Case Studies of Interest

In this month’s issue of EP Lab Digest®, we feature several interesting case study articles. Archana Kodali, MD and Koroush Khalighi, MD, FAOP, FACC, FCCP from Easton Hospital in Pennsylvania describe the association of superior vena cava syndrome (SVCS) with an intracardiac device and antiphospholipid antibodies. A partial or complete obstruction of the superior vena cava results in a variety of symptoms called SVCS. The authors present a case study, and discuss both the presentation and management of SVCS. They write that even though the majority of SVCS cases are from an underlying malignancy, with the increased usage of intracardiac devices, there should be a high suspicion for clinical diagnosis in these settings.

Kenneth Yamamura, MD, FACC and Bonnie McDonald RN, CEPS, RCIS from the Pepin Heart Institute at Florida Hospital Tampa in Florida present a case of a 67-year-old woman with undiagnosed persistent left superior vena cava (PLSVC). This is the most common congenital venous anomaly in the chest, occurring in between 0.3-0.5% of all patients. A PLSVC can be accurately diagnosed by echocardiography, CT or MR imaging, or intraoperatively during vascular access by noting an unusual course of a guide wire, catheter, or pacing lead.

Finally, Alyssa M. Feldman, MS and colleagues from Winthrop University Hospital in New York describe a case of atrial fibrillation recurrence in which repeated cardioversion, contact pressure, patch placement, and preloading with sotalol helped result in a successful outcome. The patient was a 61-year-old man who was clinically obese, with an elevated body mass index of 40.6 kg/m2. Their case highlights the principles of changing patch placement and applying pressure over the patch to lower transthoracic impedance. In addition, increasing cardioversion energy delivered by the defibrillator proved useful in this case.

Social Media and Clinicians: About our Interview Series

This month we round up our three-part series on EP clinicians and social media. In this article series in EP Lab Digest®, we highlighted various EP clinicians who more recently joined Twitter. These feature interviews described clinicians’ thoughts on joining the social media site, what their experience has been like, and tips to other clinicians considering joining social media.

In our September issue, EP Lab Digest® featured an interview with Pasquale Santangeli, MD from the Electrophysiology Section, Cardiovascular Division of the Hospital of the University of Pennsylvania, in Philadelphia, Pennsylvania. He can be found on Twitter at @Dr_Santangeli.

In the first installment of this interview series, we talked with Deb Halligan, RN, BSN, CCDS, Clinical Leader of the Pacemaker/ICD Clinic at North Shore Medical Center in Salem, Massachusetts. She can be found on Twitter at @debhalligan. We also previously spoke with Suneet Mittal, MD, FACC, FHRS, Director of Electrophysiology for the Valley Hospital Health System. He can be found on Twitter at @drsuneet.

Have you checked out EP Lab Live recently?

EP Lab Live is a great resource for those in the cardiac electrophysiology field. It offers an extensive video library on EP  topics from clinical experts. A listing of current topics can be found here:

•  Conducting a Successful Screening and Implantation of the S-ICD System
•  De Novo ICD Implant Using the Aquamantys® Bipolar Sealer for Pocket Hemostasis
•  Reducing the Risk of CIED Infections – Welcome Reception
•  Reducing the Risk of CIED Infections – Welcome and Introduction
•  Reducing the Risk of CIED Infections – Latest Trends in CIED Infections
•  Reducing the Risk of CIED Infections – Antibiotic Prophylaxis and Resistant Organisms
•  Reducing the Risk of CIED Infections – Mortality with CIED Infections and Antibiotic Envelope RCT
•  Reducing the Risk of CIED Infections – Impact of the Antimicrobial Pouch on CIED Infection Rates
•  Reducing the Risk of CIED Infections – The Economics of a CIED Infection
•  Reducing the Risk of CIED Infections – Wrap-Up and Q & A
•  Biventricular ICD Upgrade and Capsulectomy with TYRX™ Absorbable Antibacterial Envelope and PEAK PlasmaBlade®
•  Subcutaneous ICD (S-ICD™ System) Implant with Dr. Martin Burke
•  Device Pocket Management How to Maximize Life of Leads
•  CRT-D Pulse Generator Replacement/Capsulectomy Using PEAK PlasmaBlade
•  Chronotropic Incompetence: Prevalent, Relevant, Treatable
•  Advancements in Fluoro Reduction for the Electrophysiology Lab
•  Arctic Front Advance™ Cardiac CryoAblation Catheter: Simply Cool
•  Initial Experiences with the ThermoCool® SF Catheter Webinar
•  Innovations in 3D Rotational Imaging
•  Benefits of Advanced Technology in the EP Lab
•  Hemodynamic Support During Complex VT Ablation: Use of Impella 2.5
•  Maximizing integration with EP navigator’s real-time 3D image acquired in lab and Biosense Webster’s CARTO 3
•  Philips Advanced Tools in Practice — Recorded Live Case with Pierre Jaïs MD in Bordeaux-Pessac, France

New Video Commentary!

Dr. Kevin Campbell, a cardiac electrophysiologist with the University of North Carolina at Chapel Hill, is now a special contributor for EP Lab Digest®! Dr. Campbell will be providing weekly video commentary on recently published EP Lab Digest® articles. Check out some of the content already available:

VisualEP Virtual Training Environment

• Electrophysiology Clinicians on Twitter

• Utilizing Google Glass in the EP Lab

• Thoughts on the Subcutaneous ICD

• What the Sunshine Act Means for Healthcare Providers

• New Technologies for Electrophysiologists: The AliveCor Heart Monitor

Tips for Troubleshooting in the EP Lab

Two interesting articles this month discuss approaches for troubleshooting in the cardiac electrophysiology (EP) lab. In the first article, Luann Hallahan, RN, BSN, BC from UPMC Passavant in Pittsburgh, Pennsylvania, determined if a single, dedicated EP lab could improve its turnaround time efficiency to compare to the Operating Room turnaround time national average of 20-25 minutes. After process improvements were in place for three months, turnaround time tracking was done to compare with the baseline results. Turnaround time tracking involved a detailed study of each step of the process and the role of each member involved. It was found that small steps to cut off minutes became impressive in the end result. Three months after process implementation, the EP logbook tracking proved turnaround time improved between cases by 7.4 minutes.

In another article this month, authors Adel Mina, MD, FACC and Nicholas Warnecke, PA-C from UnityPoint Health Methodist in Peoria, Illinois, describe how cases must be individualized when it comes to stroke risk reduction prior to pursuing direct current cardioversion and/or ablation. They discuss five instances in which simply following current medical guidelines may not be enough to sufficiently reduce the risk of stroke. In these five cases, their patients were appropriately managed with therapeutic oral anticoagulation, yet atrial thrombus development still occurred. Their cases help to emphasize the importance of thorough evaluation for the presence of atrial thrombus prior to direct current cardioversion and/or ablation, especially in patients with a low ejection fraction, as this may represent an advanced hypercoagulable state.

Don’t Miss What’s New This Month!

We have a lot of great new features for you this month! In one of our cover stories for EP Lab Digest®’s July 2014 issue, Mary P. Orencole, MS, ANP-BC and colleagues provide information on the Multicenter Automatic Defibrillator Implantation Trial – Chemotherapy-Induced Cardiomyopathy (MADIT-CHIC). Led by Dr. Arthur Moss of the University of Rochester Medical Center as well as by Dr. Jagmeet Singh of Massachusetts General Hospital, MADIT-CHIC will be the first prospective study of the cardiac resynchronization therapy defibrillator in chemotherapy-induced cardiomyopathy.

In another special feature this month, we highlight two emerging technologies in EP. Daniel S. Goldman, MD, FACC, FHRS from The Cardiology Center, Inc. in Delray Beach, Florida, and Linda Moulton, RN, MSN, Owner of Critical Care ED and C.C.E. Consulting, and Faculty of the Order and Disorder Electrophysiology Training Program in New Berlin, Illinois, describe a new “non-invasive” device for skin closure (Zip® Surgical Skin Closure, ZipLine Medical, Inc.) that was recently approved for low-tension surgical wounds. According to the authors, the Zip® is easy to apply and remove, and produces excellent cosmetic results. Nicole Habel, MD also provides an overview article about VisibleEP, an interactive learning software that brings a virtual EP laboratory to your personal computer. This technology was conceived by Dr. Peter Spector and colleagues at the University of Vermont.

In addition, in a new article series in EP Lab Digest®, we are speaking with various EP clinicians who have more recently joined Twitter. In the first installment of this interview series, we’re speaking with Deb Halligan, RN, BSN, CCDS, Clinical Leader of the Pacemaker/ICD Clinic at North Shore Medical Center in Salem, Massachusetts. She can be found on Twitter at @debhalligan. In following issues we will be speaking with Dr. Suneet Mittal (@drsuneet) and Dr. Pasquale Santangeli (@Dr_Santangeli).

Finally, don’t miss out on the upcoming Kansas City Heart Rhythm Symposium 2014, taking place August 16-17 at the Sheraton Crown Center in Kansas City, Missouri. Included in our July issue is an overview of what to expect at the meeting.

Technology in the EP Lab

In a new article in EP Lab Digest®’s June 2014 issue, Dr. Nishant Verma and colleagues from Northwestern University discuss their recent opportunity to trial a smartphone-based wireless ECG monitor, the AliveCor© Heart Monitor, which resulted in a high level of physician and patient satisfaction. They conclude that the AliveCor Heart Monitor is an easy to use and convenient option for remote monitoring in patients with suspected arrhythmia.

In another technology-related article this month, Dr. Senthil K. Thambidorai and colleagues describe their use of Google Glass to transmit the images and videos of five simulated cases from the EP lab at Houston Northwest Hospital to a laptop at the UTH outpatient clinic. They note that using Google Glass in the EP lab helps them maintain a hands-free format as well as obtain an expert second opinion during cases.

In addition, in a new video series, Dr. Kevin R. Campbell with North Carolina Heart and Vascular, at the UNC Chapel Hill School of Medicine, talks about the AliveCor Heart Monitor and how it is revolutionizing EP care. He also provides commentary on how the Sunshine Act affects all of us, including physicians and industry.