2018 Speakers Group Pic.jpg
2018 LRH CV Symposium Speakers. From left to right, Dr. Khanna, Dr. Carl Pepine, Dr. Fred Kusumoto, Dr. Daniel Yip, Dr. Andres Medina, Dr. Williams. Not pictured: Dr. Doug Ebersole and Dr. Victor Cotton.

Thanks to all the faculty and attendees of the 2018 Lakeland Regional Health Cardiovascular Symposium! We appreciate the time away from family and hope the education proves to be worthwhile. You will find link to PDF’s of all lectures below; please note that faculty may have altered their presentations from these files.

2018 Pepine Pic
Dr. Carl Pepine from the University of Florida discussing women and heart disease. Forty two percent of adult women have hypertension which is the number one cause of mortality! Dr. Pepine is a true giant of cardiology.

Pepine CVD in Women


2018 Yip Photo
Dr. Daniel Yip from Mayo Clinic discussing management of congestive heart failure.

Yip LRH CV Symposium 2018

2018 Kusumoto Pic
Dr. Fred Kusumoto from Mayo Clinic discussing anticoagulation for atrial fibrillation.

Kusumoto LRH CV Symposium 2018

Dr. Doug Ebersole from The Watson Clinic discussing left atrial appendage occlusion in clinical practice.

Ebersole LRH CV Symposium 2018

Cotton 2018 Pic.jpg
Dr. Victor Cotton explaining medical liability risk mitigation. Always a great speaker and hard to tell if he is more entertaining or informative!

Cotton LRH CV Symposium 2018

Dr. Andres Medina of The Watson Clinic and Lakeland Regional Health discussing transcutaneous aortic valve replacement.



Medina 2018 TAVR

Thompson CV Symposium 2018

Khanna 2018 EKG

Williams LRH CV Symposium 2018

Thanks again for attending and please let us know what you’d like to hear about next year. You can submit suggestions for next year by commenting here.

We hope you will join us for Lakeland Regional Health’s 2017 Cardiovascular Symposium. We believe that you will find this opportunity to learn from leaders in our profession both educational and inspiring. Speakers from University of Pennsylvania, Vanderbilt University, University of Pittsburgh, and University of South Florida as well as local faculty will be presenting state-of-the-art topics in cardiovascular disease.

Lakeland Regional Health is committed to delivering nationally recognized healthcare, strengthening our community and advancing the future of healthcare. The experienced physicians of our Heart Center place patients at the heart of all they do. We are Polk County’s pioneer in expert cardiac care and have been for more than three decades.

Upon completion of our Symposium, participants should be able to:

  • Understand the latest research in managing patients with artificial hearts and/or ventricular assist devices.
  • Describe the long-term impact of cardiovascular care on function in the elderly.
  • Identify outpatients with pulmonary hypertension.
  • Recognize and describe the pros and cons of rate versus rhythm control for atrial brillation.
  • Identify and describe interventional cardiology technologies that are currently available to treat structural heart disease.
  • Describe the latest methods for outpatient management and diagnosis of peripheral vascular disease.
  • Describe the current inpatient and outpatient congestive heart failure care continuum.
  • Understand survival rates and long-term complications of adults with congenital heart disease.

    We look forward to seeing you in February. If you have any questions, please do not hesitate to contact us at 863.687.1190.

The Symposium offers 5.25 AMA Category 1 CME credits) and registration is free at 2017 Lakeland Regional Health Cardiovascular Symposium.

What is a Defibrillator? Cover

A defibrillator implant is a small device surgically implanted in the chest to maintain the heart’s electric rhythm. The surgery is very common: over 130,000 Americans receive a defibrillator implant every year.

If you or a loved one requires a defibrillator implant, you’ll undoubtedly have many questions—questions that can’t always be adequately explained in a forty-five minute doctor’s appointment. I recently published a complete, easy-to-understand guide to defibrillator implantation.

What Is a Defibrillator? begins with an explanation of how defibrillators work and the conditions they treat. I then discuss how doctors determine whether patients are good candidates for defibrillators and provides an overview of the implantation process. Potential complications both before and after defibrillator implantation are discussed, as is surgical recovery and follow-up treatment. For readers having difficulty with medical terminology, there is a helpful glossary at the back of the book.

Patients, caregivers, and family members alike will benefit from these straightforward explanations. If you’re a candidate for defibrillator implantation, this book can help you approach surgery with a full understanding of the procedure and what it means to your quality of life.

What is a Defibrillator? is available in print and electronic versions at Amazon.com (http://www.amazon.com/What-Defibrillator-Cardiologists-Patients-Providers-ebook/dp/B011EXAQL4/ref=sr_1_4?s=digital-text&ie=UTF8&qid=1438283493&sr=1-4).

A recent article from The Advisory Board Company found a group of hospitals that had an advantage when it came to providing an excellent patient experience: specialty hospitals. An Advisory Board analysis of recent Hospital Compare data suggests that specialty hospitals dominate the rankings when it comes to patient satisfaction.

Patient satisfaction may not be the only benefit of a specialty hospital or “center of excellence.”  We examined the demographics, complications, re-admissions, and accessibility of care in a community electrophysiology (EP) program to add to the body of knowledge of ‘real-world’ EP device implant complications. Two hundred and fifty consecutive patients who underwent device implantation by a single electrophysiologist in a new non-academic community hospital EP program starting from its inception in July 2008 were included for analysis. Standard procedures for implantation were used. Pacemakers, defibrillators, and generator changes were included; temporary pacemakers were excluded. Major complications were defined as in-hospital death, cardiac arrest, cardiac perforation, cardiac valve injury, coronary venous dissection, hemothorax, pneumothorax, transient ischemic attack, stroke, myocardial infarction, pericardial tamponade, and arteriovenous fistula. Minor complications were defined as drug reaction, conduction block, hematoma or lead dislodgement requiring re-operation, peripheral embolus, phlebitis, peripheral nerve injury, and device-related infection. This community cohort had similar ejection fractions but was older with worse kidney function than those studied in prior reports. There was one major early complication (0.4%) and seven minor early complications (2.8%). Left ventricular lead placement was successful in 64 of 66 patients (97%). This was the first community-hospital based EP program to examine device implant demographics and outcomes, and revealed an elderly, ill population with lower overall rates of complications than seen in national trials and available reports from single non-community centers. Contrary to current perceptions, these data suggest that community centers may subselect an elderly, ill patient population and can provide high-quality, cost-effective, and more accessible care.


“Specialty hospitals are under increasing scrutiny, but there may be a role for ‘niche’ hospitals that, while offering the full spectrum of general hospital care, can provide certain procedures at an exceptional level of quality and cost-effectiveness. Recent literature continues to document the paucity of data available on rates and predictors of ICD implantation in routine clinical practice.(24,25) The Ontario ICD Database (24) revealed major complications related to de novo defibrillator implantations in 4.1% of procedures. Adjusting our data to match their definition of major complications, our center had major complications in 1.0% of de novo defibrillator implantations (a 76% relative reduction in major complications). The cost of major complications among Medicare beneficiaries receiving implantable defibrillators was examined in 30,984 patients.(25) They found that 10.8% of patients experienced one or more complications resulting in an increase in length of stay by 3.4 days and costs by $7,251. Superiorly performing ‘niche’ hospitals that reduce major complication rates from defibrillator implants by 76% in the uS (conservative estimate of 100,000 yearly implants) could realize an estimated $60 million in cost savings while improving patient safety.” (Williams et al, 2010, full link to reference below)

Demographics and complication rates seen in this report versus those reported from non-community centers and national trials.
Demographics and complication rates seen in this report versus those reported from non-community centers and national trials.

Please take this one question poll about specialty hospitals:

For More Details Please See:

Please join us for the Sixth Annual Lebanon Valley Cardiovascular Symposium on Saturday May 30, 2015. It has been very well received by a broad swath of care providers in Pennsylvania. We continue to increase our attendance and registrant feedback was overwhelmingly positive! As you can see, we have a great lineup of faculty and topics for this year’s Symposium.

The 2015 Symposium (Saturday May 30, 2015) will feature Dr. Michael Ezekowitz (Director of Atrial Fibrillation Research & Education, Cardiovascular Research Foundation, Main Line Health) and faculty from the University of Pittsburgh, Jefferson Medical College, WellSpan (York Hospital) and The Good Samaritan Hospital. Topics will include Target Specific Oral Anticoagulants for Atrial Fibrillation, Outpatient Identification of Pulmonary Hypertension, Treatments for Venous Insufficiency, and more. This year we will also have our Electrophysiologists (Drs. Williams and Stevenson) debating rate versus rhythm control for atrial fibrillation.

The Symposium has grown into one of the largest Cardiovascular Symposiums in Pennsylvania and we will again be cosponsored by the PA Chapter of the American College of Cardiology! The Symposium offers 6.5 AMA Category 1 CME credits (including 2 hours patient safety and 10 MOC credits) and registration is free at www.gshleb.org/lvcs.

Final 2015 LVCS Brochure


Abstract Presented at the Heart Rhythm Society 2014 Annual Sessions, May 8, 2014

Patient Awareness of High Frequency Jet Ventilation to Minimize Cardiac Motion during Interventional ProceduresAuthors:
Jeffrey L. Williams MD MS FACC FHRS, David Lugg BS RCIS, Robert Gray BSN RN, Rose Benson CRNA, Marie A. DeFrancesco-Loukas CRNA, Paul J. Teiken MD. Heart Rhythm Center, The Good Samaritan Hospital, Lebanon Cardiology Associates, Lebanon Anesthesia Associates, Lebanon, PA.

Introduction: High frequency jet ventilation (HFJV) is used to minimize pulmonary and hence, cardiac motion during interventional procedures. Patient awareness during routine use of HFJV has not been evaluated in this setting. A Bispectral index (Bis) value of less than 60 is generally accepted as appropriate level of sedation during general anesthesia. Methods: Seventy two consecutive patients underwent EP studies including ablation for supraventricular and ventricular arrhythmias (n=74) in an invasive EP laboratory using HFJV. Any EP studies where ablation was attempted were included for analysis. Patients underwent induction of general anesthesia with endotracheal intubation using inhaled positive pressure ventilation with sevoflurane in the EP laboratory prior to vascular access. HFJV was then provided by a commercial system with initial settings: ventilation rate at 100 cycles per minute and drive pressure at 20-25psi. Total intravenous anesthesia was then provided with dexmedetomidine and propofol as well as fentanyl and rocuronium titrated to Bis score. Results: The overall mean age of patients was 55±18 years (range=18-84years) and the overall mean Bis score was 40±5.3 (see Poster). No patient experienced awareness during the procedure. Conclusions: This first report of patient tolerance using high frequency jet ventilation in an invasive electrophysiology laboratory demonstrates that HFJV is well tolerated by patients with an average Bis score of 40±5.3 and no patient experienced procedural awareness.

Please join us for the Fifth Annual Lebanon Valley Cardiovascular Symposium on Saturday May 31, 2014. It has been very well received by a broad swath of care providers in Pennsylvania. We continue to increase our attendance and registrant feedback was overwhelmingly positive! As you can see, we have a great lineup of faculty and topics for this year’s Symposium.

The 2014 Symposium (Saturday May 31, 2014) will feature Dr. Henry Halperin (2010 AHA Distinguished Scientist Award Recipient, Johns Hopkins University) and faculty from the University of Pennsylvania, Lancaster General Hospital, WellSpan (York Hospital) and The Good Samaritan Hospital.  Topics will include Outpatient Management of CHF, Cardiac Resynchronization Therapy, Novel Oral Anticoagulants for Atrial Fibrillation, and more. This year we will also have two of our Interventionalists (Drs. Tadajweski and Fugate) debating radial versus femoral artery access for cardiac catheterizations.

The Symposium has grown into one of the largest Cardiovascular Symposiums in Pennsylvania and we will again be cosponsored by the PA Chapter of the American College of Cardiology!  The Symposium offers 5.25 AMA Category 1 CME credits) and registration is free at www.gshleb.org/lvcs.


Final 2014 LVCS Brochure

I wrote What is a Pacemaker? Cardiologist’s Guide for Patients and Their Care Providers to fill a gap in available resources for patients who have undergone or are under evaluation for pacemaker implantation. Please consider this a resource for your patients, colleagues, friends, and family.

The fastest growing population segment in the United   States, seniors commonly undergo pacemaker implantation. Although doctors’ offices typically provide short pamphlets on pacemaker implantation, there is rarely any comprehensive yet understandable reference material for the patients to obtain…until now. Explaining the “what, why, and how” of pacemaker implantation, this invaluable new guide provides an in-depth summary of pacemakers, from the initial patient evaluation and device implantation to the issues that could potentially arise during a long-term follow up.

Pharmaco-Kinesis Corporation has developed an implantable pump for localized cancer-fighting drug delivery. This first-generation Nano-Impedance Biosensor (NIB) detects vascular endothelial growth factor (VEGF-165) which is a biomarker correlating to the presence of a cancerous tumor in the body. The NIB is about the size of an aspirin and can detect VEGF at levels as low as 1 to 10 protein molecules in the billions of molecules present in 1 mL of body fluid. Products using NIB technology could ultimately become available over-the-counter to enable patients to measure biomarkers for cancer and other chronic illnesses. One can envision implantable sensors to track brain natriuretic peptide or troponin to enable instant therapy delivery for cardiovascular patients.

A recent article in the Journal of the American College of Cardiology examined the use of intracardiac echocardiography (ICE) to detect cardiovascular implantable electronic device-related endocarditis.  The goal of this study from Narducci et al was to compare transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) for the diagnosis of cardiac device–related endocarditis (CDI).  The diagnosis of infective endocarditis (IE) was established by using the modified Duke criteria based mainly on echocardiography and blood culture results.

The group prospectively enrolled 162 patients (age 72 ± 11 years; 125 male) who underwent transvenous lead extraction: 152 with CDI and 10 with lead malfunction (control group). They divided the patients with infection into 3 groups: 44 with a “definite” diagnosis of IE (group 1), 52 with a “possible” diagnosis of IE (group 2), and 56 with a “rejected” diagnosis of IE (group 3). TEE and ICE were performed before the procedure. In group 1, ICE identified intracardiac masses (ICM) in all 44 patients; TEE identified ICM in 32 patients (73%). In group 2, 6 patients (11%) had ICE and TEE both positive for ICM, 8 patients (15%) had a negative TEE but a positive ICE, and 38 patients (73%) had ICE and TEE both negative. In group 3, 2 patients (3%) had ICM both at ICE and TEE, 1 patient (2%) had an ICM at ICE and a negative TEE, and 53 patients (95%) had no ICM at ICE and TEE. ICE and TEE were both negative in the control group.

They found that ICE represents a useful technique for the diagnosis of ICM by providing improved imaging of right-sided leads and increasing the diagnostic yield compared with TEE.