Establishing AF Care Within St. Luke’s Regional Medical Center

Tonja LaDue, RCIS, MBA, Regional Director, Heart & Vascular Services, St. Luke’s Regional Medical Center, Boise, Idaho
Tonja LaDue, RCIS, MBA, Regional Director, Heart & Vascular Services, St. Luke’s Regional Medical Center, Boise, Idaho

As the only Idaho-based, not-for-profit health system, St. Luke’s Health System is a part of the communities we serve. Each St. Luke’s Health System hospital is nationally recognized for excellence in patient care, and St. Luke’s Regional Medical Center’s EP services are consistently rated among the best in the country. For the fourth consecutive year, St. Luke’s was ranked in the 50 Top Cardiovascular Hospitals by Truven Health Analytics. Nestled within St. Luke’s Health System is the St. Luke’s Regional Medical Center EP laboratory as well as our new outpatient Heart Rhythm Center, which includes our Center of Excellence for Atrial Fibrillation.

EP services originated inside St. Luke’s Regional Medical Center’s cardiac catheterization lab in 1991. In May 2004, a standalone EP laboratory was constructed. At that time, device implantation was the primary procedure performed in the lab. With the recruitment of additional electrophysiologists, we now perform a high volume of ablation procedures as well. The second EP lab was developed in early 2013 inside the cardiac cath lab, and the dedicated Heart Rhythm Center, including the Center of Excellence for Atrial Fibrillation, opened later in December 2013. 

The Heart Rhythm Center allows our electrophysiologists to centralize the outpatient care of our patients to one convenient location within a couple of blocks of the hospital. This comprehensive center provides monitoring services as well as tilt table testing, device interrogation, and regular follow-up for patients who have required inpatient treatment or device implantation. It also has space for initial consultation and evaluation of patients referred for heart rhythm problems.

Patients are initially evaluated in the Heart Rhythm Center by one of our three board-certified electrophysiologists. The Clinical Medical Director is Marcos Daccarett, MD, MSc, FACC, FAHA, FHRS. Joining him are Melinda Marks, MD, FACC, and Daniel Noonan, MD, FACC. This center not only helps our patients stay connected with one primary specialized physician but also helps increase efficiencies for the hospital. Having centralized our patients to the Heart Rhythm Center, the hospital is able to standardize lab tests, pre-test transesophageal echocardiograms (TEEs) as needed, and there is a continuity of care for each patient. From the moment they schedule an appointment with one of our electrophysiologists for their procedure and finally to discharge, they are with one team of care providers (RNs, physician, and an EP coordinator). 

As we moved to improve the care of our EP patients, we streamlined their processes as well. A patient’s dedicated EP service starts with his/her visit to the Heart Rhythm Center. This visit could include an echo, stress testing, and other diagnostics. If the patient has a device currently implanted, they are seen in our cardiac device clinic within the center. 

Patients with atrial fibrillation (AF) also now constitute a significant volume of patients referred for electrophysiology consultation. Melanie Williams, RN is our AF nurse coordinator who directs the patients’ course for evaluation in the Heart Rhythm Center. The patient is registered with our internal AF registry and receives a Quality of Life survey that is continuously updated through their treatment and follow-up. If an intervention is required for management of the patient’s arrhythmia, Melanie schedules the procedure for the patients with the appropriate electrophysiologist. Patients are seen post procedure at seven days, and our patients who are treated for atrial fibrillation with an ablation procedure are also followed up with at six weeks and at three, nine and twelve months. 

Last year, out of 2,115 patients, nearly 1,200 were seen and/or treated for AF. With the increase in AF ablation procedures, and recognizing that AF patients were requiring more aggressive care and treatment, a second EP lab was needed. Therefore, an underutilized cath lab was converted into an EP lab with standardized supplies and equipment from the first lab. 

In the EP labs, we also perform ablation procedures for all types of supraventricular arrhythmias, as well as ventricular arrhythmias including ventricular tachycardia of both ischemic and non-ischemic etiologies. Additionally, we provide a catheter-based therapy for all atrial arrhythmias, including right and left atrial flutter as well as ablation of paroxysmal and persistent atrial fibrillation. Additional procedures include implantation of devices such as pacemakers and defibrillators (including biventricular) as well as loop recorders. We have improved our equipment utilization from simple implantable devices to the most advanced services to include 3D electroanatomical mapping, intracardiac echocardiography, and different ablation technologies (e.g., open and closed irrigation radiofrequency ablation, and cryoablation). In the upcoming months, our services will also include left atrial appendage closures and subcutaneous ICDs. Along with our adult patients receiving EP services, we are now also seeing pediatric patients.

As a health system, we provide our patients with a broad array of high-quality diagnostic and therapeutic cardiac services. As a specialized Heart Rhythm Center and EP program, our goal is to provide comprehensive EP services to the people of our region.

For more information about our Heart Rhythm Center or EP Lab Services, please contact Tonja LaDue (laduet@slhs.org) at (208) 381-2164, or Melanie Williams (willime@slhs.org) at
(208) 322-1680
 

Disclosure: The author has no conflicts of interest to report regarding the content herein.