dr Opel is passionate about supporting the next generation of cardiologists, particularly women entering the specialty. As an educational supervisor and mentor, she has received positive feedback from trainees and Health Education England for her contribution to training. She also plays an active role in professional leadership, serving on the councils of the British Heart Rhythm Society and the Specialist Advisory Committee for Cardiology.
Dr Opel studied medicine at University College London and holds a PhD from the University of London. She trained in cardiology and electrophysiology at Barts Heart Centre before her consultant appointments at the Royal Brompton and Harefield and Chelsea and Westminster hospitals.
Qualifications:
MBBS, University College London
PhD, University of London
Dr Opel's research focuses on understanding and improving the treatment of abnormal heart rhythms, particularly atrial fibrillation. She has published in peer-reviewed cardiology and electrophysiology journals, with studies exploring the biological mechanisms underlying atrial fibrillation, comparing cryoablation and radiofrequency ablation techniques, and investigating the use of ultra-high-density mapping to guide treatment of atrial tachycardia in adults with congenital heart disease. She has also contributed to published guidance on the management of atrial fibrillation, including updates to NICE recommendations.
Her research also reflects her commitment to improving patient care. She has published an evaluation of the award-winning day-case atrial fibrillation ablation service she established, comparing its outcomes with those of a specialist cardiac centre. The service has since been adopted elsewhere, and Dr Opel has been invited to share her experience at conferences.
Alongside her research, Dr Opel is actively involved in training and mentoring cardiologists, with positive feedback from trainees and Health Education England. She also contributes to professional leadership through her appointments to the councils of the British Heart Rhythm Society and the Specialist Advisory Committee for Cardiology.
Key publications:
Comparison of a high throughput day case atrial fibrillation ablation service in a local hospital with standard regional tertiary cardiac centre care. Europace. 2019;21(3):440–444. DOI: 10.1093/europace/euy153
Characterization of the mechanism and substrate of atrial tachycardia using ultra-high-density mapping in adults with congenital heart disease: impact on clinical outcomes. J Am Heart Assoc. 2019;8(4). DOI: 10.1161/JAHA.118.010535
Long term outcome and pulmonary vein reconnection of patients undergoing cryoablation and/or radiofrequency ablation: results from the Cryo Versus RF Trial. J Atr Fibrillation. 2018;11(3):2072. DOI: 10.4022/jafib.2072
The contribution of pathways initiated via the Gq/11 G-protein family to atrial fibrillation. Pharmacol Res.2016;105:54–61. DOI: 10.1016/j.phrs.2015.11.008
Absence of the regulator of G-protein signaling, RGS4, predisposes to atrial fibrillation and is associated with abnormal calcium handling. J Biol Chem. 2015;290(31):19233–19244. DOI: 10.1074/jbc.M115.666719
Updated NICE guidance on the management of atrial fibrillation. Prescriber. 2014;25(20):7. DOI: 10.1002/psb.1258
Cryoablation versus radiofrequency ablation for treatment of atrioventricular nodal reentrant tachycardia: cryoablation with 6-mm-tip catheters is still less effective than radiofrequency ablation. Heart Rhythm. 2010;7(3):340–343. DOI: 10.1016/j.hrthm.2009.11.029
MRCP, Royal College of Physicians
British Heart Rhythm Society (council appointment)
Specialist Advisory Committee for Cardiology (council appointment)
Appointments are available at 1 Welbeck Street, London W1G 0AR.
Enquire online or call 020 3653 2005.


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An electrophysiologist is a cardiologist who specialises in diagnosing and treating problems with the heart's electrical system, which controls its rhythm, such as atrial fibrillation, supraventricular tachycardia (SVT), unusually fast or slow heart rates, and inherited heart rhythm disorders. You might see an electrophysiologist if you experience palpitations, dizziness, unexplained blackouts or collapse, or if an abnormal heart rhythm has been detected during another investigation.
Dr Opel will assess your symptoms and may recommend an electrocardiogram (ECG), which records the heart's electrical activity. If symptoms occur intermittently, continuous ambulatory ECG monitoring or an implantable loop recorder can help capture changes in heart rhythm over a longer period.
An echocardiogram may also be recommended to assess the heart's structure and pumping function. For more complex rhythm problems, an electrophysiological study can help identify where abnormal electrical signals originate and guide treatment.
Atrial fibrillation (AF) ablation is a procedure used to treat an irregular heart rhythm by targeting areas of heart tissue responsible for triggering abnormal electrical signals. Fine tubes called catheters are passed through blood vessels into the heart, where energy is used to create small areas of scar tissue that help prevent these signals from disrupting the normal rhythm.
Dr Opel specialises in AF ablation and established an award-winning day-case service that allows patients to undergo the procedure and return home the same day. She can assess your condition and advise whether day-case ablation at Welbeck is a suitable option for you.
Yes. Dr Opel specialises in cardiac device therapy, including pacemakers, which help regulate a heartbeat that is too slow. She also offers implantable loop recorders, small devices placed beneath the skin that continuously monitor heart rhythm and can help investigate unexplained palpitations or blackouts.
Yes. Women's heart health and cardiovascular disease prevention are among Dr Opel's specialist interests. She can assess symptoms such as palpitations, chest pain and breathlessness, as well as cardiovascular risk factors including high blood pressure and high cholesterol.
She also offers cardiovascular screening and advice on managing risk factors to help protect long-term heart health. Her approach is tailored to your symptoms, medical history and individual risk factors, with a focus on identifying potential problems early and discussing appropriate investigations or treatment.