The Rear Mirror
I vividly remember how pleased I was when Circulation Research published my first papers, one on the ventricular refractory period following changes in heart rate and another on the dual inputs into the atrioventricular node, in 1969. I thought then that Circulation Research was the top journal for basic research in the cardiovascular field, and I still think so today.
Many things have changed since then, and much progress has been made. Still, it is wise to remember the words of the Austrian writer Robert Musil: “Progress could be wonderful, if only it would stop.” I often felt like that when trying to follow the explosive developments in molecular biology, and I am very happy that Circulation Research now has a section on Integrative Physiology. I feel at home there.
Browsing through the 1969 volumes, I came across an Editorial by Julius H. Comroe, Jr, in the October issue: “Answers to a Congressman’s Questions.” After reading it, I realized that in some areas things have not changed much. The issue at hand was a reduction in NIH funding for medical research, and some questions had emerged: “Can’t we fire the 16% who receive ALL their salary from research grants without influencing the teaching function of the medical school?” and “Wouldn’t the country be better off if half of our medical researchers went into the practice of medicine and delivered health care?” Does this sound familiar? I know it is difficult nowadays to get hold of issues of journals published before 1990, but it is worthwhile to read Dr Comroe’s answers. They are still valid. A Dutch psychologist, Lea Dasberg, once remarked during a television interview: “History has something in common with driving a car. In order to proceed, one must from time to time look in the rear mirror.” Please, look up Dr Comroe, in the rearview mirror of Circulation Research.
Looking into the rear mirror myself, one of the things that impressed me over the years was the content and the tone of the reports of the reviewers for Circulation Research. The reviewers were not out to crush you, but usually began by saying a few kind words and then came up with suggestions to improve the paper. When Brian F. Hoffman was Editor of Circulation Research, he once told me: “If you are a lawyer and have to prepare a difficult case for the Supreme Court, you can ask the advice of a colleague. He will give it to you for $500 per hour. I ask the advice of the world’s experts and they give it for free.” I think this is something the research community can be very proud of. During my term as Editor of Cardiovascular Research, we received more than 20 000 reports from our reviewers. The vast majority of these reports had the same characteristics: providing ideas to improve the paper and emphasizing the strong points. Much as though I applaud that, it is difficult for an Editor to reject a paper when the comments to authors begin with: “This is a very interesting paper. However, ….” We rejected more than 80% of submitted manuscripts, whereas the reviewers recommended rejection in only 23%. This illustrates how kind reviewers are and how mean the Editors.
Looking into the rear mirror that covers my field of interest, cardiac electrophysiology and mechanisms of arrhythmias, it is easy to see the changes. The field went molecular at a relatively late stage, but when it did, how it exploded. Looking at the publications in recent years, one is almost led to believe that there are only two kinds of arrhythmias, those of the long-QT and the Brugada syndromes. What has been learned in an astonishingly short time about these relatively rare disorders will be of immense value when molecular biology and molecular genetics are applied to the two, as yet almost unconquered, giants of arrhythmias: atrial and ventricular fibrillation. This is already happening, although, as one American past vice-president remarked, “Prediction is difficult, especially when it concerns the future.” I think that many exciting developments in this area can be expected.
For a last look in the rear mirror: which area of my own research, published in Circulation Research, has given me the greatest satisfaction? I think it is the work on the atrioventricular node, especially where it deals with dual inputs into the node and atrioventricular nodal reentry in the late 1960s and early 1970s. Long after I stopped working on the atrioventricular node, and was fully immersed in trying to unravel the electrophysiological changes and mechanisms of arrhythmias during acute myocardial ischemia, I met Dr James L. Cox during a meeting in Gent, Belgium. I knew about his papers, which were on electrophysiological studies, and thought of him as an electrophysiologist, not realizing that he is a cardiac surgeon. To my delight, he told me that after reading our papers on the atrioventricular node it occurred to him that one way to cure atrioventricular reentrant tachycardias would be to cut through one of the input pathways into the node. He did so, was successful, and, together with others in Australia and South America, paved the way for the immensely successful catheter ablation therapy for this arrhythmia. The lesson: Circulation Research is not only read by basic scientists but by interested clinicians and surgeons as well, who on occasion are inspired to invent new therapies for cardiovascular diseases. To me, this is a source of immense satisfaction.
Finally, it is a remarkable feat for a journal to be at the top of the field for so many years. To get there is one thing, to remain there another. The past Editors and the present Editor, together with his team, are to be congratulated for maintaining the highest standards of scientific excellence and for avoiding the arrogance that so often is one of the unpleasant side effects of success. Happy anniversary, and my very best wishes for the years to come.
The opinions expressed in this editorial are not necessarily those of the editors or of the American Heart Association.
