Why did you become a doctor?
Growing up, I was fascinated by science and biology. I toyed with the idea of getting a Ph.D. but chose medicine because I enjoy working with people. Practicing medicine is a very tangible way of doing good in the world. I like the instant gratification of helping someone, like Kathi, get her life back.
I was drawn to the engineering aspects of science. Cardiology is very mechanical. If you think about it, the heart is just a pump with a sophisticated electrical system. The mechanics fascinate me. Plus, cardiologists can often fix things that go wrong with the heart, which makes the specialty very rewarding.
What led you to cardiac electrophysiology as a sub-specialty?
Electrophysiology is the study of the heart's electrical system. As someone who loves electrical engineering and body mechanics, it's the perfect fit for me. I excel at logical problem solving, which is critical in my field. From a diagnostic standpoint, electrophysiology is incredibly demanding. An irregular heartbeat is an intricate puzzle waiting to be solved.
Can you explain your patient Kathi Sigona's heart problem?
Kathi has an abnormal heart rhythm called atrial fibrillation. Atrial fibrillation affects millions of people in the United States. Symptoms include heart palpitations, irregular heartbeat, shortness of breath and fatigue. Atrial fibrillation is the leading cause of stroke, so it's important to get it under control.
Up until a few years ago, drugs were the only option. But now a procedure called ablation is offering new hope. During an ablation, a thin catheter is threaded into the heart and used to destroy or disrupt parts of the electrical pathways that are causing the irregularity.
Why did you choose UCSF?
That's an easy one. The very first ablation in the world was done at UCSF in 1982, and UCSF has been a leader in the field ever since. The fact that a physician at UCSF was given the support and resources he needed to pioneer this work speaks volumes about the institution and its academic culture. In fact, I just saw the patient who got that first ablation. Today she's in her mid-40s and running marathons.
I first came to UCSF for my three-year residency. Then I stuck around for a four-year fellowship. After finishing my training, I landed my first academic job at Indiana University School of Medicine. I enjoyed my time in Indiana but when UCSF offered me a job in 2003, I jumped at the chance to return to the place where it all began.
In the field of electrophysiology, UCSF is at the epicenter. UCSF is full of the best, most innovative and talented electrophysiologists in the world. If you want to do this work in cardiology, UCSF is absolutely the best place to be.
Kathi remembers you asking "How do you really feel?" at her first appointment. Why is that question an important part of your exams?
That's what my work is all about. If I can't make people feel better and live longer, I don't have much to offer. How a patient feels on a day-to-day level is an important barometer for me. With something like atrial fibrillation, the symptoms can range from nonexistent to debilitating. I wanted to fully understand Kathi's experience before I made a recommendation for treatment.
UCSF has a reputation as a high-tech medical center with cutting-edge science, but none of that matters if we don't approach our patients with compassionate care.