Tell us about your medical background and how you came to work in the field of electrophysiology. What interested you about this field?
My initial career interest was in engineering — medicine was, at first, an afterthought. I was fortunate to be admitted to a program at Northwestern University that assured me admission to their medical school after three years of engineering undergraduate education. I took the opportunity and didn’t regret it. I was surprised how much I enjoyed the human aspects of medicine, but still missed the problem-solving component of engineering. ECG interpretation drew me back into this type of thinking, and the field of cardiac electrophysiology was a natural move after that. The learning curve in EP is really steep, and I enjoyed the challenge.
Describe your position as Director of Cardiac Electrophysiology. What is a typical day like for you?
We’ve got a great organization here at The Christ Hospital, and this allows me to be predominantly a clinician. I spend most of my working days taking care of patients. When purchasing contracts roll around or we need to organize new programs, my administrative responsibilities increase significantly. It’s my job to keep my eye on the future and work on strategic planning. I also need to attend my share of meetings, of course.
What is one of the more memorable EP cases that you have worked on?
In 15 years here, I’ve seen a lot. For example, my first ablation comes to mind. We found an epicardial posteroseptal accessory pathway and ablated it from within the coronary sinus. Back in 1997, that was a pretty big deal, and no one here had ever seen that done before. I’ve still got the electrograms hanging up in my office. Another important case occurred a few years later. We were very early in our experience with CRT, and I was asked to do a biventricular pacemaker upgrade on a favorite patient. All eyes were on me and, of course, it was a very difficult case. Long story short, after about six hours, we successfully completed the procedure and the patient did extremely well. I think those two cases were very important in establishing my confidence and local reputation.
Tell us about your involvement in some “firsts” in electrophysiology, including implantations of the world’s first bipolar transvenous left ventricular pacing lead and first pressure-sensing ICD.
The Lindner Research Center here at Christ has allowed me to participate in a lot of great clinical EP research. Dean Kereiakes, our director, has built a nimble organization that can take on projects and generate data efficiently. There have been a couple of times that we’ve been able to get our projects ready quickly enough to be first in the world. I implanted the world’s first Medtronic 4194 LV pacing lead and the world’s first investigational Chronicle ICD. We had to hustle to get those cases scheduled and done, or we’d get beaten to the punch by someone else. We’ve performed many local and regional firsts as well. I think our whole organization is drawn to new technology, but we try to use it responsibly.
What aspects of your work do you find most rewarding?
As much as I enjoy completing tough cases in the lab, nothing beats the thrill of seeing a happy CRT responder on their first visit back to the office. Once I had a patient literally shout at me down the hall when he saw me from a distance. When he got up close, he gave me a giant bear hug. That really felt good. I’m still amazed that biventricular pacing works as well as it does, and that fact drives me in the lab.
Discuss your work in new medical device design and clinical research.
If you’re a doctor with an engineering bent and specialty interest in devices, you really have to partner with industry to get anything done. I don’t think anyone is designing pacers independently in their garages anymore. We’ve been proud and transparent in our relations with industry. I’ve been fortunate to consult in the planning stages of several devices that we use today. Talking with smart industry engineers is one of the most rewarding things I do. These relations have also allowed us to be strong participants in many industry trials (including a few whose ideas originated at our institution). It’s great to be able to get this advanced technology back to our patients here in Cincinnati.
Tell us about your experience using Twitter. For example, when did you create the Twitter feed at twitter.com/EJSMD, and why? What have been some of the challenges?
Most EPs are techies, and I’m certainly no exception. I’ve know about Twitter for years, but didn’t really see how it might fit into my life. Wes Fisher, an EP in Evanston, Illinois, is an old friend and pioneer in cardiology blogging (drwes.blogspot.com). Wes published a guide to Twitter on his blog, and so I decided to give it a try about a year ago. It’s really hard to articulate what’s great about Twitter. Most folks look at you like you’re weird when you talk about it. I like how easily you can make an impact to a broad audience. I’ve enjoyed meaningful dialogues with prominent cardiologists, industry people and journalists through this medium. It’s very easy to stay current in the field as the pace of information flow is striking. I think I really saw Twitter’s power firsthand when I live tweeted the discussions at the Riata ICD Lead Summit in January. My tweets were widely cited, and a summary I wrote got picked up by Forbes.com.
What advancements do you hope to see in the field of cardiac electrophysiology in the next five years? What specific areas of EP and/or patient care need more attention?
I have to say that after reading Eric Topol’s new book, The Creative Destruction of Medicine, I’m really intrigued by the future of personalized medicine. We’ve really got to find a way to target our therapies more effectively to those who stand the most to benefit. In addition, I think our ability to wirelessly monitor these patients will continue to improve and become a routine part of care delivery. I’m amazed how much real health care I can now deliver from my desk through review of device data. This power can only grow further. We’ve got to find a way to make all of this affordable, though.
What advice would you give to others in EP who are currently at the start of their career?
Focus on the patient first — everything else is secondary. Make it your personal mission to provide high-quality care to everyone, and don’t let anything make you waver from this mission. Work hard at developing your own skills, so you can be proud of the care you deliver. Don’t spend money foolishly. If you can deliver great care cheaply, do this. Make sure everything you, your patient, or your hospital buys is a good value.
Has anyone in particular been helpful to you in your growth as an electrophysiologist?
I have a very selective personal “Hall of Fame” for these folks. Early in my training at the University of Pittsburgh, Bill Follansbee and Ali Mehdirad were major influences. At Cleveland Clinic, Pat Tchou, Greg Kidwell, and Bruce Wilkoff taught me most of what I know today. Here in Cincinnati, my partner Ted Waller has taught me how to function in the private practice system with grace and skill. Dean Kereiakes has also given me a platform to work upon and supported me greatly. I look up to all of these folks and they have my gratitude.