CASPER — A new $7.3 million lab at Banner Wyoming Medical Center could save central Wyoming heart patients hours of travel that some were making for relatively simple 15-minute procedures.
It also provides the equipment necessary for specialists to implant and manage pacemakers and defibrillators.
The hospital opened its new electrophysiology (EP) lab in June, staffed by two Colorado-based doctors, each working four days per month. As demand grows, these services will mean those services are likely to expand.
The doctors, electrophysiologists — heart specialists for the electrical part of the heart — started traveling to Casper and seeing patients in December.
“It helps so patients don’t have to travel out of state,” said Dr. David Bicknell, one of the electrophysiologists. He said some patients have been traveling out-of-state for simple ablation procedures that correct abnormal heart rhythms.
“They were traveling eight hours for a 15-minute procedure,” he said. “You have to be an electrophysiologist to do an ablation.”
The hospital estimates that as many as 300 patients were leaving the state for electrophysiology visits and procedures.
The Casper-based lab is the second in the state. Cheyenne Regional Medical Center also has an EP Lab that was created in 2009 and is staffed by two electrophysiologists.
In addition to Bicknell and his partner Dr. Daniel Wann, the Casper EP Lab is staffed by a Banner Wyoming Medical Center team of specially trained nurses and technicians.
Prior to the new room, the hospital began offering electrophysiology procedures in December in a hybrid operating room while construction of the new EP Lab continued in an adjacent space.
Some of the members of the new EP lab team are from left, Dr. David Bicknell, Matt Carey, R.N., Andrew Parsell, cardiology interventional technologist, Maranda Morris, R.N., and Tucker Bopp, cardiovascular procedure technologist. (Dale Killingbeck, Cowboy State Daily) 
Banner Wyoming Medical Center has opened a new electrophysiology (EP) lab that may save many central Wyoming patients time in traveling to treatment for heart rhythm disorders. (Dale Killingbeck, Cowboy State Daily) 
Lead vests hang outside the doorway of the EP lab. Everyone who works inside the lab wears a vest to protect them from radiation during a procedure. (Dale Killingbeck, Cowboy State Daily) 
The hospital characterizes its new EP lab as “state-of-the-art” with imaging equipment that helps doctors insert catheters into veins that they can move to the heart as well as heart mapping equipment that shows the electrical impulses of the heart. (Dale Killingbeck, Cowboy State Daily) 
he EP lab includes a procedure room as well as a control room that is separated by glass. (Dale Killingbeck, Cowboy State Daily) 
The control panel for the device that projects images of the patient’s body during a procedure. (Dale Killingbeck, Cowboy State Daily)
Atrial Fibrillation A Common Problem
Bicknell said much of his practice is expected to focus on Wyoming residents with atrial fibrillation or AFib, a condition that develops as people age into their 70s and 80s. As many and one-in-four people develop the condition in their lifetime.
The condition involves the upper two chambers of the heart beating irregularly and out of sync with the two lower chambers. Symptoms can include a faster heartbeat or fluttering feeling, chest pain, dizziness, fatigue, lightheadedness, and weakness.
Apple watches and other “smart devices” being marketed to health-conscious consumers means more people are becoming aware of the condition. Bicknell said the Apple watch actually spots AFib correctly about 34% of the time.
He has noticed a trend among patients coming to his office, referred first by their watches.
“I would say of the amount I see, 10 to 15% say, ‘My watch said this…’” he said.
Untreated, AFib takes away a person’s quality of life and preventing them from doing many activities, he said. It also can lead to a stroke. Certain AFib patients may be put on blood thinners to prevent stroke and correcting the AFib means certain patients on blood thinners may be able to go off the blood-thinning medications, he said.
Lab Technology
The technology inside the new lab allows Bicknell to map the hearts electrical system and see where it is misfiring.
It also allows him and his team to place catheters through a patient’s veins, often in the groin, and then to the heart where he can cauterize or freeze the area of the heart that is creating the irregular heartbeat and the AFib condition.
“We’re able to eliminate AFib in about 70% to 80% of individuals who have AFib,” he said.
A typical procedure lasts from one to two hours.
Bicknell said a lot of people, especially those in more rural areas of the state, are known to just choose to live with the condition rather than make a trip to get it treated. The new lab and his services now help provide them another option.
Another common issue treated by Bicknell and Wann, is supraventricular tachycardia — a condition where people of any age can experience fast heart rhythms.
“It’s a relatively easier procedure,” he said. “In most instances, we can cure them of that.”
Bicknell said he also will use the lab for “lead extractions” — pacemaker wires placed inside a part of the heart that have failed. There is also the possibility of using the lab to implant “bullet” size lead-less pacemakers in qualified patients.
“They are for the right patient, not every patient,” Bicknell said. “Those have been around for 10 years and we’re getting them here, too. They haven’t put one in yet, but we’re getting approval to get them done here.”
Preparing for the new lab meant the Casper-based cardiac nurses and technologists participated in hands-on training at Banner North Colorado Medical Center in Greeley, in addition to on-site training in Casper.
Bicknell said the EP Lab brings the Casper hospital a nearly complete menu of heart services for central Wyoming.
Hospital spokesperson Mandy Cepeda said those who think they may benefit from seeing one of the electrophysiologists should talk to their primary care doctor about a referral, or they can call 307-233-0250.
Schedule Filling
Cepeda said the electrophysiologists are already booked significantly into the future and the hospital is working to get them more days in Casper.
A future goal is to recruit a full-time electrophysiologist for the hospital.
Bicknell said the immediate plan is to increase the days available for EP Lab use but that will take time.
“We can potentially run this lab four to five days a week,” he said. “(But) it requires a team … this is just not me, because often times there is an anesthesiologist, a couple of technicians, one or two nurses, and support staff. So, there is a team approach.”
Dale Killingbeck can be reached at dale@cowboystatedaily.com.
