Anne Curtis (UB distinguished professor and the Charles and Mary Bauer professor and chair, Department of Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA) is past president (2005–2006) of the Heart Rhythm Society. She has been involved in various clinical trials in electrophysiology including her most recent trial, BLOCK HF, and is currently a member of different editorial boards in the field. She spoke to Cardiac Rhythm News about her career achievements, memorable cases and the major challenges executing a trial
When did you decide you wanted a career in medicine?
I always had an interest in science and mathematics, which led me to a bachelor’s degree in chemistry. I did not make the decision to attend medical school until my junior year at Rutgers University, New Brunswick, USA. I had considered pursuing a PhD in chemistry versus a career in medicine. Ultimately, I decided that working in a basic research laboratory was too isolated; I wanted to interact with people on a regular basis, and a career in medicine would allow me to combine that interest with the study of human biology.
Why did you decide to specialise in cardiology and electrophysiology?
I chose internal medicine because of the comprehensive approach to patient care and the long-term relationships one can have with patients. I was always drawn to inpatient and critical care, and I enjoyed doing procedures as well. Putting that all together made cardiology a natural choice of subspecialty. From the time I chose cardiology, I knew I wanted to concentrate in electrophysiology. I find electrophysiology to be the perfect combination of intellectual insight, with the need to work through complex tracings to arrive at the correct diagnosis of a rhythm disorder; and the procedural aspect, requiring advanced skills to perform ablations or device implantations.
Who were your mentors and what influence did they have on your career?
My first mentor was Dr Joan S Valentine, a chemistry professor I had in college. I did research in bioinorganic chemistry in her laboratory, and my first scientific publication was on the results of that research. At the time, she was married and had two small children; she was also a full-time member of the faculty at Rutgers University, so she was an excellent role model for combining family and a career at the same time.
Another mentor was Dr C Richard Conti, who was my division chief when I took my first academic position at the University of Florida. He was very supportive in my career development in academic medicine and he helped me to get started on national committees and service.
Most recently, Dr Myron Weisfeldt from Johns Hopkins University, Baltimore, USA, gave me valuable advice when I became chair of the Department of Medicine at the University at Buffalo, New York, USA.
What is your biggest motivation of working in medicine?
We are truly blessed in medicine having to work, on a day-to-day basis, with our patients and making a direct impact on their health and lives. We have a responsibility to do our best for them every day, which means keeping up-to-date on the latest medical advances and also generating new knowledge for their benefit.
What have your proudest moments been?
On a personal level, I have three children who are doing well in their chosen paths in life. My oldest daughter, Diana, is a resident in anaesthesiology at the Maine Medical Center in Portland, USA, after graduating from medical school at Florida State University this past year. Katherine also graduates this year from the University of Florida and will be married in early 2014, while Alex graduates from the University of Virginia in 2014.
On a professional level, I was honoured to serve as the president of the Heart Rhythm Society (HRS) in 2005–2006. It was the culmination of many years of service on committees, most of which I chaired at some point, and the Board of Trustees. During my tenure as president, a crisis developed with device recalls, and I was proud of how HRS took a leadership role in working through how to handle it for the benefit of our patients.
What has been your most memorable case and why?
I can think of a number of cases that have been memorable. Sometimes a case has been memorable because I was able to evaluate a patient and confidently recommend that a procedure was not necessary. In other cases, by performing a catheter ablation or implanting a cardiac resynchronisation device, I was able to cure a patient or greatly improve his/her health and quality of life. It is gratifying to know that our training and experience lead to the clinical judgment to provide the best care for each individual patient.
In your view, what has been the most important development in electrophysiology during your career?
Clearly, the development of catheter ablation for the treatment of cardiac arrhythmias has been the most important development during my career. At one time, arrhythmias could only be treated with medications, and then a major advance was surgical treatment of arrhythmias. Once the same results could be achieved with radiofrequency catheter ablation, many more patients could be cured of disabling arrhythmias.
What are three unanswered questions in the cardiac rhythm field?
1. How can we better predict who is at risk for sudden cardiac death? Our existing risk stratification methods have poor positive predictive value, yet so far we have not been able to find better approaches to solving this problem.
2. What causes atrial fibrillation to develop and progress in different patients? I believe we tend to treat atrial fibrillation as if there is a common etiology and path of progression in all patients. While I accept that pulmonary vein triggers are important in many cases, the story is much more complex and requires further research.
3. How can we better identify patients who are likely to respond to cardiac resynchronisation therapy (CRT), and how can we minimise the number of non-responders who receive these devices?
As a member of different editorial boards and a manuscript reviewer, which research paper published, in the last year, do you consider the most interesting?
While it is not one specific research paper, I think one of the most important advances over the past year or two has been the approval of novel oral anticoagulant drugs for prevention of thromboembolism in patients with atrial fibrillation. The problems with warfarin are well known, and many patients who should be treated are not. The newer drugs should help increase the number of patients who receive proper treatment for stroke prevention in atrial fibrillation.
What piece of your own research are you most proud of and why?
The BLOCK HF trial is the research which should possibly have the greatest impact on patient care among the research projects I have been involved with. It was a large, prospective, randomised clinical trial that took nine years to complete. It was designed to determine the best way to pace the ventricles in patients with atrioventricular block and left ventricular dysfunction. We found that biventricular pacing was superior to right ventricular pacing in these patients.
You have been involved in various clinical trials; from your experience could you tell us what are the major challenges executing a trial?
The key to any clinical trial is the study design. It is critical to craft the hypothesis and primary outcome measures carefully, and to determine inclusion and exclusion criteria so that enrolment of subjects is feasible in a reasonable period of time. However, even if all of that is done well, “study fatigue” is always a problem. Once a study has been ongoing for a while, enthusiasm for enrolling subjects can wane. It is important to keep up the interest in the study until the last patient is enrolled and followed to study completion.
You have been involved in the education of residents and fellows; what advice would you give to medical students wanting to specialise in electrophysiology?
Electrophysiology is a wonderful field, and I would encourage residents and fellows to consider it as a career path. It is a great combination of the consultative aspect of medicine, including interpretation of electrocardiograms (ECGs), rhythm strips, and device interrogations; and the procedural part, including catheter ablations and implantable devices. It is important to have a solid foundation in cardiology first, including ECGs and imaging, because they are so fundamental to the procedures we do.
Many of the leading figures in electrophysiology are male. What can be done to encourage more women into electrophysiology and how can they be encouraged to be leaders in their field?
Encouraging women to pursue a career in electrophysiology has been a long-standing interest of mine. Through the Women’s Leadership Initiative of the Heart Rhythm Society, we have held programmes and developed networking opportunities to encourage women to enter the field. Several of the device companies have also supported programmes to encourage women to train in electrophysiology.
To be leaders in the field, women should seek out their own mentors and contribute to scientific discovery through investigator-initiated research or active involvement in key clinical trials. They should also look for opportunities to get involved in committees and national professional societies, and they should follow through on any opportunities that do come their way.
What are your current areas of research?
I continue to be involved in clinical trials of CRT. We are looking at the potential benefit of CRT in different populations of patients with less severe heart failure, with the goal of preventing progression of the disease. I am also interested in the management of patients with atrial fibrillation, including the use of new methods of detection and medical management.
Outside of medicine, what other hobbies or interests do you have?
I am a big believer in physical activity. I enjoy playing tennis, and I try to get on the court two or three times a week whenever I am at home. I am also a runner, putting in three miles on the treadmill or around the park near my home when tennis is not on the agenda. I also work out twice a week. Aside from that, I enjoy being outdoors and spending time with friends, now that we have an empty nest at home.
Fact File
Present appointments–
2013 Distinguished professor, University at Buffalo, USA
2010 Charles and Mary Bauer professor and chair, Department of Medicine, School of Medicine and Biomedical Sciences, University at Buffalo
Most recent national and international scientific activity
2003 VA Merit Review Committee – ICD clinical trials
2003– BLOCK HF principal investigator
2003– 2011 Insync registry Events committee
2004– Improve-HF steering committee
2005–2007 Clinical and Integrative Sciences Study Section, National Institutes of Health, temporary member
2007–2012 Sarnoff Foundation, board of directors
2007– Publications committee, IMPROVE HF
2008–2011 NIH Cardiovascular Sciences Study Section, SBIR, reviewer
2009 NIH Center for Scientific Review Special Emphasis Panel, CV Sciences Small Business Activities
2009– Catheter Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial, Data and Safety monitoring board
Professional memberships–
1988 Fellow American College of Cardiology
1989 Member North American Society of Pacing and Electrophysiology (now Heart Rhythm Society)
1990 Member American Federation for Clinical Research
1992 Member American Heart Association Council on Clinical Cardiology
2004 Fellow American Heart Association
2005 Member Association of Professors of Cardiology
2006 Fellow Heart Rhythm Society
2013 Fellow, American College of Physicians
Editorial boards–
PACE, Journal of Interventional Cardiac Electrophysiology, Clinical Cardiology, Cardiac Arrhythmias: Index and Reviews, Journal of Cardiovascular Electrophysiology, Journal of the American College of Cardiology, Advisory Panel, US Cardiology (2005–2006), Heart Rhythm (2005–2006), Journal of Interventional Cardiac Electrophysiology, associate editor, Multimedia and Defibrillation (2007–2008), Circulation: Arrhythmias and Electrophysiology, associate editor (2008–) American Heart Journal (2009–)
