Tutorial: Drafting a Referral Letter to Electrophysiology

This tutorial walks you through drafting a referral letter from a general cardiology clinic to an electrophysiology service. You will see the full exchange: what you type, what the tool produces, and how you refine it into a letter ready to send.

The scenario: you are referring a 49-year-old woman with symptomatic paroxysmal atrial fibrillation (AF) that has failed two antiarrhythmic agents. She is asking about catheter ablation. She is active, works full-time as a teacher, and finds the palpitations significantly disruptive to her daily life.

Step 1: Write your clinical bullet points first

Before you open the tool, spend two minutes writing down the key clinical facts in bullet points:

- Woman, 49, teacher
- Symptomatic paroxysmal AF for 3 years
- Symptoms: palpitations, fatigue, occasional lightheadedness during episodes
- Episodes lasting 4–12 hours, occurring approximately 2–3 times per month
- Two antiarrhythmic agents tried: both at therapeutic doses, both failed 
  to maintain sinus rhythm (I will add specific names in the final letter)
- Echo: normal LV function, mild LA dilatation, no structural disease
- 72-hour Holter: documented paroxysmal AF, max ventricular rate 138bpm 
  during episode, sinus rhythm between episodes
- Anticoagulation: on appropriate anticoagulation for CHA2DS2-VASc score
- Thyroid function: normal
- BP: well controlled
- Request: assessment for catheter ablation
- Urgency: routine

Step 2: Open the tool and set the format

Open claude.ai or chat.openai.com and start a fresh conversation. Type:

You are helping a cardiologist draft a referral letter to an 
electrophysiology service. I will give you anonymised clinical 
bullet points. Draft a professional referral letter with these 
headings: Reason for Referral, Clinical Background, Investigations, 
Current Medications (placeholder — I will complete), Request.

Be concise. The receiving electrophysiologist needs clear information, 
not a narrative essay. Do not include specific drug names or doses.

Step 3: Paste your bullet points

Paste the clinical notes from Step 1. The tool will produce a draft. Here is an example:

Dear Colleague,

Re: Referral for Electrophysiology Assessment — Catheter Ablation for Paroxysmal Atrial Fibrillation

Reason for Referral

I am referring this 49-year-old woman for electrophysiology assessment with a view to catheter ablation for symptomatic paroxysmal atrial fibrillation that has been refractory to two antiarrhythmic agents.

Clinical Background

This patient has a three-year history of paroxysmal AF causing significant symptomatic burden — palpitations, fatigue, and occasional lightheadedness during episodes. Episodes last four to twelve hours and occur approximately two to three times per month. She is a working teacher and finds the episodes significantly disruptive to her professional and daily life.

Two antiarrhythmic agents have been trialled at therapeutic doses and have failed to maintain sinus rhythm. She remains on appropriate anticoagulation in line with her thromboembolic risk score.

Investigations

Echocardiogram: normal left ventricular function, mild left atrial dilatation, no significant structural disease.

72-hour Holter monitor: documented paroxysmal AF with a maximum ventricular rate of 138bpm during an episode; sinus rhythm confirmed between episodes.

Thyroid function and blood pressure: both within normal range.

Current Medications

[Clinician to complete — including antiarrhythmic agents trialled and current rate control and anticoagulation regimen]

Request

I would be grateful for your assessment of this patient's suitability for catheter ablation. She has been counselled that ablation is one option and is keen to discuss this further with your team. This is a routine referral.

Yours sincerely, [Your name, title, contact details]

Step 4: Review the draft as a clinician

Read the letter as the receiving electrophysiologist will read it. Ask yourself:

• Is the reason for referral immediately clear? Yes — "refractory to two antiarrhythmic agents" is the key phrase. Good.
• Is the symptom burden clear? Yes — the letter explains this is significantly disrupting her work and daily life. That clinical context matters for an ablation assessment.
• Is the echo finding described accurately? The mild left atrial dilatation is relevant and correctly included.
• Is anything missing? The specific antiarrhythmic agents are missing — this is correct, as the prompt told the tool not to include drug names. You will add those.

Step 5: Add the medications

Copy the draft into your clinical system letter template. Find the "Current Medications" placeholder and complete it from your records:

• The two antiarrhythmic agents trialled, with approximate duration and reason for discontinuation
• Current rate control medication if applicable
• Anticoagulant name

These details come from the patient record, not from the AI tool.

Step 6: Tighten the referral question

The current request says "assessment of suitability for catheter ablation." You want to be slightly more specific — you want the electrophysiologist to know that the patient has already been counselled about what ablation involves, that she has realistic expectations, and that she is asking about pulmonary vein isolation specifically. Ask the tool:

In the Request section, make the referral question slightly more 
specific: note that the patient has been counselled about catheter 
ablation including the concept of pulmonary vein isolation, understands 
it is not a guarantee of symptom resolution, and is keen to proceed. 
Keep it to two sentences.

The tool will revise the Request section. Read it. If the language about the patient's expectations is accurate, keep it. If it overstates what you discussed in the consultation, adjust.

Step 7: Check the urgency classification

"Routine" is correct for this patient. But your local electrophysiology service may use a different urgency classification system. Check your local referral pathway and adjust the language to match.

Step 8: Add identifying details and send

Back in your clinical system, add:

• Patient name, date of birth, NHS number
• Your name, GMC number, and contact details
• The receiving clinician or service address
• The date

Review the completed letter. It should now be: clinically accurate, specific in its request, complete in its medication list, and ready to send.

What the tool does badly

The tool produces a well-structured letter, but it cannot assess whether the referral is clinically appropriate. That is your clinical judgement. It also cannot know whether your local electrophysiology service has specific referral criteria, information requirements, or preferred formats. Check your local pathway before sending.

The medications placeholder is intentional. Filling it with accurate drug names is your responsibility. A referral letter with incorrect medication names causes clinical errors — it tells the receiving team a different clinical story from the real one.

Building a referral library

Once you have drafted two or three referrals using this method, save the prompts that worked best for each referral type you send regularly — electrophysiology, cardiac surgery, inherited cardiac conditions, cardiac imaging. Refine each prompt once and use it repeatedly. Your second referral using the same prompt takes three minutes, not ten.

Remember: AI is a helpful assistant, not a clinician. You make the call.