Electrophysiology Legend Dr. Hugh Calkins Interview
Hugh Calkins, MD, FACC, FAHA
Dr. Hugh Calkins is a member of the K2P Legends Series faculty and has provided a video entitled “Electrophysiology: State of the Science.”
He is the Catherine Ellen Poindexter Professor of Cardiology and Director of the Electrophysiology Laboratory and Arrhythmia Service at the Johns Hopkins Hospital. An internationally recognized expert on electrophysiology with more than 500 articles and book chapters to his name, Dr. Calkins is an Associate Editor of the Journal of Cardiovascular Electrophysiology and serves on the editorial board of many other cardiology journals.
Additionally, Dr. Calkins is a former member of the American Board of Internal Medicine Electrophysiology Boards Test Writing Committee and led a 44-member international task force whose 2012 Expert Consensus Statement gave recommendations for treatment and research of atrial fibrillation. Dr. Calkins is regularly recognized as one of the top cardiologists in America. He is a past president of the Heart Rhythm Society and was inducted into Hopkins’ Miller Coulson Academy of Clinical Excellence in 2014.
Q&A with Dr. Hugh Calkins
What would you like learners to take out from your Legends Series talk on electrophysiology?
I think it’s important that physicians be aware of the remarkable history of the field of arrhythmia management and electrophysiology. It’s striking that over the last really 60 years, the entire field went from nonexistent to what it is today. There were the early phases where pacemakers were developed and antiarrhythmic drugs were tested and developed, and then we moved into the era of implantable defibrillators and catheter ablation. The change keeps accelerating year by year. I think as we look toward the future, it’s always important to reflect on the past and the remarkable history of our field.
Where do you think we’ll be in the management of arrhythmias in 10 years?
I would anticipate that in 10 years, arrhythmias like atrial fibrillation can be easily and safely treated when they first develop. I think that implantable devices, both pacemakers and defibrillators, will have far longer longevity and they’ll increasingly be implanted in an intracardiac position or subcutaneous position, with a much simpler procedure. I think biventricular pacing may completely fade away and be replaced by left bundle branch block or conduction system pacing.
So, the rate of change is extraordinary and a decade from now, we’ll look back at what we’re doing now as being rather primitive. I’m extremely optimistic. If you look at the past and what’s happened in the past, and you think about the future, and the rate of change, you can only smile and look forward in an enthusiastic way to what’s to come.
What are your best practices in the assessment of atrial fibrillation?
When one thinks about the management of atrial fibrillation, there are really four pillars of management. Stroke prevention with anticoagulation or left atrial appendage occlusion, and then rate control and rhythm control, which we’re getting more information about the importance of being in sinus rhythm and I think we’re increasingly going to see a shift toward more aggressive attempts to keep people in sinus rhythm and treat atrial fibrillation early.
The pillar that has received a lot of attention over the last five years is risk factor modification. We now know it’s critically important to lose weight, to limit alcohol intake, control blood pressure–and modifying these risk factors is critical in the long-term management of patients with atrial fibrillation.
What is the greatest advice you were given by a mentor that still holds true today?
I’ve been lucky to have some wonderful mentors during my career, who really led by example, showing me that I can be both an excellent clinician and an excellent researcher that helps to move the field forward. And that doesn’t have to research in a wet lab, but rather clinical research that you carry out as you care for your patients every day. When patient care and research services inform each other, it makes life really very exciting and stimulating. I’ve very much enjoyed my career in electrophysiology.
How has your career been different than you expected?
My career has been totally different from what I expected when I was training. I always figured I’d end up in clinical practice and be “a big fish in a small pond.” I’d work at a community hospital being a good doctor. I did not think I would end up in academic medicine.
It was really coming to Johns Hopkins to do my cardiology fellowship and getting my first taste of what it’s like to do research that taught me the joy of research and publishing and academic advancement. Then I had a remarkable opportunity to work with Fred Morady at the University of Michigan for three years as catheter ablation was being developed. It was a remarkable experience to work side by side with Dr. Morady to see how he cares for patients and was incredibly productive academically. It was really those two experiences that made me shift from a strictly clinical approach to an academic career in a big medical center, focused on clinical research and teaching, along with patient care.
What career would you have chosen if you hadn’t chosen to become a physician?
I think I could have enjoyed almost any career. I would not have picked a career in athletics, because that’s not my forte. And I think being an attorney would have been unbelievably boring for me. But I could see that being a teacher, an educator would have been a very rewarding career for me. A career in business would have also been interesting. But nothing compares with being a physician.
What is an interesting fact about you?
I’m one of nine children in my family. Both of my parents are physicians. I’m number six in the lineup and I’m one of three physicians in the family–two of my sisters are pediatricians.