Practical Electrophysiology: A New Resource for the EP Lab Professional

What prompted you to write this book? Electrophysiology is expanding in leaps and bounds. More and more implantable defibrillators and catheter ablation procedures are being performed each year. In order to keep up with these developments, it is important to educate and inform the myriad of EP lab staff members, vendors, cardiology fellows, internists, cardiologists, as well as electrophysiology fellows. However, most of the educational materials in the field of pacing, defibrillators, and catheter ablation have been geared towards the electrophysiologist-physician scientist. Therefore, there was a real need to provide an educational resource that would be very easy to read with respect to all aspects of electrophysiology. Who is this book geared towards? For example, what information is provided for radiologic technologists in particular? As stated in the overview for the textbook, the purpose of this book is to introduce a new EP staff member to the field of the electrophysiology, the electrophysiology laboratory, and the variety of procedures performed in the laboratory. In particular, this book is good for nurses, physician assistants, nurse practitioners, and EP/radiology technicians, though it may also be particularly useful for cardiology fellows during their initial rotation on the electrophysiology service. This book will also serve as an introductory educational for the novice catheter and pacemaker-defibrillator sales representative or engineer. In addition, it may be a useful resource for internists, family practitioners, and cardiologists. It may even serve as a useful introduction and review for EP fellows prior to diving deeper into the field of electrophysiology. In particular, with respect to your question on the radiologic technologist, this book provides information related to radiation protection. In fact, there is an entire chapter devoted to this particular question. In addition, our radiologic technologists participate in many EP areas including inventory management. Inventory management tools (including a checklist) are provided in the book. The radiologic technologist s role as a member of the EP team is also described in detail in our chapter on the members of the EP team. How are the chapters organized? What are the subjects covered in this book? The chapters are organized into four major components: Part I: Introduction to Electrophysiology Part II: The Electrophysiology Study and Basic Arrhythmias Part III: Implantable Devices Part IV: Administration Finally, there is an Appendix containing some key information related to lab inventory, ACT monitoring, discharge instructions, etc. This book covers most of the key topics that are necessary for understanding electrophysiology studies, radiofrequency catheter ablation, complex mapping procedures, implantable devices including pacemakers, implantable cardioverter-defibrillators, and biventricular implantable devices. In addition, the essential anatomy and cardiac action potential background is supplied. The book orients the reader to the modern electrophysiology laboratory, mechanisms of arrhythmias and pharmacotherapy. Finally, issues that have not been well addressed previously in literature, including preoperative and operative management of patients, as well as the various components of the EP lab and team, are also discussed. ICD coverage is the hot topic in EP right now, especially since Medicare has expanded reimbursement. What other information is given about ICDs in this book? The ICD component of Practical Electrophysiology is well described in the book. First, the critical contributions of Drs. Morton Mower and Michel Mirowski in developing the first implantable cardioverter-defibrillator is discussed in the History of Electrophysiology chapter, as well as the numerous advancements since their discovery. Subsequently, in the chapters related to ventricular tachycardia, implantable cardioverter-defibrillators, and cardiac resynchronization therapy, those subjects are covered in detail. Specifically, the current indications for implantation of these devices, both standard implantable cardioverter-defibrillators and biventricular devices, are discussed and highlighted in table format. Second, the variety of devices, the particular trials that led to the expansion of indications for their implantation, and their appropriate function and features, are also discussed. The implant approaches, techniques and potential complications are described. In addition, each of the major manufacturers implantable cardioverter-defibrillator devices as well as biventricular devices are discussed. The book incorporates the latest advances in implantable technology by Guidant, St. Jude Medical, and Medtronic. Wireless ICD technology and implantable hemodynamic monitoring systems incorporated into these devices are also discussed. Finally, the role of the vendors as well as their contact information are included along with some future potential implantable devices and applications. One chapter is dedicated to hereditary conditions and sudden death. How is genetic research and testing transforming the treatment of these conditions? Genetic research has made tremendous advances. Particularly, genes have been isolated that relate to long QT syndrome, Brugada syndrome, and arrhythmogenic right ventricular dysplasia. Blood tests are now available for testing for genetic conditions related to the HERG gene and the SCN5A gene. In addition, centers have been developed to help screen family members in order to prevent sudden death. At Winthrop University Hospital, we are in the process of setting up a sudden death prevention center specifically geared towards screening, diagnosis, and treatment of these conditions. The last chapter features an overview on future electrophysiology. What are some advancements in EP you think we will see in the future? Electrophysiology continues to grow at an exponential pace. Some of the recent promising components are discussed in the Future of Electrophysiology chapter. In that chapter we discuss a myriad of innovations related to facilitating and improving catheter ablation techniques as well as implantable devices. First, robotic systems are being developed by a number of companies (Stereotaxis, St. Louis, Missouri; Hansen Medical, Inc., Mountain View, California; and Cardiac Inventions Unlimited, Inc., Port Washington, New York). Each system, in different stages of development, utilizes different technology for facilitating a remote manipulation of EP catheters. The Stereotaxis System uses specially-designed EP catheters and magnetic guidance to help manipulate the catheter remotely. The Hansen Medical System employs a steerable sheath that can be remotely manipulated using a motion controller. The Cardiac Inventions Unlimited System employs a catheter feeder, handle control device, and controller that may permit the delivery of standard EP catheters without utilizing a specially-designed steerable introducer sheath. Overall, I envision robotics as playing a major role in the delivery of complex EP procedures and even perhaps device implantation techniques in the near future. Similarly, device expansion including four-chamber systems, the application of hemodynamic sensors into implantable defibrillators and biventricular devices and remote device management with wireless/Internet technology will be an important future component. In addition, we have seen investigation into biatrial pacing and biventricular pacing, and the prospect for four-chamber systems remains a distinct possibility. Some of the devices discussed in the book that are undergoing investigation include a nonvascular implantable defibrillator system (Cameron Health, Inc., San Clemente, California) and the OPTIMIZER III (Impulse Dynamics N.V., New York) device, which might possibly be useful to improve cardiac performance specifically in patients with a narrow QRS complex. The latter is accomplished via non-excitatory stimulation in the ventricular refractory period of patients, who have congestive heart failure. In addition, books such as Practical Electrophysiology, with their ability to educate EP staff and vendors, will help facilitate the rapid growth of the field of electrophysiology. What unique features of this book make it different from other EP books on the market (for example: checklists, discussion of roles in lab, case reports with photos, etc.)? Presently, there is no book providing all the functions that are accomplished by Practical Electrophysiology. First of all, it is written in a very straightforward and simplistic manner that can be understood by the novice device/catheter salesman, nurse, physician assistant, and radiologic technologist. It is also useful for the cardiology fellow in that they can get a lot of information very quickly in a relatively short and concise chapter covering key topics which may be found on board examinations related to internal medicine and cardiology. In addition, all the latest indications are highlighted in very clearly written tables in the appropriate chapters. For example, the indications for permanent pacemaker implantation, ICD implantation, and cardiac resynchronization therapy are boldly highlighted in their respective chapters. All the figures are very clear and concise with book being extremely well illustrated throughout. I am very happy with the beautiful artistic images that were created by HMP Communications artist team, the photographs provided by the various manufacturers of their associated catheters and implantable devices, as well as the images I obtained during actual electrophysiology procedures. The book also includes appropriate case reports and examples, and takes from some key cases related to ventricular tachycardia ablation, as well as accessory pathway ablation in patients with Wolff-Parkinson-White syndrome. The book also includes some very useful components such as a preoperative checklist that we found to be very helpful in assuring that patients are ready for elective EP procedures. In addition, we include a copy of our patient discharge instructions as well as an inventory management checklist with appropriate par levels. Lastly, an ACT form is also available for recording anticoagulation administration and ACT surveillance during EP procedures. The images of all the current and latest devices related to catheter ablation as well as implantable devices are beautifully photographed and illustrated in the textbook. You are a frequent contributor of general articles as well. Have you always been interested in writing? I was interested in both writing and creating. Since high school, I have enjoyed participating in research, developing new technologies, and writing about these experiences. I am mainly interested in scientific writing; however, I also enjoy editing, drawing, painting, and teaching. Which projects are you working on next? Related to Practical Electrophysiology, I have currently begun work with HMP Communications with respect to webcasts getting the message out related to all the key issues of electrophysiology. With the expansion of implantable devices to the cardiology community, there is a real need to educate the community on these devices. Presently, we are planning a series of webcasts covering some (if not all) of the key topics that are included in Practical Electrophysiology. This book will eventually be available in other languages besides English, to assist in global EP education. I am at present considering a Practical Electrophysiology workbook. In addition to this, I am very excited about my company, HeartPass, Inc., which allows cardiac patients to have their critical heart information available anytime anywhere via the web. I have also helped to develop an EP Robotic System that can remotely drive and control standard EP catheters. I hope to continue to contribute to the things that I like the most, which include inventing, writing, and teaching. Is there anything else you would like to add? I would like to thank HMP Communications for all the great opportunities that they have provided me. It had been a real pleasure to work as the Section Editor to the Electrophysiology Corner for the Journal of Invasive Cardiology as well as the Editor-in-Chief of EP Lab Digest. I have certainly enjoyed all the support of the people who have been involved with the publication of Practical Electrophysiology as well as HMP s other cardiac journals. Specifically, I would like to thank Jeffrey Martin, Alex Slonim, Jodie Elrod, Laurie Gustafson, and Richard Shaw, PhD. These individuals have helped motivate me to continue to provide an education to the EP community. Their enthusiasm helped to make Practical Electrophysiology a reality.