The Paediatric Cardiology Department deals with diseases that affect the heart from the foetal period. Foetal cardiology is developed in collaboration with the Obstetrics, Gynaecology and Neonatology Departments, which have all the human and technical resources necessary to guarantee quality care for treatment of heart disease, congenital or otherwise, detected during the foetal period.

In Catalonia, around 600 babies are born every year with congenital heart disease (between 5 and 12 per 1,000 live babies), of which about 25% will need surgical care during childhood.

Thanks to technological advances and improvement in surgical techniques, the survival rate of these patients has increased in recent years. This does mean that more and more children are growing up to develop cardiac insufficiency and suffer heart failure, meaning they will need a heart transplant. In addition, the rate of myocardiopathies, meaning genetic or acquired diseases that affect the strength of the heart muscle, is 1 per 100,000 inhabitants, and about 40% of children die within two years of diagnosis of the disease.

The Adolescent and Adult Congenital Heart Disease Unit (UCCAA) is the result of a collaboration agreement between Vall d'Hebron University Hospital and University Hospital of Santa Creu i Sant Pau, to bring together the efforts, resources and experience of the two hospitals with the greatest tradition in treatment of these diseases in a single level three congenital heart disease unit for adolescents and adults.

In order to group together outpatient care for congenital heart disease into a single area, the UCCAA Unit outpatient clinic is located in the Maternity and Children's Hospital, next to the Paediatric Cardiology clinic. This common area allows us to share workstations, databases and tools (3D ultrasound) and makes transfer and continuity of treatment simple, from paediatric age to adulthood, for what is a congenital and lifelong pathology.

Patients who require admission do so at the General Hospital, and stay on the Cardiology and Cardiac Surgery ward. Depending on their clinical circumstances, some of these adult patients with congenital heart disease must be admitted onto special wards:

Patients in critical condition: Coronary and Intensive Cardiological Care Unit of the Cardiology Department.

• Patients just out of operations: Cardiac Surgery Postoperative Unit of the Cardiology Department.
• Pregnant patients with congenital heart disease:
• Primarily obstetric pathology: Obstetrics Ward of the Maternity and Children's Hospital.
• Postpartum with serious cardiological risk: Coronary and Intensive Cardiological Care Unit of the Cardiology Department.
• Postpartum with mild cardiological risk: Intensive Obstetric Care Unit of the Maternity and Children's Hospital.

 

Portfolio of services 

• High-resolution outpatient clinic, including visits and electrocardiogram and/or echocardiogram in the same visit.
• Diagnostic imaging. The Department is equipped with the latest technology to achieve the highest quality diagnostics thanks to high-quality imaging.
• The technology the Department uses includes the Vivid™, a portable device that weighs just 4.5 kg and can be used at outpatient clinics, during heart surgery, in the haemodynamics and electrophysiology wards, and in paediatric and neonatal intensive care units, right by the patient’s bedside.
• The study and treatment of arrhythmias, linked to the Cardiology Department of the General Hospital.
• Diagnostic and interventional haemodynamics. The Haemodynamics Laboratory is equipped with digital radiological equipment that is biplanar with rotational angiography. This allows us to obtain diagnostic images of the highest quality, reduces procedure time and minimises the radiation received by the patient.
• We have advanced anaesthesia and resuscitation equipment; transthoracic, transoesophageal and intracardiac echocardiography; and we are able to carry out procedures that require ventricular assistance (Berlin Heart (R), Levitronix (R)) or that require ECMO support.
• Thanks to our technology and resources, we are able to carry out procedures that require the use of radiofrequency to ablate structures, and pressure guides to access locations that cannot be reached by usual catheters.
• The structure of the haemodynamic room allows hybrid procedures to be performed with interventional haemodynamists and surgeons and cardiologists acting simultaneously.
• Diagnostics and operations are carried out on patients from the immediate neonatal period (first day of life) as well as throughout the disease evolution of the disease.
• The Haemodynamic Laboratory supports procedures for foetal operations.
• Hospitalisation at the Neonatal and Paediatric ICU.  
• Conventional hospitalisation.
• Heart transplant. The Paediatric Cardiology team plays an active role throughout the process of the heart transplant before, during and after the operation.
• Telemedicine. For more than ten years, now, the Paediatric Cardiology Department has been connected to other hospital centres. Telecardiology allows us to make decisions in consultation with other teams, and prevents unnecessary movement of patients around the hospital.

The Arrhythmia Unit works closely with the Critical Cardiology Unit, the Adult Congenital Heart Disease Unit, and the Inpatient and Cardiac Surgery Areas. The Arrhythmia Unit was created in 1975. Since then it has expanded and specialises in various fields.
The most important are as follows: 

• ablations of complex arrhythmias in congenital heart disease in adults
• paediatric ablations
• ventricular tachycardia substrate ablations
• atrial fibrillation ablations

The Arrhythmia Unit has two theatres. One of them is completely dedicated to procedures such as:

• electrophysiological study
• atrial fibrillation ablation 
• supraventricular tachycardia ablation
• focal atrial tachycardia and macro-reentrant atrial tachycardia ablation
• premature ventricular contraction and idiopathic ventricular tachycardia ablation
• ventricular tachycardia ablation in patients with structural heart disease
• atrioventricular node ablation
• heart device implants for diagnosing and treating arrhythmias, such as pacemakers, defibrillators or resynchronisation therapy
• tilt table test
• electrical cardioversion
• drug provocation test 

The unit also has specific clinics to treat and monitor patients with cardiac arrhythmia. These include consultations about devices and five clinics dealing with the following matters: 

• channelopathy and sudden death 
• arrhythmia in congenital heart disease 
• ventricular tachycardia 
• atrial fibrillation

In 2019, the unit carried out:

• 279 ablations, 40% of which were ventricular tachycardia or arrhythmia in congenital heart disease. 
• It also fitted 99 complex intracardiac devices, such as defibrillators and resynchronisation therapy. 

The Arrhythmia Unit works jointly with the Paediatric Cardiology Department on invasive treatment of cardiac arrhythmia in paediatric patients. 

 

Diseases related to this speciality 

People can suffer from slow arrhythmia or fast arrhythmia. This often occurs in hearts affected by a cardiac disease, but also occurs in hearts with a normal structure.

The most common fast arrhythmia is atrial fibrillation, which requires medical treatment and, occasionally, ablation with a catheter. This is a safe procedure and commonly gives good results.

The most common slow arrhythmias are those that appear with age.  They are caused by degeneration of the heart’s electrical system. They usually require a pacemaker to be fitted.

  

Treatments and diagnostic tests related to this speciality

• The electrophysiological study consists of putting a catheter into the heart to analyse the electrical parameters. This is often accompanied by an ablation of the arrhythmia. 
• The ablation consists of applying an energy source to create a lesion in the place where the arrhythmia is generated.
• Fitting a pacemaker enables slow arrhythmias to be controlled. This is done using a device that generates electrical impulses. 
• Fitting a defibrillator enables fast arrhythmias to be detected. This is done using a device that generates an electrical shock so that the heart goes back to beating normally. 
• Cardiac resynchronisation therapy is used in cases of cardiac failure with a loss of power in the heart’s contraction. It consists of fitting special devices that improve the heartbeat and the patient’s quality of life. 

The Arrhythmia Unit also carries out common non-invasive procedures such as:

• 24 hour Holter monitoring. The Holteris a portable, cardiac control device.
• 3 week Holter
• Tilt tests. These tests are done to check the body’s reaction to a change of posture.

 

Research

The Arrhythmia Unit has extensive experience in researching the field of cardiac arrhythmias. It has published many times in specialist journals. The following research lines are highlights:

• Arrhythmia in congenital heart disease
• Loss of consciousness (syncope)
• Intracardiac devices
• Strokes of indeterminate origin, in collaboration with the Neurology Department
• Mechanisms involved in physiological and pathological cardiac remodelling
• Mechanisms involved in atrial fibrillation development
• Effects of air pollution on the development of arrhythmias
• Strategies for improving diagnosis of hereditary illnesses causing sudden death
• Therapies aimed at patients with hereditary illnesses causing sudden death
• Effects of COVID-19 on the development of arrhythmias

 

Education

The Arrhythmia Unit's team of professionals take active part in academic education and practical training on the medicine and nursing degree courses. Cardiology residents usually spend time at the unit, along with residents in other specialities at the hospital. Residents from other hospitals in the Vall d’Hebron area and from other Spanish, European and Latin American hospitals also do so, if they are interested in training on the treatment of arrhythmia diseases. 

The unit's team regularly takes part in training activities outside the hospital. The unit offers the following specific, staff training courses periodically: 

• Cardiac stimulation and implantable systems
• Atrial fibrillation refresher days
• Meeting of experts in arrhythmia in patients with congenital heart disease
• Course on arrhythmia in congenital heart disease

 

Experts

The Arrhythmia Unit has a coordinator and four assistants. They work with the nursing staff, consisting of seven specialist professionals, who deal with caring for patients and doing the invasive electrophysiology treatments. They also monitor patients with intracardiac devices on-site and remotely.