Case Study #1: Incessant Supraventricular Tachycardia (SVT)
A two-month-old, 4.5 kilogram infant presented with incessant SVT and tachycardia-mediated cardiomyopathy. The patient required intubation and mechanical ventilation due to respiratory failure. Previous treatments, including medical therapy with esmolol, amiodarone, and procainamide, were unsuccessful. Resting ECG exhibited WPW-A, indicating a left-sided accessory pathway. Due to hemodynamic deterioration, the patient was taken for ablation.

Procedure. Single R IJV access was obtained using the Seldinger mi

The success of LV lead placement varies from 70-90%.^1-3 A lower success rate is typical for attempts during the operator s early experience, and even the experienced operator still encounters challenging anatomy. Failed implantation necessitates an additional surgical procedure for epicardial lead placement in 5-10% of cases; worse yet, in centers without an experienced or dedicated surgeon, it may lead to abandonment of CRT for that patient entirely.
One of the challenges that may lead to difficult or failed LV placement is CS cannulation, especia

What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab?
Our electrophysiology department consists of five dedicated invasive labs and three non-invasive labs. We have a sixth lab, which remains shelled for development at a later date. We have a total of 37 registered nurses, four patient care technicians, two inventory specialists, and a unit secretary on staff. Our nurses come from areas including open-heart recovery, ICU/CCU, the emergency room, and cardiac step-down. Each of them brings a unique skill set. We also have a

Adopting Remote Device Monitoring vs. Hiring Staff
At Cardiology Consultants, there is no such thing as a "typical day at the office." Our 26 physicians practice across the entire State of Delaware, as well as some rural areas of Maryland and New Jersey. Our clinic staff includes two advanced practice nurses (Rita Lucey, RN, MSN, APN, and myself), one registered nurse, three cardiovascular technicians, three electrophysiologists, and one administrative assistant. Rita and I jointly log approximately 330 miles a week within a 120-mile radius to cover all clinic patients. Certain days o

Dr. Shen and his colleagues at the Mayo Clinic conducted the Syncope Evaluation in the Emergency Department Study (SEEDS). The genesis of the study was based on the central question whether an area designated for syncope evaluation in the emergency department or a syncope unit could affect the diagnostic yield and the rate of hospital admissions for syncope patients with intermediate-risk profiles for a poor prognosis. The hypothesis was that a syncope unit equipped with diagnostic resources that target the common causes of syncope would improve the diagnostic yield and reduce the hospital admission rate compared to patients undergoing a standard work-up.

Causes of Syncope

Describe the role of the Alliance of Cardiovascular Professionals (ACVP). Approximately how many members are there currently?
ACVP represents 3000+ individuals involved at all levels and in all specialties in the cardiovascular arena. We have over 40 years of continuous service representing cardiovascular professionals across the globe. Our members practice in all areas including echocardiography, invasive, electrophysiology, noninvasive and cardiopulmonary. In fact, the EP area is rapidly growing. We also represent all levels of practice: administrators, managers, supervisors, nurses,

The physics of ICE are the same that are used for all applications of ultrasound. These include: 1) Mechanical waves with frequencies greater than 20,000 Hz; 2) Laws of sound wave reflection and refraction while crossing borders between materials of different densities; and 3) The application of miniaturized transducers and techniques that create images.
These images can then be displayed as M and B modes, with Doppler Effect (pulsed wave, continuous wave, or color flow imaging), and as three-dimensional reconstruction.
Two-dimensional ICE is the primary echo modality used in today s

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New Questions Under Discussion:

Establishing an EP Lab
Our hospital is a tertiary cardiac care center located in the southern part of Delhi, India. We are looking for established EP centers to help us in starting an EP lab and arrhythmia services at our center. Can you help?
V. Sharma, MD
(Readers, to reply to this question, p