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Clinical history and review of available results of investigations to arrive at a diagnosis

 Pacemaker implantation is usually performed to help treat symptomatic slow heart rates. A defibrillator is an advanced pacemaker which can both deliver pacing treatment as well as recognise and treat very fast dangerous heart rates. An implantable loop recorder continuously monitors the heart rhythm and is useful to obtain ECG-symptom correlation to establish a diagnosis.

Assessment of the electrical properties of the heart's conduction system and adjacent  myocardial tissue. Electrical recordings of the heart are performed via catheters placed within, accessed form the groin through a key-hole puncture. The aim is to assess the electrical conductive properties and also to induce the palpitation symptoms by reproducing the clinical tachycardia. This will enable the team to triangulate the origin of the arrhythmia in order to plan treatment accordingly, including catheter ablation if suitable and safe.

The key-hole delivery of either radiofrequency ablation energy to heat cardiac tissue, cryo-ablation to freeze or more recently pulsed field ablation (PFA) applied upon the identified myocardial tissue in order to create tissue injury and get rid of areas which precipitate the arrhythmia and clinical symptoms . 

Lifestyle , Behavioural Adaptation and Arrhythmia Management is Increasingly becoming both popular and effective. This has been supported by recent  published work over the last decade. 

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