Treatments/Procedures
The most common treatments/procedures we perform are as follows:
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Atrial Fibrillation Ablation
What is Atrial Fibrillation Ablation?
Atrial Fibrillation (AF) is a chaotic heart rhythm.
Atrial fibrillation ablation helps maintain a normal heart rhythm. Ablation uses small burns or freezes to cause some scarring on the inside of the heart that helps to break up electrical signals that cause an irregular heart rhythm. This can return your heart to normal sinus rhythm (SR).
Why do I need Atrial Fibrillation Ablation?
Atrial fibrillation (AF) can cause some unpleasant symptoms like shortness of breath and heart palpitations. It also greatly increases the risk of stroke and anticoagulation medicines pose their own risks.
Ablation controls the symptoms of atrial fibrillation, but usually does not eliminate the needs for medication for stroke prevention.
If you have atrial fibrillation that has lasted for 7 days or less, ablation may be more likely to work long-term. It may not work as well long-term if you’ve had more persistent atrial fibrillation. Your cardiologist will decide if you need AF Ablation.
What happens during Atrial Fibrillation Ablation?
You will usually have a general anaesthetic.
Your cardiologist will put catheters into a blood vessel in the groin and thread it up to the heart giving them access to the collecting chambers (Atria) inside your heart. The catheter is then used to scar a small area of the heart by making small burns or small freezes. Radio frequency energy will be used to make small burns, and a technique called Cryoablation is used to create small freezes.
The scarring helps prevent the heart from conducting the abnormal electrical signals that cause atrial fibrillation.
You will usually be sent home the same day.
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Risks with Ablation
Most who undergo atrial fibrillation ablation have a successful outcome, although there are risks including:
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In the groin – bleeding, infection or pain from the catheter insertion
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Damage to the blood vessels from the catheter
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Puncture to the heart
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Damage to the heart
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Blood clots
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Narrowing of the pulmonary veins
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Radiation exposure
You can discuss any concerns you may have with your cardiologist.
Atrial septal defect closure
What is an ASD?
An Atrial Septal Defect (ASD) is a hole in the heart that you are born with. If small, then it may be that no treatment is required. However, if larger and causing a strain in the heart, or if paradoxical embolism has occurred, then the ASD will need to be closed.
ASD Closure with an umbrella device involves closing the hole in the heart without needing to perform open heart surgery. Certain parameters such as the size and position of the hole, and presence of any other heart defects will determine the strategy used to close the ASD.
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What happens with ASD Closure?
You will need tests to ensure you are suitable for device closure of your ASD. These will include ECG, Echocardiography, Transoesophageal Echo (TOE) and MRI scanning.
Before your procedure, you will be given a general anaesthetic. To help your consultant navigate, your operation will be guided by X-rays and by ultrasound pictures from a probe in your throat.
A pipe will be passed through a catheter which will be placed from your groin up to your heart and a wire passed across the hole. A balloon may be used to assess the size of the hole.
A stiff tube will be passed over the wire and an “umbrella device” is placed into the hole to close it. Its position is assessed for stability and safety, and if looking perfect, it is released in position from the delivery cable.
You will usually go home the same day. Blood thinners will be needed for a few months. You will be asked not to lift more than 5-10Kg for about a month.
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Risks of ASD Closure
ASD closure is a low risk procedure- <1% risk. However, complications can occur, including:
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At the vascular access site i.e. pain, bleeding, bruising
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Device displacement
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Stroke
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Internal bleeding at the time of the procedure
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Internal bleeding later due to device causing erosion in the heart
Coronary angioplasty and stenting (PCI)
What is Coronary Angioplasty & Stenting ?
Coronary angioplasty and stenting (PCI) is a procedure used to widen a blocked or narrow coronary artery, the main vessels that supply blood to the heart.
A catheter is taken from the wrist or groin up to the heart. A wire is steered across the blockage in the coronary artery. A balloon is used to stretch open the narrowed or blocked artery. Usually, a short wire-mesh (stent) is placed into the artery during the procedure. The stent is permanently left in place to allow blood to continuously move more freely.
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Why do I need a Coronary Angioplasty & Stenting?
Arteries can become narrow and harden which can cause coronary heart disease. The heart needs a constant supply of blood supply, so if it becomes restricted it can lead to chest pain known as angina, usually triggered by physical activity or stress.
If the narrowing suddenly worsens, with a clot forming, then the situation can become unstable, and a heart attack (Acute Myocardial Infarction) can occur.
A Coronary Angioplasty (PCI) may be required to restore the blood supply to the heart when medication is ineffective. It is also used as immediate treatment after a heart attack.
In stable angina, it is mainly a symptom treatment i.e. life is probably not made longer, but is of a better quality! In a heart attack, acute or “Primary”, angioplasty saves lives.
What happens during a Coronary Angioplasty?
You will be given a local anaesthetic before your procedure, meaning you’ll be awake for the duration.
A catheter will be inserted into your groin, wrist or arm and fed up through one of your arteries to your heart. The position of the catheter will be constantly monitored by X-ray.
When the catheter is in place, a thin wire will be fed through the catheter and into the affected section of the artery carrying a small balloon. The balloon is inflated to widen the artery, squashing fatty deposits against the artery wall so blood can flow through freely again. Usually a stent is left as a scaffold to keep the artery open. The stent is covered in medication to help reduce re-narrowing (Drug Eluting Stent or DES) before the balloon, wire and catheter are removed.
This procedure usually takes between 30 minutes to 2 hours to complete.
If done from the wrist, you may go home the same day. You will need Aspirin and another agent (Clopidogrel or Ticagrelor) for one year after your procedure.
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Risks with Coronary Angioplasty & Stenting
As with all types of surgery, complications can arise including during or after an angioplasty. The overall risk us usually less than 1%.
Common complications include:
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Bleeding
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Bruising
More serious but less common complications include:
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Damage to the artery-requiring more stents, or emergency surgery
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Excessive bleeding
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Heart attack or stroke
Left atrial appendage closure
What is a Left Atrial Appendage?
When blood flows through the heart slowly, as it does in Atrial Fibrillation (AF), it tends to form clots. These mainly form in and out pouching of the heart called the Left Atrial Appendage (LAA).
Closing the LAA has been shown to reduce the risk of stroke.
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Why do I need a Left Atrial Appendage Closure?
In Atrial Fibrillation (AF) the blood flow through the heart slows down, and the risk of a stroke rises.
Warfarin therapy is the most common way of reducing the risk of stroke; a type of medicine that reduces the risk of clots by thinning the blood. Alternatives are the Direct Oral Anticoagulants (DOACs) such as Apixaban, Edoxaban, Dabigatran, and Rivaroxiban.
If anti-coagulation cannot be taken, the LAA closure can be done to reduce stroke risk. To assess for this, your stroke risk and bleeding risk are assessed and you may have a Transoesophageal Echocardiogram (TOE) and CT scan.
What happens with a Left Atrial Appendage Closure?
Before your procedure you will be given a general anaesthetic. To help your consultant navigate, your operation will be guided by X-rays and ultrasound pictures from a probe in your throat (TOE).
A pipe will be passed through a catheter which will be placed from your groin up to your heart and a wire passed across your heart and into the mouth of the appendage.
A stiff tube will be passed over the wire and a plug-like device is place into the mouth of the appendage. Once the cardiologist is happy that the device is well placed, it will be released and all other equipment removed.
If you are not suitable for device based closure, a surgical procedure to close the LAA may be suitable for you.
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Risks of a Left Atrial Appendage Closure
Although a fairly safe procedure, a risk of 3-5% is usually quoted. The main complications with LAA closure include:
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Groin issues- bleed, bruise, pain
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Internal bleeding
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Incomplete closure of the left atrial appendage
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Dislodgement of the device
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Blood clotting forming on the device, leading to stroke
Pacemakers
What is a Pacemaker?
A Pacemaker is a small electrical device that sends electrical pulses to your heart to keep it beating regularly. A Pacemaker can significantly improve quality of life in those with a slow heart rate.
The Pacemaker will be fitted during a small surgical procedure by a Consultant cardiologist who will place it under the skin near the collarbone on the left side of the chest. The Pacemaker Box links to a wire that is guided through a blood vessel to the heart.
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Why would I need a permanent Pacemaker?
The Pacemaker consists of a pulse generator, which has a battery and tiny computer circuit with one or more wires leading from it, attaching to your heart.
When the signals that control the pumping of the heart become disrupted, it can lead to a number of potentially dangerous heart conditions including:
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An abnormally slow heartbeat (bradycardia) or abnormally quick heartbeat (tachycardia)
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Heart block
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Cardiac arrest
If the Pacemaker senses that your heart has missed a beat, or indeed beating too slowly, it will send a signal at a steady rate through the wire and to the heart. Most modern pacemakers fitted include a special sensor to recognise body movement and breathing rate and allows them to speed up the discharge rate when the body is active.
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Risks with a Pacemaker
Any electrical equipment or appliance that produces a strong electromagnetic field can interfere with a Pacemaker but most household electrical equipment such as microwave ovens and hair dryers won’t be a problem if they’re used 15cm or more away from your Pacemaker.
If you feel dizzy or feel your heart beating faster whilst using an electric appliance it is important to move away to allow your heartbeat to return to normal.
A consultant’s biggest concern with fitting a pacemaker is the Pacemaker losing the ability to control the heartbeat due to a malfunction with the Pacemaker itself or the attached wire. A Pacemaker can sometimes be reprogrammed to fix a malfunction using wireless signals.
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Other Complications include:
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Infection at the Pacemaker box or on the electrical lead
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Bruising at the insertion site
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Pneumothorax (collapsed lung)
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Pacemaker syndrome-if your own heart beat and the Pacemaker interfere with each other
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Diaphragm twitching
Other types of Pacemakers
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Implantable cardioverter defibrillators (ICDs)
Similar to a Pacemaker, an ICD sends a larger electrical shock to the heart which is essentially ‘rebooting’ the heart to get it pumping again.
An ICD is often used as a preventative measure for those who are potentially at risk of cardiac arrest in the future.
If the heart is beating at a potentially dangerous abnormal rate, the ICD will sense this and deliver an electrical shock to the heart, helping the heart to return to a normal rhythm.
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Cardiac Resynchronisation Pacemakers (CRT)
A CRT is used to help improve the hearts rhythm and the symptoms associated with an arrhythmia. A cardiologist implants the CRT in the same place as a simple Pacemaker and three wires are used to monitor heart rate, detect heart rate irregularities and emit tiny pulses of electricity to correct them. A CRT is used to ‘resynchronise’ the heart.
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Paravalvular leak closure
What is a Paravalvular Leak Closure?
A Paravalvular Leak is a rare complication in the surgical treatment of valve disease. Leaks can emerge over time or be an acute occurrence soon after surgery. The causes may be:
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If you’ve had the same valve replaced numerous times, weak tissues occur
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If you have been treated for endocarditis, infection can weaken the sutures
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If there is severe calcification of the valve annulus, the stitches pull through the chalk
Once a leak occurs, symptoms include breathlessness and tiredness. In addition, the heart may weaken, leading to heart failure, infection (endocarditis) or anaemia.
Treatments include redo surgery or device-based Paravalvular Leak Closure.
Your cardiologist will perform an Echocardiogram to confirm a Paravalvular Leak and will help to choose the right strategy to treat your condition. In addition, blood tests, a Transoesophageal Echocardiogram (TOE) and CT scanning are usually needed.
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How is a Paravalvular Leak Closure performed?
A paravalvular leak closure is a similar procedure to that of an angiogram or angioplasty.
Before your procedure you will be given a general anaesthetic. To help your consultant navigate, your operation will be guided by X-rays and ultrasound pictures from a probe in your throat (TOE).
Your cardiologist will steer a wire across the leak, and then an umbrella-like device will be passed through a catheter which will be placed from your groin up to your heart and across the gap between the valve and the heart tissue.
The device is deployed after testing the stability and function of the valves.
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Risks with a Paravalvular Leak Closure
Device based Paravalvular Leak Closure is safe, and is seen as lower risk than redo open heart surgery. As with any procedure there can be risks, and with Paravalvular Leak Closure these include:
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At the groin site- bruising, bleeding infection
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Stroke or heart attack
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Increased valve dysfunction – if the umbrella device upsets the artificial heart valve
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Anaemia- if a small hole is left behind, blood can be damaged as it passes through – haemolysis
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Device embolization – if the device moves after deployment
Patent foramen ovale closure
What is a PFO?
A Patent Foramen Ovale (PFO) is a flap essential when you are in your mothers womb. It is not a hole, unlike an Atrial Septal Defect (ASD). In most people the flap seals spontaneously and in a quarter of the whole population, the flap can open briefly with a cough or sneeze.
The only people in whom the PFO might cause a problem are those who have had strokes or decompression illness and no other cause has been found.
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What happens during PFO Closure?
Before your cardiologist starts to repair the hole, you will need to be assessed using a small probe which is put down your throat called a Transoesophageal Echocardiogram.
Once it has been established that the hole can be repaired, a catheter will be inserted into a vein in your groin and passed up to your heart. A small balloon lays inside the catheter which is used to measure the exact size of the hole so your consultant can choose the best device to close it.
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Using the probe in your throat and X-ray imaging, the consultant can make sure that the chosen device is in the correct position and so the two umbrellas on either side of the device can open up and close the hole.
You will go home the same day. You will need some blood thinners for a few months.
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Risks with PFO Closure
PFO closure is a very safe procedure.
However complications can occur in about 1 in 100 people.
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At the groin puncture – bleeding, bruising, injury to the vein
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Internal bleeding at the time of the procedure which very rarely might need emergency surgery
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Palpitations even after you have gone home. These usually settle within a few weeks
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Stroke caused by blood clot passing through the heart
Transcatheter aortic valve insertion (TAVI)
What is a TAVI?
A TAVI (TAVR if you are from the USA) is used to treat a severely narrowed aortic valve (Aortic Stenosis). It is suitable for patients in need of an aortic valve replacement but is not well enough to have open heart valve surgery due to age or being a higher risk patient. Open heart surgery is still the standard form of treatment for this type of heart problem.
Aortic Stenosis can be associated with chest pain, breathlessness or even blackouts. Once symptomatic, treatment is proven to reduce the risk of death.
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Why do I need a TAVI?
If you are a higher risk patient, you may be suitable for a TAVI.
Extensive investigation and assessment will be performed by your cardiologist before you are deemed suitable for this procedure.
Investigations you will need include ECG, Echocardiography, Blood Tests, Lung Function. You will be given a CT scan of the whole aorta to prepare for a TAVI procedure.
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What is involved with a TAVI?
There are several approaches your Cardiologist can take when performing your TAVI:
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Transfemoral – a catheter is placed via your leg if your blood vessels are big enough
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Transapical – directly through the chest via a small cut and straight to your heart
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Trans-axillary – via the left or right shoulder
Whichever approach your Cardiologist takes, you will be in a special theatre (catheterisation laboratory). An anaesthetist will be present along with a large team in case of emergencies.
A catheter will be positioned with the opening of the aortic valve and a new tissue valve which will be placed into position. The new valve will either expand by itself, or is expanded by a balloon depending on which type of valve is used.
The balloon, if used, is deflated and removed along with the catheter, and the new valve sits inside your damaged valve. The position and function are checked on X-ray and echocardiography.
Normally you are awake for the procedure. You may spend the 1st day on the intensive care unit as a precaution.
You will go home a few days later. You need to take it easy for the 1st week, and are not allowed to drive (it is the Law in the UK) for 1 month.
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Risks with a TAVI
TAVI is a safe procedure. However, as only patients at a higher risk get this treatment there are a number of possible complications including:
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At the vascular access site i.e. pain, bleeding, bruising
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Disruption of the normal electrical conduction system of the heart, which may mean you may need a Pacemaker
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A leak around the new aortic valve also known as a Paravalvular Leak
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Internal bleeding around the heart which may require emergency surgery
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Stroke or heart attack