ENCOMIUM to Professor Hein J.J. Wellens: a stellar and comprehensive cardiologist

Henrick Joan Joost Wellens, who chose to be known as Hein, was a Dutch cardiologist born on 13 November 1935, in The Hague, and who passed away on 9 June 2020 in Maastricht, The Netherlands, at the age of 84 years (Figure 1). Trained as a cardiologist at the Wilhelmina Gasthuis in Amsterdam, under Professor Dirk Durrer, Wellens witnessed the initiation of a new era in cardiac arrhythmology, namely the unravelling of the electrophysiological basis of human cardiac arrhythmias. He left Amsterdam in 1976. After a brief sojourn as visiting professor at the University of Liege, Belgium, he arrived in Maastricht in February of 1977, to become part of a very innovative university and faculty of medicine project. Professor Wellens trained and inspired many young physicians from all over the world during his long professional career as a cardiologist, researcher, teacher, and mentor. Early in his career, Wellens was involved in exploring the technique of programmed electrical stimulation of the heart in the study of tachycardia in man. In 1971, he presented and published a PhD thesis entitled Electrical Stimulation of the Heart in the Study and Treatment of Tachycardias.1 This thesis included the first electrophysiological and electrocardiographic description of a wide QRS complex tachycardia due to an accessory pathway exhibiting Mahaim physiology. A pivotal contribution of Wellens was his paper on the use of programmed cardiac stimulation in patients with ventricular tachycardia.2 This was a very conflicting study, finally published in Circulation in 1972 after the resolution of several ethical reserves concerning the propriety of inducing ventricular tachyarrhythmias in the human catheterization laboratory. Without this paper, many subsequent advances would have been impossible, particularly the acceptance of the automatic implantable defibrillator. In this regard, we should remember that, 2 months after the publication of Wellens’ paper on ventricular tachycardia, Bernard Lown had written, when considering the implementation of an automatic implantable defibrillator: ‘Even in this age of derring-do and erosion of ethical constraints, it is unlikely that VF will be induced deliberately to ascertain performance’.3 During his term in Maastricht, Wellens became one of the most legendary teachers and mentors in cardiovascular medicine of the last four decades. Wellens, and the many fellows from the five continents coming for training to Maastricht, continued to use invasive clinical electrophysiologic studies to unravel the mechanism of tachycardia in man. It is difficult selecting the most important contributions during his tenures as Professor of Cardiology, first in Amsterdam and then in Maastricht. The book entitled Professor Hein J.J. Wellens: 33 Years of Cardiology and Arrhythmology has achieved this task.4 After retiring in 2000, according to PubMed, he published 219 papers. It would be impossible to comment on the most relevant of these contributions made during this 20-year period of alleged ‘retirement’. He remained active authoring papers until the very end of his life. A search in PubMed returns one paper in 2021, and eight in 2020. Professor Wellens is one of the most relevant giants in the field of cardiac arrhythmology and electrocardiology. His stature is defined not only by the weight of his contributions as a scientist but probably more by the tremendous impact of his teaching and mentorship. His fatal illness was sadly unforeseen by him, his family, and his close friends. After his death, several of his pupils and friends have written obituaries, some of which we cite here.5–12 We would emphasize in particular how deeply he cared for his fellows and others with whom he collaborated. Three of us remember with affection the kindness and hospitality Hein and his family provided us in Amsterdam (R.H.A.) and Maastricht (J.F. and E.B.S.). Wellens not only listened carefully to the queries and doubts of his arrhythmia fellows but wanted to know details of their personal and family lives. He was always eager to help in any possible way. Sometimes he arranged donations of recording and ablation apparatuses for ex-fellows returning to low-income countries, thus allowing them to continue to perform the invasive arrhythmologic procedures they had learned at his feet. In 2018, Wellens started working with all four of us on some of the manuscripts representing his final conceptual contribution in the field of accessory pathways, an area attracting his interest from the very early days of his productive scientific activity.13–16 If he were still alive, these papers would have been finished much earlier. For us, this is one additional reason to miss Hein Wellens. Conflict of interest: none declared. Hein J.J. Wellens with an electrocardiogram as background from a patient with an acute coronary syndrome due to a subtotal occlusion of a proximal left anterior descending coronary artery, a condition that has received the name of Wellens’ syndrome. This term, profusely utilized in the literature, was first coined by a nurse with very deep interest in the 12-lead electrocardiogram.17