Work at the Department
The Department of Electrophysiology and Electrostimulation is an integral part of the Cardiology Clinic. The clinic has an inpatient unit where all patients who are treated for various forms of heart rhythm disorders are accommodated. Most patients are those who undergo invasive electrophysiological procedures: electrophysiological examination, catheter ablation of cardiac arrhythmias, implantation of permanent pacemakers, cardioverter defibrillators or diagnostic loop recorders, but also for electrocnoversion for atrial fibrillation or intravenous antiarrgyrhmic therapy. Furthermore, patients suffering from severe forms of cardiac insufficiency and those undergoing other cardiac procedures (coronary angiography, PCI, TAVI, ASD closure, FOA) are accommodated in the cardiology inpatient unit. Medical doctors and other medical staff at the department actively participate in the admission, processing, preparation and monitoring patients before and after these procedures. Immediately after being admitted at the department, each patient is completely processed by the medical team, which once again determines his/her current condition, the existence of indications for a particular intervention, other important diseases, and also develops a strategy for his/her treatment.
During the time spent at the Department of Cardiology, patients are subjected to various procedures (blood sampling, ultrasound heart examinations, scanner imaging of the heart, chest and aorta). Patients are thoroughly monitored immediately before and after cardiac procedures and prepared for discharge. Medical doctors of the Department also participate in monitoring patients after the completion of interventional procedures. Patients who are subjected to implantation of a pacemaker or defibrillator must be telemetrically monitored and their wounds dressed prior to discharge.
Divisions and departments:
- Electrophysiology Division
- Electrostimulation Division
List of procedures
- Diagnostic electrophysiological examination: The examination is performed under local anesthesia, by injecting the anesthetic into the right groin. After administering the anesthetic, the femoral vein is punctured, and two thin plastic tubes are placed, through which catheters can be inserted to the heart and removed without causing any problem or pain. Three or at most four catheters are usually used during the examination. Catheters are made of a special plastic material, and have smaller metal rings at the top used to establish direct contact with the inside of the heart chambers. Catheters are inserted under the X-ray guidance into the heart cavities, which is completely safe for the patient. These catheters help register electric signals inside the heart from different positions. These signals are stored and analyzed in a special computer system. Analysis of these signals provides insight into the existence of disorders in the creating or conducting cardiac electrical impulses. Then, using an electrostimulator, the heart is stimulated with low- power electrical impulses which do not cause any pain to the patient. In that way, different natural heart rhythms can be imitated; it is possible to provoke tachycardias, which the patient experiences outside the hospital, which ensures setting an accurate diagnosis. Finally, catheters are removed from the heart and vein, and the puncture wound is closed with a compression bandage. It is necessary for the patient to remain in a lying position after the examination, without bending the leg used to perform the procedure. The procedure usually takes about 30 minutes.
- Radiofrequency catheter ablation:This is a method of treating heart rhythm disorders – most often tachycardia or accelerated heart rate. During the electrophysiological examination, it is possible to determine the cause of tachycardia, which is often a part of the heart tissue – the muscle bundle. This part of the heart tissue, “responsible” for the development of tachycardia, is destroyed during ablation by heating to a temperature of about 50-60ºC. This is possible by inserting a specially made catheter into the heart cavity and attaching the tip of the catheter to the place responsible for tachycardia. Then, a high frequency current produced by a special generator is released through the catheter. The application, current release, lasts about 60 seconds on average, after which the effects are controlled. If the medical doctor is not satisfied with the results, i.e. if the target zone of the heart tissue is not completely neutralized, the application of electricity is repeated until the result is satisfactory. Releasing the electricity through the catheter and further through the heart tissue is not painful in most patients, or in the worst case scenario, it creates a feeling of light pressure behind the sternum. Only in rare cases can the application of electricity be painful. In these cases, the patient is given a painkiller (analgo-sedation), which again makes the entire procedure easily bearable. The procedure usually lasts maximum 120-180 minutes, in case of simpler conditions about 60 minutes, in case of complex cardiac arrhythmias up to 240 minutes. More than 500 procedures are performed annually at our Institute.
- Cryoballoon catheter ablation: Cryoballoon catheter ablation is a technology based on a special balloon which destroys the tissue responsible for the continuation of arrhythmia (atrial fibrillation) using low temperatures (instead of using heat which is the case with classic radiofrequency ablation). This technology ensures better adhesion of the catheter to the tissue, enabling greater stability at the desired location. The temperatures applied reach -50ºC. A significant advantage of the method is the possibility of checking the desired position using contrast radiography. The main “disadvantage” of the method lies in the fact that not all patients with atrial fibrillation are good candidates for the application of this method, i.e. results in such patients are poorer than those achieved when using classical radiofrequency ablation. Cryoballoon catheter ablation is a relatively new method. The procedure itself takes longer than classic radiofrequency ablation and is more comfortable for both the patient and the medical team performing it. The procedure usually takes up to 90 minutes. Over 100 procedures are performed annually at our Institute.
Instructions for patients
General information:
General information: Patients are admitted to the Department of Electrophysiology and Electrostimulation according to previously scheduled appointments. Upon admission each patient should provide all available medical documentation, blood and biochemistry test results not older than 15 days, blood type as well as previously performed specifically requested test results (INR, bleeding time, 24-hour Holter ECG, coronary angiography, etc.). Patients are admitted at the outpatient unit on weekdays from 07:00 a.m. to 10:00 a.m. During their stay at the Department, patients are obliged to follow the advice of medical doctors and medical staff.
Working hours:
07:30- 15:30
Required documentation:
All required documents for the preparation of the patient for interventional procedures shall be provided to the patient upon scheduling the admission at the competent outpatient units (link to documents for coronary angiography, PCI, electrophysiological procedures)
Outpatient unit
The arrhythmology outpatient unit performs the following activities:
- First diagnostic examination: Examination of patients with heart rhythm disorders, referred by a competent internist or cardiologist. Patients should provide a Holter ECG, ultrasound of the heart and an optimal ECG record of heart rhythm disorders or tachycardia. The specialist in electrophysiology compiles a report and, if necessary, submits the documentation to the electrophysiological medical advisory board.
- Telemetric controls of pacemakers, defibrillators, loop recorders: Assessment of pacemaker or cardioverter defibrillator function, electrode operation, battery condition, device memory review
- Analysis of 24-hour Holter ECG monitoring – Installation, removal of Holter monitor, analysis of ECG records and diagnosis of arrhythmia detected during Holter monitoring.
- Electrophysiological medical advisory boardmakes a decision on the method of treating the patient and determines indications for interventional procedures: electrophysiological examination, catheter ablation, implantation of a pacemaker, cardioverter defibrillator or diagnostic loop recorder. The decision of the medical advisory board can be taken over by the patient at the main counter of the Institute.
Working hours of the outpatient unit: on weekdays 08 a.m. – 08 p.m.
Procedure for scheduling outpatient unit examination: Appointments can be scheduled through the IHIS System or directly by contacting the outpatient unit at 011 3601 665 and 011 3601 666.
Contact details
Telephone:
- 011 3601707
- 011 3601708
Fax:
E-mail: the department has no official e-mail