11th Nordic-Baltic Conference on Biomedical Engineering Regional meetinng of: IFMBE  and EMBS. 6-10 JUNE 1999 TALLINN, ESTONIA
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Keynote address

        Title: "Independence, reductionism and integration, in biomedical engineering history as illustrated in electrocardiography; and the outlook for the 21st Century."

         Abstract: Electrocardiography was one of the earliest topics in the life sciences to attract the attention of engineers. Among various electrophysiological signals it was the largest and hence easiest to measure. Furthermore the origin of the ECG was a well defined cardiac source leading to a simple electrical model. Early engineering contributions were based on rationalizing the clinically useful heart model, introducing lead systems entirely consistent with this model, and, of course, improving on the instrumentation to take advantage of advances in electronics.

           With the advent of computers and inexpensive low-noise solidstate amplifiers multiple leads, body-surface potential maps, multiple catheter leads, and inverse computer processing was introduced; these made possible, for example, the location of ectopic and accessory sites non-invasively or minimally invasively. These topics illustrate that biomedical engineers eventually became independent investigators making contributions to basic and clinical research. Another such illustration is the current effort to elucidate the origins of arrhythmias (in particular fibrillation and defibrillation). This has led to the development of models of cardiac tissues and cells which include ionic and junctional channels and from which simulation of activation and defibrillation is possible. (New engineering tools have been the basis of new physiological information through sophisticated experimental studies.)

          Over the past 50 years the role of the engineer changed in two important ways. First rather than rationalizing and improving an existing clinical system they began to forge out on their own. And secondly, from a whole body approach they moved to a consideration of smaller and smaller component elements, (i.e. from the heart to the cell, to membrane, to ion channel, and to the genetic and molecular structure).

          At the origins of biomedical engineering it was linked with integrative physiology through the application of systems and control engineering. The 21st century will surely see further breakthroughs based on molecular biology as they affect cardiology and other organ systems. This extension of reductionist interest has affected biomedical engineering. It is already quite apparent in the topics included in this and other BME conferences; further rapid development is inevitable. But biomedical engineering has a dual contribution to make, both in the elucidation of biological processes utilizing a reductionist approach along with an integration of such elements to the whole body, a role fully consistent with biomedical engineering capabilities and traditions. In carrying out these dual tasks it seems no longer necessary to question biomedical engineering as an independent life science discipline.

 

Robert Plonsey, Duke University



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