ANNUAL REVIEW master Final3a - St Vincent's University Hospital

Department of Cardiology
The demand for outpatient based clinical cardiological services continues to increase. A total of 6,965
patients were seen at cardiology clinics during 2007 – an increase of 10% over the previous year. This was
also reflected in the 13% rise in non-invasive investigative tests (ECG, echocardiography, stress testing,
rhythm monitoring) to 19,266 procedures – almost 400 per week. In-patient activity as evidenced by
admissions / discharges / bed days used remains generally unchanged (~1% rise) understandably due to
saturation of available resources. For similar reasons the number of invasive cath lab based procedures were
unchanged at 2,453 however there was clearly an increase in the need for emergency out-of-hours
procedures – particularly direct coronary angioplasty / stenting for evolving acute myocardial infarction – a
need which is certain to continue to grow and place a substantial extra burden on already strained resources.
Cardiac Arrhythmia Service
The Cardiac Arrhythmia Service now provides the following services:
Implantation of Cardiac Arrhythmia Devices:
Implantable loop recorders, use of selective Para-Hisian high septal pacing in order to reduce cardiac
dysynchrony for patients with bradycardias, ICD therapy, and biventricular cardiac resynchronization therapy.
The development of the cardiac arrhythmia services at St. Vincent’s University Hospital has been facilitated
by the subspecialisation of cardiac technicians with dedicated arrhythmia interests. The follow-up of
implantable loop recorders, pacemakers, implantable cardioverter defibrillators and resynchronization therapy
devices has been greatly enhanced by the high level of expertise by our cardiac technicians and has allowed
the service become less dependent on technical support from industry for the interpretation of error
messages, alarm signals and optimization of programmable features. 2007 has seen a grown concern for
device advisories and recalls. Such problems require increasing vigilance for adverse trends in electrical
parameters (impedance, voltage, high frequency noise) on follow-up visits and subsequent communications
with patients, referring physicians, device extractions (in selected patients in conjunction with our cardiac
surgical colleagues) and replacements. The more sophisticated implantable device technology becomes the
greater the potential for technology defects and device recalls.
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