Top Docs 2012: Matters of the Heart

Meet the Top Doctors who keep an eye on the rhythms of the city.

August 2012

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The high-tech field of clinical cardiac electrophysiology is evolving every day.

If there’s one area of medicine that inspires awe in the operating room, it’s cardiac electrophysiology. Colorful images and wavy lines streak across multiple monitors while a blue-ish three-dimensional rendering of a heart pulses on-screen. On another display, a small video camera reflects internal anatomy in real time. The physician—in this case, Saint Joseph Hospital’s Dr. Laurent Lewkowiez—uses every advanced imaging technology at his disposal to move tiny instruments into the exact right place inside the patient’s heart.

Cardiac electrophysiology is the practice of treating irregularities, called arrhythmias, in the electrical conduction system of the heart. Using intracardiac catheters—small instruments threaded through arteries and veins to the heart—electrophysiologists can place pacemakers or defibrillators, or they can ferret out heart cells that are misfiring and deactivate them using burning or freezing technologies (called ablation). The field has been around for more than 30 years, but recent improvements in high-tech, high-resolution imaging are changing the practice at warp speed. “EP was advancing so rapidly when I came out of training in the late 1990s,” says Lewkowiez, who is a Kaiser Permanente doc, “that I decided to do another fellowship I was not required to do to practice medicine.”

After nine years of post-medical-school training—and now more than a decade of on-the-job experience—Lewkowiez feels more than comfortable treating the variety of maladies that afflict his patients. Things like supraventricular tachycardia (a generally benign but annoyingly fast heartbeat), ventricular tachycardia (a life-threatening rhythm in one of the ventricles), and atrial fibrillation (which increases the risk of stroke and heart failure) are everyday problems that Lewkowiez can solve. “That’s really what’s special about EP,” he says. “You cure people.”

That is, if you’re doing it right. Lewkowiez says that when done well, EP is a minimally invasive procedure with remarkably low complication and mortality rates. But because the field is progressing so quickly, patients need to be proactive when choosing their physicians. “There’s no harm in asking a lot of questions of your electrophysiologist,” he says, “as well as checking that he or she is giving you the right answers.”