Our services at a glance:
Catheter-based aortic valve replacement
Coronary heart disease
- ECG: Electrocardiography (ECG) records the electrical activity of the heart and produces a graph (trace). When heart muscle tissue is destroyed as a result of a myocardial infarction (heart attack), this will lead to typical changes in the ECG trace. These changes provide information on both size and location of the infarct.
- Laboratory tests (cardiac enzymes): The damaged heart muscle releases enzymes into the blood stream. Raised blood serum levels can therefore be a useful indicator of a heart attack, in particular where they refer to enzymes that are mainly found inside the heart muscle.
- Ultrasound examination of the heart (echocardiogram): The main use of ectrocardiography is to give the doctor exact information on the site of the infarct as well as on how badly the infarct has damaged the heart muscle and, thus the ability of the heart to pump blood around the body. The greater the size of the infarct the more pronounced will be the impairment of cardiac function.
- Cardiac catheterisation: Cardiac catheterisation can provide information on which of the coronary vessels are narrowed or blocked. The main benefit of this particular technique lies in the fact that it can locate the narrowed or blocked arteries, as well as allowing the doctor to treat the affected vessels without any delay. This makes cardiac catheterisation more than a diagnostic tool, it makes it one of the most important techniques used in treatment.
- Opening closed vessels (recanalisation)
- Bypass surgery
- Drug-based therapy
Cardiac arrhythmias - clinical cardiac electrophysiology
The Clinical Cardiac Electrophysiology Unit forms part of the Medical Clinic B. The Unit specialises in the investigation of all types of arrhythmias, as well as offering patients treatment and advice. The Unit offers the most up-to-date treatment methods, ranging from anti-arrhythmic drug treatment, to all types of catheter-based treatment techniques, including catheter-based procedures for the treatment of atrial fibrillation. We have many years of experience in the area of pace makers and defibrillators, with particular expertise in the treatment of patients with challenging and complex conditions. We also regularly use pacemakers for patients with weak heart muscles.
Investigations / Treatments offered on an outpatient basis:
- Specialist consultations (Atrial Fibrillation Outpatient Services, Syncope Outpatient Services)
- Arrhythmia Outpatient Services
- Long-term ECG recording, event recorder (telemonitoring)
- Monitoring of defibrillators (ICD) and pacemakers
- ICD-testing to evaluate defibrillator functioning
- Tilting table test
- Pacemaker implantation on a day case basis
- Magnetic Field Imaging (MFI) to assess the risk of sudden cardiac arrest in scientific studies
- Life Vest (portable wearable defibrillator)
Investigations / Treatments offered on an inpatient basis:
- Computer-assisted electrophysiological investigations
- Catheter ablation for arrhythmias
- Supraventricular and ventricular tachycardias, including atrial fibrillation and arterial macroreentry
- using radiofrequency ablation (heat), cryoablation (cold), three-dimensional mapping and navigation (NavX/Ensite) and epicardial ablation
- Implantation of pacemakers and ICDs, including systems for cardiac resynchronisation therapy, implantable loop recorders
- Complex procedures; epicardial electrodes, subcutaneous arrays, cardiac electrode extraction (in cooperation with the Hospital's Cardiac Surgery Clinic)
- Life Vest (portable wearable defibrillator)
You have been diagnosed with a type of arrhythmia that is called atrial fibrillation. This means the contractions of the upper chambers of your heart are too fast and irregular, which can lead to skipped beats, shortness of breath, dizziness and general weakness. The aim of electric cardioversion is to stop the atrial fibrillation and achieve a regular, normal heart rhythm. This is achieved by applying an electric shock to the heart via two large electrodes, which are placed on your chest.
This treatment usually involves two separate outpatient appointments, the first will be a meeting to prepare for and discuss the procedure, and the second will be for the procedure itself.
There is no need to fast prior to your first appointment. We will perform an ECG and provide you with a detailed explanation of what will happen during the procedure, as well as explaining any potential risks involved. Please ensure that you bring your Marcumar (anticoagulant) card to the first appointment, as well as any clinical documents or medical reports and a list of current medications (you may need to contact your general practitioner). In addition, you will need to bring your admission letter from your general practitioner (this is for purely administrative reasons, as the procedure is still classed as an outpatient procedure).
Please ensure that you do not eat anything on the day of your procedure. If you need to take medicines in the morning you may do so with a sip of water (except insulin and antidiabetic medications). Please come directly to the Echocardiography Unit, which is located on Floor 3 of Building B.
You will undergo a procedure called a transoesophageal echocardiogram (TOE, or TEE in US English). This is an ultrasound examination of the heart, which is performed via the oesophagus and is intended to rule out the presence of any blood clots in the atria. This procedure is performed under local anaesthesia (and, if you prefer, we can also give you a mild sedative). Following this procedure you will be taken to the Clinical Electrophysiology Unit (on Floor 5, Building B). If the TOE findings were unremarkable the cardioversion procedure will be performed immediately following the TOE. The procedure will be performed under general anaesthesia, which means it will be completely painless for you. However, you may notice some reddening of the skin on your chest. Once the cardioversion procedure is completed, you will need to remain in hospital for a number of hours, for observation.
Due to the anaesthesia medications used during the cardioversion procedure, you will not be allowed to drive or operate heavy machinery for the rest of the day. Please ensure that you bring the following with you on the day of your procedure (if you have not already provided this information):
- Signed consent forms
- Marcumar card
- Admission letter
- List of current medications
- A little snack (particularly if you are diabetic)
Anticoagulation therapy (with a target INR of 2.5) will be required for a minimum of 4-6 weeks following cardioversion. We will provide you with a recommendation for your general practitioner, which will be based on your personal stroke risk profile (CHADS score). An admission letter will be required for billing/reimbursement purposes.
The aim of a pacemaker is to alleviate problems associated with slow arrhythmia, such as dizziness, syncope and general weakness). This is achieved by the pacemaker stimulating the heart to beat faster. Depending on the type of arrhythmia involved, a single or dual chamber pacemaker may be used, i.e. either one or two wires (called electrodes or pacing leads) will be inserted into either one or two of the chambers of the heart.
Surgery will take around 1.5 to 2 hours and will be performed under local anaesthesia.
A small incision will be made in the skin just below the collarbone and one or two pacing leads will be threaded through a vein into the heart, where they will be fixed to the heat muscle (with barbs or a screw mechanism). This procedure is pain-free but may be associated with some irregularities in heart rhythm. Once the leads have been attached to the heart, they will be connected to the pacemaker, which will be fitted into a small pocket created under the skin of your upper chest before the incision is sutured. A chest X-ray will be taken following the implant to check the positioning of the pacing leads.
The wound should be kept clean and dry for 14 days. In most cases, suture removal will not be required.
One or two days after surgery, pacemaker function will be tested via a wireless programming device. This will allow us to fine-tune the pacemaker and adjust it to your individual requirements. You will also receive a pacemaker ID card. Once your pacemaker has been tested, you should be able to return home.
Another pacemaker test will be required after 3 months and then regularly every 6-12 months. Normal battery life span means that replacement surgery will be required after about 6-10 years.
Implantable Cardioverter Defibrillator (ICD) implantation
The aim of ICD implantation is to control fast and potentially life-threatening arrhythmias (ventricular fibrillation and ventricular tachycardia) via pain-free overstimulation of the heart or via the ICD delivering an electrical shock to the heart. ICD implantation is recommended for patients who have survived sudden cardiac arrest brought on by ventricular fibrillation and for patients who have a high risk of experiencing life-threatening arrhythmias in the future. Depending on the type of arrhythmia involved, you may be given a single dual or triple chamber defibrillator. It is also worth mentioning that a defibrillator can also act as a pacemaker (stimulating the heart to control a slow pulse).
Surgery will take around 1.5 to 2 hours and will be performed under local anaesthesia or under general anaesthesia.
A small incision will be made just below the left collarbone and, depending on the type of defibrillator involved, between one and three defibrillator leads will be threaded through a vein into the heart, where they will be fixed to the heart muscle (with barbs or a screw mechanism). This procedure is pain-free but may be associated with some irregularities in heart rhythm. Once the leads have been attached to the heart, they will be connected to the ICD, which will be positioned in the chest wall, under the pectoral muscles. The device will then be tested in a procedure that involves inducing ventricular fibrillation. This is necessary to ensure the device can successfully detect and terminate life-threatening arrhythmias. A chest X-ray will be taken following the implant to check the positioning of the defibrillator leads.
The wound should be kept clean and dry for 14 days. Where appropriate, sutures will be removed after 10 days.
Two days after surgery, ICD function will be tested and you will receive an ICD ID card. Once your ICD has been tested, you should be able to return home.
Further ICD tests will need to be scheduled every 3-6 months and will also be on an outpatient basis. Normal battery life span means that replacement surgery will be required after about 3-5 years.
Electrophysiological investigations / catheter ablation
Electrophysiological investigations are conducted to establish an accurate diagnosis of the exact type of arrhythmia involved in a particular case, while catheter ablation is a technique that is capable of curing certain arrhythmias completely. These procedures are performed in the Cardiac Catheter Laboratory. You will be asked to lie on a special exam table and will be covered with a sterile cloth (infection control). Following local anaesthesia, 2 to 4 thin catheter electrodes will be inserted in the blood vessels in the groin area. Under X-ray guidance they will then be pushed all the way into the heart. You will hardly feel anything at all during this process. With the catheter electrodes inside the heart, it is possible for us to assess your heart's electrical activity. We can also stimulate the heart in the same way a pacemaker does (meaning that your heart follows our "command"). The procedure involves stimulating the heart at different rates, known as simulation manoeuvres. You may experience some irregularities in your heart beat during this procedure. One purpose of the procedure is to determine whether you have a tendency to experience regular, potentially dangerous arrhythmias (i.e. whether you may require a pacemaker or defibrillator). We can also use this procedure to recreate the type of arrhythmia you experience in your day-to-day life. This allows us to investigate possible underlying mechanisms and thus decide on a suitable strategy to control these. In most cases, this procedure will be immediately followed by a catheter ablation procedure. In some cases, however, we may also recommend some form of drug-based treatment. During catheter ablation, the areas responsible for producing abnormal heart rhythms are cauterised with a heated electrode. This produces scar tissue which is no longer capable of producing or conducting electrical impulses.
You may experience some of the induced arrhythmias as a racing heart beat. Some patient may feel dizzy or may briefly lose consciousness. We can terminate these arrhythmias at any point. To achieve this we may have to use electric shocks (cardioversion). As this particular procedure will only ever be performed if the patient loses consciousness, or while the patient is under general anaesthesia, this will not cause you any pain.
Unless you have been advised otherwise, you should stop taking your anti-arrhythmia medication at least 48 hours prior to the procedure taking place. It is rare for the procedure to take longer than approximately 1.5-2 hours. This will only happen with very complex arrhythmias. Once the ablation has been performed, the catheters are removed from the groin area and a compression bandage is placed over the insertion site. This will need to remain in place for a number of hours and means that you will need to observe bed rest. You should normally be able to leave the hospital on the day following the procedure.
Cardiac CT scanning
Ludwigshafen Hospital has a 128-slice cardiac CT scanner, the latest generation in a line of CT scanners. The 128-slice scanner offers a highly accurate means of producing images of the heart and coronary arteries.
Why and when is cardiac CT scanning used?
Coronary heart disease is one of the most common diseases in the western world. Coronary heart disease is characterised by narrowing of the arteries, caused when the arteries become furred up with fatty deposits, a process known as atherosclerosis. This narrowing of the arteries (stenosis) leads to an impaired blood supply to the heart. Coronary heart disease may lead to an artery, or arteries, being blocked. This is what is known as a heart attack.
Cardiac computed tomography (cardiac CT) is a technology that allows coronary heart disease to be detected early or, alternatively, it is possible to exclude significant coronary heart disease with almost 100% certainty.
Cardiac CT is a particularly useful option for patients presenting with the following symptoms or conditions:
- Uncharacteristic chest pain in patients with low to medium risk of coronary heart disease (e.g. slightly overweight, aged 45 - 65, former smoker etc.)
- Uncharacteristic chest pain with inconclusive or borderline exercise stress test results
- Congenital abnormalities of the coronary arteries (coronary anomalies)
- In asymptomatic patients this technology can be used to measure the presence of calcium in the coronary arteries (Coronary Artery Calcium Score) in order to determine the risk of developing coronary heart disease.
Cardiac CT is not an option when patients present with the following symptoms or conditions:
- Chest pain indicative of cardiac symptoms and high risk of coronary heart disease
- Irregular heart beat (arrhythmias such as atrial fibrillation, ectopic heartbeats etc.)
- Very fast but regular heart rate (sinus tachycardia) while at rest
- Inability to hold breath for approximately 10 seconds
- Allergy to iodine containing contrast media
- Clear evidence of reduced renal function (known as renal insufficiency, stages III and IV)
How does cardiac CT scanning work and how long will a scan take?
Cardiac CT scanning is basically a type of computed tomography (CT), i.e. an x-ray scan that is taken as the x-ray machine moves around the patient's body in a circle. The important difference, however, lies in the superior imaging capacity of the CT scanner, which can produce images of multiple thin cross-sectional layers each time it circles the body.
The CT scanner used at Ludwigshafen Hospital is one of the latest generation of CT scanners manufactured by Siemens and can produce 128 cross-sectional images per rotation. This means that an image of the entire heart can be produced after only four or five rotations. What this means for you is that we are able to produce high-resolution images of your coronary arteries whilst keeping your radiation exposure to an absolute minimum.
Although the actual scan itself only takes a few seconds, we would ask that you schedule about 1.5 hours for a scan. Preparation for the scan, analysis of the results and, finally, discussing the results with you will all mean that the total procedure takes longer than the scan itself.
What happens during a scan?
Prior to having the scan you will have your heart rate measured. Should your heart rate be higher than 65 beats per minute we will administer a short-acting beta blocker to achieve a target heart rate of about 60 beats per minute. To do this, we will need to insert a catheter. This catheter will also be used later to inject a contrast medium.
In order to make a clear image of the coronary arteries possible, we will need to inject you with about 70ml of a contrast medium (Imeron).
This contrast medium is usually very well tolerated. Many patients report feeling a warm sensation when the medium is injected but this is completely harmless. Rarely, the contrast medium may cause an allergic reaction and, very rarely, use of the contrast medium may impair renal functioning or cause hyperthyroidism. If a patient is known to be allergic to contrast media, has impaired renal function or hyperthyroidism, the scan will require certain preparatory steps to be completed or it may not be possible at all.
After lying down on the scanner's sliding table you will be connected up to an ECG machine, enabling the CT scanner to adapt to your heart rate.
The scan will only take a few seconds and you will be asked to hold your breath during this time. This is necessary because the heart sits right on top of the diaphragm and is moved up and down quite significantly when we breathe in and out.
How to prepare for a scan?
We will need to see your current blood test results for "creatinine" (kidney function) and "TSH" (thyroid function) as well as a recent ECG trace.
We would ask that you refrain from ingesting anything that may increase your heart rate, such as coffee, tea or caffeinated fizzy drinks, prior to having your scan. With nicotine having a similar effect, we would ask all smokers to refrain from smoking prior to having their scan. There is nothing else that you need to do.
If you are taking medicines, please continue to take these as normal.
What happens after a scan?
A doctor will discuss the scan with you approximately 15 minutes after the scan.
If you were given beta blockers you will be asked to remain in the unit for another 30 minutes.
Your doctor will receive the results of the scan within a few days. The final diagnosis will be made in Ludwigshafen Hospital. The involvement of both the radiology and cardiology teams ensure that you will benefit from the combined expertise of both units.
What are the costs involved in having a cardiac CT scan?
Please note that cardiac CT scans do not form part of the range of services covered by statutory health care providers.
Total costs will be calculated based on currently applicable standard fees for doctors (as per the statutory document "Gebührenordnung für Ärzte" or "GOÄ"). A Coronary Artery Calcium Score costs approximately 100 Euro. A complete cardiac CT scan costs approximately 550 Euro.
Ltd. Senior Consultant Dr. Bernd Cornelius, Central Institute for Diagnostic and Interventional Radiology
Tel: 0621 503 0
Alternatively, please contact the office of Prof. Dr. Günter Layer, Senior Consultant, Central Institute for Diagnostic and Interventional Radiology
Tel: 0621 503 4501
Alternatively, please contact the office of Prof. Dr. Ralf Zahn, Senior Consultant, Medical Clinic B
Tel: 0621 503 4001