Cardiac Rhythm Management
Articles Articles 2014 May


Samuel Asirvatham, MD and John Day, MD, FHRS, FACC

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Dr. Samuel Asirvatham of the Mayo Clinic is interviewed by Dr. John Day on his experience and life time achievements.

Day Can you tell us about your childhood and what ultimately led you to the field of EP?

Asirvatham My childhood was in a difficult time and spent mostly in India, although we did travel outside India significantly during my school days. My early goal was clearly on a path towards theoretical physics. It was my physics mentor who eventually convinced me that I was more suited for medicine but to make physics and electronics a hobby down the road. In medical school, I had focused on neurosurgery, particularly the electrophysiological mapping for stereotactic surgery. It was the decision to come to the United States that made me re-explore career options, and, at this time, while I was waiting for a patient to be put on the table in my hospital, I read a landmark paper from Dr. Jackman on non-surgical arrhythmia ablation. I knew immediately that this was a field that would grow, and the logic of the writing and findings in the manuscript was spellbinding. The decision was made on that day.

Day Can you tell us about your family?

Asirvatham My father is the most remarkable man I have met thus far in life. He combined success at so many levels, achieved in the most trying and difficult circumstances, and yet was the most consistently inspiring and positive man I came across. My wife, Usha, is the most giving, insightful person, and simultaneously the most cognizant of fulfilling all responsibilities that I have come across. She is the most remarkable person that I have had the privilege to know. I have three children: the first, Rohit, an aspiring lawyer and part-time comedian; a daughter Roshini, an aspiring electrophysiologist and part-time writer; and my youngest son Hemanth, an aspiring software engineer and inventor and part-time clown. My sister is a GI radiologist and was and always will be the brains of the family.

Day I hear you are a semi-professional chess player and that in India you would play several chess matches simultaneously while blindfolded. Is this true? Can you tell us about your chess career?

Asirvatham I was a competitive chess player but never professional, and in adult life I donated any prize winnings. I was privileged to be the least talented member of my home city's only chess club, a club that has subsequently produced four grand masters, 18 international masters, India's best chess coach, and one world champion. It was early and highly instructive exposure for me to understand what world-class talent and mental prowess can be.

While most competitive chess players are capable of simultaneous blindfolded displays, I did do more of these exhibitions than most of my contemporaries. In my first job after medical school, I was the only physician in a fairly large village hospital. We were continuously short of funds, and to try and raise money I invited anyone who would pay to face me in a simultaneous blindfolded match. The outpatient waiting room could seat 16 people, so I would play 16 at a time, and it became a good breadwinner for our hospital, so I did it every other week continuously for 2 years. I had an unbeaten streak of about 60 matches and then lost to an 11-year-old boy who would become my student and later the number 1 ranked player in the state I was working in, and number 6 in the nation in his age group. To put this in perspective, however, truly good chess players, even a lower-ranked grand master can quite easily play upwards of 30 people simultaneously, blindfolded. I presently do not play competitive chess, but until 2005 I taught chess in a small school particularly for younger people.

Day Can you tell us about your EP training experience in Oklahoma under the tutelage of Dr. Jackman? What was the most important lesson you learned from fellowship?

Asirvatham My time in Oklahoma was an amazing period as a student and for the EP field. It was incredible to be in the presence of true giants, Drs. Lazzara, Scherlag, Jackman, Xunzhang Wang, Mario Gonzalez, Hiroshi Nakagawa, and Mauricio Arruda, among others. Each of them were visionaries and movers of the electrophysiology field in their own right. The two most important lessons I learned from that time were:

A. Integrity and honesty when trying to interpret and treat an arrhythmia.

B. A vision of the level at which invasive electrophysiology can operate that I likely would never have seen otherwise.

Day What has been the biggest struggle of your EP career?

Asirvatham Finding the time that I know it takes to counsel and comfort the number of patients who seek us in clinic and in the EP laboratory, while yet trying to innovate or devise the solutions that need to come in the future, continues to be a major struggle.

Day If you could have any “do overs” in your career, what would you have done differently?

Asirvatham There are two that come to mind immediately:

A. When I was the physician in our village hospital, many patients would come in without money but seeking emergent care. Whenever I could, I had been paying out of pocket or trying to raise money, but this was causing a catastrophic financial loss for the hospital since I was only providing for the admission fees. The nurses, allied staff, gardeners, etc., had just met with me and explained to this 22-year-old upstart that it simply would not work, and I must learn to turn patients away. About 20 minutes later, the emergency bell rang. An older man, whom I had treated previously for abdominal trauma, had come running several kilometers carrying his grandson who had a high fever and seizures for our care. He did not have any money. The grandfather knew my style and expected me to pay. I did not and turned him and his grandson away. I remember him looking straight at me, wondering what had changed and if I was the same person. I never found out what happened to that young boy, but I am sure I know. Until today, the look in the grandfather's eye haunts me. I instruct our trainees frequently to remember that the immediate needs of those who seek our help—our patients—are real. The greater good may or may not exist.

B. A few years ago, I was asked to come and visit another facility as a possible recruit to their faculty. I had not realized that the prior director of the EP lab in that facility was still in the process of transition. While the visit was more general and involved providing input, by coincidence, it occurred at the same time as a meeting where the former director had invited me to speak. This understandably gave the appearance of subterfuge, and while that was clearly not even a remote intention, it led to prior friends and respected colleagues feeling maligned. It taught me that in relationships with colleagues who do not know you personally, not to assume that they would think the best of your intentions at all times.

Day How has the field of EP changed in your career? What changes do you expect to see in the future?

Asirvatham I believe atrial fibrillation ablation has changed the field of EP for a generation of trainees. The focus is more on imaging and anatomy and less on physiology. Unfortunately, I believe that for solving AF in a meaningful fashion, the next generation will need to concentrate far more on physiology, possibly myocardial and neural physiology.

Day What motivates you to get out of bed each morning and do what you do?

Asirvatham The knowledge that there is someone whose life is unpleasant because of an arrhythmia and either I or a student can potentially change that is a tremendous motivator.

Day What has been the greatest success or accomplishment of your career?

Asirvatham The accomplishments in my career that I value the most include the knowledge that through interactions with them, young electrophysiologists have developed a love and appreciation for our art. The greatest accomplishment in life so far has been the knowledge that I have been able to at least partially instill the values in my children that my father instilled in me.

Day You have won many teaching awards over the course of your career. Why is teaching so important to you? What motivates you to give so much of your time to teaching others?

Asirvatham I cannot even come close to giving to our trainees and students what I have been fortunate to receive from truly unbelievable teachers. My professor of physiology and professor of anatomy were not only great teachers, but their insights now seen in retrospect are simply amazing. However, my physics mentor, who in his own right was a leading physicist, was a teacher like no one else. I spent, after hours, anywhere from four to eight hours in his home, and then hitchhiking a ride back to my own home because public transportation would have stopped. He answered any and every question, and I always left fulfilled and challenged at the same time. Most remarkable is that Professor Gnanapragasam never took a paisa (penny) for all this instruction. With examples like that, how can I not be compelled to teach?

Day Can you tell us about some of what you are doing to help develop the EP community and training in India?

Asirvatham Anything that I have done or tried to do in India has not been philanthropy, but is simply the duty to give back to a place and people that I gained tremendously from. I have tried to do this by teaching and guiding when I can, directly supporting patient care, and sponsoring chess and talent-finding tournaments in small areas. EP in India has come a long way and now is more of a mutual learning experience than teaching per se.