Meeting Highlights

New in EP Lab Digest® are featured highlights from the 1st International Symposium on Left Atrial Appendage (ISLAA 2013). This two-day symposium took place March 1-2, 2013 at the InterContinental Hotel in Kansas City, Missouri. Leading the event were course co-directors Dhanunjaya Lakkireddy, MD, Andrea Natale, MD, Saibal Kar, MD, and David Holmes Jr., MD. ISLAA 2013 focused on an important new frontier in cardiovascular medicine: the left atrial appendage (LAA). Physicians from premier institutes such as the Mayo Clinic, University of Kansas, Cedars Sinai Hospital, and Texas Cardiac Arrhythmia Institute came together to provide an opportunity for participants to update their knowledge on the various research studies and recent technological developments related to the LAA. The symposium featured comprehensive CME agenda, detailed presentations of different LAA closure techniques, live case demonstrations, debates, and panel discussions. Next year’s conference will be held March 14-15, 2014 in Kansas City, Missouri.

Two videos accompany the article on ISLAA 2013. In the first video, Dr. Lakkireddy discusses an ongoing feasibility study at the University of Kansas Medical Center to assess the impact of left atrial appendage exclusion on atrial physiology and systemic homeostasis (LAA-EXPOSIS). In the second video, Dr. Lakkireddy describes the outline of the Left Atrial Appendage Ligation and Ablation for Atrial Fibrillation (LAALA-AF) registry.

In another article this month, Mellanie True Hills, Speaker and CEO of StopAfib.org, shares some patient perspectives from the Sixth Annual Western AF Symposium, which took place March 1-2 in Park City, Utah. Mellanie was part of the 2013 faculty. In her article, she lists some simple strategies that can promote better adherence with patients.

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Experience with Robotic Catheter Navigation

In the May 2013 issue of EP Lab Digest®, Andrew Kaplan, MD from Banner Heart Hospital in Mesa, Arizona shared his experience using Hansen Medical’s Sensei® X Robotic System over the past three years. In June 2010, Banner Heart Hospital purchased the Sensei® X Robotic System to help decrease the variability in procedure time, reduce radiation exposure for the physician, and provide the ability to navigate atrial anatomy due to the “steerable” nature of its catheter and instinctive driving. A few months after implementation of this system, they published an article in our October 2010 issue describing their initial experience with the technology. At the time, they had completed a total of 19 robotic procedures with the Sensei; three years later, they have now logged 100 cases with the system.

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Also included in our newest issue of EP Lab Digest® is an article about the development of a training program that incorporates robotics early into EP fellowship. Sarah K. Hussain, MD and J. Michael Mangrum, MD from the University of Virginia write that since the Hansen Medical robotic navigation system was installed at their institution in 2008, a growing number of fellows coming through their training program were expressing interest in incorporating robotic training into their EP fellowship. Therefore, incoming EP fellows are now being trained simultaneously on the Hansen system while at the same time still developing manual skills.

Travel Healthcare

Ever wondered what it is like to be a travel nurse? In the newest issue of EP Lab Digest®, we feature the stories of three cardiac electrophysiology (EP) professionals who have worked with MedSource Travelers to pursue a career in the travel healthcare industry. The article outlines such things as costs involved, lessons learned, etc. Cristina Cuellar, RT(R) shares her story, “The Lifelong Adventures of a Traveling Cath Lab Technologist”; Cathy Lucey, RN, BSN, MS contributed “The Best Years of my Nursing Career have been as a Travel Nurse”; and Renee Meunier, RCIS provided “Tips from a Seasoned Traveler”. Enjoy!

In our November 2010 issue, we published another article on travel nursing considerations. In this article, we spoke with Kim Windsor, Vice President of Clinical Services and Quality Services at AMN Healthcare, the nation’s largest healthcare staffing and workforce solutions company. AMN Healthcare places thousands of travel nurses each year. Kim notes that ideal candidates for travel nursing are those with flexibility, a positive outlook, excellent clinical skills and an eagerness for a new adventure.

In May 2009, we also spoke with a travel nurse named Epstein LaRue, RN, BS about how the economy downturn had affected the cardiac travel nursing industry. She wrote that the need for travel nurses is much greater in the cardiac fields than for any other medical field.

Have you worked in the travel healthcare industry? Let us know what your experiences were!

Data on Subcutaneous ICDs

In our recent May 2013 issue, Steven P. Kutalek, MD, FACC, FHRS from Drexel University College of Medicine, Hahnemann University Hospital in Philadelphia, Pennsylvania, provided a thorough review of the subcutaneous defibrillator (S-ICD). He writes, “The rapid acceptance of the S-ICD for clinical practice, its straightforward implantation technique, and its proven ability to treat malignant ventricular arrhythmias all indicate that the S-ICD will remain as a strong, viable part of the selection of defibrillators we have to offer our patients.”

We’ve been following the development of the S-ICD in issues of EP Lab Digest®. In our November 2010 issue, electrophysiologists from the Hospital of the University of Pennsylvania reported on subcutaneous ICD implantation. Dr. Fermin C. Garcia and colleagues were the first in their region to implant the S-ICD system as part of a clinical trial. They concluded at the time that this could be another option in the treatment of patients at risk of ventricular arrhythmias and sudden cardiac death.

In addition, in his January 2010 editorial, EP Lab Digest® Editor-in-Chief Dr. Bradley P. Knight had addressed the initial development of a totally subcutaneous defibrillator system. He wrote that such devices could have a big impact by reducing the morbidity associated with currently available transvenous devices.
For more information on the S-ICD, stay posted to EP Lab Digest®!

Highlights from Heart Rhythm 2013

The Heart Rhythm Society’s 34th Annual Scientific Sessions took place May 8-11, 2013 in Denver, Colorado. Included here is a brief summary of some of the clinical news highlights from the conference:

• St. Jude Medical Announces Results from Independent Analysis of Optim-Insulated Defibrillation Leads in Late-Breaking Clinical Trial Session at Heart Rhythm 2013

• Biosense Webster Reports Compelling Results from Ground-Breaking SMART-AF IDE Study on the Safety and Effectiveness of the THERMOCOOL® SMARTTOUCH™ Catheter

• New Four-Year Data from Boston Scientific Demonstrated WATCHMAN® Device was Superior to Warfarin for Mortality and Primary Efficacy in Patients with Atrial Fibrillation in Long-Term Follow-Up of the PROTECT AF Trial

• Endosense Underscores Significance of Contact Force Parameters with New Study Data at Heart Rhythm 2013

• Nanostim Announces Preliminary Results from LEADLESS Study in Late-Breaking Clinical Trial at Heart Rhythm 2013

• Use of TYRX Antibacterial Envelope Associated with Extremely Low 90-Day Cardiac Device Infection Rates

• Landmark Study Demonstrates Lower Rate of Inappropriate Shocks in Patients with Sorin Dual Chamber ICD Devices

Biventricular Pacing Reduces Symptoms and Improves Quality-of-Life in AV Block Patients with Heart Failure and Reduced Pumping Function

• Three Scientific Societies Collaborate to Release Expert Consensus Statement on Diagnosis and Management of Patients with Inherited Primary Arrhythmias Syndromes

In addition, to see more HRS-related news from the meeting, please visit the Heart Rhythm Society website.

For more information on this news and more, please check out our Heart Rhythm conference highlights article in the upcoming June 2013 issue of EP Lab Digest®!

One EP Program’s Experience with a Robotic Catheter System

In June 2010, Banner Heart Hospital in Mesa, Arizona purchased the Sensei® X Robotic System by Hansen Medical. The Sensei robot was an investment made to help decrease the variability in procedure time, reduce radiation exposure for the physician, and provide the ability to navigate atrial anatomy due to the steerable nature of its catheter and instinctive driving. A few months after implementation of this system, Andrew Kaplan, MD and Rodrigo Chan, MD published an article in the October 2010 issue of EP Lab Digest® describing their initial experience with the technology. In the May 2013 issue, the authors provide an update on their use of the system three years later.

After their initial experience with the technology, the authors commented that the Hansen Medical Sensei X Robotic Catheter System had been an exciting addition to their electrophysiology program, and that they expected it to help improve efficiency and make procedures safer and more effective.

In their three-year update, Dr. Kaplan writes that the Sensei robot is now fully integrated with the 3D mapping system, and total procedure time and fluoroscopy exposure have decreased.They have also been able to use the robotic system to address patients who would not have normally been candidates for an EP procedure.

Integrated Approach to Atrial Fibrillation

In our May issue of EP Lab Digest®, we take a look inside progressive atrial fibrillation (AF) programs offering an integrated approach to care.

In this interview we speak with electrophysiologists and cardiovascular surgeons from two heart centers that have evolved their AF programs to highly integrated AF teams, delivering a new standard for comprehensive AF care. The article highlights some of the key aspects of how these collaborative AF teams work together to provide a wider range of treatment options, and the impact of their collaboration on patient outcomes and referral volumes. One of these heart centers is Sentara Heart Hospital in Norfolk, Virginia, including Dr. Jonathan Philpott, Director of the Sentara Atrial Fibrillation Surgery Program, and electrophysiologist Dr. Robert C. Bernstein from Sentara Cardiology Specialists.

In our November 2012 issue, Jonathan Philpott, MD and electrophysiologist Ian Woollett, MD also featured an update on the Dual Epicardial Endocardial Persistent Atrial Fibrillation Study (Staged DEEP) feasibility trial. Sentara Heart Hospital was the first in the world to begin performing surgeries in this trial.