Interview With Rahul N. Doshi, MD, FACC, FHRS On Leadless Multi-Sensor Wireless Monitoring

DOI: 10.19102/icrm.2015.060702

ANGELINA WAGNER

Editor-in-Chief

Introduction

New preventative leadless and wireless sensors are critical for patients due to limited facilities in the hospital setting. These wireless patch sensors provide chronic ambulatory monitoring for continuous data for patient and respiratory activities. Continuing advances in these systems will improve predicted adverse events and outcomes. Technology among the electrophysiology field is providing new measures for patients that are advancing in ways never imagined.

With these advancements, Dr. Doshi provides his insights on how remote monitoring can provide further understanding and treatment developments for patients with atrial fibrillation and heart failure.

Dr. Doshi a native of Los Angeles, California has held positions as Clinical Electrophysiologist and Clinical Director at Cardiovascular Consultants of Nevada, Clinical Assistant Professor of Medicine at University of Nevada School of Medicine, Director, Electrophysiology at Sunrise Hospital, Director of Electrophysiology and Clinical Electrophysiologist at Fullerton Cardiovascular Medical Group, Director Arrhythmia Services, St. Jude Medical Center, and Assistant Professor of Medicine and Director Electrophysiology at the University of California.

Dr. Doshi also serves on the Communications Committee (Co-Chair) and Philanthropy Task Force at the Heart Rhythm Society. He has published several peer review manuscripts in various high profile journals throughout his career. Dr. Doshi has also been a part of several multicenter trials, advisory boards and educational programs. As a fellow of both the American College of Cardiology and the Heart Rhythm Society, Dr. Doshi has experience in all areas of electrophysiology, including complex ablation and implantable device therapy.

We speak with Dr. Rahul N. Doshi, Director of Clinical Cardiac Electrophysiology and Electrophysiology Laboratory and Associate Professor of Medicine at the Keck USC Medical Center in Los Angeles California, about the advances being made in leadless multi-sensor wireless monitoring.

Wagner: What were the key motivating factors that drove you to the exciting field of electrophysiology?

Doshi: My pursuit of a career in clinical electrophysiology came originally from my love of cardiovascular physiology and specifically the electrocardiogram (ECG). It still amazes me the insights that can be derived from such a ubiquitous tool, and the classical mechanisms of cardiac activation and arrhythmia that the pioneers of our field derived from the ECG.

Wagner: What were some of the unexpected hurdles in research development for leadless multi-sensor wireless monitoring?

Doshi: Surprisingly, not many, given the ease of use. From the research standpoint, the biggest challenge going forward is determining what type/extent of arrhythmia is significant. The answer to that question is very dependent on the endpoint you are looking for.

Wagner: Through your research at Keck Medical Center, what increased benefits have you see in these areas?

Doshi: Having active research in these types of technology has led to their increased usage. Increased monitoring translates to increased diagnostic yield. We hope that this will translate to better patient outcomes.

Wagner: How common are arrhythmias detected through the metric data findings of these leadless devices?

Doshi: The answer depends on the definition. In our study “Chronic Ambulatory Monitoring: Results of a Large Single-Center Experience,” published in the November 2014 issue of the Journal of Innovations in Cardiac Rhythm Management, Dr. Evann E. Eisenberg demonstrates utilizing the ZIO Patch in an academic practice that 99% of patients have some type of arrhythmia. Many of these findings would be considered insignificant. However, 20% of patients were seen to have atrial fibrillation and 12% had bradycardia demonstrated with heart rates less than 40 bpm.

Wagner: In your research, how have you seen monitoring and health informatics revolutionize healthcare?

Doshi: These devices clearly show improved diagnostic utility compared to the office ECG or older Holter monitors, and thus we will be able to make the diagnosis of heart rhythm disturbances more readily. If we can accurately diagnose patients, we may be able to treat patients more effectively and have better patient outcomes.

Wagner: How have leadless sensors provided freedom and assurance to patients?

Doshi: The increased ease of usage these technologies offer result in more patient freedom since they are less cumbersome than older ambulatory monitors. In addition, this leads to improved compliance and utilization. The increase in diagnostic yield of these devices then also results in increased patient assurance, as well as to the prescribing physician.

Wagner: What is the potential demand of these leadless multi-sensor wireless monitors?

Doshi: The demand is almost limitless, as patients with complaints or findings suggestive of an arrhythmia are very common in a cardiology practice. The pandemic proportions of atrial fibrillation alone would support widespread increase in monitoring.

Wagner: How is technology playing a role throughout remote monitoring?

Doshi: There are a variety of technologies moving forward that will make patient monitoring even more commonplace. At the University of Southern California, Dr. Leslie Saxon and the Center of Body Computing are leading the advancements of these technologies. For example, we are currently investigating an App that uses the AliveCor ECG smartphone case to track heart rhythm disturbances after ablation for atrial fibrillation. The ability to involve the patient in their own unique health problem is critical, as this drives compliance and increased diligence. Creating patient ownership is central to the premise of “body computing.”

Wagner: What are key strategies you could give on implementing this monitoring solution within daily clinical practice?

Doshi: Actively involve the patient in the decision process as to what type of monitoring, and stress the benefits of compliance!

Wagner: How has your research in leadless multi-sensor wireless monitors invigorated change and new developments in the field?

Doshi: The investigations that we and others are currently involved with are certainly leading to further questions and hypotheses. I believe that this is just the beginning of what we will be able to use these technologies for.