Cardiac procedures

Coronary angiogram

A coronary angiogram is a special x-ray of the blood vessels that surround the heart (the coronary arteries).

During the procedure long tubes, or catheters are pushed from the skin through the large blood vessels to the heart. Contrast dye is injected into the coronary arteries while X-rays are taken.

In this way we can see if there are abnormalities with the blood vessels that might require repair.

Percutaneous coronary intervention (PCI or ‘stent’)

In some cases, a narrowing in a coronary artery can be fixed with a percutaneous coronary intervention, or stent. This consists of a small synthetic mesh tube placed over a balloon that is inflated at the site of the coronary narrowing.

As the balloon is inflated the stent is expanded and left in place, effectively keeping the artery open.

Stents are prone to forming blood clots on their surface, and so for the first few months after a stent you will need to take special blood thinners to prevent this. Speak with your cardiologist about the type and duration of blood thinners you need.

Pacemaker implantation

A pacemaker is a small device (approximately 4cm by 5cm) implanted under the skin below your collar bone. The box has some small wires (‘leads’) that travel through the major blood vessels into your heart.

The device monitors your own heart rhythm, and provides electrical impulses to trigger the heartbeat, if your own ‘intrinsic’  electrical impulses are not functioning well.

There are several reasons why a pacemaker is needed, and your doctor will discuss this with you. The procedure is usually done under a local anaesthetic, rarely, general anaesthetic is required.

A pacemaker is an overnight procedure. Further information about the procedure, it’s risks and recovery, will be given to you by your specialist.

Internal Cardioverter Defibrillator Implantation (ICD)

An implanted cardiac defibrillator (ICD), is similar to a pacemaker, but has the additional function of being able to provide an internal direct current reversion (DCR) or shock, to resuscitate someone from a life-threatening cardiac arrhythmia or cardiac arrest.

Practically, a defibrillator implantation is similar to a pacemaker procedure.

Some devices have leads on the outside of the heart, these are termed subcutaneous or extravascular devices. These devices are often chosen for young people, who may be at risk of cardiac arrest, but do not require a pacing function.

In some cases an ICD implantation is performed under general anaesthetic to allow testing of the device.

TAVI (transcatheter aortic valve implantation)

A TAVI (or TAVR) is the implantation of a prosthetic heart valve to replace a diseased aortic valve. Usually this is done for a narrowed and stiff aortic valve, termed aortic stenosis.

The new prosthetic valve is delivered through a long tube called a catheter. It is pushed into position and expanded over a small balloon to push the old heart valve leaflets to the side and leave a new functioning valve in its place.

TAVI is minimally invasive and usually doesn’t require more than a few days in hospital.

EP study and arrhythmia ablation

An electrophysiology (EP) study is a procedure where the electrical pathways of the heart are evaluated for abnormalities that could produce arrhythmias.

It requires long narrow tubes to be inserted via the femoral vein in the groin, through the large veins to the heart, where the cardiac electrical impulses are assessed via a variety of strategies.

This procedure may be done awake, or under general anaesthetic.

If an abnormal circuit or impulse is identified, an ablation may be recommended. Often this is done in the same procedure. This involves the delivery of energy to ablate the tissue that is producing the arrhythmia.

Ablation may be done for supraventricular tachycardia, atrial flutter, atrial fibrillation or ventricular arrhythmias. In AF ablation, discrete areas of the left atrium are ablated to prevent impulses which are known to trigger AF.