EP Staff Education
A working reference for the EP lab team.
Conditions, procedures, device function and interrogation, drugs, and lab setup — written for nurses, techs, fellows, and clinicians working with Dr. Colombowala.
Conditions
Mechanism, ECG features, differential, work-up.
Atrial Fibrillation
Disorganized atrial activation, most commonly driven by triggers from the pulmonary vein sleeves. Spectrum from paroxysmal to long-standing persistent, with progressive atrial remodeling over time.
Atrial Tachycardia (focal & multifocal)
Tachycardia originating from a discrete atrial focus (focal AT) or multiple competing atrial foci (MAT). Mechanisms span automaticity, triggered activity, and micro-reentry — each behaving differently on the table.
Atypical Atrial Flutter
Macro-reentrant atrial tachycardia using a circuit other than the cavotricuspid isthmus — usually left-atrial roof, mitral isthmus, or scar-mediated. Common after AF ablation or atrial surgery. Long cases, lower success rates, high-density mapping essential.
Procedures
Setup, equipment, technique, common pitfalls.
AF Ablation (PVI)
Catheter-based pulmonary vein isolation to eliminate AF triggers. Energy options include pulsed field, radiofrequency, and cryoballoon; PVI is the foundation, with adjunctive lesions reserved for persistent disease.
Atrial Flutter Ablation (CTI)
Catheter ablation of the cavotricuspid isthmus to interrupt the typical right atrial flutter circuit. High success, short procedure, low complication rate.
AV Node Ablation
Catheter ablation of the AV node to produce complete heart block in patients with refractory atrial tachyarrhythmias who already have (or will receive) a ventricular pacing system. A short, high-yield procedure with a predictable workflow.
Devices & Interrogation
Function, interrogation walk-throughs, troubleshooting.
CRT Interrogation (Optimization)
CRT-P and CRT-D interrogation focused on the unique parameters of biventricular pacing — BiV pacing percentage, AV/VV optimization, LV vector selection, and the phrenic surveillance that protects this therapy.
ICD Interrogation Walkthrough
Clinic and remote ICD interrogation workflow with emphasis on shock review, detection programming, lead diagnostics, and the high-stakes decisions an ICD interrogation can trigger.
Loop Recorder Remote / In-Office Check
Implantable loop recorder review workflow — battery, sensing, episode triage, and how to handle the high volume of false positives that come with long-term continuous monitoring.
Drugs
Anticoagulants, antiarrhythmics, sedation, reversal.
Adenosine
Fast-on, fast-off AV-nodal blocker. Diagnostic for SVT, used to unmask dormant PV conduction, and to test accessory pathways.
Amiodarone IV
Broad-spectrum antiarrhythmic for VT, recurrent AF, and rhythm control in the EP lab. Effective but slow-loading and full of late effects to remember.
Atropine
Anticholinergic for vagally-mediated bradycardia and AV block. Crash-cart staple, used reactively in EP for vagal reactions during sheath placement and ablation.
Lab Setup
Room layout, sterile setup, equipment checks, safety.
EnSite X Mapping System (Abbott)
Abbott's EnSite X EP platform — hybrid impedance and magnetic localization, the HD Grid catheter, and the omnipolar mapping workflow the team should know.
Affera Mapping & Sphere PFA System (Medtronic)
Medtronic's integrated platform — one catheter that maps in high density and delivers either pulsed field or RF ablation, all on the Prism mapping software.
Rhythmia HDx Mapping System (Boston Scientific)
Boston Scientific's ultra-high-density mapping platform — the IntellaMap Orion mini-basket, Lumipoint automated annotation, and the workflow nuances the team needs to know.