Common heart procedures and what to expect

When you are living with heart disease, it’s likely that you’ve undergone one—if not multiple—cardiac procedures and tests. Some procedures require complex surgery, like open heart bypass surgery, and others are non-invasive imaging tests to view your heart’s muscles, valves and blood vessels.

Some common heart procedures include:

• Catheter ablation, a treatment option for atrial fibrillation, is a catheter-based procedure that addresses an irregular heartbeat (arrhythmia) by making a scar across the part of the heart muscle that conducts electricity.
• Pacemaker placement, which involves surgically implanting a battery-operated device (like an implantable cardioverter defibrillator) into the chest with electrical leads to the heart that help maintain a normal heartbeat.
• Coronary artery bypass graft (CABG) is an open surgery in which veins from other parts of your body are grafted onto your heart to allow blood to flow around blockages that cause a heart attack.
• Left heart catheterizations help diagnose and treat clogged arteries of the heart by passing a thin, flexible tube through the blood vessel to view or treat the affected area.
• Transesophageal echocardiogram uses ultrasound placed through the mouth into the esophagus to take moving images of the heart, which can be used to assess the heart or monitor a procedure. A transthoracic echocardiogram takes the same images from the surface of the chest.
• Cardioversions use electricity or medications to return a fast or irregular heartbeat to normal.
• Transcatheter Aortic Valve Replacement (TAVR) is a minimally invasive alternative to open heart surgery which replaces the aortic valve using a catheter through the femoral artery in the groin.

How is heart arrhythmia treated?

The medical therapies that treat arrhythmias either control the rate or the rhythm of the heartbeat.

“There are several different classes for rate control: beta blockers and calcium channel blockers are the most common. And for rhythm control, there are also several classes of antiarrhythmics, the most common being Amiodarone,” said Dr. Andrew Ferguson, an interventional cardiologist at IU Health Bloomington Hospital. “If these do not work, a more invasive option to control arrhythmias is ablation or pacemaker implantation.”

What is an angioplasty?

Angioplasty is a minimally invasive way to dilate a narrowed or obstructed blood vessel to improve blood flow and treat coronary heart disease. Angioplasties almost always involve placing a stent, or tiny, wire mesh tube that props open the blood vessel in an obstructed area.

“An angioplasty begins with a balloon that we inflate to a certain diameter to expand the area of the blood vessel that’s narrowed,” Dr. Ferguson said. “Stents are positioned across the area of narrowing and expanded by a balloon to match the proper vessel diameter.”

What diagnostic tests are done prior to selecting cardiac treatment options?

Much of this depends on your presenting symptoms, along with your medical history and physical examination. Your doctor may order an electrocardiogram (a recording of the heart’s electrical signals), echocardiogram (an ultrasound of moving images inside of the heart) or some form of stress test (an exercise test) or wearable event monitor to record your heart’s activity.

“These tests evaluate the electrical, structural and function of the heart,” Dr. Ferguson said.

What should I expect before a cardiac procedure like heart catheterization?

Your doctor will discuss your heart procedure and what to expect in the appointments leading up to your procedure. Be sure to ask your physician for additional materials to learn more about your care.

“I describe what the procedure entails, but I also highly encourage my patients to search online and watch general patient educational videos,” Dr. Ferguson said. “This helps them visualize and understand what they’ll encounter during and after the procedure to help them feel more comfortable and able to ask questions.”

For many of these procedures, your doctor will ask you to not eat or drink anything after midnight before your procedure. Your care team may want you to continue taking approved medications, though they may ask you to stop taking blood thinners prior to your procedure. If you aren’t sure what’s permitted, confirm with your doctor’s office which medications you should take or hold before the procedure.

Many cardiac procedures are offered on an outpatient basis, so you return home the same day as your procedure. For procedures like a heart catheterization, you will remain at the hospital for several hours, but you will probably return home that day. Patients who undergo more invasive procedures, like a coronary bypass or a complex angioplasty, may remain in the hospital for several days.

What is recovery like following a cardiac procedure?

Given the variety of heart procedures, recovery can vary greatly. However, most will require you to avoid driving for a while.

A procedure that goes through an artery in the groin, like a stent, will require some bed rest and restrictions like no driving or heavy lifting for two to five days.

Implanting devices like pacemakers involves an incision in the chest wall, so there will be restrictions on arm movements and longer driving restrictions. Patients who have left-heart catheterizations that go through the wrist have greater mobility after the procedure but are still asked to avoid driving for a couple days.

Transesophageal echocardiograms and cardioversions have no restrictions outside beyond the day of the procedure, until anesthesia wears off.

Will my procedure need to be repeated?

“The non-invasive cardiac testing is quite common, and over time, people have a handful or more of these,” Dr. Ferguson said. “The more invasive procedures are hopefully rarer for patients. For example, procedures like pacemakers need to have the battery changed in 10 to 15 years. Sometimes atrial fibrillation ablations need to be repeated to achieve a higher rate of success. If a patient has recurrent disease, they may have several left heart catheterizations in their lifetime.”

To learn more about cardiac procedures and what to expect from yours, check out resources at IU Health Cardiology and the American Heart Association.