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Clinical Specialties - Cardiac

Interventional Cardiac Procedures

Percutaneous Transluminal Coronary Angioplasty (PTCA)

PTCA is similar to your coronary angiogram procedure. It is performed in the cardiac catheterisation laboratory under local anaesthetic. A small catheter with a balloon attached is inserted into your artery via a small puncture in your arm or leg and is guided up to the narrowed or blocked section of the coronary artery. The balloon is positioned across the blockage and then inflated. This compresses the fatty deposits in the artery and increases the diameter of the artery which improves the bloodflow in the artery.

During the procedure it is normal to experience some chest pain whilst the balloon is inflated; however it is still important to tell your doctor or nurse if you experience chest pain so it can be treated.

After your PTCA and/or stent you will be taken to the Coronary Care Unit where you will be closely monitored for the next 24 to 48 hours. You will be on bed rest for 12 to 24 hours. Prior to going home you will be seen by a Patient Educator who will give you guidelines for your recovery at home. Once you are home, continue to check the puncture site and report to your doctor any bleeding, swelling, bruising or ongoing discomfort. Avoid heavy lifting, bending over and straining on the toilet for 48 hours. Support the puncture site with light pressure when performing the above activities and also when coughing.

If you have had an angiogram via the radial artery in the arm, continue to observe the puncture site for any bleeding or significant swelling and avoid heavy lifting.

Coronary Stent

After you have had a PTCA you may go on to have a stent inserted. A stent is a small latticed stainless steel tube that is placed within your coronary artery. It is designed to support the walls of the coronary artery to help keep the artery open and therefore improve the bloodflow within that coronary artery. The stent is incorporated into the balloon catheter used for PTCA. The stent and catheter are then manoeuvred into the blocked or narrowed artery and the balloon is inflated. This causes the stent to expand inside the artery. The balloon is deflated and removed and the stent remains in the artery permanently.

Many stents are now "drug eluting". The stent contains a substance to prevent inflammation and cell overgrowth in the artery walls that can cause re-occlusion.

As with the PTCA procedure you may experience chest pain whilst the balloon is being inflated and the stent is being expanded. Although this is quite common it is still very important to notify the nursing and medical staff if you are experiencing any chest pain so they can treat your pain accordingly.

After your PTCA and/or stent you will be taken to the Coronary Care Unit where you will be closely monitored for the next 24 to 48 hours. You will be on bed rest for 12 to 24 hours. Prior to going home you will be seen by a Patient Educator who will give you guidelines for your recovery at home. Once you are home, continue to check the puncture site and report to your doctor any bleeding, swelling, bruising or ongoing discomfort. Avoid heavy lifting, bending over and straining on the toilet for 48 hours. Support the puncture site with light pressure when performing the above activities and also when coughing.

If you have had an angiogram via the radial artery in the arm, continue to observe the puncture site for any bleeding or significant swelling and avoid heavy lifting.

EPS and RFA

An EPS (Electrophysiological Study) is a special type of heart procedure that involves the stimulation and "mapping" of normal and abnormal electrical patterns of the heart rhythm. Normally, electricity flows throughout the heart in a regular, measured pattern and is the stimulus for heart muscle contractions. Sometimes the electrical system may develop a problem which may prevent the electrical signals from reaching the atria and the ventricles regularly, or the signals are generated too slow, fast or erratically.

This procedure involves the insertion of catheters into a vein which are directed to your heart. The doctor will then evaluate the electrical system of your heart by giving it a series of small electrical impulses that cause your heart to beat at different rates. You may feel a few skipped beats but don't be alarmed. If you feel any chest pain or discomfort you should let the staff know.

The procedure itself may take from between 1-3 hours and you will need to stay in bed for 4 hours after the procedure has finished. Most people are able to go home the same day.

RFA (Radio Frequency Ablation) can be performed after an EPS when an abnormal electrical pathway is detected. Abnormal pathways can lead to rapid, uncoordinated heart rhythms called "supraventricular tachycardias".

When an area of abnormal electrical signal is found, a mild radiofrequency energy is transmitted via a catheter which destroys the carefully selected heart muscle cells by cauterizing or burning it. This stops the area from conducting the extra impulses that caused the rapid heartbeats.

You will need to fast 4 hours prior to this procedure and stay in bed for 4 hours afterwards. Most people are able to go home the same day.

Pacemaker and Leadless Pacemaker

Pacemaker insertion will have been recommended if your heart's normal rhythm has become disturbed. This may mean that your heart is beating too slowly, irregularly or too fast. The pacemaker interprets your heart's natural rhythm and sends out an impulse to your heart as your heart needs it. Therefore, only when your heart is not beating normally will the pacemaker take over its function. This can be programmed to work continuously or intermittently depending on the type of pacemaker your doctor decides you will need.

The procedure does involve a small operation which is done under general or local anaesthetic in the operating theatre. The pacemaker 'box' or pulse generator is usually placed under the skin of your upper chest, below your collarbone. The pacemaker lead is then guided to your heart through a vein and the electrode which delivers the impulses to the heart is placed in the right atrium, ventricle or both depending on the type of pacemaker your doctor has chosen for you.

After you return to the ward your cardiac rhythm will be monitored to check your pacemaker is working properly. Approximately 24 hours after your pacemaker is inserted, a pacemaker technician will review your pacemaker to ensure it is functioning at its optimum level and provide you with more in-depth literature on living with a pacemaker.

For two weeks after having a pacemaker inserted:

  • You should not lift anything heavier than 3kg
  • You should not drive
  • You should not raise your arms above your head (eg. do not hang washing on the line)


These restrictions are for two weeks only and then you should be able to resume your normal activities.

Leadless Pacemaker

Your doctor may suggest that a leadless pacemaker would be the best option for you. A leadless pacemaker is a small implantable device that sends electrical pulses to the heart whenever it seems that the heartbeat is too slow.  Leadless pacing devices are placed directly in the heart without the need for a surgical pocket and insulated wires (called leads).

Because the device does not have wires, a generator, or surgical pocket on the chest, there is less chance of complications over the long term. When it is in place, there is no lump under the skin on the chest or leads anchored to the muscle bed which can cause minor discomfort in patients.  It also means that you do not need to limit upper body activity after the implant.

Implantable Cardiac Defibrillator (ICD or AICD)

An ICD delivers pacing or electric shocks to your heart to treat rhythm disorders.

Your doctor has many options in programming the ICD to treat and interrupt the abnormal heart rhythm. The ICD is implanted inside your body similarly to the permanent pacemaker described above.

Usually the day after implantation, the ICD function is checked and if necessary it is reprogrammed to ensure the best therapy will be delivered if your heart goes into an abnormal rhythm. Before leaving hospital you will be given more in-depth literature related to your ICD and how it may affect your life. There are support groups available and the staff will provide you with a contact number to such a group during an education session prior to leaving hospital.

For two weeks after having an ICD inserted:

  • You should not lift anything heavier than 3kg
  • You should not raise your arms above your head (e.g. hanging washing on the line).


There will be a non-driving period after the implantation of your defibrillator. Check with your doctor for how long this should be.

Patent Foramen Ovale (PFO) Closure

A patent foramen ovale can be called a "hole in the heart" where an opening remains between the right and left atrium of the heart. This results from incomplete natural closure of the opposing atrial walls soon after birth and can allow a very small amount of blood to leak between the two chambers.

The procedure to close this opening involves the insertion of a long thin catheter into a vein in the groin under local anaesthetic. The catheter, guided by X-ray, allows a special device to be put in place to close the PFO. The PFO device is deployed by expanding its shape to straddle each side of the hole. The device will remain permanently in place with the body’s own tissue growing over the device over a period of 3-6 months.

The procedure generally takes 1-2 hours and you will need to fast for 6 hours prior to the procedure and generally stay overnight in hospital. You will need to remain on bedrest for 6 hours after the procedure.

Blood thinning medication will be required for a period of time as determined by your cardiologist. If you are to undergo any surgical procedures or dental work you will need to have antibiotic cover for approximately the next 6 months.

You will not be able to feel the device and the implant will not be affected by airport or security sensors, nor any household appliances. Always be sure to inform anyone of the device you have in your heart prior to any medical tests or procedures. It is important to carry your identification card on you to show if necessary.

Following the closure of your PFO, it is important to avoid strenuous activity, in particular scuba diving, for up to 8-10 weeks. Discuss your activity restrictions or any other issues with your cardiologist.

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Sydney Adventist Hospital Clinical Specialties and Services