This lab was originally profiled in our September 2003 Spotlight Interview. In this month’s feature, we get an update from the lab. In addition, they test out our new Spotlight Interview questions! To get a copy of our new questions, download them from our website (www.eplabdigest.com) or email “jelrod@hmpcommunications.com” and we’ll send them to you.

From left to right: Jean Gima, RN, NP, Marmar Vaseghi, MD, Cardiology Fellow, Eric Santa Ana, RT, David Cesario, MD, PhD, Director, Clinical Arrhythmia Service, Co-Director, CCEP Fellowship Program, David Geffen School of Medicine, Angela Urso, RT, Ramandeep Brar, MD, EP Fellow, Shelly Cote, RN, NP, and Barbara Natterson, MD, Director of Imaging & Interventional Echocardiography, David Geffen School of Medicine.

How has your lab grown in size since it was last profiled in 2003? What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab?
Yes, we have increased to four EP faculty + 1 pediatric EP up from two faculty. We have 20 staff members that cover three labs — they are cross-trained and help cover interventional cardiology cases. We have a mix of RNs, RTs and CVTs.

Approximately how many procedures are performed each week?
We perform 18–20 procedures/week, of which six to eight are complex ablations.

What is the primary goal of your program (AF ablation, lead extractions, BiVs, etc.)?
Our primary goal is performing catheter ablation, including AF and VT.

Has your EP lab recently expanded in size and patient volume, or will it be in the near future?
We are moving into a new medical center in January 2007, with four EP labs.

How do you select and program primary prevention devices?
All devices are programmed as two-zone devices.

What are you thoughts about non-EPs implanting ICDs? Do you train such individuals?
We support the HRS guidelines on this issue. However, we have not received any requests from non-EPs for training.

What about dealing with device recalls?
One at at time! We have had to weigh the risks versus benefits on a case-by-case basis.

Do you contract with vendors?
No.

Staff at UCLA Cardiac Arrhythmia Center.

Who do you select for AF ablation? What approach do you use?
We select highly symptomatic, drug refractory atrial fibrillation patients without any major structural heart disease. The only asymptomatic patients we have ablated are the ones with tachycardia-induced cardiomyopathy.

What do think the next steps are for innovation in EP?
We hope to see better definition of non-pharmacological approaches to atrial fibrillation and better risk stratification for sudden cardiac death.

Are you ACGME-approved for EP training? What do you think about two-year EP programs?
Yes, we are ACGME-accredited. Two-year programs will become inevitable, simply because of the skill level required for EP practitioners.

Which approach do you use for lead extractions? Where do you perform them?
We perform laser extractions (combined with snares in selected cases). In general, we do them in the OR.

Are you doing web-based/transtelephonic device follow-up?
Not yet (for web-based). We have an active transtelephonic monitoring program.

Do you use cryo? For what reason?
Yes, we use cryo for peri-nodal accessory pathways and epicardial VT foci that are near coronary arteries.

Do you perform only adult EP procedures, or do you also do pediatric cases? Is there cross training for pediatric cases?
We perform procedures from childhood to senescence. We have one dedicated pediatric EP and all members of our group perform procedures for adult patients with congenital heart disease.

Do you cross-train staff?
Yes.

How do you maintain efficiency?
The managers have started a QA process for dealing with this.

How do you prevent staff burnout?
We prevent burnout by making staff part of the extended EP team and ensuring that people take vacations.

What about cost containment?
We have a bi-annual review of costs with the hospital administration, and we also meet regularly about cost per case (variables).

What procedures, if any, do you perform on an outpatient basis?
We perform SVT ablations, loop recorder insertions, diagnostic EPS and occasional generator changes and lead revisions.

How have you developed your referral base?
Our referral base has been developed by our ongoing work on complex ablations.

Do you participate in clinical research studies? Which ones?
Yes. We have been a part of COMPANION, SCD-HeFT, RHYTHM ICD, CryoCor, and DETECT SVT. We will also be a part of RISK, RETHINQ and SCD MRI.

Describe your city or general regional area. How does it differ from the rest of the U.S.?
We are a part of a large metropolitan area (greater Los Angeles) with several high-quality EP programs in our vicinity. We have very good academic interactions with all groups in our area. Therefore, our practice is somewhat more focused on tertiary and quaternary care EP.

For more information about this lab, please visit: www.cardiology.med.ucla.edu/arrhythmia/