Author + information
- aUniversity of California Los Angeles (UCLA) Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, Los Angeles, California
- bMolecular, Cellular, and Integrative Physiology Program, David Geffen School of Medicine, UCLA, Los Angeles, California
- cNeuroscience Interdepartmental Program, David Geffen School of Medicine, UCLA, Los Angeles, California
- ↵∗Address for correspondence:
Dr. Kalyanam Shivkumar, University of California Los Angeles Cardiac Arrhythmia Center and Electrophysiology Programs, 100 UCLA Medical Plaza, Suite 660, Los Angeles, California 90095.
The first issue of this journal appeared in March 2015 as the fifth member of the Journal of the American College of Cardiology family of journals. In a short span of 5 years, the JACC: Clinical Electrophysiology has seen remarkable growth and is now an established journal in the field. The founding editor Dr. David Wilber and his team worked tirelessly to establish the foundations and have handed this valued member of the JACC family of journals to the current editorial team. We eagerly embark on this next stage of the voyage, combining our enthusiasm for basic science that inspires clinical innovations, clinical research, and the clinical practice of cardiac electrophysiology (EP).
Cardiac electrophysiology, unique among various fields of cardiology, is a “young” field and indeed many of the influential people who created this specialty are still active in clinical care and teaching. In a short span of 3 decades, a field that was predominantly a diagnostic specialty, with few therapies other than drug testing and a small number of surgical procedures, has been transformed into a dynamic interventional specialty. Sophisticated procedures in the cardiac EP lab are now routinely evaluating and treating even the most challenging arrhythmias. In recent years, therapeutic approaches for arrhythmias and heart disease have been powerfully influenced by advances in neurosciences, inflammation biology, bioengineering, and computational and/or data sciences.
The most exciting feature of cardiac EP is the fact that clinical practice provides an opportunity to “test” hypotheses and discern facts for oneself, without having to take current dogmas at face value. Identifying mechanisms of arrhythmias by testing is a great example of “physiology” in action in EP labs across the world on a daily basis. This is also the reason why any new concept that is promulgated can be tested and confirmed, and by extension all fallacies are indeed very short-lived in the world of cardiac EP! For this reason, mechanistic studies will always be a feature of the journal. The permanent vector of all biomedical science is directed toward clinical care and therefore basic, translational, clinical, and population sciences are of interest for our readership and our team aims to make this content accessible and meaningful.
The basic science on which the field of cardiac EP is founded is fascinating, revealing, and deserving of emphasis, as all current treatments can be traced to fundamental discoveries. Cardiac impulse formation is a story that started 3.4 billion years ago, when ionic fluxes needed membrane proteins and subsequently ion channels evolved to support life in a young earth. Ultimately nature refined this tool kit to ensure adaptation to life on land, evolving sinus rhythm in the hearts of our mammalian ancestors (about 160 million years ago). At a cellular and organ level, the muscle cells of the heart (only one-third of the cells in the heart are the myocytes) are activated in a synchronized manner to generate the biological marvel of excitation-contraction coupling. Indeed, the heart beats faithfully approximately 3 billion times in an 80-year life span. Myocytes are profoundly influenced by the other two-thirds of cell types, which include ones that nourish them (vascular cells) and regulate them (neurons), and other cell types (fibroblasts and immune cells), which also play crucial roles in physiology and pathophysiology of disease. Clues to causes of heart disease and therapies for arrhythmias have and will emerge from the studies relating to all these facets of biology.
So what are the areas of focus for this next phase of JACC: Clinical Electrophysiology’s voyage? The journal will always feature content that will ultimately inform patient care. Clinical excellence, in large part, is predicated on increasing understanding of basic sciences of anatomy and physiology. The entire field can be viewed from the perspective of “structure and function.” At a macroscopic and/or organ level, this is immediately appreciated when viewing the intricate anatomy of the heart and the beauty of the propagation of the cardiac impulse. In cellular and molecular terms, these concepts can be appreciated at the level of ion channels and in recent times this area has witnessed powerful mathematical modeling approaches with atomistic scale simulations of ion fluxes across cell membranes. We anticipate publishing interesting science in all these dimensions in addition to the cutting edge clinical papers that the journal already publishes (including simultaneous publication of late-breaking clinical trials from international meetings).
In terms of the journal content areas and article types, all the previous categories will continue, and new sections will be added. These new sections will include ‘Innovations in Clinical Electrophysiology’ and ‘Innovations in Basic/Translational Electrophysiology’, which will be shorter than full research papers, but more detailed than research correspondence papers. These will provide a unique forum to present cutting edge ideas that can pave the way for more definitive work. There are new components for trainees with a special article type ‘Global EP Rounds’, which will feature cell-to-bedside discussions by key international investigators regarding how scientific advances are applied to patient care. We will also inaugurate this issue with a special ‘Conversations With Legends in Cardiac Electrophysiology’ series that will be of interest to all cardiac electrophysiologists.
The ultimate vision of the new editorial team for the journal is to continue to seek and publish the best scientific work that can inform and improve patient care. We also hope to entice the cardiac EP community to follow the journal more closely, by providing content that will enable readers to keep up with new basic and translational science discoveries and ultimately empower physicians and researchers to gain a deeper understanding of the multiple facets of our fascinating field. We envision JACC: Clinical Electrophysiology to be the natural home for work by investigators, physicians, and allied professionals who want to constantly innovate and bring new treatments into clinical practice.
The future holds remarkable possibilities for scientific work that spans the spectrum from in silico to molecules, cells, organs, and ultimately humans; discoveries at all these levels will continue to have significant clinical implications in the coming years. There are still major puzzles to solve in cardiac electrophysiology; we do not understand the biology of fibrillation, and significant progress is needed in the risk stratification and prevention of sudden cardiac death. Our incomplete understanding of causes and mechanisms of common arrhythmias has delayed development of better treatments and ultimately progress toward prevention. The sheer magnitude of sudden cardiac death (by some estimates 22 deaths/min in the world) has worldwide societal implications. At the time of this writing, amid a pandemic, biomedical science is yet again the only path forward to a global solution, highlighting that our missions in science and patient care transcend all types of borders, and unites us.⇓
Dr. Shivkumar would like to thank the entire editorial team for their input for this communication.
Dr. Shivkumar is supported by National Institutes of Health grants OT2OD023848 and OT2OD028201.
- 2020 American College of Cardiology Foundation