6 (Nov/Dec)
Cardiac Surveillance at Home
- Sat, 5/3/08 - 1:34pm
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- 3576 reads
Outpatient ECG
Each of these modalities has different characteristics that influence their use. For example, Holters are inconvenient for recording over about 48 hours and the diagnostic data can be delayed by up to several days, while event recorders can capture only symptomatic events.1 Telemetry provides ECG monitoring with rapid response capability and is routinely used as a potentially life-saving measure for essentially 100% of the nation s heart attack victims who are monitored during their hospital stay,2 but is not available on an outpatient basis.
Cardiac Surveillan
What You See is Not Always What You Get
- Sat, 5/3/08 - 1:34pm
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Case Report.
The patient K.S. is having her palpitations again. She has been evaluated in the past and not received a diagnosis. This time, she has an event recorder on and she pushes the button. After the palpitations have not gone away for an hour, she decides to go ahead and call in the event. Once on the phone, she downloads the rhythm and is told to immediately call 911, to be taken to the emergency room. K.S. decides to drive herself.
Once in the local ER, things move along pretty fast. She is in a wide complex tachycardia at a rate of 188 bpm (Figure 1). Lidocaine IV is pushed without result; Procan is tried next with conversion to SR. Now stabilized, she is transferred to our facility at St. Mary s Hospital for further evaluation and treatment.
Spotlight InterviewMercy Heart Institute, Mercy General Hospital
- Sat, 5/3/08 - 1:34pm
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We have recently participated in device studies for biventricular pacemakers/defibrillators with Medtronic, Guidant and St. Jude for heart failure, a drug study to evaluate new drug therapy for SVT, and catheter studies for VT ablation and AF using linear ablation techniques. Advanced technology and highly trained physicians are important elements of Mercy s heart program, but the most important ingredient in the success of our program is the teamwork and skills of those providing the patient care. Mercy s electrophysiologists, cardiac nurses, and specially trained technicians work together to deliver high quality care that emphasizes the personal needs of the patient and their family members.
What is the size of your EP lab facility and number of staff members? What is the mix of credentials
at your lab?
SASEAP 2002 Proceedings
- Sat, 5/3/08 - 1:34pm
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Basic Electrophysiology
Sgt. Albert Paul, CVIS
Walter Reed Army Medical Center
Washington, DC
My opening lecture at SASEAP 2002 was on Principles of Electrophysiology Studies. This talk was designed to give beginners in the field of electrophysiology a base on which to expand their knowledge during the rest of the conference. It also allowed those more experienced professionals among us a chance to review the basic principles that are important for success in the EP lab.
The anatomy of the specialized conduction system was discussed. Special attention was paid to the anatomy and physiology of the atrioventricular node, as an understanding of conduction through this structure is vital to an appreciation of the methods and purposes of the programmed electrical stimulation that is performed in the EP lab. Fluoroscopic images of catheter placement during a typical EP study were also presented and discussed.
Training in Cardiac Electrophysiology: The Lahey Clinic Experience
- Sat, 5/3/08 - 1:34pm
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The practice consists of approximately 1,000 physicians in multiple sites; the Cardiology Department has twenty-five staff physicians with three full-time electrophysiologists. Training in this institution is performed at multiple levels, and there exists active relationships with both Harvard and Tufts Medical Schools for the teaching of medical students. In addition, there are medical and surgical residency programs as well as residencies in multiple medical and surgical specialties. Cardiology training is one of the many subspecialty programs that are offered within the Department of Medicine, and within the Department of Cardiology, there is subspecialty training in interventional cardiology and cardiac electrophysiology.
A Study of Carotid Sinus Massage and Head-Up Tilt Table Testing in Patients with Syncope and Near-Syncope
- Sat, 5/3/08 - 1:34pm
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An abnormal response on HUT was elicited in 18% of patients and carotid sinus syndrome was diagnosed in 13%. Mild carotid sinus sensitivity was seen in 14%. Both tests were positive in 4 patients (3%; 11% of patients with a positive test). There was no significant relationship between HUT outcome and CSM result (p = 0.03). Patients with an abnormal CSM result were older (p < 0.001) and more likely to have prior cardiovascular diagnoses (p = 0.01). The opposite applied to patients with abnormal HUT (p = 0.02 and p = 0.0048, respectively). In conclusion, we did not find a concordance between HUT and CSM outcomes in patients with syncope or near-syncope of undetermined origin.
Can Patients with Implantable Pacemakers and ICDs Safely Undergo MRI?
- Sat, 5/3/08 - 1:34pm
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Over the past several decades, increasingly sophisticated permanently implanted electronic devices have been developed that are used as the standard of care to diagnose and treat important brady and tachyarrhythmic disorders.4 Increasing numbers of these devices are being implanted, with comprehensive data acquired for 1997 showing that over 460,000 pacemaker implants and 38,000 cardioverter defibrillator (ICD) implants were performed worldwide. 5-7 Recently expanded indications for pacing in heart failure and the use of ICDs for the primary prevention of sudden cardiac death, 4 as well as potentially new device indications,8 highlight the rapidly increasing number of patients who are now and will be treated with device therapy.
