Interview With Dr. George Klein, Chair of Cardiology at London Health Sciences Centre

Why did you choose to work in the field of electrophysiology? Describe your medical background and what led you to work in EP. When I did my fellowship at Duke University in Durham, North Carolina, the field of clinical electrophysiology was very much in its infancy. In the late 1970's, EP was transitioning from pure research into practical application. The major role of EP in those days was providing the data necessary to facilitate an operative correction of the arrhythmia. Of course, this was well before the cure of arrhythmias by ablation. It was in 1978 that I participated in my first invasive electrophysiology study at the EP Lab at Duke, and I knew this area was to become my Labour of Love. In 1980, I was active in setting up the EP lab at London Health Sciences Centre (LHSC) in London, Ontario, Canada. I initially modeled our laboratory at LHSC after the successful and internationally renowned EP Lab at Duke, at a time when there were only half a dozen EP labs in existence in North America and the field itself was largely untapped. I feel privileged to have been a part of Duke's EP lab in its early days. At that time, the Duke Lab had been in existence for less than 10 years. My mentor and friend, Dr. John Gallagher, at Duke University, was a pioneer in EP and someone who continued to inspire the field for many years. Tell us about your role at the EP lab at London Health Sciences Centre. What is a typical workday like for you? Our EP lab is currently under the directorship of Dr. Allan Skanes. Several of us supervise the laboratory on a rotating basis, but we all converge to help each other with difficult cases. We have an active fellowship program and are fortunate to always have bright and capable young trainees participating in the cases. What changes have you made at your lab recently to help improve efficiency? There have been many changes to the LHSC EP Lab since it started in 1980. In the old days, the EP labs were primarily used for diagnostic studies only, often to prepare for a subsequent operative procedure or to facilitate selection of medication. In the last 10 years especially, there has been a heavy focus on ablation. The ability to do a procedure that essentially determines the mechanism and fixes the arrhythmia in the same-day procedure continues to be a great source of satisfaction to all of us. I'm something of a fossil when it comes to EP labs: I have seen the introduction of new technologies that make labs and procedures more efficient than they ever were in my day. When I started doing operative ablation, open-heart procedures were necessary. This was in itself very rewarding and worked well, but it is of course much more satisfying and much less traumatic for the patients to have it done by catheter ablation. Do you remember participating in your first EP procedure? Describe what it was like and how you felt. My first invasive electrophysiology procedure took place in 1978 at Duke University. At the time, I remember being terribly impressed by all the technology. Much of this technology was homemade, and technicians and engineers were on site during the procedure to troubleshoot. It is certainly much simpler now, with all the wonderful technology that has been developed and perfected in the interim. We have not yet profiled a lab in Canada for our Spotlight Interview. What are some of the differences you might find in a Canadian lab versus one found in the United States or Europe? I find that most labs that I visit are remarkably similar regardless of the country. Some better-funded labs have more technologies and there are newer ones, but the fundamentals are not that different. Our lab tends to be more informal, with all the staff encouraged to participate intellectually as well as doing their specified jobs. Will you be presenting any clinical research or data at this year's Heart Rhythm meeting? I personally am involved in a debate and chairing some other sessions. My colleagues and our fellows will be involved in presenting some original work from our group. We are very much a team. What advancements for do you hope to see in the near future? Atrial fibrillation has come so far in the last number of years, but it is still a time-consuming process with the threat of serious complications. I am looking forward to a shorter and safer procedure that hopefully will not be so operator-dependent. There are many exciting new technical advancements coming in our field. The areas of imaging technology, real-life CT scans and MRIs, leading edge ablation techniques we are on the cusp of a vast array of new technologies. Is there anything else you would like to add? While many cases are routine, there are things that make each one different. Each one is a puzzle that our whole team gets into and enjoys resolving. I am very proud of our whole team it is their enthusiasm and dedication that keeps me motivated!