In this month’s “10-Minute Interview”, Dr. James McClelland describes his background in electrophysiology. Sacred Heart Medical Center, a 432-bed hospital, is the largest between Portland, Oregon and San Francisco, California.

Figure 1.

Dr. McClelland.

Please describe your medical background and education. Why did you choose to work in the field of electrophysiology?
       I did my medical training at the University of Connecticut, Temple University, Oregon Health Sciences University, and Duke. In 1990, I joined the faculty at the University of Oklahoma to work with Sonny Jackman, Karen Beckman, Ralph Lazzara, Ben Scherlag, and others. In 1997, I came here to Eugene to join a private practice.
       I chose electrophysiology mostly because of the people I met along the way, such as Chuck Walance, Joel Cutler, Jack Kron, and Jack McAnulty. However, I also chose it because catheter ablation was just becoming clinically relevant at the time, and it is fascinating — it’s always like a puzzle or a brainteaser, trying to figure out the best way to investigate and then ablate the arrhythmia. Except, of course, the anatomic methods of AF ablation, which don’t have much of that.

What has been your most rewarding experience in practicing medicine as of yet?
       The most rewarding things I've done in medicine would probably include the early years at the University of Oklahoma. It was great to work with Sonny [Jackman] and the others, especially in the early days. He had lots of ideas and was always way ahead of the curve. Quite a few of the techniques and equipment that we still use today were developed then, and it was exciting to be around.
       Since then, I have had a lot of fun doing some other things, such as helping to organize the Northwest EP Society meetings. I've recently been appointed to a position at our hospital which will allow me to work on some patient care issues that I’ve thought to be important, such as developing a system to increase the percent of people in our region who are appropriately anticoagulated for atrial fibrillation. We’ve recently given some thought to performing standard ablations in the outpatient free-standing lab setting, which could be done safely and with a better patient experience, at lower cost to the healthcare system.
       Most recently, the best thing has been training people in our lab to suture, insert venous sheaths, and manipulate catheters. It’s very satisfying to see how much they enjoy that, and to see the progress. In addition, it’s fun to teach. It is also a major advance for the lab — they were already deeply engaged in the cases, but are even more engaged now.

Are you currently involved in any cardiology or electrophysiology clinical trials?
       Our group has a dedicated clinical trial department. We are involved in about 10 trials, about five of which have to do with EP.

What is your best piece of advice to give to others in the field of electrophysiology?
       Surround yourself with good people and treat them well, and almost everything else will follow.

What technology and/or procedures in EP do you find most promising?
       Well, of course, routine catheter ablation of atrial fibrillation has been just around the corner for many years now. We did our first here in February of 1999, when we began putting tiny Cardima catheters out the pulmonary veins and ablated “triggers.” However, this field is still very much in flux, and after we became aware of reports of a new serious complication, we stopped doing the “wide-area circumferential” or “Pappone” technique this spring. Perhaps a minimally invasive surgical procedure such as primary therapy for atrial fibrillation, followed by “touching things up” (perhaps ablating the autonomic ganglia?) endocardially by electrophysiologists is the future of AF ablation.