Intervention Cardiology





Interventional cardiology conducted at the advanced cardiac catheterization laboratory includes:

  • Coronary angiography
  • Radial angiography
  • Coronary angioplasty or primary angioplasty
  • Valvuloplasty
  • Peripheral angioplasty
  • Permanent pacing
  • ICD implantation
  • Rotablation

The 3 state-of-the-art cardiac catheterisation laboratories handle an array of diagnostic and therapeutic procedures. A skilled team of cardiologists and technicians have ensured that the success rate is at par with international standards and the mortality rate is as low as 0.0001%. To date, BMB has performed over 19,000 cardiac interventions.


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Least Invasive Angiography (Radial)

Earlier, coronary intervention had to be performed via the femoral artery. Following this procedure, the patient needed to lie flat, without bending their leg for 2 to 6 hours, or sometimes longer, to allow the artery to heal. In some cases, even if immobile, severe internal bleeding could occur requiring blood transfusions or surgery to repair the femoral artery. Today though, these procedures are being performed via the radial artery. Most patients find radial catheterisation comfortable compared to femoral catheterization, as it allows patients to immediately to sit up, walk and eat normally. Radial catheterisation also reduces bleeding complications, and allows the patients go home the same day.

Coronary Angiography, also know as a Coronary Arteriography or Coronary Angiogram, is a test that produces pictures of the blood vessels and chambers of the heart through X-rays. A Coronary Angiogram tells Cardiologists how well the chambers of your heart and your heart valves are working. This test can also provide other essential information, like the blood pressure inside your heart. Coronary arteries are those blood vessels that carry blood from your heart to the rest of your body. The blood then returns to the heart through veins. A Coronary Angiogram can also show narrow or blocked blood vessels that surround the heart. If blockages are detected, the patient may need further treatment.

Human heart is a muscular organ that pumps blood around the body delivering oxygen and other nutrients to the body cells. Heart gets its blood supply from the coronary arteries, which play a vital role in keeping the heart healthy and pumping properly. Coronary arteries can become narrowed because of fatty deposits built up within the artery walls, which reduce blood flow to the heart and cause chest discomfort.

  • About the Procedure

Coronary Angioplasty is a procedure used to open narrowed or blocked heart arteries by putting up a stent and thereby restoring normal blood flow to the heart muscles.

  • Benefits of Coronary Angioplasty

Angioplasty can improve symptoms of blocked arteries such as chest pain and shortness of breath. It can also be used during heart attack to quickly open a blocked artery and reduce the amount of damage to the heart and improve the chances of survival.

How safe is Coronary Angioplasty?

A Coronary Angioplasty is one of the most common types of treatment for the heart and is a life saving procedure. The risk of routine Angioplasty is 0.5 % (1 in 200).

  • Is Angioplasty painful?

No. Angioplasty is done under local anaesthesia with very little or no pain. Patients are completely awake and may even watch the procedure on screen.

  • How is the procedure done?

Angioplasty is done in the Cardiac Catheterization Laboratory (Cath Lab). It is a minimally invasive procedure done under local anaesthesia by inserting a catheter (thin tube) through a small puncture in a leg or arm artery. Some dye (contrast) is injected into the catheter so that the arteries can be seen on the X-Ray screen. This helps in showing where the narrowing in the arteries are and how severe they are. Watching on the special X-Ray screen, a thin wire is then passed inside the artery through the blocked segment. This is followed by insertion of a tiny balloon at a spot where the artery is narrowed to help widen the artery. The final step involves permanent placement of a small wire mesh tube called the stent, to fully open the artery and reduce the risk of it narrowing again.

  • How long does the procedure take?

The procedure can take anything between 30 min to 60 min (or even longer if multiple narrowing are present). Patient typically spends 2 days in the hospital.

Post Angioplasty

Patients are advised to lie down in bed for a few hours after the procedure. They usually start walking the next day and can return to normal physical activities in a few days.

As a precaution, it is usually recommended to avoid heavy lifting or vigorous physical activity for 1-2 days after the procedure.

Recovering from an Angioplasty

Before leaving the hospital, a patient is advised on:

  • Medication
  • Desired improvement on diet and lifestyle
  • Wound care and hygiene during recovery

A follow-up appointment is provided to monitor progress.

Lifestyle changes

If you have undergone Coronary Angioplasty, it is still important to follow certain precautionary measures to reduce the risk of having problems in the future:

  • Stop smoking
  • Eat a healthy diet with low level of fat and salt
  • Try to lose weight if you are overweight
  • Be active and exercise regularly
  • Take all your prescribed medication on time everyday
  • Control diabetes and high BP with appropriate medication
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Other Procedures

The human heart is divided into four chambers — two ATRIA and two VENTRICLES. Sitting right on top in the atria is a tiny electrical generator, called the SA node, which produces electrical impulses 60-100 times each minute regularly and in rhythm. This in turn is conducted to lower chamber by electrical wiring system of heart comprising AV node, left bundle (anterior and posterior branch) and right bundle. Each electrical impulse creates one contraction of the heart. First the atria contracts followed by the ventricles. The heart is totally dependent on this current to pump blood out.

Whenever a defect develops in any component of the electrical system and the rate becomes very slow, an artificial pacemaker is required to restore normal heart rate. Pacemaker is a small device that provides micro electric stimulation to help the heart beat regularly.

Single Chamber Pacemaker

Single chamber pacemaker has one lead which goes either to the right ventricle or to the right atrium and it gives impulses to that single chamber.

Dual Chamber Pacemaker

Dual chamber pacemaker has two leads. One goes to the right atrium and the other to right ventricle and both chambers are therefore sensed (observed) and paced when required.


Benefits of having a Pacemaker

The pacemaker help the heart beat regularly and does not allow it to pause or beat too slowly. It improves the ability of the heart to pump regularly and on time. Having the pacemaker can significantly improve the quality of life for someone who is suffering from a slow heart rate. The device can be life saving for some people. Many patients get relief from symptoms such as light headedness, dizziness and fainting. Some people feel they have more energy. Some people feel safer as the pacemaker can keep their heart beat going, in case it goes amiss.


How Pacemaker works?

A pacemaker is a small device about the size of a match box that weighs 20-50gm. It consists of a pulse generator which has a battery and a tiny computer circuit and one or more wires known as pacing leads, which get attached to the heart. A pacemaker uses batteries to send micro electrical signals to the heart helping it to beat regularly when required. The pulse generator emits micro electrical impulses through the wires to the heart. The rate at which the electrical impulses are sent is called the pacing rate.

Almost all modern pacemakers work on demand. This means they discharge micro electrical impulses only when needed by the heart. If the pacemaker senses that the heart has missed a beat or is beating too slowly, it sends signal at a steady rate. If it senses that the heart is beating normally by itself, it doesn’t send out any signal.

How is Pacemaker fitted?

Having a pacemaker implanted is a relatively straight forward process. Implantation neither requires a surgeon or anaesthetist nor does it require operation theatre. The procedure is done in Catheterization Laboratory (Cath Lab) by a cardiologist. It is usually carried out under local anaesthesia, which means that someone undergoing the implantation can be awake and is able to talk during the procedure. The generator is usually placed under the skin near the collar bone on the left or right side of the chest. The generator is attached to a wire that is guided through a vein to the heart. The procedure usually takes about an hour and most people leave the hospital a day or two after the procedure.

After Pacemaker implantation procedure

After the procedure, one should be in a position to return to most normal physical activities. As a precaution it is usually recommended that strenuous activities should be avoided for around 4 to 6 weeks after having a pacemaker fitted. One should avoid lifting arm on implantation side above the shoulder height and taking it behind the back, for couple of weeks. One can feel the pacemaker after implantation, but would soon get used to it. It may seem a bit heavy at first and may feel uncomfortable when lying in certain positions

The human heart is a biological pump controlled by electrical signals generated within the body. A healthy heart beats steadily and rhythmically at about 60 to 80 beats per minute while at rest and up to 150 or more beats per minute during sustained strenuous exertions.

What is Arrhythmia?

An arrhythmia is caused by a disruption of your heart’s normal electrical system, which regulates your heart rate and heart rhythm. It describes an irregular heartbeat ranging from too fast, too slow, too early, to irregular


Abnormal slow heart rate (below 60 beats/minute) is known as bradycardia.


Fast heart rate (more than 100 beats per minute) is known as tachycardia, and abnormally fast heart rate of around 150-200 or more beats per minute is called tachyarrhythmia.

Ventricular Tachycardia (VT)

When the heart beats too quickly and abnormal fast impulses begin in the lower chamber, the fast arrhythmia is called a Ventricular Tachycardia (VT).

Ventricular Fibrillation (VF)

Regular VT can degenerate into a completely irregular, unstable and chaotic electrical activity, and as a result instead of contracting, ventricles just quiver ineffectively and no blood is pumped by the heart. This condition is called Ventricular Fibrillation and is the cause of cardiac arrest. The patient loses consciousness immediately after the commencement of VF and death occurs within minutes, unless life saving shock therapy is administered to the heart.

SCA (Sudden Cardiac Arrest)

Sudden Cardiac Arrest is the sudden, abrupt cessation of effective pumping of blood by the heart either due to stoppage of heart beat or quivering of heart due to VF or fast VT, leading to immediate loss of consciousness and death. It is a life threatening condition which can occur without any warning and can lead to sudden death if not treated with defibrillation shock or pacing within 4-6 minutes.


It is a technique in which a brief high energy electric shock is administered to the heart to treat life threatening tachyarrhythmia (fast VT, VF etc.) and bring it back to normal rhythm.



An ICD (Implantable Cardioverter Defibrillator) is an electronic device that constantly monitors your heart rhythm. When it detects a very fast, abnormal heart rhythm, it delivers energy to the heart muscle, and brings the heart to beat back to a normal rhythm again. This may also be achieved by an automatic high rate burst of pacing for a very short period by the device.

Why is an ICD needed?

Ventricular tachycardia and ventricular fibrillation are two life threatening heart rhythm disturbances that causes the heart to beat very fast. These conditions can be fatal if not treated immediately. The doctor recommends an ICD when someone has had at least one episode of these heart rhythms or is at a high risk of developing these types of heart rhythms.

Who needs an ICD?

An ICD may be recommended for people who

  • had a prior episode of sudden cardiac arrest
  • had a prior episode of ventricular fibrillation
  • had at least one episode of ventricular tachycardia
  • had a prior heart attack and have an increased risk for Sudden Cardiac Arrest (SCA) or Sudden Cardiac Death
  • have low Left Ventricular Ejection Fraction (LVEF) of less than 30-35%
  • have hypertrophic cardiomyopathy and high-risk factor for SCA

Benefits of implanting ICD

ICD is useful in preventing sudden death in patients with known, sustained ventricular tachycardia or fibrillation. Studies have shown ICD to have a role in preventing cardiac arrest in high risk patients who haven’t had, but are at risk for life threatening ventricular arrhythmia. Newer generation ICD has a dual function which includes the ability to serve as pacemaker. The pacemaker features would stimulate the heart to beat if the heart rate is detected to be too slow.

How does an ICD work?

  • The ICD monitors the heart rhythm, identifies abnormal heart rhythm and helps to return the heart beat to a normal heart rhythm
  • The ICD has a pacemaker feature. When the heart beat goes slow, it works as a pacemaker and sends tiny electric signals to the heart in order to keep it going at a normal rate
  • The ICD gives a short burst of rapid pacing or defibrillation shocks to stop the abnormal rhythm when the heartbeat is too fast or chaotic. It works 24 hours a day

How is the device implanted?

The implant procedure takes place in Cardiac Catheterization Laboratory (cath lab). The device is implanted with the patient under local anaesthesia only. The ICD is usually implanted using the endocardial (transvenous) approach. During the procedure, a local anaesthetic (pain relieving medication) is injected to numb the area. Small incision is made in the chest where the lead(s) and device are inserted. The lead is inserted through the incision and into a vein, then guided to the heart with the aid of the fluroscopy machine. The tip of the lead is attached to the heart muscle while the other end is attached to the pulse generator. The generator is placed in a pocket created under the skin in the upper chest. The device implant procedure may last for 1- 1 1/2 hour and biventricular ICD may take 2-4 hours. When the endocardial approach is used, the hospital recovery time is generally 48 hours.

After the procedure

One may feel discomfort at the device implant site during the first 48 hours after the procedure. The doctor will guide what medications one can take for pain relief. The doctor or nurse needs to be briefed if the symptoms are prolonged or severe.

How do I live with ICD?

  • Visit the doctor regularly
  • Stay away from magnets and strong electrical fields
  • At the airport, tell security screeners that you have an ICD
  • Tell your other doctors and your dentist that you have an ICD
  • If you go to a hospital, tell the doctors and nurses that you have an ICD
  • Carry device ID so others know that you have a defibrillator

Care of your Incision

  • Keep your incision covered with small sterile dressing for a few days to protect it from dust, sweat etc
  • Observe your incision daily. Call the device clinic or your doctor if you notice any redness, swelling or drainage
  • Wear loose clothing
  • You may take a shower 5 days after your ICD implant procedure. Do not rub the area with a towel, instead pat it dry


  • You may return to your normal activities two weeks after your ICD implant procedure. Talk to your doctor about your return to work
  • Avoid swimming and hot tubs / whirlpools, until your incision is completely healed (usually 6-8 weeks)
  • Avoid lifting heavy objects for 1 week after your ICD implant procedure

Can I use cell phone or microwave oven if I have an ICD?

  • You may use microwave oven, TV and remote control for TV, computer. You can use a cell phone too if you follow these steps
  • Cellular phones should be used on the side opposite to your implant
  • When your phone is on, try to keep it at least 6 inches away from your implant
  • Don’t carry your phone in your chest pocket


Follow-up visits are important to ensure your ICD continues to work properly, to check the ICD’s battery status and any episodes or therapies delivered by the device, to monitor any medication you are using and to check the possible interaction with ICD.

Regular follow-up visit with the consulting doctor is essential. If everything is stable, your doctor might only need to see you once or twice in a year.

Biventricular Pacemaker or Cardiac Resynchronisation Therapy (CRT) is a treatment for patients with severe heart failures. These patients generally have an abnormal electrical system of the heart. This treatment can restore the coordinated contraction of the left ventricle and improve the functioning of the heart. Scientific evidence has shown that CRT implantation reduces the number of heart failures.

An Electrophysiology study (EP study) is performed in a cardiac catheterisation laboratory with the help of a technology known as the EP system. An EP study and the procedure of ablation are done to analyse and monitor heart activity. This study is done to patients with a heart rate much below normal, resulting in dizziness, blackouts and an underlying rhythm disorder.


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