EP Team Conducts First-in-Human Case with HisPro System
Duke electrophysiologist Brett Atwater performed the world’s first-in-human use of a new conduction system pacing (CSP) lead implantation system, called the Agilis HisPro, on Friday afternoon at Duke University Hospital. The system was used twice on Friday. The first case was in a patient with an existing defibrillator/pacemaker with a lead in the right ventricular apex. Due to advancing disease of the heart’s natural conduction system, the patient required pacing from this lead and had developed worsening shortness of breath, leg edema and fatigue as a result of worsening heart failure. Atwater hopes that a successful CSP implantation using the HisPro catheter will help the patient regain energy and improvement with their heart failure symptoms. (The second case was performed in a patient receiving their first placement.) Both cases were live-streamed from the Duke EP lab to Abbott 
Laboratories.
In 2016, Atwater began a protocol in collaboration with Abbott Medical to completely rethink the design of CSP implantation equipment. The team used previously acquired CT data to reconstruct 3-dimensional models of a variety of patient anatomies, simulating the variations seen in the normal course of patient care (photo 1). Scientists at Abbott medical then used 3D printing to produce replicas of our patients hearts, complete with valves, ridges, and veins entering and arteries leaving the heart chambers. The location of the conduction system, acquired from prior electrophysiological testing was then marked carefully inside the models (photo 2). Using these 3-dimensional models, production engineers then designed a variety of catheter shapes and tested them with 
thought leaders from around the world.
The final design, now known as the Agilis HisPro catheter (photo 3) received FDA 510k approval two weeks ago. The design incorporates active catheter deflection and mapping electrodes to identify the characteristic electrical signals produced by the conduction system. By using the electrical signals identified on the HisPro sheath electrodes, we believe the implantation should be faster, use less radiation, and have a higher likelihood of success compared to CSP implantation procedures using existing implantation systems.
This is a huge achievement and reflects years of work, persistence, and innovative creativity. Atwater helped design and develop 
this catheter, including its pre-clinical work in animal models. Approximately 50 labs were competing to get this distinction. This is a terrific accomplishment and wonderful example of the incredible work taking place within Duke Electrophysiology. Great job and congratulations, Brett!
Duke EP Performs First NC Use of SBRT to Treat VT Patient
Two weeks ago, our Duke EP team celebrated another remarkable first – two years in the making and under the stewardship of Al Sun, Jason Koontz, Zak Loring and Manisha Palta (radiation oncology), the Duke team successfully performed Duke’s first non-invasive Stereotactic Body Radiation Therapy (SBRT) treatment of refractory ventricular tachycardia (VT).
The use of SBRT at Duke is not new, of course. This technology is used daily for the treatment of patients with brain tumors and other cancers. However, the use in patients with hard to reach and/or difficult to treat arrhythmias such as refractory VT has only been done at a few select centers worldwide. This is the first time the treatment has been used for a VT patient in North Carolina.
The team performed their case on Thursday, June 18 in a patient for whom no other treatments were working, and the patient was experiencing daily runs of irregular rhythms, not improving and feeling awful. The EP team was basically out of options and, after lengthy discussions with the patient and their family members, opted to try SBRT.
We look forward to sharing more on this story in the coming weeks. We know the availability of SBRT to our EP team will be great benefit to our patients with VT that is resistant to antiarrhythmic drug therapy and catheter ablation. Congratulations to the EP team for their outstanding dedication in seeking new ways to provide help to Duke Heart patients. You’re doing incredible work!
Lewis Named Director, Lead Management Program for Duke EP
We are pleased to announce that Robert Lewis, MD, PhD will be assuming the role of Director of the Lead Management Program in the Division of Cardiology and Duke Heart Center, which was effective last week. Lewis completed his electrophysiology fellowship at Duke and worked at the University of Alabama at Birmingham after fellowship before returning to Duke in 2015. The Duke Lead Management team, comprised of Linda Lewek, RN; the Duke CT Surgery and Anesthesia programs; Jonathan Piccini, MD, MHS; Donald Hegland, MD; Sean Pokorney, MD, MHS; and Dr. Lewis, have made several important contributions to the field, including pioneering the implementation of CT imaging to facilitate procedural planning and safety of lead extraction. They are recognized authorities in lead extraction and host highly regarded quarterly on-site training sessions with U.S.-based and international attendees.
We thank Dr. Piccini as the outgoing director of the Lead Management Program, a role he assumed in 2013. His leadership has been instrumental in building the lead management program at Duke to its current status as a world leader in both research and clinical volume. We are excited to benefit from Dr. Lewis’ continued vision for the lead management program, from a programmatic, clinical, research, and educational perspective.
Congratulations Rob!
CVRC’s Headley Family Award Funding Announced
Sudha Shenoy, PhD, has been named the first recipient of the Headley Family Award for research within the Duke Cardiovascular Research Center (CVRC). The award to Shenoy, in collaboration with Jon Campbell, PhD, of the Duke Molecular Physiology Institute, is for her project ‘A novel approach to treat Diabetes Mellitus: Modulation of glucagon receptor ubiquitination.’
The project is focused on how a particular protein tag called ubiquitin can effect certain types of G protein-coupled receptors (GPCRs) and how they communicate signals. Her lab has been exploring how ubiquitin tagging affects the glucagon receptor (a type of GPCR), which regulates blood glucose levels. While doing so, they stumbled upon a new and unexpected finding that had not happened with other GPCRs they’ve tested.
“This award comes at a time where we have sort of stumbled onto a new finding that is of great interest to me, and there was no external funding available to support further investigation,” said Shenoy, an associate professor of medicine in the Duke division of cardiology. “I cannot put into words just how good this timing is for me, for my lab and for my work. I’m very happy and grateful to receive this funding.”
The funding is particularly important with suspension of research due to COVID-19.
“Scientific funding is incredibly competitive, says Maria Price-Rapoza, executive director of the Duke CVRC. “To have an additional tier of research support thanks to philanthropic donors is very meaningful, particularly with the impacts that COVID-19 has had on the research community. We are delighted to provide this award to Dr. Shenoy.”
The Headley Family Award was established earlier this year and made possible through the generosity of Mr. and Mrs. Harry and Dorothy Headley in support of basic cardiovascular research at Duke. The CVRC used an invited application process which began in early March. The award will provide annual one-year seed grants of $25,000 (plus indirect costs at 15 percent) targeted toward CVRC researchers who are conducting innovative research into the causes and treatment of hypertension, atherosclerosis and related cardiovascular diseases. The Headley’s, who celebrated their 61st wedding anniversary in May, have lived in Durham since 2004. The CVRC is grateful for the support they have provided to our research team.
The award is effective July 1. Congratulations, Dr. Shenoy!
Interventional & Structural Fellows Celebrate Year-End
On Thursday evening, the Duke Interventional Cardiology and the Duke Structural fellowship programs held their annual year-end celebration via Zoom. Schuyler wrapped up his first year as the interventional cardiology fellowship director and did a great job with the event, which included multiple costume changes and a photo montage for each fellow, as well as dinner from Convivio for each of the honorees.
The 2020 Walter Newman Award, dedicated by Mr. and Mrs. Walter Newman (a patient of Dr. Robert “Jess” Peter), is voted on by the faculty and given annually to 
the ‘outstanding fellow’, was awarded to Angela Lowenstern.
Congratulations to the completing fellows who were celebrated on Thursday evening:
Adam Banks (Structural); Jennifer Rymer (Interventional); Angela Lowenstern (Interventional); and David Manly (Interventional).
Shout-Out: Good Catch, Newman!
A shout-out this week to Joanna Newman, PA, of the Cardiothoracic Step-Down Unit in Duke University Hospital for her recent Good Catch Award. Her unit was caring for a post-heart surgery patient experiencing hypotension and dwindling urine output. Providers had already tried several things to treat the patient, but issues persisted. Newman’s daytime colleagues had noted their concerns prior to her starting an evening shift with the patient. It occurred to Newman that the patient could be experiencing cardiac tamponade, so she escalated the situation and it was determined that the patient needed to be returned to the OR. Although the Good Catch was awarded to Newman, she is quick to point out that problem-solving for complex patients, including this one, is a “team sport” and that everyone on the unit takes a turn carrying the problem and attempting resolution. We know this is true each and every day in Duke Heart – thank you for the time you and your colleagues took to troubleshoot and think deeply about our patient. Congratulations for this good catch and for the many others that go without an official award!
Poster Presentation, AAPA 2020
Todd McVeigh and Jordan Hausladen, two of our Duke Cardiology APPs, are authors of a poster selected by the American Academy of Physician Assistants for podium presentation at AAPA 2020, which was originally scheduled for May 16-20 in Nashville (but cancelled due to COVID-19). Their poster Developing Standardized Note Templates for Inpatient Rounding Teams was instead presented virtually and can be viewed here: https://www.aapa.org/research/eposters-2020 (scroll to 4th row under ‘workforce gallery). The poster illustrates findings of the Cardiology APP survey data collected regarding documentation templates.
The team sent a survey to inpatient APPs and physicians as well as outpatient APPs in cardiology to get a sense of how people viewed the documentation templates. They then worked with internal teams to determine what was liked/disliked in order to develop a more efficient documentation template that maintained what was needed for compliance and billing purposes.
Results showed that overall, people’s biggest complaint was that the old templates took too long to complete, leading to job dissatisfaction. The new template allows providers to spend less time on notes, which has led to overall better balance between documentation times and actual provision of patient care.
Great work, Jordan and Travis — what a terrific honor to be selected for an AAPA podium presentation! We know you’ve made an even greater impact on your colleagues by helping with their work satisfaction. Way to go!
ICYMI: ACC & SVS Registry Announcement
The American College of Cardiology (ACC) and Society for Vascular Surgery (SVS) announced this week they are collaborating on a single vascular registry to harness the strengths of both organizations in improving care and outcomes of patients with vascular disease. Effective January 2021, the ACC’s National Cardiovascular Data Registry (NCDR) will collaborate with the SVS Vascular Quality Initiative (VQI) to support and steer a single vascular registry. This registry will be operated by SVS, creating a co-branded VQI program that will be a unique, comprehensive resource for measuring and improving the care provided to a growing population of patients with vascular diseases. To read more about it, visit this article on Healio.
COVID-19 Updates:
All the latest official DUHS information regarding coronavirus/COVID-19 response at the following locations:
Have news to share?
If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart at tracey.koepke@duke.edu. We would love to hear about your latest accomplishments, professional news, cool happenings, and any events or opportunities that may be of interest to our Duke Heart family. Please call with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged.
Duke Heart in the News:
June 19 — Joseph Rogers
WUNC 91.5/NC Public Radio
NC Hospitals Have Capacity For COVID Patients — For Now
https://bit.ly/3i6kyUN
June 19 — Oliver Jawitz
Medscape/Reuters
SAVR Following TAVR May Present Extra Risks
https://www.medscape.com/viewarticle/932569
June 20 — Sunil Rao
tctMD/the heart beat
Newer TAVR Devices Reassure in Failed Surgical Valves
https://bit.ly/2ZeNRMm
June 22 — L. Kristin Newby
WBTV (Charlotte, NC)
Duke’s MURDOCK Study launches COVID-19 research in Cabarrus County
https://bit.ly/3eAfwxH
June 23 — L. Kristin Newby
WRAL Tech Wire
Duke launches COVID-19 research project in Kannapolis, Cabarrus County
https://bit.ly/3eFQkpt
June 24 — Joseph Rogers
Bloomberg Law
Hospitals Are Counting Beds Again With Virus Cases Rising
https://bit.ly/386yhX7
June 24 — Joseph Rogers
WTVD
ABC 11 Eyewitness News at 11 p.m.
https://bit.ly/2Ze8gRH
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