10-Minute Interview: Salem N. Sayar, MD

Dr. Sayar is an electrophysiologist with Eastlake Cardiovascular in St. Clair Shores, Michigan. He was nominated by his colleagues to participate in this special 10-minute interview! Tell us about your medical background and how you came to work in the field of electrophysiology. What interested you about this field? I was not one of those physicians who knew at birth exactly what they wanted for a career. My interest in medicine began after my volunteer work with EMS and with the emergency room at West Virginia University. Prior to medicine, my interest was engineering. However, during my training at the West Virginia University School of Medicine, I was drawn to both surgery and internal medicine. The holistic and cognitive challenge that internal medicine provided me, also allowed me to pursue internal medicine at Emory University. I again had superb training there and found myself interested in cardiology, especially areas of cardiology in which one can use their hands. I did not know a lot about electrophysiology at that time, but I found it fascinating. I went to the Ohio State University for cardiology fellowship — not only do they have a great football team, but they also have a great cardiology division! I knew there that I wanted to be an electrophysiologist. The field of electrophysiology was new, exciting, cognitively challenging, and extremely gratifying. I was interested in complex ablations, device therapy, and warmer weather. Later I went to the Medical University of South Carolina (MUSC), which provided an incredible balance of exposure to complex ablations and device therapy. Describe your position as an electrophysiologist at Eastlake Cardiovascular (ELC). How long have you been with Eastlake Cardiovascular? What is a typical day like for you? I have been an electrophysiologist with ELC for two years. This group consists of 14 cardiologists, so I stay very busy. I manage a device clinic which is staffed by three wonderful professionals. My typical day involves rounding with my nurse practitioner (NP) at 7:00 am, with operations or ablations beginning at 8:00 am. Consults are staffed with my NP between cases. After rounding, I go to the office to return patient phone calls and to catch up on paperwork. What is one of the more unique EP cases that you have worked on? I find every case unique and learn something from each patient. One interesting case involved a patient who had supraventricular tachycardia and presented for catheter ablation therapy. We usually obtain access to the heart from the femoral veins; however, this patient had total occlusion of the inferior venae cavae. As a result of the occlusion, the azygos vein was prominent. This vessel connects the inferior venae cavae with the superior venae cavae (SVC). Therefore, all the catheters were placed into the heart through the SVC, and a successful ablation of atrioventricular node reentry tachycardia was performed. What aspects of your job are most challenging? I find it most challenging to find time in the day to do all of the things that I would like to do. I would like to be more involved in inpatient and outpatient clinical research. I also would like to find better ways to educate our patients. I believe many patient misconceptions are related to misinformation. To combat this problem, our group has started a popular device support group. What are your research interests? Tell us about some of the clinical research you're involved in. I am interested in ventricular arrhythmias and atrial fibrillation. When I first joined the group, I started a project looking at our group’s compliance with documenting current recommendations for sudden cardiac death prevention. With the help of my NP, I started a tracking system to look at all patients in the group who are at risk for sudden cardiac death. I am proud to report our group’s compliance is greater than 98%, while the national average is around 50%. We are also looking at genetic testing for determining other risk factors for sudden cardiac death, as current data still fails to capture the majority of patients at risk for sudden cardiac death. In the future, I would like to be more involved in research projects related to atrial fibrillation, as this is an area of great interest to me. What aspects of your work do you find most rewarding? I feel very fortunate to be in this field because I find almost every aspect of my work rewarding. I truly love the intellectual stimulation and the instant gratification of a curative procedure. I have witnessed catheter ablation therapy and heart failure device therapy make instant improvements in people’s lives. I love what I do, and I am always looking for ways to make things better. What advancements do you hope to see in the field of cardiac electrophysiology in the next decade? I hope to see better treatments for atrial fibrillation and ventricular arrhythmias. These ubiquitous diseases are becoming more prevalent with our aging population, and we have to find better ways to prevent and treat them. What is the best advice you have received so far in your medical career? The best advice I have received in my career is “never trust anyone,” “never give up,” and “you will always sleep better when you treat each patient like one of your relatives.” I try to practice these words every day. I always verify information when it comes to my patients. I never give up, and I treat every patient as a family member. When patients ask me what I would tell them if they were one of my parents, I joke by saying, “you are assuming that I like my parents,” which of course I certainly do! Has anyone in particular been helpful to you during your career in EP? Absolutely! Many people have been very helpful. I was inspired by Dr. J. Willis Hurst at Emory University. He was nearing his 80’s and would be at the hospital at 5 am waiting for the cardiology fellows to start morning report. His dedication to medicine was truly inspirational. During my cardiology training at The Ohio State University Medical Center, Dr. Stephen Schaal was an amazing mentor. He taught by example and taught me how to take excellent care of my patients by being a great listener, yet never missing any details. He played a pivotal role in my interest in electrophysiology. During my EP training, each of my mentors played a different role in making up the sum of what I know about electrophysiology. Dr. Marcus Wharton’s ability to navigate the heart, his understanding of electrophysiology and his relentless application of critical thinking are brilliant. Dr. Michael Gold has a very practical approach to electrophysiology. He showed me how to not lose sight of the forest for the trees. He also has an incredible talent for being focused and identifying important research frontiers. Dr. Robert “Buddy” Leman is an electrophysiologist and an interventional cardiologist who taught me how to be creative in difficult situations. Dr. Lacy Sturdivant taught me how to be efficient with patient care. For more information, please visit: www.eastlakecardiovascular.com