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A recent upgrade to Mediclinic Midstream’s cardiac catheterisation lab has introduced electrophysiology equipment not yet available elsewhere in Africa, broadening the hospital’s offering and improving outcomes for heart patients.
How a cath lab saves lives
Having a cardiac catheterisation lab readily available at Mediclinic Midstream means patients with acute cardiac symptoms can receive time-critical care closer to home. For heart attack patients, the sooner doctors can reopen a blocked artery using balloon angioplasty, the better the outcome, says interventional cardiologist Dr Jameel Moosa. In cardiology, this is known as a patient’s “door-to-balloon time”.
That’s why the cath lab has long been an integral part of Mediclinic Midstream’s cardiac care. Not every hospital has this facility, which allows specialists to treat cardiac emergencies as quickly as possible. With many cardiac patients from the surrounding area coming to the emergency centre over the years, the upgraded cath lab remains a specialised service that can help save lives.
“For example, someone having an acute heart attack needs a blocked artery to be opened as quickly as possible. A few hours without blood to the heart muscle will cause permanent heart damage and even death. This makes the cath lab an important service for both the hospital and the surrounding community,” emphasises Dr Moosa.
New cath lab equipment
There are generally four staff members working in the cath lab:
- The operator (cardiologist or electrophysiologist)
- Nurse
- Cardiac technologist
- Radiographer.
One of the most important imaging tests performed in the cath lab is a diagnostic coronary angiogram. “This is to visualise the arteries that supply your heart with blood, and keep your heart pumping,” Dr Moosa explains. It involves injecting dye into the patient’s arteries to monitor blood flow and identify blocked or narrowed arteries.
The upgraded lab now contains the most radiation-safe cath lab X-ray system currently available, making it safer for patients, and especially for staff, who are repeatedly exposed to radiation.
Doctors now have access to all the tools that a modern cath lab should have, says Dr Moosa, including rotational atherectomy and intravascular lithotripsy, both of which break up arterial plaque before stent placement. This makes delivery of stents easier, less complicated and overall, better for patient care.
New electrophysiology capabilities
Electrophysiologists – cardiologists who specialise in the treatment of rhythm problems, where the patient’s heart beats too fast or too slow – also rely on the cath lab for the procedures they perform. “When the heart goes too fast or irregularly, it may be treatable with an ablation procedure,” says Dr Ruan Louw, an electrophysiologist at Mediclinic Midstream.
“This means we insert small catheters through the patient’s groin and guide them along the blood vessels to the heart. We then treat the rhythm problem by delivering energy to a specific area of tissue, with the aim of correcting – and hopefully curing – the arrhythmia.”
In the cath lab, this procedure is performed using pulsed field ablation (PFA). PFA can be used to treat rhythm problems such as atrial fibrillation, which affects the atria, or ventricular tachycardia, which affects the ventricles. “PFA works by delivering an electrical current to the heart that creates little holes in the cell membrane,” Dr Louw explains. “The cell then dies due to these holes.”
The upgraded lab includes new equipment for these procedures. “We’re the first, and currently the only, hospital in South Africa and Africa offering the latest second-generation PFA ‘balloon-in-basket’ technology integrated with three-dimensional mapping,” says Dr Louw. This facilitates more efficient, safer ablation procedures, with a lower risk of complications than earlier technologies.
Mediclinic Midstream is also the only hospital in Africa with access to focal dual-energy catheter technology. “It allows us to be more precise in terms of where we are delivering the energy,” adds Dr Louw.
Each type of equipment offers different advantages, he explains. One may create a larger treatment area and work faster, while another allows for greater precision. Depending on the patient and the rhythm problem, the specialist decides which catheter is best.
These catheter-based procedures may offer advantages over older radiofrequency or cryo-ablation methods, which use heat or cold to destroy cells and create scar tissue, Dr Louw says. “The main benefit of the PFA energy is we are able to get the same, if not superior results than before, at a lower risk of collateral damage to surrounding tissue.” This may reduce the risk of complications.
For patients with a slow heart rhythm or heart failure, an electrophysiologist may also implant a specialised pacemaker. This can help improve how the heart works or prevent it from beating too slowly.
These new services enhance Mediclinic Midstream’s cardiac care offering and support better outcomes for patients.