Changing Electrophysiology Climate: Taking the Field to a New Level

Todd J. Cohen
Todd J. Cohen
ecent advances in electrophysiology have led to an expansion in the fields of electrophysiology. In order to compete in this ever-changing environment, I felt it necessary for our program to take electrophysiology to a new level. What is the new level and bar raised by the EP community? Certainly, the electrophysiology study and simple device implants have become almost mundane in the year 2003. In order to take electrophysiology to a new level, one must be performing all the latest and greatest techniques. However, what are these techniques? First, the hottest technique currently being explored by advanced electrophysiologists at university centers is radiofrequency catheter ablation of atrial fibrillation. This may be perceived as a new frontier in which electrophysiologists must perform a transeptal method in order to isolate the pulmonary veins. In our laboratory, this is an anatomic procedure in which we identify the pulmonary vein ostia, place a lasso outside the ostia and circumferentially ablate around the pulmonary vein. During this procedure, we use three-dimensional mapping to minimize the radiation exposure, and then proceed and isolate all pulmonary veins. Second, in 2003, one must be able to offer cardiac resynchronization therapy/biventricular pacing defibrillation. In order to perform this technique, one must be able to access the coronary sinus and place a left ventricular lead effectively without consuming the bulk of time in the electrophysiology laboratory. The volume of the device implants in our EP lab, which encompasses biventricular pacing, is increasing on a monthly basis. During our first year of biventricular pacing, we achieved approximately 50 implants, most of which occurred in the last few months of 2002. We are in the process of quantitating our success rate with this technique and our outcome. The majority of our patients appeared to benefit from these devices, and we had significant success placing the transvenous leads without requiring a thoracic surgeon (only necessary in one case). Third, for many years, we have been sending complex infected pacemakers and/or defibrillators that require lead extraction to a center of excellence. The center had the ability to extract the infected pacing and defibrillator lead with the use of a laser lead extraction system. Through the philanthropy of our hospital and patients, we were able to obtain such a system and began performing such procedures. We have already performed two such procedures successfully and have not had the necessity of sending such cases to another institution. In closing, we must stay at the top of our game in electrophysiology, in order to remain a competitive center and provide the latest and greatest techniques with excellent outcomes. We are doing this at Winthrop University Hospital and are excited about the prospects for the future.