Hein Heidbuchel, director of Electrophysiology at the University Hospital Leuven, and full professor at the University of Leuven, Belgium, found the way to combine medicine with his interest in engineering in cardiac electrophysiology. In this interview with Cardiac Rhythm News, he spoke about his career, influences and proudest moments. He also described the innovations that shaped his career, new technologies and EP education.
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.
What is the most interesting paper you have come across recently?
This is a time of revolutions, the falling of old guards. The same is true for vitamin-K antagonists in all sectors of anticoagulation management, from prevention after orthopaedic surgery, pulmonary embolism, to atrial fibrillation, and who knows what will come next. The results of the RELY trial with dabigatran were unexpectedly positive and sent a big roar throughout cardiology. Similarly positive findings have been reported with direct factor Xa inhibitors like rivaroxaban (ROCKET-AF, although not published yet) and apixaban (AVERROES). On the other hand, medicine will have to develop new ways of following-up on these patients and make sure that they comply with treatment. Moreover, an intriguing issue is how regulatory and paying authorities will deal with it. But it is clear that these drugs are a major change for patients.
What technologies are you looking closely?
Remote monitoring technology. We will only be able to deal with all the complexities of chronic disease management by making healthcare delivery more efficient. I got interested in the field from the perspective of ICD remote monitoring, but the concepts are applicable to many other areas. Again, the major hurdles will not necessarily be technological, but rather how medicine reorganises itself around it. As principal coordinating investigator of the European Health Economic Trial on Home Monitoring in ICD Therapy (EuroEco) we want to explore the cost impact of remote technology on the providers of care, physicians and hospitals. It is the main driver in acceptance or rejection of new technology. The findings will of course be important for payers of health care, since reimbursement will guide how technology is implemented in practice.
As chair of EHRA’s Education Committee, what direction do you see for EP education in Europe?
Although EHRA is clearly the leading EP organisation in Europe and provides certification for Pacing and Electrophysiology, we have no pretention that we can and want to provide all EP education ourselves. We recognise the important educational efforts by industry, often in smaller groups and with hands-on facilities, and by external organisers. Therefore, we have set up an Educational Framework. The backbone is a Device track and an Interventional EP track, each with EHRA Courses of 2.5 days and a number of online EHRA Webinars and other online learning tools. We affiliate external educational activities, based on quality and on their complementarity to the EHRA activities. All this information is brought together on EHRA website.
Outside of medicine, what other interests do you have?
One woman, three children, 20 horses, and innumerable lost golf balls…
1979–1986 Faculty of Medicine, University of Leuven
1992 PhD in Physiology
1993 Specialist Degree in Internal Medicine
1993–1994 Fellowship Clinical Cardiac Electrophysiology, University of Oklahoma, Oklahoma, USA (W Jackman)
1995 Specialist degree in Cardiology
Clinical – University Hospital, KU Leuven, Belgium
1986–1994 Clinical assistant
1997–2004 Adjunct medical director
2004–present Medical director
1987–1987 Research assistant of the University of Leuven (Lab of Physiology)
1987–1991 Research assistant of the National Fund for Scientific Research Belgium
1993–1994 Research Fellow of the National Institutes of Health (Fogarty International Center), supported by a Fulbright-Hays grant-in-aid
1994–1998 Docent, University of Leuven
1998–2004 Senior lecturer, University of Leuven
2004–2007 Professor, University of Leuven
1996–2006 “Fundamental clinical investigator” of the Fund for Scientific Research, Flanders
2000–present Founder and head of ECG CoreLab – Leuven Coordinating Center
2007–present Full professor, University of Leuven
Scientific society activity
- International chair (2009–2013) and member (2005–2009) of the Educational Committee of the European Heart Rhythm Association (EHRA). EHRA Board Member (2009–present) and course director Case-based course (2008–2011)
- Chair of the Section on Sports Cardiology of the European Society of Cardiology/EACPR (2010–2012) and nucleus member (2006–present)
- Member of the ESC Education in Cardiology Committee and ESC Task Force on Education Online (2010–2012)
- EHRA Research Network (2008–present)
- Scientific Committee member (2006–2010) and member of the EuroPRevent Congress Program Committee 2008 and 2009 (EACPR)
- Member of the Europace 2007, 2009 & 2011 Congress Program Committee (EHRA)
- Fellow of the European Society of Cardiology (2007–present)
- Board Member (Councillor) of the Belgian Society of Cardiology (2005–2011)
- Nucleus member of the Belgian Working Group on Cardiac Pacing and Electrophysiology(1994–present)