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Electrophysiology was love at first sight

Professor Charles Antzelelvitch (Lankenau Institute for Medical Research, Wynnewood, USA) is internationally known for his work in cardiac electrophysiology and arrhythmia syndromes. His body of research has expanded scientific understanding of the heart's electrical system in a number of ways. In this interview with Congress News, he explains why he became an electrophysiologist and talks about his research and the questions that still need to be answered in the field.

Invasive Electrophysiology and Ablation

Why did you choose to specialise in electrophysiology?

I started my scientific career as a biochemist. One of my rotations in graduate school was in an electrophysiology laboratory. It was love at first sight. I promptly traded in my test tubes for microelectrodes.

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

Our field has witnessed great strides in our understanding of the structure and function of ion channels responsible for the generation of the action potential and excitation-contraction coupling as well as huge advancements in our understanding of the mechanisms underlying cardiac arrhythmias and the mechanisms of action of antiarrhythmic drugs and radiofrequency ablation techniques.

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

Working with my talented colleagues, my scientific achievements include: the discovery and characterisation of reflected re-entry, phase 2 re-entry, and late phase 3 early after depolarisations (EADs) as mechanisms of extrasystolic activity capable of precipitating life-threatening ventricular tachycardia (VT) and fibrillation; work demonstrating electrical heterogeneity within ventricular myocardium, particularly transmural dispersion of repolarisation and discovery of a unique population of cells, named M cells, which opened new doors to our understanding of electrophysiology and pharmacology of the heart and arrhythmogenic mechanisms; delineation of the cellular and ionic basis for the long QT, Brugada, and short QT syndromes as well as catecholaminergic VT; design of novel approaches as therapy for these syndromes; the cellular and ionic basis for the J wave and T wave of the ECG; uncovering the genetic basis for Brugada, short QT, long QT and early repolarisation syndromes and design of novel therapeutic modalities; and discovery of novel therapy for atrial fibrillation using atrial-selective sodium channel blockers.

What has been the greatest technical achievement in electrophysiology?

Our greatest technical achievement has been the development of the coronary-perfused wedge preparation, which has allowed us to peer inside the walls of the heart. The preparation has taught us about the cellular basis for the repolarisation waves of the ECG and made possible the discovery of the M cells in the deep subendocardial regions of the ventricular wall as well as the mechanisms responsible for many atrial and ventricular arrhythmias, including the discovery of novel approaches to therapy of life-threatening arrhythmias, which are today used clinically the world over. This preparation continues to play a key role in guiding us in the development of innovative new approaches to therapy.

How has attending congresses helped your career?

Sharing our ideas and findings with colleagues and learning from their achievements is a critical element to advancing science and medicine. Congresses are designed to facilitate this exchange.

What advice did you receive that you would pass onto physicians just coming into the profession?

Believe in yourself and do not be distracted by your detractors. Most of our discoveries would not have been possible if we had not heeded this advice.

What are the most important unanswered questions in electrophysiology?

While we have made important 
progress in our understanding of the genetic basis of electrophysiological derangements, we remain at the tip of the iceberg in this field.