Introduction
Atrial fibrillation (AF) is a rapidly growing condition, and one that is growing in prevalence on a global basis. It is also costly to the healthcare delivery system.1 In the United States, this condition is expected to double by 2050, and is a significant cost burden. More than ever, improvements in the processes in the Electrophysiology laboratory (EP) can be valuable from a cost standpoint.
Moreover, reducing the time spent by patients undergoing a procedure has positive outcome benefits, such as a reduction of time under anesthesia among other benefits. Improvements are being made annually, but in the past decade AF recurrence rates have remained relatively constant at 17.6%2
Costs and Electrical Noise are High
In the EP lab, space is usually at a premium, and many labs suffer from background noise that can affect electrophysiological recordings. These factors alone can contribute to inefficiency in terms of marking and reexamining patient recordings. Childers, et. al have demonstrated that the cost of operating room time is between $36 and $37 per minute.
Examining the causes of noise problems in electrophysiological recordings can be time consuming and a series of trial-and-error exercises.3 Noise problems can often come from outside the EP lab, as well as from within. Poor ground connections, broken connections in the electrical path or physical damage from electrodes can all cause background noise during procedures. Unfortunately, this “noise” has the potential of disrupting and blurring tracings coming from mapping and other systems.
Until now, “not much attention has been given to the most basic component of any invasive electrophysiology study: the accurate recording and display of the intracardiac electrogram.”4 That’s changing with the introduction of the Pure EP™ technology which eliminates the noise found in an EP lab. Pure EP™, collects raw signal and processes them in the digital domain, allowing physicians to see even the smallest fractionated signals without the interference of noise. It makes small fractionated, and previously unrecognized signals come to life.5
Although not evaluated in a formal clinical trial as of yet, Pure EP™ can assist the physician to identify high-frequency, low-amplitude signals easier, leading to greater efficiency during an ablation procedure.6
Improving Efficiency Benefits Patients
Reducing patient time spent in the EP laboratory means that the patient is under anesthesia for a shorter time, reducing the risk of complications. It also means that the patient has less chance of backaches and other orthopedic issues because time spent on the table is reduced, as well.
While specific efficiencies are still being measured, a clearer view of patient’s arrhythmia circuit and diseased tissue holds the promise of further reducing procedure time as well as ablation time.
Direct Cost Savings Nominal, but Will Grow with Experience
Initial studies have demonstrated that the average time per ablation procedure can be reduced by 11 minutes by using pure EP™. Using the average cost of $$35.00per minute this equates to $385 in opportunity cost savings per procedure. While this may appear nominal, it is a start that can:
- Reduce the propensity to use overtime for staff;
- Allow for greater room turnover, or the avoidance of costs associated with expanding EP labs; and
- Improve workflow and staff morale through more efficient procedures.
This is especially true in the case of more complex arrythmia procedures. It may also have a positive impact on variable expenses such as drugs and disposable products.7
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1Hung, Man, Hon, Eric, et. al, “Machine Learning Approach to Predict Risk of 90-Day Hospital Readmissions in Patients With Atrial Fibrillation: Implications for Quality Improvement in Healthcare”, 2020, Health Research and Managerial Epidemiology, Volume 7: 1—7.
2Ibid.
3Yasar, Nafi, “Causes of Noise in Electrophysiological Recordings”, June 28, 2021 at https://plexon.com.
4Elrod, Josie, “Incorporating Advanced Intracardiac Signal Information Into the Clinical Workflow: Interview with G. Joseph Gallinghouse, MD”, December, 2021, EP Lab Digest ISSN 1535-2226
5See www.biosig.com.
6Elrod Op. Cit., p. 35
7Wesley, Carol, “Change and Challenge: Understanding the Finances of the Electrophysiology Lab”, EP Lab Digest, October, 2019, ISSN 1535-2226
