ADVERTISEMENT
MercyOne Iowa Heart Center
EP Lab Digest. 2023;23(3):1,16-18.
EP Lab Digest provides an update on the cardiac electrophysiology (EP) program at MercyOne Iowa Heart Center, which was originally featured in our May 2018 issue.
What is the size of your EP program?
We have 3 EP laboratories, 2 of which are hybrid rooms. In 2023, we hope to update our third lab to a hybrid room.
Who manages your EP lab?
Our EP program is managed by electrophysiologist codirectors Troy Hounshell, DO, and Jason Meyers, MD. Jessica Swihart, RN, BSN, MHA, is the market director of cardiovascular services. Christine Greaves, RN, BSN, is the director of the Heart Rhythm Center.
What is the number of staff members?
There are 8 staff members consisting of registered nurses and EP laboratory technicians.
What types of procedures are performed at your facility?
We perform left atrial appendage occlusion (LAAO), lead extraction, leadless pacing, catheter ablation (for atrial fibrillation [AF], ventricular tachycardia, premature ventricular contractions, and supraventricular tachycardia [SVT]), device implantation (permanent pacemakers, implantable cardioverter-defibrillators, and implantable loop recorders), remedē System implants (Respicardia), and Cardiac Contractility Modulation (Optimizer CCM, Impulse Dynamics).
Approximately how many catheter ablations (for all arrhythmias), device implants, and LAA closures are performed each week?
Per week, we perform approximately 15 pulmonary vein isolations, 5 LAAO device implants, 4 SVT ablations, and 30 device implants.
What are some of the new equipment, devices, and products recently introduced at your lab? How have they changed the way you perform procedures?
The technologies recently introduced here include the Optimizer CCM therapy and remedē System implants, new fluoroscopy systems, Vantage Vue monitors (Davis Instruments), and the VersaCross Transseptal Platform (Baylis Medical).
The new fluoroscopy systems have helped us dramatically reduce fluoroscopy exposure. With the Vantage Vue monitors, we have a higher degree of customization in display layout for differing providers. We find that the VersaCross Transseptal Platform allows for faster and safer transseptal access, increasing the number of Watchman procedures (Boston Scientific) that can be performed in a day.
How did the COVID-19 pandemic impact your EP lab, hospital, or practice?
It forced us to perform more outpatient same-day discharge (SDD) procedures. Before the COVID-19 pandemic, our SDD rate was about 5%; today, the rate is greater than 95%.
Tell us about your primary approach for LAAO.
We use general anesthesia for all cases. We have a dedicated transesophageal echocardiography (TEE) physician team for imaging consistency. We do preimaging with TEE for patients with chronic kidney disease (CKD) and computed tomography imaging for non-CKD patients. We have a dedicated Watchman coordinator to help with patient navigation through the program. Our main approach is the Watchman FLX (Boston Scientific) using transseptal access with technology from Baylis Medical. We still use TEE and fluoroscopy as our primary imaging modalities during the procedure.
Does your program have a dedicated AF clinic and/or a dedicated lead extraction program?
We have a dedicated AF clinic. We are the only program in the Des Moines Metro area that performs lead extractions.
What approaches has your lab taken to reduce fluoroscopy time?
We have new x-ray equipment as well as increased provider utilization of intracardiac echocardiography. We also have increased use of pressure waveform monitoring during cryoablation.
What are some of the dominant trends you see emerging in EP?
We are seeing a national increase in SDD, AF ablation procedures, and leadless pacing technology.
How do you use digital health and wearable technologies in your treatment strategies?
We encourage patients interested in wearable technologies to do so and bring their data with them to appointments.
What are the best features of your EP lab’s layout or design?
There is a separate control room to protect staff from radiation. All EP equipment is boom mounted to free the floor from as many cables and cords to prevent work-related injury. A robotic fluoroscopy arm allows optimal position variation for a myriad of procedures.
Please tell our readers what you consider special about your EP lab and staff.
Our lab is set up with safety in mind for staff and patients. We maximize room for patient transfers, limit radiation exposure, and have the flexibility to do all types of procedures in one room. Our providers and staff come together to optimize the utilization of these rooms to maximize the standardization and provide excellent quality of care to our patients.
For more information, please visit:
https://www.facebook.com/mercyonedesmoines
https://twitter.com/MercyOne_Iowa
