Richard Fogel, president-elect of the Heart Rhythm Society and chief executive officer at St Vincent Medical Group in Indianapolis, USA, considers he entered the field of electrophysiology at “the perfect time” when radiofrequency ablation and implantable cardiac defibrillators were emerging as a therapy to treat cardiac rhythm disorders. Fogel participated in the strategic design of the St Vincent Heart Center of Indiana, which he recognises as the most valuable achievement in his career. He spoke with Cardiac Rhythm News about this work, his interests in research and policy and the highlights of this year’s Heart Rhythm Society’s (HRS) scientific sessions.
Why did you choose a career in medicine and, in particular, why did you choose to specialise in Electrophysiology?
When I was young, I was keen to pursue a career in engineering. My father and brother are engineers, and I have a mathematical mind. I also was interested in biology and medicine and at one point thought that I would become a bio-medical engineer. In the end, I decided to attend medical school because I realised I could use my talents better in medicine. While studying medicine, I went back to my roots in engineering and entered cardiology and electrophysiology, which is the engineering of the electrical system of the heart.
Who were your career mentors and what do you still remember from their wisdom?
I had three key mentors in electrophysiology. The first person is Dr Paul Levine, who was my first attending physician when I was an intern. He had an interest in pacemakers and introduced me to this field almost 30 years ago. The second person is Dr Philip Podrid, a cardiologist who taught me a lot about the care for patients with heart rhythm disorders. Dr Podrid connected me with Dr Eric Prystowsky, who is my primary mentor. In 1992, I completed a year of fellowship with him in Indianapolis and in 1993, he asked me to become his work partner. Each one of these doctors have given me the knowledge and excitement about electrophysiology and Dr Prystowsky-in particular-taught me how to understand the heart’s electrical components and began my journey in electrophysiology.
Which innovations in electrophysiology have shaped your career?
I entered the field of electrophysiology at the perfect time, when two big innovations-radiofrequency ablation and implantable cardioverter defibrillators-were emerging as a therapy to treat cardiac rhythm disorders. Initially, radiofrequency ablation was used for the treatment of supraventricular tachycardia. Since then, I have watched the development of this technology to help us treat not only supraventricular tachycardia, but many other heart rhythm disorders, including atrial fibrillation and ventricular tachycardia.
I also have seen the development of implantable cardioverter defibrillators. At first, these devices were used specifically in people with sustained cardiac arrest and had to be implanted in an open surgical procedure. Today, this is a commonplace procedure.
Could you describe a moment early in your career when you realised the potential of what electrophysiology could achieve?
There were two moments. The first moment is regarding Wolff-Parkinson-White syndrome. I was amazed by the fact that we could cure a patient for life. In a matter of seconds, with an ablation, a person who had trouble for years with the syndrome would be cured. The other moment was when I recognised that we could treat young people at risk for a cardiac arrest with an implantable device that could potentially save their lives. It was exciting to me that we could cure Wolff-Parkinson-White syndrome or potentially save lives.
Of the research that you have been involved in, what do you consider to be your greatest achievement and why?
It is really not research per se but the work that I am most proud of is participating in the design and building of a hospital dedicated to the care of patients with heart problems. In 2001, I was asked to be the chairman of the board of a project which became the Heart Center of Indiana in USA [now called the St Vincent Heart Center of Indiana]. I am proud of being part of a team that strives to provide a new model to more effectively treat cardiac patients. With this philosophy in mind, the hospital is a place where patients have excellent outcomes and where health care providers have saved thousands of lives.
Were there any other heart hospitals of this kind in the USA until then?
There were other heart hospitals in the country, but this was the first one developed primarily by a group of cardiologists who came together to work for the betterment of their patients. It was tremendously exciting. It was a hospital focused on cardiology and with a new philosophy.
Can you describe a memorable case that you treated?
When I was in training, I remember a young female student who came into our emergency room. She had passed out in the cafeteria of her high school. When I looked at her ECG, I noticed that there was something wrong and I immediately admitted her. Over the next several hours she had multiple cardiac arrests due to Long QT syndrome. By recognising and understanding her condition, I was able to save her life. Now she is a middle aged woman and enjoying her life. I was the first doctor to recognise that she had Long QT syndrome, and the first one to start the appropriate treatment. This case is memorable because my diagnosis saved her life, and because this event occurred very early in my career. This situation sparked my interest in becoming an electrophysiologist.
What are your current research interests?
Currently, my research interests focus on critical health policy issues. I am interested in discovering how to deliver the most cost effective care to the most people worldwide.
I also am interested in understanding the causes of cardiac arrest and sudden cardiac death and what the Heart Rhythm Society can do to educate people as a preventive measure in USA and throughout the world.
The economic crisis is affecting many countries. How do you think this will affect healthcare innovation in the field of cardiac arrhythmias?
With the economic crisis, I am concerned that the dollars will be shunted away from research. We, as the leaders in electrophysiology and cardiology, need to help promote at an individual country level and globally that cardiac disease is still the number one killer of people in USA and in many other countries. We cannot let the economic crisis take away our ability to develop healthcare innovations to treat cardiac disease. We need to work closely with both industry and governments to develop adequate technology.
How do you see the electrophysiology field developing in the future?
There are three areas that I will focus on. First, we need a clearer understanding of what causes atrial fibrillation in order to select the best treatment options.
Second, we are starting to better recognise what causes cardiac arrest. We are also understanding the impact of cardiac arrest globally and are beginning to institute measures that can help minimise the problem, and either prevent it or treat it more effectively.
The third area, which is incredibly exciting, relates to understanding the genetic underpinnings of heart rhythm disorders. We are starting to identify problems at a cellular level. With this in mind, we could potentially target our therapies based on the fundamental mechanisms of the disease and start treating the problem rather than just treating the symptoms.
Could you tell us what the highlights of the Heart Rhythm Society annual scientific sessions are for this year?
At every meeting I am always excited about the late-breaking clinical trials. The live cases also are part of this year’s meeting and will show the latest technologies and how the leaders in the field are implementing them. Other highlights include the Atrial Fibrillation Summit, the Ventricular Arrhythmia Summit and the Basic Scientist Summit. Finally, the Opening Plenary session is a must attend. We will be talking about the role of technology and we have a great panel of speakers.
You have been a member of the Heart Rhythm Society since 1995 and have participated actively in its scientific sessions and in different committees; could you describe how these roles have helped you in your medical career?
When you become a doctor you are focussed on treating patients at an individual basis, but when you are part of a medical society-such as the Heart Rhythm Society-you are looking at the issue globally. So instead of taking care of one patient, you are developing an understanding of problems that improve the care of hundreds or thousands of patients. The opportunity to be involved in the Heart Rhythm Society gives me the ability to influence the lives of thousands of patients through different policies or programmes-hopefully in a very positive way. On a personal level, it has helped me to become a more effective leader in the organisation.
You are the CEO at St Vincent Medical Group, what skills-apart from the medical knowledge-does a physician need to embark on a role like this?
You need to be able to develop a vision of the organisation’s future. Understanding your environment and listening critically to the different stakeholders also is crucial. Finally, you have to communicate well to lead people to your vision. Those are the skill sets that are important-have a vision, listen well and communicate.
What advice would you give to young physicians wanting to specialise in electrophysiology, and to those wanting to become leaders in the field?
I will give several pieces of advice. The first is to do the things that you feel passionate about. Electrophysiology is an incredible field because you get to touch and save people’s lives. You get to cure young people with an ablation of a heart rhythm disorder that would otherwise haunt them for the rest of their lives. You also can treat a rhythm problem, which could potentially lead to disabilities. You can also take someone who is at risk for cardiac arrest and prevent it. If that is your passion, then you are in the right field. Being an electrophysiologist is not just a job; it is a calling.
The world is going through a very disruptive time as it relates to healthcare and the economic crisis. If you like being involved in solving complicated problems and helping lead others through critical times, this is a great opportunity to be a healthcare leader. Leaders in the field are looking at how to transform the delivery of healthcare for the next 50 to 100 years. Given all the changes that are happening in the world economies and in disease prevalence, this could be your chance to have some sort of impact.
Outside of medicine, what are your interests and hobbies?
When I detach from the professional world, I like to spend time with my family. Being a husband and the father of three children are very important roles in my life. I also like to read, travel and ski.
1993 Staff cardiologist and electrophysiologist St Vincent Medical Group, Indianapolis, USA
2010 Chief executive officer St Vincent Medical Group
2013 President-elect Heart Rhythm Society
1983 Undergraduate Brown University (Providence, USA), ScB Biology
1986 Medical School Brown University
Post graduate training
1986–1987 Internship Boston University Medical Center
1987–1989 Medical Residency Boston University Medical Center
1989–1992 Cardiology Fellowship Boston University Medical Center
1991–1992 Clinical Electrophysiology Fellowship Boston University Medical Center
1992–1993 Clinical Electrophysiology Fellowship St Vincent Hospital
1979 National merit scholarship
1983 Academic award for excellence in Biology, Brown University
1983 Induction into Sigma Xi Honor Society, Brown University
1983 Honors in Biology, Brown University
1983 Magna Cum Laude, Brown University
1987 Induction into A.O.A. Medical Honor Society, University Hospital
2006 Attained fellowship status Heart Rhythm Society
1984–2003, 2009 American Medical Association
1986 Massachusetts Medical Society
1987 Alpha Omega Alpha
1993 Indiana Medical Society
1994 Fellow American College of Cardiology
2005 Fellow NASPE (North American Society of Pacing and Electrophysiology)/Heart Rhythm Society