EP Lab Digest - May 2008 - (Page 46)

46 EP TECHNOLOGY MAY 2008 Highlight on Technology: Video-Audio Integration for the EP Lab Laurence M. Epstein, MD Brigham and Women's Hospital Boston, Massachusetts Figure 1. The current state of EP labs is often a definition of clutter. istorically, electrophysiology laboratories were designed on the model of catheterization laboratories. In this model, the x-ray images were the focal point of the procedure. This model worked for early electrophysiology laboratories, which included single-plane fluoroscopy and thermal or ink recorders for a limited number of electrogram channels. H However, many labs today are equipped with biplane fluoroscopy (4 monitors), multichannel recording systems (2-3 monitors), one or more threedimensional mapping systems (1-2 monitors), intracardiac echocardiography (1 monitor), three-dimensional reconstruction workstations (1-2 monitors) and robotic catheter manipulation systems (2-3 monitors). The role of anatomy in arrhythmia treatment has become increasingly recognized, and the integration of multiple imaging modalities guide therapeutic procedures. Catheter ablation to treat atrial fibrillation is a clear example of how image-guided therapy enables the treatment approach. Unfortunately, advances are often accompanied by challenges.The modern electrophysiology laboratory has become the very embodiment of clutter (Figure 1). With technology advances such as cryoablation and saline cooling, equipment occupies more and more space in the modern electrophysiology laboratory. This has created two major issues: • The clinician must search for appropriate information amidst the clutter on the myriad monitors around the room. • There is a lack of space. Choices must often be made limiting which technology can be viewed, simply because there is not enough space in the room. There is now a need to integrate and display information rationally within a dramatically reduced footprint. Ideally, the clinician would be able to customize the organization and display of the information. A team of trained personnel now performs most complex procedures. In order to maximize procedural safety and efficacy, clear communication among the team performing the procedure is crucial. When the recording/mapping workstations are in a separate room, communication depends on overhead speakers and microphones. This can create a loud and noisy situation, and can be unsettling to the patient. Ideally, the communication system should allow private communication among all care providers. Figure 2. The CurlView system at Brigham and Women’s Hospital. In this photo, electrograms, biplane fluoroscopy, 3-D mapping and intracardiac echocardiography are displayed on a single display. high-resolution video panel. 2. The operator can control multiple computers with one mouse and keyboard. 3. The entire clinical team can have private, whisper-sensitive wireless communication. 4. Concentration and focus are enhanced by background music. Video Processing and Display. The system employs a single 56-inch ultra high resolution video display panel. The display controller allows the clinician to have any combination of images, placed anywhere and in any size on the display. There is full control to manipulate the images for different segments of the case or for different procedure types. Each image can be “right sized” or even removed if not required. The front end of the system takes up to 22 input sources and selectively routes them to the Video Processing Engine. The processing engine takes up to 12 sources of virtually any video resolution or format, and displays them simultaneously on a single 56” 8 Megapixel display panel. The user can select preset configurations to manipulate the images and optimize their viewing accuracy, priority, and comfort, or may customize the display in real time to suit a particular situational need. Typically, the large display is used in the procedure room, but it can also be used at the control console to provide a duplicate view. Consolidated Keyboard and Mouse Control. The system has the option of controlling multiple computers via a single keyboard and mouse on a single display. The control of the remote machine is performed either through a USB interface or through a LAN applet. The native keyboard and mouse for each machine can also be operated independently in the event there are multiple operators during the case. Wireless and Wired Intercom. The system provides intercom options that deliver clear and accurate voice communication. The wireless option provides whisper sensitivity and privacy, regardless of commotion and distractions. The physician’s instructions and team replies are delivered to all participants. Individual users can select between “Push-to-Talk” or “Full-Duplex” modes. The wireless option also provides the added benefit of allowing participants to leave the room EP Lab Solutions One solution to the problems of information display, operating room clutter and private communications is CurlView IGT (Figure 2). The primary benefit of the CurlView system is that it allows the clinician and staff to maintain maximum focus and collaboration during a case. This is achieved as follows: 1. The system integrates all video displays currently carried on 6-12 separate monitors onto one large, very Editor’s Note: This article underwent peer review by one or more members of EP Lab Digest’s editorial board.

Table of Contents Feed for the Digital Edition of EP Lab Digest - May 2008

EP Lab Digest - May 2008 Is There an Under-Referral of Women for Atrial Fibrillation Ablation? A Hybrid Approach to the Cure of Atrial Fibrillation Contents Letter from the Editor Spotlight Interview: University of Michigan Health System 10-Minute Interview: Amit J. Shanker, MD Modular EP Units: Are They Possible? One Hospital’s Experience All About My Job: Technician Supervisor (New Column!) Alcohol Septal Ablation in the Cath Lab: What is it All About? About the Canadian Heart Rhythm Society: Interview with Martin J. Gardner, MD, FRCP(C), FACC Email Discussion Group: May 2008 Second Annual Salary Survey My First Year in Electrophysiology: What Have I Got Myself Into? Highlight on Technology: Video-Audio Integration for the EP Lab On the Horizon: A New Remote Catheter Manipulation System Striving for Excellence in the Care of Cardiac Patients Five Reasons to Participate with a Professional Organization Suspected Shunting of Defibrillation Energy in the EP Lab Can Digital Music Players Cause Interference with Implantable Devices? ECG 101: Ambulatory ECG Monitoring Events Calendar Industry News and Products Classifieds Advertisers Index

EP Lab Digest - May 2008

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