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Becker’s Healthcare Podcast
Dr. Mansour Razminia on Advancing Electrophysiology with ICE and Radiation Free Ablation
00:20:36
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- [00:00]
A
Welcome everyone, to the Beckers Healthcare Podcast. I'm Mariah Taylor, assistant editor, and I'm thrilled to be interviewing Mansoor Razminia, Medical Director of Electrophysiology for the Bloom Cardiovascular Institute at Northwestern Medicine Palos hospital. Thank you, Dr. Rosmenia, for joining me today. I'm so excited to learn more about your innovations in ice. But before we dive into that, I'd love to give you a chance to introduce yourself and tell us a little bit more about your background.
- [00:28]
B
Thank you so much, Mariah, and thank you very much for the opportunity. My name is Mansoor Razmini. I'm a cardiac electrophysiologist, practicing EP, in short, we call it EP, of course, and practicing for about 23, 24 years as a cardiac electrophysiologist. And I joined Northwestern Medicine Palos Hospital about a little bit less than two years ago, and we have been having a quite robust and very busy program here.
- [00:59]
A
Excellent. Now, some of our listeners might already be familiar with you, and some of them might not, but I just wanted to note that you're considered to be a pioneer in the ICE procedure and implementing it in hospitals. And for everyone listening, they might already know you, though they might know you by your nickname, the Ice King. So can you tell us a little bit more about what you're doing with ice and how it's been changing the industry?
- [01:27]
B
Sure. Thank you so much. That was a nice introduction. So basically, ICE is short for intracardiac echo. So basically we use intracardiac ultrasound for couple decades during almost every procedure when we perform CAT ablation. So ice is so essential that it really helps us to be able to see our catheters, see the contact of our catheters with the heart tissue during the procedure. Basically going back to many, many decades ago, epa, we started doing ablation. Our pioneers started doing this probably three or four decades ago. And then ICE was introduced about 20, 25 years ago. And we were able to place this small catheter through the groin into the heart and visualize the heart so clearly that it really made our procedures going much smoother and I believe, much safer. In 2010, I started performing catheter ablation. Try to understand the ice as good as. So we can perform every procedure without needing any fluoroscopy, because if you are going to be able to understand the ice, you would be able to see everything. So there is really no need to use any X ray during the procedure. So I started teaching myself the ice, how I can manipulate the ice without using X ray, how I can see the ice going to different chambers of the heart and how I can stop using any X ray during any procedure, actually exactly December 8, 2010, which is close to 16 years ago, was the last day I ever use X ray. So I have done over 7,500 procedures of ablation without consecutive, without any X ray. So the main thing with the eyes has been basically to be able to visualize your catheter, visualize the heart muscle, visualize to see if there is any immediate complication, without, you know, seeing anything on the X ray and then being able to perform these procedures without putting the patient and in the risk of radiation exposure. You know, some of this procedure, in the past it used to take hours of X ray, now we are reducing it. But still majority of the hospitals, especially the teaching hospitals, they use X ray during their every catheter ablation procedures. But being able to understand the ice, being able to rely more on the ice as opposed to X ray, it has so many advantages. You know, we can expose the patient. We don't need, we don't want to expose a patient to X ray. Imagine that some of these patients, everybody knows if you have afib, you may have sometimes people who have chronic afib, they may have, you know, they may need to come for few more procedures for afib, especially if that is has been a very long standing afib. So each time they are going to be coming and you're going to expose this patient to radiation. There is, there is it just, even though it may be small, but there is a risk of radiation exposure, skin burn, radiation exposure, cancer, genetic changes in the future, and staff in the lab who are going to be exposed to this radiation every day. And being, you know, wearing all those heavy lead aprons, it's really. Then you're going to see a lot of orthopedic injuries of the people who work in this industry. My colleagues as physician, take it from physician to the staff, all the techs, nurses in the lab. So that is what ICE has been able to help me to be able to completely eliminate radiation. I never forget that this was about 15 years ago that I was called and then from another hospital that they had a patient on the table and they realized the patient was pregnant, but they had already started the procedure. So even though I was not working in that hospital, they called me and I was happy to just immediately go get into my car, drive to that hospital and just teach them by not even scrubbing because I didn't have privilege, but letting them know how to perform that procedure without x Ray so they were able to perform that procedure, entire procedure, without exposing that pregnant patient to radiation. And of course, we usually don't want to do any procedure on a pregnant woman. You know, we want to do conservatively. But it is, if it is something that we absolutely have to go ahead and perform this procedure because of the, you know, some rhythm abnormalities that may put the patient or the baby at risk, we can certainly take these patients and perform this procedure without exposing mom and the baby to any radiation. So this really has been a paradigm shift. It really helps everybody to be able to understand this. They would be able to learn this and being able to perform every procedure as far as ablation is concerned in the EP lab without exposing patients, the physician or the lab staff into radiation exposure.
- [07:28]
A
That's an amazing example. I know here at Becker's we've covered several societies and lawmakers who are pushing to get rid of those heavy lead vests you were talking about. Just because for those exact reasons, it's hurting physicians long term and it's leading to joint problems and all these other issues. So, so this alternative sounds like a really great way to help physicians in the cath lab and also to deal with kind of an issue hospitals are managing, which is how do you reduce that radiation. Right. In a cost effective way. And what I think is maybe more interesting about your experience and your background is that you've built this national and even international reputation around using ice, all while working outside of an academic center, which is where we usually see the pioneers of procedures like this. So I'd love to know how has been in a community hospital environment influenced your ability to innovate and where has it created some friction compared to an academic setting?
- [08:31]
B
Sure, excellent question. So basically we started, you know, as I mentioned, I started doing these procedures in 2010 and at the time, actually I was at Illinois Masonic, a community hospital we were affiliated with at that time with uic. And I was training two fellows every year. So two EP fellows. And really I just want to let you know that really those two fellows that we were able to train every year probably were the only fellows in the world that they were being exposed to completely X ray free procedures or so they become really the best, you know, physicians who were going to be out, going out and starting practicing electrophysiology without exposing any of their patients to X ray. So it is very interesting, one of my fellows that she graduated many years ago when I was training at Masonic. The fellow, that person, she had gone to a another state and interestingly enough she was pregnant and they had told her that they are not going to. So they have to wait for her to start performing in the lab. And she had said no, I would do my every procedure without having let on. So she started doing ablation procedure while she was herself, she was pregnant. So as we all know, absolutely, we all owe it to all the pioneers who have been in academic centers. Everything where we are right now, we take it for granted because that is what we started learning from all those pioneers, pioneers because they taught us what the EP is. But then things started changing. You know, in majority of the academic centers, probably almost all, all of them, I don't know of any academic center at this stage that they do their entire procedures including watchman implantation without any X ray. So all those fellows that are going to are being trained right now, many of them, they are having heavy exposure to X ray. So that is what I think is missing because including I have always talked about Heart Rhythm Society. So we just have the heart rhythm. We are going to have heart Rhythm Society conference in, in here in Chicago. But including Heart Rhythm Society we have never had any dedicated, you know, a good day of lectures, hands on lectures to be able to train physicians. So if the physician who is in academic center as an attending and working for 10 to 20, maybe 30 years and they just place the ice intracardiac echo inside the heart to puncture the septum to go to the left atrium and then they leave it alone and the rest of the procedure would be done with X ray and mapping. So that person probably won't be able to train a fellow to be able to be exposed to radiation reduction. The main thing is what my message is this. We don't want to necessarily talk about keep saying floraless or irradiation free procedure. It is the matter of the fact is when you understand the ice, when you know the ice and when you use the ice for any, every single procedure, for every part of this procedure inside the heart. And if you are performing a procedure in the left atrium, you place the ice inside the left atrium. If you're performing an ablation in the right ventricle, you place the ice inside the right ventricle. If you know how to do that and if you train your fellows, then you understand that there is no need to use any X ray because absolutely X ray in that situation would be completely useless because it is going to show fewer, you know, ribs, two lungs, a hard shadow and a catheter going right and left. It doesn't have any other significance of Significance in. During that procedure. So because of that, you know, many times this has been actually sponsored mainly with the industry. So to be honest with you, Abbott, which used to be Saint Saint Jude, I started, I founded this conference that Abbott is sponsoring called Refine, which is Radiation Reduction in Electrophysiology or Radiation Elimination Electrophysiology. And because of those, because I helped Mentis to develop a simulator. So when we have these conferences, which is a workshop, it is literally a boot camp because it is 11 hours, so three hours like on a Friday and eight hours on a Saturday. And this is a boot camp that usually 24 physicians come and we have 11 simulators, one for me and one for every kind of two physicians. And then that boot camp really, when they come to those refined, you know, seminars, they really many of those physicians and majority of them, they are the fellows. That is the only way they would be able to really come and understand the ICE at their beginning of their career. And then they come, let's say, imagine like a martial art. They come with a white or yellow belt. They. Everybody leaves that conference with a black belt and four stripes on it. Because you imagine sitting behind a simulator and just listening and whatever I try to teach them, we go back and forth, back and forth. And at the end they, they are mesmerized. They are stunned at how much they didn't know about the ice and when they leave, how much they understood about the ice. So we do three or four of these Refine in us. I do three of them back to back on a. Usually on a Thursday, Friday and Saturday in Brussels for European physicians. And some of them we do. We are going to do like now one in Mexico. Last year we did one in Colombia. So we do a lot of them in the outside of the country, you know, internationally, basically to be able to disseminate this knowledge of the ice. I always say, you know, I love how we were able to come here, but it is time for change. We cannot say still that, okay, we had the Ford Model T and we are going to go with Ford Model T. Now it is, it is electric car. Now it is lucid, it is Tesla. Let's change. Let's just not be get stuck in the back that that is how we do it. Because I always say, really, you know, this is not my quote, but I love this quote that says the most dangerous phrase in a language is we have always done it this way. That is not right. We have to be open to change. But doing this for 15, 16 years, it has been a really Battle to be able to change the, especially the, you know, the academic centers to try to have it, you know, rely more on ice. But again, for an attending to be able to teach the fellow how to use the ice, that attending first has to know the ice. But the way that I see it, there are extremely few physicians that I know of that they are so good and they would be able, and their fellows are extremely lucky to be able to learn and come out of that program and being able to help their patient and help their staff and themselves without radiation exposure. I just want to tell you this, that there was a study many, many, many years ago that really they showed there was a study published that because the X ray always stays on our left side, left hand side, when during the procedure. So they had looked at the brain tumor on the physicians, including EP radiologists as well as interventional radiologists and interventional cardiologists. You know, if you have brain tumor in a normal population, it's going to be 50, 50 on the right and left. But they had looked at that and they had seen that 84% of the tumors on those physician was on the left side. Which means unfortunately, probably because of radiation exposure, let alone other things such as cataract and everything else. But really it has been very difficult to be able to really convince, especially the academic centers that to please come learn and teach your fellows because this is the most important thing that you can do and you can save at this stage. You're back. You know, many of these physicians, they may, you know, we are getting older, we are getting back pains, knee pain, hip pain. Why do I have to wear that lead apron? Entire procedure. I sit down on a surgical chair, do my procedure and everybody is happy because nobody was wearing lead. Patient is very happy. So everybody is happy. So this is something that I really. It has to start somewhere. It is 16 years too late for Hartm society and other societies to really look into it and to see that what are the ways that we may we can do this realistically happening because me Starting this in 2010, I published two books. My co editor is Dr. Paul Tsai who is at Brigham Woman. And he's one of the only ones in the world that also perform all these procedures, you know, without radiation exposure. And we wrote these books. We know we. I play so many movies in it. I In my second book, our second book, I have 14 movies for a duration of almost four hours. All of them are narrated from five minutes to 35 minutes. And this is how I have been able to you know, disseminate the knowledge so that they can see this. Some of these people really some of the physician called me to say, Dr. Razmi, I just went to your book watch your video and was prior to my procedure because I was going to do this procedure on Monday. So I was looking at that video how I should do that. But then it is just watching this video is something but being able to really being trained your two years of EP fellowship and performing that is, you know, is very different.
- [20:08]
A
Absolutely. And it's just so cool hearing you talk about what it's like to be at the forefront of this new procedure and helping to bring it to the mainstream practices. So really appreciate you taking the time to walk us through that a little bit more all the advantages you're seeing in some of those use cases. So thank you again for being on the podcast today and thank you to everyone who joined us.
- [20:32]
B
Thank you. Thank you so much, Maria.