Cardiac catheterisation is a procedure in which a thin, flexible tube (catheter) is inserted into a blood vessel and guided to the heart or coronary arteries under X-ray imaging (fluoroscopy). It allows the heart’s structure, pressures, and blood flow to be directly measured and visualised, and forms the basis for most interventional cardiac procedures.
The catheter is most commonly inserted through the radial artery at the wrist (radial access), which has become the preferred approach in the UK due to lower bleeding risk and faster recovery compared to the older femoral (groin) approach. The choice of access site depends on patient anatomy and the planned procedure.
Cardiac catheterisation is used for several clinical purposes. Coronary angiography involves injecting contrast dye into the coronary arteries to visualise blockages or narrowings, and is the key investigation for coronary artery disease and heart attack. PCI (balloon angioplasty and stenting) is performed to open blocked arteries, often during the same procedure as angiography. Right heart catheterisation measures pressures in the right heart and pulmonary circulation, used to diagnose pulmonary hypertension and guide heart failure management. Electrophysiology studies investigate the heart’s electrical system to identify arrhythmia mechanisms before catheter ablation.
For cardiac arrest survivors, emergency cardiac catheterisation is often performed within hours of resuscitation to identify and treat a coronary blockage if heart attack is the suspected cause. The procedure is carried out under local anaesthetic and mild sedation and typically takes 30 to 90 minutes.
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