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NewsJuly 2018, No. 37

Chief editor:Kazuo MATSUMOTO

Deputy editor:Yoga YUNIADI Hsuan-Ming TSAO

Managing editor:David HEAVEN Anil SAXENADavid O’DONNELL Pipin KOJODJOJONwe NWE Jacky CHANKatsuhiko IMAI Naomasa MAKITAJae-Min SHIM Toshiko NAKAYAMAMing-Shien WEN

C O N T E N T SP1 APHRS “Country to Country Match” Programs

P3 Exercise and AF

P5 A Review of GenesisCare - Australia’s Largest Provider of EP Services

P7 HowRhythmiaMappingSystemWork(Real-timePositionManagement,RPMBostonScientific)

P9 IntroductionofCardiacArrhythmiaTeamofTaipeiMedical University Health System

P12 APHRS 2018: Taipei

APHRS “Country to Country Match” ProgramsMinglong Chen

Chair of Membership SubcommitteeThe First Affiliated Hospital of Nanjing Medical University,

Jiangsu Province Hospital

In our global village, Asian-pacific region is apromisingandharmoniousfamily,andAPHRS,isjustlikeascientificinterestgroupofmanyfriendlyfamilymembers. Thanks to the “country to country match” programs of APHRS, the family members advancehand in hand in recent years. This program also meets wellwithChina’s“TheBeltandRoadInitiative(BRI)”program. In response to this program, our EP teamhas worked closely with EP colleagues in South-east Asia countries very recently.

Bangladesh is a country in South Asia, whichshares land borders with India and Myanmar. It is a developing country with a market-based mixed economysystem.Thisspring,thenameofourcardiacelectrophysiologyteamappearedontheBangladeshinational news. This report was about how theteam had helped Bangladeshi finish their first atrialfibrillation radiofrequency ablation guided by 3Dmapping navigation system. This projectwas led byamember of our EP team, Doctor Gang Yang fromNanjing.“Whenyouwalkaroundinthehospital,youcanseepatientsareeverywhere.Youcantellintheireager eyes that they are hoping someone could be there and help them free from their illnesses. I will

teacheverythingIknow,everyskillthatIlearnedandpasstheknowledgetothesenewgenerationdoctorsand let themhave the skills to treat their patients” Dr. Gang Yang said, and that was what he did.

Forthefirsttime,a3Dmappingnavigationsystemwas introduced and applied to guide the complex arrhythmia ablation in Bangladesh. With that, ninecases were successfully done.

APHRS “Country to Country M

atch” Programs

Asthis“EPcountrytocountrycollaboration”goes,the friendship between the two countries grows stronger,theEPtechniquesinthedevelopingcountriesexpandsandadvances,andtheimprovementofworldheathprojectaccelerates.

InApril,wewerealsoinvitedtoHyderabadCAREHospital in Southern India to work with Prof. Calambur Narasimhan for a workshop focusing on complex substratemappingforatrialtachycardias(ATs).InIndiaandChina,wehaveahandfulofATpatientswiththescenarioofrheumaticheartdiseaseandhypertrophiccardiomyopathy. For such patients, the substratemaintainingATisverycomplex.However,withthehigh-densitymappingtechniques,theEPdoctorscannotonlyunderstand themechanismsof theAT, butalsofurther look intothesubstratespromotingsuchATs.Thiscanhelpus todesign theablationstrategytargeting the index AT and preventing the future AT as well. Five cases were successfully done and the workshopattracted200attendants.

Join us today!http://aphrs.org/membership/join-now

Annual Membership Fees:• Regular Member: USD50• Associated or Allied Member: USD25• Industry Member: USD50

As a Member of the APHRS, you can enjoy the following benefits:•Discountregistrationtotheannualscientificmeeting

and other symposia organized by APHRS

•Eligibilitytoapplyforalltheeducationandtrainingprograms organized or endorsed by APHRS; as well as APHRS Fellowship Programs

• FreeSociety’snewsletterandpublications

• Online access to APHRS Members Portal

•EligibilitytovoteinAPHRSBoardelections

The APHRS is a big platform for all healthcareprofessionals who are interested to promote the advancement in the study and care of the patientswithcardiacrhythmdisordersintheAsia-Pacificregion.

We the Membership Subcommittee would like to welcome more EP doctors, nurses and alliedprofessionals to join us and boost this platform.Together we can contribute to the development of EP and pacing and benefit more patients of the region throughthecollaborationactivitiessuchasabove.

APHRS Membership Subcommittee 2018

Chairperson MinglongCHEN(China)

Members JosephYSCHAN(HongKong,China)

Dicky HANAFY (Indonesia)

AkihikoSHIMIZU(Japan)

SootKengMA(Malaysia)

QuocKhanhPHAM(Vietnam)

HarisHAQQANI(Australia)

Jin-LongHUANG(Taiwan)

DanielCHONG(Singapore)

MalikFAISAL(Pakistan)

2

Exercise and AF

Exercise and AFDarragh Flannery and André La Gerche

Baker Heart and Diabetes Institute,Department of Sports Cardiology, Melbourne, Australia

The otherwise healthy athlete presenting with symptomatic atrial fibrillation (AF) is a fairly commonpresentationforthepracticingelectrophysiologisttomanage.Thismayseemlikeaparadoxinthiseraofriskfactormodification includingweight loss becoming a cornerstone of AFmanagement. However, it has beenobservedinseveralstudiesthatendurancesportssuchascycling,rowingandrunningareassociatedwithanincreased risk of developing AF.(1)Endurancesportisassociatedwithmanyhealthbenefitsincludingimprovedmortalityandlessmajoradversecardiacevents.However,dependingonthestudy,endurancesportisassociatedwithanapproximately2-5foldincreasedriskofAF.Incomparison,hypertension,themostcommonunderlyingAFriskfactorinthewiderpopulationonlyconversarisk1.4timesthatofthosewithouthypertension.Thisexcessriskhasnotbeenreplicatedinnon-endurancesportsandnorhasanassociationbetweenhighlevelsofexerciseandAFbeendefinitivelyobservedinfemaleathletesofanyathleticdiscipline.

athletes.However,thereareafewfactorsencounteredin athlete that can influence management in arelativelyuniqueway.

The issue of the role of exercise in promotingAF should be discussed with the athlete whilst acknowledging that there is no hard evidence to guide decision-making on this point. As has been highlighted,endurancesportincreasestheriskofAFand it is reasonable to suppose that reducing physical activitymay decrease the frequency and burden ofAF.However,thereislimitedevidencetosupportthisstrategy and it is important to highlight that complete detraining is probably inadvisable, given that asedentary lifestyle has been strongly associated with increased risk of AF.

It is also important to consider other risk factors for AF in athletes. Hypertension is very common and asymptomatic.ItisimportanttoscreenforandtreatinanyonewithAF,evenanotherwisehealthathlete.Furthermore, athletes should be advised aboutthe potential additive effects of alcohol ingestion in

Though numerous studies have shown an increased risk of AF in endurance athletes, it is not known iffemale endurance sport athletes are at increased risk ofAF.Thismaybedue,inpart,tothefactthatwomenare poorly represented in most of these studies. In the Tromsø study men and women had similar risk ofAFifparticipatinginendurancesportbutbecausethereweresofewwomen inthestudyparticipatingin endurance sport this did not reach statisticalsignificance.(2) Studies explicitly investigating femaleathletes’ risk of atrial fibrillation are rare and thosethatdoexistaresmall.Thus, itwouldbe fair tosaythat the association between endurance sport andAF in women is yet to be fully elucidated although it seems that the risk may be smaller than in men.

The mechanisms by which endurance sport increase the risk of AF are unknown. There are a number of putative mechanistic factors, someextrapolated from known risk factors in the general populationandsomethatarerelativelynovel.Theseinclude structural remodelling of the left atrium,elevatedleftatrialpressure,inflammation,myocardialfibrosis, vagal tone, sinus bradycardia and geneticpredisposition.Allofthesefactors,withtheexceptionof genetic predisposition, have been shown to beassociatedwithendurancesportparticipation.(3) It is yet to be proven however whether the increased risk ofAFinathletesisduetosome,allornoneofthesefactors.

Unfortunately, there is very little evidence toguide management of AF in athletes. Given the lack of evidence, the same principles of reduction insymptoms and prevention of stroke that guide AFmanagement in non-athletes should be applied to

3

Online Real-tim

e Phase Mapping System

: The ExTRa Mapping Project from

JapanExercise and AF

REFERENCES1.Abdulla J,Nielsen JR. Is the riskof atrial fibrillationhigher in athletes than in the general population?A systematic reviewandmeta-analysis.Europace:Europeanpacing,arrhythmias,andcardiacelectrophysiology:journaloftheworkinggroupsoncardiacpacing,arrhythmias,andcardiaccellularelectrophysiologyoftheEuropeanSocietyofCardiology.2009;11(9):1156-9.

2.MorsethB,Graff-IversenS,JacobsenBK,JorgensenL,NyrnesA,ThelleDS,etal.Physicalactivity,restingheartrate,andatrialfibrillation:theTromsoStudy.Europeanheartjournal.2016.

3.FlanneryMD,KalmanJM,SandersP,LaGercheA.StateoftheArtReview:AtrialFibrillationinAthletes.HeartLungCirc.2017; 26(9):983-9.

4.KoopmanP,NuyensD,GarwegC,LaGercheA,DeBuckS,VanCasterenL,etal.Efficacyofradiofrequencycatheterablationin athletes with atrial fibrillation. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of theworkinggroupsoncardiacpacing,arrhythmias,andcardiaccellularelectrophysiologyoftheEuropeanSocietyofCardiology.2011;13(10):1386-93.

promoting AF. There is accumulating evidence thateven modest levels of alcohol consumption mayincrease incident AF and promote AF recurrence.

Many athletes, though not all, are symptomatic.Somedescribeacutefatigueandexerciseintolerancewith the onset of AF but others are completely asymptomatic.Asinnon-athletes,thereasonfortheheterogeneity in symptomatology is intriguing but remainsunexplained.Forsymptomaticathletes,atrialofmedicaltherapyisusuallyrequired.ForanathletewithinfrequentparoxysmsofAF,sotalolcanbeuseful.Althoughit istruethatathletesareoftenintolerantofbetablockers,thisshouldnotbeassumedandthiscan beasimpleandeffectivetherapyinaminorityofathletes.

In our experience the most effective anti-arrhythmicforathletesisflecainide.However,an important consideration is the risk of rapidlyconductedatrialflutterandthusitshouldbecombinedwith an AV nodal blocking agent such as metoprolol ordiltiazem.

Flecainide can be used as both a regular medicationorasa‘‘pillinthepocket”strategy.Regularflecainide(incombinationwithabetablocker)ismoreefficacious,however,manyathletesprefernottotakeregularmedications.

For athletes who continue to have symptomaticAF and have failed or are unable to tolerate medical therapy,werecommendcatheterablation.Despitethe cardiac remodelling which occurs in athletes,AF ablation has been proven to be as efficacious inathletes as non-athletes.(4)

With regards to stroke prophylaxis, carefulconsiderationoftheathlete’sriskofstrokeandrisksfromanticoagulation shouldbemade.Useofa riskscore such as CHADSVASc is helpful. On occasion,sport practicewill introduce unique considerations,such as the potential for more serious bleedingin a competitive mountain biker. The risks ofbleeding need to be very carefully explained and these factors should not be overlooked in shared decisionmaking.However,wewouldcautionagainstwithholdinganticoagulationinpatientsatsignificantthromboembolicrisktoenablesportsparticipation

In general athletes tend to be healthy and the risks ofstrokearelow.Asathletesage,however,theriskofstroke rises as does the risk of developing other stroke riskfactorssuchashypertension.Consequently,whilemostathletesmaynotrequireanticoagulationatthetimeofdiagnosis,thismayneedtobereconsideredastheriskprofilechangesovertime.

Athletes are typically healthier and live longer than non-athletes.Nevertheless,itisclearthatendurancesport increases the risk of AF in men. Endurance sport participation is increasing progressively over time. Endurance sport associated AF is likely to become increasingly prevalent over the coming years. Furtherresearchinthisareawillbecriticaltofurtherunderstanding the mechanisms by which it develops as well as how best to treat incident cases.

4

A Review of GenesisCare - Australia’s Largest Provider of EP Services

A Review of GenesisCare - Australia’s Largest Provider of EP Services

David O’Donnell, Glenn Young, Steve Pavia

GenesisCare was formed 10 years ago by a small group of cardiologists and health care experts to address Cardiac and Cancer care, the two biggesthealth concerns facing patients in the Australian Healthcaresystem.GChasgrownintoamultinationalcompany with over 3000 employees in all states ofAustraliaaswellas theUnitedKingdom,Spain and China.

There are 85 cardiologists working at 98 sitesacross Australia including 16 electrophysiologistsand a number of device specialists. GenesisCare is Australia’s largest provider of AF ablation, deviceimplantation, cardiac resynchronization therapy,atrial appendage occlusion and remote monitoring. The annual procedural volume of the EP doctors exceeds 4000 cases (including more than 1000 AFablations) and over 3000 device implants. Acrossthe network the remote device monitoring service encompassesalmost3000patients.

MostAFablationsaredonewithRFand3Dmapping.Cryotherapy represents less than 10% of the cases but this number is growing. The cases mix is typical of large volume centreswith just over60%of ablations

for paroxysmal AF, 30% for persistent AF and 10%for longstandingpersistentAForAF inthesettingofcardiomyopathyorsignificantstructuralheartdisease.

Why is GenesisCare different?

For many years doctors have focused on what they can do individually to help patients. InEP thishasbeencentredaroundacquiring thelatest treatment techniques, using contemporarytechnology and being up to date with latest research and developments. While no one can argue with the importance of these fundamentals GenesisCare has at its core the principal of designing better healthcaremodels.Whilstclinicalandproceduralexpertiseis fundamental to good patient care, there areadditionalwaystoimproveoutcomesforourpatientsandoptimisetheiroverallhealth.GenesisCarehasastrong belief in value based healthcare. In this model remunerationisbasedongoodoutcomesratherthansimply based on “doing”. Some of the key pillars to the value based healthcare system are accurate and comprehensive data collection to assess outcomesalong with patient reported measures of their HealthCare experience.

5

A Review of GenesisCare - Australia’s Largest Provider of EP Services

1 Data collection

With a single national electronic heath record and multiple clinical and procedural databases GenesisCare has improved ability to collect and utilise thisdata toassessall aspectsofhealthcaredelivery within the clinical network. Increasingly our clinicsutiliseappbased technology to improve theefficacyofthedatacollectionprocessandoptimiseclinicalworkflows.

Patientsundergoingprocedures,imagingandthosewith heart failure are prospectively entered into aninternallydesigned,externallymanageddatabase.Thedatabaseshouseover17,000patientswithcompletedemographic and procedural information. Doctor engagement with the databases and appropriate clinical management has significantly improved theproceduraloutcomesforpatientsinthepast4years.The latest analysis of the device database has shown amajorcomplicationrateacrossallimplantsof<1%which exceeds published benchmarks. At the same timethepatientfeedbackisexcellentwithapositivepatient feedback score consistently exceeding 90%whichissignificantlyabovethemedicalcarestandardof40%andthedefinedworldclassstandardof70%.

2 Research and Innovation

Genesisisinvolvedininvestigatordriven,firstinman andmulticentre research projects. At current120 trials are ongoing or recently completed. The structure of Genesis Care allows a single ethics submission and single contract across the network to recruit fromourannualvolumeofover160,000uniquepatientsacrossour98sites.Thissignificantlystreamlinesthesiteinitiationandactivationprocesswithaslittleas30daysfromsigningamemorandumofunderstandingtofirstpatientrecruitment.

TheEPgroupcurrentlyhasanumberofprojectsacross the network including:

1.AnovelmappingtechniqueduringCRTimplant

2. Assessing and improving Implantable loop monitordiagnosticalgorithms

3. Remotemonitoring

4. Pulmonaryarterypressuremonitoring

5. Atrial appendage occlusion

6.UseofdevicebasedalgorithmstooptimizeCRT

3 Designing Better Care

Innovationdoesnotjustrelatetoclinicalresearch,but also the model of health care delivery. One example is leveraging doctor’s time and expertiseby involving nurses, physiologists, technicians andtrained practice staff to co-manage the patient toallow optimal use of each individual’s time. And by implementing technology that streamlines dataflow, increases efficiency and improves the patientexperience.

The future of healthcare is upon us and the traditionalmodelthatsitsthedoctoronapedestalat the centre of the system is changing. But thechange to a value and outcomes-based model is best achieved with the buy in of doctors and alignment of doctors with the key stakeholders. A scalable and transportablemodelofcare,suchasthatproventobeeffectiveatGenesisCare,addressestheseneeds.

6

How

Rhythmia M

apping System W

ork

Rhythmiamapping systemusemultipolarbasketcatheter(BC)bycombining3Dmappingandnavigationsystems for the ablation catheter.7 The system has been successfully used to aid mapping ventricular tachycardias, atrial tachycardias, atrial flutter andeven inside pulmonary veins to map and ablate foci thatinitiateatrialfibrillation.8 The rhythmia mapping method combine electrophysiologicla data with anatomic information. The need to simultaneouslymapahighnumberofendocardialsites in3Dspacehaspromptedintroductionofthebasketcatheter.

Basket Catheter (BC) Mapping

TheBCiscomposedof64electrodesmountedon8flexible, self-expandingnitinol splines (Fig-1.)Eachsplinesisidentifiedbyaletter(fromAtoH)andeachelectrodebyanumber(distal1toproximal8)andiscapable of acquiring electrophysiological data frommultiplesitessimultaneously.

How Rhythmia Mapping System Work(Real-time Position Management, RPM Boston Scientific)

S M Hossain Sadi.Labaid Cardiac Hospital, Dhaka, Bangladesh

Thisarticleiswrittenasafollow-uptoElectroanatomic Non-fluroscopic Three Dimensional (3D) Voltage Mapping for Diagnosis and Radiofrequency Ablation of Arrhythmias,

previously published in APHRS News Mar. 2018, No. 35.

Fig-3: Example of ECG Recording by BC during AF mappingRecording from a right upper PV (200 mm/s). Distal electrodes of BC (A 1/2, B 1/2.... H 1/2) are placed on top of figure under surface lead ECGs (I, aVR, aVF), and proximal electrodes (A 7/8, B7/8... H 7/8) of BC on bottom. PV discharge is not conducted after first 2 beats (↓); third PV discharge (*) is conducted to left atrium with induction of AF.

Fig-4. Example of an ostial isolation of a right upper PV with help of BC, Left, Activation of right upper PV in sinus rhythm before ablation. At electrodes 5/6 level, we can clearly identify 2 separated potentials, first, a far-field atrial potential, and second, a PV potential; at electrodes F and G 7/8, 2 potentials are fused. Because no catheter stability was achieved at 7/8 level, ablation was performed at electrodes G 5/6, Middle, after RF ablation, we have blocked pathway at this point with a change in activation sequence. PV is now activated by electrodes B 5/6. Right, Ablation on electrodes B 5/6 resulted in complete conduction block with disappearance of all PV potentials.

Fig-1: Left, 64-pole BC (Constellation) with 8 self-expanding splines of nitinol and 8 electrodes per spline for a 3D high-density mapping. Right, Fluoroscopic anteroposterior view of a transseptal position of BC in a right upper PV.

Fig-2: For Rhythmia Mapping system location of reference back patch on-to the patient’s back in a medial stable position.

7

How

Rhythmia M

apping System W

ork

Fig-5: Exact localization of ablation catheter inside BC is given by Astronomer navigation system. Top, Fluoroscopic anteroposterior view of a right upper PV with BC and ablation catheter inside. Bottom, Localizatin of tip of ablation catheter by Astronomer navigation system at basket electrode D5.

Fig-6: System Set Up for Blazer Open-Irrigated Ablation Catheter, Stockert 70 Radiofrequency Generator, Coolflow Irrigation Pump and Coolflow Irrigation Tubing Set or BSC Irrigation Tubing Set and Compatible Cables.

The accuracy of the maps created by a basket system depends on the number of splines on the basket, the number of electrode on each splinesand the percentage of both that achieve endocardial contact.8 Electrograms and color-coded activation maps are reconstructed online and are displayed on a monitor. Thus, tachycardia mapping is improvedalthoughwithrelativelylimitedresolution.

REFERENCES7.ArentzT,RosenthalJV,BlumT,etal.

Feasibility and Safety of Pulmonary VeinIsolationUsingaNewMappingandNavigationSystemisPatientswithRefractoryAtrialFibrillation.AmericanHeartAssociation.Circulation.2003;108:2484-2490

8.EckardtLars,BreithardtGünter.ConstructionandInterpretationofEndocardialMaps:FromBasicElectrophysiologyto3DMapping,MohammadShenasa,GerhardHindricks,MartinBorggrefe,GünterBreithardtEditors.CardiacMapping.THIRDEDITION2009;13-26

9.EldarM,OhadDG;GoldbergerJJ,etal.TranscutaneousMultielectrodebasket catheter for endocardial mappingandablationofventriculartachycardiainthepig.circulation.1997;96:2430-2437.

Navigation system

TheAstronomersystem(BostonScientific)isusedfornavigationinsidetheBC,Thissystemconsistsofaswitching/locatingdeviceandanoff-the-shelflaptopcomputer. The device and the laptop communicate onastandardRS-232interface.ThedevicedeliverACcurrentbetween the ablation cathetertipelectrodeandareference(skinpatch)electrodeandtheresultingelectricalpotentialsaresensedateachBCelectrode.9 On the basis of the sensed voltages at each of the BC electrodes, the Astronomer device determineswhether the roving electrode is in close proximity to a BCelectrodesandlightsthecorrespondingelectrodesoftheBCdisplayedonthelaptop.

Ablation Catheter used for Rhythmia Mapping System

BlazerOpenIrrigatedablationcathetermaybeusedfor Radiofrequency ablationwith rhythmiamappingsystemusingBC.(Fig.6)

8

Introduction of Cardiac Arrhythmia Team

of Taipei Medical University H

ealth System

Introduction of Cardiac Arrhythmia Team of Taipei Medical University Health System

Chung-Hsing Lin, MD, Ming-Hsiung Hsieh, MD

HISTORY Taipei Medical University (TMU) Health System

comprises three hospitals. The first one is TaipeiMedical University Hospital (TMUH) which wasestablished in 1976. Its present location is in theXinyidistrict,Taipeicity,andsharesthesamecampuswith TMU which is very close to the famous 101 building. In 1997, the Municipal Wan-Fang hospital(WFH) in Wenshan District was delegated to TaipeiMedical University. Dr. Yi-Jen Chen (YJ Chen) and Dr. Ming-Hsiung Hsieh (MH Hsieh) joined WFHin 1998 and 1999, respectively. Dr. Yung-Kuo Lin (YK Lin) andDr.Wei-TaChen joined theWFHgroupafterward and accelerated the growth of complexablationprocedures.

In2008,Shuang–Hohospital (SHH), inChung-Hodistrict,NewTaipeiCitywasalsodelegatedtoTaipeiMedical University. Dr. Shuen-Hsin Liu and Dr. Chung-Hsing Lin joined SHH in 2008, 2016, respectively. Inaddition,Dr.Shuo-JuChiangandDr.Chao-ShunChanand joined TMUH in 2012, 2013 respectively. Theseyoung EP doctors open the new field of catheterablation.AlltheEPphysiciansreceivedthedelicateandextensive training in Professor Shih-Ann Chen’s (SA Chen) laboratory inTaipeiVeteransGeneralHospital(TPEVGH). Furthermore, Dr Chen, Dr Hsieh and Dr Lin in WFH have excellent achievements in both basicstudiesandcatheterablationofSVT,AFandVT.

Fig. 1. Location of 3 hospitals. (TMUH: Taipei Medical University Hospital. WFH: Wan-Fang Hospital. SHH: Shuang–Ho Hospital)

9

Introduction of Cardiac Arrhythmia Team

of Taipei Medical University H

ealth System

NOWTMUH,WFHandSHH formamedicalhealthcare

golden triangle in the grand Taipei area with a total capacity of 3,000 beds and can support each otherwheneverneeded.(Figure1).Thereare8certificatedEP physicians out of 41 cardiologists (Fig. 2, 3, 4).They can offer a wide range of invasive cardiac electrophysiologicalprocedureswiththe3Dmappingsystem and the delicate techniques of devicesimplantation(pacemaker, implantablecardioverterdefibrillator,andcardiacresynchronizationtherapy).

Beside clinical achievements, the EP physiciansin TMU health system also have abundant academic studies.Dr.YJChen is internationally famous forhisstudies about molecular electrophysiology of AF and ventricular arrhythmia, and he is also the professorof Graduate Institute of Clinical Medicine, TMU. Dr.MHHsieh andDr. YK Lin inWFHparticipated inthepioneergroupoftheAFablation,ledbyProfessorSAChen,andnowhaveoutstandingacademicarticlesabout molecular mechanism of AF. The other EP physiciansalsohaveexcellentacademicpublications.

Fig. 2. Members of cardiology section of Taipei Medical University Hospital Fig. 3. Members of cardiology section of Shuang –Ho hospital

Fig. 4. Members of cardiology section of Wan-Fang Hospital

FUTURE Comparedwithothermedical centers in Taiwan,

such as Taipei VGH, National Taiwan UniversityHospital,andChangGungMemorialHospital,theEPphysiciansinTMUhealthsystemarerelativelyyoung.

However, we are enthusiastic and engaged in thebettercareofcardiacarrhythmicpatients.Wehopeto share our experience with other EP physicians from Asian-Pacificcountries.WelcometoTaipeiandvisitus!

10

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