Conversations With Cardiologists: Christopher Ellis, MD, FACC
Dec 16, 2015 | Jared O'Leary, MD and Travis Richardson, MD
Christopher Ellis, MD, FACC, is an associate professor of medicine at Vanderbilt Heart Institute.
Why did you choose to pursue an academic career within cardiac electrophysiology (EP)?
The potential for advancing science and changing clinical practice while maintaining somewhat better work-life balance pointed me towards an academic career. I did not have a desire to do basic science, nor to write National Institutes of Health grants, but rather, have the presence of a strong academic institution behind me where I could be more foreword thinking in my approach to patient care. Once I established a successful busy clinical practice through hard work, attention to detail, strong communication with referring MD's and a focus on excellent outcomes, I was able to create some of my new skill sets from within my own practice. This is critical when learning new skills, to have a longer standing relationship with patients and families (particularly with left atrial appendage (LAA) closure, hybrid surgical atrial fibrillation (AFib) ablation and laser lead extraction).
What do you see as the most intellectually stimulating part of your job today?
I am able now to participate in investigational device exemption (IDE) trials of experimental invasive devices and procedures, and to be able to parlay my new skill set into investigator initiated research projects with common goals for both myself, the university and our industry partners.
Despite being in your early career you have been very successful in participating in industry sponsored research. What do you think has allowed you to be successful in this area?
First, you have to be excellent in regards outcomes, complex skill sets, and being able to learn new innovative approaches while maintaining your practice. This is where industry will turn to for IDE studies. A few bad operators can sink a very promising technology, which is so costly that industry cannot afford to pull the plug once you get to human clinical trials (example, the LAPTOP trial for implanted LA pressure sensor for heart failure). At least half of what I do now (seven years into practice) I did not learn at ALL during EP fellowship.
Regarding investigator initiated studies (IIS), I have maintained a realistic view of where I can impact quality and innovation in practice, and also align common endpoints or goals for industry partners. There is a ton of available resources to help carry out good ideas from faculty. Personal relationships and building partnerships with industry does not have to be so 'evil' as it seems institutions and the public perceive it. A healthy ongoing dialogue with medical directors, chief executive officers and other MD's with common viewpoints have led to success in building a large portfolio of IIS studies.
What do you see as the role of industry in academic cardiac electrophysiology?
There can definitely be a partnership. Some technology innovations are clearly going to improve patient outcomes and at the same time reduce costs. These are focus areas that we would have a common goal. Device versus device or registries for cardiac implantable electronic device (CIED) performance are less appealing but do bring essential funding to the clinical research programs that otherwise would fold financially.
What emerging technology in clinical electrophysiology do you find most exciting and why?
Clearly my focus has shifted towards LAA closure for stroke prevention in AFib. The Watchman U.S. Food and Drug Administration (FDA) approval was a big step forward, but there is a ton of work to do. Medicare is putting restrictions on coverage and most private insurers are denying payment despite strong data that this is a mortality reducing and cost effective approach. Being able to get involved in this space on the front line with LARIAT, Atriclip, Watchman, etc., is a great joy to me, and I know will eventually be a front line therapy for all AF patients.
Being a top implanter of transcatheter pacemakers with MICRA was a great step in my career and will lead to further study on next generation platforms for this game changing technology. Leadless pacing will save lives in the long run. I often have to remind MD's that a device generator change is the most dangerous procedure we perform with a 2-3 percent infection rate associated with one year mortality of 20 percent (thus a 0.15 percent rate of death from each generator change).
What advice do you have for fellows in training interested in an academic career within a procedural subspecialty like electrophysiology?
Clearly getting into the EP lab is the first step. I have to laugh when I look back: I decided on EP as a specialty, and had never actually scrubbed-in on a case ever. Then I find out for a solid 30 hours a week I will be doing invasive procedures and wearing lead. I wouldn't change a thing, but many trainees may not truly understand what an EP career is like.
How would you suggest that fellows interested in working with the device industry seek out opportunities?
A good place to start is actually the smaller academic meetings and symposia. Meet folks there and start discussions about what work needs to be done. Examples for me included the LAA meeting, Frankfurt LAA CSI conference, and Boston AF and the satellite symposia for lead extraction and persistent AF ablation. Also, when working with faculty on projects at your institution, make it clear you are interested in taking the lead on a project. Build trust early. I have found industry to be quite supportive later of dealing directly with EP fellows on future projects. Many institutions have restrictive policies on relations with industry and I generally find this counter-productive. A bad policy often trumps the best noble intentions.
This article was authored by Jared O'Leary, MD, and Travis Richardson, MD, clinical fellows in training at Vanderbilt University in Nashville, TN.