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.

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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.