This month we highlight the efforts of the Midwest Heart Foundation, a non-profit organization headquartered in Illinois that also organizes an innovative cardiac screening program.

Tell us about the creation of the Midwest Heart Foundation. When was it formed, and why?
Midwest Heart Foundation (MHF) was established in 1988 as a non-profit research and education foundation dedicated to improving the prevention and management of cardiovascular and related diseases through research, education and community leadership.

There are several interesting new questions this month, including one about whether or not to discharge patients post procedure when there is no caregiver there to drive them home. If you can provide any input on any of the discussion questions, please email us at eplabdigest@hotmail.com or visit us online at www.eplabdigest.com (and click on the email discussion group link). Remember, when responding to the discussion group, don’t forget to let us know if you would like your name and/or location listed. We look forward to hearing from you!

New Questions:

Procedure Scheduling
I am looking for references pertaining to block scheduling of procedures in EP labs. Does anyone use this method and what are the rules?
— LeeAnne Hockey, RCIS, Sentara Heart Hospital, Norfolk, VA
(To reply to this question, please type “Procedure Scheduling” in your subject line.)

Electrocautery Cut/Coag Settings

The Silent at Heart Project uses art as an expressive means to promote awareness of sudden cardiac death in the United Kingdom. Read more about this innovative project.

Tell us about the South East London Cardiac Network. When and why was the Silent at Heart Project created?

What This Means for the Allied Health Professional

Allied health professionals play a major role in the follow-up of patients with cardiovascular implantable electronic devices (CIEDs). A recently released consensus document from the HRS and EHRA contains recommendations for follow-up for specific types of devices and provides guidelines for performance for the specific personnel involved in giving care to these patients. This article will discuss general issues of follow-up and then will look at recommendations related to the allied health professional.

At the American Heart Association’s Scientific Sessions in 2004, the results of the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) were first announced publicly and subsequently published.1 This led to expanded Medicare coverage of primary prevention implantable cardioverter-defibrillators (ICD) on January 27, 2005. All patients with an ejection fraction (EF) of 35% or less with NYHA class II or III congestive heart failure (CHF) became eligible to receive primary prevention ICDs. The cause of the reduced EF (ischemic or non-ischemic) did not matter.

There were, however, a number of caveats thrown into the coverage decision:
• If a patient had experienced a recent MI, there was to be a 40-day waiting period;
• If the patient was revascularized, either by coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA), then there was to be a 90-day waiting period.

While electrophysiologists and clinical staff deal with the critical physiological aspects of electrophysiological (EP) procedures, the EP laboratory’s administrators must handle critical concerns of a different sort: business issues that determine the financial viability of their programs. This article will address some of the most common challenges that can impact the fiscal success of any EP program. Some solutions to these challenges are suggested, based on the successful experiences shared by a group of EP administrators who met for the purpose of discussing these issues at the Administrators Advisory Board sponsored by Biosense Webster, Inc.

1. Operative Reports
Complete operative reports and reports that are prepared with the needs of coders/billers in mind are very helpful in streamlining the process of coding and in conveying the information clearly to payers. One way of accomplishing this is to create a template that includes the following:

In EP Lab Digest’s new “How To” section, articles will focus on one learning objective each month.

Michaela Gagne, Miss Massachusetts 2006.

Friday, April 21, 2000 was a day I will never forget. I was 17 years old and sitting at the dinner table, about to take my first bite of salad, when the phone rang. My mom answered, and soon the tears began streaming down her face.
I knew right away that the tears were for me.
The doctor was calling to confirm I had the life-threatening heart condition called long QT syndrome (LQTS). For two years we had waited for an answer as to why I had collapsed at the finish line during a track meet. After that, my world as I knew it came crashing down. I realized I would now have to live my life without the one thing I had felt most defined me: sports.

Dr. Liem provides a brief summary on the recently revised ACC/AHA/HRS guidelines for device-based therapy.

The 2008 ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities1 are a further expansion to those published in 2002. There were significant modifications to the 2002 AHA/ACC/NASPE guidelines, mainly by incorporation of the ACC/AHA/ESC 2006 guidelines for sudden death prevention.2,3 Also importantly, these evidence-based guidelines reflect recently published data and therefore incorporate additional recommendations accordingly, with the most notable being items relating to cardiac resynchronization therapy.

for ICD/CRT Implantation in Pediatric and Congenital Heart Patients: What You Need to Know

The author provides an overview of the recently revised guidelines presented by the Heart Rhythm Society and the Pediatric and Congenital Electrophysiology Society (PACES).

An increasing number of ICD/CRT-D implants are being performed in the pediatric and congenital heart disease patient groups. No prospective clinical trials of safety and efficacy have ever been conducted within these device populations. However, the advances in technology that have occurred in recent years have made these therapies available to these groups.

Work of the Task Force