Week 1 - Jada Okaikoi

This first week of immersion has focused on familiarizing myself with the hospital environment and gaining a better understanding of the clinical work my mentor, Dr. Kim, is involved in. The first half of the week was centered on observing electrophysiology procedures, including a case involving a patient with atrial fibrillation originating in the left atrium. During the procedure, the clinical team performed ablation around the pulmonary veins. The physician leading the case explained that abnormal electrical conduction or signaling near the pulmonary veins can disrupt normal cardiac rhythm and contribute to atrial fibrillation. I also learned that the source of circuit disruption can vary between patients, making patient-specific mapping an important part of treatment.

This case used a Medtronic catheter system that was able to both map and ablate tissue, which I found especially interesting from a device and engineering perspective. I learned that some competing systems, such as Abbott, may require separate catheters for mapping and ablation. Seeing how device design can influence procedural workflow helped me better understand the connection between biomedical engineering, clinical decision-making, and patient care. I also had the opportunity to observe a transesophageal echocardiogram (TEE) and an atrial septal defect (ASD) closure of the superior vena cava from the right atrium. The ASD case was particularly unique because the defect was large enough that the physician needed to use two stents. I learned that the largest available stent size in the United States is approximately 6 cm, but this patient required coverage closer to 9 cm, which prompted the physician to adapt the approach by using two stents.

Throughout the week, I also met several fellows in Dr. Kim’s lab and observed their imaging reading sessions. During these sessions, they reviewed patient cardiac magnetic resonance imaging (MRI) scans and discussed possible diagnoses, prognoses, and clinical interpretations. It has been very interesting to see how physicians use different imaging modalities, including computed tomography (CT), TEE, and MRI, to visualize the heart and identify pathologies. My research this summer will most likely focus on tricuspid regurgitation, which involves backward flow of blood through the tricuspid valve due to incomplete valve closure. This week, I was able to see what regurgitation looks like using echocardiography and color Doppler, which helped connect the clinical presentation of valve disease to the imaging-based questions I may explore in my project.

I also had the opportunity to speak with representatives from companies such as Medtronic and Watchman from Boston Scientific about the use of their devices and the services they provide to the hospital. This was eye-opening because I had not previously thought as much about the many non-clinician roles present in the hospital environment, including device representatives who support procedures and help clinicians use specialized technologies. I wrapped up the week by following the cardiology team during rounds, where I was able to observe a variety of patient cases and clinical discussions. Overall, this first week has been a valuable introduction to the hospital setting, cardiovascular imaging, electrophysiology procedures, and the interdisciplinary nature of patient care.