Electrophysiology Expert Witness
Arrhythmia mechanisms, catheter ablation, implantable devices and sudden cardiac death. The consultants instructed on these cases are practising electrophysiologists, verified against the GMC specialist register before allocation.
- Catheter ablation
- ICD & pacemaker
- Sudden cardiac death
- Atrial fibrillation
- Ventricular tachycardia
The electrical arm of cardiology.
Most medico-legal work in this subspecialty turns on rhythm decision-making: whether the arrhythmia was correctly diagnosed, whether ablation or a device was indicated, whether the procedure was performed to the accepted technical standard, and whether the complications that followed were foreseeable and managed appropriately.
Accepted UK practice is set by the British Heart Rhythm Society and the European Society of Cardiology, whose arrhythmia, pacing and device guidance is the reference a report is tested against. For atrial fibrillation, NICE NG196 also applies.
Six arrhythmia domains.
The six areas below cover the medico-legal ground most electrophysiology cases sit within.
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Atrial fibrillation ablation
Pulmonary vein isolation, posterior wall ablation, and the decision to ablate in paroxysmal versus persistent AF — tested against ESC atrial fibrillation guidance and NICE NG196.
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Ventricular tachycardia ablation
Substrate mapping, epicardial access, and the decision to ablate in structural heart disease versus idiopathic VT, against ESC ventricular arrhythmia guidance.
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ICD implantation
Primary and secondary prevention, device selection, and the decision to implant in non-ischaemic cardiomyopathy, against ESC guidance on device therapy.
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Pacemaker implantation
Bradycardia pacing, cardiac resynchronisation, and the decision to implant in sinus node disease versus AV block, against ESC pacing and resynchronisation guidance.
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Sudden cardiac death
Post-mortem evaluation, inherited arrhythmia syndromes, and the decision to implant an ICD after unexplained cardiac arrest.
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Device complications
Lead displacement, infection, inappropriate shock, and the management of device-related complications.
Where electrophysiology opinion is instructed.
Electrophysiology evidence is most often required in clinical negligence work. The subspecialty is also instructed in personal injury, coronial, criminal and regulatory matters where rhythm decision-making is in dispute.
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Clinical negligence
Missed or delayed diagnosis of arrhythmia, unindicated or delayed ablation, inappropriate device selection or programming, and procedural complications. Tested against ESC arrhythmia guidance and the relevant NICE guidance.
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Personal injury
Cardiac sequelae of trauma where arrhythmia management is required, and the impact of device implantation on functional capacity for quantum.
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Inquest & coronial
Sudden cardiac death, unexplained cardiac arrest, and Article 2 inquests where systemic failures in arrhythmia management are alleged.
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Criminal & regulatory
Causation of death where an unlawful act precipitated a fatal arrhythmia, and GMC fitness-to-practise proceedings concerning an electrophysiologist’s clinical conduct.
Typical reports in this subspecialty.
Five report types cover the bulk of electrophysiology instructions. Each is prepared to the same CPR Part 35 framework and signed by a cardiac electrophysiologist.
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Screening & Merits
Early-stage view on whether the arrhythmia management fell outside accepted practice, and whether the case has prospects worth pursuing.
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Breach of Duty
Full liability opinion on arrhythmia management — indication, technique and complication management — tested against ESC guidance.
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Causation
Whether the breach caused or materially contributed to the cardiac outcome, addressing both but-for and material contribution where the medicine permits.
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Condition & Prognosis
Post-ablation or post-device cardiac status, arrhythmia burden and the likely future course — the foundation for the quantum discussion.
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Critique & Rebuttal
Independent read of an opposing electrophysiologist’s report — methodology, references, reasoning and conclusions tested before joint discussion or trial.
For the full report catalogue, see reports.
Four reasons to insist on the subspecialty match.
A general cardiology opinion on an electrophysiology case is rarely enough. Four practical reasons the match matters at the point of instruction.
Active ablation practice.
Each consultant continues to perform catheter ablation and device implantation in current NHS practice. Procedural activity is submitted to the national cardiac rhythm management audit, so the data behind the opinion are current rather than recalled.
Current evidence base.
Opinions are referenced to current ESC arrhythmia guidance and the relevant NICE guidance — not how procedures were done a decade ago.
Rhythm decision-making.
The decisions a case turns on — when to ablate, when to implant, when to defer — are assessed by consultants who make them every week.
Subspecialty indemnity.
Each consultant holds medico-legal indemnity covering electrophysiology expert witness work specifically. Indemnity is verified before the instruction is allocated.
Instruct an electrophysiology expert.
Send the records bundle with a brief outline of the arrhythmia issues in dispute. Scope, quotation and named consultant returned the same working day. Fast-track available where the trial window or limitation deadline requires it.
Active ablation practice ESC-aligned Same-day allocation