Heart procedures and devices

An ablation (or ‘catheter ablation’) can treat abnormal heart rhythms. This procedure removes the area of the heart where the abnormal electrical signals are coming from.

What does ablation involve?   

• You will be given a local anaesthetic and sedation to keep you comfortable during the procedure.
• Your doctor will insert a long, thin tube (catheter) into a blood vessel in your groin. The catheter has an electrode at the tip.
• The catheter is threaded up through the blood vessel until it reaches your heart.
• The electrode uses heat (radiofrequency waves) or freezing (cryoablation) to deactivate the part of the heart that’s creating or passing the abnormal electrical signals. 

Ablation doesn’t usually fix the abnormal heart rhythm right away. It may take a few weeks to see if the treatment has worked or not.

Some people with heart failure can benefit from a cardiac resynchronisation therapy device. This device is a special type of pacemaker, sometimes also called a ‘biventricular pacemaker’ or ‘CRT’.

This device helps the left and right side of the heart beat together. It can improve heart failure symptoms and can keep people out of hospital.

This type of pacemaker is often combined with an implantable cardioverter defibrillator (CRT-D).

Cardioversion aims to return an abnormal heart rhythm to a normal rhythm. 

There are two main types of cardioversion.  

Electrical cardioversion 
You will be given a general anaesthetic to put you to sleep. Pads are attached to your chest. The pads are connected to a machine called a defibrillator (see ‘defibrillation’). The defibrillator gives your heart a small electrical ‘shock’ to get the heart back into a normal rhythm. You might need more than one shock. Your heart rhythm will be monitored during and after the procedure, to make sure it has been successful.

Pharmacological cardioversion (cardioversion using medicines)
Your doctor will give you special heart medicines to return your heart to a normal rhythm. This is usually done in hospital so your doctor can monitor your heart rhythm to see if the medicine has worked.

Coronary angioplasty (with or without stent insertion) is a common treatment for people with coronary heart disease, after a heart attack or angina (chest pain) episode.

This procedure improves blood flow to the heart by opening the coronary arteries using a small, inflated balloon. Sometimes a stent is inserted at the same time to stop a blockage happening again. This procedure is also called ‘percutaneous coronary intervention’.   

What does coronary angioplasty involve?

• You will be given a local anaesthetic and you will be awake during the procedure.
• Your doctor will insert a long, thin tube (catheter) into a blood vessel in your groin or wrist.
• The catheter, which has a tiny balloon at the end, is threaded through the blood vessel until it reaches your heart.

When the catheter reaches the blocked or narrowed part of your coronary artery, the balloon is gently inflated to open up the artery.

As part of the angioplasty procedure, your doctor may decide to insert a stent into the coronary artery to make sure it stays open. In this case, the balloon is deflated and taken out while the stent stays in place.

During a cardiac arrest, a person’s heart has stopped beating. Defibrillation is an emergency treatment to help the heart start beating again. Paddles or pads are put on your chest and a small electrical current or ‘shock’ is delivered to your heart to make it start beating regularly again.

Defibrillation can also be used to treat abnormal heart rhythms (for example, if your heart beats too fast or in an irregular way). In these non-emergency situations, you will be given a general anaesthetic.  See ‘cardioversion’.

Depending on the heart condition you have, your doctor may recommend that you have an implantable cardioverter defibrillator (ICD) inserted. See ‘implantable cardioverter defibrillator’.

Some people with severe heart conditions may need the support of a special type of life-support machine (extracorporeal membrane oxygenation machine).

The machine replaces the normal action of the heart and lungs. ECMO is used when your heart and lungs need help to heal.

It may be used in the care of people with COVID-19, those with severe inflammation of the heart muscle (myocarditis) or those waiting or recovering from a heart transplant. See ‘heart transplant surgery’.

If your coronary arteries are very narrowed or blocked, treatments like medicines, angioplasty and stents may not be effective. Your doctor may recommend heart bypass surgery depending on the location of the blockage, and how many coronary arteries are affected.

This surgery can improve blood flow to your heart, relieve angina (chest pain) symptoms and prevent future heart attacks.

What does heart bypass surgery involve?

• This a type of open-heart surgery. You’ll be given a general anaesthetic and will be asleep during the surgery.
• Your surgeon will take a healthy blood vessel from somewhere else in your body (the chest, leg or arm).
• Your surgeon will attach the healthy blood vessel above and below the blocked part of the artery. This allows blood to go around (bypass) the blockage.

Read more about heart bypass surgery, here.

A heart transplant is a type of surgery to replace a heart that is not working properly with a donor heart.  

A transplant is most often recommended for people with severe or ‘end-stage’ heart failure. Only a very small number of heart transplants are performed each year in Australia at specialist transplant centres.

If your doctor thinks you could benefit from a heart transplant, you will be assessed to see if you can go on the transplant waiting list. You may be added to the list right away, or your condition might not be severe enough to be added to the list. In this case, your condition will be monitored regularly, and you will be added to the list at the appropriate time. 

For some people, a heart transplant isn’t suitable.  

Ventricular assist devices

For people on the heart transplant waiting list, a type of device called a ventricular assist device can help people to survive longer. Your doctor may also recommend a ventricular assist device if you aren’t suitable for a heart transplant.  

A ventricular assist device is a type of artificial heart pump that can help people with heart failure. The device is inserted into the heart to help the heart pump blood around the body more efficiently. It’s connected to a control unit that the person must wear on the outside of their body all the time.

Find more information about heart transplants, here.

Heart valve diseases can sometimes be treated with a procedure similar to coronary angioplasty. A balloon is inserted into a narrowed heart valve using a catheter. The balloon is then inflated to widen the opening of the valve, so blood can flow through the heart more easily. This procedure is sometimes called a ‘balloon valvuloplasty’ or a ‘balloon valvotomy’.  

If this procedure is not suitable, surgery may be needed. Heart valve surgery repairs or replaces heart valves that aren’t working properly and helps your heart to pump blood. 

To replace the damaged valves, your surgeon will use a mechanical valve or biological tissue valve. Biological tissue valves come from pigs, cows or sometimes from human donors. 

There is another type of valve surgery used to treat a condition called aortic stenosis (narrowing and stiffening of the aortic valve). This surgery is called transcatheter aortic valve implantation (TAVI), where a new valve is inserted to sit inside the damaged valve.  

Read more about treatments for heart valve diseases, here.

An ICD is a small battery-powered box (smaller than a matchbox) that is inserted under the skin, usually in the space just below the collar bone (clavicle). Thin wires connect the ICD to the heart. The ICD continuously monitors your heart and can correct dangerous abnormal heart rhythms if needed.

An ICD can: 

• correct an abnormal heart rhythm by making your heart beat regularly 
• give your heart small electrical ‘shocks’ to make your beat normally again if the abnormal heart rhythm is life-threatening
• support the heartbeat (like a pacemaker) if it’s beating very slowly. 

There are different types of ICDs available. Your doctor will discuss with you which ICD is most suitable for you.

ICDs can also store information about your heart's activity for your doctor to check.

Read more about ICDs, here. 

The heart has a natural pacemaker to make it beat normally. The natural pacemaker (also known as the sinoatrial node) is a group of cells located at the top of the heart. The sinoatrial node sends electrical signals to the heart to make it contract and pump blood around the body. If that’s not working reliably, an artificial pacemaker can be inserted to do the same job. 

A pacemaker is a small device that is put under the skin on your chest, usually below your collar bone (clavicle). It has one or more wires that connect to your heart’s chambers. A pacemaker produces small electrical currents that stimulate your heart to pump regularly. 

Modern pacemakers are very comfortable and reliable. They shouldn’t affect your day-to-day life. You may need to make a few small changes for a short time. People who have pacemakers and devices need to have regular follow-up appointments to make sure the device is working well. A pacemaker battery usually lasts between five to 15 years, depending on the type of device. Your doctor will check the battery. When the battery is running low, you will need to go back to hospital to have a new pacemaker inserted.

Read more about pacemakers, here.

Thrombolysis or ‘thrombolytic therapy’ is a treatment to dissolve blood clots. It is often used in people who have had a heart attack, to dissolve a blood clot that is narrowing or blocking a coronary artery. The ‘clot-busting’ medicine is given to you through a drip. Dissolving the clot improves blood flow to your heart muscle and around your body.