Tell us about your medical background and how you came to work in the field of electrophysiology. What interested you about this field?
I attended medical school and residency at the University of Washington in Seattle. During residency I learned about EP, and when I applied to cardiology fellowship, I looked at programs that had established EP centers. I, like a lot of electrophysiologists who trained in Oregon, was inspired by Dr. John McAnulty, an electrophysiologist and the former chairman of cardiology at Oregon Health and Sciences University. He inspired us with his passion for electrophysiology.
Describe your work at PeaceHealth Southwest Heart and Vascular Clinic in Vancouver. What is a typical day like for you?
I worked as a solo electrophysiologist and am in the EP lab 2–3 days per week. Most of my work involves straightforward EP studies for SVT or atrial flutter (that is more commonly what we see). However, since August 2011 I have been performing pulmonary vein isolation procedures using Medtronic’s Arctic Front® cryoablation system with considerable success. I perform between 110–160 EP studies a year, and since early 2011 have been performing the majority of the cases using no fluoroscopy. We have learned to use EnSite NavX mapping (St. Jude Medical) so successfully that, even when we use fluoro, we require less than 10% of what we used even a year ago. I perform 2–3 EP studies, or several device implants, a day. The rest of a given day involves consults and seeing patients in clinic as time allows.
What is one of the more memorable EP cases that you have come across?
Two years ago we brought to the lab a 40-year-old woman who had had a successful ablation done for WPW in the early 1990s and had recurrence of documented SVT. Assuming it was her pathway back, we were surprised to find it was AVNRT. What was more challenging was that the slow pathway was only ablated after considerable time and effort, when I finally ablated in the roof of the coronary sinus with near-immediate success after several hours of effort.
What aspects of your work do you find most rewarding? What motivates you to continue your work in the EP lab?
Like every EP, I find most rewarding the knowledge that we can truly fix most rhythm problems. What motivates me is the speed with which the field is changing (for the better) and I am constantly learning.
Tell us about your research or outside interests.
I travel to Russia twice a year and work with colleagues in an EP lab, sharing ideas and teaching them. We work together speaking Russian.
What advancements do you think will be seen in cardiac electrophysiology in the next few years?
I believe the benefits of three-dimensional mapping will carry over into more aspects of our work, including device implantation. I see this an another important way to reduce exposure to fluoroscopy.
What advice would you give to others in EP who are currently at the start of their medical career?
Soon after leaving training, visit other centers to learn how to refine your skills at implanting devices and performing EP studies. We are all trained at centers with biases, and the sooner we learn new ways to work and to reduce fluoro use and complications, the better.
What medical textbooks or online EP resources do you recommend?
One of the best sources for current news in EP is the American College of Cardiology’s ACCEL CDs. One of the best reviews I have found was the Mayo Clinic’s EP board review, which can be purchased on DVD.