Treatment
We presently have 4 cardiac catheter laboratories where angiograms, angioplasty, ASD/PFO closures, valvuloplasty, trans-aortic valve implantation, cardioversion, pacemaker, biventricular pacemakers and ICD implantations take place Our pacemaker laboratory been updated to provide a combination laboratory where cardiac catheter procures and pacemakers can take place along with developing our electrophysiology service which serves to investigate and treat irregular electrical pathways in the heart (irregular heart rhythms).
Angiogram and Angioplasty
If you are asked to attend for an angiogram or a procedure known as angioplasty, a technician will attach electrodes to your arms and legs to enable us to monitor your heart. During the procedure a local anaesthetic will be administered to the access site in your arm or leg and x-ray equipment moved into place around your chest while the cardiologist feeds a thin hollow tueb called a catheter through your artery (wrist or groin). Depending on the particular treatment you are to undergo, the duration of the procedure could be between 30 minutes and two hours.
Percutaneous Coronary Intervention (PCI)
PCI is a treatment procedure that unblocks narrowed coronary arteries without performing surgery. This can be done in various ways:
Balloon catheter angioplasty
During this procedure, the cardiologist inserts a cardiac catheter with a small balloon around it into the coronary artery. The cardiologist then places the balloon in the narrowed area of the artery and expands it . This pushes the blockage to the sides of the artery where it remains. This technique reduces the narrowing in the artery . The cardiologist removes the balloon catheter at the end of the procedure.
Stent
The cardiologist places a small, hollow metal (mesh) tube called a “stent” in the artery to keep it open following a balloon angioplasty. The stent prevents constriction or closing of the artery during and after the procedure. Drug-eluting stents are now used. These stents are coated with medication that helps prevent re- narrowing of the artery.
Internal Cardioversions
A large number of patient in cardiology suffer from an abnormal heart rhythm known as atrial fibrillation (see glossary), and a procedure called a cardioversion attempts to stop this abnormal rhythm and put the heart back into a normal sinus rhythm .
A catheter (thin tube) is fed, under local anaesthetic into a vein in your groin up to the right side of your heart. When at the correct location in your heart sedation is given and when you are asleep a small shock is applied through the chambers causing the problem. This is very effective at stopping the abnormal rhythms but may only be considered if you have had an external cardioversion that hasn’t stopped the rhythm.
Closure of septal defects
Atrial septal defect (ASD), ventricular septal defect (VSD) and patent foramen ovale (PFO) are the most common heart defects that adults present with, having them from birth. They are characterised by the persistence of one or more holes in the upper or lower chambers of the heart with communication present between either the left and right atria or left and right ventricles. Patients presenting with a ‘’stroke’’ (cerebrovascular event) relatively young in life are now fully investigated to exclude a PFO by echocardiography.
Endovascular closure of a septal defect or PFO involves making a small incision in the groin to introduce a guidewire into the femoral vein which is threaded up into the heart, through the defect. A delivery sheath is then advanced over the wire across the defect (or hole). An occluder device is advanced through the delivery sheath and expanded so as to close the defect under echocardiographic and X-ray guidance. Patients can usually go home the following day after the procedure.
Valvular intervention
A small number of patients are suitable for stretching of a narrowed valve of the heart, using balloon technology. Most patients have narrowed valves replaced by surgery but sometimes this isn’t feasible.
Catheter laboratory based valve procedures are explained below:
Valvuloplasty
Valvuloplasty is the repair of a stenotic valve using a balloon catheter inside the valve. The balloon is placed into the valve that has become stiff from valve thickening and calcium build-up. The balloon is then inflated in an effort to increase the opening size of the valve and improving blood flow.
Transcutaneous Aortic Valve Replacement (TAVI)
Transcutaneous aortic valve implantation (TAVI) has been designed to treat patients who would be at high risk during standard cardiac surgery. TAVI allows aortic valve implantation without the need for opening the chest or cardiopulmonary bypass. The procedure may be performed from the leg artery or neck artery depending on the size of the blood vessels.
Lancashire Cardiac Centre has been selected to take part in a clinical evaluation of this procedure and we look forward to its use to help improve the quality of life of patients with valvular disease.
Pacemakers, Biventricular pacemakers and internal cardio-defibrillators (ICDs)
Patients suffering from dizzy spells and faints/blackouts are all investigated thoroughly to examine if the cause is due to slow, irregular heart rates. Patients that are found to have slow heart rates causing them symptoms may go on to have a pacemaker fitted.
Biventricular pacemakers are fitted to patients that are suffering from heart failure and the device works to re-synchronise the heart ensuring both ventricles are pumping together. This has been seen to decrease patient’s symptoms (breathlessness, ankle swelling, reduction in activity)and also to increase their quality of life.
Patients are fitted with ICDs due to either episodes of dangerous irregular rhythms or a high chance of them developing these rhythms.
The devices work by either giving a small shock to terminate the fast irregular rhythms or by using a fast pacemaker to work faster then the abnormal rhythm and break the fast cycle.
All these devices (Pacemakers, Biventricular pacemakers and ICDs) are inserted in a similar way using a vein near the collar bone and a pocket made deep under the skin layers to the top left or right of the chest. The leads are fed to the heart through the vein and the device is inserted in the pocket.
Patients will stay in over night and have a pacemaker check (see pacemaker clinic) and an X-ray the next day.
Electrophysiology Service
Electrophysiology is the medical specialty of heart rhythms. It is a diagnostic procedure to look more closely at the electrical function of your heart. It is the most accurate and reliable method of evaluating your heart rhythms and will help your physician determine the treatment option that is most appropriate for you.