Launching this month, a new article series in EP Lab Digest will address key aspects of remote monitoring for cardiac implantable electronic devices (CIEDs). In this ongoing monthly section throughout 2016, various clinicians in the field of cardiac electrophysiology will explore current and future challenges and possibilities with respect to remote monitoring.
Suneet Mittal, MD, FACC, FHRS (The Valley Hospital Health System, Ridgewood, New Jersey; New York, New York), Section Editor of the Remote Healthcare series, wrote the introduction entitled “Remote Patient Monitoring of Patients with a Cardiac Implantable Electronic Device”, which will be published in our May 2016 issue (link to be posted shortly!). Other topics in this article series will be as follows:
Cover story in our May issue.
HRS 2015 remote monitoring guidelines
Barriers to incorporating remote monitoring into clinical practice: Allied Health Professional perspective
Barriers to incorporating remote monitoring into clinical practice: Physician perspective
Efficacy of remote monitoring as a function of CIED type
Using remote monitoring to guide anticoagulation decisions
The future of remote patient monitoring
Building an infrastructure to handle the incoming data
Check out the Remote Healthcare series in EP Lab Digest and let us know what you think! Our May issue will also be available at the Heart Rhythm 2016 conference — don’t forget to stop by booth #2137 to pick up your copy!
In EP Lab Digest®’s December 2014 issue, we feature three fantastic case studies. Editor-in-Chief Emeritus Todd J. Cohen, MD and colleagues highlight the potential applications of the Reveal LINQ™ Insertable Cardiac Monitor (Medtronic, Inc.) for the diagnosis and treatment of syncope of unknown etiology. James Kneller, MD, MSc, PhD, FHRS, CCDS discusses his approach to PVC ablation and presents a successful case combining the principles of this workflow. Hanscy Seide, MD and Hae W. Lim, PhD examine the potential efficiencies that may be possible with the Arctic Front Advance cryoballoon system (Medtronic, Inc.) through short and predictable time usage to help maximize staff and EP lab utilization.
We also hear from an array of new voices! Michael McCullough, author of the blog Afibrunner.com, shares his experience living with persistent atrial fibrillation. Jerry W. Jones, MD, FACEP, FAAEM discusses courses available at the Medicus of Houston, a provider of continuing education for physicians and other medical personnel specializing in advanced ECG interpretation and dysrhythmia analysis. We also feature the EP program at Washington Regional Medical Center in a Spotlight Interview.
In addition, don’t miss our newly redesigned EP Lab Digest® website, including an online-exclusive multimedia section of videos from your favorite EP Lab Digest® articles. Take a look and let us know what you think!
On December 12-14, many of the leaders in pediatric and adult congenital EP will gather at the Paris Hotel in Las Vegas for PACES Advancing the Field: Forum on Practice Innovation, Scientific Achievement, and Career Development in Pediatric and Adult Congenital Electrophysiology. In a new article this month, Course Directors Vincent C. Thomas, MD and Anthony McCanta, MD provide highlights of what to expect at this year’s meeting.
We’re also including a special feature on Parent Heart Watch in EP Lab Digest’s December 2014 issue. Michele Snyder and Martha Lopez-Anderson describe how almost a decade ago, four mothers who each lost a child to sudden cardiac arrest came together to found Parent Heart Watch, a grassroots network of parents turning their tragedy into positive actions to save young lives. Don’t miss their upcoming 10th annual national conference taking place January 16-18 in Scottsdale, Arizona.
In addition, for an updated list of cardiac electrophysiology conferences and meetings in 2015, please check out our full calendar listing!
In two new articles in EP Lab Digest®’s October 2014 issue, authors discuss how they approached achieving certification in their medical programs. For example, Stroke Coordinator Susan Maynard, MS, RN-BC, CCNS, CCRN-CMC describes the process Mount Nittany Medical Center underwent to achieve Primary Stroke Center certification. Primary Stroke Centers were established in 2003 by The Joint Commission as a result of recommendations from the Brain Attack Coalition and the American Stroke Association. Mount Nittany Medical Center, located in State College, PA, is a 260-bed acute care facility under the umbrella of Mount Nittany Health. Because of the Medical Center’s location and demographics, in 2010, leadership recognized the need for the creation of a stroke program to ensure a future of high-quality care for the community. They achieved the Primary Stroke Center certification designation on June 19, 2014.
In another article, EP Lab Digest® speaks with William “Bill” Nesbitt, MD, a cardiac electrophysiologist on the medical staff at Texas Health Heart & Vascular Hospital Arlington, and Hoyt Frenzel, MD, Medical Director of Texas Health Arlington Memorial’s emergency department (ED) and an emergency medicine physician on the hospital’s medical staff. Texas Health Heart & Vascular Hospital Arlington, located on the campus of Texas Health Arlington Memorial Hospital, recently earned full Atrial Fibrillation Certification status from the Society of Cardiovascular Patient Care. They note that this certification was a logical step toward a unified guideline-based approach in the treatment of atrial fibrillation.
In this month’s issue of EP Lab Digest®, we feature several interesting case study articles. Archana Kodali, MD and Koroush Khalighi, MD, FAOP, FACC, FCCP from Easton Hospital in Pennsylvania describe the association of superior vena cava syndrome (SVCS) with an intracardiac device and antiphospholipid antibodies. A partial or complete obstruction of the superior vena cava results in a variety of symptoms called SVCS. The authors present a case study, and discuss both the presentation and management of SVCS. They write that even though the majority of SVCS cases are from an underlying malignancy, with the increased usage of intracardiac devices, there should be a high suspicion for clinical diagnosis in these settings.
Kenneth Yamamura, MD, FACC and Bonnie McDonald RN, CEPS, RCIS from the Pepin Heart Institute at Florida Hospital Tampa in Florida present a case of a 67-year-old woman with undiagnosed persistent left superior vena cava (PLSVC). This is the most common congenital venous anomaly in the chest, occurring in between 0.3-0.5% of all patients. A PLSVC can be accurately diagnosed by echocardiography, CT or MR imaging, or intraoperatively during vascular access by noting an unusual course of a guide wire, catheter, or pacing lead.
Finally, Alyssa M. Feldman, MS and colleagues from Winthrop University Hospital in New York describe a case of atrial fibrillation recurrence in which repeated cardioversion, contact pressure, patch placement, and preloading with sotalol helped result in a successful outcome. The patient was a 61-year-old man who was clinically obese, with an elevated body mass index of 40.6 kg/m2. Their case highlights the principles of changing patch placement and applying pressure over the patch to lower transthoracic impedance. In addition, increasing cardioversion energy delivered by the defibrillator proved useful in this case.
This month we round up our three-part series on EP clinicians and social media. In this article series in EP Lab Digest®, we highlighted various EP clinicians who more recently joined Twitter. These feature interviews described clinicians’ thoughts on joining the social media site, what their experience has been like, and tips to other clinicians considering joining social media.
In our September issue, EP Lab Digest® featured an interview with Pasquale Santangeli, MD from the Electrophysiology Section, Cardiovascular Division of the Hospital of the University of Pennsylvania, in Philadelphia, Pennsylvania. He can be found on Twitter at @Dr_Santangeli.
In the first installment of this interview series, we talked with Deb Halligan, RN, BSN, CCDS, Clinical Leader of the Pacemaker/ICD Clinic at North Shore Medical Center in Salem, Massachusetts. She can be found on Twitter at @debhalligan. We also previously spoke with Suneet Mittal, MD, FACC, FHRS, Director of Electrophysiology for the Valley Hospital Health System. He can be found on Twitter at @drsuneet.
Two interesting articles this month discuss approaches for troubleshooting in the cardiac electrophysiology (EP) lab. In the first article, Luann Hallahan, RN, BSN, BC from UPMC Passavant in Pittsburgh, Pennsylvania, determined if a single, dedicated EP lab could improve its turnaround time efficiency to compare to the Operating Room turnaround time national average of 20-25 minutes. After process improvements were in place for three months, turnaround time tracking was done to compare with the baseline results. Turnaround time tracking involved a detailed study of each step of the process and the role of each member involved. It was found that small steps to cut off minutes became impressive in the end result. Three months after process implementation, the EP logbook tracking proved turnaround time improved between cases by 7.4 minutes.
In another article this month, authors Adel Mina, MD, FACC and Nicholas Warnecke, PA-C from UnityPoint Health Methodist in Peoria, Illinois, describe how cases must be individualized when it comes to stroke risk reduction prior to pursuing direct current cardioversion and/or ablation. They discuss five instances in which simply following current medical guidelines may not be enough to sufficiently reduce the risk of stroke. In these five cases, their patients were appropriately managed with therapeutic oral anticoagulation, yet atrial thrombus development still occurred. Their cases help to emphasize the importance of thorough evaluation for the presence of atrial thrombus prior to direct current cardioversion and/or ablation, especially in patients with a low ejection fraction, as this may represent an advanced hypercoagulable state.