Heart treatment and surgery: Cardiac interventional procedures

Cardiac catheterisation (coronary angiography)
Percutaneous transluminal coronary angioplasty (PTCA)
Coronary stents
Radio frequency ablation
Cardioversion
Implantable cardio-defibrillator (ICD)

Cardiac catheterisation (coronary angiography)

Cardiac catheterisation is an X-ray test that uses dye to visualise the coronary arteries. The test helps pinpoint the presence and severity of blockages and determines the best treatment available. If the test reveals blockages, the patient will be offered one of three treatments: medications only, angioplasty or by-pass surgery.

The test is done as a day patient. The patient is usually mildly sedated but awake during the procedure. A local anaesthetic is used to numb the chosen area. Soft plastic tubes (catheters) are inserted into the artery and then advanced under X-ray guidance. The dye is injected into the heart chambers and coronary arteries and pictures are taken from different angles. This is the best test available to find and visualise blockages.

Percutaneous transluminal coronary angioplasty (PTCA)

The preparation for this test is similar to a routine cardiac catheterisation (see previous description) and is often performed at the time of the initial catheterisation.

A thin plastic tube with a balloon at the end is placed at the level of the blockage and inflated for a few seconds to expand the artery and is then deflated and removed. The patient usually goes home the next day.

Coronary stents

A stent is a small tube shaped piece of mesh, that holds the artery open. The procedure to put a stent in place is the same as that for a balloon angioplasty. After the blockage in the artery has been opened to some extent with a balloon, a second balloon with a small crimped stent is positioned at the place of the blockage and deployed. The expanded stent stays in the artery. The healing that occurs in the first four to six months will cover the stent, which then has become part of the artery wall.

Stents have been shown to reduce the likelihood of re-blockages and are used in about 70-80% of angioplasties today. Patients are given medication after the procedure to prevent clotting.

Radio frequency ablation

After an initial electrophysiology study (EPS), a special catheter may be used to deliver radio frequency to the precise area of the heart causing the abnormal heartbeat to return to a normal rhythm. This is called radio frequency ablation. This mode of therapy has a high rate of success, low incidence of complication and low recurrence.

Cardioversion

Cardioversion is a procedure where a small electrical current is delivered to an irregularly beating heart to restore it to normal. Most patients will be able to leave the hospital about three hours after procedure, however some may need to stay in hospital for one to two days to monitor the heart rhythm if certain antiarrhythmic medications are used.

Permanent pacemaker Implantation

A pacemaker is an electronic device that prevents your heart from beating too slowly, and consists of two parts: a generator (battery) and one or more electrodes (wires). The electrodes carry electrical impulses from the generator to your heart and make your heart beat consistently.

Implantable cardio-defibrillator (ICD)

An ICD is an electronic device that prevents your heart from beating too quickly. This fast heartbeat usually arises from an abnormal heart rhythm called a ‘tachyarrhythmia’. The ICD consists of two parts: a generator (battery) and one or more electrodes (wires).

In a life-threatening situation, these electrodes can correct fast heart rhythms by carrying electrical impulses or even an electrical shock from the generator to your heart. Modern ICD devices can also act as a standard pacemaker to stop your heart beating too slowly.