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W H E N R O B E R T N . GOLDSTEIN, MD, FHRS, was recruited by Lake Health to be Director of Cardiac Electrophysiology (EP) in November 2013, the goal was to expand EP services. Less than six months later, the community hospital system now offers advanced tertiary-level EP services and technologies, including advanced cardiac cryoablation, laser lead extraction, subcutaneous implantable cardioverter defibrillator (S-ICD), and insertable cardiac monitor (ICM). The former Director of University Hospita ls' Ca rdiac Dev ice Clinic, Dr. Goldstein saw many advantages to joining Lake Health. "At Lake Health, we have physicians who bring years of experience to each proce- dure," says Dr. Goldstein. "We also have a new hybrid operating room (OR), where select EP procedures are now performed." Advanced Cardiac Cryoablation Atrial fibrillation is the most common arrhythmia worldwide. Many patients can present with a spectrum of symptoms including shortness of breath and fatigue. To treat this condition, Lake Health offers Arctic Front Advance cardiac cryoabla- tion. Reportedly, this is one of the most advanced and effective procedures cur- rently available for atrial fibrillation. Through a minimally invasive proce- dure, the electrophysiologist guides the cryoablation catheter to the heart. Liquid nitrogen is delivered through the catheter's tip to moderately freeze the tissue in the left atrium, which is the source for the perpetuation of atrial fibrillation. After pinpointing the arrhythmia's origin, the tissue is frozen to minus 50 degrees Celsius and destroyed, electrically isolating the pulmonary veins from the remainder of the left atrium. " This met hod of fers def initive, circumferential lesions safely and effec- tively in a fraction of the time compared to traditional older modalities utilized to treat atrial fibrillation," says Dr. Goldstein. Following the roughly two-hour proce- dure, patients generally spend the night in the hospital for monitoring. Hybrid OR for Safer Laser Lead Extraction Lake Health opened the doors of its $4 million hybrid operating room (OR) in March 2013. Located at West Medical Center in Willoughby, this 1400-square- foot OR is a sophisticated EP laboratory and technologically advanced surgical suite all in one – ideal for patients undergoing open, minimally invasive and catheter- based procedures. "The hybrid OR seamlessly converts from imaging suite to operating room, so we don't waste time moving patients from room to room between procedural stages," Dr. Goldstein says. "It's the safest place to perform laser lead extraction, and Lake Health's West Medical Center is the only local hospital conducting this procedure in a hybrid OR." Cardiac leads for pacemakers and ICDs require removal when they malfunction, become broken or cause infections. Usually, leads that have been in place less than one year can be removed easily and with minimal risk. Those that have been in place longer and are encapsulated in scar tissue are more difficult to remove. "Instead of solely extracting leads with more traditional tools, which may result in tearing fragile veins or even result in the inability to remove old infected leads, we use an innovative laser device," Dr. Goldstein explains. During the procedure, which is per- formed under general anesthesia, the pacemaker or ICD is removed and discon- nected from the lead. A laser sheath is then guided through the targeted vein and Robert N. Goldstein, MD, FHRS, Director of Cardiac Electrophysiology at Lake Health, is shown here with members of his surgical team. By Michael Ferguson HIGH-TECH CARDIAC EP NOW AT LAKE HEALTH +++++++++++++++++++++++++++ + +++ + +++ +++++++++++++++++++++++++++ HOSPITAL SPOTLIGHT 2 6 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ J U LY/AU G U S T 2 0 1 4