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Is your heart skipping a beat?

Establishing a diagnosis or a course of treatment: “Our discipline can accomplish both missions,” explains one of the specialists in cardiology and rhythmology and the Clinique des Grangettes.

Cardiac rhythmology? “The heart can beat too fast – that would be tachycardia – or too slowly – which is referred to as bradycardia. In either case, we have to intervene.” An electrocardiogram generally delivers a diagnosis. In certain complex cases, little catheters (like narrow stems) can also be inserted into the body for a more indepth examination. This allows doctors to observe the heart’s electrical system and to intervene if need be, and act on the cause of the problem. These minimally invasive interventions do not affect the actual organ being analysed (or only very little). They are usually done on an outpatient basis requiring less than twenty-four hours of hospitalization and using a local anaesthetic.

If bradycardia is detected, two permanent electrodes are inserted into the heart and connected to a stimulator (pacemaker). If tachycardia is diagnosed, then thin catheters are introduced through a vein in the groin to deliver a small ablation (burn) in the heart using radio frequency. The advantage is simply that one heals! The patient does not have to take medication forever. Life goes back to normal again.

The heart can also beat in a manner that is totally inadequate. To treat this so-called arrhythmia, which comes from the ventricles (that is, each of the two lower compartments of the heart, separated by a wall), a special electrical cardiac stimulator – an automated, implantable cardioverter-defibrillator/ AICD – is used to stimulate several specific points, which prevents the risk of sudden death.

“The numerous operations needed to insert the instruments or devices capable of correcting the problems related to heart rates are quite simple these days. Complications are possible, of course, but there is low risk,” says one of the cardiologists at the Clinique. As for drug treatments, they are no longer really able to compete with the surgical techniques carried out by the experts in rhythmology. They can be justified in very particular cases, but longterm action often requires another intervention. By the same token, many of the techniques involved in the limited surgical interventions aimed at “repairing” a heart whose rhythm has been failing have seen phenomenal advances these past years. Besides, costs for the interventions have dropped, so they can now be performed more widely.

One of the latest technical challenges is the attempt to do away with harmful rays for both the patient as well as the medical personnel. Irradiation is the result of minimally invasive surgical techniques that are very common in the field of rhythmology: the operations are performed using X-rays for guidance. Happily, a number of solutions are being developed to change this situation. For example, 3D body cartography provides the surgeon with a very precise visualization of the organs. It is one of the promising avenues being explored in order to perform operations without X-rays.

Pacemakers continue to be miniaturized as well. And other medical devices will also be experiencing progress in the coming years, as will the robotisation of certain surgical systems. Telemedicine has also been beneficial to those involved in rhythmology, since remote care of patients nowadays is quite normal. In case of a problem, the doctor is alerted immediately.

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