Why did you decide to become an electrophysiologist?
I took an unusual path to electrophysiology, completing a PhD before going to medical school. My goal was to be a research scientist. My area of interest was neurobiology, and my PhD thesis was “The Neurobiology of Heart Rate Control and Learning.” When I started a post doc, I realized a medical degree would help open up more opportunities for research, and offer more flexibility in my career. That’s what stimulated me to go to medical school, rather than the more typical, “I wanted to be a doctor since I was five years old.”
As I went through medical school, I planned a career in neurosciences. When it came time to do my clinical rotations, I just found cardiology to be more interesting, exciting, and innovative than neurology. There were great developments in cardiology at the time. So, I made the decision to do my post-graduate training, internship, and residency in internal medicine rather than neurology. There was no doubt about continuing a career in research, but it changed from neurophysiology to cardiac electrophysiology. With a cardiology fellowship, it then became logical that my clinical specialty be cardiac electrophysiology.
In your opinion, what has been the most interesting advancement in the field of electrophysiology in the last year?
It would be hard to restrict EP to a single advancement because it’s such a rapidly changing field. Certainly, the development of left atrial appendage closure devices, as well as the development of leadless pacemakers, has to rank near the top. In addition, the focus on how to optimize ablation therapy in the treatment of ventricular arrhythmias and the continuing evolution in our best treatment of atrial fibrillation are making their mark on patient care. Most of the great advances right now, clinically, are procedurally based, but we continue to make great progress with best practices even though this is less “glitzy.”
In the next few years, there are many more exciting goals that are actively being addressed. The Holy Grail we’ve been looking for for many years is the cure for atrial fibrillation with ablation-based therapy. And while we’re making many advances, we still have a long way to go. Another goal for the future will be multi-chamber leadless pacing systems with subcutaneous defibrillation, enabling us to pace either ventricle and the atrium, and defibrillate patients without ever having to put leads into the heart.
I think one of the beauties of this field is the synergies between technology and new research. Understanding mechanism leads to innovation and treatments that we never would have envisioned a decade ago. And those a decade ago wouldn’t have been envisioned two decades ago. That’s part of what is so much fun about this field.
What do you see as the biggest challenge facing all members today?
Our challenges may differ by geographies, but we are all being constrained by spiraling healthcare costs. There are so many things we’d like to do clinically, but with declining reimbursement it’s harder to justify some of the procedures or medical treatments.
The development of new technology gets hampered by those constraints, as well. The field of electrophysiology is a high-technology field. We tend to have a closer working relationship with industry than other fields of medicine. The pendulum has swung toward keeping physicians more at arm’s length with industry to avoid conflicts, bias and undue influence, which is important. But we have to avoid allowing that to become a barrier to continued collaboration, and achieving our common goals.
So certainly, the regulatory aspect of medicine has become more onerous. The costs of healthcare place constraints on us all. While these challenges may be limiting in some aspects, we are certainly not limited by new ideas, opportunities, or patients who can benefit from our therapies. It’s a never-ending stream of challenges and opportunities.
What would you tell a new HRS member is the culture of the society?
HRS is probably the largest family you’ll ever get to know. This is the largest meeting of its kind in the world. The culture, however, remains one of a very close-knit community. There is a casual and comfortable relationship among people, which is so clearly reflected in the interactive nature of the meeting. My fondest memories of HRS are always the one-on-one interactions, not any specific presentation I might have given, that just randomly happen during the meeting. There’s nothing formal or stuffy about HRS. Attendees, all of them our colleagues, are always so willing to engage, meet, and debate. This informal interaction, the ability to ask questions, discuss techniques, and get individual guidance, goes hand in hand with the formal didactic aspects of what we do in the field. HRS, for me, like it is for so many others, is my professional home.
Outside of medicine and EP, what are your hobbies and interests?
I’ve now been in Charleston, S.C., for more than 14 years. It’s a great place to live. My wife and I play tennis — for some fun and exercise — and love to spend time on our boat as we live on an island. Culturally, there’s the theater, and of course, world-class restaurants — I’m a bit of a foodie. I enjoy travel and look forward to that as part of my role with HRS over the next year. I’ve been very fortunate to see a lot of the world through my career in electrophysiology, and hope to see even more of it.