Below is a range of information about the different conditions we treat at Leeds Teaching Hospitals Trust and what you can expect as part of your treatment with us.
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 or doctor which type of pacemaker you have and how it will help your symptoms.
Ablation
What is 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 international normalisation ratio (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.
Implantable Cardiac Defibrillator (ICD)
What is an 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
What is a 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 on your bed or a trolley. You will have leads attached to your chest so that we can monitor your 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.