Invasive tests and procedures: (performed in hospital)
Dr Maros Elsik has appointments at both public and private hospitals and can therefore arrange these procedures for all his patients, irrespective of health insurance status.
The information provided here is general in nature. These procedures are performed for a variety of reasons. The details of all invasive tests including the reasons for their recommendation, alternative treatments, success rate, risk of complications and likely outcomes vary in each patient. These procedures are discussed with patients in detail prior to being arranged and performed.
Trans-oesophageal Echocardiogram (TOE):
This test is commonly called a TOE. It is an ultrasound based procedure designed to obtain detailed information about your heart, that is not able to be obtained by an external echo. The procedure is performed in hospital under sedation/light anaesthesia. A TOE probe is passed into your oesophagus (swallowing pipe). The oesophagus is located immediately behind the heart, and placing the TOE probe in this position allows the doctor to obtain detailed pictures of the heart. It is especially useful in evaluating valve abnormalities, checking for clots in the heart and evaluating the aorta. The procedure can be associated with a mild throat discomfort. The procedure takes approximately 20-40 minutes. Patients are typically discharged a few hours after the procedure.
Patients with irregular or abnormally fast heart rhythms (atrial fibrillation [AF], atrial flutter and others), can sometimes benefit from restoration of a normal regular heart rhythm. This procedure a called a cardioversion or an electrical cardioversion. The procedure is performed under deep sedation (and will not be felt or rememberd by the patient). It is commonly preceded by a TOE to ensure that there are no clots in the heart. Special electrodes are placed you a patients chest and connected to a defibrillator. Once the patient is “asleep” a controlled electrical shock is administered to the heart, which commonly abolishes the irregular heart rhythm and returns the heart to a normal rhythm. Chest discomfort can sometimes be felt after the procedure. Patients are usually discharged home a few hours after the procedure.
Implantable loop recorder (ILR or loop recorder):
This is a small electronic device, that is commonly used to monitor patients with blackouts or faints, in whom other tests have not revealed a cause. The loop recorder insertions is performed in hospital, under local anaesthesia with light sedation. Only a small incision is needed and the device is inserted under the skin. Patients are typically discharged a few hours after the procedure. The loop recorder has a battery life of up to 3 years, and a memory (a bit like an airplane blackbox), that is continually used to monitor your heart rhythm. The device is programmed to specifically record any abnormal slow or fast heart rhythms. If you experience any symptoms, you can also activate the device to remember that specific time period with a special remote control. The device can then be interrogated, and any symptoms that are experienced can be correlated with a hearth rhythm that occurred at the time.
Electrophysiological study (EPS):
EPS is a diagnostic procedure designed to test and evaluate your hearts electrical system. It is usually recommended as a test in some patients with of palpitations, racing heart, syncope, faints, black outs, near black outs and other specific symptoms and conditions. The procedure is performed in hospital under light sedation, though is some cases it is performed under deep sedation or anaesthesia. Local anaesthetic is administered in the groin which is associated with mild temporary discomfort. Following this, the procedure is generally painless. Catheters (specialised wires) are inserted into the heart to test the hearts electrical system. The procedure typically takes approximately one hour, though it can sometimes take longer. Patients can usually be discharged a few hours after the procedure.
Ablation of cardiac arrhythmias (Ablation):
Patients suffering from cardiac arrhythmias may elect to have these treated with an ablation. This procedure can offer a permanent cure in many cases, depending on the cause. In most patients an ablation can be performed at the time of the electrophysiological study. This involves inserting an ablation catheter (specialized wire) into a specific part of the heart responsible for the arrhythmia. Application of heat energy at this point causes cauterization of the abnormal tissue. The procedure can in many cases be curative for arrhythmias. The procedure is generally quite safe.
There are many different types of arrhythmias and many different types of ablation. Many are fairly straightforward and others can be more complicated an involved. The exact details of the procedure vary depending on the type of arrhythmia as well as your general health, and these are discussed in detail prior to the procedure.
Insertion of pacemaker / biventricular pacemaker / defibrillator:
Patients with abnormally slow heart rhythms may require treatment with a pacemaker. Some patients with dangerously fast heart rhythms my require treatment with a defibrillator. Selected patients with heart failure may require treatment with a biventricular pacemaker or a biventricular defibrillator. The insertion of these devices is typically performed under local anaesthesia and light sedation. Deeper sedation or general anaesthesia is sometimes needed in more complex cases. Pacemaker leads (specialized wires) are inserted through a vein under the collar bone and passed through the veins into the heart. The leads are then tested and connected to the pacemaker/defibrillator, which is inserted under the skin just below the collar bone. Patients are generally able to be discharged home the following day. In most patients, only mild discomfort is associated with the procedure, which is usually able to be managed with simple pain killers such as paracetamol (panadol). The exact details of the procedure are discussed with each patient prior to the procedure.
A coronary angiogram is a diagnostic test performed to check the patency of coronary arteries (arteries that supply the blood supply for the heart). The procedure is performed in hospital under local anaesthesia and light sedation. The procedure is performed by inserting a catheter (a specialized tube) into the artery in the wrist or the groin and passed to the heart. Local anaeshetic is used prior to the procedure, which is associated with mild discomfort. The rest of the procedure is not generally painful. A dye injection is used to delineate the coronary arteries. At the end of the procedure, the catheter is removed and pressure is applied at the insertion site in the wrist or groin. Patients can usually be discharged later in the day, though in some cases, an overnight stay is required. The procedure takes approximately 30-45 minutes. The procedure is generally safe. As with all invasive procedures, there is a small risk of potential complications. The exact details of the procedure are discussed with each patient prior to the procedure.
Coronary angioglasty / stenting:
Angioplasty and stenting is a procedure used to open up narrowings in coronary arteries. If required, it is commonly performed at the same time as a coronary angiogram. Specialized wires are passed into the narrowed arteries of the heart, using which specialized balloons and stents (wire scaffolds) are used to dilate and open the narrowings. Patients are typically hospitalised overnight following angioplasty / stenting.