UK doctor conducts procedure

2018-02-14 06:01
After the electrophysiology are (from left) registered nurse Lethiwe Zandile Mcoyi (Intensive Care), Pramsava Naidoo (patient), Dr Kevin Michael (cardiologist and electrophysiologist) and Kavi Maharaj (Intensive Care manager). PHOTO: supplied

After the electrophysiology are (from left) registered nurse Lethiwe Zandile Mcoyi (Intensive Care), Pramsava Naidoo (patient), Dr Kevin Michael (cardiologist and electrophysiologist) and Kavi Maharaj (Intensive Care manager). PHOTO: supplied

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TALENTED cardiologist and electrophysiologist Dr Kevin Michael performed a very successful electrophysiology procedure on Pramsava Naidoo.

This was the first EP case in the newly refurbished Catherization Cath Lab.

Dr Michael has a super specialisation and comes from the United Kingdom. He brings his rare skills to the KZN region.

He is not only a highly regarded cardiologist but researcher, and will be running the heart rhythm management and pacemaker centres at Netcare St Anne’s Hospital.

• WHAT IS ELECTROPHYSIOLOGY?

Electrophysiology is a sub-branch of cardiology. It deals with heart rhythm disorders that encompass both slow and fast heart rates.

The most recognisable context is the implantation of pacemakers in patients with abnormalities of impulse generation and conduction and this is the device management aspect of electrophysiology.

The faster heart rhythms are best dealt with a procedure referred to as an ablation.

This is an all-encompassing term that is obviously more complex with ablations that are highly specific relying on technology to map and identify the discreet origin of the tachycardia (fast heart rate) with steerable catheters inserted through a groin vein up to the heart under X-ray guidance. Once the source is identified then energy is applied down the catheter to a discreet location burning off or alternatively freezing the culprit region, returning the heart rate to normal. These catheters are guided to the precise location by using mapping equipment which helps navigate the various chambers of the heart.

These procedures are typically conducted in an electrophysiology laboratory.

Netcare St Anne’s hospital has recently upgraded it new diagnostic imaging equipment used to visualise the vascular system and the chambers of the heart in order to accurately diagnose cardiovascular conditions and guide treatment with minimally invasive interventions.

The new equipment at St Anne’s comprises the highly sophisticated Siemens Artis Q imaging device, which has a new generation X- Ray tube and flat detector which decrease radiation closes and enhances 2D and 3D imaging.

The ablation is often curative, meaning that the patient requires no further medication or intervention in the majority of cases, depending on the underlying rhythm disorder. Alternatively, the procedure may ameliorate symptoms thus improving the quality of life. Ablation procedure reduce morbidity but may also be lifesaving.

Lethal ventricular tachycardias (arising in the lower chambers of the heart) can be the cause of sudden cardiac death. This can even be the first presentation. They can occur in patients who were previously well, such as in genetically inherited conditions or after a previous heart attack or a viral infection leaving a cardiac scar which becomes electrically unstable. Sometimes the cardiac arrest can occur months or years after the heart has sustained the injury.

Even though a culprit coronary artery may be grafted by a surgeon, the scar remains within the myocardium and becomes the fulcrum for an electrically unstable circuit.

An indicator of this risk is the measure of the contractility of the heart. In fact, patients with reduced cardiac muscle contractility are regarded as high risk of sudden cardiac arrest and the recommendation is to implant a device called an implantable cardioverter-defibrillator or ICD.

This device is essentially a pacemaker with all the features of a standard pacemaker but can also terminate the lethal fast rhythms by overdrive pacing the heart or delivering a small shock internally into the ventricle. This therapy has been shown to be more effective than medication and saves lives.

Unfortunately, the implantation rate of ICDs in South Africa is well below that of the Western world and shows that we are not achieving our optimal health-care objectives. Patients with ICDs require routine (usually six monthly) device check-ups. This is also relevant to those patients just implanted with just pacemakers as these devices now have such advanced algorithms and regular “device” check-ups are necessary to maintain standards and the health of the patients.

Cardiac device implantation and maintenance is the other facet of electrophysiology and is the essential outpatient service that is fundamental to any comprehensive cardiac rhythm management service.

In short, all patients with cardiac devices need specialised follow–up, which comprise remote trans telephonic monitoring and/or walk-in clinic attendance periodically. Most cardiology practices are ill-suited for the technical expertise required for adequate analysis of the devices or for the specific device-related issues occurring in these patients. Patients are therefore implanted with no definite follow-up plan or structure and management tends to occur on an ad hoc basis. — Supplied by Netcare St Anne’s.

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