Nilofar H. Islam, MD, FACC, CEPS is the Director of Electrophysiology at MidMichigan Medical Center - Midland in Midland, Michigan. MidMichigan Health recently announced a $57 million construction project, of which $30 million is dedicated to a new Heart and Vascular Center on the campus of MidMichigan Medical Center – Midland. In this brief interview, we learn more about this EP program and upcoming expansion.
Tell us about your EP program.
The MidMichigan EP laboratory first opened its doors in 2007, soon after the Heart and Vascular Program started at MidMichigan Health. I was the only electrophysiologist on staff at the time, and it was expected that the EP lab would see perhaps 100 device implants and 50 ablations per year. That first year, we did 300 cases! A decade later, there are about 300 ablations and 700 device implantations performed annually in the EP lab.
Our EP program has dedicated EP lab staff as well as some circulating cath lab staff. Our EP lab team consists of five nurses and radiation techs; certified nurse anesthetists are also present as part of the team. Electrophysiologist Dr. Opesanmi Esan joined our staff in 2012. As MidMichigan Health continues to grow very quickly, we are excited to welcome our third electrophysiology partner next summer.
A second fully functional EP lab is expected to open its doors in 2018, as the single lab is working beyond capacity. Cryoablation will be introduced with the inception of the second lab, expanding the available treatment options for our arrhythmia patients.
Describe your role in the EP lab. What is a typical day like?
A typical day in the lab starts with an atrial fibrillation (AF) ablation case. Usually, this is followed with additional ablations. In the afternoons, we continue with device implants. There are outpatient clinics in between the lab weeks. In a continuous fashion, we staff inpatient consults and make rounds with the EP dedicated nurse practitioners.
What technologies have recently been added to your EP program?
A complete laser lead extraction program was started in 2015. All devices and related leads can be extracted at MidMichigan. This is an area of growth I am particularly passionate about. Before this service was available, we had to refer our very sick patients. At times, they would experience delays as a consequence. However, we can now take care of these patients with the greatest needs in a safe, effective, and efficient manner that is close to home. This decreases the amount of travel and expense, as well as stress to our patients and their families.
The newest aspect to our EP program has been the addition of left atrial appendage (LAA) closure procedures. Closure of the LAA revolutionizes stroke management for our arrhythmia patients; the option of coming off long-term anticoagulation is life changing for our patients. This is a collaborative effort between our structural heart group, electrophysiology, and advanced imaging cardiologists. We have experienced great success with these cases since beginning the WATCHMAN (Boston Scientific) procedure in September 2017. At the current time, we have done over 20 WATCHMAN implants. Each case is unique, and presents an opportunity to learn something new.
Why did you choose to work in the field of cardiac electrophysiology? What interested you about EP?
Being a good physician means being a good diagnostician. Being a good surgeon is having good technical skills. As an electrophysiologist, you get to hone both of these skill sets. It is a little like being a good detective and collecting clues that will give you the answer, and then putting in the work to fix the problem.
What motivates you to continue your involvement with the EP lab?
The EP lab is a passion of mine. It is also an area of tremendous growth and innovation, and this keeps me motivated.
Tell us about the upcoming expansion.
MidMichigan Health is part of the University of Michigan Health System. MidMichigan Health is set to open up a new Heart and Vascular Center in 2019 as part of its commitment to excellence and its determination to be the leader in cardiovascular care in the area. This facility will be state of the art and bring all the different facets of cardiovascular care under one roof. Cardiology, structural heart diseases, electrophysiology, vascular surgery, and cardiothoracic surgery will be in one location, providing a streamlined experience for our patients. Cardiac rehabilitation and cardiovascular imaging services will also be in this location, making it easier for our patients to access. There will be a concierge available to help patients find their area of service.
What advice would you give to others in EP who are currently at the start of their career?
At the start of any career, there is clearly a learning curve. In electrophysiology, often the steepest part of the learning curve has to do with navigating the EP and cath lab relationship, which may be different from the one you are used to in fellowship training. It is important to build strong collaborative relationships that will serve you and your patients well. The same is true of building relationships with the new community you inhabit, including your referring partners and community physicians. A reputation is as important as any technical skill acquired in fellowship.
Any final thoughts?
I am very proud of our team here at MidMichigan Health — they understand electrophysiology concepts at an advanced level and are passionate about learning. My proudest moments are during ablations, when staff appreciate good sites for ablation and feel confident when a signal has been ablated, or when they provide their interpretation and analysis of an arrhythmia mechanism in a complex flutter or tachycardia case.
Look for their Spotlight Interview in an upcoming issue of EP Lab Digest!