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

We presently have two rooms dedicated to electrophysiology procedures. These include an EP lab and a lab for device implants. We are currently in the process of constructing a new EP lab. Our Arrhythmia Service of 11 members includes 4 attending physicians, 1 nurse practitioner, 3 registered nurses (one dedicated to research studies), 1 surgical technician, 1 RCIS, and 1 secretary. Cardiology fellows rotate through the EP Service facilities, but our institution does not sponsor an EP fellowship.

In this article, the authors discuss their comprehensive approach to treating atrial filbrillation, exploring both medical and surgical approaches for each patient.

Atrial fibrillation (AF) is a condition that affects millions of patients and is rising in prevalence. Longer life expectancy, improved survival of heart failure patients, and the epidemics of obesity and its associated comorbidities are just some of the factors contributing to the growing population of patients with AF. New estimates project that by the year 2050, AF will affect between 12 and 16 million Americans.¹ It is estimated that the lifetime risk of developing AF is 1 in 4, regardless of gender.²

Less than three years ago, my article in this publication¹ (“MR Imaging: New Techniques for the Treatment of Atrial Fibrillation,” November 2008) noted that, “as advanced techniques for scar imaging become available, MRI will be an indispensable tool within the catheter lab itself.” Since then, research involving delayed enhancement magnetic resonance imaging (DE-MRI) has accelerated at an ever-quickening pace.

In this article, the authors describe a case involving two different wide complex tachycardias. The authors also highlight the importance of a thorough electrophysiological evaluation when evaluating a wide complex tachycardia in a young patient.

Case Report

A 38-year-old Caucasian male presented to the emergency room with rapid palpitations and was noted to be in wide QRS tachycardia at 216 beats per minute. The tachycardia terminated with intravenous adenosine. Review of the electrocardiogram showed a typical left bundle branch block (LBBB) pattern with QRS duration of 160 msec and no clearly discernible P waves (Figure 1). A 12-lead electrocardiogram following tachycardia termination showed normal sinus rhythm with no evidence of preexcitation.