Many approaches to AF ablation have been proposed over the past 5-10 years. Some of these are catheter-based, and some require surgery. Catheter ablation approaches have included pulmonary vein isolation and creation of linear lesions. Most prominent among the surgical approaches has been the open-chest approach of the Cox-Maze procedure.
Stroke from clots that form predominantly in the left atrial appendage (LAA) during AF has been one of the most feared outcomes of atrial fibrillation. Approaches to management of this problem have included anticoagulation and development of devices

Background
The patient is a 17-year-old male diagnosed with ventricular preexcitation since the age of 9. Initially he complained of only intermittent palpitations, but more recently demonstrated an adenosine-sensitive sustained supraventricular tachycardia (SVT). Although he was well-controlled on beta-blocker therapy, he was a competitive swimmer and preferred nonpharmacologic curative therapy.
He underwent diagnostic electrophysiology testing eight months prior to the curative ablation. This evaluation diagnosed a manifest posteroseptal pathway (Figure 1) and a concealed rig

What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab?
We have five cardiac catheterization labs, one of which functions as an electrophysiology lab. Our lab is staffed with registered nurses, radiology techs, and emergency medical technicians. Out of a staff of 36 people, five are core electrophysiology personnel.

When was the EP lab started at your institution?
Our EP program started in the spring of 1999.

What types of procedures are performed at your facility?
We currently perform EP studies

Summary of Recent Advisories
Medtronic, Inc. (Minneapolis, MN) issued a physician advisory letter in February 2005 regarding an increased risk of sudden battery failure in some of its ICDs in the Marquis family. This involved a shorting mechanism attributed to a specific battery design. Some devices were explanted, but the majority was followed closely. The initial response of the medical community was to exchange these devices; however, more patients were likely harmed by the explantation approach than helped by it. In our practice, two patients were referred from other centers for de

Not so very long ago, it was probably easier to win the lottery than qualify to get an implantable cardioverter-defibrillator (ICD). ICDs were considered extreme measures for the most desperate cases. As such, patients had to have survived not one but two documented episodes of sudden cardiac arrest, be drug refractory, but also be strong enough to be able to undergo a thoracotomy to implant the device. Somehow, some patients qualified and received devices!
However, the life-saving potential of ICDs was apparent to many physicians. The ICD world changed when a few committed physicians got tog

To understand where risk management is going, we need to appreciate its past. Historically, risk identification/ management was instituted in the corporate world in the 1940 s as a quality control technique. In the 1970 s, the nation faced a medical malpractice crisis, with a dramatic rise in the number of malpractice claims being filed and given staggering jury awards. The large awards affected professional liability insurance markets. Faced with potential bankruptcy, insurers either withdrew from the market or demanded heightened accountability in reporting and managing risks f

New Questions:

Licensed Personnel
Double-checking Certain Medications During Procedures
I work in a university-based hospital electrophysiology lab. We have a policy that requires 2 licensed persons to check certain medications prior to administration (e.g., heparin, insulin, chemotherapeutics, etc.) The policy arbitrarily states that these licensed practitioners may be a RN, MD, or resp. therapist. We would like to add the rad tech [RT(R)] as well. Frequently, during a late case, there may only be  1 RN, 1 MD, 1 rad tech and 1 CVT in the procedure room, and the MD would