© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.
EDITORIAL
Editorial
PIC Coordination Centre, Division of Cardiology CHUV, Rue de Bugnon 46, 1011 Lausanne, Switzerland
Tel.: +41 21 314 0010; fax: +41 21 314 0013. E-mail address: lukas.kappenberger{at}chuv.hospvd.ch
With the introduction of computers into science, a new era in biologic research began. Today, integrative biophysical computer models provide unique insights into mechanisms that conventional experimental procedures could not offer. Of course, one might argue that a computer model is too simplistic but on the other hand a biological model has too many uncontrolled parameters. As both these arguments are valuable and strong, we have to find an appropriate balance between simplicity and complexity.
The biennial "Workshop on Computer Simulation and Experimental Assessment of Electrical Cardiac Function" organized by the LausanneHeart group is based on this integrative approach. While in the past, the bench-to-bedside concept dominated, in this meeting the bedside thinking is the "primum movens" and computer simulation is considered a tool for better understanding of mechanisms underlying diseases, specifically arrhythmias. The value of integrative modelling is that is does not limit us to consider what happens in the isolated cells but allows us to extend to the whole organ. As a result, research can be bi-directional, meaning that changes on the membrane-level can be projected and tested in the tissue and the global anatomical context and clinical observations can be dissected to identify possible cellular and molecular sources. Such freedom of action was so far not possible within the classical approaches of experimentation, where all quantities of interest cannot be readily measured in the same preparation.
As isolated from the bedside, as many of the problems discussed in this issue of Europace might look, for the clinical cardiologist the connection to the human is the focus on arrhythmias of the heart. Embracing the integrative approach, one begins to appreciate that by connecting simple, virtual cells into an organ, activity can emerge that appears similar to that seen in human hearts. While preparing this workshop, we decided that we should not simply restrict the analyses to the isolated organ, but try to put the work in the context of life. While the scientist may want to know why the heart beats, the doctor must know why it lives.
This workshop stimulated thoughts about the bridges from organ to life, from cellular membranes to palpitations. The organ can be viewed as a structure composed of different cells and tissues and capable of producing, reacting and interacting with other organs but it has no initiative. The living organ is characterized by its metabolism and its function but this function only makes sense in the context of the superior structure, which is the organism. An organism is the integration of many organs into what we call an individual. Interestingly the sum of the organs alone is not yet the full creature as there is something additional to give it life. This special feature is the ability to reproduce and evolve, and we as human beings cannot fully comprehend it since it may not be possible to perceive the true meaning of things for which we have no sensor.
Performing integrative biophysics is an old dream (or rather a nightmare) of the scientific community and was perhaps first brought to the public's attention by Mary Shelly's Frankenstein. Putting together organs to reconstruct a human body and then putting this into function by an electric shock application was the stuff of horror over 100 years ago. The fears generated by the creation of life out of control are similar to those expressed nowadays about genetic manipulations, at least when the tools are in the wrong hands. Interestingly in both situations the feasibility was accepted, but the result was feared because of what damage might result.
Using computers to analyze the cardiac rhythms is, of course, far away from any attempt to assemble parts to a functional organ. Nevertheless, we have to retain the message that every discovery and technical progress generates fears and skepticism as to their utility. Who would have ever imagined that airline pilots could be fully trained by using only a computer programme known as a flight simulator? The question will therefore arise whether computers and computer modelling can contribute to the goals of science. That is, to understand (1) where we come from, (2) how we function and (3) why we exist. The first question is usually addressed to the geneticist, the second to the physiologist and the physician and the third is asked of the theologist.
We are convinced that models and computers can help us integrate ideas and provide new insights into function of the heart, knowledge that cannot come from observation alone. The study of the anatomy of birds and their observation in flight has not allowed men to fly. Leonardo da Vinci was to analyze the bird's wings in much detail and designed from it a model of a wing. Only through the power of integrating his, and many other pieces of knowledge, was it possible to develop the first power driven flight Byman a century ago. While this example teaches us how integrative thinking can lead to progress, we hope that the paradigm can be used to gain similar progress in the field of rhythmology covered by this Journal today. Although the articles in this Europace issue might reflect small elements of biology, they may start the process for better understanding arrhythmias and improving patient care in the future.
With these thoughts that were part of the humble conclusions of this workshop bridging basic electrophysiology what to the beating heart, we realize that we can never capture the subtleties of life regardless model we use. Life is neither predicable nor limited. As Linus Pauling said, life is not in the molecules but in their interaction. Life is visible at any moment in nature, music, art and human relations and the contributors to this workshop also felt this. So each paper in this Europace issue oscillates between essential scientific findings and the conclusion that more is needed to understand the secrets behind electrical cardiac function and the living heart.
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