Douglas Mah, MD
During my residency, it came down to a choice between cardiology and oncology. I really enjoy developing relationships with patients and I liked that both of these specialties involved long-term care for patients.
But after going through training, I discovered I was especially interested in the physiology of the heart. There’s a math or physics to it that’s different from oncology. I also liked that cardiology gave me a much wider range of kids to care for; I work with some who are chronically ill, but also see kids who get better right away with treatment.
How did you begin to specialize in pacemakers and ICDs?
Through my training, I was always interested in the mechanics and programming of pacemakers and defibrillators, and had volunteered at the pacemaker/ICD retreat we run for kids, the Keeping the Beat Retreat. However as is most things in life, I was in the right place at the right time. As the former medical director of the Pacemaker Program and the retreat moved away, I took his place and have become more heavily involved and deeply invested since then.
What have you learned from the Keeping the Beat Retreat?
Attending the retreat every year gives me a different perspective seeing these kids outside of the medical environment. When you only see them in the hospital, you can sometimes forget that they’re real kids doing real things. At the retreat, I develop a different kind of bond with them.
It’s only one weekend a year, but the impact the retreat has on the kids is amazing. They get to run around and do things they wouldn’t be able to do at other retreats. And they get to meet other kids who have the same issues they have. It’s a real bonding experience.
Are you currently working on any research?
We’ve been working with the New England Congenital Cardiology Association (NECCA) to optimize follow-up for our devices.
Like any piece of machinery, pacemakers can malfunction or break down, so it’s important for us to check them once a year. We also ask our patients to send us telephone transmissions every three months so we can watch remotely to make sure the device is working correctly. But when we reviewed our numbers, we were surprised to find that about 30 percent of our pacemaker patients don’t come for annual visits, and about 50-60 percent don’t send us telephone transmissions on a regular basis.
To address this, we’ve started a quality-improvement initiative where we track patients in a centralized registry so we can monitor them more closely and make sure they get follow-up care. I think it will have a huge impact on the quality of care that patients receive, and ultimately improve long-term care.
What is the future of pacemakers?
Wireless pacemakers are already being used in adults. These pacemakers look like small bullet-shaped contraptions and don’t require a separate battery or wires that go into the heart. Right now, they are too big to fit inside a kid’s heart, but eventually they will make smaller ones that can be used in pediatrics.Wireless pacemakers eliminate a lot of the problems that are caused by the wires that go into the heart. For example, because they are beating with the heart all the time, these wires wear out. So, if you can get rid of the wires, you can get rid of a lot of the complications we see.
We’re also hopeful they will eventually develop pacemakers for use on the outside of the heart. Some of our patients can’t get the ones that go inside the heart. If there’s a way we could place just a tiny little microchip on the surface of the heart — that would be amazing.