Electrophysiological procedures

Electrophysiology study

This procedure consists in the insertion of special multipolar electrocatheters through a vein in the groin (or  arm in some cases)  which are then threaded into the heart. The catheters can both be used for the electrical stimulation of the heart (very low-intensity impulses are generated), and for the measuring of electrical signals. The doctor can therefore record the electrical activity of the heart and determine what kind of heart rhythm problem the patient has. This procedure is performed under local anesthesia. A two-or three-day hospitalization is recommendable because the physician needs to:

• assess how well the heart beats
• detect the cause of tachyarrythmia
• detect any possible arrythmia pathogenesis of proxystic symptoms (palpitations, lipothymia, syncope)
• assess the risk rate in patients with arrythmia
• assess the effectiveness of a particular drug in the prevention of arrythmia

 

 

Transcatheter ablation

Transcatheter ablation is a relatively new procedure (Policlinico di Monza was one of the first Italian hospitals to perform it in the 90's) that was especially designed to permanently remove all anatomical substrates that cause  arrythmia just by using heat (the temperature remains below 56-58C°). Thin flexible wires are used to send hot energy to the heart. The patient does not feel pain because the heart has not got any nerves (it's like using a hot plate on your hair) .
After the procedure the patient does not need to take drugs to control arrythmia. Before the procedure patients must undergo a number of clinical tests to guarantee the highest possible safety (blood tests, ECG, cardiogram)

transcatheter ablation is performed under local anesthesia. Thin wires (catheters) are implanted in the patient’s thigh or groin (arm or neck in some cases) and the threaded to the heart. The procedure is not painful. Once in the heart, the wires are connected to special devices which record the electrical activity of the heart. During the procedure catheters are used to give the heart light electrical impulses in order to determine the area where arrythmia starts.
Once this area has been identified, the doctor sends electrical stimulations, radio waves,  to the heart by means of the catheters (the ends of which are heated at a temperature lower than 60C°). Heat coagulates the tiny area of the muscle that causes heart rhythm problems and destroys it.
After the procedure catheters are easily removed. Medication patches are applied and removed the day after.

Internal electrical cardioversion

In the event of unsuccessful external cardioversion or if the patient can’t be given general anesthesia, internal cardioversion can be performed. This procedure 
involves the insertion of catheters and does not require general anesthesia.Medical staff include a radiologist. The catheters transmit a low-intensity electrical shocks (between 5 and 10 J, whereas external cardioversion uses 100-200 J). Local anesthesia is used and the patient only feels a slight pain in the chest when the shock is given. This procedures has proved to be more effective with a  success rate of 95-98% and allows the patient to reacquire normal heartbeat also in the event of fibrillation.

Heart Pacemaker

A pacemaker is a small, battery-operated device that is implanted under the skin through a small cut, usuallly on the left side of the chest bone. It senses when the heart is beating irregularly or too slowly.
Pacemakers are small metal round-shaped boxes. Their sizes vary according to the model and range from 4 to 6 mm in length and from 7 to 9 mm in height.
pacemakers weigh as little as 20-30 grams. The box contains a small computer and  a battery that can last up to 12 years, depending on battery depletion and decay.
The procedure is painless and performed under local anesthesia.

Implantable Cardioverter Defribillator (ICD)

The ICD is a small device that is placed in the chest and helps treat irregular heartbeat by giving the heart short electrical pulses. These shocks grow in intensity if the device sense a significantly irregular heartbeat that may cause a heart attack and restore normal heartbeat.
ICDs are similar to pacemakers, though a little bigger, with longer-lasting batteries.

 

Implantable Loop Recorder (ILR)

The ILR is a subcutaneous, electrocardiographic monitoring device. It is very small, smaller than a lighter (62 x 19 x 8 mm), and lasts up to three years. It is typically implanted in the left parasternal region and is capable of storing data automatically in response to  abnormal heartbeat or in response to patient activation. It is particularly useful either if the symptoms are infrequent (short palpitations, fainting of unknown origin) or  when long-term data storing is required (patients with severe arrhythmia).