The Leeds Teaching Hospitals NHS Trust


Heart Treatments


If you require a procedure to treat your condition and you would like more information, please see below. More information will be added shortly.

Angioplasty 

Angioplasty, or percutaneous coronary intervention (PCI) is an X-ray guided procedure performed to reopen narrowed or blocked arteries using a catheter delivered from outside the body. A wire is carefully threaded through any narrowed areas and balloons (usually) with stents are used to reopen these sections of diseased arteries. Stents are mechanical frames used to keep the artery open once the balloon is removed. This procedure is performed using local anesthesia and in the majority can be performed using the radial artery in the forearm, which is safer and more convenient for patients.

PCI is performed for stable angina (predictable chest pain or breathlessness on exertion) or for unstable symptoms that come on at rest or in the context of a heart attack

Annually more than 2000 coronary angioplasties are performed in Leeds.

Leeds offers a 24/7 service for emergency coronary intervention for heart attacks in the West Yorkshire region and was one of the first centres in the UK to offer primary angioplasty for acute ST elevation myocardial infarction. Every year approximately 1100 patients are treated by emergency angioplasty.

Please download the Coronary Artery Stent booklet, or pdf A Patient and Carer’s Guide to Understanding Planned Angioplasty (712 KB) for more detailed information about this procedure.

Chronic total occlusion PCI (CTO PCI) 

Chronic total occlusions are complete blockages in coronary arteries. Treatment of these complete blockages is more difficult and sometimes requires complex techniques to reopen successfully. These techniques may include sending wires backwards from the other side of the blockage or occasionally deliberately tearing the internal lining of the artery to break through resistant narrowings. Historically the success rate of reopening CTOs successfully was approximately 50%. Leeds offers a CTO service led by Dr Jon Blaxill and patients who require these complex techniques or who have had failed procedures elsewhere are usually treated successfully.

Bio-resorbable Vascular Scaffolds (BVS) 

These are stents that over resorb over a period of 2-3 years. The advantage of a dissolving stent is that once the stent has been fully resorbed this can leave the coronary artery to work normally and ‘re-model’ or grow outwards rather than re-narrow inwards. Also late complications related to stents such as sudden blockage due to clot may be reduced 

Pacemaker 

What is a pacemaker?

A pacemaker is a battery operated device, inserted into the body just below the collar bone. A wire or ‘electrode’ leads into the heart.

The most common pacemaker is designed to ‘sense’ the speed of your heart beat. If the rate falls below a certain level, the pacemaker ‘senses’ this and sends impulses along the electrode to stimulate or ‘pace’ the heart beat at a faster more appropriate rate until your own heart beat increases again.

There are many different types of pacemakers which are individually selected for your particular needs.

Why do I need a pacemaker?

There are many reasons why people may need a pacemaker.  If your pulse falls to a slow rate you could feel dizzy, tired and sleepy.  You may even have been experiencing blackouts which can lead to personal injury.  Some people experience a fast erratic heart rate causing ‘palpitations’.  You may also feel breathless.  It is also possible not to experience any of the above but your doctor may still advise a pacemaker.

Please discuss your nurse / doctor which type of pacemaker you have and how it will help your symptoms.

Please download the Take Heart pdf 'Your Pacemaker and Box Change' (293 KB) booklet for further information.

Ablation 

Ablation is a procedure that uses energy (usually radiofrequency) to destroy or isolate sources of abnormal electrical impulses that can cause or maintain atrial fibrillation (AF), It is performed by placing catheters into the heart through a vein usually in the groin or occasionally the arm or neck, guided by x-ray. The term ablation means making small burns in the heart tissue in order to cause a small scar, which can no longer conduct abnormal impulses. Most healthy tissue is unharmed.

Left atrial ablation for AF

Paroxysmal AF often originates from the four pulmonary veins that drain blood from the lungs into the left atrium. With this procedure, catheters are placed in the heart and guided to the left atrium. Ablation is then performed around the pulmonary veins to prevent the abnormal electrical impulses from entering the left atrium and causing AF. The particular pattern of ablation performed varies from specialist to specialist. In patients with persistent AF, additional lines of ablation in the left atrium may be required. This type of ablation procedure is usually reserved for patients who have significant symptoms from their atrial fibrillation and have failed medication.

Before the procedure and pre-assessment:

If you are not on warfarin we will either refer you to the anticoagulation clinic or your GP to get it started.

You will be invited to attend a pre-admission clinic a few days before the ablation. Please ensure that you have not had anything to eat or drink from midnight.

We will fill in our pre-assessment form and take a note of your medication.

Your blood will be tested. In particular, we will check your INR levels to ensure that your blood is neither too thick nor thin for the procedure. Generally we will ask you to continue taking your usual dose of warfarin, however we may advise you to amend the dosage or stop warfarin before the procedure.

There will be opportunity to discuss the procedure with a Nurse Specialist and hopefully any questions you have will be answered.

You will also find out whether you need to avoid eating and drinking prior to admission and instructions will be provided regarding your current medications such as which to stop and for how long beforehand.

After seeing the nurse you may need to have an ultrasound scan of the heart called a transoesophageal echocardiogram. The purpose of this test is to view the heart in detail and ensure that there are no blood clots within the heart which could lead to stroke if an ablation procedure is performed.

How this is done

Your throat will be sprayed with a local anaesthetic to make it numb. You may then be given sedation into a vein. Following this you will be asked to swallow a probe into your gullet and stomach. The test takes about 30 minutes. Common side effects of the test include a sore throat and discomfort during the procedure. Although there is a risk of damaging your food pipe, this is very rare.

Please download the Take Heart 'pdf Ablation (178 KB)' booklet for further information. 

Implantable Cardioverter Defibrillators (ICD) 

ICDs are implanted to protect from serious fast heart rhythm disturbances (arrhythmias).

The ICD is a small device containing a battery and computer; it differs from an ordinary pacemaker because it has the ability to deliver large electric shocks and can treat fast rhythm problems.  It is usually implanted in the left chest wall under the collarbone and connects to the heart via 1, 2 or 3 leads or wires.  Its job is to constantly monitor the heart rate.  Should it detect a fast rhythm it can deliver electrical therapy to “reset” the heart back into a normal rhythm.

ICDs are mainly aimed at treating electrical problems in the heart, in general they will not alter other cardiac symptoms; for example chest pain or breathlessness.

Patients who are considered for this type of device have either experienced a serious arrhythmia or are likely to do so. Your nurse or doctor can explain how it applies to you. 

Cardioversion 

This is the delivery of a small direct electrical current (a shock) to the heart in an attempt to interrupt the abnormal activity, this interruption allows the pacemaker of the heart to step in and a normal rhythm to take over. The small electrical shock is delivered by a specialised machine called a defibrillator. Two pads are placed on your chest and the defibrillator which has two paddles on it is placed over these pads and the electric shock is administered. You will be asleep during the procedure and therefore will not feel anything.

The procedure will take place in a small anaesthetic room attached to the ward. The nurse will give you a gown and ask you to remove any dentures. You will be taken to the anaesthetic room o yourbed or a trolley. You will have leads attached to your chestso that we can monitoryour heart. You will be asked to lie flat with one pillow under your head (if possible).

A venflon (a small needle) will be placed in the back of your hand to allow the anaesthetist to give you medication to put you to sleep.

A doctor and an anaesthetist will be with you at all times. You will be asked to breathe deeply through into an oxygen mask. You will be asleep for a short while during which time the procedure will take place.

Please download the Take Heart 'pdf Your Cardioversion Booklet (275 KB)' for further information 

Mitral valve treatments 

Narrowing of the mitral valve is rare in the UK and is usually caused by rheumatic fever. Stretching the valve is often an effective therapy in young patients and may avoid or substantially delay the need for cardiac surgery. The technique is called percutaneous mitral valve commissurotomy (PTMC) and is performed by sending a special balloon through the top of the heart across the valve. This service is led by Dr Jim McLenachan and patients are referred from throughout Northern England. 

Transcatheter aortic valve implantation (TAVI) 

Transcatheter aortic valve implantation allows the aortic valve to be replaced without the need for open-heart surgery, and is therefore a good option for patients in whom the risks of open-heart surgery are unacceptably high.

What does the procedure involve?

Transcatheter aortic valve implantation is usually performed under a general anaesthetic, though can be performed under local anaesthetic with sedation. Your doctors will tell you which approach they plan to use for you.

Tubes are then passed into the arteries and veins in your groin. Through one of these tubes the doctors pass a large balloon into the aortic valve and inflate the balloon to stretch open the narrowed valve. A long tube or ‘delivery sheath’ is then passed through the artery in the groin and up to the heart. The new aortic valve is contained within this tube. The valve is a ‘tissue valve’ made out of the lining of a pig’s heart and then sewn into a metal tubular frame.

The delivery sheath is passed across the aortic valve, and then pulled back to deliver the new valve. The metal tubular frame containing the valve expands of its own accord, pushing your old valve out of the way, and allowing the new valve to start working immediately.

After the procedure you will spend the first 48 hours on the coronary care unit, after which you will be transferred to the ward. You will be discharged home about 5-7 days after the procedure.

For further information about the TAVI procedure, please visit the TAVI website

Cardiac surgery 

For information about cardiac surgery, please visit the Yorkshire Heart Centre webpage. For information about rehabilitation after surgery, please download the Take Heart 'Rehabilitation After Heart Surgery (813 KB)' booklet