Arrhythmias of the Heart: Two Cases

Interview with Bobby Smith, MD

Describe your background in electrophysiology. I am currently located at Piedmont Hospital in Atlanta, Georgia. It is one of five hospitals in town that have full-time dedicated electrophysiology services. We were the fourth hospital in Atlanta with an electrophysiology service when I arrived here; mine was one of the first two full-time electrophysiology practices that Piedmont Hospital had beginning in August 1994. I got into electrophysiology entirely accidentally. I completed my internal medicine residency training at the University of Tennessee; at the time, the cardiology fellowship program had been filled for when I would have been finishing my medicine residency. However, one of the cardiology fellows was offered the position of chief resident, and deferred her cardiology fellowship for a year. Therefore, there was a slot open. I got a telephone call at home on a Friday evening from the division attendings. They were discussing their dilemma, and my name had come up. I had to be allowed to think about it over the weekend, and then interviewed with four cardiologists the following Monday and Tuesday. I told them that based on the reading I had done as an intern and resident on the subject of electrophysiology, I thought I wanted to practice the subspecialty. I was actively discouraged from even considering it, on the expectation that EP was something that no one would ever be able to do in full-time private clinical practice. I kept that in my mind, but still entered the cardiology fellowship thinking that this was what I wanted to do. When the first month of my cardiology fellowship was actually spent in an electrophysiology lab, that sealed the deal. It was in 1986 when I started the cardiology fellowship. At that time, there were few electrophysiology programs in the country. Most of the ones that did exist were only taking fellows from within their own program. I trained at Case Western University under Albert Waldo, MD at the University Hospitals of Cleveland. I spent two years on the medical school faculty at the University of Kentucky, then went back to Memphis, Tennessee for three years. I came to Atlanta to start this practice in 1994. When the Fuqua Heart Center of Atlanta at Piedmont Hospital opened in January 1994, an electrophysiology laboratory had been planned and built, even though at the time there was no electrophysiologist with a full-time commitment to developing an electrophysiology practice at Piedmont. I was leaving my job in Memphis and was interviewing when I got a call from someone in the pacemaker/defibrillator industry who had gotten involved with my case. He said there was a job in Atlanta that I had to take. The next evening, I was on the telephone with one of the founding members of our practice. Fifteen minutes after I arrived at this hospital, I knew it was where I needed to be. I came here in August 1994 as the first to have a full-time dedicated electrophysiology practice at Piedmont. Another electrophysiologist, Thomas Deering, MD, who is the co-director of the lab with me, was working predominantly at another local hospital when his group moved its practice here. Within two years, his electrophysiology practice was full-time dedicated to Piedmont Hospital as well. That was the genesis of the program. Piedmont Hospital s generosity has been unlimited. Before I arrived here, they asked me for a wish list; there was nothing that I asked for that I didn t get. We were off to that kind of start, and there has been active and aggressive growth and expansion of our offerings since that time. Tell us about the two cases that took place during the Arrhythmias of the Heart webcast on July 20. Two procedures were performed. There are two large cardiology groups at Piedmont Hospital: one is Cardiology of Georgia, which is my group, and the other is Cardiac Disease Specialists, which includes Dr. Deering and Dr. Dan Dan. In one procedure, Dr. Dan implanted a dual-chamber implantable cardioverter-defibrillator in a patient with severe left ventricular dysfunction secondary to ischemic cardiomyopathy. It was a standard, straightforward dual-chamber defibrillator implant that ran very smoothly. The other procedure, performed by my partner, Joseph Poku, MD, was an electrophysiologic study and catheter ablation performed in a young woman with a long history of supraventricular tachycardia. The mechanistic diagnosis of her arrhythmia was atrioventricular reentry or accessory pathway tachycardia mediated by a concealed left-sided accessory pathway. The diagnostic study led to transeptal puncture and mitral annular mapping to localize and ablate the accessory pathway. Both procedures went very nicely. Is it true that the cases were done simultaneously? Yes. We had two immediately continguous labs, with a live microphone/earphone feed to me so that I knew what was going on in each room at all times. We went back and forth between rooms as the natural flow of things led us. How are the patients doing now? They are both doing perfectly well. They went home the next day. How did you become involved in this webcast? The hospital administration was looking for an innovative way to market and promote the electrophysiology section of cardiovascular services at Piedmont. It was guided by the public relations department; the first interviews were several months ago. Who is this webcast best geared towards? It was aimed at the general patient population. It was also aimed at anyone who might have curiosity about electrophysiological procedures, or knows someone who had one performed or who may have been evaluated for an arrhythmia or pacemaker or has symptoms suggestive of an arrhythmia. It might also be informative for people who were not aware that there was an EP program here. How many EP studies and implants does Piedmont Hospital perform annually, on average? Annual case volumes include approximately 200 EP studies per year, approximately 125 ablations per year, about 150 pacemaker implants per year, and about 550 ICD implants per year. Is there anything else you'd like to add? Piedmont Hospital is aggressively promoting further expansion of EP services. Presently we have four full-time electrophysiology practices. We expect to have four full-time EP rooms by the end of February 2006. Additionally, each of the cardiology groups anticipates adding another electrophysiologist starting in July 2006. Another interesting recent development is that the electrophysiology laboratory has been made administratively independent of the cardiac catheterization lab. For more information, please visit: www.piedmont.org www.or-live.com