10-Minute Interview: Andrea Natale, MD

Tell us about the creation of the Texas Cardiac Arrhythmia Institute (TCAI) at St. David's Medical Center. What attracted you to move to St. David's? It was a combination of factors — the most important one is because of the group of very talented physicians here that are already doing a remarkable volume of clinical cases, which for me is important — I wanted to support and continue some of the pioneering work that they are doing. It is also because TCAI has all the technology that I needed to continue on with my academics. In addition, the hospital has been very generous in terms of their resources in adopting a research institute, so for me these benefits were all the evidence that I needed to quickly step in and continue my research and clinical work here. Tell us about your blog on St. David's website. Will this be something you will update regularly? Yes. It is a way to provide information to the patient about atrial fibrillation and complex arrhythmias, beyond cytogenetic information and the activity of the institute. The blog will also include information about manuscripts and books that are relevant to patients with heart conditions who need to make a decision on treating and managing their condition. Describe what your role will be at St. David’s. What is a typical day like for you as an electrophysiologist? I usually am in the lab every morning by 6:30, either giving a demonstration or discussing administrative issues with the nurses. I also see patients between procedures, and usually by the end of the day I am taking care of some administrative duties such as reading papers or discussing manuscripts that need to be sent out or reviewed. I am in the lab pretty much every single day, so when I am there, I do try to mix my clinical work with some academic work. You have had quite an extensive career in electrophysiology; what are some of the more memorable cases you have worked on? I have had many difficult cases that were memorable, and I have also had many cases in which I treated patients that were well known but whose names I won’t mention. However, that doesn’t really matter — I think the most rewarding thing is to be able to see the patient when they are cured, no matter who they are. That is always what has encouraged me to work so hard and to continue what I have been doing for the last 15-20 years. What aspects of your work are most challenging? Electrophysiology cases are a combination of physical and mental work. Although some of what we do now in the EP lab is robotic and you can sit down, most of the work we do still involves standing at the table and at the same time trying to concentrate on what is going on during the case. Therefore, many times there is a conflict between the physical and electrophysiological point of view. This can sometimes be challenging, because after a day’s worth of cases, you can work as long as 12 hours. Will you be involved in any EP-related research at the Texas Cardiac Arrhythmia Institute? What will be the main focus of your research? Mostly I am going to continue with atrial fibrillation as the main focus; I will also study general complex arrhythmias as well as focus on what should be done for these specific patients. At the same time we must carry on with the clinical trials that address the more important and general issue of how we practice EP, such as deciding if ablation can be used as a first-line therapy and if ablation is better than a device in patients with heart failure. It is crucial to continue to test new devices and concepts in order to move forward in our field. What advancements in electrophysiology are still very much needed? I think what is imminent even for the best EPs is the amount of time required during a case, and so I would like to see more of an ongoing effort to try and make it easier on your patients and do different components of the procedure. Obviously there are components that we will never be able to replace, but the the robotic devices are one example of trying to make things easier for the physicians who do this procedure. There are other things that are important, including the most consistent ones that we use like the recording system — everything that we do can be used to make our procedures and workflow better and easier on the people that are doing this. Is there anything you would like to add? There is one thing that is important for me to mention — one of the main decisions that brought me to this group in Austin is so that I could bring these procedures and my expertise out into different communities. This group has already been very active in Texas with their outreach program, and I would like to continue on with that, not just in Texas but also outside the state so that people who cannot travel or who do not have the opportunity to have this procedure in their neighborhood will have the opportunity to do so. We are already looking at different options in San Francisco and Ohio (Akron General and MetroHealth), and are looking into other affiliations as well. This is part of an effort not only to bring complex procedures to patients in different parts of the country, but also to create a group of centers that work well together in producing clinical research. For more information, please visit: www.stdavids.com/ www.TCAheart.com/ www.andreanatale.com/