• Clinical science

Cardiac catheterization

Summary

Cardiac catheterization is a procedure used in the diagnosis and treatment of cardiovascular conditions. It involves the insertion of a catheter into a cardiac vessel (coronary catheterization) or chamber by way of a suitable vascular access (usually a femoral or radial artery). Once in position, a cardiac catheter can help evaluate the blood supply to the cardiac musculature (angiography) or open up narrowed or blocked segments of a coronary artery by means of a coronary angioplasty with stenting (percutaneous coronary intervention, or PCI). Additionally, it can be used to perform a cardiac tissue biopsy, open narrowed heart valves via valvuloplasty, examine electrophysiological pathways, or measure pressure and oxygen levels in different chambers (hemodynamic assessment). The procedure is associated with a low rate of complications, with the most common among these being bruising and bleeding at the site of IV access. Rarer, more severe complications include arrhythmias, cardiac arrest, embolization of existing plaques, and infection.

Procedure/overview

General

Coronary angiography/ventriculography

Coronary angiography is not a screening method for coronary heart disease in asymptomatic patients!

Percutaneous coronary intervention (PCI)/percutaneous transluminal coronary angioplasty (PTCA)

Electrophysiological examination (cardiac)

  • Testing of the electrical conduction system of the heart to assess electrical activity and conduction pathways via a cardiac catheter
  • Indications
    • Diagnostic: to evaluate various, repeatedly refractory cardiac arrhythmias
    • Therapeutic
      • Radioablation of areas of accessory pathways (areas that generate and conduct the arrhythmias)
      • Placement of intracardiac pacemakers or defibrillators

Right heart catheterization

References:[1][1][2][3][4]

Contraindications

References:[5][2]

We list the most important contraindications. The selection is not exhaustive.

Complications

Periprocedural complications

Complications at the site of vascular access

Complications at the cardiac level

Other complications

Delayed complications

  • Most common complication: restenosis
  • Stent thrombosis (0.5–5%)
  • Vascular complications
    • Systemic embolisms: stroke due to cerebral emboli (< 1%)
  • Infection (localized or generalized bacteremia)

References:[1][6][7][8][9][10][11]

We list the most important complications. The selection is not exhaustive.

Alternative methods

Coronary artery bypass graft (CABG)/aortocoronary bypass (ACB)