10-Minute Interview: Mauricio S. Arruda, MD

Dr. Mauricio Arruda is leading the new Atrial Fibrillation Center at the University Hospitals (UH) Harrington-McLaughlin Heart & Vascular Institute in Cleveland, Ohio. Dr. Arruda also serves as the Director of Electrophysiology Laboratories and Director of Electrophysiology Services in the Harrington-McLaughlin Heart & Vascular Institute.

Tell us about your medical background and how you came to work in the field of electrophysiology.

My professional accomplishments have been in the field of clinical and experimental electrophysiology. I have been privileged to collaborate in pioneering research and teach electrophysiology fellows at highly recognized institutions for the past two decades. I trained and practiced in Brazil, Canada, and the United States. I was privileged to be trained in cardiology, pacing and electrophysiology at outstanding institutions to become a co-investigator with prominent leaders in electrophysiology worldwide. I am sought after as a speaker and live-case instructor for national and international educational programs. My past experience and technical skills with the use of advanced transcatheter mapping and ablation technologies applying different energy sources such as radiofrequency delivery via an irrigated tip electrode, ultrasound, laser and cryo, will be instrumental in advancing clinical treatment of cardiac arrhythmias, research and development here at Case Western Reserve University. I have had the unique opportunity of using both magnetic and robotic remote navigation for mapping and ablation procedures, and have taught these novel techniques to many physicians in the field. I serve as a chair and faculty member of the Annual Scientific Sessions of the Heart Rhythm Society, American College of Cardiology and American Heart Association. I am a reviewer for the Journal of American College of Cardiology and Journal of Cardiovascular Electrophysiology, and have directed arrhythmia symposiums and lectured in the United States, Europe, Asia and South America.

Describe your position as Director of the Atrial Fibrillation Center. What is a typical day like for you? What are your responsibilities in this position?

I feel privileged for the opportunity to lead the Atrial Fibrillation Center here at the Harrington-McLaughlin Heart & Vascular Institute. Dr. Daniel Simon, chief of cardiovascular medicine and director of our Institute, along with administrative members of the University Hospitals, have demonstrated their support to launch one of the most comprehensive medical centers dedicated to the research, diagnosis and treatment of atrial fibrillation focusing on quality of care. We typically meet with our AF Center coordinator early in the morning to review and respond to any questions or concerns that may have occurred to any of our hundreds of patients currently followed in the AF Center. Subsequently, we meet with our EP lab nursing staff to plan the ablation procedures scheduled for the day. We then make rounds on our in-patient EP service and return to the EP labs to perform the procedures of the day. During and after the cases, we review with our EP fellows and nurses the main findings and teaching points extracted from the EPS and ablations. We then discuss the clinical cases scheduled for the following day and make our final visit to our in-patients.

What are the goals for this new center?

Established in February 2008, the Atrial Fibrillation Center has grown steadily, both in inpatients and outpatients. We have a team of cardiac electrophysiologists, nurse practitioners, research nurses/coordinators, and an expanding EP lab staff who are dedicated to the treatment of atrial fibrillation. Our state-of-the-art facilities have 3 electrophysiology laboratories equipped with the latest technologies, including three-dimensional mapping systems and a stereotactic remote magnetic navigation system, ensure the UH commitment with patient care. Our atrial fibrillation ablation outcomes over the past 18 months surpass the procedural success rates of experienced centers worldwide. We have included older patients with associated co-morbidities and have not noticed any significant difference in efficacy and safety of the procedure. In fact, we were recently recognized as a “Center of Excellence for AF Ablation using Remote Navigation.” Inaugurated in July 2008, our third state-of-the-art laboratory offers continuous intracardiac echocardiography monitoring and three-dimensional integration with pre-acquired cardiac CT and MRA to facilitate accuracy and safety of catheter manipulation and anatomic selection of ablation sites. The lab is in final installation stages of a computerized rotational fluoroscopy system, which will allow three-dimensional reconstruction of contrast-enhanced cardiac fluoroscopy for prompt use during the ablation procedure. The lab is also fully equipped for diagnostic catheterization and interventional cardiac and vascular procedures. The lab’s media integration is outstanding; ceiling cameras are connected with the UH television center with capability of live case transmission, webcasts, etc. In addition, the “Stop AF @ UH” program, which stands for “Simplified Treatment Options for Paroxysmal/ Persistent/Permanent Atrial Fibrillation,” will serve as a comprehensive educational resource for physicians and patients; provide the best state-of-the-art therapies for patients with atrial fibrillation including medical, ablative, and surgical treatments; measure and compare outcomes of different atrial fibrillation treatment modalities; and enhance our clinical and translational research programs in atrial fibrillation. We believe that each patient should receive an individualized treatment taking into account the severity and frequency of symptoms, risk of thromboembolic events (stroke) and overall cardiac functional status. The “Stop AF @ UH” program will evaluate patients’ eligibility for ablative therapies that may eliminate atrial fibrillation or decrease the consequences. Our atrial fibrillation ablation program offers access to the latest interventional therapies. Several members of our team have been in the forefront of research and development of currently available technologies designed for mapping and ablation of atrial fibrillation.

In addition, tell us about your new positions as Director of the EP Labs and Director of EP Services at the Harrington-McLaughlin Heart & Vascular Institute. What is a typical day like for you? What are your responsibilities in these positions?

In addition to my clinical, teaching and administrative responsibilities, I coordinate clinical, research and education activities for the electrophysiology laboratories of University Hospitals Harrington-McLaughlin Heart & Vascular Institute. My weekly clinical practice consists of daily electrophysiology procedures in the cardiac electrophysiology laboratories (including mentoring EP fellows and sharing experiences with my electrophysiologist colleagues) and outpatient clinic at Case Medical Center on Mondays and Fridays. I attend UH outreach clinics every Wednesday afternoon. I also actively participate on two weekly electrophysiology teaching conferences.

Will you be involved in new clinical initiatives or be involved in evaluation of new technologies in this position?

We are about to start enrollment in three FDA clinical trials, all related to new technologies for ablation of atrial fibrillation. We also plan to establish an additional experimental research EP laboratory for pre-clinical evaluation of novel technologies for cardiac mapping, ablation, pacing and defibrillation. In addition, we plan to launch the “International Center for Research in Electrophysiology and Pacing.” This center would serve not only for internal research, but would also facilitate affiliated investigators to conduct their externally funded research in collaboration with our group.

What is one of the more unique electrophysiology cases that you have worked on?

There have been many unique EP cases over the past two decades. A recent case comes to mind: A 35-year-old male was referred for placement of an implantable defibrillator as primary prevention of sudden death due to his severely compromised cardiac function and exercise capacity. He presented in a wheelchair. We noted this young man had been in atrial fibrillation for a while, with fast heart rates. He did not have any other structural heart disease. We assumed he could have developed a tachycardia-mediated cardiomyopathy due to his rapid ventricular response in atrial fibrillation. We discussed possible therapeutic options, and he chose to undergo atrial fibrillation ablation at our center. The procedure was uneventful. When he presented for his 3-month follow-up visit, he had been AF free since his ablation. We were all pleasantly surprised of his recovery. He stated “I feel great…no more shortness of breath…I’ve been jogging over 1 mile three times a week.” His LV function went from an ejection fraction of 15% to 45% in 3 months.

What aspects of your work do you find most rewarding? What motivates you to continue your work in electrophysiology?

What I find most rewarding are the dynamic aspects of EP practice, particularly deciphering the arrhythmias and applying new technologies to optimize our mapping and ablation outcomes. The ultimate goal is to provide the best patient care possible.

What advancements do you hope to see in the field of cardiac electrophysiology in the next five years?

I hope to see simpler, safer and more accurate treatment for cardiac arrhythmias.

What advice would you give to others in EP who are currently at the start of their career?

My advice would be to focus on mastering the understanding and practice of EP. “Do no Harm”.