Harlingen Medical Center
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EP LAB DIGEST. 2024;24(12):1,12-13.
Frank Mazzola, MD, FACC, FHRS, Director of the EP Program, and Linda Bull, LVN, CVT, Catheterization/EP/Interventional Radiology Lab Director Harlingen, Texas
When was the cardiac electrophysiology (EP) program started at your institution, and by whom?
Harlingen Medical Center is a 112-bed community hospital in the heart of the Rio Grande Valley in Harlingen, Texas. The hospital was initially conceived of and built in 2002 by our premier cardiology group, South Heart Clinic, in conjunction with MedCath, Inc. Our cardiac EP program was founded by Dr Frank Mazzola, who was the first electrophysiologist in the Rio Grande Valley back in 1995. After leaving the valley in 1999, he returned in 2008 and started the EP program at Harlingen Medical Center in 2013. The program has grown considerably thanks to our hospital administration, led by CEO Candice Constantine-Castillo, DHA, DNP, MBA, MSN, FACHE, NEA-BC, CENP, CNE, CPHQ, CPHRM, HACP, CCRN-A, CEN, CNML, and our cath lab director, Linda Bull, LVN, CVT.
What drove the need to implement an EP program?
The Rio Grande Valley is considered an underserved area. Many patients were not receiving the advanced care that they needed, and many had to travel away from home for EP services.
What is the size of your EP facility? Has the EP program recently expanded in size, or will it soon?
The facility has 2 large, state-of-the-art cardiac catheterization laboratories, one of which is used for EP procedures. There are plans for a third lab, which will primarily be a dedicated EP laboratory. The catheterization/EP laboratory works closely with the recovery area to efficiently get patients in for their procedures.
Who manages your EP laboratory, and what is the mix of credentials and experience?
Linda Bull, LVN, CVT, is the director of the cardiac catheterization and EP laboratories. There are currently 7 registered nurses, 3 radiology technologists, and 1 cardiovascular technologist/performance improvement coordinator. We also rely on our anesthesia department for procedures that require general anesthesia or closely monitored anesthesia care.
What types of procedures are performed at your facility?
In the EP program, a full spectrum of procedures is performed, including ablations for paroxysmal and persistent atrial fibrillation (AF), typical and atypical atrial flutter, premature ventricular contractions, ventricular tachycardia, and supraventricular tachycardia, as well as pacemakers, conduction system pacing, defibrillators, cardiac resynchronization therapy devices, subcutaneous defibrillators, and leadless pacemakers.
What types of EP equipment are commonly used in the laboratory?
The facility recently upgraded the EP equipment to become the most advanced state-of-the-art lab south of San Antonio. An Abbott recording system and Carto 3 (V8) mapping system (Johnson & Johnson MedTech) are utilized. The CartoSound FAM Module (Johnson & Johnson MedTech) and Vivid S70 ultrasound system (GE HealthCare) are also used to enhance mapping accuracy and procedure efficiency. Catheters that are used include the DecaNav, Octaray, Optrell, SmartTouch, and QDot (all Johnson & Johnson MedTech). These upgrades have allowed for more precise mapping, enhanced patient safety, and greater efficiency.
Can you describe the extent and use of vascular closure devices at your laboratory? Tell us about your approach for same-day discharge.
A hybrid approach is used depending upon the patient as well as the number and size of sheaths. This ranges from vascular closure devices (Vascade, Haemonetics), figure-of-8 suture, and manual pressure. Most outpatients are discharged same day.
Discuss your program’s approach to lifestyle risk factor modification for reduction of AF.
Our EP program works in close association with the arrhythmia center and device clinic at South Heart Clinic. In this outpatient setting, strong emphasis is placed on modifying all risk factors, particularly obesity and obstructive sleep apnea.
What are your thoughts on recommendations from the 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of AF, and how has it impacted your clinical practice?
These guidelines have served as a springboard for educating referring physicians regarding the need for early treatment of AF and the expanding role for catheter ablation. In addition, the new staging system from the guidelines has been adopted, which emphasizes aggressive risk factor modification prior to developing AF. Harlingen Medical Center also has a weight loss center that offers free educational seminars on weight loss as well as the option of bariatric surgery for morbidly obese adults.
How does your EP laboratory handle radiation protection for physicians and staff?
Most ablations are performed with minimal or no fluoroscopy. For device implants, fluoroscopy is minimized is much as possible, x-ray exposure is monitored, and appropriate shielding is always maintained.
What is considered historic about your EP program or hospital? Has your program or hospital recently experienced any “firsts”?
Harlingen Medical Center is among the first EP programs in the Valley. In addition to providing clinical services, the facility and physicians team with community outreach programs, and interface closely with the medical community.
Describe your city or general regional area. How is it unique?
The Rio Grande Valley is a region in deep south Texas separated from Mexico by the Rio Grande River. It includes cities such as Mission, McAllen, Weslaco, Harlingen, and Brownsville. It is largely a Hispanic community, with many immigrants from Mexico, Central America, and South America. It is a warm and friendly community, rich in Mexican culture. During the winter months, it becomes home to a large number of “Winter Texans”, largely from the Midwest. Many of these patients live in rural areas and receive their more complex medical care in the Rio Grande Valley.
Please tell our readers what you consider special about your EP laboratory and staff.
Under the leadership of Linda Bull, cath lab director, we maintain a family-like environment. All staff members are mutually supportive and work cohesively. Both in the catheterization and EP arenas, the team’s performance in complex cases and unexpected emergencies is exemplary.
