The Electrophysiology Laboratory at St. Joseph's Hospital Health Center in Syracuse, New York has been using dexmedetomidine (Precedex) for sedation of atrial fibrillation patient for the past three years. Our medical director, Dr. Ali Al-Mudamgha, began performing atrial fibrillation ablations in the Spring of 2003. Dr. Al-Mudamgha uses the Pappone method of circumferential pulmonary vein ablation. Our Electrophysiology Laboratory is dedicated to electrophysiology procedures; implants are performed in the operating room. The staff consists of one nurse manager, three staff nurses and one administrative assistant. St. Joseph Hospital has strict policies regarding moderate sedation. Registered nurses must complete a moderate sedation inservice and maintain yearly competency. Sedation nurses may then administer midazolam, Fentanyl, Demerol and morphine, under the physician's direction.

I read that this Heart Fair was your concept. Why was it important to organize such an event? The Heart Fair idea was started by Medtronic, who offered to bring their training truck to Marin General. This truck offers virtual training opportunities to physicians to practice implanting pacemakers and defibrillators in a simulated environment. I have always wanted to plan a community service to raise the public awareness of the problems of congestive heart failure, sudden cardiac death and atrial fibrillation, as well as the latest therapies available for these conditions. I already had plans for two campaigns: Do You Know Your EF?

Sacred Heart Medical Center, located 110 miles south of Portland, in Eugene, Oregon, is the largest hospital between Portland and San Francisco (432 beds), serving as a regional referral center and the only level II trauma center in the region. What is the size of your EP lab facility and number of staff members?

With the growth of cardiovascular services at our medical center and the May 2006 opening of a new 200,000 square foot, five-floor facility, it was important that our organization optimize the purchase and utilization cycles of high-cost catheterization equipment to ensure successful quality, financial and operational outcomes. As an organization with a vision of providing World Class Care in our Communities, efficiency and cost containment are part of the ingredients for providing the best possible patient care. Identifying the Challenges Our first step was to identify the main challenges facing the catheterization labs. A small committee made of managers, staff, the information systems manager and the financial director was convened. After completing an operational and financial analysis, the committee identified these primary issues.

Recurrent unexplained syncope and presyncope comprise approximately 1 - 6% of emergency room and approximately 1% of hospital admissions.^1,2 The estimated incidence of self-reported syncope is 6.2 per 1,000 person years in the Framingham study.³ The overall incidence is approximately 3 - 6% over 10 years, and in a select group of patients, the prevalence of syncope could reach almost 50%.⁴ A symptom-rhythm correlation is often difficult to obtain during spontaneous episodes because of the sporadic, infrequent and unpredictable nature of syncope.¹ A significant percentage of patients referred for Holter monitoring, tilt-table test and electrophysiology study have inconclusive results. In addition, many of these patients also have a negative neurological workup.

The Technology and Device The Optimizer technology is based on a new concept of treating heart failure known as Cardiac Contractility Modulation (CCM). Cardiac Contractility Modulation is a method for treating failing hearts in which non-excitatory electrical impulses are delivered to the heart during the absolute refractory period (ARP). Unlike signals generated by other cardiac devices (i.e., pacemakers), CCM signals do not initiate a heartbeat or action potential. Traditional pacing signals are delivered during the "excitatory" period of the cardiac cycle and are able to initiate a new heartbeat. In contrast, CCM signals are intended to modify heart cell function in a manner that affects the contractility of the heart muscle and strengthens the muscular contraction.

What prompted your move to Children's Hospital of Atlanta (CHOA)? The cardiology program at Children's Healthcare of Atlanta Sibley Heart Center is an expanding, exciting group in a dynamic big city. The opportunities for clinical research and busy clinical service were very inviting. How did you get into the field of pediatric electrophysiology (EP)?

Under Discussion: Recycling Platinum Tips I am a new Nurse Manager to the Cath/EP lab, and one of my staff brought to my attention that we could possibly recycle the platinum tips off of the catheters and get some money back for our hospital. Does anyone know anything about this, as far as who do you send them to, as well as the steps involved in doing it?