Clinical Innovators: A Renaissance Man in the Golden Age of Cardiology An Interview with Douglas Zipes, MD | Interview by Katlyn Nemani, MD

CardioSource WorldNews | Douglas Zipes, MD, MACC, is a renowned cardiologist and expert in arrhythmias. He invented the implantable transvenous cardioverter, the first device of its kind that could be introduced through a catheter into the heart. Dr. Zipes completed his medical school training at Harvard Medical School in 1964 and went on to complete his medicine residency and cardiology fellowship at Duke University Medical Center.

Dr. Zipes has spent most of his career as a cardiologist at Indiana University School of Medicine, most recently as Distinguished Professor of Medicine, Pharmacology, and Toxicology. He has published over 800 articles and 21 textbooks. Recently, he started a new chapter in his life as a novelist.

When did you decide to become a cardiologist? Who were some of your mentors along the way?

After graduating Harvard Medical School, I interned at Duke University Medical Center. Initially I wanted to become a nephrologist. Explaining clinical conditions by their pathophysiology appealed to me. Then, Duke opened the first CCU in the south and I when I rotated through, I fell in love with the same phenomenon for which nephrology appealed, but cardiology added fascinating squiggly ECG lines to interpret and that sealed my decision to switch.

Eugene Stead, MD, Duke chair of medicine, had an early influence. His philosophy was that the patient’s interests lay at the heart of all we did, and that the best way to learn to take care of patients was to immerse yourself in their care. To accomplish this, Dr. Stead made sure we practically lived with the patient and his/her illness to absorb all there was to know. Interns worked in the hospital 6 and a half days a week, and were on call 5 nights out of 7.

The second major influence was Gordon Moe, MD, FACC, with whom I trained in basic electrophysiology. Gordon directed the Masonic Medical Research Laboratory in Utica, NY. I benefited not only from Gordon’s scientific genius but also from his kind heart, generous spirit, and sense of humor (he left his replacement at Syracuse a giant horse condom to which was pinned the note, “Dear Jim: I know you can fill my shoes, but…”).

The third person is Eugene Braunwald, MD, MACC. Gene invited me to write the EP section for the 2nd edition of Braunwald’s Heart Disease, and I have written it for every edition since. Then, he invited me, with Peter Libby, MD, FACC, to co-edit the entire book with him beginning with the sixth edition, later joined by Bob Bonow, MD, MACC, Doug Mann, MD, FACC, and Gordon Tomaselli, MD, FACC. I will be the editor-in-chief for the 11th edition,which is in preparation. Gene is THE most outstanding cardiologist in the world today and his integrity, intellect, and insights have provided a role model that has profoundly impacted me over the last 35 years.

You have had an enriching career spanning over 50 years of patient care and clinical research. What have been some of the most satisfying milestones for you?

Patient care has been the most satisfying. That, and the ability to go from the lab to the bedside and vice versa have been the highlights of my career. I could take a clinical observation and study it in the lab, or make a laboratory discovery and apply it clinically. My career has been filled with these very gratifying experiences.

I have had two other interests, important to my career, both of which have been questioned by others. The first has been an association with industry beginning at a time (1975) when it was not very acceptable. I am very proud that I consulted for Medtronic for 35 years until 2010, and not once has my integrity been challenged because of that relationship, nor has my industry association prevented me from becoming president or chair of a number of very important organizations, such as the Heart Rhythm Society, the ACC, and the American Board of Internal Medicine, and editor-in-chief of seven cardiology journals, five of which I was the founding editor.

The second has been medical legal work. Often shunned by doctors, I have been challenged: why do it? I have often thought that issue through. I’ve concluded—not to get too high and mighty—that it’s like paying dues to live in the society we have, with all its warts. Certainly I am well paid for what I do, but it’s more than that. Someone with an important reputation needs to stand up and do what’s right: defend the innocently accused or confront the wrongdoers. It’s that simple. Many physicians want no part of it, but I think expert testifying is a necessary duty. Without it, our legal system could not function.

Decades ago, you developed the implantable transvenous cardioverter. How did you come up with the idea of delivering a shock via catheter and bring it to fruition?

In 1983 I invented the synchronous intravenous cardioverter based on a new (now well-established) concept of delivering an electric shock over a catheter in the heart to terminate VT. I invented it while consulting for Medtronic. Per my contract, all the proceeds went to them and I’ve never received a penny (my wife has reminded me many times that, while I might be a smart doctor, I’m a lousy businessman). Medtronic made the device for me to test and implant in patients. Medtronic then created the PCD, a pacemaker, cardioverter, and defibrillator combined into one device, that incorporated my invention.

Some of your recent research involves using spinal cord neuromodulation for the treatment of heart failure. Can you tell us a bit about this and where things currently stand?

I have been interested in the autonomic nervous system for much of my career and have published many clinical and basic research observations in this area. Spinal cord stimulation (SCS) has been used successfully for a long time in Europe to treat refractory angina in patients with non-revascularizable coronary artery disease. Many years ago, Medtronic asked me to study the mechanism. I remembered a clinical observation by Sam Levine (a Brigham great MD, in the 1950s) that carotid massage relieved angina, and I wondered whether SCS worked via that mechanism. We showed that SCS did indeed induce a cardiac vagomimetic and/or sympatholytic action. We then showed SCS could prevent ischemic VF and ultimately remodel heart failure in dogs. Medtronic funded the clinical study: prospective, randomized, blinded and---it was a bust! No clinical impact in heart failure patients. Sadly, I think the concept has died—at least for the moment.

What are some of the major advances you anticipate in the field in the coming decade or two?

Genetics, certainly. In a recent article on induced pluripotential stem cells from Brugada patients, authors cured the disease in a dish by reprogrammed the genetic abnormality. A long way from clinical application, but it will happen in your lifetime.

We need additional research and ultimately advances in two arrhythmic areas: atrial fibrillation, a major scourge because of the large number of patients affected; and sudden cardiac death, still taking over 300,000 lives annually in the US.

You recently started a new chapter in your life as a novelist. Can you tell us about some of your latest works?

In the twilight of my medical career I have turned to a new challenge: becoming a novelist. My first venture was The Black Widows, a tale about two elderly widows living in the US heading a world-wide terrorist organization. The hero detective has to solve a series of apparent random murders directed by the Black Widows.

The second novel, Ripples in Opperman’s Pond is based on a trial and my interactions with the lawyers, in which I was a plaintiff expert testifying against a major drug company accused of hiding cardiovascular side effects of a new drug for arthritis. I combined my experiences in this trial with testifying at one other trial when I defended a colleague from a malpractice charge, and fictionalized them into Ripples in Opperman’s Pond. The third novel, Not Just a Game, takes three generations of a Jewish family and places each in an important Olympics: the father in 1936 Berlin Olympics; the son in the 1972 Munich and the slaughter of 11 Israeli athletes; and the grand daughter in 2016 Rio, where she has to deal with a resurgence of Nazism while winning a gold medal in fencing.

How do you spend your time when you’re not providing patient care, conducting research, or writing?

I love opera, listen to it a lot and support our local opera company. In fact, I have an opera review! When I was president of Indianapolis Opera (years ago) and we needed money, my board suggested I go on stage in between the first and second acts of Otello and pitch an appeal to the audience. The Indy paper the next day said, “Otello was wonderful, and Dr. Zipes’ presentation, though tacky, was necessary.”

What advice would you give early career cardiologists?

  1. Follow your love and pursue what you want to do, not what others tell you to do.
  2. Focus on a particular area to be the best there is in that area.
  3. Family first, always.
Read the full December issue of CardioSource WorldNews at ACC.org/CSWN

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: CardioSource WorldNews, Heart Failure, Catheters


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