Dr. Skipitaris is the Director of Cardiac Electrophysiology and the Heart Rhythm Center at Lenox Hill Hospital in New York. In this interview he speaks with the Administrative Director of Cardiovascular Services, Rakesh Budhu, MS, RCES, RCIS, CRTT.
I always knew that I wanted to be a cardiologist, even during medical school. On the simplest level, I think that it was because I had a background in music (I was an a cappella singer in college), and I liked using a stethoscope to listen to heart sounds. Beyond that, the breadth and depth of cardiovascular diseases and the diagnostic and therapeutic modalities that were available to confirm and treat a cardiac illness excited me. I started my cardiology fellowship wanting to be an interventionist. In my second year, I even had an interventional training position lined up for the third year of my fellowship. I then did two months, back to back, of an EP rotation and it changed my whole perspective. The intellectual and diagnostic challenges, the technology, the procedures, and the ability to actually cure patients of their arrhythmia problem through ablation made me re-think the course that I was going to take. Fortunately, I was able to get a great training position in a growing program without losing any time. I wound up doing two dedicated years of EP training in the third and fourth year of my cardiology training, and here we are.
Describe your work as the Director of Cardiac EP and the Heart Rhythm Center at Lenox Hill Hospital. What is a typical day or week like for you?
Most days consist of patient care, electrophysiology procedures, and directing the high-level administrative operations associated with running an electrophysiology program in Manhattan, New York, which is a very competitive environment. Though challenging, I enjoy juggling a very busy clinical practice — both in and out of the laboratory and hospital — teaching and growing our EP program. Administratively, there are always meetings and presentations to attend — somehow all of this fits into the schedule of the day, and things get done. I am fortunate to have a fantastic and very capable staff of office-based administrative and medical assistants, EP lab nurses, nurse practitioners, physician assistants, and two EP physician colleagues. I have worked with and handpicked many of these people over the years, and our loyalties and commitment to each other and to our “EP mission” runs deep. I believe in leading by example, so I know that if I am working hard, I can expect others on the team to do so as well. I think that people respect and respond positively to this. I also think that it is important to trust and incorporate the opinions and experience of the staff to make everything run better. I think that the program and the quality of care that we deliver is better because everyone feels responsible, vested, if you will, in the enterprise. Finally, we try to have fun together — I think that comes from being proud of the good work that we’re doing.
Describe one of the more memorable EP cases that you have been involved in.
There have been countless, satisfying cases over my career. It’s always terrific to figure out a complex arrhythmia mechanism in the lab, and then successfully ablate it after many hours of patience and meticulous work. I remember a lot of those, even going back to EP fellowship years ago. However, the thing that makes a case “memorable” is the patient story that goes with that procedure — that is what makes the difference. Here is an example: I have a patient with an ischemic cardiomyopathy and an ICD who loves to do Greek dancing, but every time he would “overdo it,” he would experience ventricular tachycardia (VT) and get a shock. We tried various medications but were limited by side effects. He had a long and complex but successful VT ablation, and it changed his life! He recently danced at his daughter’s wedding and was thrilled to tell me about it. This is the kind of thing that keeps me going back for more.
What aspects of your work do you find most rewarding? What motivates you to continue your work in the EP lab?
I thrive on the patient-doctor relationship and the unique opportunity I have as a physician to make a significant impact in a person’s life. This can happen in the clinic or in the lab. I believe like most electrophysiologists, I like being in the lab and doing procedures most of all. However, in my position as director of the EP program, I’m also responsible for overseeing and guiding the implementation of new policies and procedures in our EP program. I enjoy working with the staff and my colleagues, developing best practices, improving the operations of our department, seeing the results of our labors improve the patient experience and outcomes, and watching our program grow.
Tell us about your research or outside interests.
We are involved in various device trials and have submitted a protocol for evaluating interventional treatment options for persistent atrial fibrillation. I have a particular interest in prevention of out-of-hospital cardiac arrest through education and public access defibrillation programs.
What advances do you think will be seen in the cardiac electrophysiology field in 2015?
I think that the use of remote monitoring of arrhythmias and other physiologic parameters will continue to change the way we understand and manage atrial fibrillation and sudden cardiac arrest.
What advice would you give to others in EP who are currently at the start of their medical career?
It is not easy being a physician these days, particularly in this health care environment, but it is rewarding. Do it because you love it and enjoy the challenge of EP.
What medical textbooks or online EP resources do you recommend?
Of course, Josephson and Zipes are the classics, but the availability of PubMed or similar search engines on virtually any computer, with easy access to primary resources/literature and the most current information, well before being published in the textbooks, makes that an invaluable resource.
Is there anything else you’d like to add?
Over the last few years, I have devoted a significant amount of time in community outreach to educate the public about sudden cardiac arrest and to teach CPR and AED use. I have also been involved in programs that have screened more than 4000 children and young adults for syndromes associated with SCA, using that opportunity to educate and teach CPR/AED use to the participants and their families. I was honored and recognized for this work, having recently been awarded a 2014 American Heart Association Heartsaver Award at the New York Chapter Annual Heart Gala and a Life Saver Award from the Dominic A. Murray 21 Memorial Foundation, Inc. Through organized volunteerism and education, I think that we can make a difference in the survival rates of sudden cardiac arrest.■