“The only constant in my field is that it’s always changing,” said Dan Cantillon, MD, staff physician and Associate Section Head of Cardiac Electrophysiology and Pacing in the Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute at Cleveland Clinic, when asked to recall how his specialty has developed through his course of practice. An electrophysiologist by trade, Dr. Cantillon deals with the electrical impulses in the heart and works to diagnose and treat arrhythmias. But a forward-thinker and frequent inventor, he drives several other practice-changing projects that many electrophysiologists could only dream of.
The son of Olympic and Collegiate-level fencers, Dr. Cantillon fell naturally into a student-athlete role during his undergraduate education at Michigan State University – a situation he claims bred his ability to wear several hats. And at present, he wears many. In addition to his Associate Section Head responsibilities, Dr. Cantillon serves as the Medical Director for Cleveland Clinic’s Central Monitoring Unit – an offsite facility that provides continuous, 24/7 monitoring for cardiac patients at the main campus and ten other US Cleveland Clinic sites –
Research Director for the Section of Cardiac Electrophysiology and Pacing, and holds an academic appointment in the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.
But his achievements are not limited to his appointments. In February 2014, Dr. Cantillon was the first Cleveland Clinic physician, first Ohio physician, and third North American physician to successfully implant a leadless cardiac pacemaker. He also performed the first successful Cleveland Clinic percutaneous retrieval of a chronically implanted leadless pacemaker in March 2017, and was selected as one of the “Top Doctors” in Cardiovascular Medicine by Cleveland Magazine in 2018, 2019, and 2020.
Below are some of Dr. Cantillon’s thoughts as they relate to innovation in the field of electrophysiology – its presence, importance, and best examples in the pipeline at Cleveland Clinic:
Responses have been lightly edited for clarity and length.
Question: Cardiovascular care has many pieces parts. Could you describe for us electrophysiology as a field, and how you’ve seen it develop over the course of your practice?
Dan Cantillon, MD: The heart is just like your house – it has plumbing and electricity. So we sort of informally talk about cardiologists being of either the variant of ‘plumbers’ or ‘electricians,’ and we, as electrophysiologists, are the electricians. We deal with the arrhythmias of the heart and the heart's electrical system.
The only constant in my field is that it's always changing. And the only certainty in my field is that the way we're doing things today is completely different than the way we’ll be doing them a year from now. And so, one of the wonderful aspects of my field is that there is constant innovation, there is constant improvement. It's a heavily tech-driven field, hence its steady evolution, and that gives me the opportunity to be involved in research and care delivery that are under the influence of really exciting changes. It’s something I fully embrace.
Q: In our time working together, you’ve been quite a prolific inventor. What are some past projects you’d like to highlight for their influence in the field?
DC: In terms of my own personal projects, the past project – which I think is sort of the most mature and on its way – is what we call the eCMU (enhanced CMU). eCMU has allowed us to double the number of patients that we monitor. It prioritizes the patients that we're monitoring in the CMU so that the sickest patients are the ones getting the technicians' attention first. We developed and validated the algorithm on which it's based, as well as the technical aspects of the platform, in-house here at Cleveland Clinic. It's currently in the process of commercialization, with the data under review by the FDA. It brings tremendous value to the care of our patients within our organization. It allows us to be better in our roles within the CMU, as sort of the ‘eyes in the sky’ to help support the clogs on the ground.
We are very proud of the fact that in situations where our technicians provide advanced notification of a patient that requires an emergency response team activation, we see upwards of 93% survival in those patients who go on to suffer a cardiac arrest in the hospital. To give you a benchmark to compare that to, statistics from the American Heart Association suggest that in-hospital survival for non-ICU patients from cardiac arrest is about 25% give-or-take, each year. So we're, again, incredibly proud that here at Cleveland Clinic, the care that we provide, the offsite monitoring that we provide, directly leads to improved survival experiences and greater safety for our patients in the hospital.
Q: What are you and your team working on now? What does the ‘innovation pipeline’ look like?
DC: The thing I'm most excited about is something called Advanced Cardiac Waveform Analytics; we call it ACWA for short. Basically, what this is, is precision analytics of the ECG waveform using machine learning. What we're really interested in is the ability to predict decompensation of heart failure, of cardiac ischemia, heart attacks, acute coronary syndrome, metabolic derangements, etc. We believe it's highly possible to unlock all of the data that is kept about our patients in their ECG waveforms. So we have a very robust collaboration going on with this project to advance the science of ECG waveform analysis.
In a similar vein, we are interested in using machine learning to predict the likelihood of a patient going into atrial fibrillation after they've had cardiac surgery here at Cleveland Clinic. We know about a quarter of our patients will go into AFib after cardiac surgery, so we're interested in exploring some technology that will allow us to predict who that's going to be before it happens. This way, we can potentially initiate a treatment to prevent it from happening. My boss refers to this project as our ‘precog work,’ making reference to the Tom Cruise film where they were able to see the future and intervene before bad things happened.
The thing that I'm perhaps best known for overall is my work with leadless cardiac pacing – pacemakers that are completely implanted in the heart with catheters. These miniaturized pacers, if you will, require no incisional access and have no wires stretching through the veins. I am the global PI (principal investigator) for a study in which we'll be looking at the world's first lead-less pacemaker/defibrillator that is entirely extravascular. We're very excited about this, as it will be a first-in-mankind type of innovation.
Lastly is the innovation of the dual-chamber leadless pacemaker. Today, we're talking about multi-chamber pacing – with leadless pacemakers in the upper and lower chambers that can talk to each other. This will allow the benefits of leadless pacing to reach a much greater number of patients in our practice that require rhythm support. I have the privilege of being the global PI for this study as well, not just for Cleveland Clinic, but all the other centers in the United States and Canada that will be enrolling patients.
Q: Obviously, you're no stranger to remote monitoring and connected devices to keep contact with your patients. How do you see the increased adoption of these technologies in COVID-19 transforming your clinical practice moving forward?
DC: What we’re seeing is very encouraging. We’re seeing better integration of the health IT ecosystem and a breakdown of barriers between the brick and mortar hospital and the outpatient environment. As clinicians, we view technology as an opportunity to better track the care of our patients. We’re able to pull data from wearable sensors that patients have outside the hospital environment to provide greater situational awareness when we have clinical encounters – virtual or physical. And we’re able to get that data into the hands of people who can do something with it. It's not just data for data's sake – it has a purpose, it's focused, and it's well-integrated into an increasingly sophisticated health IT ecosystem. But at the end of the day, what’s important for us clinicians to remember, is that the technology isn’t the end goal of what we’re trying to achieve – it’s a tool we can use to deliver the best possible care.
My own prediction is that this trend of digital integration will continue – we will only continue to make these transitions in care paths more seamless. I think where it matters most for patients is in the area of readmission rates for things like heart failure, diabetes, and other difficult to manage chronic medical conditions. Our ability to pick up early warning signs or deterioration, where we can make a meaningful adjustment in the patient's care, alter their trajectory, and prevent them from being readmitted to the hospital – that’s going to be the game-changer.
Q: What are your predictions for the future of cardiovascular care – in your specialty and beyond?
DC: I think the future is bright for cardiovascular medicine. If you look at all of the technologies, all of the healthcare delivery mechanisms that we have, we're advancing on all fronts – not just in my field, but in all areas. There's probably never been a more exciting time to be involved in cardiovascular medicine. And of course, first and foremost, what it means for our patients is that people are going to live longer and receive better care for their cardiovascular conditions than at any point in human history. It's so exciting to be a part of that and leverage some of the things we're doing with healthcare informatics, machine learning, and the technologies I’ve previously mentioned. I expect incredible things in the years to come.