Spotlight Interview

Spotlight Interview: Deborah Heart and Lung Center

Carol Mantoni, RN, BSN, CCRN-K, Nurse Manager, EP Lab, and Raffaele Corbisiero, MD, FACC
Browns Mills, New Jersey

Carol Mantoni, RN, BSN, CCRN-K, Nurse Manager, EP Lab, and Raffaele Corbisiero, MD, FACC
Browns Mills, New Jersey

When was the EP program started at your institution?   

Electrophysiology services began here in 1985, and the first ablation in New Jersey was performed at Deborah Heart and Lung Center. Our electrophysiology team is led by Dr. Raffaele Corbisiero (Division Director), Dr. Pedram Kazemian, and Dr. B. John Hynes.

What is the size of your EP lab facility?

We have 3 enclosed, dedicated EP labs (one with Stereotaxis remote navigation), and a holding area.

What is the number of staff members? What is the mix of credentials at your lab?

We have an all-RN lab staff with 12 full-time positions and 2 EP lab assistants. Our department is also supported by 5 full-time APNs.

What types of procedures are performed at your facility? Approximately how procedures are performed each week?

We perform device implants, extractions, left atrial appendage (LAA) closure devices, leadless pacemakers, subcutaneous ICDs, diagnostic EP studies, ablations (pulmonary vein isolation, ventricular tachycardia, SVTs, AV node), cardioversions, and tilt table tests. Our team also just announced our 100th implant of the Gallant (Abbott) Bluetooth-enabled ICD in April 2021.

We performed an average of 38.5 of these procedures per week in 2020. Including cardioversions, lead extractions, implantable loop recorder (ILR) implants/explants, tilt table tests, and defibrillation threshold testing, we averaged 60 procedures per week in 2020. Our EP team performed more than 130 lead extractions last year.

What types of EP equipment are most commonly used in the lab?

We use the LabSystem PRO EP recording system (Boston Scientific) with stimulators by MicroPace in all 3 labs. We have two CARTO 3 mapping systems (Biosense Webster, Inc., a Johnson & Johnson company) and one EnSite Precision Cardiac Mapping System (Abbott). We utilize intracardiac echocardiography (ICE) for transseptal punctures with ACUSON AcuNAV (Siemens) or SOUNDSTAR (Biosense Webster) catheters. We utilize Stereotaxis robotic navigation for many of our complex ablations, and in 2020, our team completed the 2000th robotic procedure, distinguishing Deborah as the most experienced robotic ablation practice on the East Coast. Dr. Corbisiero has personally completed more than 1000 robotic ablations. For device implants including leadless and His pacemakers, we utilize Abbott, Boston Scientific, BIOTRONIK, and Medtronic. His bundle pacemaker implants are performed by Dr. Kazemian.

Who manages your EP lab?

The nurse manager is Carol Mantoni, RN, BSN, CCRN-K. She oversees the day-to-day lab operations including department staffing, budget, new equipment, and patient scheduling.

Tell us about your device clinic, including its staffing model.

Our device clinic is staffed with 4 RNs, and vendor support is available. Remote monitoring is promoted, and PaceMate is utilized for remote follow-up.

In what ways has the COVID-19 pandemic impacted your hospital, EP lab, or practice?

There was a decrease in procedures in 2020 due to the COVID-19 pandemic, but we have since returned to our baseline in the EP lab. All patients have a COVID-19 screening test up to 96 hours pre-procedure, and patients who have had COVID-19 are scheduled according to CDC guidelines. We have completed multiple urgent cases on COVID-19 patients, following CDC guidelines for safety.

What new initiatives have recently been added to the EP lab, and how have they changed the way you perform procedures?

We added a second CARTO 3 system in 2019, allowing us to perform simultaneous complex ablations and increase the weekly number of these cases.

Tell us what a typical day might be like in your EP lab.

We complete 2-3 complex ablations a day, along with 2-7 device cases and/or SVT ablations.

Do you utilize a same-day discharge approach for AF ablation cases?

Most patients are same-day care; however, patients undergoing complex ablation procedures stay overnight.

How do you ensure timely case starts and patient turnover?

The nurse manager monitors case starts and room turnover on a daily basis.

In what ways have you cut or contained costs in the lab and device clinic?

We added a second vendor for reprocessing, which has allowed us to take advantage of lower prices on certain items from each vendor. We use both Stryker and Sterilmed to reprocess catheters and cables.

What types of continuing education opportunities are provided to staff?

Our EP team all completed Springboard Health’s EP Academy course in 2019 and 2020. This comprehensive program was beneficial to our newer and seasoned EP lab staff.

Describe a particularly memorable case from your EP lab and how it was addressed.

Dr. Corbisiero performed a successful retrograde aortic PVI utilizing Stereotaxis on a patient with paroxysmal atrial fibrillation and congenital heart disease. According to Dr. Corbisiero, this procedure has been performed in the U.S. only 15 times.

What is your primary approach for left atrial appendage occlusion?

We use the WATCHMAN FLX device (Boston Scientific) for LAA occlusion.

What approaches has your lab taken to reduce fluoroscopy time? What percentage of cases are done without fluoro?

Utilizing Stereotaxis for robotic ablations reduced fluoroscopy time in our cases. Dr. Kazemian performs the majority of ablation cases without fluoroscopy.

How do you manage radiation quality checks of the imaging equipment?

Equipment is tested monthly by a radiation technologist.

What are some of the dominant trends you see emerging in the practice of electrophysiology?

We find there is a quicker adoption of non- pharmacological therapies, such as utilizing ablations and CRT therapy.

How do you utilize digital tools or wearable technologies in your treatment strategies?

Our team promotes monitoring of atrial fibrillation via the Kardia (AliveCor) and Apple Watch.

Describe your city or general regional area. How is it unique from the rest of the U.S.?

Browns Mills is located in a rural part of New Jersey, yet is in relatively close proximity to Philadelphia and New York City. As a former TB hospital, Deborah was placed in an isolated part of the New Jersey Pine Barrens. Currently, Deborah is an alliance member of the Cleveland Clinic Heart, Thoracic & Vascular Institute.

What specific challenges does your hospital face given its unique geographic service area?

As an independent specialty hospital, we must work to attract patients based on our state-of-the-art and cutting-edge treatments in cardiovascular care.

Please tell our readers what you consider special about your EP lab and staff.

Our team is dedicated, hardworking, and continually rises to meet daily challenges.