Michael Glikson (director of Davidai Arrhythmia Center, Heart Center, Sheba Medical Center, Tel Hashomer, Israel and the current president of the Israel Heart Society) has contributed to the development of technologies for cardiac resynchronisation therapy (CRT), modern lead extraction, advanced mapping ablation of atrial fibrillation (AF) and ventricular tachycardia (VT) and left atrial appendage (LAA) occlusion. He has produced over 200 research papers in the field. Glikson’s current projects as president of the Israel Heart Society and co-president of the International Dead Sea Symposium (IDSS) on Innovations in Cardiac Arrhythmias and Device Therapy reflect his innovative approach in the field. He speaks to Cardiac Rhythm News about these projects, other highlights in his career and the value of attending medical conferences.
Why did you choose a career in medicine and, in particular, what drew you to electrophysiology?
It was at a very early age when I decided that I wanted to become a physician. The combination of different factors including science, human interaction and a competitive yet compassionate environment drew me to the medical field. I liked electrophysiology as soon as I was exposed to it early in medical school because I regarded it as a field where accurate diagnoses and evidence-based therapies can be applied and solve severe medical problems.
Who were your career mentors and what do you still remember from their wisdom?
My medical mentors taught me that internal medicine is the mother of medicine; I also learned from them the importance of being meticulous and systematic in this career. My main mentors in electrophysiology: Steve Hammill, David Hayes and Doug Packer of Mayo Clinic and Michael Eldar from my own centre, to mention just a few, taught me everything that I needed to launch my professional and scientific career. Professor Eli Ovsyshcher taught me about the importance and how to organise scientific meetings and I collaborate with him in organising the biannual IDSS, which I consider is one of the best moderate-size meetings in the field.
Which innovations in cardiac rhythm management have shaped your career?
I was at the right time and place in my career to adopt evolving technologies for CRT, modern lead extraction, advanced mapping, ablation of atrial AF and VT and LAA occlusion. I have also participated and contributed to the evolution and development of some of these technologies.
Could you describe a moment early in your career when you were amazed by what electrophysiology could achieve?
I was a cardiology fellow when the first ablation of Wolff-Parkinson-White (WPW) syndrome was performed at my centre by doctors Michael Eldar and Bernard Belhassen. Until then, symptomatic WPW was a nuisance as well as a threat to patients for whom medications or extensive surgery were the only options. As soon as they turned on radiofrequency (RF), the delta wave disappeared and I realised that we were at the dawn of a new era. I think it was my final decisive moment to become an interventional electrophysiologist.
Of the research you have been involved in, what do you consider to be your greatest achievement and why?
I was involved and led quite a few studies mainly in the field of pacing and defibrillation. Several studies that I led at my centre, as well as studies that I did with my dear collaborator Paul Friedman from the Mayo Clinic, may have contributed to paradigm shifts in device management, dealing with issues such as defibrillation threshold (DFT) testing, implantable cardioverter-defibrillator (ICD) detection enhancement algorithms, the approach to non-functional leads and many others.
Can you describe a memorable case you treated?
Several years ago we treated a family of patients where two of the children had died suddenly from an unclear aetiology. At that point, the family and the physicians were nervous so ICDs were implanted in two teenage sisters of the deceased children. In the orthodox religious community where they lived, carrying a defibrillator was considered a defect and no one would marry them. Then, we conducted extensive clinical and laboratory studies on this family. One year later, we found that the cause of the disease was a definite mutation of Ryanodine. We were then able to definitely rule out the disease in the two sisters and explant the defibrillators, and could give them a health certificate which led soon thereafter to their marriages. This case was an unbelievable mix of clinical medicine, device practice, top-notch medical science and emotional moments.
What are your current areas of research focused on?
With my fellows and junior staff we deal with many clinical studies. A fair amount of our recent research has focused on analyses from the Israeli national ICD registry that became a very successful project that we established back in 2010.
What new techniques/technologies are you keeping your eye on?
On the ablation side, at the Sheba Medical Center we are interested and trying to achieve an interventional magnetic resonance imaging (MRI) suite that may change the environment of future ablations. This project will eventually lead to fluoro-less operations as well as to real-time imaging of lesions during their creation. I know it is a long shot but we have decided to invest in that direction.
You have been an active speaker at several medical conferences in the field; from your personal experience could you tell us what the most valuable benefits of participating actively at medical conferences are?
One of the main advantages of participating in a meeting rather than following it on the internet is that you are dedicated full time to learning without interference. Preparing lectures is a fantastic way to organise your own thoughts. Watching abstracts and posters give you the chance to learn about the latest scientific developments and networking with colleagues and companies is valuable for establishing mutual collaboration in research and development. I consider the annual meetings from the European Heart Rhythm Association (EHRA) and the Heart Rhythm Society (HRS) the basis for research and collaborations. My belief in the importance of medical conferences is that strong that I collaborate running the IDSS meeting as co-president in Israel.
As co-president of IDSS, could you tell us what the highlights for next year’s meeting are?
The IDSS has become one of the best international meetings of pacing and electrophysiology (EP). In addition to many educational sessions as well as workshops with the best experts in the field, we are making an effort to develop the area of innovations in cardiology as our main theme. Start-up companies and inventors from throughout the world are going to present their recent inventions at the meeting next year. Being a hub for many innovations and inventions in the field, Israel, “the start-up nation”, is the natural home for such a meeting. (The IDSS meeting will take place in Tel Aviv, 6–9 March 2016).
You are the director of the Davidai Arrhythmia Center in Israel, which is considered one of the most prominent arrhythmia centres in the country. Besides the medical knowledge, what does a physician need to embark in a role like this?
It probably varies between countries but in my environment, you are required to be a professional expert as well as great organiser, teacher, and scientist. You are required to be able to find original solutions to advance your field and build your own centre in an environment of permanent cost containment and cost-cutting, and you must excel in all aspects. If you do not run fast you are pushed back. One of the most important issues is to be able to mentor young experts in the field, helping them to make their own way but with your support. You cannot control everything on your own and you cannot master all fields but you have to maintain an environment of constant learning from every case, especially the difficult ones to find solutions together.
You established a collaboration between Mayo Clinic and the Sheba Medical Center; what are the best outcomes from this initiative?
Ever since I came back from my fellowship at the Mayo Clinic I maintained ongoing collaboration with my mentors and colleagues there. This collaboration resulted in more than forty papers written together, many training opportunities for Israeli fellows at Mayo who now work in Israel and in forums of mutual consultation and discussion of cases. We now have a special fund based on donations that support collaborative activities in cardiovascular medicine between the centres.
As president of the Israel Heart Society, can you describe what the next key steps for Cardiology in Israel should be?
Changing the fellowship programme and establishing official training tracks in cardiology subspecialties is one of our most important goals. Whereas many fellows travel abroad for advanced training, many centres in Israel are equipped and staffed so that they can provide similar fellowships in subspecialties of cardiology for fellows who are unable to travel abroad for years. Moreover, by establishing subspecialty programmes we will also be able to standardise the requirements from those who consider themselves experts in the various subspecialties of cardiology.
Making cardiology more accessible to the public is another goal as well as the effort to educate the public about prevention of cardiovascular disease.
Increasing the involvement of Israeli cardiology in European Society of Cardiology (ESC) bodies and activities is another important aim.
We have many other aims to achieve during my term and hope to be able to come back to you in two years and tell you that we have been able achieve at least some of them.
Outside of medicine, what are your interests and hobbies?
I have very little time left but some of my hobbies ever since I was a teenager are hiking, driving and navigating. If I had not been accepted to medical school I could have been a great tour guide!
Fact File
Current appointments
2015–2017 President Israel Heart Society
Director of Davidai Arrhythmia Center, Heart Center, Sheba Medical Center, Tel Hashomer, Israel
Co-president (previously secretary) of International Dead Sea Symposium (IDSS) on Innovations in Cardiac Arrhythmias and Device Therapy
Chairperson of the scientific program committee for Europace- Cardiostim
Professor of Cardiology , Tel Aviv University
Education
1974–1980 School of Medicine, Hebrew University Jerusalem, Israel
1986–1988 Residency in Medicine, Hadassah – Hebrew University Medical Center, Jerusalem, Israel
1988–1991 Fellowship in Cardiology, Sheba Medical Center
1992–1994 Fellowship in clinical pacing and electrophysiology at Mayo Clinic, Rochester, USA
Past and current editorial positions
Member of editorial boards of Europace, PACE, HeartRhythm, Journal of Israeli Military Medicine, Cardiology Management
Membership – Societies (most recent)
1996– Fellow of the American College of Cardiology
2003– Member of the Israeli National Council of Cardiology
2004 Fellow of the European Society of Cardiology
2007 Secretary General of the Israel Heart Society
2009 Chairperson of the Israeli Working Group of Pacing and Electrophysiology
2009 Member of the writing committee on Device activation in terminal patients European Heart Rhythm Association
2009 Member of Scientific Document committee of the European Heart Rhythm Association
