Medicine Q&A with Dr. Elaine Wan

This past week, we sat down for another Q&A with Elaine Wan, MD from our Cardiology Division. 

Q. How long have you been with us at the Department of Medicine?
A. I graduated from medical school here in 2005 and have stayed on ever since because I truly enjoy the people I work with every day. I am thankful for my colleagues who are like family.

Q. What are your current roles here at Columbia?
A. I'm currently an Associate Professor, Director of Electrophysiology Research, in the Division of Cardiology. I'm a cardiac electrophysiologist, a physician-scientist on the tenure track, and I serve as the Director of Electrophysiology Research.

Q. Tell us about your research. What excites you?
A. My research is specialized on imaging in cardiac electrophysiology to understand and visualize the mechanisms of cardiac arrhythmias. I'm particularly interested in atrial fibrillation, which is the most common cardiac arrhythmia and presents as an irregularly irregular heart rhythm. I also study what causes other dangerous rhythms like ventricular tachycardia and ventricular fibrillation. As a physician-scientist, I see patients with rhythm disorders: patients with atrial fibrillation, and pregnant women with arrhythmias. I perform ablations as well as implantations of devices like pacemakers and defibrillators. What's really exciting about electrophysiology right now is the rapid technological development of new therapies, catheters, and technology for treatment of atrial fibrillation and diagnosis of heart arrhythmias. But despite all these technical innovations, we're still not exactly sure why patients develop atrial fibrillation. For decades, we've been searching for the answer to that fundamental question.

Q. It's American Heart Month. What's something happening in cardiology that you think more colleagues should be aware of?
A. It is a misconception that atrial fibrillation is something patients can feel—that they have must have symptoms like palpitations or fluttering in the chest. What we've found is that a lot of patients can have asymptomatic atrial fibrillation. They don't even know they have a heart rhythm disorder. The only way to detect it is really on an EKG. Now with the advent of wearables like the Apple Watch, Fitbit, sometimes these devices will alert users that their rhythm is irregular and recommend they get checked out. So even though a patient doesn't complain about symptoms, they may be having a heart arrhythmia. Routine EKG checks and listening to the heart for rhythm disorders can help diagnose it.

Q. What do you see as the future of wearables in monitoring AFib?
A. I'm the national principal investigator of an industry-sponsored trial called Boston Scientifics LUX-DX TRENDS and we are using an insertable cardiac monitor to attempt to diagnose heart failure. While loop recorders have traditionally been used to detect irregular heart rhythms, we're now leveraging their multiple sensors to gather much more comprehensive data, including body temperature, respiratory rate, patient activity levels, heart sounds, and even sleep position. The goal is to determine whether we can use this information not just to identify arrhythmias, but to predict when patients might be developing heart failure or experiencing worsening heart failure. I think this really demonstrates how wearable technology is evolving beyond rhythm monitoring to become a tool for detecting and diagnosing a broader range of cardiovascular conditions.

Q. You recently received a tremendous honor by being elected to the American Society for Clinical Investigation. What does this mean to you?
A. The American Society for Clinical Investigation is a prestigious society in which those elected are recognized by their peers as a leader and an important player in the future of their field. I am very honored to be following in the footsteps of Dr. Andrew Marks, Chair of Physiology and Dr. Steven Marx, Professor of Cardiology at Columbia. To be in the same elected group as such magnificent scientists is humbling and a great honor. I am grateful for the support of the Department and the Division. I'm an NIH-funded physician-scientist with my own lab doing translational work: optical and ultrasound imaging, along with molecular biology to understand new mechanisms of arrhythmias. I also run all of the clinical trials in electrophysiology. I am grateful to be involved in various aspects of clinical and basic research.

Q. What advice would you give to junior faculty in your field?
A. Whatever success I have had is due to the support of my mentors and colleagues. I've been fortunate to have that support here in the Department of Medicine and the Division of Cardiology- people who will gave me the support I needed to build and continue to build my career and  lab in the direction that makes your scientific career productive and meaningful. I'm very grateful to Dr. Stephen Marx, who's been my primary mentor for more than 15 years. am grateful for the support from Dr. Ali Gharavi Dr. Timothy Wang, Dr. Ira Tabas, and Dr. Allan Schwartz, our division chief. Dr. Anne Taylor, who is retired, still serves as a trusted advisor for me. There aren't that many physician-scientists, especially proceduralists, so I'm very grateful to the support and opportunity from the Department and Division.