Procedures and treatments

Catheter ablation is a minimally invasive procedure to manage irregular heart rhythm. Used to treat atrial fibrillation and other cardiac conditions, it works by carefully interrupting abnormal electrical signals in the heart either with heat or by freezing.

As well as atrial fibrillation, catheter ablation can be used to treat supraventricular tachycardia (SVT), atrial flutter and ventricular arrhythmias. The most common ablation technique is to use radiofrequency to interrupt the abnormal heart signals. The catheter, a thin, floppy wire, is fed into the femoral vein which runs from the leg to the heart. The catheter records electrical activity and once the source of abnormality is located, radiofrequency energy is delivered through the catheter to treat the area.

The procedure typically takes between one and two hours. It’s usually performed under sedation but can be performed under a general anaesthetic if required.

The other technique is known as cryoballoon ablation. A balloon is passed through the femoral vein into the top left chamber of the heart. The balloon is inflated, and freezing is used to treat the area and prevent abnormal signals entering the heart.

Catheter ablation treatments are, generally speaking, safe. Like all procedures, however, there are some risks, such as bleeding and bruising in the leg, but more serious ones, such as a blood leak around the heart, a stroke or nerve damage, are rare.

After catheter ablation, you’ll be given blood-thinning medication for a period. If you required warfarin or similar prior to the procedure, you may need to continue taking this medication as this will reduce your risk of stroke. In low-risk patients, most can stop taking blood thinning medication after a few weeks.

The procedure is minimally invasive, so recovery is usually quick and the patient is walking soon after the procedure. Dr Lowe advises patients to avoid heavy lifting for two weeks and driving for the first 48 hours.

You may continue to experience episodes of AF after the procedure. This is usually a result of the heart adapting to the effect of the new lesions and should settle.

AF can recur or return after many years and, in these instances, further ablation may be advised. For most patients, it’s possible to assess the success of the procedure three months after surgery.

Put simply, cardioversion works to restore an abnormal heart rhythm to a normal pattern and alleviate any associated symptoms.

It aims to correct an arrhythmia or abnormal heart rhythm by sending electric signals to your heart through electrodes attached to your chest, and is often recommended for treating heart conditions, such as atrial fibrillation or atrial flutter.

An electric cardioversion is usually a day-case procedure with the patient either under heavy sedation or a short-acting general anaesthetic.

You’ll have electrodes attached to your chest and then connected to a defibrillator, after which you’ll be given one or more controlled electric shocks and your heart rate is monitored. Some patients may need to stay overnight where they will be further monitored.

For an internal cardioversion, you’ll be given a local anaesthetic to numb your groin and then Dr Martin Lowe will insert a catheter into the vein at the top of your leg to allow a fine wire to be threaded into your heart. This wire is then connected to the defibrillator machine to deliver an internal shock.

A chemical or pharmacologic cardioversion uses anti-arrhythmic medication to restore a normal heart rhythm and is often used as a follow-on treatment to electrical cardioversion.

Typically, patients don’t feel any pain during the procedure, but may experience some discomfort in the chest afterwards.

Complications are rare but, as with any procedure there are potential risks. Some of these can be serious and include dislodged blood clots and the development of other heart rhythm problems during or just after the procedure.

Dr Lowe will prescribe anticoagulant medication before your procedure to mitigate the risk of blood clots developing, or to break up existing blood clots. Patients can also have minor burns on the skin where the electrodes were attached, but this is very rare.

Cardioversion is usually a short procedure, taking around 10 to 20 minutes. Most patients can return home the same day, although you shouldn’t drive for 24 hours after your procedure. The area where the electrodes were attached may feel sore and be irritated for a few days afterwards.

A cardioverter defibrillator (ICD) is an implantable device that can help treat irregular heart rhythms and greatly improve quality of life.

As opposed to a pacemaker, which continually stimulates the heart to beat at a normal rate, an ICD monitors your heart rhythm and, it if detects an abnormality, delivers a shock to reset the heart.

An ICD is implanted in a similar way to a pacemaker, typically as a day case procedure, either with local anaesthetic and sedation, or under a general anaesthetic, depending on where the ICD is being implanted.

The device is attached to one or two leads that pass through the vein in your chest to your heart. One lead goes into the ventricle or lower chamber of the heart and, if required, one goes into the top chamber of the heart, known as the atrium.

The leads that connect the ICD to the heart are usually thicker, as they contain coils to deliver a shock as well as the components required to check the pace of the heart. The battery or generator that powers the ICD is also usually larger than a pacemaker and is therefore often placed below the chest muscles rather than just below the skin.

The patient will have check-ups every six months to a year, although it's also possible to monitor an ICD wirelessly, transmitting information on how the heart is functioning.

As with pacemaker implantation, risks are minimal. They can include infection, scratching the surface of the lung or bleeding around the heart, but these are rare.

The general advice for living with an ICD is the is the same as with a pacemaker, however exposure to anything that could cause a malfunction of the ICD could result in a painful shock or prevent it from delivering a heart reset when needed.

If you are about to undergo any diagnostic tests or medical procedures, you should contact Dr Lowe for advice in advance.

You should keep the implantation site dry for a week after your procedure, and not raise your arm above shoulder height for at least six weeks.

You’ll be given a follow-up appointment a month after your ICD implantation procedure to ensure the device is functioning correctly. You’ll then have regular check-ups every six months to a year.

There will be a period of time after your procedure during which you won’t be able to drive. Dr Lowe will advise you on how long that is.

As with a pacemaker, the battery or generator that is powering the ICD will last up to 10 years before it needs to be replaced. Usually, the leads won’t ever need to be replaced.

A pacemaker is a device that’s been in use since the 1950s to ensure the heart beats at a normal rate.

It’s a small box inserted under the skin, usually in the left side of the chest. Leads are then inserted, through the veins, into the bottom chamber of the heart, known as the ventricle. A second lead is often put into the atrium, or top chamber, of the heart.

A small electric impulse is generated and transmitted into your heart, stimulating a contraction of the heart muscles that produces our heartbeat.

Pacemakers are typically implanted in patients who have a slow heartbeat – a condition known as bradycardia. It can help to alleviate symptoms, such as fatigue, dizziness, shortness of breath, poor balance and fainting or blackouts, that are having a profound impact on quality of life.

Often, getting older can lead to a progressive slowing of the heartbeat, but bradycardia can also be a sign of more serious cardiac conditions, such as heart failure, premature conduction tissue disease and cardiomyopathy.

A pacemaker implantation is, typically, a day-case procedure, performed under sedation and local anaesthetic. An incision is made into the skin in the upper chest to form a pocket into which holds the small box containing the generator or battery that runs the pacemaker.

Wires are then inserted into the vein in the chest and then through to the heart and then connected to the generator or battery, and wound closed.

You’ll usually have some bruising on your chest or arm, and you’ll be advised to refrain from lifting the arm on the side the pacemaker was implanted – typically the left – above shoulder height for six weeks. This is to prevent dislodging the pacemaker generator or leads.

You’ll also have to keep the wound dry for a week after your procedure.

Dr Lowe will arrange a follow-up appointment, usually a month after your procedure, to ensure the pacemaker is functioning correctly. You’ll then have check-ups every six months to a year. A pacemaker will typically last for up to 10 years before it needs replacing.

This is a typically straightforward procedure and the risks are minimal. Of these, the main ones are infection, scratching of the surface of the lung and bleeding around the heart but these are rare.

This can vary, depending on the underlying cause, but you’ll usually be able to drive about a week after the pacemaker is implanted as long as you haven’t experienced any dizziness or loss of consciousness since the procedure.