EP Lab Digest Current Issue

Project Pacer International Brings Cardiac Electrophysiology to East Africa

admin — Mon, 28 Jun 2010 09:47:19 -0400

Project Pacer International, a nonprofit Boston, Massachusetts based organization that is dedicated to the provision of cardiac therapy to indigent patients in the developing world, recently completed its first visit to Nairobi, Kenya. Project Pacer International was founded in 1988 and has a long track record of providing pacing and electrophysiology services (as well as interventional cardiology) in the developing world.

Our main focus in the last 20 years has been in India and South America. In Bolivia, where Chagas’ disease is endemic and the need for pacing therapy is substantial, we have developed a close relationship with local cardiologists and now have an active practice of more than 200 patients with implanted devices.¹ Recently, however, we have broadened our horizons to include Morocco, and now Kenya.

ICDs in the Young: A Challenge for Physicians, and an Even Greater Challenge for Patients and Families

admin — Mon, 28 Jun 2010 10:27:13 -0400

For those who have had the privilege of caring for children and young adults with life-threatening heart disease requiring ICD implantation, you are well aware that much of the emotional impact of the ICD occurs after device placement.

Pediatric ICD implants account for less than 1% of devices; how- ever, with advancements in device technology, increasing genetic testing availability (potentially increasing the number of primary prevention implants) and increased longevity of young adults with congenital heart disease, the number of pediatric and young adult patients with ICDs is growing substantially.

“Can someone come turn off Mr. Smith’s pacemaker? He just found out he has terminal cancer.”

admin — Mon, 28 Jun 2010 10:45:34 -0400

Dear Readers,

Spotlight Interview North Mississippi Medical Center Heart Institute and Atrial Fibrillation Center

admin — Mon, 28 Jun 2010 11:30:51 -0400

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

At North Mississippi Medical Center (NMMC) we have two large EP rooms that are staffed with six RNs, three techs and three electrophysiologists. The EP lab is located in our hospital’s Heart Institute.

When was the EP lab started at your institution?

The lab opened in 1998.

What types of procedures are performed at your facility? Approximately how many are performed each week?

Last year we performed: 49 pulmonary vein isolation and atrial fibrillation (AF) ablations; 57 SVT ablations; 93 atrial flutter ablations; 90 AVN ablations; 2 ventricular tachycardia ablations; 56 EP studies; 382 pacemaker implantations; 173 ICD implantations; 63 biventricular pacemaker implantations; 145 biventricular ICD implantations; and 15 implantable loop recorder implantations.

Cardiac Resynchronization Therapy: Tips for a Successful and Safe Procedure

admin — Mon, 28 Jun 2010 12:18:53 -0400

Cardiac resynchronization therapy (CRT) improves symptoms, quality of life and reduces hospitalization in patients with New York Heart Association (NYHA) class III-IV classification and left bundle branch block.1,2 Inaddition,implantation of a CRT system with or without defibrillator reduces mortality in this patient population.3,4 More recently, CRT was shown to reduce heart failure progression and induce left ventricular reverse remodeling in patients with NYHA class I and II symptoms.5,6 In this article, we will review the techniques used at Emory University Hospital Midtown for CRT implantation as well as tips for a successful and safe procedure.

Implant Techniques

Venous Access

10-Minute Interview: Dr. Lynne Hung

admin — Mon, 28 Jun 2010 12:30:16 -0400

Dr. Lynne Hung is a cardiac electrophysiologist with Mission Internal Medical Group in MissionViejo, California.

Tell us about your medical back- ground and how you came to work in the field of electrophysiology. What interested you about this field?

Calendar of Events

admin — Mon, 28 Jun 2010 12:50:19 -0400

♥ July 15–17

Third Annual Cardiovascular Interventions: Head-to-Toe Meeting
Location: Napa Valley, California
Website: www.h2tmeeting.org/

♥ July 18–21

PICS-AICS 2010
Location: Sheraton Chicago, Chicago, Illinois
Website: www.picsymposium.com

♥ July 24–27

15th Annual World Congress on Heart Disease
Location: Vancouver, British Columbia, Canada
Website: www.cardiology online.com/wchd10/WCHD_ index.htm

♥ August 21

2nd Annual Percutaneous Catheter Ablation of Atrial Fibrillation: How to Incorporate this Therapeutic Option into Your Practice
Location: Hilton La Jolla Torrey Pines, San Diego, California
Email: www.med.edu@ scrippshealth.org
Website: http://www.scripps.org/ events/percutaneous-catheter- ablation-of-atrial-fibrillation

♥ August 28 – September 1

ESC Congress 2010
Location: Stockholm, Sweden

Endocardial Ablation of Hemodynamically Unstable VT: A Strategy Targeting Late Potentials Using a Closed- Irrigated Catheter

admin — Tue, 29 Jun 2010 09:16:09 -0400

Ablation of ventricular tachycardia (VT) is one of the most challenging procedures in electrophysiology. Patients with scar-mediated reentrantVT have systolic dysfunction and frequently have multiple co-morbidities and end-organ dysfunction. Additionally, multiple morphologies are often inducible from a single substrate and the majority of VTs are hemodynamically unstable. These characteristics lead to long procedure times and variable success rates. We report a case of endocardial ablation of hemodynamically unstable VT and our strategy for targeting late potentials by using a closed-irrigated catheter.

Case History

Sinus Node Modification in the Treatment of Inappropriate Sinus Tachycardia: A Clinical Update

admin — Tue, 29 Jun 2010 10:00:18 -0400

Inappropriate sinus tachycardia (IST) is a clinical syndrome defined by an increase in sinus rate out of pro- portion to physiologic needs. It is an under-appreciated etiology of persistent tachycardia often misdiagnosed as anxiety or atrial tachycardia. Prior reports of radiofrequency catheter ablation have demonstrated only moderate long- term success rates with risks of significant damage to the sinus node requiring treatment with a permanent pacemaker. Recent advances that allow real-time 3D mapping of atrial activation have allowed more precise localization of sinus pacemaker cells causing early activation possibly allowing for increased efficacy and safety profile for catheter ablation in the management of IST. We report a case of long-standing IST treated with sinus node modification utilizing St. Jude Medical’s EnSite non-contact mapping and Array catheter, allowing for ablation of three distinct sites of early atrial activation.

New Opportunities in Simulated Lead Extraction: Interview with Steven P. Kutalek, MD

admin — Tue, 29 Jun 2010 10:26:18 -0400

In this interview, Dr. Kutalek talks with EP Lab Digest about his initial experience using Spectranetics’ new advanced laser lead extraction simulation system. Dr. Kutalek is the Director of Clinical Cardiac Electrophysiology at Hahnemann University Hospital and Associate Professor of Medicine at Drexel University College Medicine in Philadelphia, Pennsylvania.