Welcome to the May 2008 edition of the email discussion group. As you will see, the “EP lab work schedule” question is a hot topic this month! If you would like to join in on the discussion, please email us at eplabdigest@hotmail.com or visit us at www.eplabdigest.com (click on the email discussion group link). Remember, when posting or responding to the discussion group, please let us know if you would like your name, location, and/or email address listed. We look forward to hearing from you!

Defibrillation using biphasic energy delivery is quickly becoming the standard in the acute care setting. The major defibrillator manufacturers are racing to convert their product lines, and the models generating monophasic waveforms are becoming extinct. This shift has been based, in large part, upon a study published in Circulation in 2000 by Schneider et al; their research showed that within the first shock series, 98% of ventricular fibrillation (VF) patients were defibrillated with 150-J biphasic shocks, compared with 69% of patients defibrillated with 200- to 360-J monophasic shocks.¹ The results of this and other studies prompted the American Heart Association to adopt the use of biphasic waveform defibrillation as a Class IIa intervention² and make it part of the most current Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care.

Can digital music players (DMPs) such as iPods cause interference with implantable devices such as pacemakers and ICDs? In their research, Charles Berul, MD and colleagues recently found that DMPs can interfere with programmer communication, but not in a way that affected device function.¹ Read more about their recent research here. Dr. Berul is a Senior Associate in Cardiology at Children’s Hospital and Associate Professor of Pediatrics at Harvard Medical School in Boston.

The goals of this ECG 101 article are to define ambulatory electrocardiographic (ECG) monitoring, identify clinical scenarios where ambulatory monitoring has proven useful, and discuss the different types of monitoring available. We will highlight the three major categories of devices: Holter monitors, event recorders, and implantable loop recorders. Although implanted pacemakers and defibrillators also have monitoring capabilities, they are beyond the scope of this discussion. By the end of this article, the reader will be aware of the types of monitoring devices available and be able to select the appropriate device for a given clinical scenario.

In this interview, Gregory M. Ayers, MD, PhD, Medical Advisor of Catheter Robotics, Inc. (CRI), discusses their new catheter manipulation system.

The 8th Annual Spring Meeting on Cardiovascular Nursing took place March 14-15 in Malmö, Sweden. It was organized by the Council on Cardiovascular Nursing and Allied Professions (CCNAP) of the European Society of Cardiology (ESC).

In the next installment of the “5 Ways” column, the author provides some advice on why you should join a professional medical organization.

The Canadian Heart Rhythm Society is a professional society of Canada’s heart rhythm specialist physicians and allied health professionals. In this feature interview, current President Martin Gardner, MD tells us more about the organization.

If an EP lab advertised for an EP tech job opening that read “Wanted: Motivated individual who can stare at a monitor of irregular squiggly lines for up to 10 mind-numbing hours, able to stand for hours wearing a heavy lead apron that puts you at risk of having permanent back problems, all while exposing yourself to cancer-causing radiation,” who in the world would respond? Who would say, “Hey, that sounds really good”? Well, that person would be me, and the following is the story of my exciting first year in EP.

Historically, electrophysiology laboratories were designed on the model of catheterization laboratories. In this model, the x-ray images were the focal point of the procedure. This model worked for early electrophysiology laboratories, which included single-plane fluoroscopy and thermal or ink recorders for a limited number of electrogram channels.

In this new section, we’ll highlight the job duties of a different position (RN, RCIS, MD, etc.) in the EP lab to give readers an idea about what others do in their daily role. This month, Douglas Beinborn, MA, RN interviews Lisa Fanning, a technician supervisor, about her job.

Ablative therapy has been a staple of electrophysiology for years and a major treatment modality for various rhythm disorders. Indeed, the advent of radiofrequency ablative therapy has ushered in a plethora of curative solutions for some of the most complex rhythm disorders, including atrial fibrillation and flutter, AV nodal re-entrant tachycardia, accessory pathway mediated reciprocating tachycardia, and most recently, ventricular tachycardia. Over the past few years, a novel form of ablation that utilizes 98% ethanol has been utilized in the cardiac catheterization laboratory to treat severely symptomatic patients with hypertrophic obstructive cardiomyopathy. Performed by interventional cardiologists, the technique has become an increasingly utilized method to improve quality of life in these debilitated patients.

At this year’s ACC meeting, Dr. Russo et al presented research on the under-referral of women for atrial fibrillation (AF) ablation. Andrea M. Russo, MD is the Electrophysiology Laboratory Director and Clinical Associate Professor of Medicine at Penn Presbyterian Medical Center at the University of Pennsylvania.

Attempts to cure atrial fibrillation (AF) often require multiple drugs that usually fail over the long term. Our case report from the University of Virginia demonstrates how a collaborative relationship between the electrophysiologist and the cardiovascular surgeon can lead to a winning result.

This month we speak with Dr. Amit Shanker, who heads the Center for Advanced Arrhythmia Medicine (CAAM) located at the Bassett Heart Care Institute, an affiliate with the Columbia University College of Physicians and Surgeons, in Cooperstown, New York.