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Sheldon Brownstein may carry the M.D. after his name, but around his fellow physicians he is simply known as “the electrician.”
As one of the very few electrophysiologists practicing locally, Brownstein is the guy to call when a patient’s heart problem is actually an electrical problem.
“All the rest of the guys – the cardiologists, etcetera – are the plumbers,” Brownstein explains. “But, if there’s something electrically wrong with the heart, I fix it. I’m the electrician.”
This past year at St. Elizabeth, the “electrician” has been busier than ever, performing a whole host of tasks, from mapping arrhythmias and cardiac ablation, to implantation of defibrillators and pacemakers. Brownstein said he thinks that medicine is finally beginning to sit up and take notice of the sometimes-miraculous kinds of treatments electrophysiology can provide.
National statistics back up that notion. According to the Heart Rhythm Foundation, electrophysiology is the single fastest growing of all the already fast-growing cardiovascular disciplines.
But, worldwide there are still precious few practitioners of this complex specialty. U.S. numbers reflect the international data, showing that currently there are just about 1,500 certified electrophysiologists currently practicing nationwide.
Brownstein is among just a handful practicing in the Greater Cincinnati region. For the past eight years, the Comprehensive Cardiology Consultants specialist has practiced at St. Elizabeth South in Edgewood. Recently, Brownstein sat down for a brief question-and-answer session about his specialty, as well how and when local physicians might seek such services for their patients.
Q&A With Doc
Q: What exactly is electrophysiology anyway, and what specifically do electrophysiologists do for patients?
A: Electrophysiology is the study of complex arrhythmias, as well as their diagnoses and treatment.
So basically, it’s figuring out what the arrhythmia is and then acting on it. … Sometimes that mean ablating arrhythmias. Sometimes, it’s ablation and other managements.
Q: When you say you “map out” the arrhythmia, what do you mean?
A: Well, to figure out where they’re coming from, I use a mapping system that is state of the art at St. Elizabeth … The computer and I work together - kind of like having a GPS inside of you … to map out the arrhythmia.
Q: Describe the kinds of patients you see?
A: I see young patients who are healthy with arrhythmias, as well as older patients who are sick with arrhythmias.
So some of (the arrhythmias) are congenital – they’re born with them … and they don’t come up until later in life. Then others, that occur with coronary artery disease, are more life threatening.
And the third type of people I see is people with cardio-myopathy, where something is wrong with the muscle – sometimes from hypertension and sometimes unknown causes. … The other type of patient is the patient who passes out for unknown reasons, what we call unexplained syncope.
Q: How, then, are these conditions treated through electrophysiology?
A: The ones who have congenital (arrhythmias) - many of them are abatable. So you go in, diagnose it using a 3-D computer mapping system, and from there you cauterize the (problem) areas inside the heart and you cure the problem. …
Some of the more complex ones are more amenable to drugs … so I may see them about a year and then send them on their way. …
The more complex cases – where the guy has a life threatening condition - those we end up putting in a device of some kind. And those are lifesaving devices, like pacemakers and defibrillators
Q: When should doctors refer patients to an electrophysiologist?
A: In general, the patients we’re seeing are either coming directly from their primary care doc, or the ER, or from their cardiologists.
Typically, this happens when they have an arrhythmia and (doctors) don’t know what to do with it. … There are some large ignorance factors, where doctors sometimes don’t understand what we can cure. … So what happens quite often anymore is (a doctor) will say, ‘Can you do anything for this guy?’ and I’ll tell them yes and (the doctor) will come back and say, ‘Wow, I didn’t know you could do that.’”
Q: What’s the state of this specialty locally?
A: Well, I’ve been here eight years and it’s really taken that length of time to get people excited about what we’re doing. … I’m at a point now where I have people say, ‘Can I come and watch (an electrophysiology study)?’ and I say, ‘Sure, come and watch’ because it kind of takes the mystique away.
Also, if it’s ablation, they’ll see a lot of high-tech stuff going on. They think it’s going to be boring, but it’s not. There’s a lot of computer stuff going on, but we use the computer as a tool to help us figure out what to do.
Q: What do you see for the future of this field?
A: I hope that we get more (doctors) going into this field. As it is we have only about 50 people being trained a year.
The field nationally, is exploding. And we’re getting into more and more complicated arrhythmias. I’m also taking on much more complicated things … and I think things will continue to get better as we continue doing these complicated things.
Facts About EP and Heart Disease:
- There is 1 electrophysiologist practicing in the U.S. for every 16 cardiologists.
- EP procedures require insertion of an electrode catheter into the heart from veins in the leg or neck.
- Electrophysiology provides diagnosis and therapy for:
- Atrial Fibrillation
- Heart Arrhythmias
- Sudden Cardiac Arrest
- Congestive Heart Failure
- Syncope
- Heart disease is the nation’s leading cause of death.
- Kentucky is one of five states with the nation’s highest rates for heart disease.
Sources: Heart Rhythm Foundation and Heart Rhythm Society.
