Why did you decide to become a Cardiologist and eventually specialise in EP?
As a young man at school I wanted to be a doctor, but I wasn’t sure what parts of medicine I wanted to do. I discovered cardiology at quite a young age as a medical student, that you could treat people properly, and EP just took it that one step further forward. It’s one of the few specialties that you can actually take people with a condition and cure them permanently without having to poison them with drugs for the long term, so I think that is the attraction for me. I also guess that is the nerd in me because I quite like the toys and exciting bits of equipment we get to play with.
Where did you train?
I was a medical student in Newcastle, and did my junior doctor posts there. I came down to Manchester as a Registrar, spent some time working at Bolton and Wythenshawe. I took a lecturers post at the Manchester Royal Infirmary where I did my research, and came across to Liverpool to finish my EP training, and I have been here for 2.5 years as a consultant.
What do you see as the future role of a cardiologist in a department?
I think for me that the thing you need to constantly do is to innovate. And I suppose there is innovation in the clinical sense and innovation in a more managerial sense. Particularly in EP there are so many new things coming through. The temptation is to try everything and use everything, and although you need to innovate and use new technologies, you certainly have to be quite critical and ensure you are evaluating them properly at the same time. So a balance of trying new things and making sure you are doing the best by your patients rather than trying things for the sake of it.
On the managerial side I think that there are huge challenges in the next few years as far as NHS funding is concerned. EP has been quite fortunate over the last 5 years because of the influx of extra money, and we have going from having one electrophysiologist to having five electrophysiologists in a very short space of time. I don’t think that sort of expansion is going to continue because of the constraints we find ourselves in with the current economic climate. And we have to make EP unfortunately profitable in Trusts in order for it to continue. And that means being careful on what sort of equipment we use, trying to reduce stays in hospital, and generally being more efficient.
EP is a rapidly growing field, and appears to be overtaking intervention in regards to development. How are you keeping up-to-date with these changes?
Yes it is rapidly growing. I think we are very fortunate that EP has a pretty vibrant community here in the UK now. We have local meetings here in Liverpool, and the national HR-UK meeting in Birmingham every Autumn, which is a great way keeping in touch with people and what is going on. There are some really good international conferences such as the Heart Rhythm Congress in the USA, and CardioStim in France every couple of years, so it is reasonably easy to keep up-to-date, that way. And we have some very approachable evidence-based journals these days with opinions that you value and can keep an eye on.
There seems to be an array of new technologies for treating AF. What do you prefer and why?
Well I came to AF ablation the conventional way in that I trained in catheter based PVI. I have used the Bard mesh ablator which is interesting, it is much quicker. I suspect it is as good as, or almost as good as catheter based PVI, for patients with favourable anatomy
– patients with nice round pulmonary veins it works very well. For patients that don’t have conventional anatomy it can be quite difficult. Some of my colleagues have tried the Ablation Frontiers kit and the Cryoablation, and they have found the same thing. In patients who have relatively straight forward anatomy it’s a boon and it saves time, and it is no better than what we are doing at the moment.
What words of wisdom would you give SpR’s trying to learn EP?
All of a sudden there is a lot of people wanting to do EP. Five years ago if you asked a cardiology registrar what he wanted to do, he would say he wants to blow up balloons for a living. With the advent of Primary PCI, and people seeing what variable quality of life interventional cardiologists enjoy with their oncall rota’s, trainees are starting to think they may like to do other things. And one of those other things is EP. It used to be that you would have to go abroad and spend two years in some institution in America to get EP training, but I don’t think that is the case anymore.
The problem with EP training for registrars is that there is a lot to learn, and you need to decide early on in your registrar training that you want to be an electrophysiologist, and to let the people training you know you want to be an electrophysiologist, and you need to make sure you spend three years in a tertiary centre doing EP, because three years is the absolute minimum. You also should expect to have to do some post fellowship training program if you want to specialise in AF or VT ablation.
Are you still involved in doing any interventional / PCI work?
I did train in PCI as a registrar, and I am pleased to say I don’t have to do that anymore. It’s not that I don’t enjoy it, it’s just I think it is the sort of thing you have to do quite a bit of to keep skilled at. I don’t do any angioplasty, although I do some angiography, not unless I absolutely have to.
We do a lot of pacing. All of the interventional electrophysiologists do a list of pacing here each week, so we are all doing a couple of hundred ICD’s and pacemakers a year, as well as the interventional EP.
Hobbies and passions outside of work?
I have a wife and three children that take up most of my time. I play golf quite badly. Enthusiastic but not quite particularly talented. I do go running from time to time and will be doing the Great North run this year, so that kind of completes all the spare time I have when I am not spending my time here. |
