Fifteen years of donning a lead apron has taught me many lessons. A very wise friend once told me success in any endeavor really involves mastering the obvious. This is clearly the case in practicing medicine and more specifically, achieving favorable results in the electrophysiology lab.

Our lab is humbly equipped. There is a late model mono-plane fluoroscopy unit, a singular three-dimensional mapping system, an intracardiac ultrasound (ICE) device and an irrigated ablation system. A robot, MRI and multiple 3D mapping systems are notably absent. Enough equipment is available to achieve success, but not so much to allow dust to settle.

So what could this non-academic Thoreau-like setting offer to the cohort of EP Lab Digest readers? An attempt, not certainly comprehensive, and not likely universally agreed upon, to outline some observations, theorems and lessons learned over the years. Presented herein are notions — some specific and others more general — that hopefully will help achieve success in the EP laboratory.

Theorem number one: Strive for flexibility of the mind to learn new things.
An electrophysiologist must be a lifelong learner. Consider for example, upon finishing training in the 1990s, there was no formal teaching on the transseptal puncture, and CRT devices were yet to be imagined. In fact, when first asked of the possibility that a left ventricular lead could benefit congestive heart failure, I was dismissive and unimaginative.

But as all good doctors do, an electrophysiologist needs to accept the necessity of the learning process and know how to learn new techniques, technologies, and novel approaches so as to avoid becoming the aged doctor who clings to the past and refuses to learn the new.

Theorem number two: Framing the problem and adjusting expectations of the patient.
Seems simple, but so much of our success in electrophysiology is from having an educated patient who understands the problem at hand, the goals of the intervention and expectations post procedure. Examples abound, but take the patient who undergoes a primary prevention ICD implant expecting an “improvement” in their well-being. “Doctor, no one told me the ICD would not help my chest pain and breathlessness,” they say. Even more pertinent an example is the atrial fibrillation (AF) patient referred for left atrial ablation. With long-term success rates for AF ablation in the 65% range, many patients requiring multiple procedures, and a CHADS score determining the ability to discontinue anticoagulation post procedure, it seems best to introduce the patient to you, the electrophysiologist, as a friend — this treatment will encompass a journey rather than a single curative procedure. To the patient with AF, I often say, “you and I are going to have to become friends for a while — AF treatment is unlike the finality of removing an appendix.” So, when the patient has recurrent AF or maybe just benign palpitations after the first “successful PVI,” life is easier for doctor and patient alike.

Checklist of Specific Observations and Recommendations