Non-Surgical Treatments

St.Joseph's Hospital offers the following non-surgical interventional procedures.

Primary angioplasty

St. Joseph's offers primary angioplasty around the clock. Primary angioplasty means that if you experience a heart attack you will be treated with angioplasty instead of drugs (thrombolytics, also known as clot busters).

In recent years, medical experts have identified primary angioplasty as the "gold standard of care" compared to drug therapy. The benefits of primary angioplasty include lower death rate from heart attack, lower rate of stroke and reduced length of hospital stays.

During angioplasty, your doctor inserts a small tube into a blood vessel. A tiny balloon is pushed through the tube to the blocked area. When the tube reaches the blockage, your doctor inflates the tip to open the blockage and restore blood flow through the vessel, then removes the balloon.

Stent placement

Stents help keep arteries open. Stents are steel mesh tubes placed inside a narrowed artery after angioplasty has opened it up by pushing the plaque against the artery wall. Over time a smooth surface forms inside the stent, promoting the flow of blood.

Atherectomy

During an atherectomy, a doctor cleans the inside of arteries with a delicate, scraping action. This removes plaque and improves blood flow. Following an atherectomy, your doctor may perform other procedures, such as angioplasty.

Permanent pacemaker placement

A pacemaker is a small device that sends tiny electrical impulses to the heart muscle. The electrical impulses are precisely timed and cause the heart to beat very similarly to the naturally occurring heart rhythm.

The pacemaker system consist of the pacemaker itself (a small metal can with electronics and a battery) and one, two or three leads. These leads are insulated wires that carry the electrical pulse to the heart. The leads also provide information about the heart's activity back to the pacemaker.

There are three types of pacemakers:

Single chamber pacemakers use one lead in the upper right chamber (right atrium) or lower right chamber (right ventricle) of the heart.
Dual chamber pacemakers use one lead in the right atrium and one lead in the right ventricle of the heart.
Biventricular pacemakers have two or three leads that are positioned in the heart. One lead is in the right ventricle and one is along the left ventricle via the coronary sinus vein. This type of pacemaker may or may not have a lead in the right atrium.

Implantable cardioverter defibrillator (ICD)

An ICD is used to treat a heart that beats too fast or irregularly. The ICD is a small device about the size of a pager and is placed below the collar bone. It continuously monitors the heart's rhythm. When the defibrillator detects a heart rhythm that is too fast, it sends electrical impulses to your heart. These impulses can return your heart to a normal rhythm. A defibrillator can reduce the chance of cardiac arrest.

Most defibrillators also have pacemakers contained in their systems. They are constantly monitoring the heart and will deliver tiny pacing pulses if the heart beats too slowly.

Types of ICDs:

Single lead ICD - a lead is positioned into the right ventricle of the heart.
Dual chamber ICD - a lead is positioned into the right ventricle and also the right atrium.
Biventricular ICD - Also known as a CRT (cardiac resynchronization therapy) device, it has two or three leads that are positioned in the heart. One lead in the right ventricle and one lead along the left ventricle via the coronary sinus vein. Patients may or may not have a third lead in the right atrium.

Cardiac resynchronization therapy (CRT)

CRT is used to treat the delay in heart ventricle contractions that occur in some people with advancing heart failure.

The CRT pacemaker or implantable cardiac defibrillator (ICD) is similar to a standard pacemaker or ICD. It is similar in size and weight and has two or three leads. They are positioned in the heart to help restore proper timing of the heart's contractions and deliver small electrical impulses to both ventricles. This may improve the pumping function so the heart can work more efficiently. Over time, patients may experience a decrease in their symptoms. Patients may also need medication in addition to a CRT implant.

About electromagnetic interference (EMI)

Things that use magnets and electricity have electromagnetic fields around them. Usually these fields will not have an impact on your implantable device (pacemaker, ICD or biventricular device). However, a strong electromagnetic field such as an MRI can interfere with your device. It can temporarily prevent your device from treating you or cause an inappropriate delivery of a shock. If you move away from the source of the EMI, your device will resume functioning normally.

You can operate most household appliances and tools that are kept in good repair. These include microwaves, televisions and computers, among other things. For a complete list, visit your specific device manufacturer's web site.

Catheter ablation

Electrophysiology ablation is a procedure to correct abnormal heart rhythms. It involves inserting a catheter into a blood vessel through a site in the groin or neck, then winding it into the heart. The path from entry point to heart muscle is navigated by images from a fluoroscope, an x-ray-like machine that provides continuous, live images of the catheter and tissue.

Once the catheter reaches the heart, electrodes at the tip of the catheter gather data that isolate the location of the faulty electrical site. Once the damaged site in the heart is confirmed, energy is used to ablate (destroy) a small amount of tissue. This stops the disturbance of electrical flow through the heart and restores a healthy heart rhythm.

For many types of arrhythmias, catheter ablation is highly successful, eliminating the need for open-heart surgery or long-term drug therapy.