Description of Clinical Expertise

My cardiac electrophysiology practice is based at the Perelman School of Medicine at the University of Pennsylvania (PSOM) affiliated Clinical Practices of the University of Pennsylvania (CPUP), Pennsylvania Hospital (PAH), and Hospital of the University of Pennsylvania (HUP) in Philadelphia, PA. I serve as the Director of Complex Ablation and Director of Cardiovascular Research at PAH. My practice is comprehensive of all available cardiac electrophysiology services including consultation, diagnostic electrophysiology studies, implantable device and lead management including implant, extraction, and leadless devices, and interventional and structural electrophysiology procedures. Interventional electrophysiology procedures that are performed are comprehensive and include catheter ablation of supraventricular tachycardia, atrial fibrillation, and ventricular tachycardia by both endocardial and percutaneous epicardial approaches as well as percutaneous left atrial appendage closure procedures. Cardiac device and lead management services include implantation and extraction of cardiac pacing, defibrillation, and resynchronization devices, as well as venoplasty. Cardiac device procedures also include leadless pacemaker implants and transvenous lead extraction using laser, mechanical, and transfemoral snare extraction tools. Since my arrival at PSOM in 2023, there has been growth in cardiac arrhythmia services and procedures at PAH and enhanced integration of complex arrhythmia care between PAH and HUP campuses.

Description of Other Expertise

I previously led the Quality Assurance Program within the Cardiac Electrophysiology Laboratory at the University of Maryland. In this role, I oversaw an improved consistency in team based quarterly quality reviews of patient and procedural outcomes. I implemented a broadening of team based quality initiatives to include nursing staff and data specialists.
I previously served as Medical Director of the University of Maryland Program in Atrial Fibrillation. This program started as our left atrial appendage closure program which I co-founded in collaboration with interventional cardiology and cardiac surgery colleagues. I introduced the Watchman and Lariat procedures to the University of Maryland – these were the first two FDA approved percutaneous devices for left atrial appendage closure as alternatives to anticoagulation for patients at elevated bleeding risk. In this role, I precepted other faculty who were training in left atrial appendage closure. The Program in Atrial Fibrillation subsequently developed as a comprehensive and integrated atrial fibrillation care program. Initiatives within the Program in Atrial Fibrillation include personalized medicine programs based on molecular diagnostics, cardiac imaging, digital health, and 3-D printing to risk stratify atrial fibrillation at diagnosis and ablation. The Program in Atrial Fibrillation developed multidisciplinary care pathways that include: physicians, pharmacists, nurses, dieticians, and trainees to improve AF care at healthcare access points, using the electronic health record (EHR), novel approaches to lifestyle modification, and both patient and professional education. Through this program, we 1) designed and implemented an emergency department pathway for acute atrial fibrillation to avoid hospital admission and expedite early consultation within days, 2) expanded our percutaneous and thoracoscopic surgical LA appendage, hybrid surgical-endocardial ablation, and comprehensive atrial fibrillation services, 3) implemented a quality improvement system to integrate registry metrics with the electronic health record. As our program grew, we further developed efforts to improve atrial fibrillation quality of care at practice, medical center, and health system levels. We partnered with the American Heart Association (AHA) in the Baltimore AHA AF Care Coordination Initiative. This included securing grant funding to implement digital data abstraction to participate in the AHA AF Get with the Guidelines Program to monitor and achieve quality of care metrics.
I co-founded and co-directed a collaborative Cardiovascular Genetics Clinic at the University of Maryland with an interest in evaluating patients and families with inherited arrhythmia and cardiovascular disorders. From this, I helped develop and Co-Directed the UMMC Hypertrophic Cardiomyopathy (HCM) Program – this was the only nationally recognized Center of Excellence in the Mid-Atlantic region at the time. The Maryland HCM Program specialized in the comprehensive clinical and molecular diagnostic evaluation and therapy of affected and unaffected patients and their family members. This multidisciplinary effort includes collaborations among adult and pediatric cardiologists, cardiac electrophysiologists, cardiac surgeons, geneticists and genetic counselors, and case managers.
Since my return to the University of Pennsylvania, I have served as the Director of Complex Ablation and Director of Cardiovascular Research at Pennsylvania Hospital. At Pennsylvania Hospital, I serve on the Credentialing Committee. Within the Department of Medicine, I represent Pennsylvania Hospital on the Professionalism Committee. At the University of Pennsylvania Health System Level, I served on the Cardiac Rhythm Monitoring Integration Committee. Our committee implemented electronic integration of cardiac monitoring data to Epic to allow for improved efficiency, reduced reading to report timing, and collection of discrete monitoring data. As this implementation effort completed, I have become a member of the both the PennChart Cardiac Device Governance Committeee and Ambulatory Monitoring PennChart Governance Committee. In both groups, we oversee implementation of data transfer, reporting, and integration with PennChart. I have recently started to work with Cardiovascular Division leadership and perioperative services leadership at Pennsylvania Hospital to review digital communication tools with patients for pre-procedure communication and analysis of perioperative delays and cancellations with a goal of streamlining and improving pre- and peri-procedure outcomes and efficiency.

Description of Research Expertise

One area of research is focused on examining how circulating biomarkers of cardiac fibrosis, myocardial injury, and cardiometabolic disease may influence outcomes in cardiac arrhythmia ablation procedures. From 2016-2018, I was awarded a Mentored Clinical Research Award from the American Heart Association titled “Integrated biomarkers of myocardial fibrosis and injury predict atrial fibrillation substrate and outcome.” From this grant, we have presented clinical data regarding circulating biomarkers and epicardial adiposity, myocardial substrate, and atrial fibrillation ablation outcome at national meetings including the American Heart Association, American College of Cardiology, Heart Rhythm Society, and Society for Cardiac Computed Tomography.
Another area of research is sudden cardiac death risk in both the general and specific populations. We examined sudden cardiac death risk in heart failure populations with resolved left ventricular dysfunction. A novel variant in the KCNQ1 gene has been identified by whole exome sequencing and characterized as a novel pathogenic variant that is enriched in the Amish Research Program and causes long QT syndrome, an inherited arrhythmia syndrome with increased risk of sudden cardiac death. Our Cardiovascular Genetics Program has reported the clinical utility of a diagnostic approach to long QT syndrome that integrates genetic testing. We are further studying the contribution of cardiomyopathy gene variants to the risk of unexplained sudden cardiac death both in the Amish Research Program and Hypertrophic Cardiomyopathy Program.
I have been the site principal investigator for multicenter clinical trials, principal investigator of investigator-initiated studies, and collaborated in studies centered within and outside of the Cardiac Electrophysiology Service. Focuses of these studies have included novel risk stratification of sudden cardiac death, novel heart failure device therapies, biomarker and imaging risk stratification of atrial fibrillation ablation outcome, inherited arrhythmia syndromes including long QT syndrome, new ablation techniques and technologies for atrial fibrillation and ventricular tachycardia, and novel pacemaker algorithms for treatment of hypertension.