Cardiovascular Business - January/February 2009 - (Page 8)

electrophysiology roundtable “Intracardiac echo imaging is the one tool we use on every atrial fibrillation case,” says David. E. Haines, MD, chairman of the division of cardiovascular medicine at William Beaumont Hospital. Image: Automatic reconstruction of the left atrium using an ultrasonic catheter located in the right atrium. Source: Biosense Webster : Is there any reimbursement associated with robotics? n Natale: There is a code, but I don’t know if it is actually being paid because most of the insurance companies, especially Medicare, pay a fixed amount. It doesn’t make sense. To improve your chances of success, you have to use newer technology and image integration, which costs more, but the trend of reimbursement is going the other way. between the operator, the patient and the patient’s family, but also the operator and the referring doctors. For instance, a patient with an implantable defibrillator has to be followed—and followed under certain protocols that he or she must understand and accept. Setting expectations for somebody who has chronic atrial fibrillation in a large atrium is much different from somebody who has paroxysmal atrial fibrillation and has a normal sized atrium. Those are completely different patients and you can get a good result with both, but you have to set the expectations appropriately. l Steinberg: If we look at the supraventricular arrhythmias, including the many forms of supraventricular tachycardia (SVT), Wolff-Parkinson-White syndrome and atrial flutter, those are clear-cut indications. Many of these patients who are symptomatic with arrhythmias are candidates for ablation, certainly, if they are refractory to medications, but often patient preference dictates that the ablation be a first-line therapy as well, and that is reasonable. When you get into realm of atrial fibrillation, it becomes more complicated. In general, these patients need to be refractory to antiarrhythmic drug medications before being referred to a lab and they need to be symptomatic. There are some infrequent exceptions to that rule. The success rates are not as good and the risks are greater, so we are more judicious in whom we perform the ablation. : How important is patient selection and what knowledge have we gained in recent years? n Wilkoff: Part of it is patient selection and part of it is setting expectations and that’s an educational component that happens : How do you make the choice between ablative therapy and anti-arrhythmic drug therapy? s Morin: Essentially, some patients are candidates for both and it’s going to depend on the risk/benefit analysis. If patients are a candidate for both, they may be cured permanently by their ablation, whereas medication sometimes will need to be taken for the rest of the patient’s life. Going along with that are the risks of taking a medicine for rest of your life or the potential risks of having a device implanted or an ablation performed. “Electro-anatomic mapping has made complex ablations much easier, much more reliable and safer,” says Jonathan Steinberg, MD, chief of the division of cardiology, St. Luke’s-Roosevelt Hospital Center. Image: Noncontact multi-electrode catheter collects real-time cardiac electrical information, translating it into a three-dimensional map. Source: St. Jude Medical n Natale: The guidelines suggest that patients fail at least one medication before trying ablative therapy. The success rate of a second drug after the failure of the first is much less than what 8 cardiovascular business January/February 2009

Table of Contents Feed for the Digital Edition of Cardiovascular Business - January/February 2009

Cardiovascular Business - January/February 2009 Contents First Word Electrophysiology Roundtable Forum: A Candid Conversation about Profits, Procedures and Patients Heart Failure Care Gets Boost from Technology Emerging Technologies in Peripheral Vascular Interventions Stent vs. Graft: Choosing the Best Path for the Diabetic Patient with Multivessel Disease Cardiology Groups and Hospitals Strive to ‘Connect’ Seamlessly CT Beyond 64 Slices Clinical Study Digest: Kidney Disease & PCI; Women and Valve Disease Compact Echo Systems Come Up Big in Cardiac Care News & Views Reader Resources The ACC Corner

Cardiovascular Business - January/February 2009

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.