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Visiting the EP Labs as an Observer Instead of as a Patient

SSR at BAFS 2014by Steve S. Ryan, PhD

Every year I attend the Boston A-Fib Symposium to learn the state of the art in Atrial Fibrillation research and development. This year it was held in Orlando, Florida. (See my reports at 2014 BAFS.)
I traveled to Florida a few days early so I could make a couple of side trips. I was privileged to visit with two of the best Electrophysiologists (EPs) in Florida, Dr. Robert Fishel of Florida Electrophysiology Associates in Atlantis, FL,  and Dr. Sidney Peykar of Cardiac Arrhythmia Institute in Port Charlotte, FL.
I visited their EP labs and observed each doctor as he treated A-Fib patients with Pulmonary Vein Ablation/Isolation (PVI) and other procedures. It was a great learning experience for me.

Day 1: Dr. Robert Fishel in Atlantis, FL

Dr. Robert Fishel graciously allowed me to observe him performing ablations at JFK Medical Center in Atlantis, FL. I had to wear scrubs, a mask, radiation vest, booties and a hair cap. (And I had to keep out of the way.)

Dr Robert Fishel and Steve S. Ryan. PhD

Dr. Fishel would do one ablation, then move to another EP lab where the patient was already anesthetized and everything was already set up for him to do another ablation. Then he moved to an operating room where he replaced a pacemaker. He continued these tightly schedules procedures all day long. (He never seemed to get tired. I’m fairly athletic, but had trouble keeping up with him.)

Video Dr Fishel - Treatments of Afib

VIDEO: “Inside the EP Lab During a Catheter Ablation Procedure with Dr. Robert S. Fishel.”

One of his patients was in persistent A-Fib which is usually harder to cure. Dr. Fishel had to make extra ablation lines, but still made the patient A-Fib free in around two hours.

After observing 2-3 procedures, I couldn’t figure out how he was doing the transseptal punctures without using monitors. Only after I was back in the rental car, did it dawn on me that he was doing the transseptal punctures by feel and from his years of experience.

VIDEO: We have a video of Dr. Fishel in our A-Fib Video Library, see “Inside the EP Lab During a Catheter Ablation Procedure with Dr. Robert S. Fishel.”

Day 2: Dr. Sidney Peykar in Port Charlotte, FL

The next day I drove to Fawcett Memorial Hospital in Port Charlotte, FL, where Dr. Sidney Peykar kindly hosted me and allowed me to observe him during several PVI procedures.

He used slightly different equipment and mapping technology than Dr. Fishel. He used a vascular ultrasound probe to insert the catheter in a vein in the groin and Transesophageal Echocardiogram (TEE) for transseptal guidance and to rule out a left atrial appendage clot.

(With the help of Drs. Peykar and Fishel, I will write an extensive description of the stages of an ablation and all the equipment and personnel involved, so that patients can better understand and not be fearful of a PVI procedure.)

Steve S. Ryan, PhD and Dr Sidney PeykarAfter several PVIs, he moved to another procedure room and did an electrical cardioversion on a patient. He returned him to normal sinus rhythm after only one shock.

Dr. Peykar and I also talked about a particular area of concern: A-Fib patients with Sleep Apnea. Obstructive sleep apnea (OSA) is prevalent among patients with A-Fib and has prompted significant research to understand the relationship. Because Sleep Apnea can easily cause a recurrence of A-Fib after a successful PVI, Dr. Peykar insists his patients with Sleep Apnea receive treatment (like using a CPAP machine at bedtime). (BTW: He’s quite informed on the topic and had all the relevant research articles on his smart phone which he emailed to me with a few key strokes.)


What impressed me most about both doctors was how relatively easy and uncomplicated it is for good EPs to make patients A-Fib free by the end of the procedure (with no apparent complications, at least not while I was there.)

I’m grateful to both Dr. Peykar and Dr. Fishel for letting me experience several PVI procedures from the doctor’s perspective (my only previous experience was years ago as an A-Fib patient).GFX TV set Lights Camera Action

BTW: This first hand experience in the EP lab better prepared me for first day of the 2014 Boston A-Fib Symposium when seven procedures were performed LIVE via satellite. See my report: Live via Satellite: Seven Ablation Cases from The Netherlands, France, Italy, Germany, Russia, Boston & Michigan, USA.

References for this article
Dr. Robert Fishel, Florida Electrophysiology Associates/Palm Beach Heart Associates, West Palm Beach/Atlantis, FL 33462 Toll Free: 888-VTACHMD, (561)-434-0353 Web site:

Dr. Sidney Peykar, Cardiac Arrhythmia Institute, Port Charlotte, FL, 33952 & Sarasota, FL 34239 (800) 771-7164 Web Site:

Goyal SK, Sharma A. Atrial fibrillation in obstructive sleep apnea. World J Cardiol. 2013 Jun 26;5(6):157-63. doi: 10.4330/wjc.v5.i6.157. PubMed PMID: 23802045; PubMed Central PMCID: PMC3691496.

Posted February 2014

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