Spotlight Interview: The Second Hospital of Hebei Medical University

The Second Hospital of Hebei Medical University is a 3,000-bed regional hospital located in the city of Shijiazhuang, the capital of Hebei Province, which is 280 kilometers south of Beijing, China.

It is the largest comprehensive hospital in the Hebei Province, integrating medical care, education, and research for the entire region.

Currently, the hospital is composed of 3 branches, with a total of 9 departments of cardiology, and electrophysiological procedures are carried out in 8 of these departments.

Approximately 2,500 electrophysiological procedures were performed in the hospital over the last year; among these, 580 cases were performed in No. 4 Cardiology Department.

What is the size of your EP lab facility? Where is the EP lab in relation to the catheterization department?

In our institution, there are two shared EP/cath lab rooms. The EP/cath labs are part of an integrated facility on the basement floor. The EP program shares these facilities with other interventional procedure programs.

Are employees cross-trained?

No, the EP and cath lab staff is separate.

What is the number of staff members? What is the mix of credentials at your lab?

There are 21 staff members in our lab, including 8 physicians, 10 nurses, and a mix of cardiovascular and radiologic technologists.

What types of procedures are performed at your facility? What types of complex ablations are performed?

Our EP team performs radiofrequency ablation of supraventricular tachycardia, premature ventricular contractions (PVCs), ventricular tachycardia (VT), and atrial fibrillation (AF). We also treat hypertrophic obstructive cardiomyopathy (HOCM), perform left atrial appendage occlusion, and at times utilize cryo for atrial fibrillation ablation.

What would you consider to be the most frequent procedures performed or the most common arrhythmias seen?

Generally, atrial fibrillation procedures account for 40% of our overall cases, with supraventricular procedures accounting for 30% and ventricular arrhythmias accounting for 25%.

Approximately how many catheter ablations (for all arrhythmias), device implants, lead extractions, and LAA closures are performed each week?

Last year, our EP team performed 580 ablation procedures. On average, we perform about 10-15 procedures per week.

Who manages your EP lab?

Mrs. Jinfeng Wu, our lab nurse manager, routinely runs the EP lab along with Dr. Suyun Liu.

What type of hospital is your EP program a part of?

Our EP program is a part of the Second Hospital of Hebei Medical University. It serves as an academic institution for Hebei Medical University and also as the largest regional referral center of Hebei Province, with over 70 million residents.

Does your EP lab compete for patients? Has your institution formed an alliance with others in the area?

There is no competition between departments in our hospital. We have built close relationships with local hospitals, who refer their complicated arrhythmia patients to our EP lab.

Has your EP lab recently expanded in size or patient volume?

Yes, the number of EP procedures we perform has been increasing annually by about 25% each year for the last three years. Due to this increasing number of patients and high demand for procedures, we usually work an extra day on the weekends to perform EP procedures.

What types of EP equipment are most commonly used in the lab? What imaging technology do you utilize?

We most commonly use the CARTO 3 system (Biosense Webster, Inc., a Johnson & Johnson company) including the CARTOSOUND module, and the LEAD-9000 Electrophysiology Management System (Sichuan Jinjiang Electronic Science and Technology Co., Ltd). We use the THERMOCOOL SMARTTOUCH catheter (Biosense Webster, Inc., a Johnson & Johnson company) and Safire catheter (Abbott) for ablation.

What new initiatives or technologies have recently been added to the EP lab, and how have they changed the way you perform procedures?

This year we started to utilize intracardiac ultrasound (ICE) in atrial fibrillation and HOCM procedures. With the aid of this technology, we can now perform AF procedures with low or zero fluoroscopy.    

Who handles procedural scheduling?

Dr. Yanwei Wang handles the scheduling of EP cases.

How is inventory managed at your EP lab?

Dr. Suyun Liu works with the Equipment/Supplies Purchasing Office for necessary equipment and supplies.

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

Our department is assigned to use the cath lab every Tuesday and Friday. A normal day here usually runs from 8 am to 2 pm. The patients are checked in and prepped by the team before the operation. Each day we perform a range of procedures. Due to the high number of patients, we also perform 10 procedures every Saturday, from 8:00 am to 8:00 pm.

How do you ensure timely case starts and patient turnover?

Special staff is assigned to pick up and drop off patients to ensure a seamless turnover.

What type of quality control and assurance measures are practiced in your EP lab?

We review every individual case for possible complications and take necessary precautions when required. This includes checklists to ensure every aspect is considered. Each new staff member is also assigned to a mentor, who closely trains and assesses their progress. There is strict disciplinary action for any preventable procedure-related complication that occurs within a short period of time.

How are new employees oriented and trained at your facility?

It takes 1-3 months for a new trainee to observe the procedures in our lab. The training begins with puncturing femoral veins, inserting electrode catheters, and manipulating multi-channel cardiac EP equipment.

When this is mastered, they progress to transseptal punctures and pulmonary venography training. The ablation procedures performed progress in complexity, from PSVTs to PVCs, and then finally, to AF cases.

We also hold professional lectures and conferences every 2 weeks, during which new skills, equipment, or initiatives are introduced, and complex cases and complications are discussed.

What types of continuing education opportunities are provided to staff? How many of your staff members attend medical conferences each year?

We provide various continuing education opportunities to our staff. Our staff members regularly attend the Heart Rhythm Society (HRS) conferences around China. Additionally, they have the opportunity every other year to attend international symposiums such as the HRS and EHRA annual conferences.

How do you prevent staff burnout and turnover? What approaches do you use for team building?

We have established a training system for new staff on the basis of previous experiences and skills, which helps integrate their roles into the team. We also believe that synergy in the lab environment is essential for team building, so we have mentors for our new staff to help answer any questions they may have.

Incentives are provided according to each individual’s role and contribution. We foster an environment of fair competition, where every staff member has the opportunity to become an outstanding electrophysiologist as long as they are willing to make the effort.

Describe a particularly memorable case from your EP lab and how it was addressed.

There was a special patient in our department 2 years ago. Diagnosed with idiopathic ventricular fibrillation, she presented with electrical storm that was refractory to most kinds of antiarrhythmic medications, including esmolol, diltiazem, lidocaine, and amiodarone. We performed an emergency ablation at 11:00 pm in the left ventricular septal area, recording extensive left posterior fascicular and left anterior fascicular potentials. The ventricular fibrillation has thankfully not recurred, and the patient has continued to live a healthy life.

Does your lab use a third party for reprocessing or catheter recycling?

Unfortunately, our lab does not recycle catheter equipment.

Approximately what percentage of ablation procedures are done with cryo vs radiofrequency?

We seldom perform cryoablation in our lab. Among all of our 210 AF ablation procedures last year, only 5 ablation procedures were performed with cryoablation. The rest were with radiofrequency.

Does your lab use contact force sensing technology during radiofrequency ablation of AF?

Yes, we commonly perform AF ablation procedures with contact force sensing technology.

Do you utilize lifestyle modification as therapy for your patients with atrial fibrillation?

Definitely! We advise all of our patients to refrain from alcohol, maintain a healthy diet, and to keep fit.

What other innovative EP techniques are being utilized in your lab?

We started treating some atrial fibrillation, ventricular arrhythmia, and HOCM cases with ICE in the past year. Currently, we use the ablation index (AI) as guidance for AF ablation.

Are pediatric cases performed in your lab?

We perform procedures on pediatric patients over the age of 10 years old; these patients are usually referred from the cardiovascular adult clinic rather than pediatrics. We cooperate with the pediatric doctors in the management of arrhythmia therapy, but there is no cardiovascular genetics institute in our medical center.   

What approaches has your lab taken to reduce fluoroscopy time? What percentage of cases are done without fluoro? What types of radiation protective shielding and technology are used?

The x-ray angiography system in our lab is the Allura Xper FD20 (Philips). We use a reduced 3.75 frames in our EP procedures. We utilize very low to zero fluoroscopy with the support of intracardiac echocardiology. We wear lead protective shielding when using fluoro. All cases with pregnant patients are done without fluoroscopy.

Do you utilize remote monitoring of CIEDs?

We do not utilize remote monitoring for implanted devices.

Is your EP lab involved in clinical research studies?

We upload our AF data to the China Atrial Fibrillation Center Registry for analysis. However, we are not involved in clinical research studies at this time. We are keen to participate in clinical research studies in the near future.

Does your hospital offer a cardiac device or AF support group for patients?

We have built a platform on WeChat, China’s most popular social media, which allows for arrhythmia patients to share experiences and support each other. We also aid these groups by publishing an article every week on better disease management.

Has your lab achieved accreditation?

Our lab has received national EP accreditation, and we are an atrial fibrillation diagnosis and treatment center that is certified by the Chinese National Health Commission.

Does your lab have any physical (layout) bottlenecks or limitations?

Yes, our two EP lab rooms currently cannot provide sufficient capacity to care for our growing number of patients. The population of our province is rising rapidly, and we have plans for further expansion within the next 5 years.

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

In China, AF continues to be the main challenge in EP because of its complex pathophysiology and increasing incidence. We have observed a lot of patients being referred for AF procedures, especially long-standing persistent AF with chronic heart failure. Performing EP procedures on these patients is leading to better outcomes.

Meanwhile, clinical electrophysiologists are attaching greater importance to low or zero fluoroscopy during procedures. We have realized that the ablation index is increasingly more important in AF ablation.

Describe your city or general regional area. How is it unique?

Our hospital is located in Shijiazhuang, the capital of Hebei Province in The People’s Republic of China. The city now has a population of almost 11 million people.

We are proud to say cycling is an extremely popular method of transport in this city. Bike lanes line the side of almost every major street, making it very safe. In fact, a lot of our hospital staff cycles to work to beat the high amount of traffic, which has unfortunately become an issue in the areas surrounding our hospital.

What is considered historic about your EP program or hospital? Has your program or hospital recently experienced any “firsts”?

We were the first hospital in the region to utilize three-dimensional mapping system for EP studies and ablations. This year, we have successfully performed ablations on 7 HOCM patients with the aid of ICE, which we also utilize for the treatment of AF.

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

Most of our electrophysiologists are female. They are balancing the heavy workload at the hospital with their personal lives. They are all extraordinary women and very enthusiastic about what they do. I have witnessed their rapid growth and remarkable working ability. It inspires all of us, and I hope it means a bright future for our EP team. 

About the Author

Chenglong Miao, MD, PhD, Medical Director of the EP program, is a practiced clinician, researcher, and a disciplined leader in our field. Dr. Chenglong Miao is an accredited member of The Chinese Heart Rhythm Society, and in 2014 was the first EP physician to successfully perform AF ablation and various complex arrhythmia procedures in the region. Dr. Chenglong Miao has dedicated his life to unifying technology and treatment to help more patients. He lives by a quote that he hopes will inspire others: “Find something you love doing, and then find a way to scale it.”