Diagnosis and treatment

There are two types of work carried out by the unit – invasive and non-invasive.

Non-invasive

This is diagnosis or treatment that can take place outside the patient's body, so there's no need for needles or surgery. Non-invasive procedures include:

• ECG (electrocardiogram), which records the electrical activity of the heart over time. It can detect abnormalities or disturbances in the rhythm of the heart.
• Holter monitoring, where a portable device is attached to the patient's chest to record the heartbeat over a 24-hour period or longer.
• Cardiomemo, which is another portable device that is used to record your heart's activity when you are having an attack of symptoms.
• Tilt table test, which is when you lay on a table and is slowly tilted to a 60 degree angle. This can reproduce the cause of a blackout and help doctors understand why it happens to you.

Invasive

Invasive procedures involve some kind of keyhole surgery to find and treat the cause of cardiac rhythm disorders, or deal with the symptoms.

They include:

• Catheter ablation
• Fitting a pacemaker
• Fitting a defibrillator

Catheter ablation

If you have an abnormal heart rhythm or arrhythmia causing palpitations, your doctor may recommend catheter ablation as a form of treatment.

An abnormal rhythm or arrhythmia may occur when the heart's electrical pulse is diverted from its normal route because there is extra tissue causing a short-circuit, or when abnormal behaviour of cardiac tissue generates extra electrical activities.

To ablate means to use energy (usually heat energy) to cause scar tissue to form. Catheter ablation is the procedure that destroys this extra tissue, re-routing the heart's electrical impulses to make it beat normally again.

Catheter ablation is usually a local anaesthetic procedure performed under light sedation. It involves passing thin wires into the veins from the top of the leg or the shoulder.

Doctors use specialised imaging equipment to measure the heart's electrical activity and try to find the short circuit – where there is extra tissue blocking the heart's electrical pulse.

Very often they locate the area within minutes. Radio frequency energy is then used to destroy the areas that are causing the abnormal rhythm.

Southampton is one of the first centres in the UK to deliver ablation treatment for atrial fibrillation, or irregular heart beat.

The Cardiac Rhythm Management unit is able to carry out these complex ablation procedures because it has always been at the forefront of medical technologies, using state-of-the-art equipment, computer software and mapping facilities.

Future development using remote navigation technology would enable treatment to be delivered more precisely in a shorter time.

A routine ablation procedure can now be performed as a day case, and the long-term success rate is around 90 to 95%.

Pacemaker

Pacemakers are fitted to patients whose heart beats too slowly, too irregularly or who are at risk of blackouts.

A pacemaker is a device to stimulate contractions of the heart. It includes a pulse generator and either one, two or three electrode leads. The pacemaker is usually fitted to the upper left side of the chest and the lead is secured in a position in the heart.

The pacemaker gives the heart a signal to contract each time the heart fails to produce its own signal.

Pacemakers usually last six to 10 years before they need to be replaced. Surgery to replace a pacemaker is now carried out as day case treatment at the Wessex Cardiac Unit.

Defibrillator

For people with a very fast or irregular heartbeat, doctors may fit an implantable cardioverter defibrillator to prevent life-threatening consequences.

This is a device that is implanted under the skin on the chest wall. It monitors the heart rhythm, senses if there is about to be a severe disturbance in heart rhythm and delivers and electrical impulse or an electrical shock to stop the abnormal rhythm and allow the normal rhythm to start again.

Defibrillators usually last five to eight years before they need to be replaced. Surgery to replace a device can be carried out as day treatment at the Wessex Cardiac Unit.

Southampton is one of very few centres in the UK in which has many years' experience carrying out this type of advanced procedure.

The Cardiac Rhythm Management unit benefits from a large multi-disciplinary team that includes technicians and specialist nurses that enables them to carry out a high volume of this work and to effectively follow-up their patients.

The use of remote monitoring technology would allow routine device checks be performed in a patient's own home using a telephonic system.

Heart failure therapy

The unit is also one of the first in the UK to start implanting heart failure therapy (cardiac resynchronization therapy) devices.

This involves the placement of a pacemaker lead to the left side of the heart to resynchronize heart contraction.

It is now an established treatment for selected heart failure patients to improve their heart function, quality of life, and minimise hospital admissions.