Cardiac Rhythm Management
The Cardiac Rhythm Management (CRM) team cares for patients with or suspected of having a variety of heart rhythm problems - arrhythmias.
Arrhythmias are disturbances in cardiac (heart) rhythm and are very common. There are many different types of arrhythmia, including simple extra beats and more sustained rapid beats. Disturbances of rhythm can also sometimes cause slow heart beats. The symptoms experienced are varied. Some people may notice simple ‘skips and jumps’, others rapid heart beats. Sometimes dizziness or less commonly blackouts may occur.
The CRM service is provided by 2 Consultant Cardiologists, 2 Arrhythmia Nurse Specialists, cardiac physiologists, health care assistants and administrative staff. Dr Boullin is our Consultant Electrophysiologist & Device Specialist and Dr Edwards is our Device & Heart Failure Specialist. Patients are supported by our Arrhythmia Nurse Specialists - Kay and Jules - who give specialist advice and are dedicated to providing expert nursing care to patients suffering from or suspected of cardiac arrhythmias.
Cardiac arrhythmias range in severity from benign conditions to a potentially fatal problem. They can have a profound effect on people’s lives and therefore early diagnosis and treatment is imperative and is what the team strives to achieve. The commonest arrhythmia is Atrial Fibrillation (AF).
We provide a variety of clinics, diagnostic services and treatments. We have a specialist arhythmia clinic, a palpitations clinic and a dedicated AF clinic. Our arrhythmia nurse specialists run the DC cardioversion service for the AF patients. They may be referred to Dr Boullins arrhythmia clinic for ongoing medical management or for treatment with catheter ablation.
Dr Boullin holds a weekly arrhythmia clinic reviewing patients diagnosis and management. When required patients suitability for catheter ablation is assessed and discussed. The arrhythmia specialist nurses work alongside the Dr Boullin in this clinic. Patients that have undergone electrophysiology studies and ablation are routinely seen by one of our specialist nurses for their subsequent follow up appointments. The specialist nurse is able to assess and manage ongoing symptoms and discharge patients. Working alongside the consultant cardiologist allows the opportunity for the patient to be also reviewed by Dr Boullin if required. The appointment is usually planned for 20-30 minutes and a routine ECG is performed on arrival to the department.
Arrhythmia helpline – 01305 254920
Kay Elliot runs this is a specialist nurse led clinic to find the cause of patients suffering with palpitations. Available diagnostic tools include various heart/ECG monitoring individualised to how often and for how long a patients symptoms are. Making this diagnosis can often be challenging and this specific clinic has been developed to make this as efficient as possible.
Our local GP's refer patients into this clinic when patients have ongoing AF with symptoms that needs further assessment and treatment. This enables easy access to the right treatment as early as possible. One such treatment is called "cardioversion", where a patients has a daycase procedure to "jump-start" the heart back into its normal rhythm.
Pre-admission clinics for cardiac devices and electrophysiology studies/catheter ablation
These clinics are led by our specialist nurses to ensure patients are well informed of their planned procedures. The clinic appointment last approximately 30 minutes depending on the procedure the patient is planned to undergo.
Routine tests may need to be carried out such as blood samples or a heart tracing called an electrocardiogram or ECG. This allows the results to be analysed prior to hospital admission and can help with the planned procedure. The clinic allows time to discuss the procedure with a specialist nurse and in some cases to sign a consent form.
Ward cover for elective and non-elective patients with heart rhythm problems
The specialist nurses provide cover for patients on cardiology wards, pacemaker/defibrillator service and cardiology day unit. An important part of their role is to ensure patients are informed of planned procedures and supported throughout their treatment.
Pacemaker and Defibrillators
A pacemaker is a small electronic device which is implanted under the skin on the chest. It sends electrical pulses to your heart to keep it beating regularly and not too slowly.
The pacemaker implantation is usually carried out under local anaesthetic (a numbing injection), which means that person is awake during the procedure. It's usually placed under the skin near the collar bone (clavicle) on the left side of the chest. The pacemaker box (generator) is attached to a wire/lead that's guided through a blood vessel to the heart. The procedure usually takes about an hour, and most people are able to leave hospital on the same day or alternatively the day after surgery.
An implantable cardioverter defibrillator (ICD) is a device similar to a pacemaker but it can also treat certain fast electrical short-circuits in the heart by giving a larger electrical shock to the heart that essentially "reboots" it to get it pumping again. ICDs are often used as a preventative treatment for people thought to be at risk of cardiac arrest at some point in the future. When it is required to reboot the hear it is often life-saving treatment.
Ongoing ICD patient support
A fundamental aspect of the arrhythmia nurse specialists role is providing support to patients who have undergone implantation of an Implantable Cardioverter Defibrillator or ICD. The team meet the patients before and after the procedure to ensure they (and ideally also relatives) are informed of their planned care. On discharge the patients have access to ongoing support by being provided with the arrhythmia helpline number as below. The team help to co-ordinate a patient support group meeting four times a year to allow patients to network with other ICD patients. These meetings also allow access to the specialist nurses should they have any questions or concerns.