Spotlight Interview: Merkezi Klinika Hospital

Merkezi Klinika (MK) Hospital is located in the center of Baku, the capital of the Azerbaijan Republic. MK Heart Center has pioneered the development of cardiovascular surgery, interventional cardiology and EP in their country, and now has extensive expertise in all areas of cardiovascular medicine. It is equipped with the latest technology and offers a full range of state-of-the-art diagnostic and therapeutic cardiovascular services.

What is the size of your EP lab facility and number of staff members?

MK Hospital has about 1,000 staff, two cath laboratories, 4 cardiac operating rooms, and 220 beds, including 11 dedicated to the cardiac intensive care unit, 9 in the cardiovascular surgery intensive care unit, and 21 in the general adult intensive care unit.

Our EP lab is located in the same block with the cath lab, cardiovascular intensive care unit, and cardiovascular operating rooms. There are 2 EP physicians (Farid Aliyev and Gunay Gasimova), 1 EP technician (Gokhan Çetin), and 5 nurses (Leyla Aliyeva, Farida Qaloyeva, Mehriban Samedova, Lale Halilova, and Turane Asrafova).

When was the EP lab started at your institution?

We started EP procedures in 2008 in the cardiac catheterization lab. In 2009, we separated the EP lab from the cardiac catheterization unit. Despite a very short period of time that elapsed from the foundation of our lab, our center has become well known in the region, and we now have patients who come from neighboring countries. 

What types of procedures are performed at your facility? Approximately how many are performed each month?

We perform all kinds of basic and complex procedures in the field of electrophysiology, such as ablation of supraventricular tachycardia, atrial macroreentry, atrial fibrillation (AF), ventricular tachycardia and ectopics, including epicardial ablations. We also perform implantation of cardiac devices such as implantable loop recorders, pacemakers, ICDs, and CRTs. One of the unique features of our lab is that we perform His bundle/para-Hisian pacing in all patients undergoing permanent pacemaker implantation. We believe that this is the best way to avoid development of left ventricular dysfunction, symptoms of heart failure, pacemaker syndrome, and atrial fibrillation in patients with implanted permanent pacemakers. We perform approximately 30 EP cases and 8-10 device implantations every month. We also perform surgical RF ablation, including isolation of pulmonary veins with median sternotomy or minimally invasive surgical techniques. We always offer our patients the option of surgical ablation of AF. Surgical ablation procedures are performed at our center by the head of the cardiovascular surgery department, Kamran Musayev.

What is the primary goal of your program?

The main goal of our program is to provide our patients with high-quality medical care. We do our best to establish educational programs for cardiac electrophysiology as well as to increase the number of qualified EP physicians and technicians to facilitate the development of EP in our country.

Who manages your EP lab?

Our EP lab is managed by an EP technician (Gokhan Çetin) and EP nurse (Leyla Aliyeva), who have extensive experience in EP procedures, device implantation, and follow-up.

Are employees cross-trained?

Our nurses and physicians are cross-trained in EP and cardiac catheterization. However, other cath lab physicians are not cross-trained in EP.

What new equipment, devices and/or products have been introduced at your lab lately? How has this changed the way you perform those procedures?

Biplane cardiac fluoroangiography with 3D imaging capabilities and Biosense Webster’s Carto 3 mapping were introduced to our lab. These new imaging modalities have offered us more detailed information during ablation procedures.

Who handles your procedure scheduling? Is a particular software used?

We plan our cases on a daily basis; we do not use any special scheduling software. Emergent cases are taken without any delay at any time. We perform primary ablations for cases presenting at any time with incessant tachycardias.

Has your EP lab recently expanded in size and patient volume, or will it be in the near future?

Our EP lab is a part of the Heart Center at Merkezi Klinika Hospital. EP has a very short history in our country, so most physicians are still not familiar with indications for EP and device implantation. Despite this fact, we have expanded our volume significantly over the last two years.

Have you developed a referral base?

We have a large referral base around the country that includes cardiologists, general practitioners, and internal medicine specialists. We also make all efforts to organize educational activities out of Baku and into rural areas.

How are new employees oriented and trained at your facility?

Fellows are accepted to the EP program after at least a three-year training in cardiology. They start with basic patient follow-up, and continue on to complex EP procedures. Our nurses are accepted to the cath and EP labs after a period of work in the general cardiology clinic. Thereafter, they start to work in the cath lab and then in EP. At the moment we do not have a training program for EP and device technicians.

What types of continuing education opportunities are provided to staff members?

Staff is encouraged to participate in short- or long-term education at different centers located out of our country, at international congresses, courses, and other educational activities. We also try to organize educational activities for physicians from other centers.

How is staff competency evaluated?

We do not perform routine evaluation of competency of our staff.

Do you perform only adult EP procedures or do you also do pediatric cases?

Yes, we perform both adult and pediatric procedures.

What measures has your lab taken to minimize radiation exposure to physicians and staff?

We make every effort to decrease radiation exposure to our physicians, staff, and patients. Radiation exposure of our staff is monitored with radiation dosimetry badges. Lead suits, lead shields, and lead aprons are utilized in every case. We try to make all our fluoroscopic imaging at a 7.5 frame rate. We also use a special lead suit for pregnant patients undergoing an EP or device implantation procedure.

Do your nurses/techs participate in the follow up of pacemakers and ICDs? If so, how many device visits per week do they handle?

The physician or EP technician performs device follow-up; nurses are generally not involved. We have approximately 7-10 device follow-ups weekly.

What are some of the dominant trends you see emerging in the practice of electrophysiology? How is your lab preparing for these future changes?

Application of innovative technologies, strict procedural guidelines, experience in all aspects of EP, and procedural safety are all important aspects of success and superiority for us.

What are your thoughts about non-EPs implanting ICDs? Do you train such individuals?

At our center we do not have non-EP physicians implanting ICDs, and we do not train such persons. Personally, I am absolutely against implantation of any cardiac device by a person who is not trained in EP. It is not only a surgical procedure, it also requires appropriate assessment of a patient’s underlying arrhythmia and appropriate follow-up.

What about device recalls? How has your lab handled these?

Our lab has not yet faced this. However, several times I have had to extract recalled ICD leads implanted at other centers.

Is your EP lab currently involved in any clinical research studies or special projects? Which ones?

Our lab is involved in several research projects, including investigation of the proarrhythmic effect of biventricular stimulation on special models, the effects of long-term His bundle pacing, special electrophysiologic maneuvers, etc.

Does your staff provide any educational materials for patients who may have additional questions about their condition or procedure?

Yes, we provide each of our device patients with two handbooks: one that is provided by the manufacturer, and the other that is prepared by our staff. We also provide our patients with brochures describing various EP procedures.

Describe your city or general regional area.

Baku is the capital and largest city of Azerbaijan. The population of Baku is 1,811,000 (2006 estimate), and the population of Azerbaijan is about 8,500,000 (2006 estimate). The city is close to major petroleum fields, and oil refining is its chief industry.

The number of modern medical centers increases every year. Although the number of hospitals with cath lab capabilities is around 7, there is only 1 EP center in the country.

Please tell our readers what you consider unique or innovative about your EP lab and staff.

We have highly trained and internationally certified EP staff, and we perform all kinds of complex ablations and device implantation procedures. Despite its relatively short history, our center has become the most important EP center in its geographic area, and we have frequent referrals of patients from neighboring countries. Our center performs all kinds of emergent ablations of incessant tachycardias, irrespective of any time limitations.