Clinical Cardiac Electrophysiology Josephson Pdf File

1. Clinical Cardiac Electrophysiology Josephson Pdf Files
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Mark E Josephson (photo by Jan de Jonge)Mark E Josephson, a pioneer of clinical cardiac electrophysiology (EP), passed away at the age of 73 on 11 January 2017 after a courageous battle with cancer. With his passing, the EP community lost a great physician whose achievements will be remembered for years to come. Andrew L Wit (Emeritus Professor of Pharmacology, Columbia University College of Physicians and Surgeons, New York, USA), a close professional colleague and friend of Josephson for over 40 years, writes this tribute for Cardiac Rhythm News.Mark E Josephson’s death is an extraordinary loss to his family, friends, colleagues and to medicine and cardiology. His life was inextricably intertwined with the development of clinical cardiac EP.

Josephson was one of the pioneers of this relatively new medical discipline which was born in the 1960s. A recently published book details his legacy and aptly identifies the “Josephson School” of electrophysiologists trained by him, who will carry out his legacy.

1When Josephson began his electrophysiology training in the laboratory of Anthony N Damato at the US Public Health Service Hospital in Staten Island, USA, in 1971, clinical EP was in its infancy. Brilliant minds over five decades following the invention of the electrocardiogram (ECG) in 1903, using deductive reasoning, had established classifications of arrhythmias according to sites of origin, and hypothesised mechanisms.

2 However, clinical EP was not born until the 1960s when invention of the electrode catheter enabled the heart to be electrically stimulated directly and electrical activity to be recorded from localised regions without thoracotomy, in Amsterdam and in Paris independently. In Amsterdam, Dirk Durrer, Hein J Wellens and Reinier Schuilenburg showed that programmed premature stimuli using a specially designed stimulator, applied to the atria or ventricles initiated tachycardia in patients with accessory atrioventricular (AV) pathways. 3 This was the origin of programmed electrical stimulation (PES) to induce and terminate tachycardias that were interpreted to be caused by reentrant excitation. Subsequently Wellens and his colleagues used PES and intracardiac recordings to demonstrate that other supraventricular tachycardias as well as ventricular tachycardias could be induced and terminated by stimulation and were also likely caused by reentry. 3,4 Andrew L WitThe Damato group then began using PES of the atria to define conduction and refractory properties of the components of the AV junction in normal and diseased hearts. The Damato lab was one of the earliest laboratories in the USA that had a major involvement in the development and growth of clinical EP owing to the pioneering development of the catheter technique for recording electrical activity from the His bundle by Benjamin J Scherlag in that laboratory.

5 Josephson’s initial research with this group described the clinical EP of antiarrhythmic drugs, properties of the AV conduction system, and mechanisms of supraventricular tachycardia. 1,6 Perhaps more importantly, this is where he began to formulate his ideas about mechanisms and treatment of ventricular tachycardia (VT).After leaving this laboratory, Josephson went to the University of Pennsylvania in 1973 to join a fledgling cardiac EP group and within a few years, was head of that group while still a cardiology fellow. It was at Penn in the mid to late 1970s that he began to publish his series of ground-breaking studies that has had a lasting influence on clinical EP to the present day. Josephson and colleagues used systematic multi-site programmed stimulation to initiate and terminate sustained VT resulting from myocardial infarction 7 and developed the technique of endocardial catheter mapping of VT. 8 This approach led to recognition of the subendocardial origin of the majority of these arrhythmias adjacent to aneurysms.

8 What followed was the innovative surgical technique of subendocardial resection where a subendocardial layer of tissue was stripped off from around an aneurysm (along with resection of the aneurysm). 9 Continuing these investigations, the Josephson group described the properties of the electrophysiological substrate for VT. Mapping during sinus rhythm, they showed abnormal electrograms that provided markers for locating the reentrant circuits.

10 Subsequent investigations defined the properties of the circuits including their size and shape, the cause of slow conduction, the nature of the excitable gap and localisation of the pathways using the 12 lead ECG. This extraordinary output of new and exciting information on the electrophysiology of VT in the late 1970s and 1980s were eventually translated into innovative therapeutic methodologies, which are now widely used tools of clinical EP. These methodologies include PES to induce and terminate VT, catheter mapping during sinus rhythm and VT to locate the sites of reentrant circuits, entrainment techniques to locate the critical isthmus of the circuits and catheter radiofrequency ablation at critical sites to prevent VT, replicating the effects of the original subendocardial resection technique.Josephson continued his studies on VT after he moved to Beth Israel Hospital, Boston, USA, in 1992, where he eventually became chief of cardiology. All in all, he eventually co-authored over 50 publications on this subject. In addition, he contributed to our current understanding of AV nodal reentrant tachycardia, atrial flutter and fibrillation and ventricular fibrillation and defibrillation.

He helped design and participated in many major clinical trials that have altered and improved clinical care of patients with arrhythmias (references to all his studies can be found in reference 1).Throughout his career, Josephson was devoted to teaching and training the next generation of cardiac electrophysiologists. His nurturing of his fellows who became life-long friends, produced the second generation of clinical electrophysiologists that have made many important contributions of their own to the growth of clinical EP. They now have their own students (third generation) entering the world of electrophysiology.

These generations insure that the Josephson School of Clinical Cardiac Electrophysiology and Mark Josephson’s legacy will be perpetuated. 1 Mark E Josephson teaching about complex arrhythmias, a course he gave with Hein J Wellens, sponsored by Medtronic (photo by Rich Wawrzynski)Josephson has also reached thousands of electrophysiologists through courses at both the beginning and advanced levels in the United States and Europe. These courses have been mostly taught with Wellens (Cardiovascular Research Institute, Maastricht, The Netherlands) who as mentioned above, was one of the founding fathers of clinical EP. Many of the courses were mechanism-based. The philosophy of this approach is centred on the belief that an understanding of mechanisms is the foundation of future development of clinical cardiac EP. The treatment of patients should not be based only on published algorithms for the type of arrhythmia under consideration but should also involve an understanding of the basic electrophysiology. Those students who master these basics will be the ones who will make innovative contributions and devise new therapies in the future.

To this end he also wrote the “bible” of clinical electrophysiology, Josephson’s Clinical Cardiac Electrophysiology, which is now in its fifth edition. 11 It is one man’s approach to the practice of clinical EP based on his many years of experience. It is extraordinarily comprehensive. Another textbook focused more on basic electrophysiological mechanisms just went to press. 12I had a close personal and professional relationship with Mark Josephson throughout our careers. I have worked with him in the laboratory and the class room and have spent many hours with him at the dinner table over the past 40 years.

He has been an important part of my life. I will miss him greatly.References. Wellens HJ, et al. The Josephson School.

A legacy of important contributions to electrophysiology. Cardiotext 2016. Scherf D and Schott A. Extrasystoles and Allied Arrhythmias. A William Heinemann Medical Book Publication 1973.

Wellens HJJ. Electrical stimulation of the heart in the study and treatment of tachyarrhythmias. Leiden: Stenfort Kroese 1971.

Clinical Cardiac Electrophysiology Josephson Pdf Files

Wellens HJ et al. Electrical stimulation of the heart in patients with ventricular tachycardia. Circulation 1972;46:216‒226.

Scherlag BJ et al. Catheter technique for recording His bundle activity in man. Circulation 1969;39:13‒18. Josephson ME et al.

Effects of lidocaine on refractory periods in man. Am Heart J 1972;84:778‒776. Josephson ME et al. Recurrent sustained ventricular tachycardia. Circulation 1978;57:431‒440.

Josephson ME et al. Recurrent sustained ventricular tachycardia. Endocardial mapping. Circulation 1978;57:440‒7.

Josephson ME et al. Endocardial Excision: A new surgical technique for the treatment of recurrent ventricular tachycardia. Circulation 19‒1439. Cassidy DM et al. Endocardial catheter mapping in patients in sinus rhythm: Relationship to underlying heart disease and ventricular arrhythmias. Circulation 1986;73:645‒652. Josephson ME.

Josephson’s clinical cardiac electrophysiology. Techniques and interpretations. Wolters Kluwer 2016. Wit AL, Wellens HJ and Josephson ME. Electrophysiological foundations of cardiac arrhythmias.

A bridge between basic mechanisms and clinical electrophysiology. Cardiotext (in Press)Tributes for Mark E JosephsonElectrophysiologists such as David Callans, Eric Prystowsky, Jonathan Kalman and Peter Kowey and David Steinhaus and Julie Stephenson, both from Medtronic, pay tribute to Mark E Josephson.David Callans, University of Pennsylvania, USADavid Callans, Mark E Josephson and Bruce HookThe world of electrophysiology has lost a genius founding father, and I lost a great friend.Mark Josephson died just before his 74th birthday.

Oh, but how he lived!His extensive achievements and intellectual triumphs aside, what made Mark really amazing to the people who knew him was his expansive and often challenging personality. He was dedicated to make both himself as well as everyone he cared for as successful as they could possibly be, as a scientist, physician but especially as a human being. Although it took me a long time to understand, he was not interested in his disciples being as good as he was (thankfully, as this would have been impossible!), but was passionately concerned that they simply strive to be the best version of themselves.

Around Mark, there was no avoiding this destiny though—halfhearted efforts were always called out in an aggressive but supportive way.One of my favourite memories characterising this attribute occurred during his last year at Penn. I was hanging out in his office when one of the cardiology fellows who was senior to me, and graduating that year walked in to sheepishly confess that he was “abandoning” an academic career and had taken a position in private practice.

While he feared disappointing what he thought were Mark’s aspirations for him, Mark had actually been instrumental in getting him that position. He said: “I want you to be the best doctor that you can possibly be, that is what I want for you.”My relationship with Mark started during my fellowship, way before I was even a little equipped to understand anything he was talking about.

I would travel to his Gladwyne home for discussion about the nature of the ventricular tachycardia circuit (I so wish I had kept the diagrams he scribbled out on napkins during those talks) and the nature of life, both his and mine. I had not a chance to fully develop my sense of gratitude for his taking me on as a student, enthusiastic but slow as I was, but Mark was offering so much more, even from the start. He was offering incredibly loyal friendship, an opportunity to share in his life, not just in his work.

I was and continue to be overwhelmed by this.At his funeral, his daughter Rachel said that Mark made everyone around him feel like they were Mark’s best friend. He meant so much to so many.He shared a birthdate with another genius, Mozart, who authored a quote that I feel personifies Mark:“Neither a lofty degree of intelligence nor imagination nor both together go into the making of a genius.

Love, love, love is the soul of genius.”Despite a profound sense of loss, his love, his ideas and his passion live on in all his dedicated disciples.Eric Prystowsky, St Vincent Hospital, Indianapolis, USA Mark E Josephson and Eric PrystowskyIt is an honour and privilege for me to pay tribute to Mark Josephson, a friend for many years and one of the pioneers of our field of clinical electrophysiology (EP).

Clinical Cardiac Electrophysiology Josephson Pdf File Size

This book teaches the fundamental concepts of cardiac electrophysiology with an emphasis on the relationship of basic mechanisms to clinical arrhythmias. Understanding this relationship and the underlying mechanisms of arrhythmogenesis will be valuable to medical students in general and physicians entering the fields of cardiology and clinical electrophysiology, as well as those scientists and clinicians already working in this field.The foundations of electrophysiology are explained in a way that will enable the student/reader to go on to more advanced texts such as Josephson s Clinical Cardiac Electrophysiology by Mark E. Josephson (Wolters Kluwer), who is one of the authors of this book. It is not a complete review of basic cellular electrophysiology and only focuses on aspects that are relevant to the arrhythmogenic mechanisms. Similarly, it is not a complete compendium on electrophysiology of clinical arrhythmias.

Only selected arrhythmias are described that best illustrate the translation of the basic electrophysiological mechanism to the clinic.The book is divided into three parts that cover the major mechanisms of arrhythmogenesis: Part I Automaticity, Part II Afterdepolarizations and Triggered Activity, and Part III Abnormal Impulse Conduction and Reentry. Each part starts with a chapter that describes the basic science principles related to that particular mechanism.

Topics include: impulse initiation and rate control, membrane currents, conduction, and the effects of programmed electrical stimulation and pharmacologic agents. Subsequent chapters in each part are organized around examples of clinical arrhythmias and then focus on the relevant EP mechanisms and the characteristic responses to interventions. The characteristics of the three different mechanisms are compared and contrasted throughout the text.Each example works through these three key questions:1. What are the ECG characteristics of the arrhythmia?2. What is the underlying electrophysiological mechanism?3. What are the characteristic properties of the arrhythmia that point to its mechanism?Throughout the book, the aspects of basic EP mechanisms and examples from EP studies and pharmacologic interventions are paired with clinical examples.