Expanding Excellence in Research and Patient Care in a “Priva-demics” Model: The New Heart and Vascular Tower at AdventHealth Littleton
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EP LAB DIGEST. 2026;26(3).
Nicholas Palmeri, MD; Dan Alyesh, MD, FHRS, FACC; and Sri Sundaram, MD, FHRS, FACC
Littleton, Colorado
A Common Mission
For more than 50 years, South Denver Cardiology has been a premier cardiology practice serving the Denver community. Under the leadership of William Choe, MD, and Sri Sundaram, MD, FHRS, the electrophysiology (EP) division has consistently advanced the field through participation in numerous clinical trials while continuing to deliver world-class cardiac care.
Although the group does not have a formal academic affiliation, South Denver Cardiology considers itself a “Priva-demics” practice. The practice has led enrollment in multiple clinical trials, primarily focused on novel device therapies, resulting in a strong record of scientific output. In recent years, the group has published dozens of manuscripts, with several first-author publications in the Journal of Interventional Cardiac Electrophysiology, Heart Rhythm, Journal of the American College of Cardiology (JACC), and JACC: Clinical Electrophysiology, as well as a publication in the New England Journal of Medicine.
Dr Sundaram has presented at the Asia Pacific Heart Rhythm Society and the Latin American Heart Rhythm Society. Dan Alyesh, MD, FHRS, chair of Heart Rhythm TV, has been featured at the national Heart Rhythm Society conference and the European Heart Rhythm Association meeting. In addition, the EP lab in Denver has hosted trainees from around the world, including Australia, Canada, Cambodia, Vietnam, and Brazil, among others.
Through a close partnership with AdventHealth, South Denver Cardiology has expanded its EP services beyond AdventHealth Porter to a second location in the Denver metropolitan area. To enhance access to cardiac care, AdventHealth Littleton recently constructed an 86,000-square-foot Heart and Vascular Tower. There is a growing need for EP services in this area of Denver. The city has experienced substantial growth over the past 2 decades, much of it in the South Metro Denver region. Douglas County, Colorado, is among the top 5 fastest-growing counties in the US, with its population increasing from fewer than 300,000 residents in 2010 to more than 400,000 residents in 2025. The new tower is strategically located just north of Douglas County, in neighboring Littleton.
The new Heart and Vascular Tower was designed to support continued growth in EP services. Four new labs were established at AdventHealth Littleton, complementing the 3 existing labs at AdventHealth Porter. The first 3 of the 4 labs became operational on August 6, 2025, with senior electrophysiologist Dr Choe performing the first ablation at the AdventHealth Littleton Hospital Heart and Vascular Institute. This milestone closely followed recent breakthroughs in pulsed field ablation (PFA) technology.
New Space for New Technology
The new labs were built with 2 primary goals: delivering high-quality patient care and advancing the field of cardiac EP. To achieve these objectives, the design emphasized flexibility and resource allocation to meet the demands of an ever-changing field, including investment in advanced electroanatomic mapping software. AdventHealth recognized the critical importance of these technologies and invested in both structural hardware and mapping software to support cutting-edge ablation technology.
South Denver Cardiology has long leveraged established electroanatomic mapping technologies to optimize patient care and has maintained strong collaborations with industry partners to advance novel clinical research. Over the past year, the group has partnered with Abbott to incorporate the EnSite NavX mapping system into 2 clinical trials evaluating PFA technologies, among others. Recognizing the transformative impact of PFA on contemporary practice, the team intentionally designed the new EP laboratories to anticipate future developments. NavX is now available in all 6 operating AdventHealth EP labs.
The group places a strong emphasis on fluoroless ablation and workflow optimization. Because modern EP procedures rely primarily on mapping, AdventHealth Littleton prioritized mapping system resources during lab design. The group is recognized as a leader in fluoroless PFA, with anticipated further research forthcoming in this area. Each lab is equipped with 2 booms to accommodate multiple electroanatomic mapping software systems instead of additional fluoroscopy systems.
The rooms are substantially larger than the previous lab spaces—approximately double in size—allowing for the anticipated need of anesthesia teams, intracardiac echocardiography (ICE) consoles, and PFA consoles. This expanded footprint reflects the growing demand for EP services.
With this emphasis on advanced mapping and cutting-edge technology, AdventHealth Littleton became the first center in the region to offer the Affera Mapping and Ablation System (Medtronic) and the Volt PFA ablation system (Abbott). Because different mapping platforms offer distinct advantages, the group has adopted multiple technologies. Since the Farapulse PFA System (Boston Scientific) became the group’s primary technology after PFA transformed the ablation landscape in 2024, the team has also adopted the OPAL HDx Mapping System (Boston Scientific).
Staffing and Training
Many of the existing EP nurses and technicians from AdventHealth Porter were enthusiastic about helping to grow the new program at Littleton and joined the staff there. Former lab technicians and nurses from nearby hospitals were eager to learn new systems at Littleton, and several familiar faces brought valuable expertise that eased the transition to the new lab. For team members new to EP, cross-training across both hospitals ensured a highly skilled and cohesive EP workforce.
Establishing a dedicated EP lab staff was advantageous because it eliminated STEMI call responsibilities and ensured that all team members were fully prepared for complex EP cases.
Not Just Ablation
The expansion of AF treatment has led to growth not only in ablation procedures but also in left atrial appendage occlusion (LAAO). Reflecting national trends of increasing AF ablation volume, the LAAO volume at South Denver Cardiology has more than doubled in the past year.
The group anticipates continued participation in clinical trials evaluating LAAO technologies, as incorporation of LAAO into the ablation strategy has become increasingly important. Electrophysiologists Nicholas Palmeri, MD, and Henry Zheng, MD—both Colorado natives who returned to practice in their home state—have been instrumental in advancing concomitant AF ablation and LAAO. The EP team leads the region in LAAO implantation volume, particularly for procedures performed concomitantly with ablation, which have been available at AdventHealth Littleton since its opening.
A dedicated pre- and post-anesthesia care unit supports same-day discharge for eligible LAAO patients. The EP labs were intentionally sized to easily accommodate cardiac anesthesia and transesophageal echocardiography, although ICE-guided LAAO is also performed in appropriate candidates.
Device technologies also continue to evolve, particularly in the area of leadless pacing. Drs Sundaram and Choe participated in early clinical trials of the NanoStim device (Abbott), which later developed into the AVEIR leadless pacemaker (Abbott). South Denver Cardiology was recently selected as a study site for a novel Biotronik leadless pacemaker, with Dr Sundaram and Dr Palmeri as investigators. While leadless pacemakers offer an efficient and effective pacing solution for selected patients, traditional transvenous systems remain the most commonly used. Within the group, Jehu Mathew, MD, leads efforts focused on device therapies. Drs Sundaram, Choe, and Alyesh also participated in the much-anticipated Left vs Left trial, with results expected in 2027.
The group is fully equipped to perform lead extraction for patients with lead-related complications or infections. The laser lead extraction program was established at AdventHealth Littleton in December 2023, with Dr Palmeri serving as the primary extractor. Device implantation had been performed at AdventHealth Littleton for several years prior to construction of the tower. A laser generator was already available for other procedures, making the site a natural choice for extraction given the immediate availability of cardiac surgical backup. Over the past 2 years, the group has performed more than 30 extractions annually, including many involving long-standing and complex system configurations. A dedicated hybrid operating room supports these procedures with the necessary equipment and specialized staff.
Advancing the Field
The mission of South Denver Cardiology is to provide world-class cardiac care while advancing the field of cardiovascular medicine. This commitment is reflected in continued participation in device trials, LAAO studies, and multiple studies within the ablation space.
The partnership between South Denver Cardiology and AdventHealth has already generated new data to advance the field of EP. Expanding the program to AdventHealth Littleton has created additional opportunities for continued innovation and growth. The next phase of development includes opening the fourth EP lab, with 2 additional shell spaces already designated for future use. Given the rapid growth of both the Denver metropolitan area and the practice itself, these labs are expected to become operational within the next year or so. The future of the EP program at AdventHealth Littleton remains strong and promising.
Disclosures: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Palmeri reports consulting fees from Biotronik and Abbott, and honorarium from Boston Scientific for a presentation; Dr. Sundaram reports serving as a consultant for Medtronic, Abbott, and Boston Scientific and receiving payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events.
