Early Pulsed Field Ablation Experience in the Electrophysiology Lab: Insights From an EP Nurse Leader

Interview With Melissa May, MSN, RN

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EP LAB DIGEST. 2026;26(8):8-9.

Interview by Jodie Elrod

Melissa May, MSN, RN, describes the successful completion of the initial pulsed field ablation (PFA) cases for atrial fibrillation (AF) at WellSpan Ephrata Community Hospital in Ephrata, Pennsylvania. In the interview, she shares her early experience with the program launch, including preparation and planning efforts, workflow considerations, and practical insights from her perspective as a nurse manager.

Your team recently completed its first PFA procedure for AF. From a nursing leadership perspective, what did it take operationally and logistically to prepare the lab for launch? 
From a nursing leadership perspective, this initiative really began with the onboarding of a highly skilled electrophysiology provider, Dr Roman Marchenko, who joined us with a growth-minded approach to program development and essentially asked, “What if we could bring this technology here?” That question sparked the initial conversations.

Once we received approval from our Heart & Vascular Service Line, we moved quickly into structured planning. We performed a comprehensive gap analysis that included all key stakeholders—physicians, nursing, technologists, anesthesia, supply chain, finance, coding, emergency medical services partners, administration and many others—to evaluate our readiness and identify opportunities.

From there, we confirmed that we had proper approval from the Department of Health and ensured we were aligned from a regulatory standpoint. Operationally and logistically, it was about aligning people, processes, and technology to support a safe and effective program launch.

As Nurse Manager, what were some of the biggest workflow or staffing adjustments your team had to make during the rollout of the PFA program? 
The most significant adjustments focused on refining workflows, ensuring the necessary competencies were in place, and navigating the overall learning curve associated with these procedures. We defined clear roles within the lab to support EP-specific procedures—particularly pacing, mapping, utilization of equipment, procedural support, and patient monitoring.

From a staffing perspective, we focused on placing experienced team members with those newer to advanced EP workflows to support a safe and efficient rollout. Flexibility in scheduling and cross-training was essential during those early cases.

What truly made the difference was the team itself. Our lab team brings more than 110 years of combined experience, and as a nurse leader, I had complete confidence in their capabilities. I knew they would rise to the challenge—and they did. Not only did they embrace the changes, but they were also genuinely enthusiastic to learn new skills and expand their scope of practice.

How many PFA cases has your team completed so far, and what has stood out to you most about staff adaptation and team confidence during the early experience? 
Since implementing this service in April 2026, we have performed almost a dozen PFA cases in our lab. As we continue to grow the program and expand our service days, we expect that number to continue increasing. 

In my early evaluation of the staff, what has stood out most is how quickly our team has adapted and developed confidence—not only in their individual abilities, but also as a cohesive unit. From the beginning, there was a strong sense of motivation and curiosity. Despite the expected learning curve, the team fully embraced the experience. 

One of my technologists, who was eager to be part of the new service, had limited EP experience. However, she immersed herself in the learning process through online modules, vendor-supplied in-services, and hands-on education. This became a common theme across the staff. They supported one another, asked thoughtful questions, and continued to improve with each case. 

Their confidence has grown steadily, both in technical execution and team communication. Given their depth of experience and commitment to excellence, I had strong confidence in their ability to succeed—and they have absolutely validated that.

What did the learning curve look like for nurses and technologists, and what training or preparation strategies were most helpful for your team? 
The learning curve involved both mastering the PFA technology and integrating it into electrophysiology workflows. However, it was very manageable because of the comprehensive preparation strategies we implemented.

Hands-on training was the most impactful. Through our regional partnerships, staff were able to observe and participate in procedures prior to our launch, which significantly increased comfort and familiarity. We supplemented this with vendor education, simulation-based learning, and structured pre-briefs and post-case debriefs.

I am incredibly grateful for our relationships with regional partners, who allowed our staff to gain hands-on training experience in their lab with Dr. Marchenko. In addition, we were fortunate to already have team members with prior EP experience, which helped accelerate our readiness.

We also completed full procedural run-throughs and transfer drills as part of our preparation, which allowed the team to practice both routine workflow and emergency response scenarios in a controlled environment.

What stood out most was how the team embraced the learning curve—they approached it with enthusiasm and a strong commitment to growth.

What advice would you give other EP lab nurse leaders preparing to introduce PFA into their own programs?
My advice is to start with stakeholder alignment through gap analysis planning. Not only does it ensure that you have all the key stakeholders involved, but it also sets the tone for everything that follows. Develop a clear plan that includes operational, regulatory, and educational components.

Invest in hands-on training and leverage system partnerships whenever possible. This creates invaluable learning opportunities for staff to experience the technology before go-live.

Proactive safety planning is also important. Establish a clear, well-rehearsed transfer algorithm for escalation of care, even if it is rarely needed. Completing procedural run-throughs and transfer drills helps build confidence and ensure readiness.

Most importantly, trust your team’s capabilities. In our case, I knew we had the right foundation in place. Their motivation and enthusiasm for learning something new played a critical role in our success. They should be part of the conversations early on to build enthusiasm.

Finally, it is important to recognize the broader impact of this technology. PFA represents a significant advancement in cardiac care. Its mechanism—non-thermal, tissue-selective ablation—has improved safety compared to traditional methods. This has been a game changer for community hospitals and ambulatory surgical centers, making it possible to safely offer complex ablative procedures without the need for on-site open-heart surgery capabilities.

Ultimately, this allows us to deliver high-quality, advanced care closer to home—something that is incredibly meaningful for our patients and our community.