Quantifying the impact of equity, diversity, and inclusion in electrophysiology: Training the first female electrophysiologists from Jamaica and Saint Lucia.

Background: Delivery of electrophysiology (EP) care in developing nations and underserviced populations faces many hurdles, including the lack of local expertise and knowledge creation. The West Indies has experienced a paucity of local EP expertise. The University of Toronto has undertaken a unique collaborative educational effort with the University of the West Indies. Objective: We describe the effects of equity, diversity, and inclusion (EDI) in EP training at Toronto General Hospital in Canada by quantifying the impact of training the first female electrophysiologists to practice in Jamaica and Saint Lucia. Methods: Data from the ministries of health in Jamaica and Saint Lucia were reviewed. The number of arrhythmia clinic patients seen, EP studies and ablations performed, pacemaker clinic patients seen, and implantable devices, permanent pacemakers (PPMs), and implantable cardioverter-defibrillators (ICDs) implanted were assessed. Results: One hundred one arrhythmia consults were seen by the new electrophysiologist in Jamaica after her return from training in 2020. She has since performed 19 EP studies/catheter ablations at a newly established ablation laboratory. Three cases of left ventricular (LV) dysfunction due to tachy-cardiomyopathy were treated successfully with catheter ablation with immense improvement in LV ejection fraction. Thirteen PPMs, 1 ICD, and 3 LV leads were implanted, after which no early complications were identified. In Saint Lucia, where there is no dedicated electrophysiology laboratory, 2 patients who required catheter ablation for tachycardia-mediated LV dysfunction were identified by the electrophysiologist since her return to the island in 2018. The patients were appropriately referred, resulting in restoration of normal LV function. Six PPMs also were implanted in Saint Lucia. Knowledge translation has been limited by the lack of accessibility to the required devices, catheters, and specialized equipment and accessories, mainly because of their costs. Conclusion: Training the first female electrophysiologists from Jamaica and Saint Lucia led to a quantifiable impact on EP care in both of these Caribbean countries. EDI strategies in EP training programs provide much needed benefits to developing nations, but more support is needed to allow new electrophysiologists to fully utilize their EP training to care for underserviced populations.

Struma cordis in a Jamaican woman.

A case of ectopic thyroid within the right ventricle (struma cordis) occurring in a middle-aged Jamaican woman is described. This rare and fascinating condition is curable utilizing standard open-heart surgical techniques. Investigations to rule out primary thyroid or ovarian malignancy, as well as the presence of remaining normal thyroid tissue or other ectopic thyroid rests are important in the management of these patients.

Thoracic endometriosis syndrome in Jamaica.

Thoracic endometriosis syndrome (TES) is a rare presentation of systemic endometriosis. An unusual cluster of patients from the Caribbean who were treated at a single hospital during the year 2001 is presented. All patients were managed surgically in the acute phase, with satisfactory results. The etiology and management of TES has been controversial. A therapeutic approach that includes aggressive surgery to obliterate the pleural space combined with a course of hormonal suppression offers the best chance of cure for these patients.

Surgery for patent ductus arteriosus

The surgical treatment of Patent Ductus Arteriosus (PDA) at the University Hospital of the West Indies, Kingston, Jamaica was examined over an eight-year period. The results of standard surgical modalities were comparable to large published series. A review of the literature regarding the treatment options for PDA does not support a change in management strategy in favour of non-surgical methods. The treatment of PDA at this centre has shown excellent long-term results, with miminal mortality and morbidity.(Au)

Penetrating Injury to the Great Vessels: Case reviews and management approaches for West Indian Surgeons

Penetrating injury to the great vessels in the thorax is an increasingly common and alarming clinical scenario in the West Indies, and in Jamaica in particular. The management of these often life-threatening injuries involves careful surgical planning and prompt operation, with close adherence to the principles of adequate pre-operative stabilization and investigations, and intra-operative exposure and repair. While this may be more easily accomplished in tertiary care centres, the geographical realities of the West Indies require that every surgeon be familiar with these techniques. A report of the management of some recent cases is followed by a review of the subject and recommended treatment strategies are outlined.(AU)

Penetrating Injury to the great vessels: case reviews and management approaches for West Indian Surgeons

Penetrating injury to the great vessels in the thorax is an increasingly common and alarming clinical scenario in the West Indies, and in Jamaica in particular. The management of these often life-threatening injuries involves careful surgical planning and prompt operation, with close adherence to the principles of adequate pre-operative stabilization and investigations, and intra-operative exposure and repair. While this may be more easily accomplished in tertiary care centres, the geographical realities of the West Indies require that every surgeon be familiar with these techniques. A report of the management of some recent cases is followed by a review of the subject and recommended treatment strategies are outlined.

Ectopia cordis: ethical dilemma in a developing country

Etopia cordis is a rare congenital abnormality affecting the heart which is present either totally or partially outside the thorax. Because of associated cardiac defects, survival beyond birth is uncommon. One such case in whom death occurred on the 23rd post-operative day from heart failure is described and the management and ethical considerations discussed. This is the first case which has survived beyond birth in Jamaica. (AU)