Pulsed Up...

How Boston Scientific, Yami, and the Pepin Heart Institute changed my life

First, the reader needs to understand how I operate. Early in my sales career, I was taught a conversation stack that, when it really comes down to it, set the trajectory for my sales career (and life in general).

Credibility - Commonality - Problem - Solution

Every bit of content I put out is going to be centered around that format. Not that I am trying to sell you here but I certainly would like to grab your attention.

---

So let’s talk arrhythmia management.

In my mid 20s era, I start to feel a few palpitations here and there. I was working in real estate at the time, I am showing a home to some friends with my wife in tow. Ticker feels off, I lay down in the home I am showing and wait for the ambulance to arrive. Run some tests, first time seeing a cardiologist, nothing major. At the time, the only information I leave the experience with is that I have a RBBB (Right Bundle Branch Block).

Alright, no big deal, moving on.

Fast forward to early 30s, palpitations are starting to become more common. My personality is such that I need to be in control and it is ticking me off that I am starting to become perpetually cognizant of the thuds in my chest coming from a pretty important piece of equipment (my ticker). I am at work one day and the thuds are firing on all cylinders. Fortunately, my wife works for the same company I do and I worked for a whole host of amazing medical providers. One of my friends from the clinic comes and puts the scope to my heart to take a listen, she says “definitely some skipped beats going on here”. Back to the hospital I go. I am beyond blessed to have landed at The Pepin Heart Institute in Tampa, FL.

At the time, the facility was pretty dated and admittedly, coming from where I worked (one of the most gorgeous (and expensive) ASC/Clinics in America), I was sweating a little bit based on looks alone. Alas, a building is just a building and what matters the most is the people inside. The people inside of this facility were then and are now some of the absolute best clinicians I have ever met in my life. It is during this stay that I started to become more aware of what was going on with the ticker.

I am introduced to PVCs aka skipped beats aka premature ventricular contractions aka a real PITA to deal with. Hospital stay was about 24 hours, did some tests, introduced to my first Electrophysiologist (EP), discharged. Medication management engaged.

Over 8 years I was an antiarrhythmic and beta-blocker collector. Start with Propafenone → Bisoprolol → Metoprolol → Metoprolol + Flecainide → Metoprolol + Flecainide + Mexiletine and others that frankly I just can’t even remember.

Towards the end, the most hardcore regimen I was on was 240mg Sotalol 2x daily, 2x 50 mg Flecainide 2x daily, and 10mg Propranolol 3x daily. If you are a fan of Will Ferrell and the movie “Old School”, the below meme pretty much sums up every day I had on that medication load:

Adding to the above medication management saga - during those same 8 years, I had 7 attempts at ablation. I am a fixer and a problem solver by trade, in my mid 30s, I wasn’t really akin to dealing with my heart with medication management and all of the side effects that came along with it. I am a husband, a father to a brilliant little gal, and an absolute gamer in the medical sales industry. Medication management introduced brain fog, lack of clarity, fatigue beyond words, and just a flat out total lack of energy. When you are running game in life like I was, the limitations that came along with medication management were just not acceptable to me.

Every single ablation with the exception of 2 of them came with marginal efficacy. This was not my EPs fault at all. If you understand the nature of my condition and the episodic presence of my arrhythmias, it was always a challenge to get me into the cath labs with spontaneous presence of my arrhythmia(s). Arrhythmias is pluralized because throughout the 8 years, I presented with pretty much all of the above: PVC bigeminy/trigeminy, Atrial Flutter, Atrial Fibrillation, Supraventricular Tachycardia, Non-sustained Ventricular Tachycardia, Ventricular Tachycardia - it was a mess. Spontaneous presence of arrhythmia is really critical for successful mapping in the cath lab. As such, 2 of my ablation attempts were scrubbed while I was in pre-operative holding.

As a patient, these cancelled procedures were heartbreaking to me. When you deal with arrhythmias like I had been for so long, the date for your procedures are like a beacon of hope. Hope leading up to the the date, hope that in waking up from the other side of the loosey juicy that you won’t be in the same situation as you were leading up to the date. Soul crushing to leave the hospital in the exact same situation that you came in.

After attempt #3 at ablation, my family and I made the decision to switch EPs. Can’t overstate this, there was absolutely nothing wrong with the treatment I received from my first EP (in fact, I loved this guy and his team - his taste in music was absolute #fire). Sometimes in medicine you just need to switch around the lineup.

I remember meeting my EP Yami for the first time like it was yesterday. At the time, I was the practice director for a specialty orthopaedic practice with 2 of the best clinicians I have ever had the pleasure of working for. Why did I think they were so great? We were behind in clinic literally every single day. Not like 15 minutes behind, more like 1-2 hours behind. For our patients, however, the time didn’t matter. These were 2 of the best in the business and everyone knew it. Instead of the standard practice of clinicians coming into the exam room COW (computer-on-wheels) in tow, they sat on the stools - decidedly looking up to the patients rather than down upon them. We were behind because these providers took every bit of time that the patients needed to be educated and feel comfortable with the treatment plan. Yami was an hour behind for my new patient consult. Most people would walk out if a provider is 30 minutes or more behind - having been in both practice administration and being a patient myself, I can tell you without question you need to stick it out with the providers that are running behind. Particularly the ones in private practice (and, at the time, Yami was).

The walls were paper thin in his practice and as such I could hear Yami in the room adjacent to mine. The patient he was consulting with wasn’t having any fun either, just like me. Yami spent every bit of time that the patient needed with him to make her feel comfortable (was a nice gal he was working with). Before I even met him personally, I knew Yami was going to be the EP for me. We spent about 45 minutes in my own consult, he repeatedly referred to me as “impressive”. In the EP world, “impressive” comes across as out-of-the-ordinary, remarkable, or generally just stuff that an EP doesn’t see every day. He ordered some tests that were not the run of the mill clinical track. His office worked diligently with my insurance to make sure I was approved for a cardiac MRI (lesser performed diagnostic that proved to be pretty critical for us to arrive at a formal diagnosis). I came to know his team well over the next 5 years. I love every single one of them, as they have all stepped up for me in ways that I am forever grateful for.

Prior to one of my ablations, I had set my personal best on a 3-day monitor of 235 VT episodes. My EP at the time called me up and was like “Dude, what have you been up to? (I was working on the property that which my family and I were building our forever home)… Cool story bruh, stop doing all of that, like, right now!”. My next ablation was with Yami. Enter Boston Scientific (NYSE: BSX - if you have extra cash, throw it all at this company. This is not investment advice. I am not a financial professional. Please don’t sue me. But I strongly support, with every bit of conviction I have, what this company has done for me and what I believe they will be doing for patients in the future).

Yami calls me up the day before the ablation, says we may need to be a little aggressive here and implant an ICD. Admittedly, I was totally naïve to what this was going to look like headed into the procedure. I had my fingers crossed that it wasn’t going to be necessary. Nevertheless, I wake up from the loosey juicy with a battery in my chest and confirmation of my diagnosis from mapping/testing in the cath lab. At first I was discouraged, in my late 30s, the track I was on as an amateur golfer me had me close to earning my senior PGA tour card in 15 years if I only were able to practice 8 hours a day, abandon all of my family’s interests, and live my life by the words of golfing legend Kevin Kisner “This ain’t no hobby, Fellas!”.

This is the first time Boston Scientific and Yami changed my life. Despite every inhibition I had about my ICD at first, this hardware changed the game for me. You live with hemodynamically stable episodes of VT long enough and you start to look over your shoulder for the Grim Reaper quite often. Some real “for whom the bell tolls” type stuff. The biggest concern I had with my ICD post-implantation was not knowing if I was going to be able to handle a shock while driving my family around town. My little gal and her momma are my literal everything and the thought of taking a shock while driving terrified me. I didn’t know what it would feel like and if given the opportunity for a test drive of the hardware while I was awake - I would have accepted. I half joked with some of my LEO friends that they should just taze me (unlike that cargo short wearing Florida Gator that exclaimed “Don’t taze me bro!” - I am a Michigan man worth my salt)

Yeah bro, go ahead and taze me.

I digress - I went back to working on our land/pond after I had recovered enough from the procedure. About 3 months post-op I took 3 consecutive shocks while working out about 3 feet deep in the pond. Here is what you need to know:

• I dubbed myself the “Rider of the Lightning”

• Taking the shocks sucked hard. It caught me off guard.

• My lifeline was the pest control service person that was treating our land while I was cleaning up the pond

• I immediately removed myself from the water. Started walking briskly to my in-laws home (they live next door to us)

• As I am power-walking, here comes the boom - Shock #2

• At this point, I am a bit panicked. The pest control service lady reached my family before I could. She yelled into the home “The man with the glasses is down”

• My father-in-law comes trucking out, followed by my wife. At this point I am laying on the ground thinking it is game over.

• Here comes the boom - Shock #3. Meh.

Now, you may be asking yourself “But, my dude, you said Boston Scientific and Yami changed your life". Yes, that is a fact. The legendary Boromir of The Fellowship of the Ring (gone too soon) once said “One does not simply walk into Mordor”. In the world of arrhythmia, at least for me, ventricular tachycardia was my Mordor. My ICD ended up being the legendary Mithril that protected Frodo (me) in the Mines of Moria (Tampa DMA).

Following these shocks, I had a newly acquired confidence. I didn’t fear the Reaper as much. I had zero concern participating in life without fear. I am forever thankful for those shocks. As much as they were not an enjoyable experience, they did give me all of the bravado I needed to go out and live my life. The only thing holding me back now was the continued presence of a ridiculous amount of wicked beats. If you look at my heart like an EDM festival, my heart was 100% the headlining DJ at the Dubstep arena.

In the years that followed it was more and more medication management. I also developed Atrial Fibrillation pretty bad on top of all of the ventricular issues. Had a highly successful A-Fib ablation early January 2023. Haven’t really had any A-Fib issues since.

All of this comes down to December 9th, 2024. I had largely conceded in my battle for a procedural fix for my arrhythmias. Along the way up to this point, I had been enrolled in remote monitoring for my ICD. I get my hands on the Q3 data dump - no bueno. I was having really long episodes of erratic rhythms. Of course, without the data, I had kind of already knew what was going on. Every single day was a fight. I was on the most extreme medication load I had been on throughout this whole ordeal. Arrhythmias were still prevalent, I was totally gassed, my travel schedule for work had been ramped up, 5 days in Vegas for the Vizient Summit took its toll on me. IDN Summit the month prior required legitimately only a few hours of real work, but I put some serious hours into the AZ golf scene. Played the conference scramble (supply chain pros - love you all but me and the device sales homies can’t carry you all to the promised land. Perhaps your GPOs should commit some of your spend to GolfTEC) and then decided to play another 18 at TPC Scottsdale the same day.

(Thanks Z Dub for the photo - #1 handicap hole on the course and I smoked my 56° from 100 out to 5 feet from the pin. Missed the putt for the record. Meh.)

If you know anything about AZ golf (which I didn’t) you know playing 36 in a day with the dry heat will gas anybody. Alas, I had to go for my hole-in-one @ 16. I was close - only about 70 yards off line.

Any who, heart was in bad shape. Early December rolls around, I call up Yami’s office, tell the gang I am in bad shape. Need some help. I am asked if I can hold off until April for a trip back to the cath lab and I said I didn’t think I would be able to make it. The gang says “how about next Monday?”. This was literally 6 days out from when I called. They throw out a term that I hadn’t been familiar with - PFA (Pulsed Field Ablation). I started doing my research before the 9th of December (my scheduled date for procedure).

I am going to write an entire piece about the introduction of Pulsed Field Ablation to the American healthcare market in an upcoming article, but to keep it short, Pulsed Field Ablation in my eyes as a patient, is a total game changer. The speed alone in which ablations can be performed is such an advancement for people suffering from arrhythmia. I knew that Yami’s ask for me to push to April was probably due to the case load he was already working through. Most of the great EPs live in the cath lab and their time is incredibly valuable/sought after. I knew I wasn’t the only human in America going through arrhythmia hell. For him to add me as a case not but a week out from when we spoke blew my mind.

Boston Scientific’s Farapulse tech is largely increasing the volume of cases that a provider can effectively perform in a day. Additionally, from what I understand, the adoption track for this technology is super quick relative to other technologies. In Farapulse, you have quick adoption, you have increased case volume, and in the very least you have outcomes that are on par with the prior gold standards of thermal ablation. In my case, the safety profile made it all very appealing as well. Go too far with thermal ablation and it becomes incredibly damaging to the tissues in your heart. Electroporation made it possible for me to pursue further ablative therapy with a decreased risk profile.

Game. On.

December 9th arrives. By this point, Pepin Heart Institute and AdventHealth Tampa had come a long freakin’ way. The facilities are immaculate, and the people inside were the same great people that have always taken amazing care of me. This whole facility has been with my every step of the way. Hit up registration, go to pre-op holding, high ho high ho back to the cath lab we go. Yami pops in before the loosey juicy to say hello. Says we’ve got some new tech to play with here, no guarantees as always but lets give it a ride. I am talking to the mapping specialist before its lights out for me, she remembers me from my prior cases. As previously stated, I was an “impressive” dude in the cath lab. From what I recall, case ran super late. Think I was the last case of the day so they had time to work through the process. I wake up from the loosey juicy.

Following the procedure, for the first time in 8 long years - Normal Sinus Rhythm is back in the mix and it is dominating. Brain fog? See ya. Mental clarity? I’ve got it. Reduced medication load? Yup. I have energy for days.

So why I am posting this today? For starters, I had my device check today. Life changing appointment from the device specialist (Tom, you don’t really know it but your words meant everything to me today). Saw my friend Josh today (my favorite ARNP on the planet). Briefly got to tell him how much he and the whole squad changed everything for me.

How’d the device check go? You guessed it.

PVC Burden - way down… for me, like way way down…

Atrial arrhythmias, you ask? Nope…

Ventricular Tachycardia? Think the tech told me I had (1) 2 second run. Keep in mind, that is a 2 month time span. I once had 235 VT episodes in 3 days with a singular run that went for 28 seconds. See ya later, ventricular alligator.

Yami, Pepin Heart Institute, and Boston Scientific - I’ll scream it from every mountain top possible and even from the cruise ships sailing the newly named Gulf of America. The whole squad cardioverted my life and I am back in business. Creative juices are flowing. Kevin Flynn style “Biodigital, jazz Man”.

So, how are we going to make some Beats That Matter?

- I am building a platform to support/coach patients suffering from cardiac arrhythmias. Community based. Informative. Light-hearted and humorous (I promise to make you all laugh, fam). Not medical advice, no treatment recommendations. Cardiac arrhythmia management for patients comes with some challenging mental head games and I am a strong advocate for mental wellness being incorporated into treatment. It is simply not enough to tell a patient who is being driven nuts by the constant thuds in their chest that PVCs are “benign”. Benign as they may be, they take a toll on you between the ears. So I want to contribute to alleviating some of the mental burden that comes along with PVC burden (see what I did there?)

- Pulsed Field Ablation - the game is changing in the EP lab. See Boston Scientific Q4 earnings report. BSX Q4 Earnings. Huge. But with the adoption of new technology comes the opportunity to learn together for the benefit of patient education/outcomes as well as operator efficiencies. New caths are potentially coming to market (I for one am super pumped about Field Medical’s FieldForce™ system (FieldForce FDA TAP Pilot and Breakthrough Device Designation). I am diligently working on a data-aggregation system to draw every single new insight I possibly can into one centralized location for the benefit of patients and clinicians alike.

In almost 15 years in the healthcare industry, all of my friends and colleagues know me to be a fiery advocate for patients. Nothing has changed, fam. Thought about taking my talents to South Beach but its been done. So… look out world of electrophysiology, I am headed your way.