First published online: 1 December 2012
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ESC Congress 2012: the continuation of a success story
The annual Congress of the European Society of Cardiology has become the world's foremost gathering of cardiovascular physicians and scientists worldwide. Indeed, since it started in 1950 the Congress has grown to be the world's largest event in cardiovascular medicine. This year, &27 000 registrations were welcomed in Munich, the capital of Bavaria, with &21 000 physicians, &600 press delegates, and &5000 exhibitors.
The participants at the ESC Congress came from 139 countries with Germany, France, Italy, Japan, and the USA as the leading countries. Of note, besides other European countries, the Russian Federation was well represented by over 500 participants, as was Mexico and Argentina.
The success of the annual Congress of the ESC lies in its attractive scientific programme with lectures, pre-arranged sessions, focus sessions with interactive tools and panels, as well as oral presentations, and posters. Almost 10 000 abstracts were submitted, ~40% of them accepted either as oral presentations or posters. Abstracts came not only from the ESC countries, but also to a significant degree from the Asian Pacific Region (19%), North America (6%), and South and Central America (3%). The healthcare industries participation remained important with 79 hands-on and satellite session symposia. The exhibition remained large, but the size of the booths was on average slightly smaller, reflecting the economic environment the medical industry is currently in (Figure ).
Figure 1 Pfizer stand, ESC Congress Paris.
Michel Komajda Opening Ceremony
At the opening ceremony Prof. Michel Komajda from Paris awarded the Society's three gold medals, to Pedro Brugada for his discovery of the Brugada Syndrome, Patrick W. Serruys for his major contributions to interventional cardiology and Prof. Ryozo Nagai from Japan for his contributions to basic research in cardiology.
ESC gold medallists: Pedro Brugada (left), Ryozo Nagai (centre), and Patrick W. Serruys (right)
Of note, the European Society of Cardiology is also concerned and cares about the next generation of its members. Indeed, the cardiologists of tomorrow sessions were again a major success, as they were since their starting in Stockholm in 2010. A series of young investigator awards were also given to the most talented and successful young participants in sessions covering basic science as well as clinical science.
YIAwards Basic Science
YIAwards Clinical Science
The ESC Journal Family was also a major topic at the Congress. Since introducing closer collaboration of all the ESC journals with manuscript transfer by the current editorial team of the European Heart Journal in 2009, the family has grown bigger with the introduction of two new journals (EuroIntervention and EHJ Acute Cardiovascular Care) (Figure ).
Figure 2 EuroIntervention and EHJ Acute Cardiovascular Care.
Indeed, currently the ESC Family encompasses nine journals covering all subspecialties as well as cardiology at large. The growing impact factor, particularly of the European Heart Journal but also of the European Journal of Heart Failure, EuroIntervention, and others, contributed to the success of this educational activity of the European Society of Cardiology. The editorial board meeting of the European Heart Journal and Cardiovascular Research with a joint dinner focused on achievements and strategies for the future for both flagship journals of the ESC Journal Family.
Thus, the European Society of Cardiology is on the move and we are looking forward to the next annual Congress which will be held in Amsterdam, 31 August to 4 September 2013.
T.F. Lüscher and A. Tofield
‘Who wants to be a cardiologist?’ Quiz at the ESC Congress
The first ever ESC Cardiology contest was a successful and fun event during serious cardiology in Munich for the honour to be ‘Primus inter pares’.
At this year's ESC Congress, for the first time, three national teams of cardiologists competed against each other in a ‘Who wants to be a millionaire?’ type of quiz, to tackle challenging questions from all fields of interventional and non-invasive cardiology. In addition, the teams of Austria (headed by Gerald Maurer), Italy (headed by Sabino Iliceto) and Switzerland (headed by Thomas F. Lüscher) had to each answer one tricky question from one of the other nation's cultural or historical background. As on the TV show, 50:50, ‘ask the audience’ and a ‘telephone joker’ were available and readily used.
The quiz was organized by professors José Luis Zamorano Gomez (Madrid, ES) and Juan Luis Gutiérrez-Chico (Vigo, ES).Three teams were chosen from the many possible candidates based on their extraordinary achievements in different fields of cardiology.
Austrian European Centre, Vienna: Gerald MAURER, Irene Marthe LANG, Herwig SCHMIDINGER, Senta GRAF, Jolanta SILLER-MATULA, Diana BONDERMANN.Italian European Centre: Sabino ILICETO (Padua, IT), Vittorio PENGO (Padua, IT), Emanuele BERTAGLIA (Mirano-Venezia, IT), Alida L.P. CAFORIO (Padua, IT), Denisa MURARU (Padua, IT).Swiss European Centre, Zurich: Felix C TANNER, Jan STEFFEL, Georg NOLL, Thomas F LUESCHER, Matthias GREUTMANN, Patric BIAGGI.Each team contained six cardiologists representing one institution and consisted of
Two generals: renowned professionals known as opinion leaders in their fields.Two captains: anonymous true experts who work silently in the shadows.Two cadets: young, promising physicians in their fields. An excellent opportunity for visibility.One general was ‘Field Marshal’, acting as leader and default speaker to provide answers for each team.
A ‘Supreme Court’ presided over the proceedings and provided final verdicts for disputes that were appealed. Members were: Ignacio FERNANDEZ LOZANO (Madrid, ES): Patrick SERRUYS (Rotterdam, NL), William WIJNS (Aalst, BE),
Scorekeeper was: Yoshinobu ONUMA (Rotterdam, NL)
There were five questions and three jokers. In case of difficulty teams could ask Europe for a ‘bailout rescue’ by
find an exfind an expert by phone (list was provided);50/50 chance, two of the possible four answers would fade out.The use of rescue would cost points.
ESC Quiz trophy, Swiss European Center left to right Felix C Tanner, Jan Steffel, Georg Noll, Thomas F Lüscher, Matthias Greutmann, Patric Biaggi
In the end, team Switzerland won the competition with 2100 points: Austria 1800: and Italy 1700. However, and much more importantly, both contenders and audience greatly enjoyed the relaxed and jovial atmosphere, as well as the beautifully arranged multimodal and multimedia cases. Word of this highly educational and entertaining event spread swiftly such that, next year's event is likely to attract an even larger audience when Zurich will be trying hard to defend their title.
A. Tofield
200 years of New England Journal of Medicine
From a local print journal to a global educational platform, Barry Shurlock PhD reports.
Anyone with the faintest knowledge of medicine knows that manuscripts appearing in the Boston-based New England Journal of Medicine (NEJM) are as near as possible to the current view of ‘truth’ about any subject. Before ink hits paper or electrons hit liquid crystal displays, a report in the NEJM will have been subjected to the most rigorous tests available to editors and reviewers and will almost certainly have raised the blood pressure of the lead author on more than one occasion. What has now become NEJM.org under the hand of Editor-in-Chief Dr Jeffrey M. Drazen, MD is, of course, much more than a journal: it is an archive, a source of videos and huge banks of images, with read-to-reader and symposium-like qualities. Plus ?a change has changed!
Jeffrey M. Drazen
It is no mean feat for the NEJM to have stayed the course from modest beginnings in 1812, the year in which Napoleon was defeated at Borodino by brave Russians (or by dire weather, depending on who you believe—sadly a subject never properly peer-reviewed). But regional medical journals nowadays scarcely ever raise their heads above the parapet and authors with something important to say generally only ever consider such an outlet if it gives them the opportunity to publish in their own non-English language (or they owe the editor a favour!).
Of course, New England has long been a powerful force in the politics of the USA and the Harvard Medical School has played a similar role in medicine. Success and world recognition probably came about for the NEJM because academics and publishers stayed true to an ideal, and happened to reside in a country with a future. Also, they were not beholden to any society or other organization whose aims were wider than just getting the best stuff and publishing it. Another internationally recognized journal that was in a similar position, except that the city was London and the academics were from a collection of medical schools, is The Lancet. So firm is the position of the NEJM in the USA, that the FDA regularly seeks its views in deciding regulatory matters.
So, given this illustrious history, how should it be celebrated? The purest plan would, of course, be to carry on as if nothing much had happened (200 is, after all, only 1 after 199), but since 1812 the world has changed. Hence, the NEJM has embarked on an elaborate exercise that, among other things, reflects the profound revolution that the information industry is at this moment living through. How different was the world known to Dr John Warren, a professor of Medicine at Harvard, and the author of the first paper in the first issue (incidentally on angina pectoris), that depended on quill pens and ink, moveable type set letter by letter, printing presses turned by hand, and distribution by packhorse or handcart.
The celebrations of the NEJM can now, of course, be accessed electronically. Of particular interest to the cardiologist is a symposium chaired by Dr Joseph Loscalzo, MD, PhD, Hersey Professor of the Theory and Practice of Medicine and held at (you guessed it) the Harvard Medical School, where he holds his chair.
It was one of a number of Dialogues in Medicine symposia on major specialities held in June 2012 in Boston. Accessible on YouTube, the cardiology symposium opened with a presentation by Dr Eugene Braunwald, MD, Distinguished Hersey Professor of Medicine at Harvard—and allegedly the most cited cardiologist in the world—who reviewed the key stages in the phenomenal progress of the specialty.
Eugene Braunwald. Photo courtesy of H. Utzinger
The essence of his lecture can be found in a paper by him and Dr Elizabeth G. Nabel, Brigham and Women's Hospital, Boston, with which, with others, the New England Journal of Medicine opened its anniversary year (–63).
What is amazing—and yet taken for granted—is that anywhere in the world, as long as Wi-Fi or a 3G facility is available, anyone can now listen to some of the most authoritative people in the field giving their best for the present and future of cardiovascular medicine. Thus Dr Emilia J. Benjamin, MD, ScM, FACC, FAHA, professor of Medicine and Epidemiology at Boston University, envisages lifelong patient-specific management based on genotype scores like those followed for 12 years in Scandinavia (Kathiresan et al., NEJM 0). Although there is always much more to find out about cardiovascular science, she pointed out, now is the time in her view to focus on ‘implementation science’, involving relatively cheap preventative measures, soundly based on current knowledge. This approach was also emphasized by Dr Braunwald, who championed a daily ‘poly-pill’ to be taken from the age of 50 (containing off-patent drugs, such as low-dose aspirin, low-dose thiazide, ACE–inhibitor, and statin). He also predicted that the majority of cardiac deaths in years to come would be in the developing world, which he compared with the West in the 1950s.
Elizabeth G. Nabel (left) and Thomas F. Lüscher
The only non-American invited to the NEJM symposium was Dr Thomas F Lüscher, MD, FACC, FESC, FRCP, the editor of this journal. For him, methods of diagnosing the structural, and more importantly, the functional changes to vessels that are in the process of developing atheroma are key adjuncts to prevention. He outlined his personal insights into the ‘kitchen table’ angioplasty experiments in Zurich of his colleague Dr Andreas Grüntzig, and then his postgraduate training in the USA at the Mayo Clinic, Rochester, MN, where he learned that a vessel is ‘not a tube but an organ’. Despite strenuous efforts, although structural imaging of the coronary arteries with CT has proved possible, functional imaging presents huge challenges. Both MRI and PET have held promise, but Dr Lüscher suggested that optical coherence tomography, which provides information on the inner structure of the blood vessel, and the cap of any plaque present, may be the future. And since atherosclerosis tends to affect the whole cardiovascular system, surrogate arteries such as the carotid, may be the best way to monitor the coronary arteries. Anticipating developments in drug therapy, he envisaged a time when it would be possible to report on the atheromatous state of a patient and be able to prescribe treatment to ‘shrink or get rid of’ the plaque.
Another innovation at the Boston symposium that the founding editors of the NEJM could never have envisaged was the personal presentation by Dr Desmond A. Jordan, MD, associate professor of Anaesthesiology and Biomedical Informatics at Columbia University, New York City. For the first time in public, he gave a graphic account of his time as a patient in his own hospital, where he suffered a cardiac arrest only paces from emerging into the world of Upper West Side Manhattan and, more alarmingly, getting into his car. His experience, which presented with no suspicious prodromal symptoms, and was seemingly sparked by long hours at the clinical coal face, was a leitmotif for progress in treating cardiovascular disease, which Dr Braunwald described as ‘one of the triumphs of medicine’. Dr Jordan would not have been able to address the symposium without a rapid response team, public defibrillators, mechanical ventilation, a catheter lab, intra-aortic balloon pump, CABG, and much else. His surgeon, Dr Craig R. Smith, MD, FACS, was also invited to the symposium, and for him most promise in cardiothoracic surgery resides in miniaturization of a mechanical heart, operating in a non-pulsed fashion and placed percutaneously.
As well as the symposium, the 200th anniversary of the NEJM has been celebrated in many other ways that reflect the age.
There is, of course, a timeline of papers it has published, giving ‘selected milestones’ (the USA not yet having adopted kilometres), and there is a facility to vote online for the most influential of a numbers of papers—and to nominate others for consideration. Curiously, cardiology is represented by the idea-in-progress of Ippolito et al. on the poly-pill. Also, there is a message board which at the last count had attracted &800 messages and stories posted by physicians and healthcare professionals from around the world. Not only does the message board bulge with adulatory comments from physicians of all ages, there is at least one reader who uses it to help his son write essays at school.
What then will the NEJM look like in another 20 years, let alone another 200? Will there be prime-time television link ups, with patients being treated by doctors in constant touch with experts worldwide, and commentators explaining to the eager public what is happening and why? Will the rights have been sold by the hospital in question in order to solve its ever-growing financial problems? Do not laugh!
The last decade has seen so many changes in the world of medical information that anything seems possible.
Barry Shurlock PhD
One hundred years of myocardial infarction
Where we have come from and where we are going is discussed by Carolina Gálvez-Montón and colleagues.
Carolina Gálvez-Montón
The first description of myocardial infarction (MI) is attributed to James B. Herrick and occurred 100 years ago in 1912; the present review celebrates this magnum event for medicine in general and in particular for the cardiology community. To highlight the cumulative knowledge at both the diagnostic and treatment levels throughout this century of infarction, we have divided it into three eras: a first era of mainly clinical observation and descriptio a second era centred on the coronary care unit (CCU), the discovery of new drugs, and the development of s and a later era from the 1980s to the present focussed on invasive cardiology, devices, and novel biochemical analyses of myocardial necrosis. Additionally, we discuss a promising future with potential innovations in gene and cell therapy that might continue to further reduce the scar size and myocardial complications (Figure ).
Figure 1 Schematic illustration of myocardial infarction evolution during a century of infarction. First, a healthy heart is compared with an infarcted heart in the 1912–50s era (the treatment was based on a low-sodium diet and rest). From 1960s to 1980s the infarct scar was reduced by the use of fibrinolysis and coronary artery by-pass graft surgery. Subsequently, from 1980s until today, percutaneous coronary interventions successfully restore blood flow limiting infarct scar. Currently, myocardial infarction research is addressed to myocardial regeneration (with stem cells and tissue engineering) and gene therapy.
The era of clinical observation: s
In 1912, when electrocardiography was in its infancy, James B. Herrick established the link between clinical MI and occlusion of a coronary artery by thrombus. Six years later, Fred Smith described in experimental studies the existence of electrocardiographic changes associated with MI; at that time, MI was already regarded as one of the leading causes of death in humans.
In 1920, Pardee described the acute ECG signs of a coronary obstruction as graphic criteria for the diagnosis of MI; this report included the first description of ST-segment elevation. In the early thirties, Wolferth and Wood described the clinical use of precordial leads in MI, and Wilson introduced unipolar leads. It was a time of scientific meditation, leading researchers to understand the disease from both pathology and pathophysiology viewpoints.,
A breakthrough was the discovery of anticoagulation with coumarin in 1946 (and heparin in 1959), which improved the contemporary low-sodium, diet-based treatment. As anticoagulation decreased mortality rates, physicians began to study risk factors and epidemiology. Remarkably, in 1948, the Framingham study reported the first data on common factors contributing to the development of familiar cardiovascular disease. The 1950s saw the publication of numerous clinical studies that analysed blood lipids and lipoprotein levels and other biomarkers (AST) as diagnostic and prognostic factors for MI.
The era of the coronary units: 1960s–1980s
As technology evolved, the possibility of monitoring haemodynamic parameters invasively, increased CCUs as envisioned by Desmond Julian. Coronary care units would become the indispensable cornerstone of acute MI diagnosis, monitoring, and treatment for decades.
The 1960s were a time of intensive clinical trials and prospective studies in search of new therapies. In 1965, James Black described the β-blocker propranolol and in 1971, the pharmacologist John Vane, Nobel laureate in 1982, discovered that aspirin produced antiplatelet effects by inhibiting prostaglandin and thromboxane production. This finding significantly improved MI treatment and after the ISIS-2 trial, aspirin became a mainstay treatment. At the same time, the development of angiotensin-converting enzyme (ACE) inhibitors began, which proved to be an essential tool for preventing post-infarction ventricular remodelling. However, during the acute phase, MI treatment was based on fibrinolysis– and bed rest.
As drug treatment progressed, pioneer surgeons demonstrated the feasibility of heart transplantation. This idea was born at Shumway's' laboratory and in 1967 Barnard performed the first successful human heart transplant. Also in the late 1960s, Favaloro described the operative technique of coronary artery by-pass surgery. This new surgical technique increased both patient quality of life and life expectancy.
In 1960, Dreyfus et al. demonstrated increased circulating creatine kinase (CK) activity in MI patients, and in 1966 van der Ween showed that CK-MB was more abundant in the heart than in the skeletal muscle thus being a more specific marker of acute MI. When reliable methods were available for its measurement, CK-MB rapidly replaced total CK as the gold standard for an earlier and more specific acute MI diagnosis.
The era of interventional cardiology: 1980s–21st century
Since the 1980s, the catheterization laboratory has been the site of the hottest innovations. Indeed, interventional cardiology did not truly emerge until Grüntzig's first description of percutaneous trans luminal coronary angioplasty (PTCA), which was quickly adopted in hospitals worldwide. After several comparative studies with other techniques, primary PTCA became the treatment of choice in early MI.,
The 1990s brought the development of novel percutaneous coronary interventions (PCIs), particularly the introduction of coronary stents, initially bare metal and later drug-eluting stents to overcome restenosis. Another achievement during this era of technological breakthroughs was the automatic implantable cardioverter defibrillator developed by Mirowski et al. to convert post-MI malignant arrhythmias.
This most recent era has also been fundamental for establishing the modern diagnosis of MI using novel biomarkers. The solution came from the investigation of non-enzyme, non-CK-related biomarkers. Cummins et al. in 1987 and Katus et al.– in 1989, respectively, reported the development of a radioimmunoassay for measuring Troponin I and an enzyme-linked immunoassay for detecting Troponin T. Following these first descriptions, research on troponins progressed in the pathophysiological, methodological, and clinical aspects. The clinical impact of cardiac troponin (cTn) research was immediate since cTns were an ideal cardiac biomarker. Cardiac troponins have high diagnostic sensitivity and the existence of both a rapid- and slow-released fraction permits diagnosis from a few hours up to 2 weeks after an infarction. They also have high diagnostic specificity as they are only expressed in cardiac tissue, except in rare conditions. Furthermore, cTns are extremely useful clinically for patient monitoring and risk stratification (determining the need for primary PCIs), and there are easy automatic methods with rapid turnaround times available for their measurement.
In 2000, the consensus for a new definition of MI, and in 2007, the Universal Definition of Myocardial Infarction, recommended cTns as the biomarkers of choice for diagnosing MI. These statements set the objective for cTn measurements to be the method for the 99th percentile reference value and to be sensitive enough to detect kinetic patterns in serial cTn measurements. Research into increasing the sensitivity for detecting cTn produced the currently existing methods known as ‘high sensitive (hs-cTn)’ or ‘ultrasensitive’ cardiac troponins. The new hs-cTns represent as much of a revolution in technique as when the first cTn methods were developed.
The ECG has also played an important role in acute MI classification and in decision-making for best management. The ECG permits the classification of MI patients into two groups: STEMI and non-STEMI (NSTEMI).– The STEMI group has a critical/complete coronary occlusion, and presents with a sudden homogeneous transmural impairment of an area that was previously relatively or total in this situation, there is imminent risk of myocardial necrosis if the occlusion is not removed (‘time is myocardium’). The STEMI group includes all cases with ST elevation or the equivalent. Figure
illustrates the ECG evolution of a STEMI before and after primary PCIs.
Figure 2 Evolution of an anterior STEMI in 1970 and in 2010. (A) the evolution of a myocardial infarction towards large Q-waves in 1970 in a non-reperfused artery. (B) the evolution of a STEMI in 2010. The STEMI patient (A) was submitted to successful percutaneous coronary interventions (B), and a post-ischaemic negative T-wave appeared. A few hours later (C) the patient again presented with pain and ECG pseudo-normalized. A repeat coronary angiography demonstrated thrombosis of the stent and new PCIs was indicated with the reappearance of negative T-waves (D; a re-infarction was aborted).
The NSTEMI group usually has a partially occluded coronary artery, or if it is occluded, the perfused area still receives blood through collateral circulation and/or previous preconditioning. Therefore, the left ventricle wall involvement is not transmural, and although the risk of necrosis is evident, it is usually not imminent and does not spread as rapidly. The NSTEMI group encompasses all non-ST elevation patterns that are present in cases of predominant subendocardial, non-transmural involvement including (i) ST depression with or without final positive T- (ii) flat or mild negative T- (iii) changes of U- and (iv) normal or unchanged ECG. Although the 12-lead ECG has been successfully used for many years for diagnosis, triage and risk stratification, further research is required to refine our understanding of the pathophysiological correlations and ECG changes that are seen in these patients.–
The incorporation of imaging techniques, first echocardiography, later, isotopes and more recently multi-slice CT and magnetic resonance imaging (MRI) have allowed a better study of left ventricular anatomy and function as well as non-invasive imaging of the coronary arteries. The leading role of modern imaging techniques will very likely be boosted in coming years.
New milestones: regenerative medicine and gene therapy
At the moment a focus in MI research is myocardial regeneration, either by cell therapy or tissue engineering. Cell therapy is based on the administration of viable cells, in an attempt to replace dysfunctional organs or tissues. Within this broad concept, the main objectives include myocardial revascularization, diminished ventricular remodelling, reduced cardiomyocyte apoptosis, and improvement in electromechanical function. Cardiac regenerative medicine is promising, and a number of clinical trials in humans have already shown its indisputable safety. However, many factors remain unresolved, such as cell type (bone marrow, adipose tissue-derived progenitors, iPS, cardiac resident progenitors, or embryonic stem cells), the route of administration (intramyocardial, transendocardial, or intracoronary), and the time of optimal delivery after MI. Several multi-centre trials are on-going in an attempt to answer some of these questions and to prove true benefit in clinical and functional parameters.
Tissue engineering is also emerging as an option for cardiac regeneration. However, the challenges are enormous, including, selection of the optimal cell source, developing engineered matrices (biological or non- biocompatible or not), establishing the cellular electromechanical coupling, promoting an efficient and stable contractile function, and ensuring functional vascularization. A majority of these experimental processes have only been tested in small animal models. The transposition of a fat flap over the ischaemic myocardium has recently been proposed, with promising results in the swine preclinical model of MI.,
Finally, a new avenue being explored is gene therapy, an emerging multidisciplinary field that identifies key signalling pathways, and creates new technologies and novel vector constructs., Different routes of administration and viral vectors have been tested in small and large animal models with encouraging results. Preliminary clinical trials have been conducted for delivering AAV1-SERCA2 or AD-HGF through intracoronary infusion, and have reported benefits in patients with severe heart failure.
In spite of the great advances that have been achieved over the past century in terms of accurate diagnosis, monitoring, and treatment, MI remains a dreadful disease. The scientific community continues to relentlessly search for novel therapeutic options to significantly reduce the scar size following interventions, as well as to lower the morbidity and mortality of the leading cause of death worldwide.
Carolina Gálvez-Montón1,*, Jordi Ordo?ez-Llanos2, Antoni Bayes de Luna3, Antoni Bayes-Genis1,4,5
1ICREC Research Program, Fundació Institut d?Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain.
2Biochemistry Service, Sant Pau Hospital and Department of Biochemistry and Molecular Biology, UAB, Barcelona, Spain.
3ICCC, Institut Català de Ciències Cardiovasculars, Sant Pau Hospital, Barcelona, Spain.
4Cardiology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
5Department of Medicine, UAB, Barcelona, Spain.
*Corresponding author. Email: cgalvezmonton{
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The EHJ appoints Dr Jan Steffel from Zurich University to its editorial team.Jan SteffelJan Steffel, MD FESC a board certified internist and cardiologist, is an attending physician in the cardiac arrhythmia unit in the Department of Cardiology at the University of Zurich, Switzerland. He brings to the editorial team his interest and experience in arrhythmias.Dr Steffel studied Medicine in Bonn and Munich Germany, Lausanne Switzerland, and in Boston USA, and graduated from Medical School in 2003. By 2010 he had completed his clinical training in Internal Medicine and Cardiology. During that time, cardiac arrhythmias as well as implantable cardiac devices became his main interest and he completed a 2-year research fellowship in invasive electrophysiology and devices in the Department of Cardiovascular Research at the University Hospital Zurich, Switzerland, under Felix Tanner, MD and Thomas F. Lüscher, MD. During that time, he primarily studied the cellular regulation of tissue factor, the initiator of the coagulation cascade and its implication for cardiovascular medicine.In addition to anticoagulation, his research and clinical focus lies in non-invasive and invasive treatment of cardiac arrhythmias, as well as in cardiac resynchronization therapy (CRT) and its super-responders.Dr Steffel is an active lecturer at the University of Zurich (Privatdozent) and has published two textbooks, on general cardiology and on stroke prevention in atrial fibrillation. Building on his experience in the field of anticoagulation and cardiac devices, he is actively involved in a number of continuing medical education activities, especially in the use of novel anticoagulants as well as pacemaker, ICD and CRT troubleshooting.Since 2009, Dr Steffel has been deputy editor-in-chief for Cardiovascular Medicine, the official journal of the Swiss Society of Cardiology. In his—remaining—leisure time, Dr Steffel enjoys skiing in the Swiss Alps as well as playing tennis and travelling.A. Tofield
ReferencesSteffel
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J, Braunwald
E. Novel oral anticoagulants: focus on stroke prevention and treatment of venous thrombo-embolism. Eur Heart J ;32:1968-1976.
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European Heart Journal33(23);DOI: 10.1093/eurheartj/ehs364
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