Spotlight Interview Update: Huntsville Hospital

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EP LAB DIGEST. 2024;24(3):1,13-14.

Jay Dinerman, MD, Huntsville, Alabama

What is the size of your cardiac electrophysiology (EP) laboratory? Has the EP lab expanded in size, or will it soon?  

We currently run 3 dedicated EP laboratories and 1 shared EP hybrid structural laboratory. An additional 2 EP labs are slated for the near future. 

Who manages your EP lab? What is the number of staff members? 

Codie Vaughn, RN, BSN, manages our EP program. We have 16 registered nurses, 1 radiologic technologist, and 4 cardiovascular technologists. Our labs are also covered by the cardiovascular anesthesia service.

What types of procedures are performed at your facility? 

We perform a full range of implantable loop, pacemaker, and implantable cardioverter-defibrillator procedures, including conduction system pacing and leadless approaches. 

We perform catheter ablation of supraventricular tachycardia (SVTs), atrial fibrillation (AF), and ventricular tachycardia. We utilize cryo and radiofrequency ablation for AF, as well as unique SVTs. We perform left atrial appendage (LAA) occlusion procedures in collaboration with our structural cardiology colleagues. 

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

We perform 26 ablations per week, 35 device implants per week, and 10 LAA closures per month.

What are some of the new equipment, devices, and products recently introduced at your lab? How have they changed the way you perform procedures?  

We have recently begun using left bundle branch area pacing (LBBP) sheaths. LBBP sheaths have helped us apply conduction system pacing to more patients, and we are using this technique in most patients in whom we expect to see a significant percentage of ventricular pacing. 

We have also recently introduced use of the VersaCross RF Transseptal Solution (Boston Scientific), which has decreased procedure times. 

Advances in mapping technology have aided complex ablation of arrhythmias. We are currently using the Carto 3 (Biosense Webster, Inc, a Johnson & Johnson company), EnSite Precision (Abbott), and EnSite X (Abbott) mapping systems. 

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

We reprocess diagnostic catheters and ultrasound probes. We were granted cost savings in turn for dedicating a significant percentage of our device volume to a limited number of vendors. 

Does your lab perform His bundle pacing and/or LBBP? 

Yes, both. In October, we completed our 100th LBBP case. We had been doing His bundle pacing for many years before that.

Tell us about your primary approach for LAA occlusion. 

We collaborate with our structural cardiology colleagues to handle the very large number of patient candidates for this therapy. Procedures are performed under general anesthesia and cases are covered by an additional cardiologist performing transesophageal echocardiography.  

Does your program have a dedicated AF clinic? 

Yes, we are currently developing a dedicated AF clinic. 

What approaches has your lab taken to reduce fluoroscopy time? 

When appropriate, we utilize intracardiac echocardiography to perform catheter ablation with minimal or no fluoroscopy. 

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

Reimbursement changes for catheter ablation (increased hospital and decreased physician reimbursement) has led to a desire to increase patient throughput, and thus, increase facility capacity. This has led to the need for more EP labs. Pulsed field ablation will soon be available and is expected to favorably influence workflow. The tremendous number of device patients we follow has led to great challenges in maintaining adequate follow-up. Despite having a growing number of dedicated device nurses, we recently decided to move from an in-house approach to using Murj. During this transition period, we will outsource some portion of remote patient follow-up that we do not have the capacity to cover. 

How do you use digital health and wearable technologies in your treatment strategies? 

We frequently recommend the use of these technologies to help diagnose and monitor our patients with heart rhythm disorders.

What are the best features of your EP lab’s layout or design? 

Our newest labs are connected with a stock room that is shared. This helps with efficiency of time between procedures as well as assists with maintaining and monitoring stock, which improves overall costs.  

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

Our 5 dedicated electrophysiologists are from one group who equally rotate their lab and clinic time. Also, our nurses equally perform all roles in the lab (monitoring procedures, scrubbing, and running the fluoroscopy/mapping and ablation machines). We have always tried to foster an environment of collaboration and team building that encourages continuous education and embraces the exciting changes in cardiac EP.