Meet the EP Board: Dr. Jose Nazari

This August, Sherman Hospital in Elgin, Illinois became the first Illinois hospital to use the Freezor CryoAblation System, a new cardiac cryotherapy system that produces burns that are more sharply delineated than those produced by the commonly used radiofrequency energy source, causing virtually no clot at the burn site. Clinical Electrophysiologist Dr. Jose Nazari was the Primary Investigator in the Clinical Trials for this innovative new therapy, and helped in the development of cryotherapy and its use. Since joining the editorial board at EP Lab Digest this year, he has been a source of tremendous expertise for us. In this new monthly feature, we will introduce each of the members of the EP Lab Digest editorial board.

I graduated from the National University of Mexico School of Medicine (a six-year program with no undergraduate curriculum) in 1981. The last two years I took a pre-graduate internship in internal medicine, as part of a program at Mount Sinai Hospital, University of Wisconsin Clinical Campus. Medical school was demanding, but otherwise fun. Passing the necessary tests to certify my schooling in the U.S. (back then ECFMG and VQE) was hard. Actually, passing was easy, studying was hard! The time demands of residency and fellowship were the biggest challenge. I basically put the rest of my life on hold for 7 years. I am still catching up on things I didn't get to do back then although time doesn't come at a premium now, either. I am known as the ablationist in my group, but in reality, we share the load of the spectra of diagnostics and therapies amongst us. Ablation is just a special interest. I got the top student award in medical school (equivalent to the Valedictorian) and outstanding resident award in residency. This year, I need to re-qualify for the EP boards. Studying for those is taking up all of my educational time right now. Otherwise, I keep up with technical and scientific aspects in electrophysiology through the standard literature and conferences. My education in areas of interest outside EP is through formal and informal courses and books. Ablation of a garden variety SVTs, with success rates approaching 100% has to be the most rewarding thing I do. It is still an exciting moment when an accessory pathway goes, also telling the patient he or she is cured is an inimitable pleasure. I got a call from a patient last week, just to thank me for having been free from atrial fibrillation since having pulmonary vein isolation three weeks earlier (she used to have daily AF). I think that is as rewarding as professional life can get. Ever-changing is an understatement. When I finished my fellowship, we had done a few DC ablations of accessory pathways, and there was no ablation treatment of AV nodal reentry. How things have changed! Defibrillators and radiofrequency ablation certainly have dominated the last two decades for those in EP. However, refinements in them are only incremental and not paradigmatic changes. An exception to this may be biventricular pacing (CRT and CRTD). This technology is in its infancy, but is very promising. If we can widen the population that gets clear cut benefits from it (currently about 60-70% of carefully selected implants), we will get another therapy that leaves patients feeling much better. The promise of cryoablation through catheters is great. It holds the promise of yet one more paradigmatic change in our approach to therapies. I am in charge of maintaining the technical edge of our EP lab by selecting, applying and maintaining new technologies. I also wrote the software on which our practice is based and with which we gather all data for analysis, as well as generate all procedural and outcomes reports. We have been involved in many of the larger multicenter trials in the last few years, including FROSTY (CryoCath), DAVID (St. Jude Medical), AFFIRM, MADIT, SCDHeFT, etc. We plan to continue to be involved in multicenter trials and we have our own, smaller, in-house projects. Continued emphasis on ablation, particularly its expansion into the widespread treatment of atrial fibrillation, is my main interest. We cannot rid the world of arrhythmias, but it sure would be nice to try as long as we can do it with minimal (hopefully none) adverse effects. Cryoablation is a true paradigmatic change. The ability to affect the electrophysiological properties of a structure with almost-certain recovery of normal function is unique. Only cryoablation through catheters currently provides us with that ability, which cannot be overstated. When the arctic circler (or however the technology for cryo PV isolation evolves) becomes a clinical reality, we may have a dramatic change in how we approach atrial fibrillation.