Featured Case Studies

In our April 2014 issue of EP Lab Digest®, Gregory Woo, MD, FHRS, FACC et al discuss some obstacles and anatomic variations encountered during cardiac device implantation that can make a routine case challenging: (1) venous stenosis with chronic leads, and (2) a persistent left superior vena cava. Venous stenosis is often discovered at the time of system revision or upgrade; a persistent left superior vena cava generally occurs in about 0.3% of the population. The authors note that physicians must be able to recognize these challenges during cardiac device implantation and apply the appropriate techniques for the situation. They also write that a well-equipped lab and staff trained in EP and interventional procedures will ensure the best success with minimal risk to the patient.

In another featured case this month, Scott Kaufman, DO et al describe the value that device-based monitoring brings to their patient’s individualized plan of care. In this case, the Lumax 740 VR-T DX, when coupled with the BIOTRONIK Home Monitoring® system, identified, discriminated, and promptly transmitted data on atrial and ventricular arrhythmias in a 50-year-old male patient. The authors were able to evaluate device performance, determine actionable events and interventions, and avoid in-clinic visits and rehospitalizations.

Check out EPLD’s upcoming May issue for more case studies from the electrophysiology lab!


Health Insurance Companies and New Technologies

This month, EP Lab Digest@ Editor-in-Chief Bradley P. Knight, MD, FACC, FHRS argues that although federal health care reforms now allow patients with preexisting conditions to get health insurance more easily, health insurance companies are still in complete control about what they cover. For example, one way insurance companies can deny coverage for procedures is by deeming them “investigational”, even if the procedure has been determined to be safe and effective by the FDA, is covered by Medicare, and is evidence based. Dr. Knight presents his experience with a specific health insurance company after sending an appeal on behalf of one of his patients to receive the totally subcutaneous implantable defibrillator (S-ICD). After seven phone calls, a peer-to-peer review by phone, and faxed letter, the appeal was denied.

Boston Scientific’s S-ICD™ System is a unique implantable cardiac defibrillator placed subcutaneously beneath the skin. For more information on this S-ICD technology, please see the recent article by Kenneth Yamamura, MD and colleagues, who worked in conjunction to implant the first two S-ICD Systems at Florida Hospital Tampa.