Editorial
Clinical Electrophysiology and Precision Medicine Initiatives
T
he principal aim of Arrhythmia & Electrophysiology Review is to provide concise, timely articles highlighting clinical advances relevant to the management of those with arrhythmias. The Editors have
also from the outset1 emphasised the substantial gaps in our capacity inter alia to predict those at risk of sudden death, understand atrial fibrillation mechanisms and provide effective and safe drug treatment. In these and other areas of clinical practice many of our efforts will in hindsight be seen, despite all our best efforts, to have been primitive.2 We are however fortunate in that the characteristics of the diseases that provide our daily bread are most open to quantification amongst any of the sub-specialities.2 Precision medicine, ‘an approach to disease treatment and prevention that seeks to maximise effectiveness by taking into account individual variability in genes, environment and lifestyle’,3 and a term coined for inclusion in a US National Research Council report4 has achieved recent prominence following the announcement by President Obama of enhanced, targeted funding in his State of the Union Address on 20 January 2015.3,5–7 As an exemplar excitable tissue the heart differs from the brain8 in being accessible, relatively simple and in many aspects experimentally tractable.2 In the coming issues this journal will continue to address genetic, epigenetic and phenotypic aspects determining individual variability to clinical presentation. The whole community should contribute to national and international research programs that through deeper phenotyping,9–11 extended data gathering and an analysis of ever-larger datasets promise to provide contemporary templates for effective, efficient clinical care. Andrew Grace, Section Editor – Arrhythmia Mechanisms / Basic Science University of Cambridge, Cambridge, United Kingdom
1.
2. 3. 4.
Katritsis D. Arrhythmia & Electrophysiology Review – do we need another journal? Arrhythmia & Electrophysiology Review 2012;1:6. Grace AA, Roden DM. Systems biology and cardiac arrhythmias. Lancet 2012;380:1498–508. Jameson JL, Longo DL. Precision medicine – personalised, problematic, and promising. N Engl J Med 2015;372:2229–34. Desmond-Hellmann S. Toward precision medicine: A new social contract? Sci Transl Med 2012;4:129ed3.
ARRHYTHMIA & ELECTROPHYSIOLOGY REVIEW
5. 6.
7. 8.
Aronson SJ, Rehm HL. Building the foundation for genomics in precision medicine. Nature 2015;526:336–42. Hawgood S, Hook-Barnard IG, O’Brien TC, Yamamoto KR. Precision medicine: Beyond the inflection point. Sci Transl Med 2015;7:300ps317. Iyengar R, Altman RB, Troyanskya O, FitzGerald GA. Medicine. Personalization in practice. Science 2015;350:282–3. Alivisatos AP, Chun M, Church GM, et al. A national network of neurotechnology centers for the brain initiative. Neuron
2015;88:445–8. Delude CM. Deep phenotyping: The details of disease. Nature 2015;527:S14–15. 10. Grace AA. Prophylactic implantable defibrillators for hypertrophic cardiomyopathy: Disarray in the era of precision medicine. Circ Arrhythm Electrophysiol 2015;8:763–6. 11. MacRae CA, Pollak MR. Effect size does matter: The long road to mechanistic insight from genome wide association. Circulation 2015;132:1943–5. 9.
145
Clinical Electrophysiology and Precision Medicine Initiatives
T
he principal aim of Arrhythmia & Electrophysiology Review is to provide concise, timely articles highlighting clinical advances relevant to the management of those with arrhythmias. The Editors have
also from the outset1 emphasised the substantial gaps in our capacity inter alia to predict those at risk of sudden death, understand atrial fibrillation mechanisms and provide effective and safe drug treatment. In these and other areas of clinical practice many of our efforts will in hindsight be seen, despite all our best efforts, to have been primitive.2 We are however fortunate in that the characteristics of the diseases that provide our daily bread are most open to quantification amongst any of the sub-specialities.2 Precision medicine, ‘an approach to disease treatment and prevention that seeks to maximise effectiveness by taking into account individual variability in genes, environment and lifestyle’,3 and a term coined for inclusion in a US National Research Council report4 has achieved recent prominence following the announcement by President Obama of enhanced, targeted funding in his State of the Union Address on 20 January 2015.3,5–7 As an exemplar excitable tissue the heart differs from the brain8 in being accessible, relatively simple and in many aspects experimentally tractable.2 In the coming issues this journal will continue to address genetic, epigenetic and phenotypic aspects determining individual variability to clinical presentation. The whole community should contribute to national and international research programs that through deeper phenotyping,9–11 extended data gathering and an analysis of ever-larger datasets promise to provide contemporary templates for effective, efficient clinical care. Andrew Grace, Section Editor – Arrhythmia Mechanisms / Basic Science University of Cambridge, Cambridge, United Kingdom
1.
2. 3. 4.
Katritsis D. Arrhythmia & Electrophysiology Review – do we need another journal? Arrhythmia & Electrophysiology Review 2012;1:6. Grace AA, Roden DM. Systems biology and cardiac arrhythmias. Lancet 2012;380:1498–508. Jameson JL, Longo DL. Precision medicine – personalised, problematic, and promising. N Engl J Med 2015;372:2229–34. Desmond-Hellmann S. Toward precision medicine: A new social contract? Sci Transl Med 2012;4:129ed3.
ARRHYTHMIA & ELECTROPHYSIOLOGY REVIEW
5. 6.
7. 8.
Aronson SJ, Rehm HL. Building the foundation for genomics in precision medicine. Nature 2015;526:336–42. Hawgood S, Hook-Barnard IG, O’Brien TC, Yamamoto KR. Precision medicine: Beyond the inflection point. Sci Transl Med 2015;7:300ps317. Iyengar R, Altman RB, Troyanskya O, FitzGerald GA. Medicine. Personalization in practice. Science 2015;350:282–3. Alivisatos AP, Chun M, Church GM, et al. A national network of neurotechnology centers for the brain initiative. Neuron
2015;88:445–8. Delude CM. Deep phenotyping: The details of disease. Nature 2015;527:S14–15. 10. Grace AA. Prophylactic implantable defibrillators for hypertrophic cardiomyopathy: Disarray in the era of precision medicine. Circ Arrhythm Electrophysiol 2015;8:763–6. 11. MacRae CA, Pollak MR. Effect size does matter: The long road to mechanistic insight from genome wide association. Circulation 2015;132:1943–5. 9.
145
