SASEAP Workshop: Myrtle Beach 2001

The Friday session was devoted to the novice EP allied professional. Speakers discussed issues that included radiation safety, follow-up of the CHF patient, interpretation of difficult pacing strips, 12-Lead ECGs, syncope, pharmacology and basic EP studies. On Saturday, physicians from across the country and the U.K. led informative talks on subjects including CHF follow-up, biventricular pacing, two-dimensional echocardiograms, evidence-based treatment of SCD and non-contact mapping for VT. Sunday talks included treatment of atrial fibrillation, syncope, pediatric electrophysiology and device troubleshooting. Below are summaries from some of the presentations held on Friday, September 7th. Speakers Helen Roth, RN, BS, Linda Sue Adams, MSN, ACNP, CRNP, Sandi Sexton, RN, BSN, CCRN, Nancy M. Allen LaPointe, PharmD., and Kam Benfield, PA, have provided valuable information pertaining to their various sessions. The SASEAP symposium is held the first weekend after Labor Day. Next year, the symposium will be held in Myrtle Beach, September, 2002. For more information, contact them on the web at www.electropros.org. Heart Failure: Outpatient Management Helen Roth, RN, BS WakeMed Raleigh, North Carolina Helen Roth s presentation included the following: overview and scope of problems faced in heart failure, current trends in therapy, patient education, and key points. Also covered were issues in understanding heart failure, the recognition of its early signs and symptoms, daily weights, sodium restrictions, possible fluid restrictions, and medications and medication compliance. In addition, the session also featured how to set up an outpatient program. Such goals for a program included 1) to teach heart failure patients and their families about heart failure and how it can be managed at home, 2) to provide consistent education for all heart failure patients, 3) to improve quality of life, and 3) to decrease hospital admissions. Other topics included providing a mechanism for follow-up care, HSFA guidelines, staffing telephone guidelines, referrals to appropriate agencies, support groups, barriers to compliance programs showing decreased admissions, and increasing better patient compliance and satisfaction. Helen Roth, RN, BS, has been a cardiovascular educator for the past 18 years at WakeMed in Raleigh, North Carolina. She has developed educational programs there for pacemaker, defibrillator and heart failure patients. In addition, she chaired a task force to develop clinical guidelines for heart failure and has helped develop the criteria and guidelines for the Heart Failure Program. Tilt Table Trilogy Linda Sue Adams, MSN, ACNP, CRNP South Carolina Heart Center Columbia, South Carolina Syncope is a common clinical problem resulting from multiple potential causes. However, among these, the neurally-mediated reflex syncopal syndromes are believed to be the most common. Although some episodes of syncope are benign, this diagnosis carries considerable morbidity as a direct result from the trauma sustained with an abrupt loss of consciousness. Syncope can be defined as a transient loss of consciousness that is not compatible with other altered states of consciousness in the patient s history. Pre-syncope is defined as premonitory signs and symptoms of imminent syncope (lightheadedness, transient hearing loss, blur vision or weakness). Tilt table testing has become an accepted diagnostic tool for establishing susceptibility to neurally-mediated syncope. Treatment measures may be effective for reflex syncope, and dependent on the cause. The purpose of this presentation is to provide the learner with a comprehensive review of causes, pathophysiology, diagnostic evaluation, and current modes of treatment utilized for diagnosis and treatment of neurally-mediated reflex syncope. I am presently employed in private practice by the South Carolina Heart Center in Columbia, South Carolina. My role as nurse practitioner in clinical electrophysiology encompasses many tasks in patient care within a large medical center. I have spent over 10 years in the field of electrophysiology; during this time, my profession has taken me from lab nurse, administrative director of the EP department, to nurse practitioner, responsible for total patient management. I have devoted most of my research in diagnosis and treatment of neurocardiogenic syncope. I have published articles and lectured at NASPE on this subject. 12 Lead Interpretation for EP Sandra Sexton, RN, BSN, CCRN Moses H. Cone Memorial Hospital Greensboro, North Carolina The focus of my presentation at the SASEAP conference this September was on the fundamentals of 12-lead placement, configurations in each lead, bundle branch blocks and axis determinations. Individually, each of these topics can be very complex and can require much study. However, my goal at the conference was to introduce each concept and assist the attendees in gaining a basic comfort level and understanding of 12-lead interpretation and axis determination that they would be able to put into practice when they returned to their institutions. Understanding the principles of axis determination and QRS morphology is necessary to verify catheter placement specifically in VT studies. Understanding right and left bundle branch block morphology is significant in that many patients will present with bundle branch blocks, either pre-existing, due to heart disease, or develop them during EP study. Immediate recognition will facilitate rapid and appropriate management of the patient. Developing a strong 12-lead foundation will assist us in diagnosing more complex morphologies seen through observation of both surface ECG and internal electrograms. I have had the pleasure of working in critical care for 22 years. The last five years I have spent working in the cardiac catheterization/EP lab at Moses H. Cone Memorial Hospital in Greensboro, North Carolina. I have a passion for teaching, and in particular, for basic and advanced 12-lead ECG interpretation, myocardial infarction detection and the management of rhythm disturbances. Antiarrhythmic Agents: Review, Evidence, and Reality Nancy M. Allen LaPointe, PharmD. Duke University Medical Center Durham, North Carolina In the United States, there are currently 14 Vaughn Williams Class I or III antiarrhythmic agents on the market. Some may be safer and more effective than others for selected arrhythmias and in selected patient populations. Since the results of the Cardiac Arrhythmia Suppression Trial (CAST) were first announced in the late 1980s, more attention has been focused on potential risks associated with antiarrhythmic agents rather than just on how well they suppress a cardiac arrhythmia. In the past decade, several clinical trials have been conducted to assess mortality risk associated with some of the antiarrhythmic agents in selected patient populations, including CAMIAT, EMIAT, CASH, AVID, GESICA, etc. The results of these trials, along with the availability of newer agents during this time period, have encouraged a shift in antiarrhythmic drug use from Class I agents to Class III agents, especially in patients with coronary artery disease and congestive heart failure. The drugs in each class were discussed, along with consensus recommendations for when to use or avoid each drug. Specific dosing recommendations were discussed for the Class III antiarrhythmic agents, namely dofetilide, amiodarone, ibutilide, and sotalol. The rationale for and the steps involved in the dofetilide risk management program were also discussed. In addition, the newly released ACC/AHA/ESC Guidelines for the Management of Patients with Atrial Fibrillation were presented, with a focus on the recommendations for anticoagulation in patients with atrial fibrillation. In 1995, Dr. Nancy Allen LaPointe became the Co-director of the Antiarrhythmic Pharmacokinetic Consult Service at Duke University Medical Center, in addition to her continued clinical practice in electrophysiology and cardiology. She is also an Adjunct Assistant Professor at the University of North Carolina, School of Pharmacy. She has served as a preceptor for Clinical Pharmacy Residents from Duke University Medical Center and for Doctor of Pharmacy Students from the University of North Carolina and Campbell University. Dr. Allen LaPointe is currently working as the Project Leader and Co-investigator for the Duke Center for Education and Research in Therapeutics (CERTs). The CERTs program is a national AHRQ-funded program focused on improving the appropriate use of therapeutics (biologics, medications, and devices). Advanced EP Kam Benfield, PA Wake Forest University Baptist Medical Center Raleigh, North Carolina Advanced EP for allied professionals assumes that the listener has a basic understanding of the EP study as well as familiarity with EP terms and arrhythmia in general. The lecture began with bradycardia, those being sinus node dysfunction and conduction abnormalities. Time was spent explaining the concept that the degree of heart block is important only because it points to the site of the block. It is important to understand the principles of refractory periods and decremental conduction so one can better understand the different types of heart block and their implications. Next, the types of supraventricular tachycardias were explored in detail. The reentrant types were studied, not only from the standpoint of how they occur but why they are differentiated. The new terminology for the various types of atrial flutter was explained and time was spent on isthmus-dependent atrial flutter ablation. Toward the end of the session, there was a brief overview of pulmonary vein ablation for atrial fibrillation.