Latest / Becker’s Healthcare Podcast / Dr. Mansour Razminia on Advancing Electrophysiology with ICE and Radiation Free Ablation

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Dr. Mansour Razminia on Advancing Electrophysiology with ICE and Radiation Free Ablation · Becker’s Healthcare Podcast

0:00
Welcome, everyone, to the Becker's Healthcare Podcast. I'm
0:03
Mariah Taylor, assistant editor, and I'm thrilled to
0:05
be interviewing Mansur Rasminia,
0:08
medical director of electrophysiology
0:10
for the Bluhm Cardiovascular
0:12
Institute at Northwestern Medicine Palos Hospital.
0:15
Thank you, doctor Resminia, for joining me today.
0:17
I'm so excited to learn more about your
0:20
innovations in ICE. But before we dive into
0:22
that, I'd love to give you a chance
0:24
to introduce yourself and tell us a little
0:26
bit more about your background.
0:27
Thank you so much, Mariah, and thank you
0:29
very much for the opportunity. My name is
0:31
Mansoor Rasmini. I'm a cardiac electrophysiologist,
0:34
practicing
0:37
EP. In short, we call it EP, of
0:39
course, and practicing for,
0:41
for about twenty three, twenty four years as
0:43
a cardiac electrophysiologist.
0:45
And
0:46
I joined,
0:48
Northwestern Medicine Palos Hospital about, a little bit
0:51
less than two years ago, and
0:54
we have, been having a quite robust and,
0:57
very busy program here.
0:59
Excellent.
1:00
Now some of our listeners might already be
1:02
familiar with you, and some of them might
1:05
not. But I just wanted to note that
1:07
you're considered to be a pioneer in the
1:09
ice procedure and implementing it in hospitals.
1:13
And for
1:14
everyone listening,
1:15
they might already know you, though they might
1:18
know you by your nickname,
1:19
the ice king. So can you tell us
1:22
a little bit more about what you're doing
1:23
with ICE and how it's been changing the
1:25
industry?
1:26
Sure. Thank you so much.
1:28
That was a nice introduction.
1:31
So, basically,
1:33
ICE is short for intracardiac
1:35
echo. So, basically, we use intracardiac ultrasound
1:39
for couple decades during
1:42
almost every procedure,
1:44
when we perform catarablation.
1:47
So ICE is so essential
1:49
that
1:50
it really helps us to be able to
1:53
see our catheters, see the contact of our
1:55
catheters with the heart tissue during the procedure.
1:58
So,
2:00
basically, going back to
2:03
many, many
2:04
decades ago, EP started we started doing ablation.
2:07
Our pioneers started doing this,
2:10
probably three or four decades ago.
2:12
And then ICE was introduced about twenty, twenty
2:16
five years ago, and we were able to
2:18
place this
2:19
small catheter through the groin into the heart
2:23
and visualize the heart
2:25
so clearly that it really made
2:28
our procedures
2:29
going much smoother and, I believe, much safer.
2:32
So
2:33
in,
2:34
2010,
2:37
I started performing
2:39
catheter ablation, try to understand the ice as
2:43
good as so we can perform every procedure
2:47
without needing any fluoroscopy.
2:49
Because if you are gonna be able to
2:51
understand the ice,
2:53
you would be able to see everything. So
2:55
there is really no need to use any
2:58
X-ray during the procedure. So I started
3:02
teaching myself
3:03
the ice, how I can
3:05
manipulate the ice without using X-ray,
3:08
how I can see the ice going to
3:10
different
3:12
chambers of the heart,
3:13
and how
3:14
I can
3:16
stop using any X-ray during any procedure. Actually,
3:19
exactly 12/08/2010,
3:23
which is close to sixteen years ago, was
3:25
the last day I ever used
3:27
X-ray.
3:28
So I I have done
3:31
over seventy
3:32
seventy five hundred procedures
3:34
of ablation without consecutive without any
3:37
X-ray. So the main
3:39
thing with the eyes has been basically to
3:42
be able to visualize your catheter, visualize the
3:44
heart muscle, visualize to see if there is
3:47
any
3:47
immediate complication without,
3:49
you know, seeing anything on the X-ray, and
3:52
then being able
3:54
to perform these procedures without
3:57
putting the patient
3:59
in in the risk of radiation exposure. You
4:01
know, some of this procedure in the past,
4:04
it used to take
4:06
hours of X-ray. Now we are reducing it,
4:09
but still
4:10
majority of the hospitals, especially
4:13
the teaching hospitals, they use
4:16
X-ray during their
4:18
every catheter ablation procedures. But being able to
4:22
understand the ice, being able to
4:26
rely more on the ice as opposed to
4:28
X-ray,
4:29
it has so many advantages.
4:31
You know, we can expose the patient. We
4:34
don't need we don't wanna expose a patient
4:36
to X-ray. Imagine that some of this patient,
4:39
everybody knows if you have AFib, you may
4:41
have sometime
4:43
people who have chronic AFib. They may have,
4:46
you know,
4:47
they may need to come for few more
4:49
procedures for AFib, especially if that is has
4:52
been a very long standing AFib. So each
4:54
time they are gonna be coming
4:57
and you're gonna expose this patient to radiation,
5:00
there is there is in it just even
5:02
though it may be small, but there is
5:04
a risk of radiation exposure, skin burn, radiation
5:08
exposure, cancer, genetic changes in the future,
5:11
and
5:13
staff in the lab who are gonna be
5:14
exposed to this radiation
5:17
every day.
5:18
And
5:19
being, you know, wearing all those heavy lead
5:22
aprons, it's really then you're gonna see a
5:24
lot of orthopedic injuries
5:26
of the people who work
5:28
in this industry. You know, my colleagues,
5:32
as physician, take it from physician to the
5:34
staff,
5:35
all the techs, nurses in the lab.
5:38
So that is what
5:40
ICE has been able to help me to
5:43
be able to completely
5:45
eliminate radiation. I never forget that,
5:49
this was about fifteen years ago that
5:52
I was called,
5:54
and then from another hospital that,
5:57
they had a patient on the table and
5:59
they realized the patient was
6:02
pregnant,
6:03
but they had already started the procedure. So
6:05
even though I was not working in that
6:06
hospital, they called me and
6:09
I was happy to,
6:11
you know, just immediately go
6:13
get into my car, drive to that hospital,
6:16
and
6:17
just teach them by not even scrubbing because
6:20
I didn't have privilege. But
6:22
letting them know how to perform that procedure
6:25
without X-ray. So they were able to perform
6:27
that procedure, entire procedure
6:29
without exposing that pregnant patient
6:32
to radiation. And, of course, we usually don't
6:35
wanna do any procedure
6:36
on a pregnant woman. You know, we wanna
6:38
do conservatively, but it is if it is
6:41
something that we absolutely
6:42
have to
6:43
go ahead
6:44
and perform this procedure because of the, you
6:47
know, some rhythm abnormalities that may put the
6:49
patient or the baby at risk, we can
6:52
certainly take these patients and perform this procedure
6:56
without
6:57
exposing
6:57
mom and the baby to any
7:00
radiation. So this really has been a paradigm
7:03
shift. It really helps everybody
7:07
to be able to understand this. They would
7:09
be able to learn this and being able
7:12
to perform every procedure,
7:15
as far as,
7:16
you know,
7:17
ablation is concerned in the EP lab without
7:20
exposing
7:21
patients, the physician, or the lab staff into,
7:25
radiation exposure.
7:27
That's an amazing example. And I know here
7:30
at Becker's, we've covered several societies and lawmakers
7:34
who are pushing to get rid of those
7:36
heavy lead vests you were talking about just
7:38
because for those great reasons, it's hurting physicians
7:41
long term, and it's leading to joint problems
7:44
and all these other issues.
7:45
So this alternative sounds like a really great
7:49
way to help physicians
7:51
in the cath lab and also to deal
7:54
with kind of an issue hospitals are managing,
7:57
which is how do you reduce that radiation,
7:59
right, in a cost effective way.
8:02
And what I think is maybe
8:04
more interesting about your experience and your background
8:07
is that you've built this national and even
8:10
international reputation around using ice all while working
8:14
outside of an academic center, which is where
8:17
we usually see the pioneers of procedures like
8:19
this. So I'd love to know how has
8:22
being in a community hospital environment influenced your
8:25
ability to innovate,
8:27
and where has it created some friction compared
8:29
to an academic setting?
8:31
Sure. Excellent question. So, basically,
8:35
we started you know, I as I mentioned,
8:37
I started doing these procedures in 2010.
8:40
And at the time, actually, I was at
8:43
Illinois Masonic,
8:44
a community hospital. We were affiliated with, at
8:47
that time, with UIC,
8:48
and I was training two fellows
8:51
every year. So two EP fellows. And,
8:55
really, I just wanna let you know that,
8:57
really, those two those two fellows that we
9:00
were able to train every year
9:02
probably were the only fellows in the world
9:06
that they were
9:08
being exposed to completely
9:12
X-ray free procedures. Also, they become
9:15
really the best, you know, physicians who were
9:18
gonna be out going out and starting practicing
9:22
electrophysiology
9:23
without exposing any of their patients
9:26
to X-ray. So it is very interesting. One
9:29
of my fellows that she graduated,
9:34
many years ago when I was training at
9:37
Masonic,
9:38
the fellow that person,
9:40
she had gone to a
9:42
another state.
9:44
And interestingly enough,
9:46
she was pregnant, and they had told her
9:49
that they are not gonna
9:51
should they have to wait for her to
9:53
start
9:54
performing in the lab? And she had said,
9:56
no. I would do my every procedure without
9:59
having let on. So she started doing ablation
10:02
procedure while she was herself, she was pregnant.
10:06
So
10:07
as we all know, absolutely, we all owe
10:10
it to all the pioneers who have been
10:12
in academic centers.
10:14
Everything where we are right now, we take
10:17
it for granted because
10:19
that is what we started learning from all
10:22
those pioneers
10:23
pioneers,
10:24
because they taught us what the EP is.
10:27
But then
10:29
things started changing. You know? In
10:32
majority of the academic
10:34
centers,
10:36
probably almost all all of them,
10:39
I don't know of any academic center at
10:41
this stage
10:42
that they do their entire procedures,
10:45
including watchman implantation
10:48
without any X-ray. So all those fellows that
10:51
are gonna are being trained right now,
10:54
many of them, they are having heavy exposure,
10:58
to X-ray. So
11:00
that is what I think is missing because
11:05
including I have always talked about heart rhythm
11:08
society. So we just have the heart rhythm
11:10
we are gonna have heart rhythm society
11:14
conference,
11:15
in in here in Chicago. But including
11:18
heart rhythm society, we have never had
11:21
any dedicated,
11:23
you know,
11:25
a good day of lectures,
11:27
hands on lectures
11:29
to be able
11:30
to train physicians. So if the physician
11:33
who is in academic center as an attending
11:36
and working for ten to twenty, maybe thirty
11:39
years,
11:40
and
11:41
they just placed the ice intracardiac echo inside
11:44
the heart to puncture the septum to go
11:46
to the left atrium, and then they leave
11:48
it alone and the rest of the procedure
11:50
would be done with X-ray and mapping.
11:52
So that person probably won't be able to
11:56
train a fellow
11:57
to be able to be exposed to radiation
12:00
reduction.
12:01
The main thing is what I my message
12:03
message is this.
12:05
We are not we don't wanna necessarily
12:07
talk about keep saying fluoro less or radi
12:10
radiation free procedure. It is the matter of
12:12
the fact is
12:14
when you understand the ice,
12:16
when you know the ice and when you
12:18
use the ice for every single procedure, for
12:22
every part of this procedure inside the heart.
12:24
And if you are performing the procedure in
12:27
the left atrium, you place the ice inside
12:28
the left atrium. If you're performing an ablation
12:31
in the right ventricle, you place the ice
12:33
inside the right ventricle. If you know how
12:35
to do that and if you train your
12:37
fellows,
12:38
then you understand that there is no need
12:40
to use any X-ray because absolutely X-ray in
12:43
that situation would be completely useless because it
12:46
is gonna show few, you know,
12:49
rips and two lungs, a heart shadow, and
12:51
a catheter going right and left. It doesn't
12:53
have any other
12:55
significance of,
12:57
significance in
12:58
during that procedure.
13:00
So because of that,
13:02
you know, many time this has been actually
13:04
sponsored mainly
13:05
with the industry. So to be honest with
13:08
you, Abbott, which used to be Saint Saint
13:10
Jude,
13:11
I started I
13:13
founded this, you know, conference that Abbott is
13:17
sponsoring called Refine, which is radiation reduction in,
13:21
electrophysiology
13:23
or radiation elimination electrophysiology.
13:25
And because of those, because I helped Mantis
13:28
to
13:29
develop a simulator. So when we have these
13:31
conferences,
13:32
which is a workshop, it is literally
13:35
a boot camp because it is
13:37
eleven hours. So three hours, like, on a
13:39
Friday and eight hours on a Saturday. And
13:42
this is a boot camp that usually 24
13:45
physicians come,
13:46
and we have 11 simulators, one for me
13:49
and one for,
13:51
every kind of two physicians. And then that
13:54
boot camp,
13:55
really, when they come to those
13:58
refined,
13:59
you know,
14:00
seminars,
14:02
they
14:03
really many of those physicians and majority of
14:06
them, they are the fellows. That is the
14:07
only way they would be able to really
14:09
come and understand the ice at the beginning
14:12
of their career.
14:13
And then they come, let's say imagine, like,
14:16
a martial art. They come with a white
14:18
or yellow belt. They everybody leaves that conference
14:23
with a black belt and four stripes on
14:25
it because you imagine sitting
14:28
behind the simulator
14:29
and just listening
14:31
And whatever I try to teach them, we
14:33
go back and forth, back and forth. And
14:35
at the end,
14:37
they they are mesmerized. They are
14:40
stunned at how much they didn't know about
14:43
the ice. And when they leave,
14:45
how much they understood about the ice. So
14:48
we do three or four of this refined
14:50
in US.
14:52
I do,
14:53
three of them,
14:55
back to back on a usually on a
14:58
Thursday, Friday, and Saturday in Brussels for European
15:02
physicians.
15:03
And some of them, we do we are
15:05
gonna do, like, now one in Mexico. Last
15:08
year, we did one in Colombia. So we
15:10
do a lot of them in the
15:12
outside of the country,
15:14
you know,
15:15
internationally, basically, to be able to disseminate
15:20
this knowledge of the ice. I always say,
15:22
you know, I love how we were able
15:25
to come here, but
15:26
it is time for change.
15:29
We cannot say still that, okay.
15:31
We had the Ford model t,
15:34
and we are gonna go with Ford model
15:36
t. Now it is
15:38
it is electric car now. It is lucid.
15:41
It is Tesla.
15:42
Let's change. Let's just not be get stuck
15:45
in the back that that is how we
15:47
do it. Because I always say,
15:49
really, the you know, this is not my
15:51
quote, but I love this quote that says,
15:54
the most dangerous phrase
15:56
in a language is
15:59
we have always done
16:01
it this way. That is not right. We
16:04
have to
16:05
be open to,
16:07
change. But
16:09
doing this for fifteen, sixteen years,
16:12
it has been a really battle to be
16:15
able
16:16
to change
16:18
the especially
16:19
the, you know, the academic centers
16:22
to try to have it, you know, rely
16:25
more on ice. But, again, for an attending
16:27
to be able to
16:29
teach the fellow
16:30
how to use the ice,
16:33
that attending first has to know the ice.
16:36
But the way that I see it, there
16:38
are extremely
16:39
few
16:40
physicians that I know of,
16:43
that, they are so good and they would
16:46
be able and their fellows are extremely lucky
16:50
to be able to learn and come out
16:52
of that program
16:53
and being able
16:55
to help their patient
16:57
and help their staff and themselves without
17:00
radiation exposure. They I just wanna tell you
17:04
this that it was a
17:06
there was a study many, many, many years
17:09
ago that really they showed there was a
17:11
study published
17:13
that because the X-ray always stays on our
17:16
left side, left hand side when during the
17:18
procedure. So they had looked at the
17:21
brain tumor
17:22
on the physicians, including EP, radiologists,
17:26
as well as interventional radiologists and interventional
17:29
cardiologists.
17:31
You know, if you have brain tumor in
17:33
a normal population, it's gonna be fifty fifty
17:36
on the right and left. But they had
17:38
looked at that and they had seen that
17:41
eighty four percent
17:42
of the tumors on those physician was on
17:45
the left side, which means, unfortunately,
17:47
probably because of radiation exposure, let alone
17:50
other things such as cataract and everything else.
17:53
But,
17:54
really,
17:56
it has been very difficult to
17:58
be able to really convince, especially the academic
18:02
centers that to please
18:04
come, learn,
18:06
and
18:07
teach your fellows because this is the most
18:09
important thing that you can do. And you
18:11
can say by this stage, you're back. You
18:14
know, many of these physician, they may you
18:16
know, we are getting older,
18:18
and we are getting back pains, knee pain,
18:20
hip pain. Why do I have to wear
18:23
that lead apron? Entire procedure, I sit down
18:26
on a surgical chair, do my procedure,
18:29
and everybody is
18:31
happy because nobody was very led. Patient is
18:33
very happy. So everybody is happy. So this
18:35
is something that
18:37
I really
18:38
it has to start somewhere. It is sixteen
18:41
years too late for
18:43
Harte Determ Society and other societies to really
18:46
look into it and
18:48
to see that
18:50
what are the ways that we may we
18:52
can do this realistically
18:55
happening.
18:56
Because
18:57
me starting this in 2010,
19:00
I published two books. My co editor is
19:03
doctor Paul Tsai, who is at Brigham Woman,
19:05
and he's the one of the only ones
19:09
in the world
19:10
that also perform all these procedures,
19:13
you know, without radiation exposure.
19:15
And we wrote these books. We know we
19:19
we I placed so many
19:21
movies in it. I in my second book
19:23
our second book, I have 14 movies for
19:26
a duration of almost four hours. All of
19:29
them are narrated from five minutes
19:31
to thirty five minutes. And this is how
19:34
I have been able to,
19:36
you know,
19:37
disseminate the knowledge so they they can see
19:39
this. Some of these people really, some of
19:41
the physician call me to say, doctor Rezni,
19:43
I just went to your book, watched your
19:45
video,
19:46
and
19:47
was
19:48
prior to my procedure because I was gonna
19:50
do this procedure on Monday. So I was
19:52
looking at that video how I should do
19:54
that. But then it is just watching this
19:56
video is something, but being
19:58
able to really being trained your two years
20:01
of EP fellowship
20:03
and performing that is, you know, is very
20:06
different.
20:07
Absolutely.
20:08
And it's just so cool hearing you talk
20:11
about what it's like to be at the
20:12
forefront
20:13
of this new procedure
20:15
and helping to bring it to the mainstream
20:18
practices.
20:19
So really appreciate you taking the time to
20:21
walk us through that a little bit more,
20:23
all the advantages you're seeing in some of
20:25
those use cases.
20:26
So thank you again for being on the
20:28
podcast today, and thank you to everyone who
20:30
joined us.
20:31
Thank you. Thank you so much, Maria.