How did your collaboration with Wilson Greatbatch begin? When was Biophan created?

There were a lot of early stage innovations, and in setting it up, a friend, Wilson Greatbatch, the National Medal of Technology Award Winner (from President Bush, Sr.), who invented the implantable pacemaker technology which was licensed to Medtronic in 1961 and who also invented the lithium iodine battery, had some new technology that we started working on together. We created what became Biophan Technologies to pursue the technology to find a solution to MRI safety. Wilson was very concerned that pa

Cardiac Resynchronization Therapy in Sinus Rhythm
Patients with dilated cardiomyopathy and uncoordinated left ventricular (LV) wall motion due to intraventricular conduction delay are at increased risk for decompensated heart failure, arrhythmias, and have higher mortality rates.¹

Infranodal conduction delay, most commonly in a left bundle branch block (LBBB) pattern, displays early activation of the septal wall. This is followed by delayed lateral contraction at higher stress and systolic stretch of the early-activated septum. The net result of reciprocal sloshing of bl

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

When was the EP lab started at your institution?

What types of procedures are performed at your facility?
We perform the full complement of electrophysiology procedures, from pacemaker and ICD implants, routine ablations, biventricular device implants and complex ablations, including atrial fibrillation ablation procedures.

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

The Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) study enrolled a total of 1,520 patients with New York Heart Association (NYHA) heart failure classifications III or IV, having ischemic or nonischemic cardiomyopathies, with a QRS width of at least 120 msec and an ejection fraction (EF) of 0.35 or less. The study hypothesis asked the question of whether prophylactic cardiac-resynchronization therapy with pacemaker or with pacemaker and ICD would reduce the risk of death and rate of hospitalization in patients with advanced heart failure. Subjects in thi

The management of the patient who presents with syncope begins with the history and physical examination and almost always includes an electrocardiogram (ECG) and echocardiogram. The initial step in diagnosis involves distinguishing cardiac from non-cardiac causes of syncope.

Cardiac Syncope
Cardiac causes of syncope include disorders of autonomic function, such as neurally-mediated syncope (e.g., vasovagal syncope, carotid sinus hypersensitivity), chronic orthostatic intolerance (i.e., postural orthostatic tachycardia syndrome [POTS]), and orthostatic hypotension (secondary to vo

New Question:

National Standards
We are sharing a new EP lab with the cath lab. We are in the process of converting the device implants from the OR to our lab. Some EP/cath labs are very strict regarding sterile technique practices. Others are less rigid. Is there a national standard regarding sterile technique practices and proper cleaning of an EP lab/cath lab that performs device implants?
L. Payne, RN, Dallas, Texas

Last month s questions under discussion:

EP Protocol
Does anyone have a current magnet protocol for ICDs? Our anesthesiology departme

Case Report
In a 70-year-old male patient with prior myocardial infarction and an ejection fraction of 25%, an ICD (Medtronic GEM DR 7275, Minneapolis, Minnesota) had been implanted due to spontaneous and inducible ventricular tachycardia while receiving amiodarone.

In the ventricular channel, the mean cycle length of the noise was 120 ms (500 bpm). The VF zone of the device was programmed at a cycle length < 330 ms. The noise was intepreted by the ventricular channel as ventricular fibrillation and a 15 Joules shock was delivered. There were no indications of lead or device dysfu

Questions:
1. What is the exact diagnosis of this tachycardia: description, mechanism?
2. What diagnostic maneuver or treatment could be initiated to determine the diagnosis?

Answers:

Question #1
The diagnosis is AV reentrant tachycardia using a left lateral accessory pathway and ipsilateral bundle branch block (BBB). The first part of the ECG shows a wide-QRS tachycardia at a rate of 192 beats per minute (BPM) and a left bundle branch block. The last part of the ECG is a narrow-QRS tachycardia with a rate of 212 BPM. Loss of BBB with acceleration of SVT is highly

Dear readers,
Information in the field of electrophysiology is constantly changing and being updated. I hope this month s articles will provide you with the information you need to help you better diagnose and treat the patients you see every day in the EP lab.

At this year s Heart Rhythm Society meeting in San Francisco, I had the opportunity to speak with Michael Weiner from Biophan Technologies, Inc. I hope you will have a chance to read this interesting interview, published in this month s issue. In the interview, we discuss Biophan s innovative technology,

Genaissance Pharmaceuticals Launches its Proprietary FAMILION Test for Genetic Mutations Associated with Sudden Cardiac Death
Genaissance Pharmaceuticals, Inc. announced the launch of its proprietary FAMILION Test a genetic test for cardiac channelopathies at Heart Rhythm 2004, the Heart Rhythm Society s 25th Annual Scientific Sessions. Cardiac channelopathies is a broad clinical category that includes Long QT (LQTS) and Brugada Syndromes, two causes of arrhythmia that can result in sudden cardiac death. The FAMILION Test: 1) Confirms the presence of mutations known to cause