Spotlight Interview: Dr. Siyami Ersek Hospital

Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital was established in 1962, and has since become the cornerstone of its region for cardiology and cardiovascular surgery. The center has 14 operation rooms, 56 intensive care beds, and 572 beds in wards. Its yearly number of operations is approximately 3000 open, 500 closed surgery, 1000 vascular, and 500 thoracic surgical operations.  

When was the EP program started at your institution? By whom?

Our EP program began in 1997. It was established by Prof. Dr. Kadir Gurkan, who is still practicing and mentoring our team. Our retired chief, Dr. Tanju Ulufer, implanted the first endocardial pacemaker in our hospital in 1977.

Who manages your EP lab today?

Prof. Dr. Kadir Gürkan and Prof. Dr. Ahmet Taha Alper manage the EP lab.

What is the size of your EP lab facility? Where is the EP lab in relation to the catheterization department?

We have five cardiac catheterization laboratories and one EP lab. 

The dedicated EP lab is located inside of the cath department. We also share one of the cath labs with interventional groups for two days per week. 

The EP lab has a dedicated staff separate from the cath lab staff. This began 4 years after the program started.

What is the number of staff members? What is the mix of credentials at your lab?

We have two professors (Prof. Dr. Kadir Gürkan and Prof. Dr. Ahmet Taha Alper), two associated professors (Dr. Nazmiye Ozbilgin and Dr. Ahmet İlker Tekkeşin), and four EPs (Dr. Ceyhan Turkkan, Dr. Serhan Özcan, Dr. Yasin Çakıllı, and Dr. Göksel Çinier). 

What types of procedures are performed at your facility? Approximately how many catheter ablations (for all arrhythmias), device implants, lead extractions, and LAA closures are performed each week?  

We routinely perform all kinds of mapping and ablation procedures, including epicardial ablations. We implant pacemakers, ICDs, and CRTs, as well as perform lead extraction.

We perform approximately 20 catheter ablations, 20 device implantations, 3-4 lead extractions, and 1-2 LAA closures per week. 

What percentage of your device implants use MR conditional pacemakers or ICDs? What percentage of implants use subcutaneous or leadless devices?

About 10% of device implants are MRI conditional. Due to the insurance policy of government, we have not yet implanted leadless devices.

What type of hospital is your EP program a part of? 

Our EP program is a part of a tertiary hospital coupled with academic and educational purposes. We are one of the referral centers in an Asian part of Istanbul. Patients are referred from other hospitals all around Turkey and the Middle East to our EP lab.

Has your EP lab recently expanded in size, or will it be soon? 

We are planning to add one more EP lab to our hospital.

What types of EP equipment are most commonly used in the lab? 

We generally use the EP-TRACER (Schwarzer Cardiotek), EnSite Precision Cardiac Mapping System (Abbott) and cryoablation (Medtronic).

How is shift coverage managed (e.g., typical hours)? How does your lab handle call? 

We work from 8 am until 5 pm. There is always one night shift available for emergent EP procedures.

Tell us what a typical day might be like in your EP lab.

We start at 8 am with catheter ablation procedures. After 2-3 pm, we continue with device implantations.

Who handles procedural scheduling? 

Prof. Dr. Ahmet Taha Alper and Prof. Dr. Kadir Gürkan handle our schedule.

Who handles the purchasing of equipment/supplies?

Our inventory is managed by Prof. Dr. Ahmet Taha Alper and Dr. Ahmet İlker Tekkeşin.

What type of quality control and assurance measures are practiced in your EP lab?

Our facility is a member of the Turkish Society of Cardiology and Health Sciences University. We strictly follow their quality control guidelines.

How do you ensure timely case starts and patient turnover?

We follow a strict schedule that is put in place by our lab managers.

How are new employees oriented and trained at your facility?

We have a 1- to 2-month orientation program in the EP lab.

Do members of your staff attend medical conferences each year? 

In recent years, all of our staff managed to attend at least two international and two national conferences.

How is staff competency evaluated? Does staff receive a bonus based on performance?

Yes, we have a performance-based system provided by the hospital management.

Describe a particularly memorable case from your EP lab and how it was addressed.

Eleven years ago, a 72-year-old male presented with heart failure and multi-organ failure due to incessant drug-refractory pre-excited atrial fibrillation and severe mitral stenosis. His left and right atrium were huge. When we ablated the accessory pathway during tachycardia at the right mid-septal region, it was like guessing which wires to cut to defuse a bomb. After ablation, the patient recovered dramatically. The case was published at https://bit.ly/2KBPeLF.

Does your lab use a third party for reprocessing or catheter recycling? 

No, we don’t have a program in place for catheter reprocessing or recycling.

Approximately what percentage of ablation procedures are done with cryo vs radiofrequency?

We use cryoablation in 90% of AFib ablations.

Does your lab perform His bundle pacing?

Yes, we recently performed our first case, and will likely perform more His pacing implantations.

Are pediatric cases performed in your lab? Does your institution also have an associated cardiovascular genetics research clinic?

We have a pediatric lab that performs these procedures apart from our EP lab. We generally use private laboratories for genetic testing.

What approaches has your lab taken to reduce fluoroscopy time? What percentage of cases are done without fluoro? 

We try to use three-dimensional mapping systems to reduce fluoroscopy times. Last year, we did nearly 5% cases without fluoro.

What are your methods for device infection prophylaxis?

We routinely prescribe oral first-generation cephalosporins for three days following the implantation procedure.

Do you utilize digital tools or wearable technologies in your treatment strategies for patients?

We have started a big project on lifestyle interventions monitored by wearable technologies and digital tools. We have been recruiting patients, and hope to finish the study soon.

Is your EP lab involved in clinical research studies? 

Yes, we are involved in several international and national multicenter studies.

Are staff encouraged to participate in the EP community on social media? 

Everyone on our EP team is a solid Twitter fan!

Please tell our readers what you consider special about your EP lab and staff.

We are proud to be one of the oldest and most experienced EP clinics in our region.