Bringing New Devices, Equipment and Technology to the EP Lab:Interview with Dr. Arnold Greenspon

When did the new electrophysiology (EP) lab open? In 1980, I established the EP Laboratory at Thomas Jefferson University Hospital, which is the major teaching hospital for Jefferson Medical College. A new EP suite was opened in September 2005 in order to accommodate the increased volume of EP procedures as well as facilitate the more complex procedures that we are doing. Prior to September 2005 we were working out of one room, which limited our procedure volume. The new suite includes two EP labs (one single plane, the other bi-plane), a procedure room, a conference room, a patient family waiting area, and a patient pre/post op holding area for four beds.  Is the new lab located inside the Jefferson Heart Institute? The Jefferson Heart Institute is located at 925 Chestnut Street and is used primarily as an oupatient facility. The new lab is located on the sixth floor of the Gibbon Building at Thomas Jefferson University Hospital. All EP procedures are performed in our operating suites for both patient convenience and safety. What necessitated the need for a bigger lab? Has your patient volume or EP procedures grown considerably in the last few years? We needed to increase our physical space for the reasons mentioned above increased patient volume due to an increase in the number of patients requiring implantable devices, lead extraction procedures, as well as an increase in patients referred for RF ablation. In addition, Jefferson has initiated an Advanced Heart Failure/Cardiac Transplantation Service, which has also increased the number of patients referred for EP evaluation and treatment. How many staff members do you currently have in the EP lab? There are three faculty members: Arnold J. Greenspon, MD, Director of the Cardiac EP Laboratory, Behzad Pavri, MD, Director of the EP Fellowship Program, and Reginald Ho, MD. We have eight clinical staff personnel as well as an administrative support staff person.  What considerations or special features were included when building the new lab? The primary consideration was to deliver high quality, efficient treatment to patients with a variety of heart rhythm disorders. Since many of our procedures are now done as outpatient or same-day procedures, we wanted the experience to be a positive one for both the patient and their family. With the addition of the family waiting area, we are able to keep family members nearby and informed of the patient's progress. How many EP procedures does the EP lab perform annually? What is the percentage of ICD implants? We previously performed about 1,000 procedures out of one room. We have seen a dramatic increase in the number of procedures performed in the short time that the new facility has been open. Does the lab also include new equipment or technology? Please describe. Our bi-plane lab has a digital cine-acquisition system for storing fluoro images (still images, or cine images from venograms, etc.). In addition, we have a DICOM workstation for importing images such as chest x-rays, CT images of the left atrium, cardiac cath data, etc into the room. The room has eight flat-panel monitors, including the PA/lat fluoro live and road map, physiologic monitors (live and review GE/Prucka CardioLab, DICOM workstation, and CARTO (Biosense Webster, Inc.). Our conference room is linked to the bi-plane room with a state-of-the-art system for video conferencing. A live picture from the lab can be projected on the screen in the conference room. We are able to switch between any of the images displayed in the room such as fluoro or physiologic recorder to assist in any presentation. In the future, data from the conference room can be transmitted to any site or classroom in the university for teaching/training purposes. What do you think is the best feature of this new lab? We worked closely with the architects and facility's planning staff at the hospital to design a suite that is truly user friendly both for the physicians and staff. We were really cramped for space. This was particularly evident when performing complex procedures such as laser lead extraction or pulmonary vein isolation or other left atrial procedures. By the time you moved the intracardiac Echo machine or laser into the room, there was little room to move. If nothing else, we feel that the increased space makes the procedures safer and certainly shortens their duration.