Cath and EP Lab

The home to many cardiovascular firsts in the local community and country, such as the Watchman and Batista procedures-- Providence Saint John’s Catheritization and Electro-physiology (EP) Lab consists of four suites conveniently located on the second floor of the Howard Keck Center. Fully digital, the advanced equipment produces exceptionally clear images that can be viewed by physicians from any location in the hospital. The Lab’s central location and the ability to see real-time images increases efficiency for cardiologists, radiologists, vascular surgeons and electrophysiologists, allowing them to improve patient care that results in more accurate diagnosis, more precise treatment, increased patient safety, and improved outcomes.

Advanced technology

  • Digital subtraction angiography allows physicians to take a picture–called a “mask”–inject dye into an artery, and then take a second picture. The computer then digitally subtracts everything in the mask from the second picture. What remains is a clear picture of the artery.
  • Catheter ablation is used for patients with complex heart rhythm disorders. It is a procedure that destroys abnormal tissue.
  • Cryoablation to freeze rather than heat tissue, a procedure that is safer and usually painless.
  • Electroanatomical mapping and other forms of intra-cardiac imaging.
  • Laser balloon ablation to treat patients with cardiac arrhythmia.

Cath lab services

  • Cardiac catheterization, a technique in which a small, thin tube (catheter) is placed inside an artery and/or vein and then guided into the heart chambers by fluoroscopic guidance and X-ray. This procedure, performed in Providence Saint John’s fully equipped digital catheterization lab, allows cardiologists to obtain vital information, such as pressure measurements, regarding heart and blood vessel function.
  • Endomyocardial biopsy is a procedure to obtain a small piece of heart muscle tissue for analysis under a microscope.
  • Coronary angiograph is a procedure used to determine whether and to what degree the coronary arteries have narrowed and the exact location of the problem.
  • Angioplasty is a less invasive surgical procedure to open blocked heart arteries that is performed in the cardiac catheterization laboratory by a specialized cardiologist.
  • Left ventricular assist using the Impella device. Ventricular assist devices (VAD’s) are mechanical devices that help the heart pump blood. Use of the Impella device will allow the heart to continue pumping while efforts are being taken to perform angioplasty or stenting as a result of heart failure. In other instances the VAD may be implanted for longer term treatment.

Electro-physiology Lab (EP)

  • Watchman® Device

The WATCHMAN device can reduce the risk of stroke by closing off the left atrial appendage, which is known to be the main source of blood clots in patients with atrial fibrillation (AF).

From February 2005 through June 2008, the Providence Saint John’s team, led by Shephal K. Doshi, M.D., medical director of Cardiac Electrophysiology and Pacing, participated in a clinical trial evaluating the WATCHMAN device in 59 centers in the United States and Europe. A polyester fabric-covered, expandable metal cage that resembles a parachute, the device is guided through a catheter that is inserted into a vein in the upper leg, and then threaded through the atrial chambers.

Once appropriately positioned, the WATCHMAN is released at the opening of the LAA, where it expands to cover the opening. The body then forms scar tissue over the device, permanently sealing off the pouch and blocking the formation and release of blood clots. The clinical trial enrolled 707 AF patients randomly assigned to long-term warfarin therapy or implantation of the WATCHMAN device with discontinuation of warfarin. Results of the trial, published in the August 15, 2009 issue of The Lancet, showed that the device group had a significant reduction in the combined rate of stroke, bleeding and cardiovascular death when compared to the warfarin group. At two years, the combined event rate was 5.9 percent in the device group in contrast to 8.3 percent in the warfarin group. In successfully treated patients, the safety event rate was also lower in the device group than in the warfarin group. Based on the results of this pivotal study, an FDA Advisory Panel recently recommended approval of the WATCHMAN device.

“Saint John’s enrolled 53 patients in the PROTECT AF study, and we remain one of a select group of centers that can implant this device now in patients who meet appropriate criteria,” said Dr. Doshi. “Since the conclusion of the clinical trial, we have successfully implanted another 50 devices. We are currently the worldwide leader in implant volume, and our safety record is outstanding.” Implantation of the WATCHMAN device is available to patients at Providence Saint John’s.