Dr. Nademanee is recognized as the top groundbreaking electrophysiologist in the world, having made multiple contributions in both arrhythmia treatment and research. Having a one on one interview with him was a rather intimidating thought at first but I realized it was crucial for the patients who need electrophysiological treatment to understand the difference between him and other electrophysiologists.
Dr. Nademanee, i would be honored if you shared a little about yourself, so that patients can truly understand how you contributed so much to the world of Electrophysiology.
I was born in Chon Buri, a small town just outside of Bangkok and lived there until I was about 15, when I moved to Bangkok to finish my high school and college education. I initially started out thinking I was going to be an OB/GYN, then I thought about Nephrology and then finally decided upon Cardiology. There was so much I liked within the world of medicine but once I found Cardiology, I knew that it was where I wanted to be. I graduated from Chulalongkorn University and then went to the United States to do my internship and residencies at Tulane University. I then moved to UCLA Division of Cardiology for my fellowships and was there for several years before I accepted the position of Chief of Cardiology at Denver General Hospital. It was about that time that Electrophysiology was starting to gain traction; however, an electrophysiology study took much longer than it does today and an ablation? An ablation in those days were sometimes 8 hour ordeals – I call them an ordeal as it is an unfortunately long time for a patient to remain on a table, under sedation the entire time with full exposure to fluoroscopy (radiation).
And Dr. Nademanee, you just touched my next question – the adolescence of electrophysiology. It is not that it is new but technology has certainly helped cut down procedure times and given the fact that atrial fibrillation affects millions of people worldwide, the option for a procedure that may eliminate arrhythmias – especially lethal ventricular fibrillation – through heart remodeling is entirely enticing. But your technique is a little different than what 95% of arrhythmia centers use, do you mind telling me a little about it?
After I moved from Denver General to the University of Southern California Division of Cardiology, cardiology’s interest in treating electrical problems, rather than just managing them as usual, had started to take off. I opted to use a modified Maze procedure approach which cut down the procedure time to 4 to 5 hours in comparison the only two options at that time: a regular ablation which could take up to 8 hours or a open chest Maze Procedure, which is normally done on a patient who needs open heart surgery like a valve replacement or bypass and has atrial fib.
With the modified Maze, we were not quite there but it was a drastic improvement of the 8 hour ordeal. It was a very busy time – we not only took care of private patients at University Hospital, i also cared for the electrophysiology patients out of LAC + USC Medical Center – it was Metropolitan Los Angeles largest trauma center with an 800 bed capacity. The quantity of patients ensured that we were exposed to so many arrhythmias – and it was during this time, I started to think about fractionation.
Most electrophysiologists believe that atrial fibrillation emanates from the pulmonary vein and indeed it may, provided you catch it early enough. If the patient has remained out of rhythm for whatever reason that increases the odds of the migration of the disease into the left atrium. Now a pulmonary vein ablation may help a little but once the disease has moved further into heart, that progression demands the operator to find the additional circuits that may be contributing to the disease, and this is how complex fractionated electrogram (CFAE) approach came into existence.
I am listening intently because this is where evolution of the procedure really gets interesting….
You have also just introduced the latest technology in the world of Electrophysiology to Bumrungrad Hospital – the CardioInsight Vest. There are only two other centers in the world that have been using it for some time – Dr. Michel Haissaguerre’s lab in Bordeaux, France and Hammersmith Hospital in the United Kingdom. It has recently received FDA approval in the US but in terms of quantity of cases performed, your center and the other two are at the top of the pack. The founder and creator of this technology, Charu Ramanathan, PhD will be featured in another interview on this website.
Tell me, there are a couple of different ways to map an arrhythmia, tell me why this technology is so special?
Yes, indeed there are many ways to map an arrhythmia. There is only one way to map non-invasively. For example, if a patient came to us with vague arrhythmia symptoms of lightheadedness, near or full syncope (passing out) or racing heart, the only method to determine cause without risk of an electrophysiology study is an old fashioned EKG. With the introduction of this technology, we can now help patients who have not been able to get a true diagnosis, either because at the time of EKG, they were not out of rhythm and the EKG does not have the ability to map the cardiac anatomy externally. Or the patient was hesitant to undergo an full electrophysiology study which does pose some risk as a catheter is entered into a femoral or venous portal.
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