Spotlight Interview: University Hospital Hamburg-Eppendorf

The hospital is part of the larger University Medical Center, which is the largest among Hamburg s hospitals with approximately 1,400 hospital beds. The medical center treats approximately 50,000 inpatients annually and approximately 250,000 outpatients as well as 50,000 emergency patients. Following is a look at the University Heart Center at the University Hospital Hamburg-Eppendorf. Professor Stephan Willems and Dr. Daniel Steven discuss with us the inner workings of clinical electrophysiology and the latest advancements in medical technology that enable them to provide their patients with the utmost in care and accuracy during complex cardiac procedures. What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab? We currently have two dedicated EP labs; they are used only for interventional EP studies. Currently there are six physicians and eight nurses working in the two labs. When was the EP lab started at your institution? The first EP studies were started back in the 1980s. The number and variety of ablation procedures are still increasing. What types of procedures are performed at your facility? Approximately how many are performed each week? In our lab, we treat all arrhythmias. Atrial fibrillation (AF) is the dominant tachycardia treated in our facility. Of the 1,000 ablation procedures that we performed in 2007, approximately 530 of these were for AF; the other 500 procedures consisted of ventricular tachycardia (VT) and other SVT ablations. We reserve one day a week for ablation of complex arrhythmias such as VT or ablation procedures in children. In addition to the high volume of AF procedures we perform, we are seeing an increase in VTs in our lab. What is the primary goal of your program (AF ablations, lead extractions, BiVs, etc.)? Our primary goal is the ablation of complex atrial and ventricular tachycardias. As a part of the University Heart Center, we also perform device implantations. Is the EP lab separate from the cath lab? How long has this been? Are employees cross-trained? We now have two labs dedicated for EP procedures. This is extremely important for a university, as we train cardiologists in all areas of electrophysiology. In fact, we recently opened the second EP lab in mid-2007 to meet our training demands as well as our patient needs. The physicians working in the EP lab are trained to work in the cath lab, but are primarily focused on EP procedures. Five of our nurses are also trained to assist in the cath lab. Both EP labs are equipped to perform hemodynamic procedures. What new equipment, devices and/or products have been introduced at your lab lately? How has this changed the way you perform those procedures? We were the first institution in Germany to receive Hansen Medical s Sensei Robotic Catheter System. This was also the first European installation of the product outside of pre-market evaluation. We also have the NavX 7.0 software for the EnSite system. For VT ablation we use the EnSite Array, as we found that no other technology provides such detailed information on electrical activity. The three-dimensional mapping systems have significantly improved our performance, especially for VT procedures. So far, we have performed more than 50 procedures with the Sensei Robotic Catheter System for complex atrial arrhythmias. The most significant difference we have observed is the stable catheter position inside the atria, which makes it possible to draw accurate lines in both the left and right atrium. Who handles your procedure scheduling? Do you use particular software? Claudia Mehl is our assistant who handles all patient scheduling. She manages requests from practitioners as well as any direct patient requests. Have you developed a referral base? Relationships to referral practitioners are very important to us. Despite our workload, we personally try to keep in touch with the referring physicians in order to make sure that the treatment in our institution meets their expectations. What measures has your EP lab implemented in order to cut or contain costs? We have learned how to perform procedures with a minimal amount of equipment. We also have the capability to used re-sterilized catheters. Does your EP lab compete for patients? Has your institution formed an alliance with others in the area? Due to a high number of AF ablation candidates, there is no competition regarding patient acquisition between the two EP centers in Hamburg. In addition, we have alliances with the surrounding heart centers and cardiologists. What procedures do you perform on an outpatient basis? All EP studies are performed on an in-hospital basis. How does your lab handle call time for staff members? How often is each staff member on call? How frequently do they have to come in, on average? Is there a particular mix of credentials needed for each call team? Due to a relatively high number of colleagues participating in the call rotation, our staff usually is on call a total of one or two nights per month. In addition, staff do not work in the hospital the day after being on call. Approximately what percentage of your ablation procedures are done with cryo? What percentage is done with radiofrequency (RF)? We do not use cryo at all. All of our patients are treated with RF for AFL, and for AF we use irrigated RF ablation. Do you perform only adult EP procedures or do you also do pediatric cases? Is there cross training for pediatric cases? We perform approximately 30 pediatric cases a year in our labs and have a very close relationship with our pediatric EP colleagues. Do your nurses/techs participate in the follow up of pacemakers and ICDs? If so, how many device visits per week do they handle? Do you use any particular software for follow up? How many of your ICD/pacemaker patients require a doctor for their visits? Our staff is trained to do routine follow up, and in approximately 20 percent of the cases, a physician is needed for the routine follow up. The software is provided by the pacemaker companies. What trends do you see emerging in the practice of electrophysiology? How is your lab preparing for these future changes? We believe that AF and VT ablation will be the major issues in upcoming years. Thus, we try to keep in touch with other EP centers to follow and develop new ablation strategies. Is your EP lab currently involved in any clinical research studies or special projects? Which ones? Our lab is primarily involved in small multi-center or single-center studies. One of the larger studies we participate in is the German AF network. Describe your city or general regional area. In terms of EP, there is a special situation in Hamburg because two of the biggest EP groups are located here. Otherwise, Hamburg is known as one of the world s most beautiful cities! Please tell our readers what you consider unique or innovative about your EP lab and staff. We profit from a unique atmosphere in our EP lab in terms of clinical and scientific challenges, as well as personal contact with our patients. We are also open to new, innovative techniques and we stay in a close contact with other EP institutions worldwide.