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Electrophysiology

Pacemaker      Loop Recorder      DCR      EP Study      CRT

Pacemaker Insertion and Checks 

A pacemaker insertion is the implantation of a small electronic device that is usually placed in the chest (just below the collarbone) to help regulate slow electrical problems with the heart. A pacemaker may be recommended to ensure that the heartbeat does not slow to a dangerously low rate.

A pacemaker may be needed when problems occur with the electrical conduction system of the heart. When the timing of the electrical stimulation of the heart to the heart muscle and the subsequent response of the heart's pumping chambers is altered, a pacemaker may help.

Problems with the heart rhythm may cause difficulties because the heart is unable to pump an adequate amount of blood to the body. If the heart rate is too slow, the blood is pumped too slowly. If the heart rate is too fast or too irregular, the heart chambers are unable to fill up with enough blood to pump out with each beat. When the body does not receive enough blood, symptoms such as fatigue, dizziness, fainting, and/or chest pain may occur.

Some examples of heart rate and rhythm problems for which a pacemaker might be inserted include:

  • Bradycardia. This occurs when the sinus node causes the heart to beat too slowly.

  • Tachy-brady syndrome. This is characterized by alternating fast and slow heartbeats.

  • Heart block. This occurs when the electrical signal is delayed or blocked after leaving the SA node; there are several types of heart blocks.

 

There may be other reasons for your doctor to recommend a pacemaker insertion.

Heart of Melbourne maintains great networks with both public and private hospitals, so if the need arises for you to have a CRT device implanted, there is greater flexibility for booking the procedure. 

The procedure is performed by our specially trained electrophysiologists and usually takes 30-60 minutes in a theatre or sterile hospital lab. The device is about an inch wide and is inserted through a straight incision in the skin, usually below the left collarbone. There will be local anaesthesia and medication to relax you, and try to ensure you feel little to no discomfort during the implant. Small leads will be guided into the heart chambers under x-ray and the device will be secured in a 'pocket' under the skin, which will then be closed with sutures. 

 

While you are in hospital, tests will be performed to ensure the efficacy of the implant, and that the positioning is safe and secure. If everything goes well, you will be discharged home the following day. There is some downtime involved in the procedure and some activities may be limited for up to 6 weeks after the implant. A follow up appointment to check on the success of your implant will be scheduled a few weeks after your hospital stay, but any concerns at any time can be discussed with your specialist or the Heart of Melbourne team. 

Once the procedure is completed, Heart of Melbourne cardiologists will continue to monitor the function of pacemakers in their specialised pacemaker clinics. This is usually done at 6 months intervals.

 

Implantable Loop Recorder 

An implantable loop recorder (ILR) or Loop Recorder is a small electrical device that is capable of recording continuous heart rhythms over an extended period of time. While external devices such as holter monitors may be worn for a few days to investigate suspicions of heart arrhythmias, their limitations on time can make it difficult to catch rare or isolated events, such as those that may cause syncope. Loop recorders may also be implanted to detect atrial fibrillation if clinical suspicion.

Heart of Melbourne partners with industry to supply the best quality devices. The device size can vary from a few millimetres to a few centimetres depending on the model used. It is implanted under the skin over the heart but does not have any direct contact with the heart and is therefore lower risk than other invasive procedures.

 

At Heart of Melbourne, we maintain great networks within private and public hospitals which allows your doctor greater flexibility when arranging an implantation procedure for you. Our staff will organise for you to attend one of these hospitals, and under a mild sedation and a local anaesthetic to make you comfortable, a drape will be placed over your chest and your skin will be cleaned with an antiseptic solution.  A small incision approximately 2cm long will be made below your collar bone, in which the device will be placed within a ‘pocket’, and sutures will be placed to close the wound. The procedure takes between 15-30 minutes; however, the sedation requires a few hours of recovery in the hospital. 

When the device is implanted, it will be continuously recording without any need for you to do anything.

 

You will also be given a small device to take home with you, which you can use to manually record an event or symptom if and when you feel them, which we can view remotely to check for rhythm abnormalities.

 

Electrical Cardioversion (DCR) 

Heart of Melbourne cardiologists treat many patients with abnormal heart rhythms. These may be caused by electrical misfiring in the muscles of the heart, resulting in erratic, or disorganised heart beats such as with atrial fibrillation. In these cases, Heart of Melbourne offers specialised care under our electrophysiologists, specifically trained in assessing and improving the electrical functionality of the heart.

If you find yourself diagnosed with an electrical dysfunction and in need of an Electrical Cardioversion or DCR, the Heart of Melbourne team, using our great networks within private and public hospitals will arrange this for you. The procedure requires a synchronised and metered electrical current to be applied to your heart through your chest, and is performed in a highly equipped clinical room, under a light sedation.

Most patients preparing for a DCR will require a course of blood thinning medications for a few weeks prior. These medications greatly reduce the risk of dislodging a blood clot that may have formed in the atria of the heart during fibrillation. Your cardiologist will advise you regarding fasting or withholding medications for the procedure.

 

When you attend for your DCR procedure, you will be taken to a clinical room equipped with ECG tracing machines, and a defibrillator. A light sedation will be administered to allow you to maintain the most comfort during the procedure. Gel-like pads will be applied to your chest, and possibly your back. These will act as contact points for a metered electrical current to enter your heart. This electrical current initiates contraction of all heart chambers simultaneously, with the desired result being a ‘restart’ of a normal, regular heart rhythm.

Your health, well-being, and safety is the highest priority for Heart of Melbourne, and therefore you will be closely monitored for any breathing or blood pressure issues. There is very little downtime post-DCR, and although the sedation requires you to be in recovery for a few hours, and a family member or friend to drive you home, you should be ready to perform usual tasks the next day.

Electrophysiological (EP) Study

 

Electrophysiology is the term used to describe the study of the electrical activity in the body, with our doctors focusing on the cardiac activity. Heart of Melbourne cardiologists treat many patients with abnormal heart rhythms. These may be caused by electrical misfiring in the muscles of the heart, resulting in erratic, or disorganised heart beats such as with atrial fibrillation. In some cases, there may be no obvious cardiac symptoms, but the patient may experience palpitations, dizzy spells, or fainting episodes and blackouts.  In all of these cases, Heart of Melbourne offers specialised care under our electrophysiologists, specifically trained in assessing and improving the electrical functionality of the heart. 

An EP Study may be offered to you if it is believed you have an electrical dysfunction of your heart that has not been diagnosed by usual non-invasive testing. EP studies are completed in a theatre-like laboratory at a hospital. Given our extensive network at Heart of Melbourne, your doctor can usually be quite flexible with booking your study as soon as possible. Our staff will organise for you to attend one of these hospitals, and under a mild sedation and a local anaesthetic to make you comfortable, your skin will be cleaned at the insertion sites, usually in the groin,  with an antiseptic solution.  A small incision, less than 2mm long will be made to allow small catheters to be passed into an underlying vein, through which they will travel to the right side of your heart and collect information regarding the electrical activity in the walls of the heart chambers. These catheters also have the ability to directly stimulate highly specific areas of electrical ‘flow’ in the heart muscle. As an EP study is used specifically for diagnostic purposes, the cardiologist may use the catheters to intentionally ‘trigger’ any abnormal electrical activity in the heart muscle that will assist in your diagnosis and ensure appropriate treatment.

The procedure takes between 1-2 hours; however, the sedation requires a further few hours of recovery in the hospital and a friend or family member to drive you home. As some variables can alter the conditions of the procedure, it is best to call our clinic to check if you should withhold any of your regular medications, or fast prior to admission.

EP studies can be very useful in cases with uncertain diagnoses, and are an exceptionally specialised test, only performed by cardiologists with extensive further training. Heart of Melbourne is lucky enough to be home to multiple sought after electrophysiologists, and hope to assist in any case of undiagnosed electrical dysfunction. 

Cardiac Resynchronisation Therapy (CRT) 

A large percentage of patients under the care of Heart of Melbourne suffer from some degree of heart failure. In cases of heart failure, part of the heart muscle becomes stiff or weakened, and is not able to transfer blood through the body as effectively as it should. This is usually caused by processes occurring over a length of time, such as the building up of plaques in the arteries, uncontrolled high blood pressure, or formation of valve abnormalities, although many other conditions can contribute. The signs and symptoms can be unreasonable shortness of breath, fluid retention, or electrical abnormalities on an electrocardiogram.  In all cases of heart failure, the primary management is dietary changes and medications. 

When the heart failure signs and symptoms are problematic after optimum medication management and lifestyle changes, the Heart of Melbourne cardiologists may investigate the need for Cardiac Resynchronisation Therapy, or CRT.

 

CRT mainly focuses on the ventricles - the lower chambers of the heart. A CRT device is similar to a variation of a pacemaker, in that it sends small electrical currents to maintain heart rhythm. With CRT  devices however, they work to synchronise all 4 chambers of the heart to work together, as opposed to 1 or 2 primary chambers as with traditional pacemakers. CRT devices can also be combined with internal cardiac defibrillators if there is a risk of the heart entering into deadly rhythms. 

 

Heart of Melbourne maintains great networks with both public and private hospitals, so if the need arises for you to have a CRT device implanted, there is greater flexibility for booking the procedure.

The procedure is performed by our specially trained electrophysiologists and usually takes 2 - 3 hours in a theatre or sterile hospital lab. The device is about an inch wide and is inserted through a straight incision in the skin, usually below the left collarbone. There will be local anaesthesia and medication to relax you, and try to ensure you feel little to no discomfort during the implant. Small leads will be guided into the heart chambers under x-ray and the device will be secured in a 'pocket' under the skin, which will then be closed with sutures. 

 

While you are in hospital, tests will be performed to ensure the efficacy of the implant, and that the positioning is safe and secure. If everything goes well, you will be discharged home the following day. There is some downtime involved in the procedure and some activities may be limited for up to 6 weeks after the implant. A follow up appointment to check on the success of your implant will be scheduled a few weeks after your hospital stay, but any concerns at any time can be discussed with your specialist or the Heart of Melbourne team. 

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At Heart of Melbourne we bulk bill all eligible investigations including pacemaker insertion and checks, EP study and other device insertions. A small out of pocket "access" may be payable to the private hospital depending on the insurance category.
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