10-Minute Interview: Matthew P. Latacha, MD

Tell us about your medical background and how you came to work in the field of electrophysiology. What interested you about this field?

I first became interested in electrophysiology as an undergraduate at Washington University in St. Louis. After my first year of college, I worked in a laboratory in the cardiovascular division, where my research mentor introduced me to clinical cardiology. I have always had a fondness for physics, and I particularly like conceptual disciplines. Electrophysiology was a natural fit for these interests, and it was at this time in my life that I realized that the relatively new, technologically advanced field of EP would be the perfect career for me. I went on to the University of Nebraska Medical Center for medical school, and then returned to Washington University for my residency as well as cardiology and EP fellowships. I then returned to Omaha to practice. During my training, the field of EP has advanced rapidly with expanding device indications, CRT, and increasingly complex ablations for atrial fibrillation and ischemic VT, and ever since my undergraduate years I could not see myself in any other field.

Describe your role as an electrophysiologist at Methodist Health. What is a typical day like for you?

I am one of three electrophysiologists in a large cardiology group that works at Methodist. We cover inpatient consultations and of course ablations and device implantations. I was hired to start a complex ablation program, and in particular, an atrial fibrillation ablation program. We generally do two or three ablations each week, and devices the rest of the time. My nursing and technical staff is incredible, and my EP partners are very talented electrophysiologists, which enabled us to get the ablation program at Methodist up and running in a fairly short amount of time.

What is one of the more unique EP cases that you have worked on?

One of the most interesting cases I have ever worked on was a post cardiac transplant patient with atrial flutter, a case that I worked on as a fellow. The flutter originated in the recipient’s atria, then broke through the suture line into the donor’s atria. We ablated the point where it broke through and were able to document the recipient’s atria in atrial flutter and the donor heart in sinus rhythm.

What aspects of your job are most rewarding?

One of the aspects of EP that I find the most rewarding is the fact that it often provides us with the opportunity to actually cure patients, particularly in regard to patients with SVT. The majority of cardiology and even internal medicine in general deals with treating chronic illness, but ablation offers the chance to cure. In addition, the patients who receive CRT and come back to the clinic to tell me how much better they feel is also a very rewarding experience.

What advancements do you hope to see in the field of cardiac electrophysiology in the next decade?

I hope that we will have a better understanding of persistent atrial fibrillation which will in turn help us tailor the lesion set, as well as avoid unnecessary and potentially dangerous or pro-arrhythmic lesions. I would also like to see us gain a better understanding of who is not an ablation candidate, and who may benefit from medication/ablation or endocardial/epicardial ablation hybrid procedures. In addition, though it is still very early in development, leadless pacing technology could potentially revolutionize device therapy.

What is the best advice you have received so far in your medical career?

Above all else, do no harm. I think that this fundamental truism of medicine, that seems so obvious, it is often overlooked. The ability to ablate arrhythmias, pace, and defibrillate carries great responsibility. It is important to have a thorough discussion of the risks of any procedure with patients, and what benefits they can expect. And before every case, I take my own “time out” and mentally think about all the potential complications and how to address them should one happen.

Tell us about building the atrial fibrillation program at your institution. What challenges did you face in creating the program?

Atrial fibrillation ablations were not being done at my institution before I started. I spent quite a bit of time educating the EP lab nurses and staff, as well as the nurses and staff on the floor and in my clinic regarding the theory behind AF ablations, the procedure itself, the post-procedural and outpatient care, as well as the potential complications. Fortunately, our institution has truly outstanding employees and our cases went smoothly from day one. In the cardiac ablation business, one frequently encounters challenging and unique situations, and having an attentive and dedicated lab staff that is always eager to learn is invaluable.

What motivates you to continue working in EP? What techniques do you use to keep morale high during stressful moments in the lab?

I love the pace in which the technology in EP moves, and thus provides us with tools to treat increasingly complex arrhythmias. Just since I started fellowship, CRT, AF ablation, and even epicardial ablation have all moved from difficult and only done at a few specialized centers to becoming safe and widespread. As far as morale is concerned, we have a group of people that truly enjoy working together in the lab. I like to keep things very informal during cases, and if anybody saw anything potentially dangerous, I would never want them to hesitate to speak up. I think a relaxed, casual atmosphere is conducive to this.

What methods or resources do you use to help educate and keep your staff up to date on new procedures and technology?

I like to do as much teaching as possible during cases, I think that explaining various pacing maneuvers, and going over electrograms, as well as explaining why I am doing things during cases is very valuable. I think that most people who work in an EP lab are interested in learning, and the more teaching one does, the more interested others are in the cases. I also like to go over journal articles with the lab staff as well, particularly articles with images or electrograms. In addition, the Heart Rhythm Society website has excellent teaching resources, especially their recorded presentations.

Has anyone in particular been helpful to you during your career in EP?

I have the honor of having so many people to thank for their help. I have to thank my first research mentor, Dr. Paul Eisenberg, who first got me interested in cardiology in general. My attendings at Washington University were all wonderful, and I will always be grateful to Drs. Faddis, Smith, Chen, Gleva, Lindsay, Rhee, and Schwartz. And, of course, I could never have achieved any degree of success without the support of my wife and our three wonderful children.