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Electrophysiology trainees need to be prepared for life-long learning

In the first of a series of articles celebrating key figures in electrophysiology, Congress News speaks to Professor Douglas L Packer (Mayo Clinic, Rochester, USA) about his achievements and his advice for those new to the field. He says he believes that the most important thing for trainees to learn is “how to learn”. This is because of the rapid changes in technology and techniques.


Why did you choose to specialise in electrophysiology?

Growing up, I was always interested in all things electric; I had an electric train set and did a lot of wiring myself. I also worked as a novice electrician in high school. Then, in college, I discovered an interest in physical chemistry in general and quantum mechanics in particular. When I did my residency, I was exposed to cardiac electrophysiology and the whole thing came together—I found what had interested me for years.

What have been the biggest developments in electrophysiology during your career?

Since my electrophysiology training in 1983, the major developments have been defibrillators and ablation. More recently, highly sophisticated cardiac mapping has been a big step forward. Our most important current research concerns particle therapy. Particle or hadron therapy uses carbon atoms, or protons, to perform catheter-free ablation for atrial fibrillation and ventricular tachycardia and we are carrying out investigational studies in this area. This is interesting because it could potentially offer an alternative to invading patients’ vessels and ablating from inside the heart.

What has your biggest contribution to the field of electrophysiology been?

First, our work has advanced the understanding of the biophysics of ablation to treat atrial fibrillation and ventricular tachycardia, and therefore, also the implementation of ablation. My research has also focused on multidimensional imaging. We have worked with ultrasound, magnetic resonance and computed tomography (CT) imaging, combining, or registering complex mapping, to those images. Finally, particle therapy is a huge focus of my research now.

How has attending congresses helped your career?

Those who are just starting out in electrophysiology, or those in the middle of their career, can learn a lot from a variety of different presenters such as the fundamental principles of electrophysiology, new techniques and new technologies. As time goes on, the reason congresses such as EHRA EUROPACE - CARDIOSTIM and Heart Rhythm Society (HRS) are so important is that they give us a chance to network and interact with each other. Simply doing this puts you about a year and a half ahead, maybe two years ahead, to what you would learn by reading a journal article.

What would your advice to someone just coming into the profession be?

I would advise them to closely associate with someone who could teach them and guide them. It is not just a matter of  “book smarts”, but teaching them how to use technology, perform procedures, use techniques, and also what is (and is not) important when taking care of patients with arrhythmias. Secondly, all of us are finding that because of the explosion of new technology, innovation, and discovery, the field changes every three to five years. So I would tell the new trainee or fellow that they need to be prepared for lifelong learning, which means the most important thing they need to learn is “how to learn”. It is critically important that new trainees and fellows are surrounded by people who are willing to tell them how to practise electrophysiology and even tell them when “the way you are doing things is not right”. Otherwise, they believe that all electrophysiology originates within themselves—it does not; it originates within an entire world of investigators and clinicians.

What are the key areas for research?

The most pressing area is how to make electrophysiology procedures safer. Then, we need to make procedures more effective. In terms of the electrophysiology, and the techniques and the technologies, we need to learn how to make procedure simpler. We also need to learn how to go after questions in areas such as particle therapy, needle catheter ablation techniques, stem cell therapies and therapies to restore conduction using cells.