10-Minute Interview: Pediatric Electrophysiologists

Peggy Strieper, DO, Director of Pacing and Electrophysiology, Sibley Heart Center, Cardiology, Children's Healthcare of Atlanta

Describe your medical background.

Medical school: University of Osteopathic Medicine and Health Sciences in Des Moines, Iowa; Pediatric training - Brooke Army Medical Center in San Antonio, Texas; Pediatric Cardiology/Electrophysiology: Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia.

What made you decide to work in the field of pediatrics?

I enjoyed working with children as a medical student, and found that the children were innocent bystanders in their diseases. This was in contrast to adults, where many of our diseases are self-created by lifestyle choices. As I rotated through varying clinical areas of medicine as a medical student, I was struck by how pleasant the pediatricians were to both their colleagues and patients.

What has been your most memorable case so far?

Every day is different as a pediatric cardiologist/electrophysiologist. I have enjoyed all the EP cases. The straightforward pathways or AVNRT are fun and gratifying. Having a child who is basically well with interspersed periods of tachycardia and making them well is very satisfying. The parents are so grateful what is not to like? The difficult cases are the children with congenital heart disease and IART. The procedures are long and difficult; however, they can be rewarding if we can keep someone off medications for a year or greater without recurrences of the IART. From a pacing standpoint, the most rewarding patients at present are the children with dilated cardiomyopathy that we have implanted a CRT. These patients are very symptomatic with CHF symptoms with multiple hospitalizations. After implantation of a CRT device, the responders improve dramatically with a decrease in hospitalizations and a return to normal activities.

What are your research and clinical interests?

My research interests include ablative techniques and new catheters, as well as continuing research in our dilated cardiomyopathy cohort, trying to define which pediatric patients may benefit from CRT and which is the best method to follow these children long term.

What advances in the field of pediatric electrophysiology do you think we will see in the coming decade?

The field of pediatric electrophysiology will continue to advance in regards to pacing in pediatrics. We will see new pacemakers develop with new delivery systems for the leads, and hopefully there will more evidence-based medicine regarding placement of ventricular leads in conventional pacing, as well as with biventricular pacing.

Patrick Frias, MD, Pediatric Cardiologist, Sibley Heart Center, Cardiology, Children's Healthcare of Atlanta

Describe your medical background.

Medical school: University of Nebraska; Pediatric residency: Duke University; Pediatric cardiology and EP training: Vanderbilt University.

What made you decide to work in the field of pediatrics?

Positive experiences working with children, and the opportunity to enhance the lives of children.

What has been your most memorable case so far?

A specific case would be the infant with congenital heart block who developed congestive heart failure after the initiation of standard AV sequential pacing. She presented with failure to thrive associated with her CHF. After adding a left ventricular epicardial lead and converting to biventricular pacing, her CHF resolved and she began to thrive. Nearly two years later, she is doing remarkably well.

What are your research and clinical interests?

My research focus is in evaluating the effects of epicardial pacing on the immature and mature myocardium. The main focus at this time is in an animal model. My clinical interests are in pacing and catheter ablation.

What advances in the field of pediatric electrophysiology do you think we will see in the coming decade?

I would hope that we have a greater understanding of the mechanisms behind sudden death disorders in the young, allowing us to more accurately diagnose and treat these disorders.