Electrophysiology Center of Excellence

Tampa General Hospital (TGH) is home to highly specialized electrophysiologists who 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
Tampa General Hospital is a leading tertiary and quaternary referral center for sophisticated cardiac resynchronization therapy (CRT) for patients with reduced heart function and left bundle branch block who have not responded to conventional resynchronization techniques.

For many years, TGH’s Electrophysiology Center of Excellence has been at the forefront of research regarding timing optimization in CRT patients. This novel physiologic pacing method involves positioning leads in the millimeter-thin fibers of the heart’s intrinsic conduction system 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
TGH is a referral center for advanced ablation therapy of atrial fibrillation. In addition to conventional pulmonary vein isolation, electrophysiologists at Tampa General Hospital offer treatment options such as electrical isolation of the posterior wall of the left atrium, left atrial linear ablation and scar modification and autonomic modulation by ethanol ablation of the Marshall vein.

Tampa General Hospital’s highly individualized approach utilizing these treatment modalities leads to better outcomes, particularly in patients with more sustained and chronic forms of atrial fibrillation for whom conventional therapy has been ineffective. The Comprehensive Atrial Fibrillation Program at TGH has developed a treatment pathway that involves immediate consultation in a designated atrial fibrillation clinic and more rapid access to ablation procedures. This helps minimize length of stay in the emergency department and/or hospital.

New Pulsed Field Ablation
The TGH Electrophysiology Center of Excellence laboratory uses a new ablation method called pulsed field ablation (PFA), which has been effective in treating some forms of atrial fibrillation. The PulseSelect™ PFA system enables both mapping and precise lesion delivery using biphasic waveform optimization. By employing electrical signals that isolate and ablate specific heart cells in a precise pattern, procedure times are faster than conventional techniques and they carry less risk to the heart’s adjacent structures, making it a generally safe procedure.

LEADING REFERRAL CENTER FOR TREATMENT OF LIFE-THREATENING, COMPLEX VENTRICULAR ARRHYTHMIAS
Spearheaded by clinical cardiac electrophysiologist Dr. Chris Cook, in collaboration with the TGH Cancer Institute’s Radiation Oncology department, Tampa General’s Heart & Vascular Institute has developed a Radioablation Program to treat complex arrhythmias with radiation therapy, reserved for arrhythmias not amenable to conventional ablation.

The TGH Electrophysiology Center of Excellence is a leading tertiary referral center for catheter ablation of complex and life-threatening ventricular tachycardia and ventricular fibrillation. TGH offers conventional endocardial ablation from the inner surface of the heart, epicardial ablation from the outer surface of the heart and ablation procedures performed under heart pump support, allowing more meticulous mapping prior to 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. The TGH Electrophysiology Center’s Lead Extraction and Management Program, led by Electrophysiology Section Chief and Medical Director Dr. David Wilson, 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. The team currently runs the busiest lead extraction and device removal program in Florida, with minimal complication rates and the option of surgery, if needed.

New Implantable Cardioverter-Defibrillator
Tampa General Hospital was first in the Southeast U.S. to implant the Aurora Extravascular Implantable Cardioverter-Defibrillator (EV-ICD) by Medtronic. Since then, electrophysiologists at TGH have been able to offer patients the benefits of traditional ICDs, while reducing certain risks that come with placing leads in the heart or veins.

“We strive to deliver high-quality patient care, and this technology is another step forward in providing our patients with the latest clinical advancements to manage their cardiac condition,” said Dr. David Wilson, Electrophysiology Section Chief & Medical Director of the Lead Extraction and Management Program at the TGH Electrophysiology Center of Excellence.

The TGH Electrophysiology Center has implanted the second most Intraventricular Conduction Delay (EV-IVCD) devices in the country.

PARTICIPATION IN INNOVATIVE RESEARCH
The TGH Electrophysiology Center of Excellence is at the forefront of clinical research and innovation. TGH 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 outcomes of using LBBAP as an alternative method to conventional cardiac resynchronization therapy or applying 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 to 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
For many years, the TGH Electrophysiology Center has been at the forefront of research regarding timing optimization in cardiac resynchronization therapy, serving as a regional referral center for complex cases.

Dr. Bengt Herweg, Electrophysiology Director of Academics & Research within the TGH Heart & Vascular Institute, was the primary investigator on the first international, multi-center, real-world study group evaluating left bundle branch area pacing (LBBAP) for cardiac resynchronization.

Dr. Herweg continues to focus on collaboration with USF Health Heart & Vascular Institute translational and basic scientists, developing grant opportunities and clinical research for Electrophysiology, in his role as Director of Academics & Research Professor and Cardiologist, USF Health Morsani College of Medicine.

View the Heart & Vascular Institute Annual Highlights Booklet