Dr Segal is an expert Consultant Cardiologist and Electrophysiologist specialising in managing patients with all types of heart rhythm problems. He offers a range of the latest treatments including:
Catheter ablation, is a treatment that aims to control or correct certain types of abnormally fast heart rhythms. Most episodes of paroxysmal AF are triggered by an extra heartbeat, or ectopic, from just inside one of the pulmonary veins, which carry oxygenated blood from the lungs back to the heart's chamber called the left atrium. Cells just inside the entrances to these veins fire to cause an extra heart beat which triggers AF. A technique called Pulmonary Vein Isolation, or PVI for short, is a commonly performed procedure. It involves the process of creating an electrical barrier around the entrance to the pulmonary veins. If this barrier exists, ectopics from cells inside the veins cannot conduct to the left atrium to cause an episode of AF. The procedure is often carried out under general anaesthesia via small incisions made at the top of the leg . Catheters and other instruments can then be passed through these tubes directly up to the heart via the veins inside the body. An x-ray camera guides this process.
A pacemaker (or artificial pacemaker) is a implanted device that uses electrical impulses, delivered by electrodes contacting the heart muscles, to regulate the beating of the heart. In some cases, it may be beneficial to use Cardiac resynchronisation therapy (CRT), which treats heart failutre with an implantable device similar to a pacemaker. This device uses tiny electrical pulses to both ventricles (lower chambers) of the heart to make them beat together again in a more synchronised pattern.
Cardioversion is a procedure used to treat abnormal heart rhythms (also called cardiac arrhythmias). The most commonly treated arrhythmia is atrial fibrillation. During cardioversion, an electrical "shock" is delivered to the heart to restore its rhythm to a normal pattern. The electrical energy can be delivered externally with electrodes placed on the chest or directly to the heart using paddles on the heart during an open chest surgery. Alternately, the energy can be delivered through the electrodes of a permanently implanted device called an implantable cardioverter defibrillator. If, however, you have ventricular dysynchrony, which means that the two lower chambers of your heart are not beating together and are unable to pump blood to the body effectively, then a cardiac resynchronisation device (CRT) may need to be implanted.
Supraventricular tachycardia (SVT) is an abnormally fast heart rate of over 100 heartbeats a minute. SVT usually refers to regular fast heart rhythms, as opposed to AF (atrial fibrillation) which is irregular. There are 3 different types of treatment for SVT. Usually the first first maneouvre to be used is the Valsalva manoeuvre.This is intended to slow down the electrical impulses in the heart by stimulating a nerve called the vagus nerve. The Valsalva manoeuvre usually involves holding your nose, closing your mouth and trying to exhale hard, while straining as if you were on the toilet. There are also anti-arrhythmic drugs such as beta-blockers, verapamil, flecainide etc. However, these have varying side-effects. The third and, most likely, the most successful method is catheter ablation for SVT– Ablation involves a procedure where fine wires are advanced from veins at the top of the leg to the heart. Pacing the heart can then induce SVT. Heat applied from the tip of one of the wires causes a tiny area of localized tissue damage (the tissue is cauterized, or more properly ‘ablated’). This destroys one limb of the abnormal circuit and so cures the arrhythmia.