Paroxysmal Atrial Fibrillation

In a feature article in this month’s EP Lab Digest®, Arjun V. Gururaj, MD and colleagues from Sunrise Hospital in Las Vegas present a case of a 56-year-old patient with paroxysmal atrial fibrillation and an unusual anatomic variant that presented some challenges regarding ablation. Pulmonary vein isolation is an accepted treatment for paroxysmal atrial fibrillation; ablation success rates at 12 months are in the 65-75% range. In this case, the authors were able to isolate the four pulmonary veins acutely with low-power RF application.

In our January 2014 issue, Andrew Wickliffe, MD and Dan Dan, MD presented their experience using balloon cryoablation for paroxysmal atrial fibrillation at the Piedmont Heart Institute in Atlanta. The patient was a 64-year-old male who was initially diagnosed with paroxysmal atrial fibrillation about 5 years ago. At first the patient noticed brief episodes of palpitations or flutters, but over the course of a year, the episodes became more frequent and lasted up to 20 minutes. The patient first underwent pulmonary vein isolation using irrigated radiofrequency energy in a WACA strategy, which was acutely successful. After that point, the patient was referred to the Piedmont Heart Institute for further evaluation and management, and repeat ablation using balloon cryoablation was performed. Following the ablation, the patient felt significant improvement and has had no evidence of recurrent atrial fibrillation. They write that using balloon cryoablation for paroxysmal atrial fibrillation has resulted in a significant decrease in procedure time, fluoroscopy time, and left atrial dwell time.

Achieving AF Certification

In a feature article this month, Sri Sundaram, MD, FHRS and Brenda Yost, PhD, RN, PhD, NEA-BC discuss achieving atrial fibrillation (AF) certification through the Society for Cardiovascular Patient Care (SCPC). The SCPC began certifying hospitals for atrial fibrillation in 2011, with the primary goal of assisting healthcare facilities to better evaluate and manage patients with AF. Dr. Sundaram and Dr. Rost are located at Porter Adventist Hospital, part of the Centura Health care system in Denver, Colorado. Porter Adventist Hospital has a very active electrophysiology department. The approaches to patient care established as the standard of care as part of the AF certification process were applied broadly, not just at Porter Adventist, but to all hospitals in the Centura system.

The authors’ interest in this process began after seeing EP Lab Digest®’s interview with Genesis HealthCare System from February 2012. Cathy Huggins, MSN, RN, CNL, CCRN and colleagues from Genesis HealthCare System in Zanesville, Ohio wrote that by going through the AF certification process, they put their whole EP program under a microscope and found certain areas that were functioning very well and others that needed development. The final result of the certification process was a higher understanding of what an ideal AF program should look like.

March EPLD Preview

Don’t miss EP Lab Digest@’s upcoming March 2014 issue, which will be distributed at the ACC.14 conference in Washington, D.C.! This issue features a great selection of case studies, articles on AF management, and meeting highlights. Included below is a listing of our preliminary articles:


EP Lab Digest®

Editor’s Update: March 2014, Vol. 14, No. 3

Spotlight Interview: Presence Covenant Medical Center
Urbana, Illinois

Atrial Fibrillation Certification Program at Porter Adventist Health Care System
Sri Sundaram, MD, FHRS and Brenda Yost, PhD, RN, PhD, NEA-BC

New Hope for Patients Who Have Failed Catheter Ablation: Effective Hybrid Procedure Performed Completely in the EP Lab
Jason S. Sperling, MD and Jonathan S. Steinberg, MD

Establishing AF Care Within St. Luke’s Regional Medical Center
Tonja LaDue, RCIS, MBA

Left Ventricular Non-Compaction: A Rare Anomaly Presenting in Primary Care
Jaclyn Conelius, PhD, FHRS and Shawn M. Cole, MD

Highlights from 9th Annual Electrophysiology Symposium at Staten Island University Hospital
Valay Parikh, MD and Soad Bekheit, MD, PhD, FHRS

SICP Update

Initial Experience with the S-ICD System at Florida Hospital Pepin Heart Institute
Kenneth Yamamura, MD et al

Ablation of Paroxysmal Atrial Fibrillation in a Patient with an Unusual Anatomic Variant
Arjun V. Gururaj, MD et al

Troubleshooting Issues in the EP Lab

In EP Lab Digest®’s February 2014 issue, Craig J. McCotter, MD, FACC, FHRS and colleagues from St. Francis Heart Hospital in Greenville, South Carolina present two case examples discussing the incision site with the initial device implantation and follow-up repositioning after having the adipose properly draped downward. The authors have recently seen an increase in instances of lead dislodgement in obese patients due to adipose shifting. They write that with the ever-increasing obesity problem affecting Americans, it is imperative that medical professionals recognize possible complications and take this into account during procedures. It is estimated that by 2030, obesity rates will be above 44% in the U.S.

In our August 2013 issue, Craig J. McCotter, MD, FACC and colleagues also contributed an article demonstrating the importance of recognizing the presence of left atrial diverticula (LAD) to help reduce the risk of complications. The frequency of LADs is causing a need for physicians to become more cognizant of the potential for catheter entrapment and perforation. They also note that with atrial fibrillation being such a recurrent diagnosis, complications arising from ablation could prove to be very harmful to the patient if the physician is not aware of the risks of LAD.

Showcase Your EP Program in 2014!

This month, we check out Florida Hospital’s EP program in Orlando. Florida Hospital was named by U.S. News & World Report for 2013 as the #1 hospital in the state of Florida, scoring in the top 50 in eight different categories in the nation. It is currently the largest healthcare provider in the state. Their EP department consists of two biplane labs, two single-plane labs and one single-plane Stereotaxis lab, a cath lab/implant room, a pediatric hybrid lab, and two non-invasive procedural rooms. They have 25 EP team members which includes registered nurses (ASN, BSN), cardiovascular technicians (RCIS, RCES) and registered respiratory therapists; they also have 12 electrophysiologists and an array of implanting invasive cardiologists.

Would you be interested in having your lab showcased in EP Lab Digest@’s Spotlight Interview? Participating is easier than you think! If interested, please contact the editor at to have the questionnaire sent to you. Please answer only those questions that are most relevant to your EP lab. When your interview responses are complete, please email us your completed questionnaire, along with 5-10 photos of the lab, staff and facility. We publish the Spotlight articles in the order they are received, so contact us at your soonest convenience if you’d like to have your lab featured this year. The remaining openings for 2014 will fill quickly!

2014 EP Meetings

In the February 2014 issue of EP Lab Digest®, Paul J. Wang, MD, Professor of Medicine and the Director of the Cardiac Arrhythmia Service at Stanford University School of Medicine, presents information on the 2014 Stanford Biodesign New Arrhythmia Technologies Retreat. The event will take place Tuesday, May 6, from 7:30 AM to 6:30 PM, and bring together electrophysiology experts on the Stanford University campus. The program is directed by Dr. Wang and Dr. Paul G. Yock, Director of the Program in Biodesign at Stanford. The 2014 Stanford Biodesign New Arrhythmia Technologies Retreat will also feature a unique “rapid-fire format” in which each of the speakers presents in a 10-minute session (please check the article for a full listing of the program faculty). This program provides a special opportunity for interaction and networking with many of the world’s experts in electrophysiology, one day before the start of the Heart Rhythm conference. It is not to be missed!

To register for this this event, please visit their website. In addition, check out EP Lab Digest®’s calendar for an updated listing of EP events in your area! 

EP Coding and Billing

In the January issue of EP Lab Digest®, Jim Collins, CPC, CCC from CardiologyCoder.Com and CardiologyBiller.Com, presents information on their EP & CRM superbill. One of the first things he does for new billing clients is implements effective charge capture tools such as this one. Here he provides critical information that must be understood by each physician using this form.

Jim Collins is a frequent contributor to EP Lab Digest®. Don’t miss his upcoming article entitled “Assessing Lifetime Value (LTV) of Patients: Lessons from a Dairy Farmer” in our February 2014 issue. In this article he describes some of the unexpected similarities between operating a successful dairy farm and a cardiology program; ultimately, both go to great lengths to enhance lifetime value. Specifically, he takes into account the management of the heart failure patient versus the warfarin patient in a successful cardiology program.

For more articles on coding/billing tips and advice, please visit:

• Top Ten List: Things Electrophysiologists and Cardiologists Can Do to Increase Profitability

• Changes Coming for 2013 CPT Codes

• Top Ten Regulatory Landmines in EP

• Three Coding Updates for 2013

• The RAC Racket