• TCAI Sets Standard for Patient Safety in Ventricular Tachycardia Ablations

  Aug

  17

  2011
  Patients with Ventricular Tachycardia (VT) know—this heart rhythm disorder is serious business. One of the most life-threatening arrhythmias, VT causes the bottom chambers of the heart—the ones primarily responsible for pumping blood to the vital organs and the brain—to beat too quickly. This can cause a wide array of debilitating symptoms, including palpitations, fainting, shortness of breath, and low blood pressure. In some cases, VT can lead to a weakening of the heart muscle and even in increase risk for sudden death.
  
  Luckily for sufferers of this arrhythmia, the arsenal of treatment options for VT is continually growing. One such option is radiofrequency ablation (“ablation” for short), which can be done in a minimally invasive fashion from either inside or outside the heart muscle, depending on where the dysrhythmia is coming from. Here at St. David’s Medical Center, we are fortunate to have some of the most experienced electrophysiolgists and the most sophisticated equipment for performing this complex procedure. Because our staff is so experienced in handling this highly specialized cardiac ablation, we have developed a protocol for the procedure that focuses on the safety of the patient and the success of the procedure.
  
  VT Ablation patients start out in our Cardiology Services Department, a pre-operative area. There, they sign all the paperwork that is needed, such as consents for the procedure. Intravenous (IV) access is started and labs are drawn and sent off. Due to the complexity of these cases, it is imperative that we are prepared for any emergency situation that may arise, so special blood coagulation lab work is drawn, and the patient’s blood type is determined. An EKG performed, the patient’s weight is taken, and the patient is seen by an anesthesiologist or nurse anesthetist before coming up into the Electrophysiology Lab.
  
  Before the patient reaches the lab, nurses and technologists behind the scenes make sure that all the equipment needed for the case is setup in the rooms and working properly. Once this is determined and the patient is ready, they are brought into the room where a series of steps take place to prepare them for the procedure. After they get onto the narrow procedural table, the staff work together to ensure that all patches are placed correctly on the patient for accurate mapping and monitoring purposes. The anesthesiologist works on getting the patient comfortable and ensures that continuous blood pressure monitoring is in place. All complex VT ablation patients receive a urinary catheter. The patient is given a Propofol infusion during the insertion of the catheter for comfort purposes.
  
  Both groins and the subxyphoid area (the area at the end of the breastbone) are prepped with a sterile solution. The physician places an arterial line in the right femoral artery for close monitoring of the patient’s blood pressure throughout the procedure. Medications that are administered during the procedure may include Isuprel, Phenylephrine, Epinephrine and IV caffeine. These are just some stimulants that can help to bring out any dysrhythmia during the procedure. Monitoring of the urine output is important as the patient receives continuous fluid administration during ablation. If the physician decides to perform epicardial ablation, there is further monitoring of any fluid that may be pulled off from the pericardial space. The ablation procedure can take anywhere from 3-8 hours, depending on the complexity of the case.
  
  Once the procedure is completed, the patient is transferred to the Post Anesthesia Care Unit (PACU). The patient will remain in this area until they are cleared by the anesthesiologist to go to the nursing unit. The sheaths that were placed during the case are pulled in the PACU. If a pericardial drain is required to remain as a result of epicardial ablation, the patient is transferred to the ICU where closer monitoring is performed until it can be removed.
  
  Post-VT ablation patients generally spend the night in the hospital and go home the next day if their procedure did not include any complications. The physician may decide to keep the patient longer if there are any other factors that may warrant continued monitoring and hospitalization. Discharge planning for these patients include: repeat ECHO the next day to rule out pericardial effusion, removal of epicardial drain if left in for excessive bleeding, and Ibuprofen for chest discomfort from epicardial access. Patients are instructed to avoid strenuous activity and lift no more than 10 pounds for 5 days, wear a 24 hour cardiac Holter monitor in 6 weeks along with a physician follow up, and to call the physician’s office if they experience any palpitations, light headedness, low blood pressure or shortness of breath.
  
  Complex VT ablations present multiple challenges for everyone involved. I feel that at St David’s we have a tremendous representation of teamwork and communication from all the disciplines that come in contact with the patient. I attribute these valuable relationships to the continued successful outcomes that we provide these patients as they come through our lab.
  
  --Tami Metz, RN
  
  
  

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• U.S. Senate Approves Atrial Fibrillation Resolution

  Aug

  03

  2011
  On July 29, 2011, the U.S. Senate approved Senate Resolution 243, the Atrial Fibrillation Resolution, by unanimous consent. “Promoting increased awareness, diagnosis, and treatment of atrial fibrillation to address the high morbidity and mortality rates and to prevent avoidable hospitalizations associated with the disease,” the resolution was introduced by Sen. Mike Crapo (R-ID) in response to the growing number of Americans affected by Atrial Fibrillation (AF).
  
  Senators Robert P. Casey (D-PA), Daniel Akaka (D-HI), Marco Rubio (R-FL), Patrick Toomey (R-PA), and Daniel Inouye (D-HI) co-sponsored the resolution, which is a companion bill to the House Resolution 295. This resolution was introduced in the U.S. House of Representatives in June 2011 by Representatives Kay Granger (R-TX), Dutch Ruppersberger (D-MD), and Charles Gonzalez (D-TX).
  
  The AF Resolution recommends that the Secretary of the U.S. Department of Health and Human Services and medical community leaders should work together to develop better research, screening, prevention, and surveillance efforts surrounding AF, which currently effects more than 2.5 million Americans. The Resolution goes on to outline key components of these efforts, including developing outcome measures, adopting evidence-based guidelines, advancing research and education, and improving access to medical care for folks with AF.
  
  Passage of the resolution was facilitated by a host of health organizations, including the Heart Rhythm Society, American Academy of Neurology, American College of Cardiology, American Heart Association, and many more.
  
  
  ~ Jamie LaRue, RN
  
  
  

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• TCAI Crosses New Frontiers in Atrial Fibrillation Treatment Research

  Jul

  06

  2011
  Ever wonder how medical breakthroughs come about? How did doctors discover that they could put transplant a pig’s heart valve into a human heart and significantly improve the human patient’s quality of life? Or that they could put a little battery in someone’s chest that could pace the heart when it goes too slow? The answer is simple: hours and hours of research.
  
  The desire to cure arrhythmias—or at least significantly improve the lives of patients who suffer from them—is why the doctors at Texas Cardiac Arrhythmia Institute (TCAI) are so gung-ho about research. Several of the techniques and protocols that are standard in arrhythmia management were developed by physicians right here at St. David’s, after doing extensive research to determine what gives the best outcomes for patients.
  
  Earlier this year, for instance, TCAI became the first facility in Central Texas to use a surgical bipolar approach to treat persistent atrial fibrillation (AFib) using radiofrequency ablation. TCAI doctors performed the procedure as part of a study aimed at evaluating the effectiveness and safety of targeting the outer (epicardial) and inner (endocardial) surface of the heart with radiofrequency ablation. The procedure represents a groundbreaking collaboration between electrophysiology and cardiothoracic surgery—the electrophysiologist targets the inside of the heart and the surgeon works on the outside.
  
  While the equipment used in the study procedure was all FDA-approved when used separately, its use together, to treat AFib, is purely investigational. TCAI electrophysiolgist Javier E. Sanchez, M.D., is a principal investigator for the study, and James Edgerton, M.D., is the co-investigator.
  
  It remains to be seen whether the hybrid procedure will prove to be a breakthrough in AFib treatment. But the fact that TCAI doctors are eager to cross into unknown territory to cure AFib certainly proves exciting.
  
  
  ~ Jamie LaRue, RN
  
  

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• Heart Rhythm Society Launches AFib Public Service Announcement

  Jun

  22

  2011
  If you’ve been diagnosed with Atrial Fibrillation (AF), the heart rhythm disturbance that affects 3-5% of people over the age of 65, you know exactly what it feels like. Many AF patients describe a feeling like “a fish flopping” or “drums pounding” in the chest. But unless you’ve been in AF, it’s difficult to describe the symptoms. The problem is, Atrial Fibrillation significantly increases the risk for stroke. And if a person doesn’t know what AF feels like, they can’t tell when they’re in danger. Untreated AF can also decrease quality of life and physical stamina, and, in some cases, it can even weaken the heart muscle itself.

  
  That’s why the Heart Rhythm Society (HRS) has launched a television and radio campaign to educate the public about AF, its symptoms and its warning signs. The Public Service Announcement, dubbed “A-Fib Feels Like…” began airing on television stations in the U.S. in May. According to HRS, the campaign is “designed to help the public understand what AF feels like, help them recognize symptoms and to encourage them to seek the support of a doctor to discuss possible treatment options.” The Society has also designated September as AF Month. Check back right here for more info on that in the coming months.

  
  The good news is, there are a variety of treatment options available for AF patients, including mediation, catheter ablation, surgery, and pacemaker therapy. To request an appointment with one of the Texas Cardiac Arrhythmia Institute’s AF expert physicians, or to simply get more information on AFib from on of our nurses, fill out our on-line Request an Appointment form or visit the “Atrial Fibrillation” section of the Heart Rhythm Society’s website.
  Happy viewing!
  
  
  
  

  
  

  ~ Jamie LaRue, RN
  
  

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• Electrophysiology Conference Energizes, Empowers TCAI Allied Professionals

  Jun

  06

  2011
  If you’ve ever been to a professional conference, you know what an energizing experience they can be. You come back to the office with a new vigor for the work you do, and often you are inspired to change your work based on what you’ve learned. This was certainly true for the TCAI nurses and technologists who had the opportunity to attend the premier electrophysiology annual meeting—Heart Rhythm Society conference 2011 (HRS 2011).
  
  This year’s theme centered around Science, Discovery, Innovation, and a focus on Technology. The four-day conference featured electrophysiology’s international heavy-hitters, who presented ground-breaking research into the latest advances in the field. There was a special exhibit this year called the “Networked EP Lab,” in which practitioners could actually try out new technologies that improve patient safety and procedural outcomes. Another attraction was the Atrial Fibrillation Summit, where physicians and allied professionals learned about the current status of and future of AFib treatment strategies.
  
  Though they had the opportunity to attend any of the physician-led sessions, nurses and technologists also had their very own track at HRS 2011—The Allied Professionals Forum. Maegen Lane, RN, BSN, one of TCAI’s Atrial Fibrillation Nurse Educators who attended the conference, remarked that “the Allied Health Professionals Forum was very beneficial to me. It gave me an in-depth look into the anatomy of the electrical conduction system of the heart, pacemaker management tools and a closer look at VT ablation.” This is critical information that Maegen put to use as soon as she returned from the conference, during her patient education sessions.
  
  Most importantly, the allied professionals who attended HRS 2011 were able to network with other nurses and technologists, sharing ideas for how they can better care for arrhythmia patients. Maegen Lane and Greg Gilbert, a supervisor in the TCAI Electrophysiology Lab, met with the course directors for HRS and discussed the potential to use St. David’s Medical Center and TCAI as a site for a future Allied Health Professional regional conference.
  
  A lot was learned in the four days of HRS 2011. The benefits of attending such a conference are likely to last TCAI’s nurses, technologists, and patients until HRS 2012.
  
  ~ Jamie LaRue, RN
  
  

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