Spotlight Interview: Northwestern Medicine Lake Forest Hospital

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

In March 2018, the EP program at Northwestern Medicine Lake Forest Hospital entered a new era, when Northwestern Medicine transitioned from the original hospital building, built in 1942, to a new 500,000 square foot hospital. In the original hospital, devices and simple ablation procedures were infrequently performed. However, with the construction of the new hospital and subsequent new EP lab with more contemporary equipment, the services offered have expanded tremendously over the past 4.5 years. Nishant Verma, MD, MPH, is the EP lab director at Lake Forest Hospital, and he partners with Kaustubha D. Patil, MD, to provide the full range of available EP services.

These 2 cardiac electrophysiologists split their time between Northwestern Memorial Hospital in Chicago and Lake Forest Hospital. Ray W. Helms, MD, continues to provide EP services at Lake Forest Hospital after helping to start the EP program in the original hospital.

What is the size of your EP lab facility? Are there plans for further expansion?

There is one single-plane, dedicated EP lab in Lake Forest Hospital where all procedures that require mapping are performed. If necessary, device cases can be performed in 2 adjacent interventional labs. With the rapid growth in procedural volume and patient care needs, discussions regarding the construction of an additional biplane lab to accommodate EP procedures are in discussion.

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

We have a dedicated staff of approximately 15 members that are cross trained in EP, cardiac catheterization, and interventional radiology. The credentials of the staff members are a mix of registered nurses (RNs), registered technicians, and registered cardiovascular invasive specialists.

What types of procedures are performed at your facility?

We offer a full range of EP services, including transesophageal echocardiography/cardioversions, device implantations, and catheter ablation procedures. All types of device implantations are performed, including for implantable loop recorders, transvenous pacemakers and implantable cardioverter-defibrillators (ICDs), traditional cardiac resynchronization devices and conduction system pacing, leadless pacemakers, and subcutaneous ICDs. Ablation procedures performed include supraventricular tachycardia (SVT), typical atrial flutter (AFL), cryoablation of atrial fibrillation (AF), premature ventricular contractions, and atrioventricular node ablations. Complex left AFL ablation, VT ablation, lead extraction, and left atrial appendage occlusion are not currently offered, as the hospital does not currently have a cardiac surgery program.

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

The EP lab at Lake Forest Hospital performs approximately 2-4 catheter ablations and 2-6 device implants per week. Procedural growth in the EP lab has increased nearly 500% since 2019. In 2022, we are on track to perform over 200 procedures.

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

For EP studies and ablation procedures, we use the Bloom stimulator (Fischer Medical), Carto 3 mapping system and SoundStar Ultrasound catheter (Biosense Webster, Inc, a Johnson & Johnson company), and Acuson ultrasound machine (Siemens Healthineers). We use diagnostic EP catheters by Biosense Webster, Boston Scientific, and Abbott. We also use ablation catheters by Biosense Webster (4 mm, 8 mm, and ThermoCool) along with the Arctic Front cryoballoon (Medtronic). For device implantations, we offer pacemakers and ICDs from Boston Scientific, Medtronic, Biotronik, and Abbott.

Who manages your EP lab?

The day-to-day operations of our EP lab are coordinated and managed by our exceptional schedulers (Charity Biley and Aleks Becerra), our resource coordinator (Brandon Becker), cardiovascular tech (Kelly Burrows), charge nurse, and dedicated EP lab techs and RNs.

Tell us about your device clinic, including its staffing model.

The device clinic at Lake Forest Hospital began with less than 80 patients and now actively manages nearly 800 patients. In addition to a number of other in-clinic responsibilities, our device nurse, Stephanie Markko, is responsible for all in-person device checks as well as remote monitoring. Due to the rapid, continued growth of the device clinic, we are actively recruiting for a device tech and considering a third-party remote monitoring service.

In what ways did the COVID-19 pandemic impact your hospital, EP lab, or practice?

The COVID-19 pandemic significantly curtailed the procedural volume, particularly at the beginning and during the subsequent peaks. At one point, the majority of the hospital beds were occupied by COVID-19 patients. Present day, EP procedures have ramped back up and we are now doing more cases than ever.

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

The EP lab at Lake Forest Hospital has adopted several new techniques to improve efficiency as well as safety for patients and staff. We are performing more fluoroless procedures with SVT ablations, and AFL ablations are now routinely done without fluoroscopy. This will help limit radiation exposure for patients and staff, and hopefully reduce the use of lead over time. We hope to increase the number of procedures performed without fluoroscopy. In addition, we have added vascular closure devices to our procedures, particularly cryoablation for AF. These devices have allowed us to reduce bedrest and will afford us the opportunity to transition to same-day discharge of these patients.

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

The nationwide shortage of contrast provided a unique obstacle to performing many EP cases. In particular, we had to determine an innovative approach to cryoablation of AF. Due to the staff expertise from cross training with the cardiac catheterization lab, cryoballoon pressure waveform monitoring was easy to set up and use. This, in addition to intracardiac echocardiography imaging, allowed us to continue to provide the same level of care and procedures for our patients without any significant interruptions.

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

Lake Forest Hospital has served as a community hospital in Lake Forest, Illinois, since 1899. The hospital is located approximately 30 miles north of Chicago and serves as a community outpost for Northwestern University and Northwestern Medicine. Since the hospital has been an integral part of the community for such an extended amount of time, there is a very strong community relationship and significant community engagement, particularly as the hospital has expanded. One particularly unique aspect of our program is the ability to provide these services without an onsite cardiac surgery program. Due to the expertise and dedication of our staff, we have been able to safely offer high-quality, state-of-the-art procedures with reproducible results. The ability to provide these services to a local community to which they were previously unavailable is one of our proudest achievements.