Dr Boullin performs a number of heart/cardiac procedures. There are generally termed procedures as opposed to operations as they are minimally invasive using a “keyhole approach”, accessing the heart via a tube placed in a blood vessel away from the heart itself.
An Electrophysiology Study (EPS)
This test helps with understanding the nature of abnormal heart rhythms. An EPS can determine where an arrhythmia is coming from as well as it will help decide whether a person requires medicine, a pacemaker or whether they need to have an appropriate procedure or surgery. The EPS gives information about the problem, and is often paired with a treatment called ablation, performed immediately following this.
This is an invasive "keyhole" procedure used to get rid of a faulty electrical pathway from sections of the heart of those who are prone to developing cardiac arrhythmias. Catheter ablation involves advancing catheters/wires into the heart via blood vessels. Localised heating or freezing is used to ablate the abnormal tissue causing the arrhythmia in order to prevent it happening again. Cardiac arrhythmias treatable by ablation include the supraventricular tachycardias (SVT's) i.e. AVNRT (Atrioventricular Node Reentry Tachycardia), AVRT/WPW (Atrioventricular Reentry Tachycardia/Wolff-Parkinson White), and also Atrial Tachycardia, Atrial Flutter, Atrial Fibrillation and Ventricular Tachycardia.
AF ablation and Pulmonary Vein Isolation (PVI)
When the symptoms of AF are difficult to control with medication or when medication is not tolerated or wanted, catheter ablation may be recommended as the next step.
In patients with AF, it is often the muscle sleeves around each pulmonary vein (veins draining blood from the lungs into the top chamber of the left side of the heart), which are targeted with ablation energy. The aim of this is to prevent further difficult symptoms from AF.
A pacemaker is a medical device that uses electrical impulses, delivered to tip of a wire placed in the heart to trigger the heart to beat. The primary purpose of a pacemaker is to maintain an adequate heart rate, either because the heart’s natural pacemaker is not fast enough, or there is a block in the heart’s electrical conduction system. The pacemaker is typically placed under the skin in the chest in the pectoral region and electrical leads are passed through blood vessels into the heart. Pacemakers can be single chamber (atrium or ventricular), dual chamber (atrium and ventricular) or biventricular (atrial and/or two ventricular leads).
Defibrillator (ICD) implantation
This is a device implanted inside the body similar to a pacemaker, but able to perform both pacing and defibrillation of the heart. The device is therefore capable of correcting most life-threatening cardiac arrhythmias. The ICD is in patients at risk of sudden cardiac death due to life threatening arrhythmias - ventricular fibrillation and ventricular tachycardia. The ICD is typically placed under the skin on the chest in the pectoral region and electrical leads are passed through blood vessels into the heart. ICD’s can be single chamber (ventricular), dual chamber (atrium and ventricular) or biventricular (atrial and/or two ventricular leads). A subcutaneous ICD is the latest development, which has one lead that is placed under the skin next to the sternum instead of inside the heart via the blood vessels.
Cardiac Resynchronisation Therapy (CRT)
CRT therapy is used to treat heart failure when not all parts of the lower chambers of the heart (the ventricles) contract simultaneously (ventricular dyssynchrony) which exacerbates inefficient pumping in already weak hearts. CRT involves the implantation of a CRT pacemaker or defibrillator that has an extra electrical lead overlaying the left ventricle to stimulate both sides if the ventricles to beat at the same time.