Interventional Cardiology

Interventional Cardiology, alternatively termed interventional cardiology, encompasses a distinct subspecialty of cardiology concentrating on the diagnosis and management of cardiovascular ailments via minimally invasive techniques. This medical domain necessitates the insertion of a catheter via a diminutive incision to gain access to the heart and adjacent vasculature.

Interventional cardiologists, having acquired specialized education and copious expertise, adeptly execute intricate procedures such as angioplasty, stenting, and atherectomy. In concert with cardiac surgeons and electrophysiologists, these professionals deliver holistic care for individuals afflicted with cardiac disorders. (1) (2) (3)

The interventional cardiology curriculum at Penn Medicine boasts an eminent position nationally, achieving an angioplasty/stent triumph rate surpassing 95 percent, coupled with a complication incidence under 3 percent. This groundbreaking medical sphere has radically transformed cardiovascular disease management, ushering in expedited convalescence, diminished hospitalization durations, and enhanced patient prognosis. (4)

Definition and Overview

A subspecialty of cardiology known as interventional cardiology focuses on the catheter-based treatment of structural cardiac conditions. The cardiovascular system, which consists of the heart, arteries, and veins, is where the majority of treatments are carried out. Treatments in this sub-specialty of cardiology are performed with a minimally invasive approach through a needle hole of a few millimeters and do not require large incisions or insertion of instruments. 

Some of the conditions commonly treated by interventional cardiology, a specialized branch of cardiology that focuses on the diagnosis and treatment of various heart conditions using minimally invasive techniques, include:

• coronary artery disease, 
• vascular disease,
• acquired structural heart disease,
• ischaemic heart disease,
• stable angina,
• heart attacks. (5)

Procedures

Some common minimally invasive techniques and procedures applied in interventional cardiology are:

• Cardiac Catheterization Procedures

​​Catheterization is the most common interventional cardiology procedure, and it entails inserting a sheath into the inguinal or wrist artery and guiding a catheter through the heart to open a blocked artery using a balloon (angioplasty) or a stent (metal sheath placed to be open). In addition, arterial occlusions in areas other than the heart, such as the neck, kidneys, and legs, can be opened medically without the need for surgery.

Additionally, cardiac catheterization is a frequently employed diagnostic procedure. This procedure entails inserting a tiny catheter—a long, thin, flexible, hollow tube—through an artery or vein in the groin that supplies the heart with blood. Angiograms or moving X-ray images of the dye moving to the heart are taken by a technician after injecting dye into the catheter.

• Electrophysiology (EP) Studies

A cardiologist can precisely locate the damaged heart muscle by measuring the electrical impulses of the heart using a catheter with electrodes attached. They can also administer mild electrical impulses to affect heart rhythm problems and learn more about them.

• Electrical Cardioversion

A low-voltage electrical current applied to the chest using patches or spoons by a cardiologist can help the heart rhythm return to normal. A short-acting anesthetic is administered in combination with the operation. 

• Implantable Devices

Heart rhythm abnormalities are treated by several tiny battery-operated implants placed close to the heart.

Implantable cardioverter defibrillators: 

The rhythm of the heart is continuously monitored by implantable cardioverter defibrillators, which also supply an electrical current to correct it as necessary. The flow is regulated to react differently when defibrillation is required to restore the heart's normal rhythm or when the rhythm has to be slowed down.

Implantable pacemakers: 

Pacemakers that are implanted can stop the heart from beating too slowly. Heart rhythm sensors are built into some pacemakers, allowing them to adjust the heart rate as necessary. (6)

Candidates

Individuals who have been diagnosed with certain heart diseases that can be efficiently treated utilizing minimally invasive techniques frequently receive the recommendation to undergo interventional cardiology procedures. Following a careful examination by a cardiologist or interventional cardiologist, the decision to undergo interventional cardiology is made. The following are some circumstances where interventional cardiology procedures may be required:

• Congenital heart defects
• Heart attack
• Valvular heart disease
• Arrhythmias
• Structural heart disease (7)

Risks and Side Effects

Interventional cardiology procedures are generally safe and successful. However, as with any medical procedure, some complications, risks, and side effects may occur. These can vary from patient to patient and from procedure to procedure. The most common risks and side effects in interventional cardiology can be listed as follows:

• Injury to the heart arteries, including tears or rupture
• Infection, bleeding, or bruising at the catheter site
• Allergic reaction to the dye or contrast used
• Kidney damage from the dye or contrast
• Blood clots 
• Bleeding into the abdomen (retroperitoneal bleeding)
• A hole going through the blood vessel (perforation)
• Air embolism
• Bruise
• Heart attack
• Stroke
• Uneven or irregular heart rhythm (arrhythmia) (8,9)

Post-Procedure and Follow-up

After the procedure, it is necessary to stay flat in bed for several hours. A nurse checks vital signs, insertion site, and circulation/sensation. Depending on the situation, bed rest may last for two to six hours. The patient may be given painkillers to treat any pain or discomfort at the point of entry or from having to lie still and flat for extended periods.

After the procedure, the patient will probably spend the night in the hospital. The length of stay could be extended based on the patient's health and the procedure's outcomes. 

The patient receives comprehensive guidance on how to prepare for discharge and recovery. During the home recovery process, it is important to monitor the insertion site to check for bleeding, unusual pain, swelling, and abnormal discoloration or temperature change at or near the operated area. (10)

Recovery

Recovery is a rather easy process. There is typically a little pinhole wound in the wrist if the specialist entered through the radial artery tract. To prevent any bleeding from the high-pressure artery, plastic bandages are used for compression and should be worn for two to three hours following the treatment. If the inguinal femoral artery was used for the surgery, the access hole is often closed with the collagen plug known as the Angio-Seal, which dissolves after about three months. (11)

Results

Percutaneous coronary intervention (PCI), which uses metallic stents or drug-coated balloons to treat coronary narrowings or occlusions, is the most well-known form of interventional cardiology. They are quite successful at reducing angina symptoms and enhancing the patient's heart health. The overall complication risk for interventional cardiology is less than 1%, making it relatively safe. (12)