Spotlight Interview: Delray Medical Center

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EP LAB DIGEST. 2025;25(3):1,18-23.

Yoel Vivas, MD, FHRS¹, and Dora Jean-Charles, MSN, RN^2
1Founder of The Arrythmia Center of South Florida, Delray Beach, Medical Director of the Electrophysiology Department at Delray Medical Center; ²Executive Director of Cardiovascular Services, Cath Lab, EP, Structural Heart, Cardiac Medical, Cardiac Stepdown, CVICU and CCU at Delray Medical Center, Palm Beach County, Florida

When was the cardiac electrophysiology (EP) program started at your institution, and by whom?  

The electrophysiology (EP) lab at Delray Medical Center was established in 2002 to address the growing need for specialized care in the diagnosis and treatment of heart rhythm disorders, such as arrhythmias. Prior to the establishment of the EP lab, patients with complex arrhythmic conditions often had to travel outside the region for advanced care. 

Delray Medical Center’s EP lab became a crucial facility in the region, offering state-of-the-art technology and treatments for conditions like atrial fibrillation (AF), ventricular arrhythmias (VAs), and other heart rhythm abnormalities. 

What drove the need to implement an EP program?

One of the reasons is due to the increasing prevalence of heart rhythm disorders. Conditions like AF, VAs, and other heart rhythm abnormalities have been on the rise, particularly with an aging population. South Florida, in particular, has a large retiree population, which contributes to a higher demand for advanced cardiac care. 

The EP program was also the result of an expansion of cardiac care services. Delray Medical Center, like many hospitals, sought to expand its

comprehensive cardiac care offerings. EP was a natural extension to the hospital’s existing heart programs (such as interventional cardiology and cardiac surgery), providing a more holistic approach to treating all types of heart disease.

What is the size of your EP lab facility? Has the EP lab recently expanded in size? 

The facility has 2 EP labs (1 traditional and 1 EP hybrid) and utilizes a hybrid operating room (OR) lab as a third procedural area for EP procedures. In August 2022, the center unveiled a new EP lab equipped with the Azurion image-guided therapy system (Philips), enhancing our ability to perform minimally invasive procedures for arrhythmias such as AF. This expansion also included an expanded recovery suite, aiming to improve patient care and reduce recovery times, especially with the growing trend of same-day discharge for EP patients. An EP hybrid room combines the capabilities of a traditional EP lab with those of an OR room to enhance workflow and patient safety.

Who manages your EP laboratory, and what is the mix of credentials and experience?

Yoel R Vivas, MD, FHRS, founder of The Arrhythmia Center of South Florida, is the the medical director of the EP department at Delray Medical Center. He is board-certified in clinical cardiac EP. Dr Vivas specializes in the evaluation and treatment of arrhythmias, including ablation procedures and device implantations. 

Dora Jean-Charles, MSN, RN, is our executive director of cardiac services. She oversees the administrative operations of the cardiac catheterization lab, EP lab, and structural heart services at Delray Medical Center. Dora brings a wealth of nursing experience and leadership to the role, ensuring the delivery of high-quality patient care. 

Jorge Molina, RCIS, RCES, CEPS, is our EP supervisor. He oversees clinical support by assisting in complex EP procedures such as ablations and device implantations. Jorge has strong technical expertise in EP, a specialized skillset, and a solid clinical background in cardiovascular care.

What is the number of staff members? 

There are 7 EP lab staff members comprised of a multidisciplinary group of health care professionals, including nurses and technologists dedicated to providing comprehensive cardiac care. Their combined credentials and experience ensure that patients receive state-of-the-art treatment for various cardiac arrhythmias. Team members have also obtained advanced certifications such as registered cardiac electrophysiology specialist (RCES) and registered cardiovascular invasive specialist credential (RCIS). The team is cross-trained to handle a variety of procedures, from ablations to device implantations, ensuring flexibility and efficiency.

What types of procedures are performed at your facility? 

We perform a variety of procedures, including ablation of AF, supraventricular tachycardia, atrial flutter (AFL), ventricular tachycardia, and premature ventricular contractions, as well as device implants, including implantable cardioverter-defibrillators (ICDs), pacemakers, cardiac resynchronization therapy devices, and atrial and ventricular leadless pacemakers. We also perform conduction system pacing, cardioneuroablations, and left atrial appendage closure (LAAC) procedures with the Watchman device (Boston Scientific), and Amplatzer Amulet LAA Occluder (Abbott) and a variety of patent foramen ovale devices for endo leaks. We also perform lead extractions in our hybrid lab.

Approximately how many ablations, device implants, and LAAC procedures are performed each week? 

On average, we perform 15-25 ablations, 15-25 implants (all devices, including pacemakers and ICDs), and 10 LAAC procedures (with the Watchman or Amulet) per week. 

What types of EP equipment are commonly used in the lab? 

We currently have 2 mapping systems, Carto (Johnson & Johnson MedTech) and EnSite (Abbott). We use all catheters compatible with these systems. We have also have been performing pulsed field ablation (PFA) for AF with the FARAPULSE PFA System (Boston Scientific).

What are some of the new technologies and techniques recently introduced in your lab? How have these changed the way procedures are performed?

We are utilizing PFA for the treatment of AF, including use of the FARADRIVE steerable sheath and FARAWAVE catheter (Boston Scientific). Other technologies and techniques recently introduced include the use of dual-chamber leadless devices (AVEIR, Abbott), alcohol ablation of the vein of Marshall,  conduction system pacing (with technologies from Abbott, Medtronic, and Boston Scientific), concomitant procedures (PFA + LAAC), closure of LAA leaks, and cardioneuroablations for patients with cardioinhibitory syncope. 

Tell us more about your program’s use of PFA.

We are now close to performing 400 PFAs with FARAPULSE. We began in April 2024. We mainly use PFA in patients with paroxysmal and persistent AF. It has been an outstanding experience, making the procedure more efficient and predictable.

Discuss your use of hybrid AF ablation.

We perform hybrid AF ablation procedures in conjunction with a cardiothoracic surgeon in the hybrid OR at Delray Medical Center for select patients with long-standing persistent AF.

How is inventory managed in your EP laboratory?

Inventory in our EP lab is managed through an inventory management system that tracks usage and stock levels. A designated materials coordinator oversees daily inventory checks and orders replenishments as needed, ensuring alignment with procedural schedules. Additionally, we work closely with vendors through consignment agreements to minimize on-hand stock while maintaining access to critical supplies. These strategies have helped reduce waste and optimize storage efficiency.

Tell us what a typical day might be like in your EP laboratory.

We run 2 full labs from Monday to Friday, and perform a range of procedures, including ablations, devices implants, and LAAC procedures. We estimate that more than 70% of our time is committed to ablation of AF and AFL. 

Describe your approach to same-day discharge, including the use of vascular closure devices. 

We use Vascade (Haemonetics) and Perclose (Abbott). Both have really helped us improve our same-day discharge protocols.

Has your lab recently undergone a national accrediting inspection?

Our EP lab has not yet undergone a national accrediting inspection; however, achieving accreditation is a key goal for our team. We are actively preparing by aligning our protocols and practices with national standards. This effort includes enhancing quality assurance programs, staff training, and maintaining meticulous documentation to ensure readiness for a successful accreditation process in the near future.

How do you ensure timely case starts and patient turnover?

We ensure the first case of the day begins at 7:30 AM and have regular discussions about efficiency throughout the month to improve patient turnover.

Do you have flexible or multiple shifts? How do you handle slow periods?

Our EP lab operates with 2 staggered shifts to efficiently cover procedures throughout the day. During slow periods, staff assist with inventory management and educational activities, or are redeployed to other cardiac service areas.

How are vendor visits managed?

Vendor visits are coordinated through a centralized scheduling system managed by the EP lab coordinator. Vendors must provide advanced notice, comply with credentialing requirements, and align visits with the lab’s procedural schedule to avoid disruptions.

What measures has your laboratory implemented to cut or contain costs?

We implement cost containment measures such as negotiating bulk purchase agreements with vendors, standardizing equipment to reduce inventory variability, and optimizing scheduling to minimize downtime. These strategies have reduced annual supply costs while maintaining quality care.

What works well in your laboratory for onboarding new team members?

Our EP lab has a structured onboarding program that includes both hands-on training and comprehensive orientation sessions. New team members are paired with experienced mentors to ensure they gain practical skills and confidence in their roles. Additionally, we provide access to simulation-based training for specific procedures, which helps staff become proficient in a controlled environment before working directly with patients.

Regular check-ins and feedback sessions during the onboarding period help identify and address any learning gaps, ensuring a smooth transition into the team.

What continuing education opportunities are provided for staff members? How do staff typically maintain and renew credentials?

We prioritize continuing education by offering access to in-house training sessions, national conferences, and online learning platforms tailored to EP and cardiac care. Staff members are encouraged to participate in workshops and certification courses, and utilize continuing education to enhance skills and knowledge.

To maintain and renew credentials, team members follow a structured timeline that includes mandatory training updates, such as annual competency reviews and recertification courses. Our institution also reimburses staff for obtaining and renewing specialized certifications, reinforcing our commitment to professional development. 

We also use Medinbox; a platform used to record and stream our ablations and implants to the EP community for educational purposes. The mapping system, recording system, intracardiac echocardiography (ICE), x-ray, and an in-room camera are available to use as video sources.

Does your lab use a third party for reprocessing or catheter recycling? How has it impacted your lab?

Yes, our lab utilizes a third-party service for reprocessing and catheter recycling. This program has significantly benefited our operations by reducing overall supply costs and minimizing waste. Reprocessed catheters meet stringent quality and safety standards, ensuring no compromise in patient care. Additionally, the recycling program aligns with our institution’s sustainability goals by decreasing our environmental footprint.

The cost savings achieved through reprocessing have been reinvested into advanced technology and staff training, further enhancing our lab’s capabilities and efficiency.

Tell us about your primary approach for LAA occlusion.

We have a diversity of operators using the Amulet and Watchman devices, and have moved toward the use of ICE for these procedures. Some of these cases are currently done under conscious sedation.

Discuss your approach to lead extraction.  

Lead extractions are performed in the hybrid OR in conjunction with the cardiothoracic surgeon. We perform approximately 27 lead extractions per year.

Discuss your approach to treatment of AF in patients with heart failure (HF).

We believe patients with HF benefit the most from catheter ablation. Having an active HF service in the hospital has helped us to identify these patients.

Discuss your program’s initial treatment and management (including referrals) for patients with POTS or Long COVID. 

The Arrhythmia Center of South Florida has a very active program for patients with autonomic disorders. We perform a tilt table test and extended monitors for some of these patients.

How does your EP laboratory handle radiation protection for physicians and staff?

Our EP lab prioritizes radiation protection through a combination of advanced equipment and staff protocols. We use fluoroscopy systems with dose-reduction technology and integrate 3-dimensional mapping systems to minimize reliance on radiation-based imaging. Lead aprons, thyroid collars, and protective eyewear are mandatory for all staff in the procedure room. Radiation exposure is monitored regularly using personal dosimeters, and results are reviewed monthly to ensure compliance with safety thresholds. Additionally, all team members undergo annual radiation safety training to stay updated on best practices and regulations.

Most of our AF procedures are currently done with minimal fluoroscopy using mapping systems and ICE.

What are some of the dominant trends you see emerging in the practice of EP?

We believe PFA technology is currently in its infancy. In the future, it is possible we will be using second- and third-generation devices for atrial and ventricular arrhythmias. Another exciting area is LAA occlusion. We are waiting for major clinical trials to be completed to see if more patients will benefit from this therapy.

What is considered historic about your EP program or hospital? 

We were the first in Palm Beach County to perform PFA with the FARAPULSE. We were also the first in Palm Beach County to perform a concomitant procedure using PFA and a Watchman device. In addition, we were the first in the area to perform dual-chamber leadless pacemaker implantation. The AVEIR DR is completely leadless, eliminating the need for traditional leads (wires) that connect the pacemaker to the heart. The device is small, self-contained, and implanted directly into the heart, reducing the risk of complications associated with leads, such as lead fracture, infection, and vascular damage. It is designed for patients requiring dual-chamber pacing, offering the benefits of minimally invasive implantation, reduced complications, and advanced pacing technology without the need for traditional leads.

Describe your city or general regional area. What specific challenges does your hospital face given its unique geographic service area? 

Delray Medical Center, located in southern Palm Beach County, Florida, serves a diverse and growing population. The unique characteristics of its geographic service area present several challenges:

• Aging population. This region attracts retirees, leading to a higher concentration of elderly residents who require more frequent and specialized medical care, thus increasing health care demand. In addition, these aging patients often present with multiple chronic conditions, necessitating comprehensive and coordinated health care services.
• Seasonal population fluctuations. During winter months, the influx of seasonal residents (“snowbirds”) increases the local population, straining health care resources and potentially leading to longer wait times and resource allocation challenges.
• Diverse socioeconomic demographics. Serving both affluent communities and lower-income populations requires addressing varied health needs and ensuring equitable access to care. Transportation and financial barriers may also impact access to services and impede some patients from seeking timely medical attention.
• Competition and health care market dynamics. The presence of multiple health care facilities in the region necessitates continuous quality improvement and service differentiation to attract and retain patients.

Has your program or hospital recently experienced any “firsts”?

Yes, we are happy to report much growth and new procedures introduced:

• We experienced a yearly increase in EP patient volumes of 23.3% in 2024.
• We have performed 1000 transcatheter aortic valve replacement procedures since the start of our program.
• We achieved clinical excellence by receiving the HeartFlow CT Quality Award.
• We received the American Association of Cardiovascular and Pulmonary Rehabilitation Certification.
• We were the first in South Florida to implant the AVEIR DR leadless pacemaker.
• We were the first in Palm Beach County to perform a concomitant procedure combining use of the FARAPULSE and LAAO device implantation for the treatment of AF. 
• We were the first hospital in Palm Beach County to offer PFAs, and to date, we have performed more than 400. 

Please tell our readers what you consider special about your EP lab and staff.

We have a highly skilled staff who perform complex procedures with excellent outcomes. We are a patient-centered EP lab, and clinical outcomes are very important to us. The EP lab at Delray Medical Center stands out as a hub of excellence in cardiac care, delivering the latest treatments for arrhythmias with a patient-centered approach. It is a place where cutting-edge science meets compassionate care. The staff’s unwavering dedication to their craft ensures that patients with even the most complex cardiac conditions receive world-class treatment close to home. For anyone seeking exceptional cardiac care, Delray Medical Center’s EP lab offers a unique combination of innovation, expertise, and a genuine commitment to improving lives.