Hein Heidbuchel

How did you come to choose medicine as a career, and why cardiology and electrophysiology?

The use of technology to improve health has intrigued me since I was young. My original dream was to combine engineering and medicine studies, and to do research on bionic arms and legs. Microelectronics had just started at that time and it fascinated me. I grew up in an academic milieu, and acquaintances advised me to rather focus on medicine, combining it with training in engineering as an add-on. That is what I did for three years. The technicalities of modern cardiology and especially electrophysiology, both cellular and clinical, later proved another field in which I could integrate my interests.

Who has inspired you in your career and what advice of theirs do you remember today?

I have been lucky to have very complementary and great mentors. Prof Edward Carmeliet got me into the field of cellular electrophysiology. He is a great scientist and was the promoter of my PhD thesis. I recorded for the first time human atrial single potassium channel currents and discovered the involvement of a fourth enzyme to the signal transduction cascade of acetylcholine-activated K+ channels. I learned from him that as scientists we should have an open mind for nonconventional concepts, not rejecting them based on preconceptions that might be wrong. Scientists have the right to err, which is essential for the advancement of science since it stimulates the dialectic arguments that lead to insights. His advice still sounds in me when I evaluate the work of others. Prof Hilaire De Geest and Prof Hugo Ector, superb clinicians, believed in my career of combining technology with medicine, and greatly facilitated it. Many clinicians at that time, and even now, were suspicious about technically-inclined physicians, as if the first would be an obstacle to the second. That is a flawed preconception! Finally, Prof Warren Jackman was my greatest mentor. My two years in his lab in Oklahoma City were of greatest inspiration. I captured his relentless pursuit to unravel, understand and simplify complex issues, and I hope that I can match some of his teaching qualities that I admire so much. He advised me to develop my own methods and views, not to waver for critique, but to prove myself right by perseverance. He definitely has had most impact on my approach on academic life.

What have been your proudest professional moments?

My proudest moments were the ones when I sensed to have developed a new concept, although these moments were often unpleasant experiences. Like when I found out during a telephone conversation that the renowned professor who promised me to overcome the unfair arguments of a Science paper rejection was the referee himself. He had failed to consider the extra regulatory protein to the G-protein cascade to explain observations in his work. He published an own paper with the concept a few weeks later. Or the theory I proposed in 2003 that the right ventricle in athlete’s heart is the most vulnerable one and may be harmed by intensive activity itself. At that time, everybody believed that sport could only be good to the heart, and my paper was originally rejected based on the argument “that publication of the data would be a disservice to the athletic community”, despite the facts. Or the recognition for an own mapping technology, LARCA, that we developed at the Leuven University based on 3D-2D fluoroscopic integration. Before, everybody believed that we could not do good electrophysiology without a CARTO or EnSite system. I think we have proven them wrong.

Which innovations in cardiac electrophysiology shaped your career?

In a first stage, microelectronics that, for instance, enabled single-channel recordings. Later the realisation that ablation could offer a cure for arrhythmias, or that devices could prevent serious adverse outcomes if ablation was not possible. During the early years of my career, I was still confronted by colleagues who joked at me with the notion that electrophysiology, like neurology, could nicely describe tracings, but do nothing. Very quickly, over 10 years, this perception vanished. I still remember that evening early in 1992 when I was reading the abstracts of the upcoming NASPE (now HRS) meeting and came across the ablation of atrioventricular nodal re-entrant tachycardia abstract by Jackman. Accessory pathways could already be ablated, but I thought: if this man can do that, we will be able to ablate many more arrhythmias. The following day I called him and guaranteed my fellowship. It was the best move of my career.

Catheter ablation of atrial fibrillation is now an increasingly popular treatment. How do you see this field in the future?

The last years have not shown radical progress beyond the initial phase of recognition about the role of the pulmonary veins. But the AF problem is so massive in numbers that research will lead to simpler, safer and more effective ablation strategies. Will that come from single-shot devices or from a re-emergence of robotics? I do not know. There are arguments for both. I think that the remote navigation technologies came on the market too early, before we had solved the issues of correct 3D navigation, with compensation for respiration and cardiac motion, and without the necessary catheter tip sensor technology to make for truly hands-off equipment. But time will come when computers can better integrate the required 3D and other information and perform more accurate ablations than the human hand can do. Then finally we will be able to enjoy a cup of coffee during the procedure, while the robot performs the heavy manipulation work that now really taxes the electrophysiologist’s mind and body.

Your recent research has looked at safety of sports for patients with ICDs in one of your recent researches. What has it showed so far?

It is still unclear whether ICD recipients can safely participate in high-intensity or competitive sports. There are many good arguments to advise against it, but no hard data. A recipe for great debates! No physician has an extensive personal experience. Therefore, a multinational US-EU registry is expected to accumulate the numbers to provide better estimates of the risks. I am currently the chair of the ESC Section on Sports Cardiology, and coordinate the EU part of the registry. However, the registry will not solve all the controversy, since the more philosophical and ethical questions will remain on how well competitive athletes have the free choice to make informed decisions (even with better information) and in how far physicians should prevent potentially serious arrhythmic events rather than treat them by ICD shocks when they occur.