International Leaders in Electrophysiology Research

Super-specialized electrophysiologists care for thousands of patients with the full range of heart arrhythmias using pacemakers, implantable cardioverter defibrillators, biventricular pacemakers, and sophisticated ablation techniques for complex arrhythmias.

LEADING REFERRAL CENTER FOR CARDIAC RESYNCHRONIZATION THERAPY AND CARDIAC CONDUCTION SYSTEM PACING

TGH is a leading tertiary and quaternary referral center for sophisticated cardiac resynchronization therapy for patients with reduced heart function and left bundle branch block who have not responded to conventional resynchronization techniques.

For many years, our EP Center has been at the fore-front of research regarding timing optimization in CRT patients. Led by Dr. Bengt Herweg, our team has been involved in conduction system pacing research and innovation since 2013.

This novel physiologic pacing method involves positioning leads in the millimeter-thin fibers of the heart’s intrinsic conduction system. The goal is to establish normal physiologic and almost simultaneous activation of the heart. Conduction system pacing can correct conduction system abnormalities such as left bundle branch block, a condition associated with a high incidence of dyssynchronous cardiac activation, heart muscle weakness, and death.

LEADING REFERRAL CENTER FOR COMPLEX FORMS OF ATRIAL FIBRILLATION

We are a referral center for advanced ablation therapy of atrial fibrillation. In addition to conventional pulmonary vein isolation, our EP team offers treatment options such as electrical isolation of the posterior wall of the left atrium, left atrial linear ablation and scarmodification, and autonomic modulation by ethanol ablation of Marshall’s vein.

A highly individualized approach utilizing these treat-ment modalities leads to better outcomes, particularly in patients with more sustained and chronic forms of atrial fibrillation for whom conventional therapy has been ineffective. Under the leadership of Dr. Nick Kotch, Medical Director of the TGH Atrial Fibrillation Clinic, the HVI has developed a comprehensive atrial fibrillation treatment pathway to minimize length of stay in the emergency department and/or hospital, resulting in immediate consultation in a designated atrial fibrillation clinic and more rapid access to ablation procedures.

LEADING REFERRAL CENTER FOR TREATMENT OF LIFE-THREATENING, COMPLEX VENTRICULAR ARRHYTHMIAS

Our EP Center is also a leading tertiary referral center for catheter ablation of complex and life-threatening ventricular tachycardia and ventricular fibrillation. We offer conventional endocardial ablation from the inner surface of the heart, as well as epicardial ablation from the outer surface of the heart and ablation procedures performed under heart pump support, allowing more meticulous mapping prior to ablation. Spearheaded by Dr. Chris Cook, Clinical Cardiac Electrophysiologist at TGH, in collaboration with the TGH Cancer Institute’s radiation oncology department, the HVI has developed a radio-ablation program to treat complex arrhythmias with radiation therapy, reserved for arrhythmias not amenable to conventional ablation.

LEADING REFERRAL CENTER FOR REMOVAL OF CARDIAC IMPLANTABLE ELECTRONIC DEVICES AND LEAD EXTRACTION PROCEDURES

Removal of chronically implanted pacemakers and defibrillators can be challenging and associated with deadly complications such as the rupture of blood vessels and massive hemorrhage. Led by Dr. David Wilson, Medical Director of the Lead Extraction and Management Program, the EP Center’s lead extraction program provides the full spectrum of treatment options to remove “hardware” in patients with device system infection or abandoned and dysfunctional lead systems and devices.

Ingrown lead systems are removed with sophisticated laser and mechanical extraction devices, and adjacent infectious material can be removed by suction using the AngioVac System. Our team currently runs the busiest lead extraction and device removal program in Florida, with minimal complication rates and the option of surgery, if needed.

ELECTROPHYSIOLOGY LABORATORY EXPANSION

The HVI has expanded its electrophysiology laboratory from two to three suites that are now combined into a discrete electrophysiology laboratory. Larger space and increased efficiencies have resulted in abbreviated procedure times, higher lab turnover, and shorter waiting times for procedures.

PARTICIPATION IN INNOVATIVE RESEARCH

The Electrophysiology Center of Excellence is at the forefront of clinical research and innovation in EP. Our clinicians have collaborated in several landmark clinical trials that mapped fibrotic tissues of the heart (DECAAF trial) and participated in the first international, multi-center, real-world study group evaluating a larger series of patients undergoing His bundle and left bundle branch area pacing (LBBAP) for cardiac resynchronization.

These studies focused on the feasibility and out-comes of using LBBAP as an alternative method to conventional cardiac resynchronization therapy or apply LBBAP to patients where conventional resynchronization therapy either failed or was not feasible. A potential benefit of this pacing method is entire physiological activation of the heart, translating into improved long-term outcomes. The studies concluded that LBBAP was 85% successful and that it is a safe and feasible alternative treatment method for affected patients.

ADVANCING THE FIELD OF ELECTROPHYSIOLOGY

Dr. Herweg and his team have co-authored more than 130 peer-reviewed papers in multiple international medical journals, including a 2020 review of cardiac resynchronization and conduction system pacing, “The evolution of cardiac resynchronization therapy and an introduction to conduction system pacing: a conceptual review,” published by the European Society of Cardiology. It is considered among the most impactful publications of its kind in the field.

The EP and HF Centers co-authored a pivotal study that investigated the mechanisms of atrial tachyarrhythmias after orthotopic heart transplantation and the role of recipient-to-donor atrio-atrial connections and their relationship to the immunologic match. This study is the largest series published about atrial arrhythmias and their treatment with catheter ablation after heart transplantation. It has markedly furthered the understanding and treatment of arrhythmias in heart transplant recipients.