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Cardiac Electrophysiology

Sanger Heart & Vascular Institute's cardiac electrophysiology (EP) team achieves top outcomes by embracing innovative technology, research and a commitment to providing the highest-quality care.

Redesigning Atrial Fibrillation Care 

Since we launched the Atrium Health Sanger Heart & Vascular Institute Atrial Fibrillation Center of Excellence (AF COE) in 2021, our redesigned approach has led to tremendous improvement in outcomes. 

The AF COE is driven to provide high-quality, coordinated, patient-centered, timely and holistic care. In addition to offering access to our expert electrophysiologists, the AF COE leverages advanced practice providers and nurse care team models, virtual consults, referral pathways to other subspecialties, and integrated digital health strategies. 

This care includes:

  • Nurse navigator support for pre-procedural patients through 30 days post-procedure at our Cabarrus, Pineville and Carolinas Medical Center locations.
  • Inpatient cardiothoracic surgery, emergency department and outpatient care pathways to link patients to care at the EP clinic.
  • Systematic screening of all AF patients for control of three key comorbidities: obstructive sleep apnea, diabetes mellitus and smoking. We have also developed external pathways for expedited management of these modifiable factors through collaboration with primary care, bariatric surgery, sleep medicine, endocrinology and smoking cessation teams.  
  • Referral triage to ensure the best use of patients’ and providers’ time by requesting certain information prior to a physician visit. This helps avoid unnecessary or duplicate visits.
  • Sustainable, scalable interventions and educational initiatives for patients related to everyday AF management, health promotion and disease prevention.

State-of-the-Art Technologies

Our multidisciplinary team – including advanced heart failure, cardiac surgery, radiation oncology, and behavioral health – provides the full spectrum of care for patients with ventricular arrhythmia. We offer advanced therapy ablation including endocardial and epicardial ablation approaches, surgical ablation, radiation therapy, and surgical neuromodulation. 

Our Cardiac Device Clinic continues to be an international leader in the care of patients with implanted devices. Our volume and expertise helps establish best practices, making us one of the largest such clinics in the country, and help establish best practices in the care of patients with cardiac devices through leadership roles in national organizations and collaboration with industry partners. The technologies we offer include:

  • Cardiac contractility modulation (Sanger performed the first implant in the Charlotte region) 
  • Cardioneural ablation
  • Left bundle pacing
  • Hybrid AF ablation

Awards and Recognition

  • Silhouette of North and South Carolina, with pin marking the Charlotte area.


    First cardiac contractility modulation implant in Charlotte region

EP Volumes

  • 1,112

    Internal Data,
    September 2021 - August 2022

  • 706

    Internal Data,
    September 2021 - August 2022

  • 88

    Lead Extractions
    Internal Data,
    September 2021 - August 2022

  • 2,350

    Total Electrophysiology Ablations
    Internal Data,
    September 2021 - August 2022

  • 225

    Ablations for Ventricular Arrhythmia
    Internal Data,
    September 2021 - August 2022

  • Device Management Encounters data.  Total of 52,910, including 4,140 remote, and 11,510 clinic.

Atrial Fibrillation Center of Excellence

  • 887

    Ablations for Atrial Fibrillation

    Internal Data,
    September 2021 - August 2022

  • 79.9%

    Atrial Fibrillation Ablation
    Same-Day Discharge Rate

    Internal Data,
    January 2022 - December 2022

  • 1.02%

    Ablations for Atrial Fibrillation
    Total Complication Rate

    Internal Data,
    September 2021 - August 2022

  • 82%

    Paroxysmal Ablation
    Afib Free at 1 Year

    Internal Data,
    September 2021 - August 2022

Our AF volumes grew 41% in 2022.

Cardiac Electrophysiology Research and Clinical Trials

ASA-TOO: A prospective, randomized, multicenter, global investigation to determine the safety and effectiveness of the WATCHMAN device for subjects with non-valvular AF who are deemed not suitable for anticoagulation therapy to reduce the risk of stroke. 

ARTESIA: A study to determine if apixaban (compared to aspirin) reduces the risk of ischemic stroke and systemic embolism in patients with stroke risk factors including device-detected sub-clinical AF.

BioLibria: A study to prospectively assess outcomes of device-related ventricular tachyarrhythmias and all-cause mortality in non-ischemic cardiomyopathy patients indicated for ICD or CRT-D implantation for the primary prevention of sudden cardiac death. Outcomes differences will be evaluated by sex and device type.

EASY AF: A prospective, multicenter, randomized controlled, single-blinded clinical study to assess a reduction of esophageal lesions attributable to radiofrequency ablation with the use of esolution in comparison to conventional therapy.

HEAL: A multicenter study gathering information on participants returning at the time of CIED change-out or revision who underwent a device implantation with either a CanGaroo envelope, TYRX envelope or no envelope.

Optimizer: A study to provide long-term safety and effectiveness data for the Optimizer Smart System. 

OPTION: A study to determine if left atrial appendage closure with the WATCHMAN FLX™ device is a reasonable alternative to oral anticoagulation following percutaneous catheter ablation for high-risk patients with non-valvular AF. 

NODE 301: A multicenter, randomized, double-blind, placebo-controlled, efficacy and safety study of Etripamil nasal spray for the termination of spontaneous episodes of paroxysmal supraventricular tachycardia.

WATCHMAN FLX: A study that randomizes patients post-AF ablation to WATCHMAN versus conventional therapy.

Aspiration System for Epicardial Ventricular Tachycardia Ablation: A study evaluating outcomes of a novel technique for fluid management during ablation of complex ventricular arrhythmias. Sanger is the only center in the region that offers this procedure. 

Cardiac Rehab to Go in AF: A study to determine the feasibility of delivery of a novel virtual care intervention focused on exercise and weight loss using digital health tools for patients undergoing AF ablation.  

Multicenter Lead Extraction Registry (Coordinating Center): Established the only multicenter registry of patients undergoing lead extraction. This study will provide important insights into best practices for this complex procedure, for which Sanger is one of the largest volume centers in the country.

Same-Day Discharge for Pacemaker/ICD Implantations: As an early leader in same-day discharge practices following pacemaker/ICD implantation, this study will report on one of the largest experiences in the country with an early discharge protocol. 

Safety and Efficacy of DOACs for NVAF in the Overweight Population: A study that aims to improve the clinical outcomes of extremely overweight NVAF patients by increasing the evidence base for anticoagulation treatment. 

Asymptomatic Atrial Arrhythmia Detection Using a Novel Single Chamber ICD with Atrial Sensing Capability: A retrospective study of patient data to evaluate the benefits of the Biotronik DX technology and validate the outcomes for our patient population.

Publications and Presentations

Outcomes of Lead Extraction Using the TightRail™Sheath: An Opportunity for Increasing Access While Preserving Outcomes? Misra S, Mehta R. J Cardiovasc Electrophysiol. 2022 Feb 4.
Impact of COVID-19 on Utilization of Remote Monitoring for Cardiac Implantable Electronic Devices – A Single Center Experience. Cohen W, Misra S, Davenport E, Cooper T, Tucker A, Madjarova S, Mehta R. ACC 2022. 

How to Risk Stratify During a New Advisory Taking Industry and FDA Recommendations Into Account. Misra S. Heart Rhythm Society (HRS) 2022.

Practical Methods for Reducing Unactionable Alerts. Davenport B. HRS 2022. 

Best Programming of the Year for Heart Failure. Mehta R. HRS 2022.

Best Practices for Programming for Best QoL Outcomes. Bryant R. HRS 2022.

Best Practices for Establishing Strong EP Lab Orientation Program. Graham J. HRS 2022.

Evaluating Competencies & Progress of the New EP Lab Team Member. Cerbie C. HRS 2022.

Seal Drainage for Pericardial Fluid Management during Epicardial Ablation. Poster Presentation. Misra S, Coons T, Lesiczka M, Markert C, Mehta R, Powell B. HRS 2022. 

Safety and Efficacy of Transvenous Lead Extraction in Patients with Very Long Lead Dwell Time. Misra S, Swayampakala K, Coons T, Lesiczka M, Cerbie C, Holshouser J, Madjarov J, Mehta R. Poster Presentation. HRS 2022. 

Large Observational Study Evaluating Safety and Efficacy of Direct Oral Anticoagulants in Extreme Obesity. Saxonhouse SJ, Swayampakala K, Perle S, Saxonhouse SE. HRS 2022. 

Prescribing Patterns of Direct Anticoagulants Versus Vitamin K Antagonist in Patients with Non-Valvular Atrial Fibrillation and Extreme Obesity. Saxonhouse SJ, Swayampakala K, Perle S, Saxonhouse SE. HRS 2022.