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I fell immediately in love with the “natural beauty of electrophysiology”

For Dr. Harry Crijns (Department of Cardiology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, The Netherlands), it was love at first introduction when he came across electrophysiology, falling “immediately in love” with the discipline’s natural beauty. He talks to Congress News about the highlights of his career.

Arrhythmias


Why did you choose to specialise in electrophysiology?

I started as a medical student at Dr. Chiel Janse’s (former Wilhelmina Gasthuis, University of Amsterdam) experimental EP lab in Amsterdam in 1978.

I was immediately in love with cardiac electrophysiology (EP) for its natural beauty, especially ECG tracings and mechanisms derived from them. I felt a strong attraction because one can understand quite quickly what is happening in the heart from these arrhythmia tracings and at the same time you feel the abundance of unanswered questions. At that time EP started to grow exponentially while a summary of experimental EP could still be grasped from one book “Electrophysiology of the heart” by Brian Hoffman and Paul Cranefield.

Throughout your career, what have been the biggest developments in electrophysiology?

The very introduction of computerised recording and analysis of EP signals from the heart’s surface in 1978, derived from simultaneously recorded signals using custom made multi-electrodes. The second big development was catheter ablation—initially DC-shock-based, later radiofrequency and cryoablation; I was involved in one of the first experimental cryoablations.

Thirdly, there was implantable cardioverter defibrillator (ICD) therapy and resynchronisation therapy.  

What do you think has been your greatest contribution to the field of electrophysiology?

The RACE studies—RACE 1 on rhythm versus rate control; RACE 2 on lenient versus strict rate control—have been my greatest contribution. Furthermore, alongside Dr Francisco G. Cosio (Hospital Universitario de Getafe, Carretera de Toledo, Madrid, Spain), I introduced the notion that atrial remodelling precedes atrial fibrillation (AF) long before AF emerges (Europace 2008), which based on the notion that AF is more often a vascular disease (hypertension) than an arrhythmia.

Finally, together with Professor Gregory Lip (University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK), I introduced the CHA2DS2-VASc stroke risk score and the HAS-BLED bleeding risk score in AF, which conquered the world very quickly! Also, the HATCH score on AF progression received a lot of attention.

These scores were constructed from the Euro Heart Survey, and I am much indebted to the European Society of Cardiology (ESC)—in particular, Professor Maarten Simoons (Department of Cardiology - Thoraxcenter, Erasmus Medical Center Rotterdam). Prof. Simoons was ESC president back at the beginning of this new century and invited me to chair this “mother of all AF registries”.

How has attending congresses helped your career?

Presenting my research, convening with colleagues in key opinion leader meetings and working with colleagues on projects has helped a lot.

Above all, being invited to speak about a new topic always enhances your thinking about the topic, because you feel the urge to present the topic in great detail and very precise, so before delivering you have to study hard.

What advice did you receive from a mentor that you would pass onto someone who is just coming into the profession?

Do not be afraid of sharing your good/best ideas; we are all in the same world and if you yourself can think of an idea/notion, your peers can do the same. Also while connecting with them, they provide you with a sound board/mirror that, in the end, helps you to better form your ideas.

What are the most important unanswered questions in electrophysiology?

We need a much stronger diagnostic approach towards clinical arrhythmia mechanisms, continuous rhythm monitoring may help for that matter, as well as inducible pluripotent stem cell (IPS) technology and other cardiogenetic techniques, novel mapping techniques, etc.

We also need sophisticated molecular arrhythmia treatments to replace the current indistinct “burning of the substrate”.

Also, understanding susceptibility to major adverse cardiovascular cerebrovascular events (MACCE) in AF is highly needed to personalise anticoagulation and enhance its cost-effectiveness by avoiding overtreatment. All of this will serve to reduce the burden of arrhythmia for patients and reduce the risk of sudden death.