In EP Lab Digest’s Clinical Images section, we ask physicians to present case reports using primarily only the images for description. If you have any interesting cases that you would like to submit to this section, please email us at “eplabdigest@aol.com”.

This month, we are including some of the recent responses to our questions under discussion. In addition, please review last month’s question still under discussion. Readers, it is not too late to send in your responses to questions from past issues. If you have information or tips that might be helpful, email us at eplabdigest@hotmail.com or go to www.eplabdigest.com and click on the email discussion group link. Our website is constantly being updated with new responses, so check back often!

The Framingham Heart Study is a long-term study which began in 1948 in Framingham, Massachusetts. Much significant research in electrophysiology has come out of this study, including the association of electrocardiogram abnormalities with the risk of heart disease, the increased risk of stroke in atrial fibrillation (AF), as well as the risk factors for atrial fibrillation. Recent findings published in the Journal of the American Medical Association show that of the offspring studied in the Framingham Heart Study, having one parent with AF doubled their risk of developing AF. For those who had both parents with AF, their risk was tripled. Anne Curtis, Professor of Medicine and Director of Clinical Electrophysiology at the University of Florida in Gainesville, discusses the recent data.

A new radiation protection system designed to protect physicians and staff in the electrophysiology (EP) lab was introduced at the NASPE-Heart Rhythm Society 2004 meeting in San Francisco. The system is a new line of radiation protective drapes and shields that absorbs radiation and stops as much as 97% from reaching the physician and staff members. Todd Cohen, MD, in collaboration with Worldwide Innovations & Technologies, Inc. (WIT), designed these products. The new products are called Prometheus™ radiation protection drapes and shields, and they have been specifically created for the EP lab.

For over one year, the team at Cleveland’s Hillcrest Hospital has used the left atrial catheter ablation (LACA) technique in the treatment of atrial fibrillation (AF). It was a time-consuming process; it took one hour just to complete initial mapping and two to three more hours to perform the ablation.

On behalf of CryoCath Technologies, I want to thank EP Lab Digest for having us present on cryoablation, one of the newest energy sources to be used in the electrophysiology lab for transvenous ablation of cardiac arrhythmias. Cryoablation has been around for over 35 years in the surgical arena for the treatment of cardiac arrhythmias using a very large and stiff surgical probe. In addition, cryo has been used for over a century for the treatment of carcinoma, giving it a long history of safe and effective use in medicine. The challenge for the EP setting was getting cryotechnology into a very small, flexible transvenous catheter. About eight years ago, our engineers developed a design to get this job done. They took the idea to some prominent electrophysiologists in the Boston area, and their response was “This is really a nice idea, but it’s never going to work.” Here we are today, however, after perseverance with design and preclinical studies. In April of 2001 we started our

The Florida Institute for Advanced Diagnostic Imaging (FIFADI) recently expanded their cardiac services to include cardiac computed tomography angiography via 16-slice cardiac CT and three-dimensional reconstruction technology, to be used before ablation therapy for the treatment of atrial fibrillation. This technology will help provide physicians with the best possible images and make it possible for them to create an anatomical “roadmap” before reaching the target area during EP procedures. To find out more about this technology, EP Lab Digest contacted Dr. Steven Strobbe.

Description: A 60-year-old female presented to the Emergency Department with a tachycardia (see 12-lead ECG obtained during tachycardia). She complained of being light-headed, breathless, and was slightly diaphoretic. Upon questioning, for many years she has felt the same way when she would get in an argument with someone. This is her first visit to the Emergency Department. Questions: 1. What is the exact diagnosis of this tachycardia: description, mechanism? 2. What diagnostic maneuver or treatment could be initiated to determine the diagnosis?