Surgery for rhythm disturbances
PACEMAKER INSERTION
This is not actually performed by a cardiac surgeon in an operating theatre, but by your cardiologist in the angiography laboratory, or a special room called a ‘pacing room’. It is carried out under local anaesthetic and usually takes about an hour. It leaves you with a small scar on the left side of your upper chest. You will only need to stay in hospital for one night.
You may need a pacemaker if you have been found to have a slow heart beat causing symptoms such as dizziness, breathlessness, chest pain or collapse (blackout). There are other indications for pacemaker insertion, such as abnormal rhythms causing symptoms, but these are rarer. There are many different types of pacemakers available and, should you require one, your cardiologist will decide which type suits you the best. All pacemakers can be programmed to make the heart beat at a specific rate, and this should relieve your symptoms.
The conduction system may be damaged during some heart operations, particularly those involving the mitral valve. This may require pacemaker insertion as described above before you leave hospital.
PULMONARY VEIN ABLATION
One of the most common forms of rhythm disturbance is an irregular heart beat called atrial fibrillation (AF), and it affects hundreds of thousands of people in the UK. One in 100 people aged over 65 suffer from AF, and they need to take special drugs and attend regular clinics. AF can exist in two main ways: established AF, which is present all the time, and paroxysmal AF, which comes and goes from time to time and usually gives symptoms of palpitations.
There are now new surgical treatments for AF that have about a 75 to 80 per cent success rate. This form of treatment is called pulmonary vein ablation (PVA). It is probably not worth going through the whole process of having your chest opened to have one of these procedures, but if you are having heart surgery for another reason and you have AF, your surgeon might recommend that you have this performed at the same time. It only adds about 20 minutes to the operation and involves ‘burning’ a pattern around the electrical conduction tissue of your heart, using radiofrequency, microwaves or ultrasound. It is very safe and adds minimal risk to your operation with a huge potential benefit if successful.
Even more innovative is the current development of minimally invasive ablation equipment that will allow PVA to be performed without opening the chest, but through ‘keyhole surgery’ instead. The potential for this is enormous because a huge amount of NHS money is being spent on drugs and hospital treatment for the many people with AF.
