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Milestones in Cardiac Electrophysiology in the Past 25 Years
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Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of EP Lab Digest or HMP Global, their employees, and affiliates.
EP LAB DIGEST. 2023;23(5):6.
Dear Readers,
Many electrophysiologists spend their days doing procedures that never existed during their training. I often tell our fellows that much of what I do in the electrophysiology (EP) lab did not exist when I trained as a fellow in the mid 1990s. For example, not only was catheter ablation for atrial fibrillation (AF) not yet a procedure during my training, but none of the EP faculty independently performed transseptal catheterization. Accessory pathways were mapped and ablated using a retrograde aortic approach. Patients with heart block who needed a defibrillator required a dual-chamber pacemaker on one side and a defibrillator on the other side, because dual-chamber defibrillators had not yet been developed.
The figure below is an attempt to display a timeline over the past 25 years that includes major milestones in the field of EP. While not exhaustive, it attempts to highlight events that had a major impact on practice. It also includes a few failures. In the left column are most of the procedures that existed before 1998 and in the right column are those that are likely on the horizon. The left-hand side of each text box is approximately aligned with the date of initial US Food and Drug Administration approval of the technology. Many of the technologies were already available in Europe and existed as part of clinical trials in the US. Failures are denoted with horizontal lines through the text box.
Staying current in the EP lab can be challenging, especially in some practice environments. It is important to emphasize to trainees the importance of not only maintaining one’s procedural skills after formal training, but being willing and able to safely and effectively adopt proven new procedures, technologies, and techniques.
* Antiarrhythmic drugs included amiodarone, flecainide, procainamide, propafenone, quinidine, sotalol.
Disclosures: Dr Knight has served as a paid consultant to Medtronic and was an investigator in the PULSED AF trial. In addition, he has served as a consultant, speaker, investigator, and/or has received EP fellowship grant support from Abbott, AltaThera, AtriCure, Baylis Medical, Biosense Webster, Biotronik, Boston Scientific, CVRx, Philips, and Sanofi; he has no equity or ownership in any of these companies.
