Experts at Royal Brompton and Harefield hospitals care for patients with a wide range of complex cardiac conditions, both congenital (present at birth), inherited and acquired later in life.
Our specialists treat patients from the UK and overseas who have a variety of heart conditions including congenital heart disease, arrhythmias (irregular heart rhythms), heart failure, pulmonary hypertension, coronary artery disease, and structural heart disease.
The adult congenital heart disease (ACHD) unit at Royal Brompton is one of the largest specialist centres in the world. Our experts see more than 8,000 patients each year. The Trust is the world’s leading centre for congenital heart disease research and a national and international training centre for cardiologists, cardiothoracic surgeons and other clinicians.
The inherited cardiovascular conditions (ICC) team is expanding its service following the appointment of consultant cardiologist Dr Antonis Pantazis, who joined the Trust in January 2016. Dr Pantazis has an international reputation as an expert in cardiomyopathy (disease of the heart muscle) and will use his experience to lead and develop this area of the ICC service at both sites.
Our transcatheter aortic valve implantation (TAVI) service enjoys an international reputation. TAVI is a non-surgical alternative to open-heart surgery for patients with a narrowed aortic valve and is carried out in the Trust’s new hybrid theatre (see overleaf). Our clinical teams performed 200 of these procedures last year, making ours the largest TAVI service in the UK.
Our pulmonary hypertension service is one of only seven designated in the country that form the National Pulmonary Hypertension Service (NPHS) for England. It is one of the most rapidly expanding services and it is also one of the few combining pulmonary hypertension (high blood pressure in the lungs), adult congenital heart disease (ACHD) and lung disease expertise in a single centre.
We have one of the fastest primary angioplasty services in the UK at Harefield’s Heart Attack Centre, and offer the largest implantable cardiac device (ICD) service in the UK (including pacemakers and debrillators).
Congenital heart disease (CHD)
Congenital heart disease (where the condition is present at birth) is one of the most common types of heart defects, affecting around nine in every 1,000 babies. Many cases are diagnosed in the womb, and patients may require surgery or specialised drug therapies. People with congenital heart disease often need treatment throughout their life, and the Trust runs a dedicated transition service for teenagers and young adults moving from our paediatric to adult CHD service.
Primary angioplasty service
A heart attack happens when a blood clot blocks a coronary artery, one of the vessels that supplies the heart with blood and oxygen. The longer the artery is blocked, the more damage there is to the heart, which is why it is crucial that patients receive primary angioplasty treatment as soon as possible.
Harefield launched its primary angioplasty service in 2004 and boasts an enviable reputation for having one of the fastest arrival-to-treatment times in the UK. Rather than being taken to a local A&E, patients are brought straight to Harefield.
Our clinicians perform primary angioplasties in cardiac catheterisation laboratories, also known as cath labs. They insert a thin tube called a catheter through a small cut in the patient’s wrist or groin. The catheter is then guided into the blocked artery in the heart and a small balloon on the tip of the catheter is inflated, clearing the blockage. A small metal tube, called a stent, is put into place to keep the artery open and allow the blood to flow freely again.
Since the service was launched, the primary angioplasty team at Harefield has treated more than 10,000 patients.
Arrhythmia – innovative devices
Heart rhythm problems (arrhythmias) are experienced by more than one million people in the UK every year. The heart may beat too slowly (bradycardia), too quickly (tachycardia) or irregularly (atrial fibrillation). Certain types of arrhythmia can also cause the heart to stop beating altogether (cardiac arrest), resulting in sudden cardiac death. Therefore, it is vital that arrhythmias are treated appropriately.
Royal Brompton & Harefield NHS Foundation Trust has one of the largest pacing and complex device services in the UK. Last year, our experts implanted or renewed 878 pacemakers and 645 implantable cardioverter defibrillators (ICDs).
Patients with bradycardia often require a pacemaker, whereas patients who are at risk of life-threatening arrhythmias need an ICD.
Pacemakers and ICDs are both implanted in the chest and can send regular electrical pulses that help keep the heart beating regularly. ICDs are often used as a preventative treatment for people thought to be at risk of cardiac arrest. If the ICD detects that the heart is beating at a potentially dangerous rate, it can “pace” or deliver an electric shock to the heart to help it return to its normal rhythm.
Cutting-edge leadless pacemaker
In December 2015, a patient at Royal Brompton Hospital became one of the first in the UK to be fitted with an innovative new pacemaker that works without leads.
Bill Hill, 78, from Buckinghamshire, was implanted with a Nanostim™ pacemaker in December to treat atrial fibrillation (AF), a heart condition causing an irregular heart rate.
Pacemakers work by monitoring the heart and providing electrical stimulation to set a pace to prevent the heart beating too slowly.
The Nanostim is less than 10 per cent of the size of a conventional pacemaker and is implanted directly into the heart via a catheter, a flexible tube inserted through a vein in the thigh. This differs from a standard pacemaker, which is placed in a ‘pocket’ created in the chest or abdomen during surgery, with leads that are positioned in the chambers of the heart.
The pocket made to house pacemakers is susceptible to infection, so leadless pacemakers are believed to reduce this risk. Unlike conventional pacemakers, they also eliminate the chance that the wires can malfunction.
The Nanostim is delivered through a catheter, which means patients are not left with a scar. It contains a built-in battery that lasts between nine and 13 years and the device can be retrieved if the battery needs to be replaced.
Bill had the Nanostim fitted in December and was discharged the following day.
“Now I’m boasting about my cutting-edge pacemaker to my friends who have the traditional ones,” says Bill. “It feels good to be part of a trial, knowing I may potentially help other people.”
Heart failure
Heart failure is a long-term condition in which the heart becomes too weak to pump blood around the body. It can be treated with medication, implantable devices or surgery, depending on the type of heart failure. Experts at the Trust run regular heart failure clinics and are at the forefront of new treatments for the condition.
New microchip that monitors heart failure
In 2015, a revolutionary microchip that measures how well a patient’s heart is functioning was implanted for the first time in the UK by cardiologists at the Trust.
Designed for patients with chronic heart failure, the sensor, known as the CardioMEMS™ HF System, is implanted during a minimally invasive procedure using a cardiac catheter, a thin tube that is passed up to the heart through a vein in the leg. The miniature wireless sensor is inserted into the pulmonary artery (the main blood vessel carrying blood from the heart to the lungs).
Once in place, the device – which has no battery or replaceable parts – enables clinicians to remotely monitor changes in blood pressure in the pulmonary artery, which is a good indicator of worsening heart failure.
Each day patients lie on a specially adapted pillow for a few minutes. The pillow receives data wirelessly from the implanted sensor and is connected to a monitor that sends the readings directly to the patient’s doctors. The hospital heart failure team then analyse the readings and determine if they need to adjust treatment. This is likely to be before the patient experiences any symptoms and can prevent a potentially life-threatening deterioration.
The CardioMEMS device is now being used by 10 patients at the Trust. With around 900,000 people living with heart failure in the UK, cardiologists hope the device has the potential to improve management and treatment for many patients.
In 2011, results from a randomised controlled trial in the United States, which were published in The Lancet, showed the sensor reduced hospital admissions by an average of 30 per cent after six months, compared with a control group.
Professor Martin Cowie, consultant cardiologist at Royal Brompton & Harefield NHS Foundation Trust, says:
“With this device patients can send regular information back to their heart failure team easily and from the comfort of their own home. This will help us detect any worsening in cardiac function early and take steps to prevent it, before patients experience a decline in their health.
“It will also provide a better way of deciding whether patients are having the best treatment, allowing us to take a more tailored approach for each individual patient.”