Dr Balvinder HandaPerth Cardiovascular Institute
Refer a patient
GP Handbook · Practical Quick Reference
A practical handbook for GPs managing palpitations, atrial fibrillation, SVT, ventricular ectopy, bradyarrhythmias and unexplained syncope — with a clear pathway from recognition and initial investigation to electrophysiology referral.
Perth Cardiovascular Institute
Consultant Cardiologist / Cardiac Electrophysiologist
GP quick referral guide
Use the rhythm, symptoms and underlying substrate to decide urgency. These are practical prompts rather than a substitute for clinical judgement or local emergency pathways.
What helps with a referral
A referral does not need every investigation completed first. For urgent problems, refer or escalate without delaying care.
01 · General approach
Most rhythm presentations become easier once you answer 4 questions: what rhythm is this, is there structural heart disease, is there a reversible trigger, and does the patient need specialist treatment?
Look for the arrhythmia itself, conduction disease, pre-excitation, channelopathy patterns and QT abnormalities.
Holter monitoring and single-lead ECG devices help capture intermittent palpitations and quantify ectopic burden.
Use echocardiography first line; cardiac MRI becomes important where cardiomyopathy, scar or ventricular arrhythmia is suspected.
Check thyroid function, electrolytes and other relevant secondary triggers such as anaemia, alcohol excess and uncontrolled hypertension.
Single-lead ECG devices
For patients whose symptoms come and go, a single-lead ECG recorded during the episode can be far more useful than a normal ECG taken later in the clinic. Apple Watch ECG and AliveCor / Kardia devices are common examples, and patients can usually save or export the tracing for review.
Single-lead, Lead-I-like recording
Handheld single-lead ECG; 6-lead versions also available
The tracing is more important than the automated interpretation
It is less useful for defining QRS morphology, localising ventricular ectopy or an accessory pathway, assessing QT, ischaemia or conduction patterns, and distinguishing every tachycardia mechanism. Automated device classifications can also be wrong — review the actual trace.
02 · Atrial fibrillation
Symptoms are highly variable and often depend on the ventricular rate. Typical features include palpitations, chest pain, dizziness, fatigue, reduced exercise tolerance, syncope and, occasionally, acute heart failure.
Choice depends on age, structural substrate and contraindications.
Use according to standard stroke-risk assessment and renal/bleeding considerations.
Catheter ablation
The deck describes ablation as a key treatment for AF, using radiofrequency, cryoablation or pulsed field ablation. For paroxysmal AF, a success rate around 70% is quoted, with contemporary procedural complication rates generally low.
Detailed teaching material
The following figures preserve the additional mechanism and management material from the presentation.
03 · Atrial flutter & atrial tachycardia
Rate-control drugs are similar to AF. The presentation notes a limited role for rhythm-control medication and recommends referral of all patients because typical flutter is highly treatable with ablation.
Anticoagulation is generally not required unless AF/flutter coexist. Rate or rhythm-control medication can be used, but definitive ablation is often effective.
Detailed teaching material
04 · Supraventricular tachycardia
Rapid onset and offset is the recurring clue. Capture the rhythm if possible — a consumer single-lead ECG can be very useful, while a 12-lead ED ECG remains ideal.
The deck quotes a small but real sudden-death risk and recommends referral specifically to an electrophysiologist. Ablation is potentially curative.
Detailed teaching material
05 · Ventricular arrhythmias
Defined in the presentation as more than 3 broad-complex beats lasting less than 30 seconds. Short asymptomatic episodes can be low risk when the resting ECG and echocardiogram are normal.
Symptoms range from none at all to skipped beats, forceful beats, cough, dizziness, presyncope, syncope or chest discomfort.
The deck notes weak evidence for routine caffeine restriction.
Detailed teaching material
06 · Bradyarrhythmias, pacing & syncope
Syncope without warning, injury, dizziness/presyncope, fatigue, reduced exercise tolerance and heart failure.
Symptomatic bradycardia, Mobitz II or complete heart block with syncope, significant pauses, chronotropic incompetence and advanced conduction disease.
Low-risk implant procedure; atrial and ventricular leads with a pulse generator, typical battery life 10–14 years, MRI-conditional systems and remote monitoring.
Useful for suspected cardiogenic unexplained syncope, especially where injury has occurred but the baseline ECG is normal or low risk.
Detailed teaching material
07 · Premature atrial contractions
PACs arise from ectopic atrial foci and are frequently seen on ambulatory monitoring. They may cause a skipped beat or irregular pulse and often need only reassurance and trigger modification, although a high burden may be a marker of future atrial arrhythmia.
They often occur at rest and may become less frequent during exercise. Frequent PACs can be a forerunner of AF or flutter.
Avoid precipitating factors and excess sympathetic stimulation. Drug treatment is generally reserved for troublesome symptoms or when PACs trigger another dysrhythmia; beta blockers or calcium-channel blockers may help, and ablation can be considered in selected cases.
Detailed teaching material
08 · Inherited arrhythmia syndromes
The deck's rule is deliberately simple: all patients with a Brugada-pattern ECG should be referred for specialist assessment.
Detailed teaching material
Clinical resources
The core of this website comes from Dr Handa’s GP teaching material. These external resources provide the broader Australian and international guideline context for clinical decision-making.
Clinical resources reviewed September 2026. Always use current product information, local hospital pathways and individual clinical judgement.
About Dr Handa
Dr Balvinder Handa is a Consultant Cardiologist and Cardiac Electrophysiologist with expertise in the diagnosis and management of heart rhythm disorders and cardiac devices. His practice combines advanced electrophysiology with comprehensive general cardiology care.
His areas of expertise include catheter ablation of arrhythmias, including atrial fibrillation; implantation of pacemakers, implantable cardioverter defibrillators and cardiac resynchronisation therapy devices; lead extraction; complex vascular access and venoplasty; and the diagnosis and management of inherited cardiac conditions. He also has extensive experience in echocardiography.
Dr Handa completed his undergraduate medical training and PhD at Imperial College London, followed by general cardiology training and a 3-year fellowship in Cardiac Electrophysiology and Devices at Hammersmith Hospital, Imperial College Healthcare NHS Trust. After qualifying as a consultant in the UK, he relocated to Perth and now works across both public and private practice, including a public appointment at Sir Charles Gairdner Hospital and private practice at Hollywood Private Hospital.
He is actively involved in medical education and research, including peer-reviewed publications, book chapters, a registered clinical patent and international research awards. He is also a Clinical Lecturer / Clinical Tutor at the University of Notre Dame Medical School.
Referral & contact
Consultant Cardiologist & Cardiac Electrophysiologist
Special interests include cardiac arrhythmias, catheter ablation, cardiac devices, inherited cardiac conditions, general cardiology, ECG and Holter reporting.
Perth Cardiovascular Institute
Perth Mount Medical Centre
Suite 12, 1st floor
146 Mounts Bay Road, Perth
This website is educational material for health professionals. It is intended as a practical reference and does not replace individual clinical assessment, current prescribing information, emergency care pathways, or local hospital protocols.