​The Underdog in Cardiology

A lookback at the cardiac electrophysiology service in NUHCS

PULSE Issue 38 | January 2022

Catheter-based radiofrequency (RF) ablation became the standard of care for the treatment of arrhythmias over open-heart arrhythmia surgery when the procedure was pioneered in 1998. In parallel, implantable pacemakers were first described in 1958, followed by the first cardiac defibrillator in 1980. Singapore was far behind the curve when it came to cardiac electrophysiology (EP), but the practice in the country has since made huge strides in the last two decades. In 2002, EP procedures at the National University Heart Centre, Singapore (NUHCS) were limited to one afternoon session a week, which only allowed for either a supraventricular tachycardia ablation or a pacemaker implantation to be carried out. Patients typically waited for weeks before a procedure was scheduled, which also meant that junior doctors rarely had the opportunity to learn more about the practice. 

Asst. Prof Seow Swee Chong, then a Senior Registrar, was earmarked to specialise in this area and went to Westmead Hospital in Sydney, Australia for his specialist training. On his return in 2007, he established NUHCS’ EP team which became the cornerstone for the transformation of cardiac EP in NUHCS. Doctors were sent to different centres in Australia, Canada, the United Kingdom and the United States to train under the world’s leading cardiac electrophysiologists to achieve a wide breadth of experience and approaches. In 2008, the young team hosted the first Asia Pacific workshop on cardiac resynchronization therapy (CRT). The workshop, now an annual event, is attended by physicians from Australia, China, India, Indonesia, Malaysia, Myanmar, the Philippines, Taiwan and Vietnam. A decade later, NUHCS was recognised as a designated training centre – the first in Southeast Asia to receive such an accolade from the Asia-Pacific Heart Rhythm Society APHRS. 

Today, NUHCS’ EP team includes arrhythmia specialist nurses as well as dedicated EP technicians to support and assist in the procedure, provide support in post procedure care, and respond to follow-up queries from patients. Complex procedures such as ventricular tachycardia ablation, atrial fibrillation ablation as well as complex cardiac device implants including CRT and conduction system pacing have now become routine procedures carried out by the EP team every day. 

In 2019, 239 EP/ablations and 418 device implants were carried out at NUHCS – more than 12 times the number of procedures carried out in 2009, indicating that patients were previously underserved. Looking ahead, heart arrhythmia conditions are expected to increase in tandem with the incidence of coronary artery disease, for which arrhythmias are common complications. As such, an arrhythmia service has been set up at Ng Teng Fong General Hospital (NTFGH) under the OneNUHS cluster to spread out the patient load. Helmed by Asst. Prof Pipin Kojodjojo and Dr Elaine Boey, the service at NTFGH is currently capable of device implantation, whilst EP and ablation procedures are being referred to NUHCS. Committed to raise practice standards in the region, NUHCS has been active in accepting international fellows as well as making overseas trips to guide and proctor physicians in cardiac EP and device implantation in countries including China, Taiwan, India, Myanmar, India, the Philippines and Vietnam. The EP team is particularly active in the Asia Pacific Heart Rhythm Society, contributing and supporting its regional meetings and conferences to facilitate the furtherance of arrhythmia management in the region.

A lot has since been achieved since the early days of its inception. “As the EP service grows in maturity and capability, we envisage our role as a beacon in this region of the world. It is our hope that we would be able to give the very best treatment to our patients, to nurture and train other physicians and contribute to the furtherance of arrhythmia management in the Asia-Pacific,” says Asst. Prof Seow Swee Chong, Senior Consultant, Director of Cardiac Electrophysiology and Pacing, NUHCS.

Cardiac Electrophysiology (EP)

Cardiac EP is a sub-specialised field in cardiology which deals with heart rhythm disorders (arrhythmia) and the electrical system of the heart. It involves elucidating the conduction properties of the heart, mechanism of arrhythmias and curative ablation using radiofrequency energy or cryotherapy. It also includes the implant and management of cardiac implantable electronic devices (CIEDs) like pacemakers, defibrillators, cardiac resynchronisation devices and loop recorders.