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Focus on Mitchell Faddis, MD, PhD

Mitchell Faddis, MD, PhD is associate professor of medicine in the division of cardiovascular diseases and section head of cardiac electrophysiology.

Dr. Faddis sees patients at the Center for Advanced Medicine, Heart and Vascular Center, 4921 Parkview Place, 8th floor, Suite A; at the Heart Care Institute, 1020 North Mason Road and Barnes-Jewish West County Hospital, Medical Building Three, 1020 North Mason Road, Suite 100.

FOR AN APPOINTMENT, PLEASE CALL 314-362-1291.

What happened in the course of schooling to influence you to choose your specialty?

As an undergraduate, my interest in the electrical behavior of muscle cells led to research and ultimately a PhD. My focus on cardiovascular diseases came about as a result of my clinical training. What drew me to this specialty was the high intensity of the cardiac intensive care unit, the clinical procedures, and the fact that many of the cardiac problems were treatable.

What brought you to Washington University?

I came to Washington University in 1985 for medical school, and have been here ever since. From 1985 to 1998 it was college, medical school, residency and fellowship training. I have no regrets -- I love it here.
Dr. Faddis with his daughter on vacation in Quebec


Which aspect of your practice is most interesting?

Non-surgical ablation of arrhythmias (procedures to treat abnormal heart rhythms) is the most interesting. Although the themes are similar when short circuits develop in the heart, every patient is also a little different -- but usually treatable. The arrhythmias can be hard to pinpoint, and initially it’s not entirely clear that arrhythmia is the problem.

What new developments in your field are you most excited about?

Cardiac electrophysiology reinvents itself with a new technique about every five years. It’s very technology intense. A tremendous development combined MRIs, CT scans, as well as systems used in GPS technology to build three-dimensional reconstructions of the heart. We are able to overlay the heart’s electrical patterns seen on those reconstructions.

Atrial fibrillation is the most common electrical problem we come across. It involved abnormal electrical impulses in the upper two chambers of the heart. Yet, in spite of all the physiology, techniques and technology insights that have been developed, it’s still a very difficult condition to cure. We’re very dependent on new developments to bring a level of cure to atrial fibrillation that is similar to what we’ve achieved with other arrhythmias.

What is the standard treatment for atrial fibrillation?

We have a battery of medications designed to block atrial fibrillation, but they do it imperfectly. Some patients aren’t tolerant of the medicines, and there is a risk of life-threatening side effects. So in the end, there are many patients who continue to have atrial fibrillation in spite of pharmaceutical treatments.

In 1987, researchers at Washington University School of Medicine, led by James Cox, MD, developed a surgical cure called the Maze surgery to control these erratic impulses. In this procedure, surgeons make small, strategically placed incisions in the atria. The slits generate scar tissue that serves as barriers, trapping abnormal electric signals in a “maze” of barricades. Only one path remains intact, guiding impulses to their correct destination. It’s an open chest, on-bypass procedure that’s somewhat risky and arduous.

Because of its magnitude, there weren’t many patients with atrial fibrillation who were interested in Maze surgery. The hope was that large parts of that procedure could be translated into a catheter base – performed through IVs in the leg and requiring no surgical incisions. Over the past ten years, the catheter treatment has evolved as a very different technique compared to the Maze Surgery -- which was the initial impetus to design it.

For the least complicated forms of atrial fibrillation, the catheter-based procedure now has cure rates that approach 80% (sometimes a patient requires two treatments). Because atrial fibrillation counts for almost a third of all strokes in the United States, and there are about 3 million people in the country with this condition, there is a great deal of enthusiasm for this treatment. If we can cure atrial fibrillation, there’s a chance we can impact stroke mortality.

What causes atrial fibrillation?

It can be caused by complications of obesity, hypertension, obstructive sleep apnea, diabetes or aging. There’s a small set of patients with structural abnormalities that put tremendous stress on the heart. The resulting valve problems stretch out the upper chambers and stress is caused by excess blood. Any and all of those processes cause scar tissue to form in the upper chambers, and this promotes the electrically chaotic rhythm.

What research are you involved in?

Over the last 12 years, I helped develop a novel technique that uses magnetic fields to direct a catheter within the heart. It’s finally reached a state of evolution for use in atrial fibrillation patients. I have a clinical trial to study how efficacious it is -- we hope that it’s not only more effective, but safer than our standard manually controlled catheters.

The traditional catheter treatment is performed with a handheld catheter controlled from outside the body. The tip of the catheter doing the ablation is moved millimeters at a time, at a distance that is about three feet away from the controls. It’s like trying to sign your name with a pole that’s three feet long -- it’s not very precise.

The magnetic system is controlled by magnetic fields that interact with a tiny magnet in the tip of the catheter, and the computer uses three dimensional models to guide the tip to where we want it to be. The force that the catheter tip applies to the inside of the heart is about tenfold less than when we use a manually-directed catheter. That will probably mean it’s safer, and that’s what I’m trying to measure.

Because there is a fair amount of human skill involved with ablation and great variance in abilities from doctor to doctor -- the magnetic catheter is a revolutionary technology that will level the playing field. When a computer is guiding the catheter, there will be a consistency from procedure to procedure. If the doctor has played a video game, which most have, he or she will have the skill set to do the ablation.

Which particular award or achievement is most gratifying?

Being named head of the section of cardiac electrophysiology was most gratifying. Washington University has a long history of being on the leading-edge and defining many of the treatments in this area of medicine – which is relatively new. Through my training, I learned about this area of medicine from the people on staff here. It’s a great honor for me to be in charge of this section.

Where are you from?

I was born in Nebraska, and spent most of my childhood in Kansas. My dad teaches at the University of Kansas, and my wife’s family owns a store in Emporia, Kansas.

If you weren’t a doctor, what would you like to be doing?

I’d like to be a musician, but I’m not good enough. If I could play viola in a symphony orchestra -- that would be a wonderful job.

I like being a scientist -- maybe I would study a different area of science such as astronomy or math

What do you like to do in your spare time?

I have too many hobbies. I play in a community orchestra – the Town and Country Symphony. They have an ambitious concert schedule. The week before an orchestra concert, we’ll have about seven hours of rehearsals. I also like running, swimming, cooking and cycling.
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Copyright 2013 Washington University School of Medicine