Spotlight Interview: Baku Health Center

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EP LAB DIGEST. 2024;24(6):1,14-15.

What is the number of staff members? 
We have 4 electrophysiologists, 3 dedicated EP nurses, and 4 EP technicians. In addition, we have cardiology fellows and visiting physicians from other hospitals. As a university hospital, we have frequent student visitors.

What types of procedures are performed at your facility? 
The procedures performed at our facility include device implantations and replacements (pacemakers, implantable cardioverter-defibrillators [ICDs], cardiac resynchronization therapy [CRT], conduction system pacing, and loop recorders), and lead extractions (mostly by transfemoral approach). We also perform catheter ablation of supraventricular tachycardia (SVT), atrial tachycardia/atrial flutter, and ventricular tachycardia (VT) (idiopathic and structural), as well as epicardial ablations and ablation of atrial fibrillation (AF). We perform cryoballoon isolation of the pulmonary veins and stellate ganglion ablation. We will soon we performing left atrial appendage closure (LAAC).

Approximately how many catheter ablations (for all arrhythmias), device implants, lead extractions, and LAAC procedures are performed each week? 
As a reference center, we perform 1-2 AF ablations, about 15 ablations for different types of tachycardias, 2-5 CRTs, and about 5 other types of device implantation (pacemakers and ICDs) in a typical week. We perform about 10 lead extractions per year (about 15 to 20 leads, including ICD and coronary sinus leads). Due to lack of reimbursement, the number of loop recorders implanted is low. We plan to start LAAC procedures next month in our hospital, as the device will soon become commercially available.  
    
What are some of the new technologies recently introduced in your laboratory? 
In April 2024, we expect to introduce the Rhythmia HDx mapping system (Boston Scientific) and Farapulse Pulsed Field Ablation System (Boston Scientific) to our facility.

Tell us about your device clinic, including its staffing model.
In our device clinic, patients can easily be checked on a regular and emergency/urgency basis. There is 1 nurse, 1 technician, and 1 physician responsible for care of patients with implanted devices. We have programmers manufactured by Medtronic, Boston Scientific, and Abbott.
    
Tell us what a typical day might be like in your EP laboratory.
On days when there is an AF ablation scheduled, we will start with that case. Otherwise, we generally start with a device implantation or a more difficult or complicated case. We start at 08:30-09:00 AM and try to finish about 17:00 PM. We perform routine sterilization before, during, and between device implantation procedures to avoid device infection. Our infection rate below 0.2%, most of which were superficial device infections. Nearly all the lead extraction procedures we perform are referred from other centers. If we have a case for lead extraction, we schedule it for the last case of the day. We will have a cardiovascular surgeon and the operating room ready in case of any complications, although we have never needed a surgical intervention. A transfemoral approach is used for most of our extraction procedures.
 
Can you describe the extent and use of vascular closure devices at your lab? Tell us about your approach for same-day discharge. 
We do not use vascular closure devices in our laboratory. We prefer manual compression. For large sheaths, we use a figure-of-8 suture. A same-day discharge approach is preferred, but insurance companies in our country require that patients stay in the hospital one night after an ablation or device implantation procedure.

Do you have flexible or multiple shifts? How do you handle slow periods?
Our EP teams do not have shifts; they are on call. We do have a cardiologist and cardiology fellows who work on shifts; they generally have first contact with patients during off-hours and days.

How are vendor visits managed?
Vendors must have special permission from hospital managers and schedule an appointment in advance. 

What quality control measures are practiced in your laboratory?
Infection control measures are important and we do our best in collaboration with the infection control committee at our hospital. Continually educating our staff is also essential for keeping high-quality standards. 

What continuing education opportunities are provided for staff members?
We encourage and support our staff to participate in international practical courses and specific workshops. We also frequently organize electrocardiogram and EP courses and workshops for our physicians.  

Share a memorable case from your EP laboratory and how it was addressed.
Approximately 2 months ago, we had a case of a 15-year-old girl with Wolff-Parkinson-White (WPW) syndrome who had 5 failed ablation attempts at different centers. One by one, we ablated 2 anterograde and 3 retrograde accessory pathways around the tricuspid annulus. It was the most memorable WPW case in my career. We were happy the procedure was a success.

Does your program have a dedicated AF clinic and/or a dedicated lead extraction program? 
We do not have a dedicated clinic or program, but we are the only center that performs those procedures in our country.

Discuss your approach to risk factor modification for AF. 
We try to treat all possible risk factors for AF. This includes strict control of sleep apnea and uncontrolled hypertension. For example, if we suspect sleep apnea in a patient due to undergo AF ablation, we start continuous positive airway pressure or bilevel positive airway pressure therapy at least 3 weeks before the planned ablation procedure. We try to restrict smoking and encourage patients to lose weight in collaboration with a dietician. The maximal tolerated number and dosage of medications are prescribed in patients with AF and heart failure.

How does your EP laboratory handle radiation protection for physicians and staff?
We use radiation shielding and the lowest possible frame rate. 

What are some of the dominant trends you see emerging in the practice of EP? 
Artificial intelligence has had an important role in the prediction, detection, and management of arrhythmias, and will have further uses in the practical and scientific development of EP.  

How do you use digital health and wearable technologies in your treatment strategies? Have you seen an increase in the number of

patients using digital health technologies? What challenges or benefits do you associate with that? Has use of digital health improved patient outcomes? 
We use wearable technologies in certain populations for the detection of undiagnosed AF. For young patients experiencing palpitations, new technology is often more helpful than an implantable loop recorder. Recently, we have seen an increased number of people using digital health technologies. More frequent application and use of this technology will reduce the number of inappropriate EP studies and aid in the detection of undiagnosed tachyarrhythmias.  

Describe your city or general regional area. 
Baku Health Center is located in Baku, the capital of the Republic of Azerbaijan. It is a large scientific, cultural, and industrial center. Ancient foundations, a large area, and population all make Baku one of the oldest and largest cities in the East. Baku is situated on the shore of the Caspian Sea in the south of the Absheron Peninsula. It covers an area of 2200 square kilometers and has a population of 5 million.

Please tell our readers what you consider special about your EP program.
The EP program at Baku Health Center is equipped with the latest EP technology. We are proud to specialize in complex VT arrhythmias, AF ablations, and device extractions, and are the only EP laboratory in Azerbaijan that performs those procedures.