What is Ambulatory ECG Monitoring?
Ambulatory ECG monitoring is the continuous recording of ECG signals from patients while they are at home and engaged in routine daily activities. These are non-invasive or minimally invasive diagnostic exams that have been shown to be very efficacious and cost-effective in the right clinical scenario. From the pioneering work of Dr. Norman Holter, who published his landmark article in Science¹ (1961) discussing a new technique for continuous portable electrocardiography, ambulatory ECG monitoring has evolved to include myriad device designs that provide a wide array of recording options. The type of patient and clinical indication will dictate which device and recording options are most appropriate.

What are Some Scenarios Where ECG Ambulatory Monitoring has Proven Useful?

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.

Tell us about your research. What population of patients were studied? When were the patients studied?

We had been performing AF ablations, primarily pulmonary vein isolation procedures, since 1999, so our data included over 1,100 cases of men and women who underwent AF ablation from November 2000 to July 2007 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.

History

The patient was a 61-year-old retired male with a history of persistent AF for 7 years. His arrhythmic events were initially paroxysmal but had progressed to persistent AF. He had previously failed sotalol and propafenone. He also had mild coronary artery disease, hypertension, obesity, and hyperlipidemia. His echocardiogram revealed a left atrium (LA) size of 6.0 cm and mild mitral regurgitation (MR).

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

There are five labs total, including one with Stereotaxis, two biplane labs, and one procedure room for tilt table tests, cardioversions etc. There is also a sixth lab available (currently a shelled space) when needed.
In total we have 28 staff members, 1 technical supervisor and 1 nursing supervisor. There are seven attending physicians, 10 fellows and 1 NP. In addition, six of the 13 techs are RCES or RCIS, and 12 of the 13 techs are graduates of an accredited program.

When was the EP lab started at your institution?

Our EP program was created 25 years ago by Dr. Fred Morady.

What types of procedures are performed at your facility?

We have an all-inclusive EP service, with a special focus on atrial fibrillation and atrial flutter cases.

Approximately how many are performed each week? What complications do you find during these procedures?

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.

Why did you choose to work in the field of electrophysiology?

I find cardiac electrophysiology to be intellectually stimulating with a very palpable procedural component. Much of the novel research in our field has fundamentally caused a paradigm shift in how arrhythmias are diagnosed and treated. It is difficult not to get caught up in both the excitement and controversy that surround the field today.

Describe your role as an electrophysiologist. What is a typical day like for you?

Background

La Porte Regional Health System (LRHS), a Clarian Health Partner, is comprised of La Porte Hospital, a 227-bed community hospital; La Porte Regional Physician Network, made up of 19 physician practices; and La Porte Hospital Foundation, a philanthropic arm that supports the health system. La Porte Hospital was the first hospital in northern Indiana to achieve Magnet™ recognition, an award that is given to an elite group of hospitals for exemplary nursing leadership and quality patient care.

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.

Lisa Fanning is the technician supervisor for Heart Rhythm Services (HRS) for the Mayo Clinic, located in Rochester, Minnesota. She supervises 17 RCIS/CVT personnel. She works with 22 physicians, 3 mid-level providers, and 34 RNs in the HRS practice. She also works directly with the secretaries, schedulers, materials management, and purchasing on a daily basis. Mayo Clinic operates five invasive and one non-invasive procedure rooms each day for the HRS practice.

Background

What type of schooling did you have to complete in order to get to your 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.

Case Presentation

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.

Tell us about the Canadian Heart Rhythm Society. When was it formed, and why?

The electrophysiology community in Canada has always been one of collegiality and close cooperation. In 2003, a group of Canadian cardiac electrophysiologists formed the Canadian Heart Rhythm Working Group to address uniquely Canadian issues in cardiac electrophysiology. As work proceeded, it became clear that there was an appetite for the creation of a formal society that would represent Canada’s heart rhythm community.

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!

New Questions:

EP Schools

I was wondering if someone can let me know if there are any EP schools other than the Carnegie Institute in Troy, Michigan? I live in upstate New York.
— Ross Scardino
(To reply to this question, please type “EP Schools” in your subject line.)

Operators

Do other EP labs have both nurses and RTs operate the EnSite ablation computers and the diagnosis EKG computers (like Bard), or are these usually operated by just the RTs?