January 26, 2017 | Krishna Pothineni, MD
Education

Luigi Di Biase, MD, FACC, is the section head of electrophysiology at Montefiore/Albert Einstein Medical Center in New York.

Krishna Pothineni, MD, recently sat down with Di Biase to learn more about his career journey in electrophysiology, and his words of advice for prospective and current electrophysiology (EP) FITs.

KP: Can you tell us about your career in cardiology and how you became interested in EP?

LD: I was fascinated by cardiology during my childhood and the possible invasive procedural aspect of the field attracted me after medical school. EP in particular interested me because the analysis of waves, morphology and cycles could provide vast amounts of information about various pathologies. The fact that procedures such as ablations could completely eliminate arrhythmias felt very satisfying.

KP: Can you tell us about how your mentors have helped shape your career in EP?

LD: I did my EP fellowship in Italy and was later sent for a research elective at Cleveland Clinic where I met my mentor, Andrea Natale, MD, FACC. I started collaborating with him initially on various research projects including animal experiments and innovative design of new technologies and later clinically. He has provided me immense guidance both scientifically and clinically, and helped shape me as a successful electrophysiologist. I owe him my career.

KP: What are the challenges being faced by graduating EP fellows currently?

LD: EP requires extensive training, knowledge and sacrifice. You have to devote a lot of years to become an electrophysiologist. Over the last five years, the biggest challenge to graduating fellows has been the scarcity of EP jobs. This may change in three to four years as the number of graduates is declining. The biggest challenge would be for the fellows who constrain themselves to big urban areas and specific geographic locations in their job search. In my opinion, the job market that is going to open up will be in smaller cities and hospitals where the graduating fellows would be expected to start and develop an EP program. Fellows should be ready for this challenge.

KP: Do you support the decision to make EP a mandatory two-year fellowship? How would it impact fellowship recruitment?

LD: Training is a lifetime investment. I think the decision to make EP fellowship a two-year training is very good. I have seen many fellows who were uncomfortable with complex left-sided ablations at the end of one year of training. A two- year program will make the fellows ready for independent practice in most EP procedures. This decision may impact fellowship recruitment as the number of applicants may come down. From a fellowship administration perspective, this decision puts emphasis on incorporating both clinical and research training in the fellowship training, in contrast to purely clinical training that is currently offered in various programs. However, over a few years as the number of graduating fellows decreases, there may be more job opportunities. I am a strong believer that gaining expertise in EP takes many years. I have done multiple research and clinical fellowships in EP, and I feel that you can never be completely trained. If a particular program does not provide you enough exposure in areas of your interest, I would even recommend an additional year of training at a high volume center.

KP: You have extensive collaborations in research at multiple institutions in your home country. What advice can you give international medical graduates on maintaining affiliations with institutions in their native countries and what are the challenges you have faced in this area?

LD: Research collaboration is important for two reasons. Firstly, federal regulations in the U.S. regarding the use of various products from industry is stricter than in Europe. So having collaborations in countries outside of the U.S., where technology approval is quicker will give you an opportunity to stay abreast with the latest technological advances in the field. These collaborations will also help you develop relationships and exchange various ideas that can develop into multiple new projects. The biggest challenge is to find time off from work in the U.S., as research collaborations usually involve a lot of travel.

KP: Have you noticed any difference between the practice of EP in Europe and the EP practice in the U.S.?

LD: I have frankly not seen much difference except the use of additional tools. An example is the use of various resources during EP procedures such as intra cardiac echocardiography, which may be lower in Europe due to differences in reimbursement. European and American guidelines are usually in agreement in most areas of EP.

KP: How do you see the field of EP expanding in the next decade?

LD: EP is an ever expanding field. We are almost at the 25th anniversary of atrial fibrillation ablation. A lot of technological advances have occurred that helped improved the efficacy and safety of various procedures and these advances are ongoing. We have now opened a new avenue of appendage closure. There is a lot to be seen in the ventricular tachycardia ablation field as well. There is going to be a lot of new knowledge and techniques that the fellows need to be aware of.

ACC Resources For EP FITs

1.) ACC Clinical Cardiac Electrophysiology Questions and Board Prep Program

2.) 2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology 

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This article was authored by Krishna Pothineni, MD, a Fellow in Training (FIT) at University of Arkansas For Medical Science.