With the advent of the Stereotaxis remote catheter navigation technology (Stereotaxis, Inc., St. Louis, Missouri), we saw an opportunity to improve our ability to perform complex ablation procedures while maximizing the capabilities of an advanced 3-D mapping system. By reducing the risk of catheter perforation, limiting fluoro exposure and improving accuracy, these two systems provide a unique marriage of capabilities for our EP lab. A Simple, Straightforward Combination We began using the two systems together in January 2006, when the Stereotaxis catheter was approved for use. Both the EnSite Array non-contact catheter and EnSite NavX navigation and visualization technology have been in use at the Minneapolis Heart Institute/Abbott since the products were available. The EnSite System and Stereotaxis have worked together seamlessly from day one, providing a great union of clinical accuracy, improved safety and procedural efficiency.

Why was it important for the medical community to clarify sudden cardiac death (SCD) from heart attacks?

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

Over the past decade, there has been a concerted effort by health professionals, industry, and the government to reduce sudden cardiac death (SCD) caused by ventricular arrhythmias. One of the major milestones in cardiovascular disease has been the realization that an implantable cardioverter defibrillator (ICD) can significantly reduce mortality in a select group of patients.^4,11 We now know from multiple randomized controlled trials that patients with a reduced ejection fraction (EF), prior history of cardiac arrest, and heart failure symptoms are at highest risk from a fatal ventricular arrhythmia.^5,6,12 Furthermore, the duration of disease increases the risk of sudden cardiac death.^12,13 Unfortunately, the method of risk stratifying patients for ICDs is neither 100% sensitive nor specific. As a result, some patients may have ICD implantation without any subsequent life-threatening arrhythmias.

Children's has been named one of the Top 100 Learning Organizations annually by Training magazine since 2002. In addition, by treating nearly 30,000 children every year, Children's Sibley Heart Center has garnered national recognition for innovative treatments, leading-edge research, and compassionate care. In 2005, the Children's Sibley Heart Center was named one of the country's top four pediatric cardiac programs by Child magazine for the second survey in a row. The Cardiology Fellowship program at the Children's Sibley Heart Center continues to grow and expand its ability to offer young cardiologists from around the world a unique training experience at one of the nation's premier pediatric cardiology programs.

The official advice has always been, no MRI if your patient has an implantable pacemaker or defibrillator. Although it is still recommended that such patients not undergo MRI, two recent studies have suggested that MRI could be possible, if the scan is absolutely necessary. Nazarian et al looked at 68 MRI studies in 55 patients with a device.¹ They excluded patients with older devices that might be more prone to failure with an MRI. The authors found no significant changes in the device with the MRI (including 29 thoracic MRI studies right over the device). Sommer et al looked at 82 patients with fairly new Medtronic pacemakers who underwent MRI scans (most were brain MRIs), and none had long-term damage to the pacemaker.² In both studies, the authors carefully monitored the patients during MRI and tried to limit the MRI scanning time.

New Questions: Pay Scale Differences Since the EP/Cath lab is a multidisciplined venue, we have a multi-talented group that consists of a variety of different credentialed personnel. I would like to recruit answers/input from the EP Lab Digest readers to my question: What is the pay scale(s) or pay ranges for CVT, RCIS, RCIS, and RNs? For example, here is the approximate pay scale we have at our institution: RN: $29.00 - $32.00; RCIS: $25.50 - $28.50; CVT: $23.50 - $25.50; On call: $4.00 per hour. Patricia C. (To reply to this question, please type Pay Scale Differences in your subject line.) Competency in the EP Lab Can anyone give suggestions on how to start a competency program in the EP lab?

Describe CardioOptics' SiteSeekir technology. What types of procedures can it be utilized for? CardioOptics developed a fiberoptic catheter that allows direct vision inside the heart. It uses a laser beam, filtering out a certain frequency of the spectrum (red), thus allowing visualization of the heart structures through blood. Currently this technology has FDA approval for cannulation of the coronary sinus, but new applications (visualizing the Fossa Ovalis for transseptal puncture or the pulmonary veins) are conceivable. How many cases has the SiteSeekir technology been used on so far at the Cleveland Clinic? Also, when was the first procedure using the SiteSeekir technology performed at your institution?