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Renaissance School of Medicine

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Salvatore Capotosto hugs his wife Federica Bove at Stony Brook Medicine Match Day 2024. Kristy Leibowitz

 

By Daniel Dunaief

A former professional soccer player from Italy, Salvatore Capotosto recently experienced a different kind of pressure, this time in front of his wife and her parents.

Joining the rest of the Renaissance School of Medicine at Stony Brook University class of 2024, Capotosto awaited the countdown for Match Day to learn where he would serve his residency. 

Capotosto, who already knew he’d matched with one of the hospitals on his list for an orthopedic surgery residency, opened the same kind of envelopes medical students around the country were opening at noon Eastern Standard Time.

After the countdown, Capotosto learned he matched with his first choice, Mt. Sinai Hospital in New York City.

“It’s a very great dream for us,” said Capotosto, referring both to the opportunity for him and his wife Federica Bove to live in the city and to the excitement his extended family in the small town of Itri felt. Reading where he was going was “an explosion of emotion.”

Capotosto and Bove shed tears of happiness as they pondered the next step in an American journey that began eight years ago when they started college at Midwestern State University in Wichita Falls, Texas. While Capotosto received medical training at Stony Brook, Bove earned her Master of Business Administration at Pace University.

The first member of his family to become a physician,  Capotosto said he spent considerable time explaining the lengthy residency and matching process to his family.

“It doesn’t matter how many millions of times” he shared the medical steps with them, he said, “they will still ask” about the next steps.

Humble origins

The son of cafe owner Luigi, the future orthopedic surgery resident didn’t always set his sights on either a high-powered athletic career or on becoming an American doctor.

“I used to walk to school and stop at my dad’s cafe and eat a croissant and drink cappuccino for breakfast and I would scream that I didn’t want to go to school and that I wanted to work at the cafe,”  Capotosto said. His father kicked him out of the cafe and told him to “go study.”

The Capotosto son said he learned his work ethic from his extended family, for whom work is a responsibility and a passion. Watching his father put time and effort into his work helped him put in 100 or more hours some weeks to meeting his responsibilities and mastering medical material.

Capotosto hasn’t been able to convince his father visit him in New York since he arrived on campus. This year, however, his parents booked a trip to see their son graduate.

Packages from home supported him through school and helped reduce the distance from his close family, who sent olives and olive oil every few months that were made from the 200 olive trees on his grandfather Pietro Mancini’s property.

A rising soccer star

Capotosto developed a passion for soccer when he first started playing the game at the age of six. He poured considerable energy into developing as a goalie.

He achieved considerable success, playing in front of crowds of over 4,000 people for professional and semi professional teams. In Naples, he trained with his idol, goalkeeper Morgan De Sanctis.

Capotosto was in the academy of the professional Napoli team for four years, including training with the first team.

When he played soccer, Capotosto suggested he was a “perfectionist,” honing his technique through hard work and preparation.

During his playing days, Capotosto sustained several injuries that took him off the field, including a scaphoid bone injury that ended his career.

Unsure of the next steps in his life, Capotosto appreciated not only the help and support of the doctors who came to his aid on the field, but also the career inspiration.

“I like to say that orthopedics saved my life,” Capotosto said. “Without the flame to push me to stand up and find a new purpose, I would have taken wrong turns in those dark moments. I’m really grateful to this field.”

Some of Capotosto’s mentors at Stony Brook, in turn, appreciate the considerable positive energy the former goalie brings to medicine and the way he relates to everyone from hospital staff to patients.

“He’s immediately disarming,” said Dr. James Penna, orthopedic surgeon and Chief of Sports Medicine at the Renaissance School of Medicine at Stony Brook University. “Even patients who are scared or who are dealing with pain” relax when they are around him.

Dr. Edward Wang, Chief of Shoulder/Elbow Surgery and Clinical Professor in the Department of Orthopedics at the Renaissance School of Medicine, recalled that he offered Capotosto the opportunity to shadow him in the operating room early in his medical school career.

Capotosto picked up the do’s and don’ts of the operating room quickly, while the members of the team recognized his dedication and commitment.

“The staff took a real liking to him immediately,” Dr. Wang said. “Orthopedics is lucky he chose” the field.

In the last few months, Capotosto, who is 29 years old, has reached several milestones. He and Bove received green cards in February, which allow them to live and work permanently in the United States. The couple, who met when Capotosto was 18, also got married on April 22 in Central Park. They are planning a religious ceremony in Italy in May at Bove’s childhood church.

Sports and medicine

The field of orthopedics has attracted athletes from numerous sports, as former competitors have turned their focus and dedication towards preparing for games to the challenging world of helping people recover from injuries.

“A large percentage of applicants have some sorts of sports background,” with numerous doctors sharing stories about injuries such as a torn anterior cruciate ligament or about a relative who received knee replacement surgery, said Dr. Penna, who was not a college athlete.

“We have a lot of former athletes in our program,” added Dr. Wang, who swam competitively in a Division 1 program at the University of Miami. “Athletes like orthopedics because of the physicality and definitive nature and the exposure in the past.”

While Dr. Wang suggested that a range of character-defining elements helped shape Capotosto, he added that the former soccer star’s injuries enhanced his ability to connect.

“Being on the other side [as a patient] gives you empathy,” said Dr. Wang.

While Capotosto enjoyed his time in soccer, he is pleased with the current chapter in his life.

“Playing was a great opportunity, but, I think being an orthopedic surgeon is way better from my standpoint right now,” he said. “I believe in the mission.”

The Stony Brook medical staff, meanwhile, believes in him. 

“There will be a lot of disappointed attendees” when Capotosto leaves the school, said Dr. Penna. “The janitors knew who he was.”

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Dr. Harold Paz. File photo by Stony Brook Medicine/Jeanne Neville

Two years after he joined Stony Brook University as executive vice president for health sciences, Dr. Harold “Hal” Paz is no longer one of the most senior members of New York State’s southern flagship university staff.

An internal SBU announcement that went out Friday, Oct. 6, from the office of President Maurie McInnis indicated that Paz, whose page on the Renaissance School of Medicine website no longer links to information about him, will be replaced on an interim basis by Dr. William Wertheim.

Wertheim joined Stony Brook in 1996 and had been serving as the vice dean for graduate academic affairs at the Renaissance School of Medicine, where he had previously been interim dean.

Wertheim is also an Endowed Chair in Graduate Medical Education at the School of Medicine and is president of the Stony Brook Medicine Community Medical Group.

While Stony Brook didn’t offer a reason for Paz’s departure, officials indicated it is “not our practice to discuss personnel matters.”

Paz had come to SBU from The Ohio State University, where he was executive vice president and chancellor for health affairs and chief executive officer of the Ohio State Wexner Medical Center.

Paz, who was Chief Executive Officer of Stony Brook University Medicine, reported to McInnis and was a member of her senior leadership team.

When Stony Brook announced that executive vice president and provost Carl Lejuez joined the university in May 2022, the university signaled that Lejuez would work collaboratively with Paz.

Paz had also been working with academic, hospital and clinical leadership and with community partners in his role.

The announcement of Paz’s departure from SBU, which came two years and two days after his official start date, did not include a list of any of Paz’s achievements, initiatives or contributions to the university.

Before joining The Ohio State University, Paz was the executive vice president and chief medical officer for CVS Health/Aetna, serving as a leader in the company’s domestic and global businesses. He also served as dean of the College of Medicine at Pennsylvania State University and CEO of the Penn State Hershey Medical Center and Health System.

Paz had succeeded Dr. Kenneth Kaushansky, who retired as senior vice president of health sciences, in June 2021.

Paz serves on the National Academy of Medicine Leadership Consortium, the board of directors of Research America and the Curai Health advisory board.

In April, Paz was appointed to the National Academies of Sciences, Engineering and Medicine Amyotrophic Lateral Sclerosis: Accelerating Treatments and Improving Quality of Life committee.

Wertheim’s tenure

Wertheim started his Stony Brook career by leading the Medical Consult Services. He later served as associate program director and director of the primary care track of the Internal Medicine residency, then Internal Medicine residency program director, and then executive vice chair of the Department of Medicine and associate dean for clinical outreach.

Wertheim has also served as the president of the medical staff at Stony Brook University Hospital.

Wertheim graduated from Harvard University and New York University School of Medicine. He completed his residency at the University of Michigan Hospitals, where he served as chief resident.

Wertheim worked as a clinical faculty member at the University of Michigan’s Veterans Administration Hospital. In New York, he worked at The Brooklyn Hospital Center.

The letter from the president’s office announcing the changes urged the community to “join us in congratulating Dr. Wertheim on his appointment and welcoming him to his new role.”

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Dr. Susan Hedayati, right, and Dr. Peter Igarashi attend the ASCI/AAP meeting in Chicago Spring 2023. Photo courtesy Hedayati

She is bringing two important parts of an effective team back together.

Dr. Susan Hedayati — pronounced heh-DYE-it-tee — recently joined the Renaissance School of Medicine at Stony Brook University as vice dean for research. Hedayati was most recently a professor of medicine and associate vice chair for research at the University of Texas Southwestern Medical Center.

Hedayati plans to help improve Stony Brook Medical School’s national and international reputation by coupling frontline research with translational and patient-oriented care and studies.

The combination of a research and clinical care focus will provide for the “betterment of the health of Long Island population of patients,” Hedayati said.

In addition to enhancing clinical care, such an approach would “facilitate funding of investigator-initiated [National Institute of Health] grants and aid in the recruitment and retention of excellent M.D.-investigators,” she explained in an email.

She said she is eager to build an institutional clinical trials infrastructure that would involve a dedicated research support team.

Adding Hedayati to the medical school faculty at Stony Brook University, where she will also serve as the Lina Obeid chair in biomedical sciences, also brings two prominent kidney specialists who have different approaches to their work back together again.

Dr. Peter Igarashi, dean of the Renaissance School of Medicine and a nationally recognized nephrologist, had recruited and collaborated with Hedayati when she joined the University of Texas Southwestern Medical Center after winning first place in a clinical research award at the Southern Society for Clinical Investigation Young Investigator Forum.

When Igarashi first met Hedayati as a judge of the fellowship competition, he suggested that her expertise stood out clearly.

“She has enormous content expertise in the field of nephrology and internal medicine more broadly,” he said.

He was also impressed with her “passion” for research and her “devotion to patients and research,” which has also made her a “perfect fit” for her current position at Stony Brook University.

Combining research and clinical care will enable SBU to provide one-stop shopping at facilities like the specialty practices in Commack and the one recently opened in Lake Grove in the former Sears building at the Smith Haven Mall, he said.

Patients can receive clinical care at the same time that they can enroll in clinical trials for potential treatments of some conditions.

Hedayati “set that up at the University of Texas at Southwestern, and I’m hoping she’ll be able to grow that capability here,” Igarashi said.

Igarashi also described Hedayati, who was offered the job after a committee conducted the search, as “personable and likable.”

Complementary strengths

Igarashi described the different research approaches he and Hedayati take as “complementary” strengths.

Igarashi’s research is basic, wet lab science, while Hedayati has focused on translational and clinical research.

Their backgrounds will “be very helpful for elevating the entire research enterprise, not only in basic science but also in clinical and translational research,” Igarashi noted.

For her part, Hedayati suggested that her short-term goal is to build the physical infrastructure for clinical research and clinical trials.

Such efforts will require a clinical research staff infrastructure composed of research coordinators, research managers, regulatory personnel and biostatisticians.

“I’m hoping that, within a year, we’re going to be making some big strides in those directions,” Hedayati said.

She also hopes to build upon the existing medical scientist training program for M.D./Ph.D. students to establish a physician training program for residents to retain M.D. investigators in academic and biomedical research careers. That, she suggested, is a pool that is dwindling nationally.

Ongoing research

Hedayati, who is transferring most of her grants to Stony Brook, plans to continue conducting her own research.

She has been studying the link between chronic kidney disease, which affects about one in seven people, and other conditions, such as premature cardiovascular disease, susceptibility to depression and the role of inflammation.

“This is an area that’s prevalent, but understudied,” said Igarashi. 

She is searching for nontraditional biomarkers associated with kidney function decline, especially in patients with heart failure.

Patients with heart failure are at increased risk of acute and chronic kidney failure.

Igarashi is confident that Stony Brook’s new vice dean for research will serve patients on Long Island and beyond.

“She would not have taken this job unless we assured her that she would be able to continue to see patients in the clinic as well as in the hospital,” said Igarashi. “That is a core value for her.”

Echoing those sentiments, Hedayati suggested she has a “patient-centered approach in everything I do.”

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136 students comprise the RSOM Class of 2027, shown here reciting the Hippocratic Oath.
New RSOM student Jasmine Stansil (center), with her parents and grandparents at the school’s White Coat Ceremony.
Dean Peter Igarashi, MD
Adam Bruzzese wearing his first white coat after receiving from Andrew Wackett, MD, Vice Dean of Undergraduate Medical Education.

136 students launch journey into Medicine at traditional White Coat Ceremony

At the Renaissance School of Medicine’s (RSOM) White Coat Ceremony, 136 incoming students donned their physician “white coats” and took the Hippocratic Oath for the first time. Held at Stony Brook University’s Staller Center, the annual ceremony brings students, their families, and faculty together as the academic year begins and members of the Class of 2027 embark on their journeys toward becoming physicians. The RSOM has held the White Coat Ceremony since 1998.

The incoming students are a select group, and according to RSOM administrators is one of the most diverse classes in the school’s history. Only 8.5 percent of all applicants to the RSOM for 2023-24 were accepted into the program. Approximately 20 percent of class consists individuals from historically marginalized communities, and 54 percent of the class are women.

Collectively the students received their undergraduate degrees from 66 different colleges and universities from around the country. Stony Brook University (20) and Cornell University (17) were the undergraduate schools with the most representation. The class has a combined median undergraduate GPA of 3.89. While many of the new students are from different areas of the country, 77 percent hail from New York State.

“To the Class of 2027, you are entering medicine at an exhilarating time,” said Peter Igarashi, MD, Dean of the RSOM, who presided over his first White Coat Ceremony. “Scientific discoveries in medicine are occurring at a breathtaking and awe-inspiring rate. Diseases that were rapidly fatal when I was a medical student, such as multiple myeloma and leukemia, are now routinely treated. Advances in human genetics have enabled truly personalized medicine, and the development of an effective Covid-19 vaccine less than one year after the onset of the pandemic saved almost 20 million lives and underscored the essential role that science plays in public health.”

All of the students have a story as to how and why they have chosen Medicine as a profession.

For New York City native Adam Bruzzese, an NYU graduate, his family’s difficulties and challenges they had within the healthcare system was a big trigger to increasing his passion for medicine. Adam’s 11-year-old sister had mysteriously become paralyzed, and he played an integral part in providing her healthcare as a teenager and college student. He witnessed disparities of care as she moved through the health system, plus the myriad  of tests and physician opinions along the way. It was eventually determined her paralysis was caused by Lyme Disease.

Manteca, California native Jasmine Stansil, a standout student in high school and at the University of California, San Diego, was always fascinated by the human body as a kid. She also became captivated by how physicians can have an incredible impact on human life when she watched Untold Stories of the ER. But she was most inspired to pursue Medicine because of her grandmother, who endured multiple strokes.

“Watching doctors provide her care made me want to do the same for others,” says Stansil. “I am hoping to become an academic physician who will provide clinical care, teach and conduct research.”

Jerome Belford, one of the 20 class members who attended Stony Brook University as an undergraduate, described his interest in medicine as coming from a “passion that stems from a desire to promote physical and emotional health and wellness.”

From Long Island, Belford is a volunteer EMT who decided to attend the RSOM because of its broad research and clinical opportunities and standout education that provides experiential and hands-on medical training. He hopes to eventually provide patients who have historically not had access to the best medical resources improved care, either as an emergency physician or though primary care as an internist.

White coat ceremonies are an initiation rite and are symbolic to Medicine as a profession that combines professionalism with scientific excellence and compassionate care. In an era of telemedicine, aging populations, new knowledge about infections and diseases, and emerging technologies, Medicine remains a dynamic and changing profession that continues to impact the health and well-being of society.

All photos by Arthur Fredericks

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Represented in this illustration is the authors’ finding that DNA hypermethylation disrupts CCCTC-binding factor (CTCF) mediated boundaries which in turn lead to aberrant interactions between an oncogene and an enhancer, driving hyperproliferation and subsequently tumorigenesis from normal OPCs. Photo by William Scavone/Kestrel Studio

Study in Cell led by Stony Brook researcher provides unique analysis in a glioma model

Gliomas are incurable brain tumors. Researchers are trying to unlock the mysteries of how they originate from normal cells, which may lead to better treatments. A new study published in the journal Cell centers on epigenetic rather than genetic changes that drive normal cells to form tumors. The work reveals the precise genes that are regulated epigenetically and lead to cancer.

Genes make us who we are in many ways and are central to defining our health. Cancer is often viewed as a disease caused by changes in our genes, thus our DNA. Epigenetics is the study of how behavior, environment, or metabolic changes can cause alterations to the way genes work. Unlike genetic changes, epigenetic changes do not change one’s DNA, and they can be reversed.

“We used tumor samples and mouse modeling to discover and functionally demonstrate the role of epigenetic alterations in gliomas,” says Gilbert J. Rahme, PhD, first author and Assistant Professor in the Department of Pharmacological Sciences at the Renaissance School of Medicine, and formerly a postdoctoral fellow at the Dana-Farber Cancer Institute in Boston. “By doing this, we discovered genes regulated epigenetically in gliomas, including potent tumor suppressor genes and oncogenes, that drive the tumor growth.”

In the paper, titled “Modeling epigenetic lesions that cause gliomas,” the research team show in the model that epigenetic alterations of tumor suppressor and oncogenes collaborate together to drive the genesis of this brain tumor.

The authors explain that “epigenetic activation of a growth factor receptor, the platelet-derived growth factor receptor A (PDGFRA) occurs by epigenetic disruption of insulator sites, which act as stop signs in the genome to prevent aberrant activation of genes. The activation of PDGFRA works in concert with the epigenetic silencing of the tumor suppressor Cyclin Dependent Kinase Inhibitor 2A (CDKN2A) to transform a specific cell type in the brain, the oligodendrocyte progenitor cell (OPC), driving the formation of brain tumors.”

Rahme says the next step is to test whether therapies that can reverse the epigenetic changes observed in brain tumors can be helpful as a treatment.

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The Renaissance School of Medicine Class of 2023 included 127 graduates, shown here as a class reciting the Physicians’ Oath for the first time as MDs. Photo by Arthur Fredericks
Peter Igarashi, MD, Dean of the Renaissance School of Medicine, encouraged the Class of 2023 as they enter the field of medicine. This year he presided over his first convocation as dean of the school. Photo by Arthur Fredericks
Newly minted physicians – Graduates from the Renaissance School of Medicine celebrate and cheer during the school’s 49th Convocation. Photo by Arthur Fredericks

127 RSOM graduates begin residencies in summer; one-quarter will stay at SB Medicine, others to practice in NY and all over the country

The Renaissance School of Medicine (RSOM) at Stony Brook University celebrated its 49th Convocation on May 17 by conferring MD degrees to 127 graduates who will begin their first assignments as resident physicians this coming summer. Collectively, they will practice in New York State and 19 other states. Approximately one-quarter of the class will be residents at Stony Brook Medicine locations.

Peter Igarashi, MD, presided over the convocation for the first time as Dean of the RSOM. He also led the graduates in reciting the Hippocratic or Physicians’ Oath for the first time as MDs. John M. Carethers, MD, Vice Chancellor for Health Sciences, University of California, San Diego, delivered the Convocation Address.

“All of you are beginning a career in medicine when the need for physicians has never been greater, and the skills you have learned while at Stony Brook have laid the foundation for your career,” said Hal Paz, MD, MS, Executive Vice President for Health Sciences, Stony Brook University, and Chief Executive Officer, Stony Brook University Medicine, who delivered the welcome remarks.

“Among you, we have future residents in internal and emergency medicine, anesthesiology, neurology, psychiatry, and pediatrics, to name just a few – all committed to providing compassionate, patient-centered care in a wide range of communities. I’m delighted to learn that a majority of you are staying in New York, with many beginning your careers right here at Stony Brook.”

One of the new graduates who will remain at Stony Brook Medicine as a resident in Emergency Medicine is Erin Lavin. Remarkably, she gave birth just a day before the Convocation and was on hand – with baby girl – at the ceremony.

“For most of you, almost your entire medical school education has taken place under the oppressive cloud of the Covid-19 pandemic. This is certainly not what you signed up for when you arrived in 2019,” said Dr. Igarashi. “When the pandemic struck New York, you rapidly pivoted to remote learning and social distancing. When in-person clerkships were again permitted but vaccines were not yet widely available, you bravely came into the hospital to learn how to take care of patients. Your resilience and dedication have brought you here today.”

The graduates join more than 5,800 Stony Brook alumni who earned their MD degrees from the RSOM. This latest group of newly minted physicians joins the healthcare workforce in a post-pandemic era that requires a continuing need for more physicians because of such trends as aging populations, the prevalence of chronic diseases, and new long-term illnesses emerging from the pandemic. The transformation of healthcare such as the growth of telemedicine and more specialty care services will also broaden these new physicians’ opportunities.

Primary Care services such as Medicine and Pediatrics will remain as needed and growing practices in our society. According to an Association of American Medical Colleges (AAMC) 2021 report, our country faces primary care shortages ranging from 21,000 to 55,000 practitioners over the next decade. A significant portion (21 percent) of the graduates will enter primary care fields starting with their upcoming residencies.

Some of the new graduates moved into the field of medicine more quickly than the traditional four years. The RSOM’s 3-year MD program continues to add students. This year, 11 students graduated from that track, the highest number in the school’s history.

 

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Dr. Peter Igarashi is the incoming dean of the Renaissance School of Medicine. Photo from University of Minnesota

Stony Brook University’s Renaissance School of Medicine has named Dr. Peter Igarashi, a nephrologist and physician scientist, as its new dean, effective Sept. 12.

Igarashi comes to Stony Brook from the University of Minnesota Medical School, where he is the Nesbitt Chair, professor and head of the Department of Medicine.

At the University of Minnesota, the new dean oversaw 600 full-time and affiliate faculty, 100 adjunct faculty, and over 240 residents and fellows, all while increasing National Institutes of Health funding by 60%.

At UMN, he also helped to cut gender pay disparities, appointed women to leadership positions, developed new multidisciplinary programs, and created an Office of Faculty Affairs and Diversity.

“Dr. Igarashi is a superb, academically accomplished physician leader with a highly successful track record of clinical program growth and research advancement,” Dr. Hal Paz, executive vice president of Health Sciences at SBU and chief executive officer of Stony Brook University Medicine, said in a statement. 

Igarashi has received over $25 million in funding from the NIH during a career in which he has studied polycystic kidney disease, transcriptional regulation, epigenetics and kidney development.

Polycystic kidney disease, or PKD, is an inherited disorder that involves the development of clusters of cysts, primarily in the kidney. Symptoms of the disease can include high blood pressure, loss of kidney function, chronic pain and the growth of cysts in the liver, among others.

His lab developed unique lines of transgenic mice that he has used to study kidney-specific transgene expression and gene targeting.

In addition to writing nine chapters in textbooks, Dr. Igarashi has also authored more than 100 peer-reviewed journal articles.

Before his seven-year stint at the University of Minnesota, Dr. Igarashi had been Chief of the Division of Nephrology and founding director of the O’Brien Kidney Research Core Center at the University of Texas Southwestern Medical Center in Dallas.

At the University of Texas, Dr. Igarashi created services to provide regular kidney dialysis to undocumented and other often marginalized patients. He also led an effort to use artificial intelligence to identify and optimize co-management of patients with hypertension, diabetes, and chronic kidney disease in primary care practices.

A recipient of the NIH Merit Award, Dr. Igarashi also won the 2015 Lillian Jean Kaplan International Prize in polycystic kidney disease. The award honored his contribution to the goal of developing treatments and a cure for polycystic kidney disease.

Dr. Igarashi earned his medical degree from the UCLA School of Medicine and completed an internal medicine residency at the University of California Davis Medical Center. He did a nephrology fellowship at Yale University and also taught at the Yale University School of Medicine.

Dr. Igarashi is board-certified by the American Board of Internal Medicine. He is a member of the American Heart Association Kidney Council, the American Physiological Society, the American Society for Clinical Investigation, the American Society of Nephrology and the Association of American Physicians.

Dr. William Wertheim had been the interim dean of the Renaissance School of Medicine since February 2021, following Dr. Kenneth Kaushansky’s retirement after serving as dean and senior vice president of health sciences for 11 years.

Dr. Wertheim will return to his role as vice dean for graduate medical education. He will also have a leadership role at the Stony Brook Medicine Community Medical Group, which is an arm of Stony Brook Medicine and includes over 35 community practices with over 50 locations across Long Island.

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Director of the Heart Rhythm Center at Stony Brook Heart Institute Dr. Eric Rashba is holding the new Watchman FLX device, which provides protection from strokes for people with atrial fibrillation. Photo from Stony Brook Medicine

The butterflies that color backyards are welcome companions for spring and summer. The ones that flutter towards the upper part of people’s chests can be discomforting and disconcerting.

In an effort to spread the word about the most common form of heart arrhythmia amid American Heart Month, the Stony Brook Heart Institute recently held a public discussion of Atrial fibrillation, or A-fib.

Caused by a host of factors, including diabetes, chronic high blood pressure, and advanced age, among others, A-fib can increase the risk of significant long-term health problems, including strokes.

In atrial fibrillation, the heart struggles with mechanical squeezing in the top chamber, or the atrium. Blood doesn’t leave the top part of the heart completely and it can pool and cause clots that break off and cause strokes.

Dr. Eric Rashba, who led the call and is the director of the Heart Rhythm Center at Stony Brook Heart Institute, said in an interview that A-fib is becoming increasingly prevalent.

A-fib “continues to go up rapidly as the population ages,” Rashba said. It occurs in about 10% of the population over 65. “As the population ages, we’ll see more of it.”

The Centers for Disease Control and Prevention estimates that 12.1 million people in the United States will have A-fib over the next decade.

As with many health-related issues, doctors advised residents to try to catch any signs of A-fib early, which improves the likely success of remedies like drugs and surgery.

“We prefer to intervene as early as possible in the course of A-fib,” Dr. Ibraham Almasry, cardiac electrophysiologist at the Stony Brook Heart Institute, said during a call with three other doctors. “The triggers tend to be more discreet and localized and we can target them more effectively.”

Different patients have different levels of awareness of A-fib as it’s occurring.

“Every single patient is different,” said Dr. Roger Ran, cardiac electrophysiologist at the Stony Brook Heart Institute. Some people feel an extra beat and could be “incredibly symptomatic,” while others have fatigue, shortness of breath, chest discomfort, and dizziness.

Still other patients “don’t know they are in it and could be in A-fib all the time.”

Doctors on the call described several monitoring options to test for A-fib.

Dr. Abhijeet Singh, who is also a cardiac electrophysiologist at the Stony Brook Heart Institute, described how the technology to evaluate arrhythmias has improved over the last 20 years.

“People used to wear big devices around their necks,” Singh said on the call, which included about 150 people. “Now, the technology has advanced” and patients can wear comfortable patches for up to 14 days, which record every single heartbeat and allow people to signal when they have symptoms.

Patients can also use an extended holter monitor, which allows doctors to track their heartbeat for up to 30 days, while some patients receive implantable recorders, which doctors insert under the skin during a five-minute procedure. The battery life for those is 4.5 years.

Additionally, some phones have apps that record heartbeats that patients can send by email, Singh said. “We have come a long way in a few years.”

Dr. Roger Fan, a cardiac electrophysiologist at the Stony Brook Heart Institute, added that all these technologies mean that “we are virtually guaranteed to get to the bottom” of any symptoms.

Drugs vs. surgery

Doctors offer patients with confirmed cases of A-fib two primary treatment options: drugs or surgery.

The surgical procedure is called an ablation and involves entering the body through veins in the groin and freezing or burning small areas that are interfering with the heart’s normal rhythm. The procedure breaks up the electrical signals in irregular heartbeats.

Performed under general anesthetic, the procedure generally takes two to three hours. Patients can return home the same day as the operation, Rashba said.

As with any surgery, an ablation has some risks, such as stroke or heart attack, which Rashba said are “very rare” and occur in fewer than one percent of the cases. Additionally, patients may have groin complications, although that, too, has declined as doctors have used ultrasound to visualize the blood vessels.

In extremely rare occasions, some patients also have damage to the esophagus behind the heart, said Rashba, who is also a professor of medicine.

For patients experiencing symptoms like A-fib, doctors recommended a trip to the emergency room, at least the first time.

“If it’s not going away, one, you can reassure yourself, two, you can get treatment, and three, you can get a diagnosis quickly,” said Almasry.

The Stony Brook doctors said choosing the best treatment option depends on the patient.

“Everybody has different manifestations of their A-fib,” said Fan.

Among other questions, doctors consider how dangerous the A-fib is for the patients, how severe the symptoms are, and how much they affect the quality of life.

Doctors urged residents to make the kind of healthy lifestyle choices that keep other systems functioning effectively. Almasry cited a direct correlation between obesity and A-fib.

Reducing body weight by 10%, while keeping the weight off, can reduce the likelihood of A-fib recurrence, he said.

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