In this month’s interview we speak with Dr. Rothfeld, an electrophysiologist with Bradenton Cardiology Center as well as the Director of the EP lab at Manatee Memorial Hospital in Bradenton, Florida. Tell us about your medical background and how you came to work in the field of electrophysiology. What interested you about this field? I graduated from medical school from The Johns Hopkins University School of Medicine in 1990 and then went to the University of Vermont for Internal Medicine residency. While there, I had significant exposure to the Cardiology Department and knew I had found my field of interest. As time went by, I realized that EP provided a good mix of hands-on procedures and longitudinal care as well as a nice variety of patients. Describe your role as the Director of the EP lab at Manatee Memorial Hospital. What is a typical day like for you? As director, I meet on a regular basis with the staff and lab manager to discuss issues as they arise. I have an active office practice in EP, and do some general cardiology cases as well. What is one of the more unique EP cases that you have worked on? A 52-year-old female with long-standing vasodepressor syncope and permanent pacemaker (PPM) placement presented with a recurrent case of syncope. PPM interrogation showed a high V-rate episode. During an EP study, she was found to have AVNRT and underwent slow pathway ablation. Shortly afterward, she had recurrent episodes of syncope with intracardiac electrograms showing ventricular tachycardia. Cardiac catheterization was normal, with normal LV function. Repeat EPS was negative, and she then underwent placement of an ICD. In retrospect, I believe the AVNRT was a red herring. There is still no clear explanation for her VT, although she has improved on antiarrhythmic therapy. What aspects of your job are most challenging? The greatest challenge is trying to sort out which is the correct approach to treat each individual patient, particularly in regard to treating atrial fibrillation. It is not always clear which patient should have attempts at rhythm control versus rate control. This is especially problematic in our state of Florida, where the population is both elderly but also quite active. What advancements do you hope to see in the field of cardiac electrophysiology in the next decade? I hope to see more advancement in the field of pacing and ICDs, particularly with refinement of patient selection for prophylactic ICD placement and biventricular pacing, even in patients with normal left ventricular function. What is the best advice you have received so far in your medical career? The challenge in medicine is not in knowing the right thing to do; it is in getting yourself to do the right thing, regardless of how difficult or inconvenient that may be. What motivates you to continue working in EP? What techniques do you use to keep morale high during stressful moments in the lab? I enjoy the challenges that arise in trying to do a good job for the patient. During times of stress, I try to focus on the task at hand. I am also very quick to put my ego aside and ask for help from others. It is human nature to be defensive, and at times, in denial of an obviously straightforward diagnosis, something can be ignored, such as a perforation. Involving a third party who is not as emotionally invested can be helpful. Has anyone in particular been helpful to you during your career in EP? The most influential physician in my career has been Mark Capeless at the University of Vermont. He is the finest physician I have ever met.