EP Lab Digest welcomes Dr. Bradfield to our editorial board! In this brief interview, we speak with him about his career in EP. Dr. Bradfield serves as the Assistant Professor of Medicine and Director of the Specialized Program for Ventricular Tachycardia at UCLA Cardiac Arrhythmia Center in Los Angeles, California.
Tell us about your medical background and how you came to work in the field of electrophysiology. What interested you about this field?
I went to medical school at Northwestern University, with residency at Cedars-Sinai Medical Center, cardiology fellowship at the West Los Angeles VA Medical Center/ Olive View-UCLA Medical Center, and clinical cardiac electrophysiology training at UCLA Medical Center.
I was drawn to EP for a number of reasons. It is one of the few subspecialties in internal medicine where, in many instances, patients can actually be cured of their condition. We have the privilege to help people deal with arrhythmias that drastically affect their quality of life and, in some cases, are life threatening.
Describe your work as the Director of the Specialized Program for Ventricular Tachycardia at UCLA Medical Center. What is a typical day like for you?
Most of my time is treating patients with ventricular tachycardias (VT) and PVCs. Most days, I am in the EP lab performing endocardial or combined epicardial/endocardial VT ablations. Many of these patients are very sick due to severely depressed ejection fractions (EF) and VT storm. Therefore, many of these cases consume an entire day in the lab and may require hemodynamic support with ECMO.
When I am not in the lab or clinic, I focus my time on research projects related to VT and PVC management, and teaching our fellows and residents.
Describe one of the more memorable cases in which you were involved.
We recently had a patient that was transferred to UCLA for incessant VT and recurrent cardiac arrest at an outside hospital. His EF was 10%, and he was deemed unsuitable for transplant. Therefore, we had to perform high-risk VT ablation on ECMO. The patient actually arrested with initiation of anesthesia, but we were able to get him on ECMO and proceed. The substrate was a challenging intraseptal scar that required bipolar ablation to control the VT. The patient was subsequently able to be weaned from ECMO, and was discharged. His EF has improved to 40%, and he has been VT-free for 8 months.
What aspects of your work do you find most rewarding? What aspects are most challenging?
I have the tremendous luxury of working in a great environment and with superb colleagues at the UCLA Cardiac Arrhythmia Center. Every day, we have a chance to help people and to advance the field — for that, I am grateful.
Choosing VT ablation as a career focus is a decision with many highs and lows. We have the opportunity to save lives, as in the case described earlier, but we also have to come to terms with procedural failures after doing everything we can during challenging 6- to 8-hour cases, in some instances. The ups and downs are worth it for the patients that we help, but it’s not without its rough days.
Tell us about your research interests.
My research is focused on VT and PVC mechanisms and management. We recently published a manuscript in Heart Rhythm demonstrating how circadian PVC variability predicts PVC inducibility and procedural outcomes at the time of PVC ablation. We have a follow-up manuscript in the works that we believe will build on this data and help cardiologists know which drugs that patients will respond to in an outpatient clinical setting. We think this data could significantly change the way we manage PVCs.
What advances do you think will be seen in the EP field in 2018?
It will be interesting to see how broadly His bundle pacing will be adopted in the community. As one of my colleagues said, “it makes pacing interesting again!”
What advice would you give to others in EP who are currently at the start of their medical career?
I always tell our fellows to make sure they are joining a group with a good mentor. No one can learn EP in 2 years of training. The biggest strides you will make as an electrophysiologist are in the first 5 years of practice. Without someone to discuss cases with, back you up when needed, and provide support, it is very difficult to reach your highest potential.
Has anyone in particular been helpful to you in your growth as an electrophysiologist? In addition, what medical textbooks or online EP resources have you utilized that you can recommend?
I was lucky to have trained at UCLA and to have shown enough potential to have been asked to stay on as faculty. When I first came to UCLA, I don’t believe I was the most impressive candidate on paper, and hadn’t yet published much, etc. However, Dr. Kalyanam Shivkumar and Dr. Noel Boyle had confidence in me, and helped me develop a distinct career path. With their support, I was able to become confident at complex ablation and develop my research skills. In reality, I continue to learn every day from the 10 full-time EPs in our group. We are constantly discussing cases and helping each other when challenges arise. It’s an environment that makes the UCLA Cardiac Arrhythmia Center unique.