EP Lab Digest Current Issue

Pacemaker and Defibrillator Excimer Laser Assisted Lead Extraction at the University of Toledo Health Sciences Center

admin — Mon, 08 Feb 2010 13:20:37 -0500

In this article, the authors provide an updated overview on successful lead extraction methods for pacemaker and defibrillator cases.

Permanent pacemakers and automatic internal cardioverter defibrillators (AICDs) have been improving and saving lives for over 50 years.1 Unfortunately, in rare cases these devices can pose potential harm to a patient, thus indicating removal. Removal or replacement of the generator only does not pose as much risk as lead extraction. Abandoning or disabling malfunctioning leads will suffice in the majority of patients who no longer have an indication or desire for continued therapy. However, lead extraction is indicated when malfunction results in potential harm, when there is difficulty clearing a blood stream infection, when venous stenosis has ensued, or when procedures, normally contraindicated with implanted devices, are necessary.2

Bringing Expanded EP Services to Patients: One Hospital’s Experience of Building an Innovative EP Lab

admin — Mon, 08 Feb 2010 14:41:56 -0500

Palm Beach Gardens Medical Center (PBGMC) opened their state-of-the-art cardiac electrophysiology (EP) lab on May 22, 2009. Learn more about the new lab here.

Palm Beach Gardens Medical Center (PBGMC) recently opened its new 1,585 square foot state-of-the-art electrophysiology lab. The lab is equipped with the newest technology available and enables PBGMC to provide expanded EP services, including atrial fibrillation (AF) and atrial flutter ablations, as well as three-dimensional (3-D) mapping of the heart.

Transseptal Catheterization in 2010: Crossing into a New Decade

admin — Mon, 08 Feb 2010 14:49:19 -0500

Dear Readers,
Transseptal puncture (TSP) was first described independently by Ross and Cope in 1959. Prior to this, the left atrium was accessed via a transbronchial or direct percutaneous infrascapular approach. Initially, transseptal left atrial access was used to assess hemodynamics and perform mitral valvuloplasty, and most of the expertise related to transseptal catheterization resided in the hands of interventional cardiologists. Many electrophysiologists did not have the training needed to perform TSP. In fact, in many EP labs, left-sided accessory pathways were ablated primarily using a retrograde aortic approach; in the rare cases, when transseptal catheterization was required, an interventional cardiologist was often summoned to help.

10-Minute Interview: Donna-Lee Moore-Stout, RN, CCRN

admin — Mon, 08 Feb 2010 15:27:02 -0500

Donna-Lee Moore-Stout, RN, CCRN is the Coordinator of Cardiac Electrophysiology at Providence Portland Medical Center (PPMC) in Portland, Oregon.

Why did you choose to work in the field of cardiac EP? Tell us about your medical background and how you came to your current position at PPMC.
I’ve been employed at this institution for the better part of 36 years, with a two-year hiatus in a rural community in southeastern Alaska. There, I filled the role of the only nurse for the clinic, the emergency room, and the three-bed ‘hospital.’ I ran the pharmacy and also learned some basic x-ray skills, including developing x-rays. I learned that I could do anything if I really wanted to.

Email Discussion Group: February 2010

admin — Tue, 09 Feb 2010 09:25:50 -0500

Do you have a new question you would like to submit? You can also follow our EP discussion online at http://eplabdigest.com/discussion-questions.

Under Discussion:

Cable Disorganization
Our lab has an abundance of cables that often becomes tangled and inevitably damaged. Last week, damaged cable resulted in an intraprocedure delay of over 1 hour. Our Biomedical Engineers have authorized our department to contact a third-party vendor for consultation. Has anyone had similar issues, and if so, how did you correct the problem? Does anyone know of a vendor that services this type of problem?
— anonymous
When responding to this question, please use “Cable Disorganization” in your subject line or visit “http://eplabdigest.com/discussion/Cable-Disorganization”

Try SystemsOne, LLC. They offer a big screen, but are also about organizing the cables to reduce wear and tear as well as reduce electrical noise.
— anonymous

Also Under Discussion:

Update on Cryotherapy: Results from the CRYOTIP Study

admin — Tue, 09 Feb 2010 09:31:18 -0500

In this interview, we speak with Malte Kuniss, MD from the Kerckhoff-Klinik in Bad Nauheim, Germany, about the recent results of the CRYOTIP study.

What percentage of ablation cases at the Kerckhoff-Klinik are performed with cryo energy? What percentage are done with radiofrequency (RF) energy? Why?
In 2009, approximately 10-15% of ablations were performed with cryo, most of these with cryoballoon for pulmonary vein isolation in patients with symptomatic paroxysmal atrial fibrillation. Approximately 85-90% of ablations were performed with RF energy. This is the standard energy source for the great variability of ablations performed at our center.

What prompted the CRYOTIP study?

Psychological Management of the ICD Patient: What Have We Learned?

admin — Tue, 09 Feb 2010 09:52:07 -0500

It is now well established that the implantable cardioverter defibrillator (ICD) is an accepted means of primary and secondary prevention in those patients who are at increased risk of sudden cardiac death, arrhythmias such as Brugada syndrome, and conditions due to primary cardiomyopathies and heart failure. The data supports increased survival rates and better quality of life (QOL) by improving the ability to participate in normal daily activities and exercise programs. However, because the implantation often occurs against a complex medical background with inevitable psychological stress, all implanted patients should be considered at high risk for developing psychopathology.1

Education & Training Survey Results

admin — Tue, 09 Feb 2010 10:01:54 -0500

EP Lab Digest recently conducted an education & training survey to assess the need for formal EP education for staff across the country. We had a great response! Here are the results from our print survey. Thank you to everyone who participated!

Job Title:
Manager/Supervisor: 10%
Department Director: 0%
Physician: 0%
Technologist: 32%
Nurse: 54%
Other: 4%

Credential:
RN: 51%
CVT: 9%
RT(R): 10%
CCRN: 6%
RCIS: 1%
RCES: 2%
ENT: 0%
ST: 1%
Other: 20%
Other credentials included:
PCT 12%
CIS 12%
CEPS 34%
RRT 6%
PA 6%
BSN 6%
CMA 12%
RCES-Eligible 6%
CNMT 6%

Years of Experience in the EP Lab:
Less than 1: 11%
1-3 years: 31%
3-6 years: 31%
6-10 years: 22%
10+ years: 5%

Your Primary Role:
EP lab tech/nurse: 76%
Cath lab tech/nurse: 9%
EP/Cath lab tech/nurse: 4%
EP MD: 0%
Other: 11%
Other roles included:
EP support 25%
manager 38%

EP Year in Review: 2009

admin — Tue, 09 Feb 2010 10:07:04 -0500

This month EP Lab Digest debuted online-only content on our website, including this feature article by J. David Burkhardt, MD, FACC and Andrea Natale, MD, FACC, FHRS. In the article, the authors discuss electrophysiology advancements from the past year. Here is a special preview of the article, now available on www.eplabdigest.com.

Heartfelt Cardiac Projects: The Morrell Family’s Fight Against Hypertrophic Cardiomyopathy

admin — Tue, 09 Feb 2010 10:17:31 -0500

In this special interview, we speak with Holly Morrell, founder and executive director of Heartfelt Cardiac Projects, a nonprofit organization that offers comprehensive cardiac screenings to prevent sudden cardiac death. The mission behind Heartfelt Cardiac Projects is a personal one: several members of the Morrell family have been lost due to hypertrophic cardiomyopathy (HCM).

Tell us about your family’s history with hypertrophic cardiomyopathy. How and when were your family members diagnosed HCM?
I started the cardiac screening back in 1999 as a tribute to my loved ones that I had lost. Then, after running my screening program for approximately three years, I also was diagnosed with HCM. So although I knew I was going to be a good spokesperson, I had no idea then that I was going to be that good of a spokesperson!