The 2007 South Atlantic Society of Electrophysiology for Allied Professionals (SASEAP) Workshop

Electrophysiology Made Easy

Jamie Hoffman, RN

This presentation was geared toward the allied professional with limited EP lab experience as an introduction and/or review of basic information relating to diagnostic studies. Included in the lecture were basic action potential phases and ion transfers as they pertain to electrical impulse formation and propagation in the heart. Indications for a diagnostic study as well as a brief overview of electrograms and baseline intervals were discussed along with basic pacing maneuvers to assess electrical properties. A simple comparison of both standard and three-dimensional mapping was also demonstrated.

The Psychology of the ICD Patient

Rebecca Sotile, MS

Expanding ICD indications that have resulted in increased ICD implantation were presented. The impact of ICD implantation on patient quality of life was discussed, and frequency of anxiety and depression in the adjustment period was identified. The psychological theories of classical conditioning, learned helplessness and cognitive appraisal model were related to the ICD patient, and effective strategies were discussed. Patients at risk for additional follow-up or referral were also identified, with special attention being paid to those experiencing ICD storms or phantom shocks. Frequent patient concerns such as driving, sexual activity and device recalls were presented. The session ended with tips for self-care from the clinician.

Intracardiac Echocardiography (ICE) Applications in the EP Lab

Tom Noblett, R/CVT

Intracardiac echocardiography (ICE) is a technology that has proven its usefulness in the EP lab during radiofrequency (RF) ablation procedures for atrial fibrillation (AF). The use of intracardiac imaging allows electrophysiologists to focus more on the desired outcome of the procedure and less on the potential risks. Those who have learned to utilize this modality have witnessed its advantages and would not think of performing septal perforation without its use. ICE imaging helps identify the pulmonary veins and the atrial appendage during left atrial mapping. This potentially decreases fluoroscopy time and can shorten the length of the procedure. Observation during RF ablation can alert the physician to impending life-threatening complications prior to their occurrence. ICE is cost-effective and can be easily incorporated into existing procedure rooms. Physicians can learn to obtain the basic views quickly and become increasingly more comfortable with continued use. Technologists familiar with basic echocardiographic techniques can optimize images and monitor for adverse effects during procedures. Noblett believes that the use of this revolutionary technology will continue to expand in the EP lab, and will become as commonplace as other monitoring devices currently in use.

Deciphering Tachycardias: Where to Begin

Thomas Soos, RCIS

Thomas Soos, RCIS identified clues to look for in the baseline electrocardiogram, including p-wave, QRS morphology, and axis. Using EKGs, he presented the characteristics and origin of ventricular tachycardias (VT) that might differentiate VT from supraventricular tachycardia (SVT), atrial tachycardia, AVNRT, AVRT, atrial fibrillation and flutter, and Wolff-Parkinson-White syndrome.

The XX Files: Women and Sudden Cardiac Death

Mark Kremers, MD

Are there differences between men and women relative to sudden cardiac death? Dr. Kremers answered this question by reviewing heart disease, electrophysiological differences, and the incidence of sudden cardiac death (SCD) in women, covering risk and incidence of SCD. He used the AVID trial and other studies to address resuscitation and survival rates by age and gender differences in patients with life-threatening venticular arrhythmias. He also discussed clinical presentation, response to treatment and mortality in women with ICDs compared to men, ICDs during pregnancy, and gender differences in ICD implantation.

Congenital Heart Disease (CHD): A Different Kind of Fish

Wendy M. Book, MD

Dr. Book began by discussing the history of treatment for congenital heart disease, starting with the first successful operation in 1944 and following up with the current statistics on CHD. Dr. Book also addressed the issues that CHD patients and their physicians face. Surgical repairs for, complications from and future electrophysiological considerations were then presented for the tetralogy of Fallot, transposition of the great vessels, and the single ventricle patient. The final portion dealt with pregnancy and CHD.

SVT Differentiation

Steven Klein, MD

Dr. Klein identified the various rhythms and their variants that are associated with SVTs. The mechanism and identifying traits of each SVT was discussed, and the therapies for acute management of those arrhythmias were described. Finally, the risks and benefits of treatment for chronic management of SVT was explained.

The Impact of Electrophysiology in Patients Lives

Venkateshwar K. Gottipaty, MD

By utilizing a series of case presentations and encouraging audience participation, Dr. Gottipaty described conditions and procedures that brought patients to the electrophysiology lab. He stimulated discussion on possible lifestyle changes that patients may face after a procedure and methods to help patients adjust and cope with their illness.

EP Jeopardy Quiz

Robin Morreale, RN, MSN

Most of the participants on Saturday afternoon at the SASEAP conference had been through 4-8 didactic lectures with a lot of technical information and research. Remembering back to my school days, I felt afternoon sessions would require more participation from the audience to keep their interest. For this segment of our annual conference, I wanted to do something to help attendees be involved with their knowledge and learning. Why not conduct an EP quiz format? Using the book Practical Electrophysiology by Todd J. Cohen, MD, we developed categories, questions, and answers for the EP quiz. Groups competed against one another for prizes donated to SASEAP for the conference.

Programming Parameters for Optimal CRT Efficacy

Mark Sweesy, RCT, CPT

Five million people in the U.S. are affected by heart failure, with about half a million newly diagnosed cases each year. Fifty percent of patients die within five years of diagnosis. Cardiac resynchronization therapy (CRT) has been shown to improve hemodynamics by way of resynchronization of ventricular contraction and relaxation. Knowledgeable device programming is necessary to achieve optimal benefit from CRT therapy, and in some cases, may make the difference between a patient transitioning from being a non-responder to a responder of device resynchronization therapy. Optimal programming of device modes, rates, A-V intervals, V-V intervals, refractory periods and specialty algorithms were discussed in an attempt to optimize contraction pattern, reduce mitral regurgitation, increase diastolic filling time and deliver resynchronization therapy 100% of the time.

Panel Discussion: The Follow-up Clinic, from Soup to Nuts

Mia Brewer, CMA, CCT

This panel, moderated by Mia Brewer, CMA, CCT, was composed of three experienced device clinic professionals: DeeDee Applegate, RN, BSN, Debbie Jones, RN, BSN and Lisa Ottinger, PPM/ICD Technician. In addition to comparing and contrasting how their individual clinics operate, the panel also addressed such issues as remote follow-up, staffing patterns and staff/patient education.

For more information, please visit: www.saseap.org