This month, Vijay Swarup, MD, FHRS from Arizona Heart Hospital describes his use of the CartoUnivu Module to decrease fluoroscopy use in the EP lab. He has been using the CartoUnivu Module in their lab for approximately three months. The CartoUnivu Module is a new technology that integrates the Carto 3 mapping system with the fluoroscopic image or cine. Dr. Swarup uses the CartoUnivu Module for all atrial fibrillation and ventricular tachycardia cases at Arizona Heart Hospital, which is about 50 percent of their ablation procedures. With the use of the CartoUnivu Module, the average procedural fluoroscopy time during AF ablation has also been reduced to an average of 15-20 minutes.
There is increasing concern regarding the amount of radiation exposure during medical imaging and interventional procedures in the medical world. All who work in hospital radiation environments must make a commitment to the safer use of radiation. Important guidelines and regulations have been put into place to minimize workplace exposure, and there are other numerous ways healthcare facilities and lab staff can make radiation safety improvements. Here are just a few of the recent articles in EP Lab Digest® that provide further strategies on reducing radiation exposure for the EP operator, staff, and patient:
• Impact of MediGuide Technology on Radiation Exposure in Radiofrequency Ablation Procedures
• Electrophysiology Procedures Without Radiation in the Pediatric Population
• The Importance of Radiation Safety for Healthcare Workers as Well as Patients
• A New Option Against Radiation Exposure: Dr. Xiaoke Liu Discusses His Use of the ZeroGravity Radiation Protection System
• Reducing Radiation Exposure in the EP Lab: Interview with Dr. Roderick Tung
In a new issue, Donna M. Buchanan, PhD and John A. Spertus, MD, MPH present information on the Cardiovascular Outcomes Research Program at Saint Luke’s Mid America Heart Institute/University of Missouri-Kansas City (SLMAHI/UMKC). The Cardiovascular Outcomes Research Fellowship Training Program is funded by the National Heart Lung and Blood Institute to UMKC and hosted by SLMAHI. The objective of this two-year training program is to recruit and mentor potential researchers who are motivated to learn and apply outcomes research principles and techniques in performing comparative effectiveness research, translating existing knowledge to clinical practice, and to assess and improve quality. The clinical training programs at SLMAHI/UMKC also provide valuable opportunities to integrate outcomes research training with fellows’ clinical training, so this is an ideal opportunity for trainees interested in both clinical and outcomes research training. The SLMAHI/UMKC Cardiovascular Outcomes Research Program is currently seeking applications for the two-year postdoctoral fellowship program. Applications are due November 30, 2013 for fellowship positions beginning July 1, 2014.
In May 2013, Sarah K. Hussain, MD and J. Michael Mangrum, MD also described their development of a training program that incorporated robotics early in EP fellowship. Since the Hansen Medical Robotic Navigation System was installed at the University of Virginia, they have performed over 200 robotic cases with the vast majority being complex left atrial procedures. Incoming EP fellows are now trained on the Hansen system as well as develop manual skills. With the increasing evidence supporting the use of robotics in catheter ablation, for the current generation of fellows who are able to train at an institution with such a system, they believe integration of robotic training into a fellowship program is beneficial.
For more information on fellowship and training programs, please check out information on the Lahey Clinic Cardiac EP Fellowship Program as well as the development of a fellowship training program at the Medical College of Georgia.
Included are a few of the latest EP news highlights from the past week:
ZOLL Technology for Improving CPR Quality to be Showcased at American Heart Association Annual Conference
ZOLL Medical Corporation announced that its advanced resuscitation technology will be on display during the upcoming American Heart Association (AHA) 2013 Resuscitation Science Symposium (ReSS) and Scientific Sessions, taking place November 17-19 in Dallas. Fourteen scientific presentations related to ZOLL products and technology are also scheduled to be presented during ReSS.
Topera Announces FDA Clearance and Commercial Availability of the FIRMap™ Catheter and RhythmView™ 3D Mapping Workstation
Using electrograms captured with the FIRMap panoramic contact-mapping basket catheter, the RhythmView Workstation provides electrophysiologists with a dynamic representation of the electrical activity of the heart. Clinicians can then use this diagnostic information to tailor therapy for excellent patient outcomes. Topera’s 3D Mapping System is the first diagnostic tool designed to identify the patient-specific, unique electrophysiologic source that sustains serious heart rhythm disorders.
Device May Help Doctors Diagnose Lethal Heart Rhythm in Womb
New research shows that a promising technology may enable doctors to diagnose and possibly treat in utero a common cause of stillbirth and sudden death in infants. This study is the first to document the electrophysiological characteristics of fetal long QT syndrome and to evaluate the diagnostic accuracy of the magnetic EKG in a sizable population of at-risk fetuses.
Allegheny General Hospital Honored for Health Care Innovation With Minimally Invasive Convergent Procedure in the Treatment of Atrial Fibrillation Patients
The Pittsburgh Business Times awarded Dr. William Belden and Dr. Robert Moraca of Allegheny General Hospital in Pittsburgh, PA, as winners in Health Care Innovation for their new approaches to treating atrial fibrillation patients. AF is the most common cardiac arrhythmia, estimated to affect 5.9 million people in the U.S., with a majority of patients falling into the difficult-to-treat persistent AF population.
For more electrophysiology-related news, please visit our website.
In EP Lab Digest®’s November 2013 issue, Jeffrey L. Williams, MD, MS, FACC, FHRS and Sheetal Chandhok, MD, FACC discuss their use of radial intracardiac echocardiography (ICE) during invasive EP procedures. (Figure at left shows radial ICE guidance of transseptal puncture for left atrial access.) They write that advantages of radial ICE include providing detailed anatomy, guiding catheter ablation, enhancing procedural safety, and facilitating ablative strategies. However, they conclude that while radial ICE is readily available, it is generally underutilized.
In May 2012, David E. Haines, MD from Beaumont Heath System in Royal Oak, Michigan, also provided an overview on radial ICE imaging for atrial fibrillation ablation. Precise anatomical information is paramount to the successful completion of an ablation, and radial ICE imaging provides a useful adjunct to other methods of anatomical guidance for AF ablation. Dr. Haines notes that this also may be particularly helpful as new, innovative catheter technologies are introduced into the marketplace. Real-time radial ICE imaging offers valuable anatomical information to the operator, reducing procedure time and ultimately improving procedure success rates.
It’s hard to believe it’s almost 2014! It has been an exciting year in the field of cardiac electrophysiology, and another successful year for EP Lab Digest®. We’re currently slating articles for our upcoming January 2014 issue, which will be distributed at the AF Symposium in Orlando, Florida. The 19th Annual Boston AF Symposium will take place January 9-11, 2014 at their new location, the Orlando World Center Marriott. Since its inception in 1995, this meeting has become a major scientific program at which health care professionals can learn about the latest advances in atrial fibrillation research and management.
Interested in writing? We invite you to contribute an article to this special issue! It’s a great opportunity to have your article seen and read by colleagues in your field. We hope you’ll share a recent case study or technique used for the treatment of atrial fibrillation. Please contact Jodie Elrod for more information about deadlines and article guidelines.
In a new issue of EP Lab Digest®,Todd J. Cohen, MD, FACC, FHRS and colleagues from Winthrop University Hospital present a brief case of situs inversus totalis, a congenital condition in which all the major visceral organs are mirrored from their normal position. A 17-year-old male with a history of situs inversus totalis was referred by his internist to Winthrop University Hospital for clearance prior to joining the fire department. The referring internist was astute enough to reverse the limb leads and place the precordial leads across the right chest.
Dr. Cohen is the Emeritus Editor-in Chief of EP Lab Digest®, author of the Practical Electrophysiology series, and author of the Johns Hopkins Health Book entitled A Patient’s Guide to Heart Rhythm Problems. He is also the Director of Electrophysiology and the Pacemaker/Arrhythmia Center at Winthrop University Hospital.
In another recent article, Dr. Cohen and Dhimesh P. Patel, MD summarized the confusion between syncope and seizure disorder. They write that an electrophysiology consult should be considered in any patient suspected of having a seizure, especially when history points to a cardiac condition such as coronary artery disease or left bundle branch block.
In a new issue of EP Lab Digest®, Zhen Jiao, MD and colleagues describe a recent case in which they observed the usefulness of luminal esophageal temperature (LET) monitoring during the ablation procedure. The authors write that the LET monitoring protocol remains a useful monitoring tool during cryoballoon procedures, and that this case demonstrates that continued LET recordings through the ablation procedure are as important as the final nadir temperature for assessing collateral cold transfer to adjacent tissue structures.
This is part of a series of articles in EP Lab Digest® that discuss cryo technologies in the EP lab. In our September 2013 issue, Prasad Palakurthy, MD and colleagues reviewed the original Medtronic procedure guide of testing for PV occlusion via injection of contrast agent followed by fluoroscopy examination, and described their experience with a system that utilizes automated and measured delivery of the radiopaque contrast agent. The ACIST CVi fluid delivery system (ACIST Medical Systems) can be employed effectively to inject contrast agent and saline during a cryoballoon atrial fibrillation (AF) ablation procedure. In their current dual operator system, the ACIST device has become a welcomed asset to the cryoballoon procedure.
In May 2013, Eric Johnson, MD and colleagues discussed early procedural data from a multicenter study examining the enhancements of the first- and second-generation cryoballoon for the treatment of AF. In this registry examination, real and measurable benefits in procedural efficiencies were detected when comparing the new cryoballoon to the original Arctic Front catheter.