John Messenger, MD, is the medical director of the Cardiac Care Unit (CCU) at MemorialCare Heart and Vascular Institute. In this interview he describes his use of the AngelMed Guardian® system at Long Beach Memorial Medical Center, as well as his involvement in the ALERTS clinical study. The AngelMed Guardian system, which is currently available for investigational use only in the U.S., is an implantable cardiac monitoring and alerting system designed to warn cardiac patients of potentially life-threatening heart conditions.

Explain how the AngelMed Guardian System works. What are the components of the system?

The authors describe a case in which a permanent pacing lead was actively fixated into the middle cardiac vein of the coronary sinus — an infrequent but potentially serious complication of permanent pacemaker lead implantation.

Case Report
An 84-year-old male presented with a history of ischemic cardiomyopathy (EF 35%), congestive heart failure (CHF), coronary bypass grafting, and non-sustained VT suppressed by TIKOSYN (Pfizer, New York, NY). The patient had a transvenous internal cardiac defibrillator (ICD) system (EnTrust D154ATG, atrial lead CapSureFix model 5076, right ventricular defibrillation lead Sprint Fidelis 6949; Medtronic, Minneapolis, MN) inserted for primary prevention in March 2006 at another institution, which monitored the patient and device post discharge. Out of concern for diminishing R-waves, a 1388T pace/sense lead (St. Jude Medical, St. Paul, MN) was implanted in the right ventricular apex (RVA).

Dear Readers,
What is the difference between a “medical test” and a “diagnostic procedure”? According to Wikipedia,[1] “a medical test is a kind of medical procedure performed to detect, diagnose, or evaluate disease, disease processes, susceptibility, and determine a course of treatment.” However, physicians do not use the terms “test” and “procedure” interchangeably. The word “procedure” usually implies something invasive. But what is the definition of invasive?

The Salem Cardiovascular Center electrophysiology lab, located at Salem Hospital in Salem, Oregon, serves more than 360,000 people in a two-county region, and more from the Pacific coast to the Cascade Mountains. EP patients benefit from low employee turnover, new state-of-the-art facilities and award-winning cardiac care.

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

In this interview with Dr. Xiaoke Liu, Director of the EP lab at Borgess Medical Center, he describes his experience using the new ZeroGravity Radiation Protection System (CFI Medical Solutions, Fenton, MI). Unlike conventional lead aprons and their equivalents, the ZeroGravity system is a new option for radiation protection.

Describe the components of the ZeroGravity Radiation Protection System. How is it worn?
There are 2 components. The first is the base unit that resembles a crane. It supports and allows the second component, the radiation protection suit, to move around. The system can also be mounted on rails on the ceiling. The other component is the suit that is attached to the base through a cable and is made up of leaded glass and apron. The operator is connected to the suit through a light, magnetic vest that the operator wears.

From LinkedIn: Right-Sided EPS
Is there data to support right-sided EPS/ablations without a Heparinized Saline flush to the sheath's sideport?
— C. Reoch, RCIS,CEPS

Staffing Practices
We are surveying labs throughout the country for feedback regarding staffing practices. How many staff members are required to perform procedures? What is the role/function of each person? Have you ever performed procedures with less than a full team (as defined by your institution)?
— C. Levine, RN, BSN, MA

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Tell us about the completion of the TRUST trial (Lumax-T/Lumos-T Safely RedUceS RouTine Office Device Follow-Up). What did final results show?
Post-implant monitoring is an essential part of the management of patients receiving implantable cardiac electronic devices but optimal method is uncertain. The TRUST trial tested and compared conventional monitoring with in-person evaluations to continuous remote Home Monitoring technology in a large patient population with freshly implanted ICDs. This is the first and largest study to test the ability of remote monitoring to maintain comprehensive surveillance and reduce unnecessary hospital evaluations, yet permit rapid detection of symptomatic and asymptomatic cardiac events in patients with implantable heart pacing and arrhythmia devices.

In this article, the authors from Bryan LGH Hospital’s EP program discuss their participation in the Medtronic HEARTmark benchmarking program.

Long recognized as one of the premier electrophysiology (EP) services in the Midwest, the EP program at Bryan LGH Hospital performs over 700 EP procedures each year, from device implants to complex ablations. Bryan’s EP program credits its success and growth to a staff committed to identifying innovative methods to foster growth and improve quality. It was in this context that Bryan’s EP program joined HEARTmark®, Medtronic’s proprietary national EP benchmarking program, in 2008 and used it as a springboard for performance improvement.

Benchmarking Trends in EP

In this article the authors describe their use of Precedex in the lab during ablation cases. By adding Precedex to their moderate sedation protocol for these extended cases, they have been able to increase patient comfort and significantly decrease the amount of midazolam and fentanyl used, reducing the risk of respiratory depression. Read more about their experience here.

Background

New research in the Journal of the American College of Cardiology showed that survival rates with a wearable cardioverter-defibrillator (WCD) vest were comparable to that of an implantable cardioverter defibrillator (ICD).[1] In this interview we learn more about the study from lead author Mina K. Chung, MD from the Cleveland Clinic.

What was the purpose of this study? What prompted this study?
The reason we wanted to look at this was to see if the WCD really worked. Unlike implantable ICDs that don't require patient input to function, the WCD requires a patient to actually wear the vest for it to work. We were also interested in looking at how effective it was for terminating arrhythmias, and whether it could be as effective as an implantable ICD, since we use it for patients we consider at potential high risk for sudden death.

How many patients participated in the study? Which type of wearable cardioverter-defibrillator was utilized?