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National Leaders in Cardiac Resynchronization Therapy

By Tampa General Hospital

The Electrophysiology Center of Excellence at Tampa General Hospital (TGH) offers a multidisciplinary approach and a diversity of treatments options often lacking at other centers. Board-certified electrophysiologists care for thousands of patients with the full range of heart arrhythmias, using pacemakers, internal cardioverter defibrillators, bi-ventricular pacemakers, defibrillators and sophisticated ablation techniques for complex arrhythmias.

Leading Referral Center for Cardiac Resynchronization Therapy (CRT) and Cardiac Conduction System Pacing

Tampa General Hospital is a leading tertiary referral center for sophisticated cardiac resynchronization therapy (CRT) applicable to patients with heart muscle weakness (cardiomyopathy) and left bundle branch block who have not responded to conventional resynchronization techniques.

For many years, TGH has been at the forefront of research regarding timing optimization in CRT patients. Led by Dr. Bengt Herweg, the EP team has been involved in conduction system pacing since 2013. This novel physiologic pacing method involves positioning leads in the small 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

Tampa General Hospital is a leading tertiary referral center for advanced ablation therapy of atrial fibrillation. In addition to conventional pulmonary vein isolation, the TGH EP team offers 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 Marshall’s vein. These treatment modalities lead to better outcomes, particularly in patients with more sustained and chronic forms of atrial fibrillation who may have failed conventional therapy.

Leading Referral Center for Treatment of Life-Threatening Complex Ventricular Arrhythmias

Tampa General Hospital is also a leading tertiary referral center for catheter ablation of complex and life-threatening ventricular tachycardia and ventricular fibrillation. The TGH EP team offers 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. TGH is developing a radio-ablation program to treat complex arrhythmias not amenable to conventional ablation with radiation therapy.

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 complication such as rupture of blood vessels and massive hemorrhage. Led by Dr. David Wilson, the TGH Lead extraction service 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 TGH team is currently the busiest lead extraction and device removal service in Florida, with minimal complication risks and the option of surgery, if needed.

Participation in Innovative Research

Led by Dr. Bengt Herweg, medical director of the TGH Electrophysiology Center of Excellence and professor and consulting cardiologist in the USF Health Morsani College of Medicine, TGH is at the forefront of clinical research and innovation. Herweg has participated 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. This study focused on the feasibility and outcomes of using LBBAP as an alternative method to conventional therapies. Potential benefits of this method involve more comprehensive and effective long-term outcomes when inducing pacing in the heart. The study concluded that LBBAP was 85% successful and that it is a safe and feasible alternative treatment method for affected patients.

Contributions to Impactful Medical Publications

Herweg has co-authored more than 125 peer-reviewed papers in multiple international medical journals, including a 2020 review of cardiac resynchronization and conduction system pacing entitled, “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 to be among the most impactful publications of its kind in the field.

Research to Help Improve Heart Transplant Outcomes

In April 2021, Herweg co-authored a study that investigates the mechanisms of atrial tachyarrhythmias after orthotopic heart transplantation (OHT), the role of recipient-to-donor atrio-atrial connections (AAC), 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 these patients.

First Center in Florida to Implant Treatment for Sleep Apnea

In 2020, Herweg successfully implanted Florida’s first Respicardia Inc’s. Remede® System for the treatment of central sleep apnea. The device is implanted on the right side of the chest and leads are advanced through the cardiac venous system, allowing direct stimulation of nerves that activate the diaphragm. Preliminary results look very promising.

Training Program

Established by Herweg in 2007, the arrhythmia service at the University of South Florida and Tampa General Hospital has trained multiple physicians in the USF Clinical Cardiac Electrophysiology Training Program. The program offers a wide variety of learning opportunities for cardiologists who seek training and certification in the field of electrophysiology.