Cath Lab Procedures
Coronary angiogram / Cardiac catheterisation / right and left heart catheter
These are procedures that take place in the catheter laboratory under local anaesthetic and sometimes with the addition of sedation administered into a vein. The procedure can be a day case procedure or sometimes requires an overnight stay. This procedure is performed if you have an issue with the electrical functioning of the heart.
The ablation procedure is slightly different depending on the underlying condition that is being treated.
Some examples of these procedures are described below.
These are different names for the same type of procedure.
It is a procedure performed to investigate the coronary arteries. The coronary arteries are vessels which leave the main blood vessel (aorta) and run along the surface of the heart supplying the heart muscle pump with blood. They can become lined/furred with cholesterol plaque (atherosclerosis) which most commonly leads to a condition known as angina.
There are several circumstances where your Healthcare Professional may suggest a coronary angiogram. If you have chest pain that is suspected to be angina then an angiogram may be recommended (with or without other tests beforehand). If you are requiring heart valve surgery or keyhole valve intervention then it is usually recommended that you have a coronary angiogram first. Finally, if you have been admitted to hospital with a suspected or confirmed heart attack (myocardial infarction) then it is likely that a coronary angiogram will be arranged.
A coronary angiogram is usually a day-case procedure performed under local anaesthetic. You will be taken into the catheter laboratory/angiogram suite and asked to lie on a table wearing a gown. Usually your wrist (but occasionally the groin) will be cleaned and sterile drapes placed across you. Your wrist (or occasionally the groin) will be numbed with an injection of local anaesthetic and a small tube (catheter) is inserted into the artery and fed up toward the heart using X-Ray guidance. The tube is then directed towards the opening of the coronary artery. Once placed in position, dye is inserted down the tube (catheter) and an x-ray machine is used to make a video of the dye passing down the coronary artery. This is to look for narrowing in the coronary arteries. The x-ray camera will be moved around your body during the procedure to take pictures of the arteries from many different angles. You may be asked to hold your breath for a short time whilst the picture/video is being taken. Usually pictures are taken of the left coronary artery first and then the tube swapped or moved and pictures of the right coronary artery are taken. Sometimes you can experience chest discomfort or feel unwell during the procedure, if this is the case you should tell the doctor immediately.
Occasionally your doctor will need information about the pressures within the chambers of your heart (this part of the procedure is often referred to right heart catheterisation). If this is the case the doctor will introduce the tubes (catheters) into the chambers and take measurements and another puncture is required to introduce a tube (catheter) into the right side of the heart from a vein in the groin, arm or neck. If this information is also required then the procedure takes slightly longer. Often a coronary angiogram is combined with other procedures such as invasive coronary physiology studies or percutaneous coronary intervention (PCI / stenting). Your doctor will explain this to you if this is the case. Often, your doctor will not know whether you need these further procedures until they have performed the coronary angiogram test and will let you know once they have done the coronary angiogram what they plan to do next.
The procedure usually takes around 30 minutes (but can take longer, especially if you have had previous coronary bypass graft surgery or if you are having the pressures in the heart measured (cardiac catheterisation or right heart catheter). If the procedure is performed from the wrist then after the procedure a band is applied to the wrist to prevent bleeding for several hours after the procedure. If the procedure is performed from the groin then the puncture site is pressed firmly by the doctor or nurse for several minutes after the procedure (manual compression) or using a clamp device (often referred to as a Femstop). If you have the procedure from the wrist you will be able to sit up immediately and will be discharge from hospital after a few hours if you feel well. If you have the procedure carried out from the groin then you will need to lie flat for several hours after the procedure. If the procedure has been performed as a day-case procedure then you will usually be able to go home the same day. If you have had the procedure as an in-patient (for example if you have been admitted with a heart attack) then you will return to the ward following your procedure and usually will stay in overnight.
For most people a coronary angiogram is a safe and straightforward procedure. It is however an invasive procedure and therefore can be associated with complications. These can include bleeding / bruising / damage to the blood vessels (more likely if the procedure is performed from the groin), allergy to the x-ray (contrast) dye and kidney damage related to the dye (extremely rare unless you have pre-existing kidney problems). Serious complications are rare (occurring in around 1 in 1000 people) and your doctor will discuss this with you during the consent process.