What Does the Literature Tell Us About Anxiety? Over the years there has been a great deal of research supporting the contention that the majority of patients suffer from anxiety prior to invasive procedures. Anxiety, as defined by Wilson-Barnett, is the fear of the unknown, disproportionate to the threat and related to the future.¹ It is characterized by an individual’s inability to specify the source of the threat.² Anxiety has been shown to lead to high levels of stress, creating delays in recovery and increased length of stay within the hospital.³ Historically, nurses have handled patient physiological needs with great confidence, but patient psychological needs, such as the manifestation of anxiety, have not received the same attention.⁴ One area in which evidence-based practice can offer great value is in addressing pre-cardiac catheterization anxiety.

Tell us about what happened to Carolyn the day of her SCA. My wife Carolyn and I had recently married and had moved from Australia to Boston, where at the time she was working for IBM. She had a business trip in Dallas shortly after we were married. During her trip, I received a phone call from her boss saying she ‘had had a bit of a turn’ and that they had sent her off to the hospital — he was understating things severely. What had happened is that while at her business conference, after just having introduced herself to everyone in the room and sitting down, she collapsed to the ground. Luckily, two male colleagues helped her immediately as well as a nurse attending the conference center.

Tell us about the new VEST/PREDICTS study. What are the main objectives of both parts of the study?
The Vest Prevention of Early Sudden Death Trial/Prediction of ICD Therapies Study (VEST/PREDICTS) is an NIH-funded, multi-center, randomized clinical trial and an observational study wrapped into one — it is one study that answers two questions by combining two studies in a single cohort. The study also receives funding from Medtronic, Zoll-Lifecor and GE.

When was the EP lab started at your institution? We’ve been doing device implants and EP studies for years, but we did not have a dedicated EP lab when Dr. Bonhomme joined us in December of 2006. With Dr. Bonhomme’s guidance, we developed a vision, needs assessment and strategic plan in January of 2007. An educational curriculum was designed with Dr. Bonhomme, C. R. Bard, Inc. and some of our device vendors. In February of 2007, a recording system was purchased from C. R. Bard, Inc. and the first EP study/ablation was performed a few weeks later. Prior to initiating left-sided procedures, the staff received training at Aurora Sinai Medical Center in Milwaukee. Transseptal, anticoagulation, and patient preparation protocols were borrowed and established. We started left-sided procedures in July of 2007. By September our procedure volume had grown so dramatically that we went to the Hospital Board with a proposal to build a dedicated EP lab.

“If I have seen farther, it is by standing on the shoulders of Giants.”
— Sir Isaac Newton

I have been involved with cardiac catheterization and electrophysiology for almost 30 years. I started out as a biomedical technician and then gravitated into the cath lab. My first day in the lab was in January of 1979. Over the following decades, I moved from the clinical environment to industry and back again...several times. My career path almost always revolved around cardiology, so I have built up a resume that looks like a patchwork quilt of experience; this has afforded me quite a perspective — meaning, I’ve heard a lot of stories.

Abstract Ventricular tachycardia (VT) was mapped and ablated in a 34-year-old man with a history of a traumatic ventricular septal defect. Nonfluoroscopic three-dimensional (3D) mapping was used to guide the VT ablation. Case Report The patient is a 34-year-old man with symptomatic palpitations and nonsustained ventricular tachycardia. He had a traumatic ventricular septal defect that had been clinically stable via two-dimensional echocardiogram and cardiac catheterization, with QP:QS ratio of 1:2, and a left ventricular ejection fraction of 40 percent. Cardiac MRI demonstrated the presence of a small muscular ventricular septal defect measuring 4 to 5 mm at the base with left to right flow. The apical septum is thinned and akinetic. The left ventricle is mildly dilated with mild to moderate global systolic dysfunction (ejection fraction of 42 percent). More recently he developed symptoms of New York Heart Association Class II congestive heart failure.

Background Despite the many excellent conferences and symposiums available to the EP community, for those residing in the Asia-Pacific region, there was no dedicated and comprehensive educational program designed to educate allied professionals and EP fellows in the complex field of cardiac electrophysiology. Realizing there was a lack of formal education in this area, Jason Riley founded the Cardiac Electrophysiology Institute of Australasia (CEPIA), an independent organization with the aim of providing the ultimate EP teaching program and setting the industry benchmark for educational qualifications. After years of research and preparation, the Certificate Course in Cardiac Electrophysiology was developed, which is designed to teach all there is to know about cardiac electrophysiology, from basic anatomy to advanced 2D and 3D mapping techniques, with an emphasis on the analysis of intracardiac recordings.

Tell us about the creation of the Texas Cardiac Arrhythmia Institute (TCAI) at St. David's Medical Center. What attracted you to move to St. David's? It was a combination of factors — the most important one is because of the group of very talented physicians here that are already doing a remarkable volume of clinical cases, which for me is important — I wanted to support and continue some of the pioneering work that they are doing. It is also because TCAI has all the technology that I needed to continue on with my academics. In addition, the hospital has been very generous in terms of their resources in adopting a research institute, so for me these benefits were all the evidence that I needed to quickly step in and continue my research and clinical work here. Tell us about your blog on St. David's website. Will this be something you will update regularly? Yes.

The AtriCure Minimally Invasive Platform Highlighted by Prominent Cardiac Surgeons and Electrophysiologists at Cardiostim in Nice, France AtriCure, Inc. announced that its minimally invasive platform was highlighted during Cardiostim. On June 18, Dr. Kenneth Ellenbogen, Vice Chairman of Cardiology and Director of Clinical Cardiac Electrophysiology and Pacing at the Medical College of Virginia, chaired a symposium entitled “The Epicardial Frontier: Minimally Invasive Ablation for Atrial Fibrillation.” The session focused on the current indications and investigation of the AtriCure minimally invasive platform as a treatment alternative for atrial fibrillation (AF). Dr. Vigneshwar Kasirajan, a leading cardiothoracic surgeon and colleague of Dr. Ellenbogen, presented their patient selection criteria and patient results. European cardiothoracic surgeon Dr.

New Question:

Protocol for Tilt Table Study
I recently encountered a superior manager who halted all tilt studies unless the physician was at the bedside. Prior to this we were performing these exams while the MD was in the lab, within close proximity, and not directly watching the patient. We are only tilting the patient on a table and if they do not respond to an 80-degree tilt in 15 minutes, we spray nitro under the tongue. The worst that has happened is they have gone asystole [during which time] we place them at zero degrees, give fluids, or at the worst-case scenario, give atropine. They immediately respond. Are there any rules which state that the physician must be directly at the patient’s bedside? Are the nurses not qualified to do this if the physician is not within arm’s length?
— name withheld by request
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