Bringing Expanded EP Services to Patients: One Hospital’s Experience of Building an Innovative EP Lab

Palm Beach Gardens Medical Center (PBGMC) opened their state-of-the-art cardiac electrophysiology (EP) lab on May 22, 2009. Learn more about the new lab here. Palm Beach Gardens Medical Center (PBGMC) recently opened its new 1,585 square foot state-of-the-art electrophysiology lab. The lab is equipped with the newest technology available and enables PBGMC to provide expanded EP services, including atrial fibrillation (AF) and atrial flutter ablations, as well as three-dimensional (3-D) mapping of the heart. The EP team at PBGMC consists of two electrophysiologists, anesthesiologists, a Lead RN, EP nurse, and two technicians. A third EP physician is expected to join PBGMC in January 2010. The Lead RN is responsible for the day-to-day operation of the EP lab and serves as a liaison to the electrophysiologists, physicians, and hospital administration. The other members of the EP team are involved in all aspects of the direct care and treatment of patients undergoing procedures in the department. Bringing EP Services to the Community The new EP lab has enabled the hospital to centralize invasive cardiac services and improve staff utilization and resources. It also allows the hospital to better serve patients through the expansion of capabilities, and provide additional resources and procedures such as AF ablations. PBGMC is the only hospital in northern Palm Beach County to provide AF ablations. Prior to the new lab, patients had to travel south or out of the county in order to access this type of care. Being able to treat these patients is very rewarding, since successful treatment can change lives. In many cases, AF ablation has allowed patients to avoid taking medications and resume a normal, active lifestyle. Addition of New Technology At the heart of the new lab is the Carto™ EX EP Navigation System (Biosense Webster, Inc., a Johnson & Johnson company, Diamond Bar, CA). This electroanatomical navigation system provides unparalleled views of the electrical activity of the heart through real-time data on 3-D, color-coded cardiac maps. The detail ensures precise, real-time tracking of catheter location, allowing for safe and accurate diagnosis and burning of abnormal tissue. Designed to minimize radiofrequency applications, unnecessary radiation exposure and procedure times, the system improves location accuracy and site-targeting results while maintaining an excellent safety profile. Features include visualization of individual anatomic variations via 3-D scans or map reconstruction, maneuverability to target site facilitated by a continuously visible catheter icon, and accurate re-navigation to within 1 mm for areas of interest. We also designed our new lab around the CS-20 EP Imaging System (Omega Medical Imaging, Sanford, FL), a single-plane x-ray system, to ensure seamless integration with the hemodynamic recording system. We added the enhanced CartoSound option (Biosense Webster, Inc., a Johnson & Johnson company), which, along with the Siemens ACUSON Sequoia C512 intracardiac echo (Siemens Medical Solutions, Malvern, PA), allows the electrophysiologist to quickly create the color 3-D maps of the heart, with less radiation. The EP MedSystems EP-4 computerized electrophysiology stimulator (St. Jude Medical, St. Paul, MN) was also acquired. We believe the CS-20 EP Imaging System (Omega Medical Imaging) provides excellent visualization of cardiac anatomy and structures, such as when coronary sinus cannulation is performed during left ventricular lead placement. The new technology not only contributes to lab efficiency, it also creates greater efficacy, allowing PBGMC to treat a wider spectrum of cardiac abnormalities and elevate patient care. Of course, prescription medications designed to fight arrhythmia can also help regulate the heart rhythm and may help prevent the arrhythmia from happening again, but in our experience, success is often suboptimal. In addition, medications that reduce the risk of blood clot formation (e.g., aspirin and warfarin) can help reduce stroke risk in persons with atrial fibrillation, but again, we find these are not always successful. The Future If medication therapy has been tried without success, we can now provide our patients with catheter ablation of their atrial fibrillation due to our expanded electrophysiology services. Our lab is equipped with the latest mapping and ablation technology, allowing us to more safely isolate and treat areas of the heart causing rapid heart rhythm. For more information, please visit: www.pbgmc.com