Interventional Cardiology Suite

In This Section:

Interventional Cardiology Suite

Services:

• Coronary Angiography, (Cardiac Catheterisation)
• Right Heart Studies
• Percutaneous Coronary Intervention, (PCI/Angioplasty/Stenting)
• Permanent Pacemaker Insertion
• Automated Implantable Cardioverter Defibrillator, (AICD), Insertion
• Loop Recorder, (Patient Event Recorder) Insertion and Removal
• Fractional Flow Reserve, (FFR/Pressure Wire) Studies
• Optical Coherence Tomography, (OCT)
• Synchronised Cardioversion
• Electrophysiological Studies, (EPS) and Ablation, (early 2013)


The Interventional Cardiology Suite, (ICS /Cardiac Cath Lab), in the Bon Secours Hospital Glasnevin opened on 18 October 2011. This is a purpose built, state of the art facility which has the most modern Siemens imaging equipment available. There is a large seven bedded Day Ward / Recovery attached to the ICS. All of these beds have cardiac monitors and there is also a central monitoring station. An experienced team of Cardiologists, an Anaesthetist, Nursing staff, Radiographers and Cardiac Technicians work together to ensure a safe and efficient service is provided to patients. With this in mind, additional high quality safety equipment is available in the Interventional Cardiology Suite. This includes the latest Intra-Aortic Balloon Pump, Anaesthetic Machine, Temporary Pacemakers and monitoring equipment. All staff working in the ICS undergo ACLS, (Advanced Cardiac Life Support) training.

Coronary Angiography

Coronary Angiography, (also known as Cardiac Catheterisation), is an invasive test to find out whether or not there are any narrowings or blockages in the coronary (heart) arteries and how well the heart is pumping. This information enables your Cardiologist to determine what the correct course of action is for you. Your Cardiologist decides if you need this procedure performed.

Coronary Angiography can be done as a Day Case procedure. You will be given advice on how to prepare in advance of your procedure. It is advisable to bring an overnight bag with you, as occasionally a PCI (discussed later) will be performed in addition to your Angiography.

Unless advised otherwise by your cardiologist, you should take all your medications as normal on the morning of the procedure
Except: 1. Warfarin – stop as advised by your cardiologist
2. Metformin – should not be taken the day before your Angiogram and not
for two days afterwards.

You must arrange to be collected on discharge, as you should not drive or travel home unaccompanied.
You must have a responsible adult staying with you the night following the procedure.

The procedure normally takes around 20 – 30 minutes to perform. You will be awake for the procedure as it is performed under local anaesthetic. Light sedation will be given if required. The Angiogram is performed via either the radial (wrist) artery or the femoral (top of leg) artery. Local anaesthetic is used to numb the radial or femoral area. A thin catheter is passed up to the heart arteries under x-ray guidance. A special dye is then injected which enables pictures of the arteries to be seen and this information is recorded permanently. This dye is processed by the kidneys and excreted over the next couple of hours.

Right Heart Studies

Occasionally it may be necessary to measure pressures in the right side of your heart. This provides information about the function of the heart valves and the flow of blood through the heart chambers. This is a similar procedure to Coronary Angiography except access is through a vein, either femoral or brachial, (arm), rather than an artery. Right Heart Studies can be performed at the same time as Coronary Angiography or as an independent procedure. You Cardiologist decides if you need this procedure done.

Percutaneous Coronary Intervention, (PCI)

This is also known as Angioplasty, Stenting or, in the past, PTCA.
PCI and the insertion of a stent is a way of opening up a blocked or narrowed coronary artery, thereby increasing the blood flow to heart muscle.

The preparation is the same as for a Coronary Angiogram

PCI usually takes between 30 – 60 minutes and is performed under local anaesthetic. Sedation will be given as required. Medical and nursing staff will be present to explain the procedure to you and answer any questions you may have. The initial part of the procedure is the same as for Coronary Angiography. PCI can also be performed via either the femoral or radial artery. Once the catheter is in place, a thin wire is passed through it towards the narrowed section of the coronary artery. The Cardiologist will then pass a long thin catheter with a balloon and/or stent at its tip. The balloon/stent is then inflated for a few seconds. This may cause some chest pain. This is normal, but tell your Cardiologist if you experience any discomfort. The pain normally disappears a few seconds after the balloon is deflated. This may be repeated a few times until the artery is adequately opened. The stent is like a small metal coil which prevents the newly opened section of the coronary artery from closing again. Once deployed, the stent stays there for life.

What Happens Afterwards?

Following Coronary Angiography, Right Heart Studies or PCI, you will need to stay on bedrest for a period of time. The amount of time will depend on what procedure you had and whether or not a closure or compression device was used to seal the artery used for access. You will be given instructions on this by the nursing staff looking after you. Your Cardiologist will discuss the results with you before you go home and will make recommendations for further treatment. The nursing staff will give you post procedural information. This is important and a relative or friend is welcome to listen in for this, as it may be hard to retain all information so soon after the procedure.
If you have had a PCI, it may be necessary for you to remain in hospital overnight.

Risks and Complications

Due to the invasive nature of these procedures, Coronary Angiography, Right Heart Catheterisation and PCI carry a slightly higher risk than other, non-invasive cardiac tests. These risks are minimal and if your Cardiologist feels you need this investigation performed, the benefits far outweigh the risks.
It is important to advise the nursing and medical staff of any allergies you may have, if you think you may be pregnant, or if you have had a bad reaction to x-ray dye or iodine in the past.
 

Permanent Pacemaker

Your Cardiologist decides if you need a Permanent Pacemaker inserted. This may be indicated for people whose heart is beating too slowly or irregularly to allow them to comfortably perform the activities of daily living.
You should take all your medications as normal unless otherwise advised by your Cardiologist. You will be given intravenous antibiotics prior to the procedure, so it is vital that you inform medical and nursing staff of any allergies you may have.

A Pacemaker is roughly the size of a matchbox and sits underneath the skin, normally in the left shoulder/chest area. An incision is made and tiny leads are passed to the heart. These are then connected to the pacemaker, which will be sutured under the skin.
This procedure is performed under local anaesthetic; sedation will be given as required. It normally takes between 30 minutes to one hour. You will be required to lie flat and still for the duration of the procedure. You will be given information and instructions after the procedure. You will need to remain on bedrest for a couple of hours. Nursing staff will advise you of this.
If you have had a pacemaker insertion, it may be necessary for you to remain in hospital overnight.

Automated Implantable Cardioverter Defibrillator, (AICD)

An AICD has similar functionality to a Permanent Pacemaker and is a similar size. It has the additional capacity to provide a brief electrical current to the heart if it detects a dangerous heart rhythm. This then allows the heart to beat normally again
The procedure for insertion of an AICD is very similar to that for Permanent Pacemaker. Towards the end of the procedure, it may be necessary to give you some medication to briefly make you sleep. This is to allow the Cardiologist and the Cardiac Technician to test the new device without causing you any discomfort. It may not be necessary to do this, your Cardiologist will decide on the day.
The post procedure care is the same as for Permanent Pacemaker.

Loop Recorder

This is a device which allows irregular or unusual heart rhythms to be recorded. The Loop Recorder, also known as Patient Activated Cardiac Event Recorder, is a small device implanted under the skin, normally in the left shoulder/chest area, under local anaesthetic. Afterwards, the patient is given a hand held telemetry unit that he or she activates whenever symptoms are felt. This enables ECG (heart rhythm) recording and storage. The device can stay in place for up to 14 months and will also be removed in the Cath Lab, also under local anaesthetic. The Loop Recorder provides the Cardiologist with information to determine the correct course of treatment.
The preparation and post procedure care for this is similar to the preparation for Pacemaker, although the recovery time is far shorter for this procedure.

Fractional Flow Reserve, (FFR)

This is also known as Pressure Wire Studies. This is a procedure that can be performed during Coronary Angiography. It involves the Cardiologist using a special wire to measure the pressure gradient in the patient’s coronary artery. A medication called Adenosine is administered briefly during this process. This information provides the Cardiologist with additional information to confirm whether or not PCI, (balloon/stenting) is required.
FFR will only be performed on a minority of cases for whom the Cardiologist requires further data before deciding on the correct treatment. FFR will add around 10 – 15 minutes to the duration of the Coronary Angiogram.

Optical Coherence Tomography, (OCT)

As part of it’s ambition to provide the highest quality service to patients, Bon Secours Glasnevin has purchased an OCT machine. Only a small number of Cath Labs in Ireland currently have this equipment.
OCT is the latest diagnostic imaging tool in Interventional Cardiology and can be used in conjunction with established imaging equipment in the Interventional Cardiology Suite. It involves recording ultrasound pictures from the inside of the patient’s coronary arteries using a tiny catheter. This allows the Cardiologist to have a greater understanding of how the inside of the artery looks. This enables him/her to decide what, if any, further treatment is required.
OCT will only be performed on a minority of cases for whom the Cardiologist requires further data before deciding on the correct treatment. OCT will add around 10 – 15 minutes to the duration of the Coronary Angiogram.

Synchronised Cardioversion

This is a procedure where the patient is briefly put to sleep so that the Cardiologist can deliver an electrical impulse to the patient’s heart using a defibrillator. This is a useful procedure for patients with irregular heart beats. The Cardiologist, Anaesthetist and Nursing staff are present for this procedure
A Cardioversion takes only a few minutes to perform and can be performed as a Daycase procedure. The Cardiologist will decide what time you can go home, but this is not normally more than a few hours

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