Procedures

Pacemakers

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Internal Defibrillators

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Heart Failure Pacemakers

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Cardiac Contractility Modulation

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Implantable Loop Recorder

Implantable loop recorders are small internal devices that monitor your heart rhythm and record any rhythm abnormalities. They help us to detect symptoms that may not have been captured using an external heart monitor.

Cardioversion

Cardioversion is a procedure for restoring normal rhythm to a heart that is beating usually too quickly or irregularly. Performed under general anaesthetic, or with a heavy sedative, it uses a controlled burst of electrical energy to return the heart to its natural (‘sinus’) rhythm. What is cardioversion? Cardioversion is a fast, effective treatment that aims to restore a hearts regular rhythm by applying a carefully controlled electrical shock to the chest. Electrode patches are placed on your chest and connected to a defibrillator machine, which delivers a short electrical current to the heart. A single shock is often enough to ‘reset’ the heart and return it to a normal rhythm. The improvement in symptoms may happen immediately. Why would I need to have the procedure? The rhythm in our hearts is controlled by electrical signals running from the brain to the upper chambers of the heart (the atria). If those signals become disrupted, they can cause the heart to begin pumping at a different pace or with a different rhythm. Two major types of rhythm problems are atrial fibrillation and, less commonly, atrial flutter. These conditions can cause a range of unpleasant symptoms, such as breathlessness, fatigue and dizziness, and can raise the risk of a stroke. If you’ve been diagnosed with either condition, or if you’ve tried certain rhythm medications and they haven’t worked, we may recommend you for the cardioversion procedure. How does cardioversion actually work? Cardioversion targets the cells of the heart, called myocytes. The ‘sinus node’, is the heart’s natural pacemaker. In a heart that’s experiencing rhythm problems, the electrical signals become disrupted and chaotic. By delivering a short, sharp current of electricity to the chest (usually around 100-360 joules, in the first instance), we can often ‘jolt’ the heart out of its abnormal rhythm so that its regular, controlled rhythm returns. Cardioversion is considered to be a very safe procedure; complications are rare and most side effects tend to be temporary (see below). Although the treatment is effective for most people, it doesn’t always work for everyone. In around 20% of patients, the abnormal rhythm returns after several days, weeks or months. In these cases we might look to repeat the cardioversion, or consider another kind of treatment. What will happen during my procedure? When you arrive at the clinic, we’ll give you a check-up. The nurse will take your blood pressure, pulse and temperature. We’ll also run an electrocardiogram (ECG) test to confirm your heart is still in its abnormal rhythm. You’ll then remove your upper clothing and lie back in a raised position or flat, with your head resting on a pillow, while we place the sticky electrode pads on your chest. If you have chest hair, we may need to shave it at this point if you haven’t done so already. The anaesthetist will then deliver a short-term general anaesthetic to send you to sleep, or a powerful sedative so you’re not troubled by the procedure. This is administered through a cannula in your hand. We then deliver the shock, timed to coincide with a heartbeat. A single shock is usually sufficient, but it’s sometimes necessary to perform a second or third cardioversion with a stronger shock or different electrode positions. The entire procedure can take up to 30 minutes, but is usually completed in around 5-10 mins. How do I prepare for my treatment? The main preparation you’ll need to undertake before your cardioversion is a course of anticoagulants (blood thinners). This is because arrhythmia problems like atrial fibrillation can sometimes cause blood clots to form in the heart; although the risk is small, cardioversion could result in the clot breaking off and causing a stroke. To mitigate that risk, we’ll prescribe a very specific course of anticoagulants. You will usually start to take these around four weeks before the procedure and it’s very important that you don’t miss any of the doses. On the day of your cardioversion, you’ll need to fast for six hours before the procedure and avoid fluids two hours beforehand. What happens after my cardioversion? The anaesthetic is short-acting, so you’ll wake up soon after the procedure has finished. Once you’re awake, we’ll talk you through the procedure and explain how it went. After an hour or so, the team will repeat the ECG to confirm that your rhythm has gone back to normal. Most patients are able to go home after a few hours. Bear in mind that, due to the general anaesthetic, you won’t be able to drive for at least 24 hours after your cardioversion, so please arrange for a friend or family member to collect you from the clinic afterwards. You may find that your rhythm-problem symptoms improve immediately after the procedure (although the anaesthetic may make you feel groggy or temporarily nauseous). Cardioversions can cause temporary side effects in some patients. These include bradycardia (a slow heart rhythm), ventricular tachycardia (fast rhythm), headaches or dizziness after a drop in blood pressure, and sometimes a slight discomfort around the chest from the electric shock. These usually tend to wear off quickly, however, or are easy to treat. In most cases, you’ll need to continue taking your anticoagulant medication for at least four weeks following the cardioversion. You’ll have a routine follow-up assessment around 6-8 weeks after treatment so that we can check everything is going well.

Electrophysiology Studies

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Cardiac Ablation

Cardiac ablation – sometimes also referred to as catheter ablation – is a procedure for treating abnormal heart rhythms. It does this by targeting specific locations or areas of tissue inside the atria (the upper chambers of the heart) or ventricles (lower or pumping chambers), where rogue electrical signals may cause the heart to beat abnormally. It can be performed under a local or general anaesthetic, and has proven to be highly effective in correcting many heart rhythm problems. What is cardiac ablation? Ablation comes from the Latin word ablationem, meaning “to take away”. The aim of the procedure is literally to take away, or remove, an abnormal rhythm (arrhythmia) that has developed in your heart, and the unpleasant symptoms it may be causing, so that a normal rhythm can be restored. Heart rhythm is controlled by electrical impulses from our brains. Sometimes, however, the tissues inside the heart wall produce ‘rogue’ impulses that interfere with the process and disrupt the natural rhythm. Ablation works by generating a small scar in this defective tissue, which blocks or stops the impulses and allows the normal rhythm to resume. Why would I need to have the procedure? We use ablation to treat a number of different heart rhythm problems, such as atrial fibrillation, atrial flutter and supraventricular (SVT) or ventricular tachycardia (VT). If we’re recommending the procedure for you, it may be because you’ve already tried rhythm-controlling medications and they haven’t worked or you prefer to undergo an ablation procedure initially. Other reasons might be because you can’t take the available medications, or that you have a high risk of developing complications from your abnormal heart rhythm. But it may simply be because we think your type of arrhythmia is likely to respond very well to ablation. How does ablation actually work? Cardiac ablation is performed with catheters. These are long, thin, soft wires that are carefully inserted into the blood vessels so they can travel up into the heart. The tip of the catheter can detect electrical impulses inside the heart and determine where the rogue signals are coming from. We then pass an energy source through the wires to destroy the very small area of tissue that’s causing the problem; the energy source is either a controlled blast of heat (high-frequency radio waves) or extreme cold (cryoablation). Scarring the tissue has a number of different potential effects on the heart rhythm. It can ‘disconnect’ the pathway of the abnormal rhythm, block the abnormal pulses or promote normal conduction of impulses, or disconnect the electrical pathway between the atria and the ventricles (the lower chambers of the heart). What will happen during my procedure? Some cardiac ablations are quite quick to perform, others take several hours. The timescale for your own operation depends on a number of factors, such as the kind of heart rhythm problem you have, the technique we’re using to carry out the ablation, and whether you’ll be having it under a local or general anaesthetic. We’ll discuss these things in detail with you before your operation. If you’re going to be conscious during the procedure, we can also give you a sedative to help you relax. Once in theatre, we insert the catheter (usually through a blood vessel in the groin), locate the defective area and deliver the energy needed to create a small scar on the inner wall of the atrium. When the ablation is finished, you’ll be taken back to the ward to rest. You’ll need to lie still and flat for several hours to prevent strain on your groin. How do I prepare for my treatment? At your preoperative assessment, we’ll explain whether you need to avoid food, drink or certain medications on the day of your ablation. Depending on where the catheters are being inserted, you may also need to shave your groin(s) before you come into theatre. You may like to bring something to read or listen to while you’re lying in the ward after the procedure, and some light luggage if you’re staying overnight. Driving isn’t possible for 48 hours after an ablation, so please bear in mind that you’ll need someone to collect you from the hospital, and to help you with your bags. To avoid causing damage to the groin, you shouldn’t carry anything, and you should avoid long flights of stairs. What happens after my ablation? When you arrive back home, it’s very important to rest and take things slowly so that you can give your body time to heal – it can take as long as three months for the heart to recover fully from the procedure. You’ll need to avoid doing anything strenuous for the first two weeks, even if you’re feeling well enough to do more. For this reason, you may like to consider asking someone to help you around the home, or with childcare if necessary. The general recommendation is to stick to short walks and only a single flight of stairs for the first fortnight, with a slow, gentle progression thereafter. You should avoid lifting anything heavy for at least two weeks. Some very fit or younger patients may find they can return to work quite quickly, but many others take much longer. Although ablations are usually very successful at restoring normal heart rhythm in most patients, it can take some time for the effects to be felt. You could also experience certain other symptoms in the early stages as the heart heals. These can include palpitations, ectopic beats, a fast heart rate, and migraines, but these symptoms should settle down over time, and they don’t mean the ablation has failed. Our team will stay in touch with you after the procedure so that we can check on your progress and provide advice and further help if you need it.

Watchman

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