CLINICAL EVENTS CALENDAR
- Monday, September 13, 2010 - 23:00CEPIA Introduction to Cardiac Electrophysiologyhttp://www.cepia.com.au
- Friday, September 17, 2010 - 00:0016th Annual SASEAP Workshop for EP Allied Professionalshttp://www.saseap.org
- Monday, September 20, 2010 - 23:00Transcatheter Cardiovascular Therapeutics (TCT) 2010http://www.tctmd.com
- Friday, September 24, 2010 - 00:00VI International Symposium on Interventional Electrophysiology in the Management of Cardiac Arrhythmias
EP Lab Blogs
Effective Communication in the EP Lab Setting
Good communication skills are the ability of a person to communicate with the other in an effective manner. The electrophysiology lab requires effective communication among several disciplines and departments in order to run efficiently. Factors identified that are affected by communication include: patient care; procedural flow/scheduling; physician and employee satisfaction; interdepartmental relations; and patient outcomes. Within this blog I will describe the connection of communication and the several factors that are affected.
Patient Care:
It is imperative that all members of a specific EP lab communicate in order to provide exceptional care for the patient. The communication needs to involve each member of the team, equipment involved and physician. If anything is missed with this process, it could prove to be detrimental to the patient outcome.
Example: Communication of Heparin Administration.
Spread the Word! September is Atrial Fibrillation Awareness Month
Those of us who specialize in atrial fibrillation (AF) understand its enormous impact on a growing segment of our population, in terms of both quality of life and long-term survival. More than five million Americans have AF and the disease causes more than 66,000 deaths a year, and those numbers are rising. According to research from The Advisory Board Cardiovascular Roundtable, the number of AF catheter cases in the U.S. will increase almost 100% between 2007 and 2012.
We all want to help people afflicted with AF, but there’s one problem with the disease that we can’t fix in our labs -- the vast majority of the general public that has never heard of atrial fibrillation. As we know, such ignorance can be hazardous to their health. About 30% of people with AF have no symptoms, and often the first sign of the disease is a stroke. (People with AF are 2-7 times more likely to suffer a stroke than the general population.)
The Fourth Door
It is Friday, my regularly scheduled outpatient clinic day. As what sometimes happens, the last patient of the day and her mother are crying. This is how it unfolded. I look down and see written on the referral sheet: 16-year-old girl with QT prolongation and syncope. Sounds simple — diagnose her with long QT syndrome, take away her alarm clock, swimsuit and running shoes, start a beta blocker, print out a sheet on QT-prolonging medications, and send her on her way. Well, it is never that simple. In fact, it is always complicated. This girl’s corrected QT interval is 469, she has normal appearing T-waves, and now it gets dicey. As she tells the story, it becomes less clear whether she actually fainted. Syncope has been replaced by extreme dizziness that brought her to her knees, but she swears consciousness never left her. There is no family history of sudden cardiac death, but her 19-year-old sister had a single seizure at 8 years of age while waking up to her alarm.
Studies Show AF Ablation Has Clinical and Cost Advantages
Despite the fact that physicians have been performing radiofrequency ablations (RFAs) since the 1990s, less than 1% of the atrial fibrillation (AF) patient population in the U.S. and Europe is offered catheter-based treatment. This percentage, however, will no doubt rise significantly over the next decade. According to research from The Advisory Board Cardiovascular Roundtable, the number of AF catheter cases in the U.S. will increase almost 100% between 2007 and 2012.
Demographic trends, advances in ablation treatment and diagnostic techniques, health reform and new research will further accelerate the acceptance of AF ablation as a primary treatment strategy. Several studies have shown that AF ablation has both clinical and cost advantages in comparison with anti-arrhythmic drug (AAD) therapy.
International Allied Professionals in EP: Cardiac Clinical Technologists in South Africa
This is part of a series to profile our colleagues from around the world to learn about their role, education and efforts to improve professional practice in EP.
In the land of tribal mystique mixed with growing modernization, South Africa's public healthcare system serves about 80% of the sub-Saharan Africa’s 840 million, while a small but lucrative private sector caters to the mid- to high-income earners and the ever-popular medical tourism industry.
The Importance of Magnet Status and Nursing
Blog by: Melanie T. Gura, RN, MSN, CNS, CCDS, FHRS, FAHA and Jane A. Soposky, RN, MSN, NEA-BC , Administrative Director, Patient Care Services, Summa Health Systems, St. Thomas Hospital
The American Nurses Credentialing Center (ANCC) developed the national Magnet Hospital Recognition Program® in 1980.[1] Hospitals that receive a magnet designation are referred to as “Magnet Hospital.” It is the highest honor a hospital can receive for its nursing service. The purpose of magnet status is to recognize healthcare organizations that provide excellence in nursing, growth and development of the nursing staff, and an environment that supports professional nursing practice.
Multi-site International Study will Investigate Use of Delayed Enhancement MRI to Stage Progression of Atrial Fibrillation
The prevalence rates for atrial fibrillation (AF) are increasing, and annual costs to treat this disease are estimated to be $7 billion. Our research at the University of Utah has shown significant and promising results in applying late gadolinium-enhanced (delayed enhancement) cardiac MRI (DE-MRI) technology for non-invasive scar assessment in the left atrium (LA). For example, used prior to catheter ablation, DE-MRI can identify regions of significant structural remodeling or fibrosis. This imaging modality has also been shown to be very useful in examining the amount and distribution of ablation-related scarring.
Will Changes in Health Care Eliminate Private Practice Medicine?
Will changes in health care eliminate private practice medicine?
At the Heart Rhythm’s annual scientific sessions in May 2010, questions were raised about the future of private practice medicine. For example:
1. Will fee-for-service be eliminated?
2. Will all private practice physicians join with hospitals and/or medical institutions?
Many private practice electrophysiologists are questioning their role and existence either as a private practitioner in solo practice or as a member of a group practice. However, the long-term independence of the physician practice remains in question. Hopefully, this blog will serve as a launching pad for any remarks in this area. Please feel free to share your thoughts in the comments section below.
ICDs in the Young: A Challenge for Physicians, and an Even Greater Challenge for Patients and Families
Click to Enlarge Images
By Ian Law, MD, Jean Gingerich, RN, BSN and Nicholas Von Bergen, MD
For those who have had the privilege of caring for children and young adults with life-threatening heart disease requiring ICD implantation, you are well aware that much of the emotional impact of the ICD occurs after device placement.
HRS Scientific Sessions Show that New MRI Techniques for AF Management are Gaining Widespread Acceptance
Last month’s Heart Rhythm Society (HRS) Scientific Sessions in Denver provided ample evidence that MRI techniques will play an increasingly significant role in the diagnoses, treatment and management of AF patients. Our CARMA Center at the University of Utah, which is at the forefront of MRI research efforts, contributed to the “buzz” about MRI with our satellite symposium, investigators’ meetings, posters and awards.
We were especially encouraged by the enthusiastic response we received from representatives for influential research centers regarding CARMA’s international multi-center research project. The purpose of this study is to validate that the use of Delayed Enhancement MRI to detect atrial fibrosis is a useful diagnostic staging tool for evaluating patients and determining the most effective treatment options.
Taking Care of Business in the EP Lab
With the economic downturn and ever-increasing costs for delivering quality health care, can EP services survive and be economically viable? The answer is a qualified "YES"! However, doing so means careful attention to many details and quite a bit of education.
In this brief blog, I will highlight the three most important tools to achieve this goal:
1.) A well-designed procedure report. Creating a template that contains all pertinent information related to the procedure reduces the chance of errors in coding and billing. Some of the important information that you should consider including is: the ICD-9 diagnosis code(s), a list of procedures performed with their respective CPT codes, a complete list of catheters, guides and sheaths used in the procedure and any other diagnostic tools, e.g. intracardiac echo.
Are you performing AF ablation procedures on therapeutic warfarin?
The Heart Rhythm Society, the American Heart Association, and the American College of Cardiology have not yet come up with a consensus statement in regards to performing atrial fibrillation (AF) ablation procedures (including the transseptal component) on therapeutic anticoagulation. Several studies have reported success with this approach, but without any clear guidelines, I am interested in hearing how your labs are performing such procedures, including your results and complication rates.
Issues of interest include:
1) Are there any specific INR cut-offs at your institution for this procedure?
2) What are your target ACT values during the procedure?
3) Are there any specific issues related to the transseptal procedure and handling perforations?
4) Do you routinely use reversal agents at the end of the procedure?
5) Are there any changes in desheathing protocol in patients who are on therapeutic warfarin as compared to those who are not?
New CME Satellite Symposium Will Highlight Latest Treatment and Management Options for AF
Cardiologists and sub-specialists will have an opportunity to learn about the latest developments in the diagnosis and treatment of atrial fibrillation at a Heart Rhythm Society (HRS) Complementary CME Satellite Symposium on Thursday, May 13 at the Hyatt Regency Denver. The program, “Coming to Consensus: Defining New Treatment and Management Options for Atrial Fibrillation,” is hosted by the University of Utah School of Medicine and sponsored by an educational grant from eCardio Diagnostics.
Topics covered at the symposium, which will take place from 6:30 p.m. to 9:30 p.m., will include:
• Can ambulatory cardiac monitoring be used to prevent anti-coagulation in AF patients?
• Is there a role for complex fractionated electrograms in the management of AF?
• What are the endpoints of AF ablation procedures?
• MRI for AF management: How can this be used to follow disease progression and define optimal treatment?
International Allied Professionals in EP: Cardiac Physiologists in the UK
Blog by: Christine C. Chiu, MSc, CCDS, CEPS, FHRS, and Joel Archbald, BAppSciHMS, CEPS
This is the first of a series to profile our colleagues from around the world to learn about their role, work setting, education and their efforts to improve professional practice in EP.
AFIS: Comprehensive Software for Managing Atrial Fibrillation Patients
As I mentioned in my last blog, one of the highlights of the recent Third Annual Western Atrial Fibrillation Symposium was a presentation by Walid Saliba, MD, from the Cardiovascular Medicine department at Cleveland Clinic. Dr. Saliba spoke about the Atrial Fibrillation Information System (AFIS), the first comprehensive information system developed specifically to support the medical specialty of cardiac electrophysiology.
The primary purpose of AFIS is to assist electrophysiologists in the daunting task of evaluating numerous data sources needed for AF patient management. It captures images, monitor tests, procedural reports, clinic notes and patient history to provide clinicians with a longitudinal data set that presents a holistic view of the patient.
Patient Advocacy: Empowering Your Patient Via the Web
Many of our patients search for health information on the Internet yearly. Whether health information is needed for personal reasons or for a loved one, our patients on a daily basis view health-related web pages. Information may be found easily or may result in frustration or retrieval of inaccurate, even precarious information. As nurses and allied professionals, we can guide our patients in the appropriate direction, thus facilitating the best possible outcome for our patients.
The electrophysiology arena will continue to experience astounding advances and changes in methods of treatment and care delivery processes. In order to deliver optimal care and have patients comply with our treatment protocol, we must empower our patients. An informed patient can work as a partner with us ensuring the delivery of optimal care.
Patient Advocacy: Empowering Your Patient Via the Web
By: Melanie T. Gura, RN, MSN, CNS, CCDS, FHRS, FAHA and Lori O’Shell, RN
Many of our patients search for health information on the Internet yearly. Whether health information is needed for personal reasons or for a loved one, our patients on a daily basis view health-related web pages. Information may be found easily or may result in frustration or retrieval of inaccurate, even precarious information. As nurses and allied professionals, we can guide our patients in the appropriate direction, thus facilitating the best possible outcome for our patients.
The electrophysiology arena will continue to experience astounding advances and changes in methods of treatment and care delivery processes. In order to deliver optimal care and have patients comply with our treatment protocol, we must empower our patients. An informed patient can work as a partner with us ensuring the delivery of optimal care.
Highlights from the Western Atrial Fibrillation Symposium
Last month’s Third Annual Western Atrial Fibrillation Symposium was a resounding success. More than 300 cardiologists, physicians and others attended this world-class conference, which was sponsored by the University of Utah School of Medicine’s Division of Cardiology and hosted by the Comprehensive Arrhythmia Research & Management Center (CARMA).
The symposium’s faculty featured physicians from renowned medical centers in the U.S., Canada, Europe and Asia. Their presentations covered new research and developments regarding the pathophysiology, diagnosis, and treatment of patients with atrial fibrillation. Some of the notable presenters and their topics included:
Child Neurologists and Pediatric Electrophysiologists
In medical school, I had a professor who talked about the “TWUD” factor, i.e., “Time Wasted in Useless Discussion.” As he defined it, TWUD is the mathematical quotient of the time spent discussing a particular diagnosis on rounds, divided by the number of times it is actually encountered. As an example of a high-TWUD factor condition, the entity “arrhythmogenic epilepsy” was cited, whereas “bronchopneumonia” has a low value.
Do Atrial Fibrillation Education Centers Improve Patient Outcomes?
Management of atrial fibrillation involves a complex set of diagnostic tests, medication regimes, and in many cases, treatment with devices or cardiac ablation. At the Venice Arrhythmia conference in October 2009, I had the opportunity to facilitate a session that asked the question above. Nurses from AFib programs around the world agreed unanimously that patients had improved outcomes if their care was managed by dedicated nurses.
There is nothing “typical” about the average ablation patient – they range from young to older, with symptoms as mild as a sense of lightheadedness to severe, such as losing consciousness or having a stroke. In any phase of their treatment – from early diagnosis through procedures such as ablation – the registered nurse plays a major role in helping the patient understand the condition and its symptoms, and in monitoring the patient’s condition.
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