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.

Tracking Performance Measures

In our new May 2014 issue of EP Lab Digest®, Dr. Monica Lo from Arkansas Heart Hospital in Little Rock, Arkansas, presents ten questions regarding the role of performance measures for allied health professionals to improve the quality of healthcare. She writes that with a concrete way to measure performance, clinical outcomes can be assessed and improved upon. In the article she discusses the lack of performance measures in electrophysiology and the measures that can be taken; she also provides advice on how allied professionals can apply potential measures and affect care.

On a similar note, Dr. Jeffrey L. Williams, a frequent contributor to EP Lab Digest® from The Good Samaritan Hospital in Lebanon, Pennsylvania, recently posted a blog on “Lessons Learned from Clinical Cardiology Performance Metrics.” Their single specialty practice and community hospital have been tracking performance measures for over three years. He shares several their lessons learned over the years, including 1) Only assessing metrics that can be directly controlled and on their patients; 2) Encouraging additional resources to track metrics; 3) The importance of verifying data; and 4) Remembering that although it’s impossible to produce an error-free measure of quality of care, every effort should be made to use state-of-the-art measures. We hope you’ll check out his informative blog!

Can’t-Miss Interviews!

Our special May 2014 issue of EP Lab Digest® includes several featured interviews with KOLs in the industry. Don’t miss our interview with Dr. Vivek Reddy, Director of the Cardiac Arrhythmia Service at Mount Sinai Hospital, who discusses his use of the CIRCA S-CATH™ for helping to avoid esophageal injury during ablation of atrial fibrillation (AF). Because of its unique design, he believes the S-CATH is able to give him a better spread of what is going on and allows him to safely do AF ablation in an efficient manner.

In another exclusive interview we learn more about the multicenter CONVERGE IDE Clinical Trial, nContact’s randomized IDE Study for the treatment of persistent AF through a multidisciplinary closed-chest approach. In the interview we speak with physicians from the first two sites to enroll patients in the CONVERGE Study: John R. Onufer, MD of Virginia Cardiovascular Specialists, Levinson Heart Hospital in Richmond, Virginia, and Graham Bundy, MD of Cardiothoracic Surgical Associates, Levinson Heart Hospital in Richmond; and David R. Tschopp, MD of Austin Heart in Austin, Texas, and Faraz Kerendi, MD of Cardiothoracic and Vascular Surgeons in Austin.

Finally, we speak with Dr. Saumya Sharma from Memorial Hermann in Houston, Texas, about his tips for successful lead extraction. He performs lead extractions in the CV OR and hybrid suites using almost exclusively Cook Medical’s Evolution device.

Featured Case Studies

In our April 2014 issue of EP Lab Digest®, Gregory Woo, MD, FHRS, FACC et al discuss some obstacles and anatomic variations encountered during cardiac device implantation that can make a routine case challenging: (1) venous stenosis with chronic leads, and (2) a persistent left superior vena cava. Venous stenosis is often discovered at the time of system revision or upgrade; a persistent left superior vena cava generally occurs in about 0.3% of the population. The authors note that physicians must be able to recognize these challenges during cardiac device implantation and apply the appropriate techniques for the situation. They also write that a well-equipped lab and staff trained in EP and interventional procedures will ensure the best success with minimal risk to the patient.

In another featured case this month, Scott Kaufman, DO et al describe the value that device-based monitoring brings to their patient’s individualized plan of care. In this case, the Lumax 740 VR-T DX, when coupled with the BIOTRONIK Home Monitoring® system, identified, discriminated, and promptly transmitted data on atrial and ventricular arrhythmias in a 50-year-old male patient. The authors were able to evaluate device performance, determine actionable events and interventions, and avoid in-clinic visits and rehospitalizations.

Check out EPLD’s upcoming May issue for more case studies from the electrophysiology lab!