How often do you utilize cryo during your ablation procedures?

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What percentage of your ablation cases are done with cryo versus radiofrequency? In EP Lab Digest®’s March 2013 Spotlight Interview article, Nebraska Methodist Hospital in Omaha, Nebraska, describes their use of cryo technology:

“We use cryo for all of our atrial fibrillation ablations, which is the majority of the ablation that we do. All pulmonary vein isolation is done with cryo. Until recently, I used RF for ablation of complex fractionated atrial electrograms and linear lesions in persistent AF, but I have now transitioned to a PVI-only approach, and additional ablations (generally with irrigated RF) are only done if a non-pulmonary vein trigger is revealed with isoproterenol testing. The vast majority of our AVNRT cases are done with cryo. However, if only non-sustained AVNRT can be induced, I frequently use RF for a somewhat more clearly defined endpoint (junctional rhythm with slow pathway RF ablation). For typical atrial flutters, we use both 8 mm solid tip and irrigated RF.”

In our February 2013 issue, St. Vincent’s Medical Center in Bridgeport, Connecticut offered a different perspective:

“One hundred percent of our ablations are done using radiofrequency ablation. During our recent equipment upgrade, our EP lab obtained an IBI generator along with a Cool Point™ Pump (St. Jude Medical) that is utilized with irrigated ablation catheters during left-sided ablations.”

Of your ablation procedures in the EP lab, what percentage is done with cryo? What percentage is done with radiofrequency? Let us know!


What’s coming up in EP Lab Digest®’s next issue?

The April issue of EP Lab Digest® will be available soon! Our two featured cover stories next month include information on collaborative convergent epicardial and endocardial ablation as well as advances in left atrial appendage closure.

Ayotunde M. Bamimore, MD, J. Paul Mounsey, BM, BCh, PhD, and Andy C. Kiser, MD from the University of North Carolina at Chapel Hill describe a case utilizing the collaborative convergent technique. Suneet Mittal, MD, Dan Musat, MD, and Jonathan S. Steinberg, MD provide three case vignettes describing their use of the LARIAT® Suture Delivery Device (SentreHEART) at The Valley Hospital.

Each month you can preview a listing of the next month’s content. We hope you will enjoy these great articles:

Spotlight Interview: Loyola University Medical Center
Maywood, Illinois

Collaborative Convergent Epicardial and Endocardial Atrial Fibrillation Ablation
Ayotunde M. Bamimore, MD, J. Paul Mounsey, BM, BCh, PhD, and Andy C. Kiser, MD

Percutaneous Closure of the Left Atrial Appendage: Initial Experience with the LARIAT System at The Valley Hospital
Suneet Mittal, MD, Dan Musat, MD, and Jonathan S. Steinberg, MD

Three Coding Updates for 2013
Jim Collins, CPC, CCC

The New Mass General Institute for Heart, Vascular and Stroke Care: Interview with Jagmeet Singh, MD, PhD
Interview by Jodie Elrod

A Dual-Loop Figure-8 Reentry Left Atrial Flutter
Suneel Kumar, MD and Abraham G. Kocheril, MD

Externalized Conductor of a St. Jude Medical Riata Defibrillator Lead: Case Report and Review of the Literature
Dhimesh P. Patel, MD et al

SICP Update

Catheter-Based Renal Denervation for Resistant Hypertension Performed by Radial Access
Pedro de Araújo Gonçalves, MD, Rui Campante Teles, MD, and Luís Raposo, MD

Utilizing the New Lumax 740 DX System for Complete AV Block
Steven J. Fowler, MD and Larry A. Chinitz, MD

Have EHRs improved your quality of care?

In the March 2013 issue of EP Lab Digest®, authors Raman Mitra, MD, PhD, FACC, FHRS from Beacon Health System in South Bend, Indiana, and Michael Mirro, MD, FACC, CCDS from Parkview Health System in Fort Wayne, Indiana, present an article on meaningful use. Specifically, the purpose of the article is to address the following:

1.    What is meaningful use and its goals?
2.    What is the financial impact of meaningful use to EPs?
3.    What are the benefits and risks of meaningful use as it is currently being executed?
4.    Will meaningful use in its current state achieve its goals?

In an accompanying survey, the authors hope to better understand how the readers of this article view meaningful use and the push toward EHRs. Sample questions in the survey include: “If you use EHRs, have they improved your quality of care?” and “Should the time to meet meaningful use goals be delayed for at least five years?” We hope you will take part in this important survey!

Featured Case Studies

In this month’s issue of EP Lab Digest®, we offer three featured case studies. In the first case, authors Ann Anderson, RN, FNPC, CCA, CCDS and M. Obadah Al Chekakie, MD, MSc, FACC from Cheyenne Regional Medical Center in Cheyenne, Wyoming, describe why looking at the post-implantation ECG is important. They note that this simple basic tool can help easily recognize a complication such as inadvertent implantation of a ventricular lead in the left ventricle.

In the next article, Musa I. Dahu, MD and Mathew Jackson, RT(R) from Frederik Meijer Heart & Vascular Institute at Spectrum Health in Grand Rapids, Michigan, describe a case which revealed a decremental atrio-fasicular pathway. They present the case of a 20-year-old male patient with known asymptomatic manifest pre-excitation who experienced VF cardiac arrest. The authors stress the importance of risk stratifying young patients for lethal arrhythmias.

In the final case study, Nadim Khan, MD and colleagues from Florida Hospital Wesley Chapel in Tampa, Florida, present a case of catecholaminergic polymorphic ventricular tachycardia, an inherited arrhythmogenic disease, in a 48-year-old male patient.

We hope you will check out these great cases! If you have an interesting case report that you’d like to share in EP Lab Digest®, please contact us at:

Atrial Fibrillation: The Patient Perspective

In a new article in this month’s EP Lab Digest®, Mellanie True Hills discusses how the diagnosis and treatment of atrial fibrillation (afib) can differ for women. She touches upon the potential misperceptions about women and afib, the sources of afib-related gender differences, and rate and rhythm treatment differences for women with afib. She writes that “by being aware of these differences in afib between men and women, medical professionals can design a safer, more effective, and personalized approach to managing afib.” founder Mellanie True Hills is a frequent contributor to EP Lab Digest®. An afib survivor, she created as part of the American Foundation for Women’s Health to share the information that she and other afib patients have learned.

To see more content by this author, please see these recent articles in EP Lab Digest®:

September 2012:

Expert Roundtable Fills in Vital Pieces of Afib Treatment Puzzle: The Afib Optimal Treatment Task Force and the Expert Working Group

June 2012:
The Global Atrial Fibrillation Patient Charter and the Sign Against Stroke in Atrial Fibrillation Campaign

April 2012:
How Social Media Helps Educate Afib Patients: Patient Perspectives from the Fifth Annual Western AF Symposium

January 2012:
Stuck in the Middle: Afib Patients on Rate Control

August 2011:
Atrial Fibrillation: The Patient Perspective to Better Care

September 2011:
Stopping Atrial Fibrillation is Big News!

April 2011:
Bridging the Afib Communications Gap: Afib Patient Perspectives from the Fourth Annual Western AF Symposium

Is systematic postmortem cardiac device retrieval feasible?

In his March 2013 editorial in EP Lab Digest@, Editor-in-Chief Dr. Bradley Knight discusses how important it is that cardiac devices be retrieved and sent back to the manufacturer after a patient dies. He writes how most are unaware of how devices are handled after a patient’s death, and cites a study from Kirkpatrick et al in 2007, which showed that implantable pacemakers and defibrillators are rarely interrogated or returned to the manufacturer after a patient dies.

However, it is critical to collect this postmortem device interrogation information. Dr. Knight concludes, “Further efforts, including government legislation, support from industry, and promotion by professional organizations are needed to implement universal postmortem device evaluation.”

For more information on pacemaker reutilization, please check out this article by Timir S. Baman, MD and colleagues about Project My Heart Your Heart, a joint collaborative between citizens, physicians, funeral home and crematory directors, the University of Michigan Cardiovascular Center, and World Medical Relief, Inc. In this program, funeral homes and crematories would send used devices to the University of Michigan, where they would be tested for battery life >70%. After undergoing cleaning, testing, and sterilization, the devices would be sent to World Medical Relief, which would distribute the devices to hospitals and clinics in underserved nations. This program is currently awaiting FDA approval prior to the distribution of devices.