“Good tools are prerequisite to the successful execution of a job” --- The Development of Electrophysiology in China
February 21,2020

Dr Min Tang: Good day! It is our honor to invite the famous cardiac arrythmia specialist Dr Hong Jiang and Dr Minlong Chen in China to share the development of cardiac electrophysiology and interpret the frontier progress of the subject. First let invite Dr Hong Jiang to introduce the Electrophysiology under what circumstances to get started and how many stages has gone through in diagnosis and treatment.

Dr Hong Jiang: The subject of arrhythmia is developed with the 40 years of reform and opening up which can be divided into four stages. In the first phase was the first decade of reform and opening up from 1980 to 1990, It mainly studied the basis of arrhythmia, the representative achievement was the HIS blocked through direct current (DC) with pacing therapy to relief and control rate, arrythmias was therapied through target ablation. The second decade of reform and opening up from 1990 to 2000, it was a fast growth time in clinical. During the 10 years, through the research in Electrophysiology, we understood the development of cardiac arrythmias especially in SVT. We were able to map the start of the arrhythmia selectively and use the safe and effective RF to ablate. The third decade of reform and opening up from 2000 to 2010, the transition from electrophysiology mapping to 3D mapping. One of the advances research progress was the ability to map the pathological mechanism of complex ventricular tachyarrhythmia, then through linear ablation to stop or disrupt the mechanisms. The last 10 years is the era of transition to the more complex arrhythmias, we found that the X-ray influenced the patients and specialists. It goes to 2 ways, one is the radical cure for complex arrhythmias, another is to treat without X-ray.

Dr Min Tang: The leader and national brand—JJET has played an indispensable role in this development process. Let invite Dr Minglong Chen to talk about the significance of national brands represented by JJET for the development of arrhythmia therapy, and what they have try and effort.

Dr Minglong Chen: The products are constantly updated and expanded in JJET.  The imported Cardiac RF Ablation Generator was very expensive. But it was researched and produced by JJET and was used in clinical quickly. The original generator was power control only. Later, it was gradually improved to ensure security with temperature control function. In the early time, few hospitals had the Electrophysiology Recording System. The first Electrophysiology Recording System in JJET was 16 channels which met all the needs of treatment for supraventricular tachycardia and other arrhythmias. At present, JJET not only keeps updating the Cardiac RF Ablation Generator and Electrophysiological Recording System, but also keeps producing the catheters which has made some achievements. JJET is constantly developing, and we also hope that national brands can gradually grow and dominate in this filed.

Dr Min Tang: In most basic hospitals in China are used the Electrophysiology Recording System from JJET which signal is very clear. The clinical success rate of radiofrequency ablation of supraventricular tachycardia is above 95%. Let invite Dr Chen to talk about what factors should be considered to improve the success rate?

Dr Minlong Chen: I think, whatever the arrythmia is, the success of radiofrequency catheter ablation is “4-3-3”, 40% is electrophysiology, 30% is anatomy of the heat, 30% is the catheters operation skill exp. At first all of us were focus on the position of catheters but in fact, the catheter operation is not that complicated if you have a good understanding of anatomy and electrophysiology. So, the basic theory of electrophysiology is important, including the biophysics of catheter ablation. While achieving a 95% success rate, you also have to tackle the 5%problem. In other words, the big intervention centers and hospitals should still strive to master the precise biophysics and anatomy of catheter ablation, which also requires good operational skills.

Dr Min Tang: In recent years, domestic and foreign clinical specialists have played a great role in promoting the development of electrophysiology. National industries such as Sichuan Jinjiang Electronic has started to R&D and production of catheters in adhering to the research and development of electrophysiology. Let invite Dr Hong Jiang to introduce the promotion of national brands in the development of electrophysiology.

Dr Hong Jiang: In this field, many national brands with good performance especially JJET whose Electrophysiology Recording Systems are used in many basic hospitals and big hospitals. The performance ① Image standardization is not weaker than import brands and is even more reasonable and objective in some aspects ② image stabilization ③ Fully functional; In the era of big data, the development ability of software is no less than the imported brands, and even better in some aspects. ④ High degree of intelligence; It plays a very good role in guiding the ablation of complex arrhythmias in clinic. In addition, the quality of ablation catheter and electrophysiological catheter are very well, which are safe and effective in clinical application. Domestic enterprises not only do basic equipment, now also move to the high-end equipment. E.g. JJET is entering the high-end equipment of Electrophysiology Recording System with own characteristics. I believe the application of this product can make a greater contribution to the operation of complex arrhythmia and the reduction of Xray damage to patients. I also believe that JJET can produce more good products to instead of imported products.

Dr Min Tang: Sometimes we had some new ideas in clinical but hard to test and come true because of the imported products usage in clinical. Now national machines and catheters which can supply a new way for us in clinical. Dr Hong Jiang and Dr Minglong Cheng have participated in the clinical trial of electrophysiological catheters in JJET as the Principle Investigator. I would like to talk about your clinical experience of using.

Dr Minglong Chen: I think the catheters and electrophysiology recording system fully meet clinical standards. What is the best for us is that the catheters can design according to our ideas and thoughts? I hope that JJET can research and produce more catheters based on doctors’ ideas. The unique advantage of JJET is can supply the whole products in electrophysiology from catheters to 3D mapping system.

Dr Min Tang: We Fuwai Hospital as the Principle Investigator did the research and development. When we use the imported products, actually we just a user and hard to implement ideas but now we have the way. So I think at present JJET has obvious advantages in domestic market, now our government is promoting the combination of industry-university- research, this is the best bridge. With the development of medical technology and the joint efforts of cardiovascular experts in China, the development of arrhythmias is also advancing by leaps and bounds. Dr Hong Jiang, can you share the new technology in cardiac arrythmias and their development prospects in China?

Dr Hong Jiang: In recent years the advances in cardiovascular science are reflected in two ways. One is in very complex arrythmias ,here has four aspects ① We can map the position accurately; ②Combined with artificial intelligence, we were able to map the occurrence and development of arrhythmia, including the reentry and movement, and key position; ③We can combine some preoperative images and integrate them into our high-precision mapping to more visually represent the key position where arrhythmias occur; ④Combined with the artificial intelligence of big data, the generalization of these mapping targets can significantly improve the safety and efficacy of the treatment of the whole complex arrhythmia. On the other hand, the research advances in recently include more convenient usage, “greener” mapping system makes the patients and surgeons to minimize or even eliminate exposure of X-ray.

Dr Min Tang: We are very lucky in the era of rapid development as young and middle-aged surgeons. JJET is developing with Chinese cardiology. The development of Chinese cardiology is inseparable from the support and unremitting efforts of Chinese clinical experts. Dr Cheng, could you please talk about the expectation of national brand in the future development of arrhythmia in China?

Dr Minglong Chen: The high-end products in JJET such like magnetoelectric combined 3Ding mapping system、pressure catheter etc. will be used in clinical application soon. But different products need to have new features so they have more features. The current 3D mapping system is high-density and high-precision which is relatively accurate for us to locate the focus of arrhythmia. If the imaging technology can be integrated, and even the lesions of the image can be included, such like the scarred areas of the heart can be directly integrated into the 3D mapping system. The image, the image pathology and the 3D system can be integrated together, which will greatly improve the operation of doctors, reduce the radiation of patients and doctors. In ablation, should keep up with the new ideas and methods in the processing of research. In catheters, mostly are imported catheters which is not match for Chinese. Perfectly. I hope we can produce more own catheters.

Dr Min Tang:At last, Dr Chen, please talk about the expectation for the young and middle-aged doctors, any plans in primary doctor training?

Dr Minglong Chen: Reviewing the development of electrophysiology, first we learned operation, and then paid attention to the clinical electrophysiology study. After that we had a lot of inspirations on exploring ideas and operation. So, for the new surgeons, first to remember the basic theory of electrophysiology. Second, after mastering the technology, how to make precision ablation? In early years are solving clinical problems, but for the group should to think about the strategic issues, then at a higher age, at a higher level, need to do some work to prevent arrhythmias. So, from the basis theory of electrophysiological to ablation standards to the ultimate prevention strategy, these steps are essential.

Dr Min Tang: The emergence of new technology will bring great help to doctors, conducive to the diagnosis and treatment of diseases, but also bring good news to patients. However, not all new technologies are perfect and need further improvement. With the rapid development of electrophysiological technology, we expect national brands to achieve greater success and bring more sense of gain and happiness to surgeons and patients.