March/April 2002: Saint Vincent Health Center, Erie, Pennsylvania Update submitted by Pamela Goepfarth, Director, Quality Informatics, Saint Vincent Health System It has been an exciting time at Saint Vincent Health System's EP program over the last few years since we were previously spotlighted in EP Lab Digest. The volume of atrial fibrillation ablation procedures has dramatically increased with the development of advanced catheter and intracardiac echocardiographic (mapping) technology. Cardiac resynchronization therapy, also known as biventricular pacing, is a form of device-based therapy that resynchronizes the right and left ventricles in patients with heart failure. Just like with the atrial fibrillation ablation procedures, the volumes of cardiac resynchronization therapy implants has dramatically increased over the past few years for patients suffering with congestive heart failure. As a matter of fact, the EP program has shown such growth and future potential, we are currently in the process of installing a new GE Inova Lab as well as upgrading our other EP lab. Along with the remarkable advances in the electrophysiology lab are the highly developed and sophisticated diagnostic and programming devices in the Pacemaker Clinic. One of the best processes to increase service delivery and improve patient satisfaction is the utilization of the CareLink Monitors by Medtronic. These devices are used to check patients' ICDs via Internet technology while they stay comfortably at home. We also use the Housecall system by St. Jude as a telephonic method to remotely check ICD implants. In addition to all the advanced technology in the EP Lab and the Pacemaker Clinic are the ongoing support groups established by our EP and pacemaker clinic staff. These support groups provide emotional and psychological as well as educational support to those patients who have had any type of implantable rhythm device and their families. With our patient-centered focus, we are making great strides in providing exceptional medical care as well as targeting the emotional and psychological well-being of our patients and their families. May 2003: University of California, San Diego, California Update submitted by Gregory Feld, MD We are now operating out of three labs, two equipped with Bard Duo systems and ESI systems, and one equipped with Bard Duo and CartoMerge systems. We have also added additional staff, for a total of four nurses and four technicians, two managers, and two secretaries, and we hope to add a nurse practicioner soon. In addition, we plan to add a Stereotaxis system within the next 18 - 24 months for atrial fibrillation ablation. We are currently performing 8-10 atrial fibrillation ablations per week, with a backlog until next March/April. We are adding a new EP physician for a total of five next July. Many of our cases are complex atypical atrial flutters, either our own or referred from elsewhere, that have occurred after initial left atrial linear ablation. This is a major problem, which we are studying with a randomized trial to determine alternative approaches to ablation that will increase cure rates with fewer arrhythmia recurrences. Finally, we have expanded our fellowship program to include three ACGME-accredited first-year positions and three second-year research positions. These are filled through July 2007. March 2005: Marion General Hospital, Marion, Indiana Update submitted by Melo-Dee Perez, RN, MS, AD Cardiovascular Service Line, Chest Pain Center Coordinator, Marion General Hospital Since the article was published in March 2005, Marion General Hospital in Marion, Indiana is proud to say we are still happily working with our electrophysiologist Dr. M.N. Sharif. We have the same awesome staff that is cross-trained in Cath, EP and Vascular Intervention. We are currently working on an expansion of our Cardiovascular Service Line to include an additional lab, new private holding/recovery rooms and family waiting area. We also just hosted our third annual "shockers" meeting at the local country club, which was well attended by defibrillator patients and their family members. One bizarre case: we recently had the opportunity to treat a family member of a patient in our waiting room. The spouse of the patient initially complained of feeling faint. The secretary called one of our staff to come out and attend to her. By the time the nurse walked to the waiting room, the family member went into cardiac arrest. We were between cases, so the staff carried out a lengthy code with Dr. Sharif at the bedside. We were able to successfully resuscitate her and subsequently diagnose her with an acute inferior MI. She obviously was in "the right place at the right time." It was quite rewarding when she came to visit us this week as she started cardiac rehab.