The interventional team at CAFC consists of six interventional cardiologists all of whom are board-certified and who have several decades of combined experience in the treatment of heart artery disease. The program includes procedures ranging from straightforward diagnostic tests to complex chronic total occlusion interventions. The team is also expert at mechanical support of cardiogenic shock using the Impella catheter and extra-corporeal membrane oxygenation (ECMO) to allow the recovery of patients who might not otherwise survive. The CAFC interventional team provides services at all of our affiliated hospitals and consultative services in all CAFC office locations.
Ablation
Ablation
Arrhythmias are a series of cardiac conditions that affect the electrical system of the heart. Arrhythmias can range from minor inconveniences to life-threatening conditions. Most often, medical therapy or lifestyle changes can be sufficient to control these conditions. However, arrhythmias might require a more complicated treatment to eliminate the electrical short circuits that cause arrhythmias or modify the electrical system to allow for other treatments. These treatments that alter the electrical system are called ablations. You can find more information here. In an ablation, an electrophysiologist (cardiologist specializing in the electrical system of the heart) will insert catheters into the heart through temporary one-way valves placed into the vines of the legs. These catheters can map out the electrical system of the heart and localize the short circuits triggering the arrhythmia. Once the source of the arrhythmia has been identified, a catheter can be used to destroy the short circuit to prevent recurrences. The ablation only destroys the short circuit involved in the arrhythmia and does not result in damage to the healthy tissues of the heart. The procedure is performed at the hospital under deep sedation or general anesthesia for patient comfort and safety. Topical anesthesia is used to prevent pain at the valve insertion site in the leg. A combination of fluoroscopy (x-ray), ultrasound, and electrical mapping are used to guide the procedure. Some ablations are performed on an outpatient basis and patients return home the same day. Other ablations require overnight monitoring in the hospital. Patients usually experience no side effects from the procedure or mild discomfort at the vein insertion sites. Restrictions following ablation are minimal. Ablation can be used to treat conditions including atrial fibrillation, atrial flutter, SVTs, ventricular tachycardia, and others. Some complex conditions require a more intensive procedure. The CAFC electrophysiology team will work with cardiac surgeons to design a hybrid ablation plan tailored to each individual patient’s needs if such an approach is required. Ablation is performed by the CAFC electrophysiologists at all of our affiliated hospitals though some conditions can only be managed at St. Vincent’s Medical Center or Stamford Hospital.
Angiogram
Angiogram
In situations when warranted, invasive images of the arteries called angiograms are performed. If severe blockages are present then blood flow can be restored using a combination of techniques including wires, balloons, drills, and stents. These procedures can help alleviate symptoms and prevent complications. They are performed in the hospital with fluoroscopy (x-ray) and with sedation for patient comfort.
CardioMems
CardioMems
In patients with advanced heart failure, their conditions lead to increased pressure in the heart that leads to fluid accumulation in the lungs. This fluid makes patients short of breath and frequently requires a hospitalization when medical therapy is unsuccessful. Unfortunately, when a patient is admitted to the hospital with heart failure their risk of complications increases dramatically. Ideally, therapy should be instituted before symptoms begin in order to avoid those high-risk hospitalizations. Often, patients can weigh themselves daily since fluid retention can result in rapid weight gain over short periods of time. However, when this and other strategies do not work, then a small implantable device called a pulmonary arterial manometer can help. This device, also known as a CardioMems, is implanted into the arteries that travel between the right side of the heart and the lungs. The device is inserted via a vein in the leg using conscious sedation for patient comfort and fluoroscopy (x-ray) to guide the procedure. After the skin of the leg has been cleaned and numbed a small one-way valve is inserted into the vein in the groin and the device insertion catheter (tube) is inserted into the lung artery. The device secures itself in place and sends pressure readings to the heart failure team at CAFC through a wireless connection to a monitoring station in the home. If the pressure monitor in the heart shows an elevated value, additional medications can be used to reduce the pressure in the heart before heart failure symptoms or hospitalization occurs. The interventional and electrophysiology teams at CAFC implant the CardioMems device at St. Vincent’s Medical Center and Stamford Hospital. Monitoring is conveniently performed at all of our office locations.
Cardioversion
Cardioversion
In patients who cannot take blood thinners, a mechanical closure of the area most likely to harbor blood clots can be performed. In addition to blood thinners for stroke prevention, AF can be treated with medications to control the heart rate or to keep the heart in a normal rhythm. At times, patients may require a low-risk procedure called a cardioversion to restore normal rhythm.
Coronary Angiogram/Heart Catheterization
Coronary Angiogram/Heart Catheterization
When a patient has a blocked coronary artery (the arteries that supply the muscle of the heart) they may require a coronary intervention to restore blood flow. Direct pictures of your heart are obtained by a specialist cardiologist called an interventional cardiologist. This procedure is called a coronary angiogram or heart catheterization. During this procedure a small IV consisting of a one way valve to prevent bleeding is inserted either into an artery in your wrist or groin. Small tubes called catheters are inserted into that IV and backwards to your heart where contrast (“dye”) is injected into the arteries to take a moving picture which can detect blockages. If blockages occur abruptly they can result in a heart attack. Heart attacks require immediate attention to limit damage to the muscle of the heart.
EKOS
EKOS
Acute pulmonary embolism (PE) is a common and sometimes fatal disease with a highly variable clinical presentation. It is critical that therapy is administered in a timely fashion to prevent recurrent thromboembolism. Once blood clot such as Deep Vein Thrombosis (DVT) or pulmonary embolism is detected, this catheter-based therapy may be used to treat the problem. During catheter-assisted thrombolysis treatment, a catheter is guided through blood vessels to the location of the blood clot. The catheter will deliver special clot dissolving medicine called thrombolytics to help dissolve the clot. The device, called EKOS is a cutting-edge technology that uses an ultrasound to deliver very low doses of a clot-dissolving drug directly into the clot through a catheter. The result is rapid clearance of the clot while at the same time significantly reducing the risk of bleeding. As ultrasound waves penetrate the clot, it causes the clot to become very porous so when a clot-dissolving drug is infused, it is rapidly absorbed into the clot. The dissolving process is significantly accelerated, resulting in rapid restoration of blood flow.
Implantable Defibrillators
Implantable Defibrillators
Sometimes, the heart can suffer from dangerous arrhythmias from the lower chambers of the heart. Patients with prior heart attacks or weakened heart muscles are at greatest risk as are those who have already had such a problem or those who have certain inherited conditions. Patients might not have any symptoms of these conditions but can suffer from palpitations or passing out. These arrhythmias are very dangerous and can be life threatening. In situations when patients have had a documented arrhythmia or who are at high risk for having one, an implantable defibrillator (ICD) may be required. These devices, like pacemakers, consist of a small computer and battery contained in a sealed sterile container that is inserted just under the skin of the chest near the collarbone and wires that enter the heart itself. These devices are inserted using sedation for patient comfort and using fluoroscopy (x-ray) for safety. ICDs will monitor for arrhythmias as they occur and will treat them using a combination of specialized pacing or with the delivery of an electrical shock to the heart to restore normal electrical function. The physicians of the CAFC electrophysiology team are experts at the insertion and management of ICDs. Monitoring, both remotely from at home and in office, is performed to ensure correct device function and battery longevity. Device insertion can be performed by the CAFC electrophysiologists at all of our affiliated hospitals and monitoring can be performed wirelessly via the CAFC remote monitoring program as well as in most CAFC office locations.
MitraClip
MitraClip
Historically, cardiac surgery was required to repair or replace the diseased mitral valve to prevent heart failure or other conditions. However, mitral valve regurgitation can occur in patients who might not be candidates for cardiac surgery as a result of their age, prior cardiac surgery, other medical conditions, or the function of their heart. In these patients, a less invasive treatment called MitraClip is an option. (second link) In this procedure, a specialist cardiologist will repair the mitral valve using a catheter (small tube) inserted through a vein of the leg. After crossing from the right to the left side of the heart, a small clip similar to a clothes pin is used to bring the edges of the mitral valve closer together and reduce the degree of MR. Studies have shown that the MitraClip not only improves symptoms but prolongs life. The structural heart team at CAFC uses a multidisciplinary team to determine who will benefit most from the MitraClip and when it should be performed. This procedure is performed at the hospital under sedation with an anesthesiologist for patient comfort and using a combination of fluoroscopy (x-ray) and ultrasound. What had been a life limiting or fatal condition can now be treated with an overnight hospital stay. The structural heart team at CAFC are leaders in the field of catheter mitral valve procedures and have been performing them since 2015. We are among the highest volume operators in New England. The MitraClip procedure is performed at St. Vincent’s Medical Center.
Pacemaker Insertion
Pacemaker Insertion
At times, the electrical system of the heart can become so diseased that it cannot function normally in a way that is safe for a patient. These conditions can be a result of other diseases or can be a product of aging. Patients with these severe abnormalities of their electrical system can feel fatigued, have shortness of breath with exertion, a decline in their exercise capacity, notice swelling in their feet or legs, or lose consciousness. These conditions are usually diagnosed with electrocardiograms or heart monitors. Once a diagnosis is made, a pacemaker may be required. A pacemaker is a system consisting of a computer and battery in a small, sealed, sterile container that is inserted under the skin of the chest near the collarbone and wires placed into the heart that deliver electrical signals into the heart to help it beat. These devices are usually inserted using sedation to ensure patient comfort and fluoroscopy (x-ray) for safety. Modern pacing has become extremely complex and can serve either to help the heart’s electrical system, help improve the strength of the heart, or both.
Percutaneous Coronary Intervention
Percutaneous Coronary Intervention
If a heart catheterization shows a blocked heart artery, either after a heart attack or in a more stable situation, restoration of blood flow may be required. Restoration of blood flow is called a percutaneous coronary intervention (PCI) and is usually performed at the same time as your diagnostic angiogram through a similar tube inserted through the same IV in your arm or leg artery. Using a combination of tools including wires, balloons, drills and other techniques, your provider will enlarge the blocked artery and will usually implant a stent to keep the artery open. Angiography and PCI are hospital-based procedures performed with sedation for patient comfort and use fluoroscopy (x-ray) to guide the procedure.
PFO Closure
PFO Closure
Strokes mostly afflict older people; in some circumstances, however, strokes can occur in younger individuals without significant risk factors. Such cryptogenic strokes raise a concern for an inherited or congenital cause. When humans develop in the uterus, there is a small connection between the right and left upper chambers of the heart which allow nutrient and oxygen rich blood from the placenta to the developing organs. After birth, there is a strict separation between the arterial side of the heart with high oxygen levels and the lower oxygen levels on the right side of the heart to maximize the efficiency of the heart. To maintain this separation, the connection that exists in the uterus closes after birth. However, this connection remains open in about 15% of adults. When these connections persist into adulthood it is called a patent foramen ovale or PFO. In many individuals, these PFOs cause no problems and do not result in symptoms or complications. However, in a small percentage of patients with a PFO, clots can form within that connection and travel to the left side of the heart and eventually to the brain where they can cause a stroke. In the past, treatments consisted of blood thinners to prevent the clots that cause strokes or cardiac surgery to close the connection between the two sides of the heart. There are risks associated with lifelong blood thinners and cardiac surgery is a major undertaking with risks as well. Now PFOs can be closed using a small device that is deployed within the heart using a catheter. This procedure is performed in the hospital using a small IV placed in the veins of the legs. The procedure is performed under sedation for patient comfort using fluoroscopy (x-ray) and ultrasound to guide the procedure. Studies have shown that this procedure is superior to medical therapy and is far easier to recover from than cardiac surgery. Patients typically return home the same day as the procedure with minimal short-term restrictions. PFO closures are performed by the interventional cardiologists of CAFC at St. Vincent’s Medical Center.
Transcatheter Aortic Valve Replacement
Transcatheter Aortic Valve Replacement
Historically, the treatment for severe aortic stenosis was surgical. Medicines typically do not work for this condition. However, since aortic stenosis is often a disease of aging, surgery is sometimes not an option in an older and more frail population including those who have had cardiac surgery in the past. As a result, many patients were left without a good treatment and left to suffer from progressive symptoms. In April 2002 an aortic valve was replaced through a catheter inserted through an artery in the leg for the first time. Since that time, TAVR has revolutionized the treatment of aortic stenosis in older patients or those who are not healthy enough to undergo cardiac surgery. The procedure is performed in the hospital by an interventional cardiologist specializing in structural cardiac procedures. The structural heart team began performing TAVR in 2013 and has performed several hundred interventions to date. The procedure is performed at the hospital with sedation for patient comfort and uses fluoroscopy (x-ray) to guide the operator. In spite of its complexity, the majority of our patients are discharged home the following day with minimal restrictions. The structural heart team performs TAVR at St. Vincent’s Medical Center and Stamford Hospital.
Watchman
Watchman
For patients who are unable to take a blood thinner due to bleeding or who are at a high risk of complications due to blood thinners including people who fall, the risk of stroke remains the same even if the risk of bleeding is high. In that situation, a mechanical solution to prevent clotting may be required. 90% of the clots that cause stroke in AF come from an area in the left upper chamber of the heart called the appendage. Closing the appendage will prevent blood from pooling thus preventing clots and strokes. This procedure is call a left atrial appendage closure and the most common device used for the closure is called a Watchman. This minimally invasive procedure is performed through a vein in the leg and is not a surgical procedure. Left atrial appendage closure is performed at the hospital with sedation by an anesthesiologist for patient comfort and using fluoroscopy (x-ray) and ultrasound to direct device implantation. Patients are usually discharged home the day after their procedure with minimal limitations. Large clinical trials have proved that left atrial appendage closure reduces the risk of stroke in patients who cannot safely take blood thinners. CAFC’s structural heart team has been performing the Watchman device since 2016 and the physicians on this team are among the highest volume implanters in Connecticut. The Watchman device is performed by members of the CAFC team at St. Vincent’s Medical Center and Stamford Hospital.