The opening of a third electrophysiology lab at Sacred Heart Medical Center & Childrens Hospital in February already is helping the hospital meet fast-growing demand for procedures such as implanting cardiac defibrillators, says Sacred Heart.


The new, $2.5 million lab, located in the hospitals electrophysiology department on Level 1 of the east tower, is essentially a suite in which electronic devices that help the heart are implanted, diagnostic testing is done to determine problems with heart rhythm, and abnormal or damaged heart tissue is eliminated. Electrophysiology labs differ from the more commonly known catheterization labs, where such procedures as angiograms and angioplasties are performed, in that they usually have more advanced technology.


The hospital opened its first electrophysiology lab in 1995 and its second in 2002, says Russ Shear, who supervises the electrophysiology department. The third lab already has made a big difference, he says.


Last year, we were averaging 120 (electrophysiology) patients a month in the two labs, Shear says. In March, the first full month the third lab was open, we had 150 patients, and that number will continue to go up.


Before the third lab opened, patients who didnt have emergency needs often had to wait three months to get into a lab, due to the high demand, he says.


Its too early to predict how high the monthly patient count could climb in the electrophysiology department now that the third lab is open, Shear says. Yet, he says in March the number of biventricular implantable cardiac defibrillators placed in patients was up 44 percent from the previous month, and the number of other more common implantable cardiac defibrillators placed in patients was up 19 percent from the previous month. Defibrillators shock the heart to stop fibrillation, is a series of contractions that cause irregular heartbeat and sometimes ineffectual pumping of blood. Biventricular defibrillators treat both ventricles of the heart, and often provide both shock and pacing capabilities to help synchronize heart rhythm. The more conventional ventricle defibrillators usually shock one ventricle instead of two, and also provide pacing capabilities, says Shear.


The department expects to do well over 1,000 procedures in its electrophysiology labs this year, compared with about 880 last year, says Shear.


Patient volumes have been growing for some time, he says.


Since Sacred Hearts second electrophysiology lab opened five years ago, the number of implantable defibrillators placed in patients there has jumped 42 percent; the number of ablation procedures to destroy unhealthy heart tissue has grown 45 percent; and the number of diagnostic studies has risen 18 percent, says Shear.


He says the implantation of pacemakers has risen a modest 2 percent over that time because cardiac defibrillators now are used as an alternative to pacemakers. Shear says newer cardiac defibrillators can shock a patients heart to keep it in rhythm and provide pacing capabilities comparable to those employed in pacemakers, which supply regular, mild electric shock that stimulates contraction and restores normality to the heartbeat.


Dr. Don Chilson, co-director of the department with Dr. Tim Lessmeier, says the new, 950-square-foot lab is equipped with improved X-ray cameras that provide better three-dimensional images on computer monitors to help doctors guide catheters through patients bodies. The lab uses two such cameras simultaneously to achieve those images, Chilson says. Two of the departments three labs now have such equipment; the third has just one X-ray camera and is dedicated only to implant procedures, which dont require the same level of imagery, he says.


Each lab includes a large, about 800-square-foot procedure room and a smaller room partitioned off with a leaded glass wall where health-care personnel operate specialized computers and monitor the procedures.


All procedures done in the labs are percutaneous, which means they are performed by entering a patients body through a puncture in the skin rather than through an incision, Chilson says. He says the advent of percutaneous procedures has reduced both the pain patients suffer and the length of time they spend in the hospital. He says most patients usually spend just one night in the hospital after having an electrophysiology procedure.


Chilson says the increased demand for electrophysiology services can be attributed to an aging population, new technology that makes more patients eligible for electrical heart interventions, and a growing population base.


We have an aging population who need their electrical systems worked on as we discover new ways to treat them, he says.


About half of all the procedures done in the Sacred Heart labs involve implanting electronic devices, and that number currently is split about evenly between cardiac defibrillators and pacemakers, Chilson says.


Another about 33 percent of all procedures are diagnostic in nature, in which a catheter, normally inserted into the body through the patients femoral artery near the top of the leg, is guided to a patients heart to unmask rhythm disorders that could cause life-threatening problems, Chilson says.


The remaining about 17 percent of procedures are called ablations, in which doctors destroy abnormal or damaged tissue in the heart by using catheters equipped with specialized tips that either zap the tissue with electronic radio-frequency waves or freeze it, he says.


A new technology introduced to the labs during the recent upgrade is a computerized mapping system that uses electronic fields to reproduce a clear computer-screen image as the catheter is guided within the patients body, Chilson says. The new system obtains images by employing technology roughly similar to that used by global positioning systems, with magnetic electronic fields around the metal-tipped catheters tracked in the heart by computers.


If we can accomplish the same thing without using so much X-ray, thats very good, Chilson says. We can use the mapping system without any detrimental effects to patients.


Shear points out, however, that X-rays and the new mapping system are being used in conjunction with each other.


Sacred Heart has had a limited electrophysiology program since the mid-1980s, but didnt open its first electrophysiology lab until 1995, says Shear.


Contact Rocky Wilson at (509) 344-1264 or via e-mail at rockyw@spokanejournal.com.