10-Minute Interview With T. David Gbadebo, MD, FACC

I became interested in EP during my residency at Case Western Reserve University Hospitals of Cleveland. It was a unique opportunity to train at a program with such an established reputation in the field, and to become exposed to leaders in the field, such as Dr. Albert Waldo, who became my first mentor. EP offers a high level of excitement in cognitive challenges, in diagnostic and therapeutic opportunities, and in performing surgeries. EP is perhaps unique to the field of cardiology, as the only area where we can often permanently cure problems of arrhythmias. I never seriously considered any other field besides cardiology well maybe nephrology! I see interesting cases about every week. This week I consulted on a patient who was post-CABG for a possible pacemaker need. This patient was reported with very long first degree AV block, and intermittent atrial fibrillation/supraventricular tachycardia. It turned out this patient had AVNRT, and we were able to successfully treat his arrhythmia with a slow pathway ablation. It was special lesson to our lab staff and residents in being careful about jumping to conclusions and not missing the subtle elements. We have various research projects in the works. The newest one we were just selected for is the master study. This study is co-sponsored by Medtronic and by Cambridge Heart (the manufacturer of the T-wave alternans device, a non-invasive risk assessment device for ventricular arrhythmias/sudden cardiac death). The study is aimed at further delineating the MADIT II Type patients at risk. We are excited about the potential utility and benefits this study may add to our patient care. The biggest developments are perhaps cardiac resynchronization therapy for CHF patients, the opportunity to map and ablate ischemic ventricular tachycardia in patients with ICDs shocks refractory to anti-arrhythmic therapy, and the active area of catheter-based intervention for atrial fibrillation. I believe that we will have less justification and aggressiveness to get near the pulmonary veins, as more potent and atria-specific drugs become available for management of atrial fibrillation. No doubt some choice patients will remain prime candidates for pulmonary vein isolation, but the numbers will be far less than it is applied now. Ours is the struggle between getting procedures done in an efficient manner in order to get patients home quicker, balanced with the quality of life of the EP lab staff who often put in long hours daily. In this pressured practice climate, we have to care for ourselves and our staff as well. I believe that special sessions at NASPE and the ACC meetings address some of this need. Several device companies also have programs aimed to introduce new products. The more the better.