10-Minute Interview: Kamran Toluie, MD, Director of Cardiac Electrophysiology, Kaiser Permanente Los Angeles Medical Center

What were your reasons for choosing Kaiser Permanente Los Angeles Medical Center? What excites you about the EP program there? Kaiser Permanente is the nation's largest nonprofit health plan. It operates 11 hospitals in southern California. Its Los Angeles Medical Center is the organization's only tertiary care center for electrophysiology procedures and device implants in all of southern California except for San Diego. This means a population coverage of about three million. The Los Angeles Medical Center also has very active ACGME approved internal medicine, cardiology and interventional cardiology fellowship programs, as well as other subspecialties. When I interviewed for the directorship of the EP department at Kaiser Permanente, many complicated ablations including atrial fibrillation ablations were referred to outside institutions. Historically, almost all devices were implanted by cardiothoracic surgeons with the help of EP physicians performing ICD testing during the implants. The prospect of starting an electrophysiology fellowship program that provided a high volume of all aspects of EP, including different approaches to atrial fibrillation and VT ablations as well as device implants, was an opportunity I couldn't turn down. We also have a lot of friends and family in the Los Angeles area that makes this transition easier. I can t complain about the southern California weather either! What are some of the EP procedures performed at Kaiser? Describe the volume of EP procedures peformed there. In the last six months about 500 devices (pacers, ICDs and BiVs) have been implanted at our center, and the number of ICDs and BiVs are increasing on a daily basis. Also, more than 600 electrophysiology procedures were performed at Kaiser Permanente's Los Angeles Medical Center last year. We will be performing all aspects of EP, including atrial fibrillation ablations and device implants in the electrophysiology department; we are currently in the process of this transition. What are some of the improvements you hope to see while at Kaiser? We are progressing very quickly. With the help of my colleagues and administration at the Los Angeles Medical Center, we have already upgraded our Biosense system to the XP version, and we are the first institution in the western US to have the capability of image integration with the CARTOSYNC system. This will allow us to to synchronize and compare CT images to electronatomical 3D images for pulmonary vein isolation or left atrial circular lesions. We also purchased the next software enhancement which allows integration of CT/MRI images with the Biosense map. The continuous fluoro upgrade to pulsed fluoro is almost complete. The lab is also equipped with the most current version of Acuson intracardiac echocardiography. All of the complicated ablations, including atrial fibrillation ablations and mappable as well as unmappable VTs will be performed locally. Also, we are in the process of gradual transfer of device implants from the CT surgery department to the EP department, and will be actively recruiting electrophysiologists to our team of three board-certified electrophysiologists. Kaiser Permanente is also in the middle of building a new hospital adjacent to our current location that will be completed in 2006. We are considering two biplane labs and noncontact mapping with an Ensite system, in addition to Carto XP and intracardiac echocardiography. Is Kaiser currently involved in any clinical trials or research projects? Considering that the Los Angeles Medical Center is a teaching institution, active research is also an inherent part of the organization. Kaiser Permanente's Southern California IRB has more than 600 active research protocols. On average, more than 100 active research protocols are being monitored by the IRB every month at the Los Angeles Medical Center alone. These include national as well as in-house studies. In your opinion, what are some of the most exciting developments in EP in the past year? The technique of atrial fibrillation ablation is changing very rapidly and is being done much faster, with much less radiation exposure and higher success rates. Currently, in experienced hands, it can be done under three hours; this process will only improve in the next few years. The results of the Companion and SCD-Heft trials will also be included in the current guidelines, resulting in further significant need for electrophysiologists and supporting staff. The availability of different tools in cardiac resynchronization including the leads also has significantly reduced the procedure time and increased implant success rates.