From the desk of Secretary- IHRS
Heartfelt thanks to special friends Dr Pawan Suri, Dr Deepak Padmanabhan, Dr Avinash Verma,
Dr Suchit Majumdar, Dr Shunmuga Sundaram for all their help and contributions toward IHRS website.
Cardiac electrophysiology is the discipline of elucidating, diagnosing, and treating the electrical activities of the heart. Although relatively new, it is one of the fastest progressing fields in medicine. The language of electrophysiologists is based upon an electrocardiographic interpretation in form of “p QRS T” which they decipher and interpret with perfection. The first electrocardiography (ECG) machine was used in K.E.M. Hospital, Mumbai in the late 40's and two such mammoth size ECG machines are still available as antique specimen, one of which is still lying in the residence of Past President of CSI and another at RG Kar Medical College, Kolkata.
Invasive Cardiac Electrophysiology was initiated in the country in GB Pant Hospital and AIIMS. The first electrophysiology lab was established on 5th March, 1975 at G.B. Pant Hospital, Delhi by Dr M Khalilullah and alongwith Prof ML Bhatia, they both were the pioneers in His bundle electrography in the country. Dr KK Sethi was the first to perform catheter ablation in the country and direct current ablation was started in 1988 followed by Radio Frequency ablation. The number of centres having electrophysiology setup in the country was about 10 in 1997 and has increased exponentially in last two decades.
Cardiac pacing in India dates back to late 1960s. First cardiac pacing in India was reported by the team of Dr CC Kar and Dr AK Basu from Institute of Post-graduate Medical Education and Research (IPGME&R), Calcutta in 1966–67. Prof ML Bhatia started pacemaker implantation at AIIMS, New Delhi in 1968 and the first pacemaker was implanted in a doctor from Assam with a pulse generator that was powered by a mercury-iodide battery and lasted for about 2 ½ years, after which the patient underwent pulse generator replacement. Unfortunately, the patient succumbed to military tuberculosis about a year after that. The first ever temporary pacemaker manufactured in India was the Khalilullah-Mendez pacemaker, which was a single chamber fixed rate pacemaker with facility for adjustment of pacing rate and pacing current. Khalilullah-Mendez team also manufactured an indigenous monitor-defibrillator.
The first permanent pacemaker manufactured in India was from Pacetronix and the model Ventralith-I, which was a non-programmable VVI pacemaker, was first implanted on 9th sept, 1994 at Kasturba Hospital, Bhopal. The pulse generator being very economical was real boon for the common people of India. The first multi-programmable pacemaker of Pacetronix was implemented on June 6th, 1995 at Ramakrishna Mission Seva Pratishthan, Kolkata.
India, a developing country, has done a substantial and satisfactory progress in the field of electrophysiology over the last two decades. To begin with, in 1995 there were a couple of centres doing EP in the country but as of today in South Asia, India stands as the most technologically advanced country offering comprehensive arrhythmia care services that includes RF ablation of simple and complex arrhythmias, 3D mapping, state of art pacing modalities including His bundle pacing and Leadless Pacemakers. Excellence prevails in academic contributions as original articles in peer reviewed international journals. Active participation as Faculty in International conferences is increasing with every passing year.
The major contribution to the world of Cardiac Electrophysiology started after the advent of Indian Heart Rhythm Society in year 2006 which laid the foundation of this branch in India in a formulated fashion and paved a path forward to the growth of Electrophysiology slowly moving to the International platform. The society is working tirelessly to raise the bar for Indian cardiac electrophysiologists to be recognised at the world forum for their brilliant work.
Members and
Growing
Events
Conducted
Papers in Peer
Reviewed Journals
PATRONS
The Heart Centre, Lajpat Nagar, New Delhi, India
Delhi Heart & Lung Institute, New Delhi, India
Max Hospital, Mohali, Punjab, India
EXECUTIVE COMMITTEE
President
Vice President
Secretary
Joint Secretary
Executive Member
Executive Member
Executive Member
Executive Member
Executive Member
Editor
Immediate Past President
IHRS OFFICE BEARERS
Year | President | Secretary |
2006-2008 | Dr T S Kler | Dr Balbir Singh |
2008-2010 | Dr Mohan Nair | Dr Ravi Kishore |
2010-2012 | Dr C Narsimhan | Dr Aditya Kapoor |
2012-2014 | Dr Balbir Singh | Dr Anil Saxena |
2016-2018 | Dr Amit Vora | Dr Ajay Naik |
2018-2020 | Dr Anil Saxena | Dr Vanita Arora |
2020-2022 | Dr Yash Lokhandwala | Dr Vanita Arora |
From the desk of Secretary- IHRS
Heartfelt thanks to special friends Dr Pawan Suri, Dr Deepak Padmanabhan, Dr Avinash Verma,
Dr Suchit Majumdar, Dr Shunmuga Sundaram for all their help and contributions toward IHRS website.
Cardiac electrophysiology is the science of understanding the electrical system of heart and at the same time diagnosing and treating the dysrhythmias. Although foundation for the study of arrhythmias and clinical electrophysiology was laid by Chinese pulse theory way back in 5th century BC, the most significant breakthrough in this field has occurred in twentieth century only. The initial phase of exploration evolved into diagnostic field only, although therapeutic interventions were relatively modest. The past decade has witnessed a virtual explosion in invasive electrophysiology with increasing reliance on non-pharmacologic therapies. It has evolved from the off-shoot, largely of theoretical interest to one of the major super-specialities of modern cardiology.
The human electrocardiogram, that forms the basis of electrophysiology, was first recorded in 1897, but with analysis of the site of origin and mechanism of cardiac arrhythmias using programmed electric stimulation and intracardiac activation mapping, his bundle electrogram was recorded in 1969, considered to be a major breakthrough in the field. In early 1970’s more sophisticated diagnostic electrophysiological techniques were developed to electrically map arrhythmias and guide their drug treatment or surgical ablation as per requirement. The surgical treatment proliferated in 1970’s and 1980’s with overall excellent results, however, because of associated morbidity and mortality, it was ultimately replaced by DC energy catheter ablation in 1981 and further by radiofrequency catheter ablation in 1990. The ablation therapy is now an established and definitive treatment for symptomatic SVT’s, unifocal atrial tachycardia, atrial flutter, idiopathic ventricular tachycardia and atrial fibrillation. The most common energy source used during ablation is the high energy current, however, alternative sources like cryoablation, microwave, high frequency ultrasound and laser are also being considered in specific cases. The face of radiofrequency ablation has markedly changed with the advent of 3D mapping system and future is remote or robotic catheter ablations, that will not only reduce radiation exposure but increase precision.
The treatment of bradyarrhthmias has also revolutionised over the last six decades. The first pacemaker was implanted in a 43 year old male in Sweden in 1958 and who till his survival upto 88 years of age needed 26 replacements. Initially pacemaker implantation started as a modality to improve survival, but as the pacemaker technology progressed into 21st century, the developments are no longer solely about reducing mortality but improving morbidity as well. The journey began with the single chamber fixed rate pacemaker to the current dual chamber pacemakers that are relatively more physiological, rate responsive, have sensitive sensors like accelerometers that reflect activity more accurately. The pacemaker technology has also seen advancements in the form of better tracking, wireless remote monitoring, longer battery life, MRI compatibility and more recently transcatheter- delivered leadless pacemakers and His bundle pacing (conduction system pacing).
The role of electrophysiology has extended beyond treating arrhythmias to the management of chronic heart failure and survivors of sudden cardiac death. An implantable cardioverter defibrillator (ICD) has revolutionised the treatment of patients at risk for sudden cardiac death due to ventricular tachyarrhythmia and has definitely shown a mortality benefit in many studies. Similarly, biventricular pacing has been the next physiological pacemaker which has resulted in improvements in exercise tolerance, ventricular performance, decrease in hospitalizations and death in patients of chronic heart failure with persistent symptoms and conduction disturbance.
The innovations will continue as new technologies are introduced and new technologies are driven based upon the patient safety. Despite continued progress in intracardiac electrophysiology, the future in the field appears to lie outside the heart such as body surface mapping, epicardial gene therapy to cardiac ganglia as a method of preventing atrial fibrillation, stopping VT storm and greater use of 3D advanced visualization.