Tufts-New England Medical Center (NEMC), located in Boston, Massachusetts, has long been considered one of the best in clinical care. Their electrophysiologists provide access to the newest advances in antiarrhythmic drugs, ICDs, pacemakers and ablation techniques through a wide range of therapeutic trials. The Cardiac Arrhythmia Center currently houses three EP labs; they are also building a fourth lab that is scheduled to be finished in May 2004. Keep reading to find out about the other innovations and projects going on at Tufts-NEMC.

What is the size of your EP lab facility and the number of staff members? What is the mix of credentials at your lab?

Currently we have three labs, including one used primarily for devices, one for radiofrequency ablations (RFAs), and one room where smaller procedures are done (i.e., implantable cardioverter defibrillator [ICD] testing, cardioversions, and tilt table testing). By May of 2004, we will have a new procedure room for device and EP studies. We staff one RN and one CVT per patient, with a staff total of four RNs and four CVTs in our lab. The labs are in a 10,000-square-foot Cardiac Arrhythmia Center. We provide comprehensive outpatient evaluation for patients with heart rhythm disorders. We have dedicated rooms for pacemaker (PM) and ICD evaluation, outpatient evaluation and management (E & M), and a transtelephonic monitoring center. Overall, staff in the Cardiac Arrhythmia Center include seven full-time and three part-time RNs, six technicians, four secretaries, a business manager, three EP fellows and five staff electrophysiologists.

When was the EP lab started at your institution?

It was started in 1983, and the space was shared with our Cardiac Cath Lab. By 1984, we had a dedicated EP lab room.

What types of procedures are performed at your facility?

We perform ICD and PM implantation, RFAs (i.e. for atrial flutter, atrial fibrillation, right- and left-sided supraventricular tachycardias [SVTs], atrioventricular [AV] nodes, ventricular tachycardias), implantable loop recordings, primary EP studies, tilt table testing, cardioversions, ICD testing, biventricular PPMs and ICDs.

Approximately how many are performed each week? What complications do you find during these procedures?

Per week we perform a minimum of 10 devices, five RFAs, and 10 EP studies, plus the additional cases listed above. Complications are carefully monitored, varying upon the complexity of the procedure and status of the patient.

Who manages your EP lab?

Management occurs collaboratively amongst the director of the Arrhythmia Center, an assistant nurse manager within the lab, and a business manager.

Is the EP lab separate from the cath lab? How long has this been? Are employees cross-trained?

The EP lab is separate from the cath lab; it has been this way since 1984. Employees are not cross-trained due to this separation.

What are some of the new equipment, devices and products introduced at your EP lab lately? How has this changed the way you perform those procedures?