Cardiac Electrophysiology in China

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ardiac Electrophysiology in Chinai-Han Chen,*†‡ Huaizhi Chen,† Yongquan Wu,* Dayi Hu‡

From Department of Cardiology, Tongji Hospital, Tongji University, Shanghai, ChinaInstitute of Medical Genetics, Tongji University, Shanghai, China

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China experienced a long feudal era, adversely affecting its adoption ofodern medicine. The lack of exchange with the western world causedhina to fall far behind in, among many scientific and economic endeavors,

he field of cardiac electrophysiology. As heart specialists, we are gratefulo bear fruit from the reform and open policy of our government, which hasmproved communication between the east and the west, and has deeplyhifted the direction of cardiology in China.

Radio-frequency catheter ablation (RFCA) was performed in about0,000 cases of arrhythmia in mainland China in 2006. The majority ofhese cases were atrioventricular reentry tachycardia (AVRT), atrioventric-lar nodal reentry tachycardia (AVNRT), and atrial fibrillation (AF). Someases were ectopic atrial tachycardia, atrial flutter, and ventricular tachy-ardia. The success rate was above 98% for AVRT and AVNRT, and wasetween 50% and 80% for AF. Segmental ablation for AF was for the firstime adopted in 2001. The number of procedures performed that year wasbout 150. CARTO or EnSite systems were introduced in 2003. Theumber has doubled each year, reaching about 3000 in 2006. Since 2004,he procedure has been modified to circumferential pulmonary vein abla-ion. Now, there are about 40 CARTO and 22 EnSite equipped labs inainland China. RFCA of AF is performed in about 80 hospitals. Other

herapies for AF, such as complex fractionated atrial electrogram ablation,urgical Maze procedure, Mini-Maze procedure and microwave ablation,re also performed. The prevalence of AF is 0.77% in China. This is bothn opportunity and a challenge to electrophysiologists in clinical practicend research in China and in the entire world. As for pacemakers, the firstmplants in the mainland China were performed in the 1960s. In 1996, therst ICD was implanted. In 1999, the first patient received cardiac resyn-hronization therapy. In 2006, 30,000 pacemakers were implanted, whichere mostly VVI type, and less than 30% were DDD type.

Despite the clinical progress, the lack of new ideas continues to plague

ddress reprint requests and correspondence: Yi-Han Chen, MD, PhD,epartment of Cardiology, Tongji Hospital, and Institute of Medical Ge-etics, Tongji University, 389 Xin Cun Road, Shanghai 200065, China.

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ation of the histologic features from the encircled region in A.

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-mail: drchen@public7.sta.net.cn

547-5271/$ -see front matter © 2007 Heart Rhythm Society. All rights reserved

ur nation. Innovative and original research is still scarce in the academiceld. Financial incentives have compelled some clinicians at the universityffiliated hospitals to focus on percutaneous coronary intervention andeave basic research entirely. In addition, for the academic physicians, ouresearch scale is still very limited compared with that in the USA andurope. There is urgency to establish our data base of arrhythmia epide-iology. Yet, in spite of the difficulties, basic research in cardiac electro-

hysiology has been improved with the rapid economic development.From the increased funding and support by our government, China has

ducated more young scientists, obtained more high-tech equipments, andstablished more research centers in the recent years than any previous.ecause of these policies, Shanghai, Beijing, and Hong Kong have becomeenters to incubate talents and produce scientific research. Through edu-ation, hard work, and communication, we see an excellent opportunity toatch up with the pace of the world’s research.

China’s economic achievement has been recognized worldwide. Aver-ge individual income in mainland China is, however, still much lowerhan that in the developed countries. This limits the electrophysiologyesearch and practice. Our government is performing healthcare reform,hich may affect the future of electrophysiology. It is improving the

raining system, pushing standardization and remedying the defects inedical education and popularization. It is making efforts to minimize the

dverse effect of market policy on medicine, raising the standards of healthare in the western and central regions, where people have traditionallynjoyed less of the benefits from our rapid economic growth than those inhe east. Electrophysiology practice is limited in those areas. Our govern-ent and the Chinese Cardiac Electrophysiology Association encourage

lectrophysiologists to volunteer to work in those underserved regions.The National Ministry of Health reports that the incidence and preva-

ence of cardiovascular disease increased rapidly and that it has become theo. 1 killer in China. Medical development in such a country with such a

arge population with cardiovascular disease will affect not only China, butlso the world. We expect extraordinary growth in cardiac electrophysiol-

Legend of Figure 2 of the recently published “Abnormalxpression of cardiac neural crest cells in heart develop-ent: A different hypothesis for the etiopathogenesis ofrugada Syndrome” Heart Rhythm 2007; 4: 359-365 inad-ertently contains a typographical mistake. It should nowead (the erratum is underlined and in bold in the legend):

FIGURE 2: A-D. Abnormal myocardial tissue in areas ofhe pulmonary valve and the subpulmonar zone in RVOT. A:ulmonary valve (PV). Panoramic view of the pulmonaryalve heterotopic myocardial tissue of a 4-month human em-ryonic heart (Hematoxylin eosin x 100). B: Greater magnifi-

isorientation of the myocardial fibers intertwined with Pur-inje-like fiber cells with large diameter and a clear perinuclearone due to abundant contents of glycogen. The clear cellsorrespond to lipid vacuols and areas of lipid deposition (x00). C: Panoramic view of the subpulmonar region of theVOT of a 16-week human embryonic heart. A nodular-

haped muscular structure is observed immediately below theulmonary valve (hematoxylin eosin x 100). D: Magnificationnd detail of the encircled region from C. Areas of lipideposition and tortuous distribution of muscle cells running inany different directions, intermingled with Purkinje-like cells

x 400).

. doi:10.1016/j.hrthm.2007.04.013