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Challenges in heart rhythm: sudden death, atrial fibrillation
Douglas P. Zipes, MD, discusses his career and the challenges that keep it exciting.
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In a recent “Heart Health: Ask Dr. Zipes” column in The Saturday Evening Post, Douglas P. Zipes, MD, fielded a reader’s question about a health article she had read on the Internet about what to do if one is driving alone and starts experiencing severe chest pain about five miles from the nearest hospital. The reader wondered whether continuing to drive was wise and whether vigorous coughing – which the article recommended – was good advice.
“Who would remember to cough in that situation?” the reader wondered.
In his answer, Zipes succinctly explained the need to get to a hospital as quickly as possible, suggested stopping to dial 9-1-1 if she could not reach the hospital in a few minutes, and cast doubt on the theory that coughing would prove to be very helpful.
Answering questions like this in his monthly “heart to heart” discussion is just one of many roles Zipes plays in medicine. As Distinguished Professor Emeritus at Indiana University School of Medicine in the departments of medicine, pharmacology and toxicology, he sees patients once a week, conducts research and teaches.
“The beauty of being emeritus is that when I wake up in the morning, the day belongs to me. I’m just as busy as before, but I can decide what I want to do,” he said in a recent interview.
AEDs in every neighborhood
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Distinguished Professor Emeritus in the Departments of Medicine, Pharmacology and Toxicology Director, Krannert Institute of Cardiology and Division of Cardiology Indiana University School of Medicine |
Editor of Today in Cardiology’s Electrophysiology and Arrhythmia Disorders Section, Zipes was an early and influential advocate — through his Neighborhood Heart Watch program — of the need for easy access to AEDs in neighborhoods and schools, in police cars, at airports, aboard airplanes, in sports stadiums, and other public areas.
His numerous leadership roles have included serving as president of the American College of Cardiology and the North American Society of Pacing and Electrophysiology (now the Heart Rhythm Society), and chair of the American Board on Internal Medicine. He founded and edited the Journal of Cardiovascular Electrophysiology from 1989 to 2004 and is now the founding editor of Heart Rhythm, the new journal of the HRS. He is editor in chief of the present edition of Braunwald’s Heart Disease, co-author of Cardiac Electrophysiology and is currently writing a textbook on clinical arrhythmias while still conducting research on neuromodulation of heart rhythms and arrhythmia mechanisms.
“The most exciting part of my professional career is that I grew up with clinical cardiac electrophysiology,” Zipes said. “I began my research career as it began, and it has been wonderful riding that wave of new knowledge for the past 30 years. It’s also interesting that at various scientific symposiums I am now one of the ‘old’ people.”
Zipes invented the implantable cardioverter portion of the ICD in the early 1980s. In addition to making several key electrophysiologic observations over the years, he also identified the role of the autonomic nervous system in causing or preventing heart rhythm problems and has made specific observations on mechanisms of heart rhythm disturbances.
A graduate of the Harvard Medical School, Zipes completed his postgraduate training at Duke University Medical Center. After two years in the military as director of the cardiac care unit at the Naval Hospital in Portsmouth, Va., Zipes joined the Indiana University School of Medicine, where he was named a professor of medicine in 1976, distinguished professor of medicine, pharmacology and toxicology in 1994, and director of the cardiology division and Krannert Institute of Cardiology in 1995.
“The development of new knowledge and technology associated with the field has been absolutely incredible. What’s most exciting is that we cure patients of abnormal heart beats with ablation while virtually everything else in cardiology is palliative,” he said.
Sudden death and AF
Two major challenges remain: sudden death and atrial fibrillation. About 350,000 sudden cardiac deaths occur annually in the United States, and AF affects over 2 million people.
“We have major problems in identifying individuals at risk prior to their event, so that’s a challenge,” Zipes said.
Heart rhythm abnormalities are genetically influenced, and research should now be focused on how to identify those at risk, he added.
As chair of the ACC’s Campaign for the Future, Zipes has spearheaded efforts that have raised almost $12 million so far to address new ways of increasing the cardiology workforce and directing information and education to cardiologists to ensure the best quality care of patients.
The United States is losing research to foreign countries because many industries that control much of the medical research are going off shore to Europe and Asia where there are not so many regulatory barriers, Zipes said. About 60% of medical research comes from outside the United States, a number which was flip-flopped just five years ago.
“The NIH does as best it can with mandates from Congress, but we’re losing a lot of young investigators who are having trouble getting funding,” Zipes said. “They are going into private practice rather than fighting the bureaucracy to stay in academia and do exciting research.”
A new pleasure for Zipes is writing fiction. He recently completed his first medical thriller, has an agent who “loves the book” and is looking for a publisher.
“The novels are a relatively recent venture. It is fun after years of publishing science to move into a different discipline with all the challenges of essentially being a young unknown author,” he said.
“It’s interesting. In the medical area, the publishers come to me to do a textbook. But in the fiction area, they say, ‘Zipes who?’ Very humbling!” – by Tara Grassia