The Gap Phenomenon

The gap phenomenon, sometimes confused with supernormal conduction, was first described in 1965 by Moe in dogs and later by Ahktar in humans as a condition in which premature impulses fail to conduct but conduction resumes with even earlier premature extrastimuli. The mechanism has been well studied and is related to the inherent electrophysiological properties of conduction tissue responsible for functional and effective refractory periods of the tissues involved. The effective refractory period is the longest premature coupling interval during fixed rate pacing that fails to activate tissue. The functional refractory period is the shortest coupling interval that can result in conduction after delivery of premature extrastimuli during a fixed rate pacing.

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 10 FTEs in the department: 5 Registered Nurses, 2 Radiology Technicians, 1 Cardiac Tech, 1 Data Coordinator and 1 Regional Manager. There are 3 cardiac electrophysiologists and 1 anesthesiologist at St. Mary Medical Center and St. Catherine Hospital. There are 10 cardiac electrophysiologists on staff at Community Hospital.

When was the EP lab started at your institution?

Focal atrial and ventricular tachycardias are common diagnoses encountered in the electrophysiology laboratory. Arrhythmia burden varies from rare or paroxysmal premature beats to sustained or incessant monomorphic tachycardia. Location of the arrhythmia foci can vary, and careful contact mapping is often required to precisely locate the focus. Unfortunately, catheter ablation may fail, even when the focus is endocardial. The spatial resolution of activation mapping or pace mapping may be compromised by limitations in the steerability or reach of conventional unidirectional or bidirectional ablation catheters. The tip of a conventional steerable ablation catheter held by the operator may swing or move away from the desired ablation point with respiration and normal cardiac motion. The pressure that can be applied to ablation catheters in order to improve contact is often limited by the risk of cardiac perforation.

Why was there a need for this new RCES credential? Tell us about how the exam was created. How will it help benefit those in the EP lab?
Two years ago we were approached by Dr. Seth Worley and Letitia Esbenshade-Smith, RCIS (both of Lancaster, Pennsylvania), who inquired about creating a credential for the EP technologist. They shared with us that Electrophysiology Technology is not a recognized profession and that hospitals are finding it difficult to hire and retain individuals qualified to work in this area. The lack of professional recognition also makes it difficult for hospital a

Title: Pacing the Octogenarian Plus Population (POPP): A Comparison of Physiologic Versus Ventricular Pacing in Those Who Are 80 Years of Age and Older
Number of Patients: 200
Trial Start Date: August 2003
Trial End Date: Expected completion in August 2009
Status: Recruiting
Purpose: Of the 19,000 pacemakers implanted across Canada in 2002, one-third of them were implanted in patients 80 years and older. Unfortunately, no study has specifically been done in this age group to determine the optimal pacing mode. This purpose of this study is to determine which pacing mode, physiologi

New Question:

Roles in EP Lab
I have two questions. We are having trouble in our lab hopefully you can help me out. We have three labs, and will be getting our fourth. One of our three labs is an EP lab. We have 3 RTs, 1 RN and an EP coordinator, who is also an RN. How do you handle call time, and what is the role of the coordinator?
anonymous
(To reply to this question, please type Roles in EP Lab in your subject line.)

Under Discussion:

Back-up Defibrillator for EP Lab (Second Defibrillator)
A question that continues to be brought up in our

The AFib Summit, held during the Heart Rhythm 2007 Annual Scientific Sessions, May 9-10, in Denver, Colorado, featured world-renowned experts who presented the latest in the diagnosis, management, drug therapy, outcomes, and ablation techniques for atrial fibrillation (AF).

Sessions during the AFib Summit covered the following topics: AF mechanisms; clinical outcomes of AF ablation; new generation imaging for ablative interventions; facilitating good outcomes and avoiding bad ones; anti-thrombotic, anti-arrhythmic, and anti-inflammatory drug therapy for AF; how to perform ablative intervention; special considerations for non-pharmacologic therapies; and the means by which to pull it all together.

The Electrophysiology in the West Summit (or EP in the West Summit) brings together a nationally-known group of experts in electrophysiology in a retreat-like, historic setting on the Northern California coast. The Summit will be held from November 30 to December 2, 2007, and will present the latest advances in state-of-the-art cardiac electrophysiology in a setting that provides an opportunity for extensive discussion and interaction with the faculty and others interested in the field. The target audience includes cardiac electrophysiologists, arrhythmia nurses and technicians, and cardiologists and internists with special interest in arrhythmias. Special tracks are designed to meet the needs of each group of attendees. During the course of the two and a half day program, attendees will gain a better understanding of the advances in the field of arrhythmias, and be able to apply this information to their practices.

Cardiovascular imaging presents as a landscape of multiple maturing technologies, developed through billions of dollars of research and decades of dedication by both industry and clinicians to create diagnostic tools capable of revealing many of the elusive characteristics of cardiovascular disease. So powerful are these tools that they have become integral in the clinician s diagnostic armamentarium.^1-7 For the uninitiated, echocardiography is the utilization of ultrasound to view cardiopulmonary and the major thoraco-abdominal vascular structures and obtain structural, hemodynamic and perfusion parameters of the heart and great vessels.

What is the purpose of the STOP AF trial? Describe the trial objectives.