10-Minute Interview: Dan Dan, MD

How did you get into the field of cardiac electrophysiology (EP)? I have always been interested in the study of cardiac arrhythmias. It is a challenging and fascinating field. It can also be rewarding since only in this field can one actually cure a cardiac condition. After finishing medical school in Romania, I did an internal medicine residency, before leaving the country for political reasons. The years of training there were very patient-oriented, and helped me develop clinical skills in absence of advanced technology. During my cardiology fellowship, I worked with Dr. Blair Grubb, who helped me understand more about electrophysiology. Later I decided to do a formal EP fellowship in Virginia with Dr. Kenneth Ellenbogen. Tell us about your roles as electrophysiologist at Cardiovascular Disease Specialists and as co-director of Cardiovascular Research at Piedmont Hospital s Fuqua Cardiac Center. What is a typical work day like for you? I work primarily with patients having rhythm problems. I see referrals from within my group (of over 20 cardiologists) or from other groups. I meet with the research coordinators on almost a daily basis to review a particular patient s case or data from a clinical study. A typical day starts with a 1-hour swim, then taking the kids to school. At about 7:45 am, the phone starts ringing this is about the time that the EP lab generally starts their day. At 8:00 am I begin the first case. On average, I perform approximately two ablations and one device implant per day. I also have three half days of clinic, and luckily, my office is conveniently located very close to the EP lab. Between cases I meet with the research coordinator, discuss with families, call referring physicians, help out in the hospital, read or have a conference call. It is not a structured day. One has to be fluid but with a purpose that of maximum efficiency and quality. What are some of the daily challenges you encounter in the lab? We experience two kinds of challenges: technical-related and patient-related challenges. Some of the hardest cases are when the two coexist. One such example might be a patient with chronic atrial fibrillation and an enlarged atrium who is undergoing a left atrial ablation. Other cases that can also be very challenging are due to a lack of appropriate technologies needed for an efficient job and the difficult anatomy encountered in a particular patient. Describe a patient case that was particularly challenging or memorable for you. We had a young female patient who had been plagued by frequent atrial tachycardia episodes for several years. I did an EPS, and using standard catheters, the early activation appeared to be at the interatrial septum. I used an EnSite Array mapping catheter (St. Jude Medical), and attempted ablation at the right septum. We had a couple of late breaks of tachycardia, but I was not happy with the result. Unfortunately, by the time I used the Array catheter, the patient was already fully anticoagulated and I could not map the left atrium that day. Within two weeks, the patient had a recurrence. At the second EPS, I mapped the left side immediately following the transseptal puncture. With an 8 mm cryoabation catheter, I terminated the tachycardia during the first lesion. The patient has been arrhythmia-free for three months now. How often are cryoablation therapies utilized at Piedmont? What has been your success rate with cryo? We use cryo so often now, that there is rarely a case in which we don t utilize cryo! There are four ablationists at Piedmont, and we all use it for most of our cases. I venture to say that we use it even twice a day. Success has been similar with radiofrequency (RF), but RF does not come with the peace of mind that you get with cryo. Have you been involved in any cases in which cryo was used to successfully ablate an arrhythmia that was previously attempted with radiofrequency? I have been referred a number of patients with septal atrial tachycardia who failed RF ablation. There were also two patients with Wolff-Parkinson-White Syndrome and failed ablations in the coronary sinus. Cryo use in these instances proved to be both effective and safe. What advice can you offer for those just starting out in the field of EP? Keep asking questions, and keep your enthusiasm as high as it was when you started your training. EP is a difficult specialty to study, and you have to love it in order to do it for a long time. Are you currently involved in any clinical trials at Piedmont Hospital? Please describe. We have a very active research center in EP, cardiology, and prevention of heart-related illnesses. We are involved in a number of ablation trials as well as device trials. Among the most interesting trials we participate in are those dealing with atrial fibrillation interventional treatment. We are actively enrolling patients in ablation trials for symptomatic paroxysmal and persistent AF patients. These trials use very new, state-of-the-art technology that are very likely to change future AF treatment. For example, the STOP AF clinical trial uses a cryoablation balloon system that can deliver freezing temperature at points in the left atrium in patients with paroxysmal atrial fibrillation. The method is associated with great success and safety. What advances do you hope to see in cardiac electrophysiology in the next decade? I hope to see more technological integration, including mapping systems integrated with imaging modalities and smart catheters that can deliver therapies and give feedback.