Hospital Procedures

This is a procedure is a catheter ablation that uses radiofrequency energy, much like microwave energy, to destroy a small section of heart tissue that is causing the rapid heartbeats helping restore the heart’s natural rhythm. This procedure is recommended when medications have not been effective in controlling the condition.

Medicines can work very effectively in many patients to control the tissues that are causing the rapid heart beat. Catheter ablation destroys the tissue that is causing the condition. Ablation is a low risk procedure and is successful on most patients.

Risks

There are few risks with this procedure. Few problems occur and those that do experience issues occur due to the catheter that is inserted into the veins or arteries. These problems are extremely rare.

Prep

To prepare for your procedure:

• Inform your doctor of any and all medicines you take, including over the counter medications.
• Do not to eat or drink anything for at least 6 to 8 hours before the procedure
• Don’t stop taking your medications unless directed by your doctor
• Leave all your jewelry at home
• You will want to arrange for someone to drive you home

Home after care

• Don’t drive for 24 hours after you get home
• No alcohol for 24 hours after you get home
• Avoid heavy physical activity for three days
• A small bruise at the puncture site is normal.
  • If the site starts to bleed, lie flat and press firmly on top of it. Have someone call the doctor or hospital.
• Ask your physician when it is safe to return to strenuous physical activity or exercise

Coronary Angioplasty is a procedure that opens a blocked artery by inflating a tiny balloon in it. Your heart’s arteries can become clogged from a buildup of cholesterol, cells or other substances. When this condition causes a reduction in blood flow to your heart, chest discomfort can occur. A blood clot can form or get worse and completely block blood flow, leading to a heart attack. Coronary Angioplasty helps restore normal blood flow to your heart muscle.

Balloon

Similar to Cardiac Catheterization, your cardiologist inserts a thin plastic tube (catheter) with a thin, expandable balloon on the end into an artery or vein in the arm or leg. Once the clogged heart artery is located, the balloon is inflated. The balloon pushes plaque to the sides and stretches the artery open so blood can flow more easily.

Stent

In some patients, a collapsed wire mesh tube (stent) is opened as the balloon is inflated, thereby locking in position and helping to keep the artery open. This stent acts as a support or scaffold to support the inside of the artery and keep it open so that blood flows more easily. Some stents also contain medications that work to prevent more plaque from building up in the future.

What to expect

• Routine blood work and electrocardiogram (EKG)
• No food or liquid after midnight before the procedure
• If you wear dentures or hearing aids you will want to wear them during the procedure to assist in listening and speaking with the doctors and nurses
• If you wear glasses you will also want to bring those with you

Be sure to tell your doctor and nurses:

• What medicines you are currently taking, including over the counter
  • especially insulin, blood thinners and diuretics
• Let them know of any allergies you have
  • Shellfish
  • Iodine
  • Latex
  • Antibiotics or penicillin
  • X-ray dye

Cardiac Catheterization is a procedure to examine blood flow to the heart and test how well the heart is pumping. Your cardiologist inserts a thin plastic tube (catheter) into an artery or vein in the arm or leg. From this location it can be advanced into the chambers of the heart or into the coronary arteries.

The purpose of performing this test is to measure blood pressure within the heart and how much oxygen is in the blood. It’s also used to get information about the heart muscle and its ability to pump properly. Catheterization of the heart may also be done on infants and children to examine for congenital heart defects.

Preparation

• No food or drink 6 to 8 hours before your procedures or as directed by your doctor
• Your doctor may instruct you to pause your blood thinning medications a certain amount of time prior to your procedure
  • These include NSAIDs – ibuprofin, naproxin (Aleve, etc) and aspirin
• Take all of your medications and supplements with you to your procedure
• Rest and relax

What to expect

• The procedure will be done in an operating room that will have a special x-ray and imaging machines
• You will be awake but sedated during the procedure
• You will be placed on an IV to provide any fluids and medicines during the procedure
• The area you are having the procedure may be shaved and they will numb the area and make a small cut after it is numb to insert a small sheath that the physician will then insert the catheter into the artery
• The steps that occur next will be determined by why you are having the procedure

Cardiac Catherizations are done for the following:

• Coronary angiogram
• Right heart catherization
• Heart biopsy
• Balloon angioplasty
  • With stent
  • Without stent
• Balloon valvuloplasty
• Repair heart defect
• Heart ablation
• Valve replacement

Cardioversion is a procedure to treat an irregular heart beat or arrhythmia. This is done to bring your heart back to functioning with a normal rhythm. There are two types:

1. Chemical. If your arrhythmia is not severe or an emergency, chemical cardioversion may be used. The medicine is administered through an IV or may be taken as a pill
2. Electrical. If medicine does not work, electrical cardioversion may be prescribed. In this procedure, you will be sedated and fall asleep. Your physician will then place electrical paddles on your chest or sometimes the chest and the back and administer a small shock. You will not feel this as you are asleep. Usually patients only need one shock to bring their heart back into healthy rhythm.
   There may be some small irritation where the paddles were placed and your doctor can recommend specific lotions or creams to treat this.

This is not the same thing as a defibrillator. With defibrillation high voltage is used to shock the heart and is used in emergency situations when the heart has stopped or severe arrhythmias.

Risks

There is a risk that blood clots that have formed as a result of the arrhythmias may be knocked loose during one of the procedures. Your physician may give you medicines to take prior to the procedure to help prevent this and may do a type of ultrasound to look for clots in the heart.

Cardioversion may not stop the arrhythmias and medication and/or a pacemaker may be needed to control the condition.

Implantable cardiac devices monitor and help control heart rhythm problems in patients. The various particular devices serve different purposes in each patient and are very specific to them and to their particular condition. These devices are implanted in your chest or abdomen.

The various devices:

• BiV ICD or biventricular pacemaker. This is a battery powered device that is implanted surgically under the skin that has several lead wires placed within the heart that through electrical impuses as needed keep the heart beating in a normal rhythm. It can slow down a fast rhythm, speed up a slow rhythm, bring an erratic rhythm back into sync. It also may record the patient’s heart rhythm for analysis and help in treatment.
• ICD. An ICD of Implantable Cardioverter Defibrillator is a small implantable mini defibrillator that monitors the heart and shocks it to help it start when it suddenly stops, or shocks it to get the heart back into proper rhythm when it beats abnormally fast.
• Pacemaker is a small device implanted in the chest or abdomen to control irregular heart rhythms.
• Linq is an implantable heart monitor that allows the doctors to monitor the heart, its rhythms, heart events and ot accurately manage a patients heart arrhythmias

Procedure

This usually is a minor surgical procedure performed in a hospital. Your doctor will sedate you and you will fall asleep. They will also numb the area where the incision will occur. The steps to implant the particular device you are having implanted will occur.

After surgery, you may stay in the hospital for one to a few days depending on your particular procedure and your doctor’s specific plan for you.

EP Studies: Afib Ablation, SVT Abl, Aflutter Abl, VT Abl

An electrophysiology study (EP study) is a specialized cardiac catheterization that looks at the heart’s electrical and conduction system instead of its blood flow. The heart’s electrical system controls the beginning of each heartbeat regulates the heart rate. Cardiac arrhythmias are disturbances in the rate or rhythm of the heart’s electrical system.

EP studies may lead to the discovery of abnormal or diseased electrical systems. In these cases, an ablation may be needed to fix an abnormally fast rhythm problem. During an ablation, energy can be applied to destroy abnormal tissue. This may be done by freezing (cryoablation) or heating (radiofrequency ablation) tissue.

Our electrophysiologists also manage and implant various devices ranging from pacemakers, implantable defibrillators, and biventricular defibrillators and pacemakers. Pacemakers may be indicated in patients with bradycardia (slowing of the heart rate) and defibrillators may be indicated in patients with weak hearts (cardiomyopathies, heart failure) or in patients with sudden cardiac arrest. Once these devices are implanted, they are exclusively managed by our dedicated arrhythmia center and electrophysiologists.

Lead extractions are procedures where broken, infected, or redundant pacemaker / defibrillator leads are removed from the body. Often, specialized equipment such as an excimer laser may be needed to remove the leads. We are currently one of only a handful of practices in Dallas / Fort Worth that offer and have the capability to provide this service.

It is important to try and determine the cause of a patient’s syncope so that it may be managed. Syncope is a sudden loss of consciousness typically due to a fast drop in blood pressure which results in reduced blood flow to the brain. Some people may have experienced this if they had been in a sitting or crouching position and stood up too quickly leading to black out or lightheadedness. In Syncope however, it can occur in more instances than this and for no apparent symptomatic reason. Therefore it is important for your physician at North Texas Heart Center to evaluate your particular condition to determine what exactly may be causing your Syncope.

Through this process, they will be able to work together with you for a proper plan of action which may include lifestyle changes, medication or certain procedures to keep this under control.

An implantable cardiac defibrillator is a small device implanted in a patient’s chest or abdomen to help regulate an irregular or rapid heartbeat. An ICD uses electrical impulses to “shock” the heart when the heart rhythm is off, especially in life threatening arrhythmias, such as those that can cause sudden cardiac arrest.

An ICD works by emitting a low pulse signal to the heart to correct the issue but if that does not work it sends a higher energy pulse for defibrillation. The difference between an ICD and a pacemaker is that a pacemaker emits only a low energy pulse and are used to regulate less serious and less life threatening arrhythmia conditions. The ICD can when it needs to emit the higher energy pulse and is used in more serious arrhythmia conditions.

Procedure

This usually is a minor surgical procedure performed in a hospital. Your doctor will sedate you and you will fall asleep. They will also numb the area where the incision will occur. The steps to implant the particular device you are having implanted will occur.

After surgery, you may stay in the hospital for one to a few days depending on your particular procedure and your doctor’s specific plan for you.

The implantable loop recorder (ILR) is a small monitoring device used for diagnosis in patients for evaluation and long-term monitoring. It is used in patients with:

• Recurrent and unexplained episodes of palpitations or syncope
• Monitoring in patients at risk for for AF
• Monitoring patient with atrial fibrillation (AF)
• Monitoring patients who had a heart attack
• Patients with genetic disorders
• Syncope
• Palpitations

The device is capable of storing ECG data automatically in response to a significant arrhythmia events (bradyarrhythmia or tachyarrhythmia) or in response to patient activation. It is particularly useful when symptoms are infrequent and harder to diagnose or when long-term data (eg, burden of AF) is needed.

Procedure

This usually is a minor surgical procedure performed in a hospital. Your doctor will sedate you and you will fall asleep. They will also numb the area where the incision will occur. The steps to implant the particular device you are having implanted will occur.

After surgery, you may stay in the hospital for one to a few days depending on your particular procedure and your doctor’s specific plan for you.

Interventional cardiology is a branch of cardiology that deals specifically with catheter based treatment of structural heart disease. The benefit of catheter based procedures is that it can limit the amount of scarring that occurs with any procedure, pain and long post-surgery recovery.

An interventional cardiologist is a cardiologist with one to two years of additional education and training in diagnosing and treating cardiovascular disease as well as congenital (present at birth) and structural heart conditions through catheter-based procedures, such as angioplasty and stenting.

Interventional cardiologists rank among the world’s foremost authorities on cardiovascular disease and its treatment.

Lead extraction is the removal of one or more leads from the heart that have been placed there as a result of any of the implantable devices used in heart disease management. Doctors will recommend lead extraction if they determine:

• Internal damage to the lead or outside the lead. (Internal damage is called a lead fracture)
• Infection
• Blockage
• Clot
• Scar tissue
• Scar tissue around the tip of the lead

The procedure

1. Subclavian approach which is most common. The lead or leads are extracted through the upper chest in an incision over the subclavian vein.
2. Femoral approach is used when a doctor can not use the subclavian approach. The leads in the femoral approach are removed through a small incision in the femoral vein.

The left atrial appendage (LAA) is a small, ear-shaped sac in the muscle wall of the left atrium (top left chamber of the heart). In a normal heart, with each heartbeat the heart contracts and blood from the left atrium moves into the left ventricle.

In patients with AFib or atrial fibrillation, the electrical impulses that control the heartbeat do not travel in an orderly fashion through the heart. Instead, chaotic and disordered travel through the atria and do not allow the atria enough tim eto contract. LAA is a little “pouch” in the heart and in patients with AFib blood can collect there and clots can form in the LAA and atria. Bloods clots then can be pumped out of the heart causing stroke. People with AFib have 5 times greater chance they may have a stroke. To control this risk many patients are put on blood thinners but they can come with certain side affects and certain patients do not tolerate them well.

Studies have shown that, among patients who do not have valve disease, the majority of blood clots that occur in the left atrium start in the LAA. If you are at risk of developing clots in the left atrium/LAA, your doctor may recommend a procedure to seal off your LAA, reducing your stroke risk and eliminating the need for blood thinners.

Implantable cardiac devices monitor and help control heart rhythm problems in patients. A pacemaker is a small device implanted in the chest or abdomen to control irregular heart rhythms. It is used in lower risk conditions as it emits a lower energy pulse compared to the ICD devices that emit higher energy pulse and defibrillation.

Pacemakers can be implanted in the chest or in the abdominal cavity.

Procedure

This usually is a minor surgical procedure performed in a hospital. Your doctor will sedate you and you will fall asleep. They will also numb the area where the incision will occur. The steps to implant the particular device you are having implanted will occur.

After surgery, you may stay in the hospital for one to a few days depending on your particular procedure and your doctor’s specific plan for you.

This is a procedure is a catheter ablation that uses radiofrequency energy, much like microwave energy, to destroy a small section of heart tissue that is causing the rapid heartbeats helping restore the heart’s natural rhythm. This procedure is recommended when medications have not been effective in controlling the condition.

Medicines can work very effectively in many patients to control the tissues that are causing the rapid heart beat. Catheter ablation destroys the tissue that is causing the condition. Ablation is a low risk procedure and is successful on most patients.

Risks

There are few risks with this procedure. Few problems occur and those that do experience issues occur due to the catheter that is inserted into the veins or arteries. These problems are extremely rare.

Prep

To prepare for your procedure:

• Inform your doctor of any and all medicines you take, including over the counter medications.
• Do not to eat or drink anything for at least 6 to 8 hours before the procedure
• Don’t stop taking your medications unless directed by your doctor
• Leave all your jewelry at home
• You will want to arrange for someone to drive you home

Home after care

• Don’t drive for 24 hours after you get home
• No alcohol for 24 hours after you get home
• Avoid heavy physical activity for three days
• A small bruise at the puncture site is normal.
  • If the site starts to bleed, lie flat and press firmly on top of it. Have someone call the doctor or hospital.
• Ask your physician when it is safe to return to strenuous physical activity or exercise

A tilt table test is a way to test to find out the cause of fainting spells. A patient lays on a table and is tilted in various different angles and degrees while their electrical impulsed in their heart, oxygen levels and blood pressure are being monitored. This test is conducted in a room specially equipped for this test.

Preparation

• No food or liquid after midnight before your test
• Take your daily medications as prescribed but only with a small amount of water
• Wear comfortable clothes
• Bring a list of all medications and doses, including over the counter medicines that you take
• You will want to have someone available to drive you home
• If you have diabetes, ask the doctor how to eat prior to the procedure and how to take your necessary medications

The procedure

The test takes about 2 hours. A nurse will start an IV to provide the necessary fluids during the test. You will be connected to four different monitors:

1. Defibrillator / pacemaker
2. Blood pressure
3. Electrocardiogram
4. Oximeter

You may feel nothing at all during the test or you may pass out. Many patients may experience fainting during the test so be sure and tell the nurses and doctor any symptoms you may be feeling.

A transesophageal echocardiography (TEE) is a test that produces pictures of your heart using ultrasound to take detailed pictures of your heart and arteries. This is accomplished by placing a thin tube down your throat and into the esophagus which allows the doctor to get very detailed images of the upper chambers of your heart.

A doctor will use the TEE test to get clearer pictures of your heart and the upper chambers and the valves than they can get with the echocardiogram.

Preparation:

• No food or drink at least 4 to 6 hours before the procedure
• You will want to have someone that will drive you home

The procedure

• A nurse will administer an IV to give a small sedative to relax you and to provide fluids
• You will be given medicines to relax you and to numb your throat so that the tube may pass easily down into the esophagus
• A technician will place electrodes on your chest
• The probe is inserted and the doctor is able to obtain the images necessary for analysis
• After the test is completed the nurses will wait with you until you are fully awake

Initially you may have trouble swallowing for a few hours after the procedure which is completely normal. It is common to have a sore throat for a few days after the procedure and soothing beverages may help. If you have any severe symptoms, bleeding or pain past several days notify your doctor. Do not drink alcohol for several days after the procedure due to the sedation.