Cardiovascular Business - March/April 2008 - (Page 22) GROWING STRONGER: EP LABS COME INTO THEIR OWN “Each step that builds strong staff infrastructure in this discipline is a step in the right direction.” Edward V. Platia, MD, director of the Cardiac Arrhythmia Center, Washington Hospital Center, Washington, D.C. used to be pacemaker cases now qualify for defibrillation imimplants and 500 pacemaker implants each year. Director James plants and biventricular pacing…It’s a hard thing to get at beP. Daubert, MD, agrees that increased formal training and crecause every year or two the procedures change a little,” says dentialing—which will invariably raise the workplace value of Daubert. (Industry-wide, atrial fibrillation ablation remains the the EP tech—is worth the cost to the profession, the patient and most consistently performed procedure.) the technicians themselves. In the next two years, Strong Heart and Vascular Center will “Yes, it will cost more. When thesefolks get up to a level where construct a new multimillion-dollar EP lab, replacing its older they really understand what’s going on and can work indepenx-ray equipment, updating its mapping equipment, and acquirdently, it should translate into a relatively high salary for a tech ing a $1 million state-of-the-art Stereotaxis Magnetic Navigation position. They can make some money.” system. The robotic navigation apparatus utilizes two magnets As at the Washington Hospital Center, Strong Heart and Vason either side of the patient, “like MRI, but a weaker magnetic cular Center now routinely borrows technicians from the cath field,” says Daubert. “It enables you to continually realign the dilab to fulfill the duties of an EP tech. It works, says Daubert, “berection of the magnetic fields, and maneuvers the catheter in the cause there’s a bit of an understanding of the instrumentation, heart with a joystick. You can do the study from the next room and the computers are similar. But if they’re not fully trained and or even remotely.” all the trained people are busy in other labs, it’s a bit harder and Investments of that magnitude (Daubert estimates that a bit slower. We have to walk them through things, watch everyStrong will spend $2 million to $4 million on the new lab) are thing they’re measuring and doing.” not feasible for some facilities, says Debra Pendergrass ChinThat said, no one at Strong is trying to speed up the process, Daubert emphasizes. “We haven’t really tried to make big › Cardiac ep—once a small, highly specialized inroads on reducing the time spent on subspecialty—has evolved into a major area of cardiac these cases… Should we take a fourhour procedure and try to get it down care, particularly for patients with life-threatening to two hours? If maximizing the ecoarrhythmias. nomic impact was our only goal, we Cardiac arrhythmias arise from disturbances of heart rhythm as a result of might want to do that. But first and incorrect impulse generation. With painstaking precision, EP studies collect data foremost, we want to do [EP studies] about the flow of electricity within the heart, isolating specific areas of heart tissue well and faithfully, with a high success that give rise to the abnormal impulses. The detailed data enables the physician to rate. It’s really a moving target.” formulate an appropriate treatment response. Though lab staff routinely try to “asAlthough it is more invasive than an electrocardiogram or echocardiogram sess and improve” turnaround time beand involves initiating arrhythmias in a controlled setting, the tests produce data tween cases, the bottom line that counts to diagnose the source of arrhythmia symptoms; evaluate the efficacy of certain is not necessarily a financial statement, medications in controlling the disorder; predict the risk of a future cardiac event; but the health of “the one on the table,” assess the need for an implantable device (pacemaker or ICD) or treatment (rahe says. diofrequency catheter ablation). The increasing complexity of EP proEP studies are performed by a team, led by a physician electrophysiologist with cedures will almost certainly accelerate advanced training in the diagnosis and treatment of heart rhythm problems. The demand for skilled EP techs. physician is supported by a team of specially trained nurses and technicians. “The problem is that a lot of what 22 Cardiovascular Business March/April 2008
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